Chronic obstructive pulmonary disease (COPD)
This illness has no day on which it began. Someone smokes for two or three decades, then notices they climb the stairs more slowly and blames it on age and…
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Medicines commonly prescribed for Chronic obstructive pulmonary disease (COPD)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: PULMONARY INHALATION, 0.12% w/v SALBUTAMOL SULFATEActive substance: salbutamolManufacturer: Laboratorio Aldo Union S.L.Prescription requiredDosage form: PULMONARY INHALATION, 320 micrograms/9 microgramsActive substance: formoterol and budesonideManufacturer: Orion CorporationPrescription requiredDosage form: PULMONARY INHALATION, 320 MICROGRAMS/9 MICROGRAMSActive substance: formoterol and budesonideManufacturer: Menarini International Operations Luxembourg S.A.Prescription required
This illness has no day on which it began. Someone smokes for two or three decades, then notices they climb the stairs more slowly and blames it on age and extra weight. They come to a doctor once the lungs have already lost a substantial share of their work, and that share does not come back. What can be stopped is the decline still to come, and everything there depends on how early the person takes it seriously. Below: what actually happens inside the lungs, which signs give the disease away before it narrows your life, and which parts of treatment genuinely change its course.
What happens inside the lungs
One name covers two processes that usually run side by side.
- Chronic bronchitis: the walls of the airways are permanently inflamed, thickened and produce far too much mucus. The channel narrows and clearing the phlegm becomes hard work.
- Emphysema: the walls between the alveoli break down. Those tiny sacs are where blood picks up oxygen; instead of many small ones, large slack cavities are left, the surface for gas exchange shrinks and the lung loses its springiness.
Because that springiness is lost, the main difficulty is not breathing in but breathing out. The small airways collapse on the way out, some air stays behind, and the next breath has to be taken into an already over-inflated chest. That explains why walking fast is the hardest thing: the quicker the breathing, the less time there is to empty the lungs and the worse the trapping gets. For the same reason it helps to breathe out through pursed lips in a thin stream, which keeps the airways open a little longer.
The narrowing in COPD never disappears completely, not even after an inhaler. That is what separates it from asthma, where the airways close and then open again almost to normal, and where attacks are usually linked to an allergen, to night-time or to cold air. Telling them apart matters: the drugs and the outlook differ, and they are easy to confuse, all the more so because some people have both.
Signs usually blamed on getting older
The first thing to appear is not the cough but a mismatch: what used to be done on the move now requires a stop. What is worth noticing:
- breathlessness on exertion that arrives earlier year after year: first on a hill, then on the flat, then while getting dressed;
- a cough almost every morning, usually productive, with clear or whitish phlegm;
- wheezing and a feeling of tightness in the chest;
- colds that go "down to the chest" every time and drag on for three or four weeks;
- a habit of avoiding effort that the person does not notice themselves: walking less, never taking the stairs, parking closer.
A simple test: do you walk along a flat street more slowly than people your own age, and do you have to stop to get your breath back? If so, and you are past forty with years of smoking or a dusty job behind you, that is already a reason to be seen rather than something to keep an eye on.
Weight loss, muscle wasting and swollen ankles come later and mean the disease is well advanced. Blood in the phlegm and chest pain, on the other hand, are no part of the usual COPD picture at all: they need separate investigation, because something else may be behind them, up to and including lung cancer.
Not only smoking
Tobacco comes first by a wide margin, and the longer and heavier the smoking, the higher the risk. But roughly one in five people with the disease has never smoked, so "I don't smoke" does not rule out the diagnosis. The other routes are these:
- dusts and fumes at work: coal and silica dust, grain and cotton dust, welding fumes, isocyanates, cadmium;
- smoke from stoves and open fires in poorly ventilated homes, which in many countries is the leading cause of the disease in women who have never smoked;
- heavily polluted city air;
- severe lung infections in childhood, extreme prematurity, poorly controlled asthma: all of these leave the lungs with less reserve;
- other people's smoke, including in childhood.
One rare inherited cause deserves its own paragraph: alpha-1 antitrypsin deficiency. This protein shields lung tissue from the body's own enzymes; when there is too little of it, the lung breaks down on its own, with no tobacco involved. It is worth suspecting if COPD is found before the age of forty-five, if the person has never smoked, if the emphysema on the scan is worst in the lower parts of the lungs rather than the upper ones, if several relatives are affected, or if unexplained liver disease sits alongside the lung disease. A single blood test settles it, and it is worth doing: the diagnosis changes follow-up, changes the conversation about work, and changes what children and siblings need to know.
What spirometry shows
The diagnosis is not made from an X-ray or from symptoms but from a breathing test. You take the deepest breath you can and blow into a tube as hard and as completely as possible; the machine measures how much air came out in the first second and how much altogether. Then a bronchodilator is given and the test is repeated. If even afterwards the share of air blown out in the first second stays below 70 per cent of the total volume, the narrowing is persistent and not fully reversible, and that is COPD. The same test shows how far things have gone and serves as a baseline for the future.
The picture is filled in by:
- a chest X-ray or scan, to see the emphysema and to rule out a tumour, tuberculosis or the aftermath of past pneumonias;
- a finger probe measuring oxygen saturation and, if the readings are low, a blood gas test;
- a blood test: this also checks for anaemia or, conversely, for thickened blood in response to a shortage of oxygen, and looks at the eosinophils, which guide the choice of inhaler;
- an alpha-1 antitrypsin test in the situations described above;
- an echocardiogram if there is ankle swelling and a suspicion of strain on the right side of the heart.
A flare-up: when it cannot wait until Monday
A flare-up is a sharp deterioration on top of the usual state, most often driven by a viral or bacterial infection. There is more phlegm, it becomes thicker and turns yellow or green, breathlessness increases and the wheeze is there all the time. None of these episodes passes without a trace: afterwards lung function often fails to return to its previous level, so flare-ups are not sat out but treated, and the sooner that happens the less is lost.
Call the emergency services at once (112 across Europe) if any of the following appears:
- breathlessness at rest that makes it impossible to finish a sentence;
- lips, tongue or fingertips turning blue or grey;
- confusion, unusual drowsiness, difficulty rousing the person, or not knowing where they are;
- fast, shallow breathing that pulls in the muscles of the neck and abdomen;
- chest pain, especially a crushing pain or one linked to breathing;
- blood in the phlegm;
- fever with shivering alongside a sudden increase in breathlessness.
Confusion and drowsiness are deceptive: they look peaceful, and they mean carbon dioxide is building up in the blood. This is one of the most dangerous situations in COPD, and there is no waiting here.
What genuinely slows the disease down
Destroyed lung tissue cannot be rebuilt, and promising otherwise is dishonest. But the speed at which the disease moves on can be influenced, and day-to-day wellbeing even more so.
- Stopping smoking. The only measure proven to slow the decline in lung function, and it works at any stage. Few people manage it alone, so it is worth asking the doctor straight away about nicotine replacement and prescription medicines: with support the odds improve several times over.
- Inhalers. The backbone is long-acting bronchodilators, often two classes in one device; a short-acting inhaler stays available for sudden breathlessness. Inhaled steroids are not added for everyone, only for those with frequent flare-ups or high eosinophils. Ask a doctor or nurse to watch how you take a breath from the device: a mistake in technique cancels out any drug, and it is very common.
- Pulmonary rehabilitation. A programme of measured exercise and education lasting several weeks. In its effect on breathlessness and stamina it is comparable to medication and sometimes better, and it remains the most underrated item on the list.
- Vaccination. Influenza every year, plus pneumococcus and covid-19 according to the schedule used in your country. The logic is direct: fewer infections, fewer flare-ups.
- Oxygen at home. Prescribed not for the feeling of breathlessness but for a persistently low blood oxygen level confirmed by testing. Used that way it prolongs life, but it has to be used for many hours a day.
- Surgery. Lung volume reduction, removal of large air-filled cavities or transplantation are discussed only with a small minority of people, and only with particular findings on the scan.
Of the everyday measures, movement matters most: the less someone walks because of breathlessness, the weaker the muscles get and the more breathless the same effort makes them; that circle is broken only by activity. Watch your weight in both directions: extra weight loads the breathing, while losing it signals muscle loss and worsens the outlook. It helps to have a written plan for flare-ups agreed with your doctor, so that no days are lost in hesitation. And do not leave anxiety and low mood aside: in COPD they are very common, they intensify the sense of not getting enough air, and they can be treated.
Online consultation
Two questions are well suited to a remote appointment. The first is whether COPD lies behind your breathlessness and morning cough, and which investigations make sense: the doctor goes through the smoking history, the job and the kind of effort that catches your breath, and says which test is needed first. The second is what to do with a diagnosis you already have: check the inhaler technique, work out why flare-ups have become more frequent, put together a plan of action for a deterioration, discuss vaccination and where to start with quitting smoking. The signs in the list above are not assessed remotely: they need emergency care.
This material is for information only and does not replace medical advice.
Consult with a doctor about Chronic obstructive pulmonary disease (COPD)
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Online doctors for Chronic obstructive pulmonary disease (COPD)
Discuss your symptoms and possible next steps for Chronic obstructive pulmonary disease (COPD) with a doctor online.
