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Chronic Obstructive Pulmonary Disease
(COPD)

Key points

Chronic obstructive pulmonary disease (COPD) prevents airflow to the lungs, causing breathing problems.

It is a leading cause of death in the United States.

Smoking is the main cause of COPD, but nonsmokers can get it.

Talk with your doctor if you have COPD symptoms or previously smoked.

What it is?

Chronic obstructive pulmonary disease (COPD) is an ongoing lung condition caused by damage to the lungs. The damage results in swelling and irritation, also called inflammation, inside the airways that limit airflow into and out of the lungs. This limited airflow is known as obstruction. Symptoms include trouble breathing, a daily cough that brings up mucus and a tight, whistling sound in the lungs called wheezing.

COPD is most often caused by long-term exposure to irritating smoke, fumes, dust or chemicals. The most common cause is cigarette smoke.

Chronic bronchitis is inflammation of the lining of the tubes that bring air into the lungs. These tubes are called bronchi. The inflammation prevents good airflow into and out of the lungs and makes extra mucus. In emphysema, the small air sacs of the lungs, called alveoli, are damaged. The damaged alveoli can't pass enough oxygen into the bloodstream.

Although COPD is a condition that can get worse over time, COPD is treatable. With proper management, most people with COPD can control symptoms and improve their quality of life. Proper management also can lower the risk of other conditions linked to COPD, such as heart disease and lung cancer.

Changes in your lungs and airways in COPD include:

Loss of elasticity in your airways and air sacs in your lungs (alveoli).

Inflammation, scarring (fibrosis) and narrowing of your airways.

Thick mucus in your airways.

Destruction of the walls between your alveoli. This enlarges them and traps air.

People with COPD often get exacerbations, or worsening of symptoms, like severe difficulty breathing, thicker mucus, wheezing and cough. You might need to go to the hospital for severe exacerbations.

COPD gets progressively worse over time. Flare-ups get more severe and happen more often. This usually takes years or decades, though some people get worse faster.

Types of COPD

COPD includes both emphysema and chronic bronchitis. People with COPD often have features of both.

Emphysema: This lung condition causes destruction of the fragile walls and elastic fibers of the alveoli. The damaged inner walls of the alveoli may be destroyed, creating one large air space that is hard to empty compared with the many healthy small ones. The alveoli now have less surface area that can be used to exchange oxygen and carbon dioxide. Also, old air gets trapped in the large alveoli so there isn't room for enough new air to get in.

Chronic bronchitis. In this condition, the bronchial tubes become inflamed and narrowed. As a result, the tubes thicken, making less room for air to pass through. Extra mucus caused by the irritation blocks the narrowed tubes even more. An ongoing cough results from trying to clear mucus from the airways.

Symptoms

Common signs and symptoms include:

Cough with mucus that you’ve had for a long time (for three months or longer at a time for at least two years).

Shortness of breath doing everyday activities.

Trouble taking deep breaths.

Wheezing or other lung sounds

Barrel-shaped chest.

Excess phlegm or mucus.

Bluish skin (cyanosis).

Complications

COPD is 1 of the top 10 causes of death in the U.S.

COPD can trap bacteria in your lungs, leading to infections. It can also prevent oxygen from getting into your body and carbon dioxide from getting out. This can lead to serious complications, including:

Pneumonia.

High levels of carbon dioxide in your blood (hypercapnia).

Low levels of oxygen in your blood (hypoxemia).

Respiratory failure.

Pulmonary hypertension.

Right-sided heart failure (cor pulmonale).

Collapsed lung (pneumothorax).

Polycythemia (making too many red blood cells).

Causes and risk factors

Damage to your lungs from smoking is the most common cause of COPD. Other causes include:

Alpha-1 antitrypsin deficiency (“alpha-1”), a genetic disorder that can lead to lung damage.

Secondhand smoke.

Air pollution.

Exposure to dust and fumes from your job or hobbies.

What are the risk factors for this condition?

While smoking is the biggest risk factor for COPD, not everyone who smokes will develop it.

You may be at higher risk for COPD if you:

Are female.

Are over the age of 65.

Have been exposed to air pollution.

Have worked with chemicals, dust or fumes.

Have alpha-1 antitrypsin deficiency.

Had many respiratory infections during childhood.

Who is at risk

Some people are more likely to have COPD, including:

Current or former smokers.

People with a history of asthma.

Women.

Adults 65 and older.

American Indian or Alaska Native populations and people of more than one race.

People who are unemployed, unable to work, retired, a homemaker or a student.

People with less than a high school education.

Diagnosis

To diagnose COPD, a provider will perform an exam and ask you about your health history. They’ll test how well your lungs work and might get images of your lungs.

They may ask you questions like:

Do you smoke or have you ever smoked?

Have you had long-term exposure to dust or air pollutants?

Do other members of your family have COPD, other lung conditions or liver disease?

Do you get short of breath with exercise? When resting?

Have you been coughing or wheezing for a long time?

Do you cough up phlegm?

What tests do healthcare providers use to diagnose COPD?

Your provider might use the following tests to help diagnose COPD:

Lung diffusion test. This test shows how well the body moves oxygen and carbon dioxide between the lungs and the blood.

Spirometry. In this test, you breathe out quickly and forcefully through a tube connected to a machine. The machine measures how much air the lungs can hold and how quickly air moves in and out of the lungs. Spirometry diagnoses COPD and tells how much airflow is limited.

Lung volume test. This test measures the amount of air the lungs hold at different times when breathing in and out.

Pulse oximetry. This simple test uses a small device placed on one of your fingers to measure how much oxygen is in your blood. The percentage of oxygen in the blood is called oxygen saturation. You also may have a six-minute walking test with a check of your oxygen saturation.

Chest X-ray. A chest X-ray may show some lung changes from COPD. An X-ray also can rule out other lung problems or heart failure.

CT scan. A CT scan combines X-ray images taken from different angles to create images of structures inside the body. A CT scan gives much greater detail of changes in your lungs than a chest X-ray does. A CT scan of your lungs can show emphysema and chronic bronchitis. A CT scan also can help tell if you might benefit from surgery for COPD. CT scans can be used to check for lung cancer.

Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.

Exercise stress test. An exercise test on a treadmill or stationary bike may be used to monitor heart and lung function during activity

Electrocardiogram (ECG or EKG). This test checks heart function and rules out heart disease as a cause of shortness of breath.

Blood tests. Blood tests aren't used to diagnose COPD, but they may be used to find the cause of your symptoms or rule out other conditions.

Testing for AAT deficiency. Blood tests can tell if you have the genetic condition called alpha-1-antitrypsin deficiency.

What are the stages of COPD?

Your provider can stage COPD based on your forced expiratory volume in one second (FEV1) results. FEV1 is the amount of air you can breathe out in one second, and it can tell your provider how blocked your airways are. Your provider measures FEV1 with Spirometry.

COPD stages based on severity are:

Stage 1: FEV1 is 80 or above.

Stage 2: FEV1 is between 50 and 79.

Stage 3: FEV1 is between 30 and 49.

Stage 4: FEV1 is less than 30.

Your provider can also evaluate your symptoms and your risk for exacerbation using groupings with the letters A, B and E:

A: You have mild symptoms and a low risk for exacerbations.

B: You have more severe symptoms and a low risk for exacerbations.

E: You have a high risk for exacerbations.

Your stage isn’t directly related to your symptoms — for instance, you could be in stage 3 or 4 but still have mild symptoms. Your provider can use your stage, symptoms and number of exacerbations to guide your treatment.

How is COPD treated?

There’s no cure for COPD. Treatment focuses on improving your symptoms and reducing and treating exacerbations. Your provider may recommend:

Smoking cessation programs. If you smoke, quitting can slow down the progression of COPD.

Inhaled medications. Bronchodilators and steroids can reduce inflammation and open your airways. These might come in an inhaler or as a liquid you put in a nebulizer.

Oxygen therapy. You may need supplemental oxygen to improve your oxygen levels.

Pulmonary rehabilitation. This is an exercise and education program that can strengthen your lungs and help you manage COPD.

Corticosteroids. You might need a course of steroids to reduce inflammation during an exacerbation.

Positive airway pressure. Your provider might have you use a BiPAP machine to help you breathe, especially during an exacerbation.

Antibiotics. If you have frequent bacterial infections in your lungs, your provider may prescribe antibiotics to prevent infections and exacerbations.

Lung volume reduction (LVR). If you have severe COPD and you’re a good candidate, your provider may suggest surgery or a valve procedure that reduces the trapped air in your lungs.

Clinical trials. Clinical trials are tests of new treatments to see if they’re safe and effective. Your provider might recommend one if a new treatment could be a good fit.

Medications for COPD

The medications listed below are related to or used in the treatment of this condition.

Drug name	Rating	Rx/OTC	Preg	CSA	Alcohol
Symbicort	7.3	Rx	C	N
Trelegy Ellipta	6.9	Rx		N
prednisone	7.5	Rx	C	N
montelukast	7.6	Rx	B	N
Breztri Aerosphere	7.4	Rx		N	X
Anoro Ellipta	6.9	Rx	C	N
budesonide / formoterol / glycopyrrolate	7.4	Rx		N	X
dupilumab	5.0	Rx		N
Dupixent	5.0	Rx		N
Ohtuvayre	10	Rx		N
Breo Ellipta	6.7	Rx	C	N
albuterol	9.0	Rx	C	N
Daliresp	7.8	Rx	C	N
Stiolto Respimat	6.8	Rx	C	N
budesonide / formoterol	7.3	Rx	C	N
Incruse Ellipta	3.7	Rx	C	N
Tudorza Pressair	8.9	Rx	C	N
levalbuterol	8.6	Rx	C	N
Rayos	10	Rx	C	N
fluticasone / vilanterol	6.7	Rx	C	N
roflumilast	7.8	Rx	C	N
aclidinium	8.9	Rx	C	N
fluticasone / umeclidinium / vilanterol	6.8	Rx		N
Xopenex	10	Rx	C	N
Bevespi Aerosphere	7.8	Rx		N	X
olodaterol / tiotropium	6.7	Rx	C	N
umeclidinium / vilanterol	6.8	Rx	C	N
albuterol / ipratropium		Rx	C	N
fluticasone / salmeterol		Rx	C	N
ipratropium		Rx	B	N
Striverdi Respimat	4.6	Rx	C	N
umeclidinium	3.6	Rx	C	N
Xopenex HFA		Rx	C	N
Yupelri	10	Rx		N
Breyna		Rx	C	N
formoterol / glycopyrrolate	7.8	Rx		N	X
olodaterol	4.6	Rx	C	N
revefenacin	8.7	Rx		N
tiotropium		Rx	C	N
Xopenex Concentrate		Rx	C	N
aclidinium / formoterol	4.0	Rx		N
Duaklir Pressair		Rx		N
ensifentrine	10	Rx		N
formoterol		Rx	C	N
salmeterol		Rx	C	N

Legend
Rating	For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective).
Rx	Prescription only.
OTC	Over-the-counter.
Rx/OTC	Prescription or Over-the-counter.

Pregnancy Category		Controlled Substances Act (CSA) Schedule		Alcohol
B	Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.	U	CSA Schedule is unknown.	X	Interacts with Alcohol.
C	Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.	N	Is not subject to the Controlled Substances Act.

Can COPD be prevented?

Unlike some other medical conditions, COPD often has a clear cause and a clear way to prevent it. Most of the time, COPD is directly linked to cigarette smoking. The best way to prevent COPD is to never smoke. If you smoke and have COPD, stopping now can slow how fast the condition worsens.

If you've smoked for a long time, quitting can be hard, especially if you've tried quitting once, twice or many times before. But keep trying to quit. It's critical to find a stop-smoking program that can help you quit for good. It's your best chance for lessening damage to your lungs. Talk with your healthcare professional about options that might work best for you.

Workplace exposure to chemical fumes, vapors and dusts is another risk factor for COPD. If you work with these types of lung irritants, talk with your supervisor about the best ways to protect yourself. This may include wearing equipment that prevents you from breathing in these substances.

Here are some steps you can take to help prevent complications linked with COPD:

Quit smoking to help lower your risk of heart disease and lung cancer.

Get an annual flu vaccination and vaccination against pneumococcal pneumonia to lower your risk of or prevent some infections. Also talk with your doctor or other healthcare professional about when you need the COVID-19 vaccine and the RSV vaccine.

Talk with your healthcare professional or a mental health professional if you feel sad or hopeless or think that you may have depression.

Prognosis

Can a person with COPD get better?

The damage to your lungs from COPD is permanent and doesn’t get better. But there are ways to manage your symptoms for a long time, and sometimes even improve them. Following your healthcare provider’s recommendation and a pulmonary rehabilitation program can help improve your symptoms and your quality of life.

Can you live a long life with COPD?

How long you live with COPD depends on how severe it is and how quickly it’s progressing. Many people can live for decades after diagnosis, especially with early treatment. People in stage 3 or 4 have a life expectancy that’s six to nine years shorter than average.

Is COPD a terminal illness?

COPD gets progressively worse over time, but it’s not always a terminal illness. How quickly it progresses varies from person to person. Over time (usually years or even decades) many people with COPD won’t be able to breathe on their own. But others can live a long time without having severe symptoms.

Living With COPD

How do I take care of myself with COPD?

If you have COPD, some tips to take care of yourself include:

Avoid lung irritants and anything that makes your symptoms worse. This includes smoking, secondhand smoke, dust, air pollution and strong fragrances.

Attend pulmonary rehabilitation sessions. This includes physical and occupational therapy and education sessions. Keep up with the plan they outline even after your sessions have ended.

Talk to a registered dietitian. They can tell you if there are specific foods to eat or avoid that can help keep you healthy.

Take all of your medications as prescribed. Make sure you have daily medications on hand before you run out.

Make a plan for flare-ups. Work with your provider on a plan for what to do if you have an exacerbation. This might include having certain medications on hand and knowing when to go to the hospital.

Know how to use your medical devices. This can include inhalers, nebulizers, a CPAP machine and other devices. Ask your provider to demonstrate correct usage.

Take care of your mental health. Having a chronic illness can take a toll on your mental health. A mental health provider like a psychiatrist, psychologist or counselor can help you manage social, emotional and other mental health issues.

When should I see my healthcare provider?

If you think you could have COPD, don’t wait to see a healthcare provider. Early diagnosis and treatment can reduce your risk of your symptoms progressing.

If you have COPD, see your healthcare provider if you have signs of an infection or other changes in your symptoms, including:

Worsening shortness of breath. You may notice that you can’t walk as far as you used to, you’re having more breathing difficulty at night, or you’re using your breathing treatments or inhalers more often than usual.

Mucus (sputum) changes. This could include changes in color, bloody mucus, a foul smell, more mucus or thicker mucus than usual.

Increased coughing or wheezing.

New or worsening swelling in your ankles, feet or legs. Contact your provider if it doesn’t go away after a night’s sleep with your feet up.

Unexplained weight loss or gain.

Frequent morning headaches or dizziness.

Unexplained, extreme fatigue or weakness. Contact your provider if it lasts for more than a day.

Fever or chills.

Other signs of infection. These could include sore throat, unusual sinus drainage, nasal congestion, headaches or tenderness along your upper cheekbones.

When should I go to the ER?

Go to the emergency room if you experience:

High fever (over 103 degrees Fahrenheit/40 degrees Celsius).

Sudden or severe difficulty breathing.

Restlessness, confusion, forgetfulness or irritability.

Slurred speech.

What questions should I ask my healthcare provider?

It might be helpful to ask your healthcare provider:

What are the best ways to take care of myself?

Can I improve my symptoms?

How do I take this medication?

How do I use my inhaler, nebulizer or other medical devices?

When should I follow up with you?

When should I go to the ER?

One Final Note..

Living with chronic lung disease like COPD might feel overwhelming, scary, frustrating or even lonely at times. But there are ways to keep your lung muscles strong for as long as possible and even improve your symptoms. Making a plan with your healthcare team that will keep you healthy and reduce exacerbations can help it feel more manageable. Talk to your loved ones about how they can help, and what to do if you have a flare-up.

If you feel out of breath frequently, have a chronic cough or feel tired easily, don’t wait to talk to a healthcare provider. Early diagnosis can improve your quality of life and help keep you healthy for the years ahead.

Resources for Patients and Their Families

At a glance

Several organizations offer information and resources about chronic obstructive pulmonary disease (COPD) for patients and their families.
Resources

Awareness and Education
People with COPD, their families, caregivers, and communities can be empowered to recognize, understand and reduce the impact of COPD.

Pulmonary (Lung) Rehabilitation
Pulmonary rehabilitation teaches you how to manage your COPD symptoms and improve your quality of life. Tailored programs show you how to breathe better and conserve your energy. They also provide advice on diet and exercise.

Smoking Cessation

Cigarette smoking is the most common cause of COPD in the United States. Information to help you stop smoking can be found here

How the COPD Community is Working to Reduce the Impact of COPD

The COPD National Action Plan is the first-ever blueprint for how we can all work together—across communities and sectors—to raise awareness of COPD and reduce its impact. The Plan was developed at the request of Congress, with input from the broad COPD community. This included patients, caregivers, federal agencies, nonprofits, researchers, policymakers, industry representatives, and advocates.