COPD (chronic obstructive pulmonary disease)

01

What it is

COPD is a long-term lung condition with persistent difficulty moving air out of the lungs. It includes varying combinations of small-airway disease and emphysema and can cause breathlessness, cough, sputum, wheeze, reduced exercise capacity, and flare-ups. Symptoms often develop gradually and can be mistaken for aging or poor fitness. COPD is not contagious, and although lung damage may not fully reverse, treatment can improve symptoms, function, and future risk.

Sources for this section: [1] [3]

02

Symptoms and how it may present

COPD symptoms often develop gradually. Early symptoms may be mild, and someone may start avoiding stairs or slowing down without noticing how much their breathing has changed. Common symptoms include:

• Breathlessness, particularly during walking, climbing stairs, or other physical activity.
• A persistent cough, with or without sputum (phlegm).
• Wheezing: a whistling or squeaky sound when breathing.
• Chest tightness and tiredness that make usual activities harder.

Not everyone with COPD has all these symptoms, and the same symptoms can occur with asthma or other heart or lung conditions. A wheeze or a particular breathing sound does not establish COPD or explain a new deterioration. Discuss persistent symptoms with a healthcare professional; diagnosis uses the history, examination, and tests such as spirometry. For symptoms that are suddenly worse than usual, see when to seek help.

Sources for this section: [1] [3] [5] [7]

03

Causes and risk factors

Tobacco smoke is a major cause, but household and outdoor air pollution, occupational dusts and fumes, recurrent early-life respiratory problems, impaired lung growth, asthma, infections, and alpha-1 antitrypsin deficiency also contribute. COPD can occur in people who never smoked, and blame interferes with care. Identifying ongoing exposure matters because reducing it can slow further injury. Earlier-than-expected disease, family history, or liver disease may prompt testing for alpha-1 antitrypsin deficiency.

Sources for this section: [1] [2]

04

Diagnosis and tests

Tests should answer a clinical question and be interpreted together with symptoms, examination, and history.

Diagnosis should be confirmed with spirometry showing persistent obstruction after a bronchodilator, not symptoms or an X-ray alone. Assessment records breathlessness, activity, cough, sputum, flare-ups, smoking and other exposure, oxygen level, inhaler technique, nutrition, mood, and other heart or lung conditions. Imaging, blood tests, walking tests, or alpha-1 testing are used when indicated.

Sources for this section: [1] [2] [3]

05

Treatment options

The best option depends on severity, other conditions, likely benefit and harm, access, and personal priorities.

Long-acting bronchodilator inhalers are central; inhaled corticosteroids are added for selected patterns because benefits and pneumonia risk differ. Correct inhaler technique and access can matter as much as the prescription. Pulmonary rehabilitation improves exercise capacity and quality of life. Oxygen helps people with verified severe resting hypoxemia, not breathlessness alone, and selected severe disease may need procedures or transplant assessment.

Sources for this section: [2] [4]

06

Daily life and supportive care

Stopping smoking is the most effective way to slow exposure-related damage. Regular activity, adequate protein and energy, vaccination against relevant respiratory infections, clean-air measures, and prompt treatment of flare-ups support health. Being underweight and losing muscle can be as important as excess weight. Supplements do not reverse lung damage; sedatives and unregulated remedies can worsen breathing or interact with treatment.

Sources for this section: [1] [2] [4]

07

Monitoring and follow-up

Follow trends that can change a decision rather than collecting measurements without a purpose.

Review breathlessness, cough and sputum, activity, sleep, flare-ups, emergency visits, medicine use, inhaler technique, oxygen levels when indicated, smoking or exposure status, nutrition, mood, and other heart or lung disease. Repeat spirometry when it will clarify progression or a decision, not simply at every visit. After a flare-up, reassess recovery, treatment, rehabilitation, and prevention. Oxygen is prescribed from measured criteria; breathlessness alone does not show whether long-term oxygen will help.

Sources for this section: [2] [3] [4]

08

Complications and long-term outlook

COPD varies widely. Continued harmful exposure, repeated flare-ups, low activity, poor nutrition, and coexisting heart disease can worsen outcomes, while exposure reduction, appropriate inhalers, pulmonary rehabilitation, vaccination, and early flare-up treatment can preserve function. Advanced disease may involve low oxygen, high carbon dioxide, weight and muscle loss, pulmonary hypertension, or respiratory failure. Goals-of-care and advance planning should be offered without withdrawing active symptom treatment.

Sources for this section: [1] [2] [4]

09

When to seek urgent help

Recognize a change from your usual symptoms

A COPD flare-up, also called an exacerbation, is a worsening beyond usual day-to-day variation. Breathing may become harder, a cough may increase, or there may be more sputum or a change in its colour. Wheezing, chest tightness, fever, or greater difficulty with usual activities may accompany the change. Compare with what is normal for you rather than with another person's symptoms.

Symptoms do not identify the cause on their own

Respiratory infections, smoke, dust, or poor air quality can trigger worsening. Fever can be a sign of infection, but fever, coloured sputum, or wheezing alone cannot tell you whether there is a bacterial infection, whether antibiotics are needed, or whether COPD explains the whole problem. Many exacerbations are not bacterial. Other illnesses can also cause breathing symptoms, so a new deterioration needs assessment rather than self-diagnosis.

Contact the care team promptly

Contact your healthcare team promptly if breathing, cough, or sputum suddenly worsens, or if you develop a fever. Follow your agreed action plan while seeking advice, and do not wait for the next routine appointment. Explain what changed, when it started, how it affects normal activities, and what prescribed treatment you have used and whether it helped. Keeping a brief symptom record can help the conversation, but must not delay getting care.

Know when it is an emergency

For these warning signs, seek emergency help rather than waiting for a routine appointment or a callback.

Agree a written plan before a flare-up

Ask the care team to make a plan with you, and with a family member or carer if you wish. It should explain your usual treatment, changes to watch for, who to contact during and outside normal hours, and when emergency help is needed. Any instructions about inhalers, steroids, antibiotics, or oxygen must be specific to your prescription and situation. Do not start or increase medicines or adjust oxygen based on this article; use only the instructions agreed with your care team. Review the plan after a flare-up and when treatment or access to care changes.

Prepare a useful symptom record for your care team

Sources for this section: [5] [6] [8] [9] [10]

10

Questions to discuss with a care team

Bring a description of your usual symptoms and recent changes, your medicine list, and your inhalers so the team can check technique. Explain if cost, transport, caregiving, or difficulty using a device makes the plan hard to follow.

• What supports my COPD diagnosis, and could another condition explain these symptoms?
• Which changes from my usual symptoms should make me contact you promptly, and which need emergency help?
• Who should I contact outside normal hours, or if I cannot reach the usual team?
• Can we write down exactly how to use my prescribed treatment during worsening, and check that I understand it?
• After a flare-up, what follow-up, inhaler check, rehabilitation, or prevention review do I need?

Prepare your questions and information for an appointment

Prepare questions about your spirometry report

Prepare for a review of your inhaler technique

Sources for this section: [3] [6] [9]