What Is COPD? Symptoms, Causes, Diagnosis and Treatment

Created: 22.08.2024 · Last Updated: 13.08.2026 · Category: Pulmonology · Prepared by the Academic Hospital Web and Editorial Board.

What Is COPD?

Chronic obstructive pulmonary disease (COPD) is a chronic lung condition associated with persistent airflow limitation caused by structural changes in the airways and/or lung tissue.

Small-airway narrowing, inflammation, excess mucus and damage to the air sacs of the lungs can occur in different combinations.

COPD can progress over time, but appropriate treatment, smoking cessation, reduction of harmful exposures, regular physical activity and correct inhaler use can reduce symptoms and exacerbations and improve daily function.

COPD does not occur only in people who smoke. Tobacco is a major risk factor, but occupational dusts and chemicals, air pollution, biomass smoke, early-life factors and rare genetic conditions can also contribute.

Chronic Bronchitis and Emphysema

COPD was traditionally described as a combination of chronic bronchitis and emphysema. It is now understood as a heterogeneous condition in which different abnormalities can occur together in varying proportions.

Chronic Bronchitis

Chronic bronchitis is characterised clinically by persistent cough and sputum production and may involve airway inflammation and increased mucus production.

Emphysema

Emphysema refers to structural damage and enlargement of the air spaces in the lungs. Loss of elasticity can make it more difficult to empty air from the lungs and can cause air trapping.

What Are the Symptoms of COPD?

  • Shortness of breath
  • Persistent or recurrent cough
  • Sputum production
  • Wheezing
  • Chest tightness
  • Reduced exercise capacity
  • Fatigue
  • Recurrent respiratory infections

As COPD progresses, everyday tasks such as walking quickly or climbing stairs can become increasingly difficult because of breathlessness.

What Causes COPD?

COPD usually develops through long-term interaction between harmful exposures, lung development and individual susceptibility.

Important causes and exposures include:

  • Cigarette smoking and other tobacco products
  • Second-hand smoke
  • Occupational dusts, fumes and chemicals
  • Indoor pollution from biomass fuels
  • Outdoor air pollution

What Are the Risk Factors for COPD?

  • Long-term tobacco exposure
  • Occupational dust and chemical exposure
  • Air pollution
  • Indoor biomass smoke
  • Factors affecting lung growth during childhood
  • Prematurity and other early-life factors
  • Some severe or recurrent childhood respiratory infections
  • Asthma and airway hyperresponsiveness
  • Alpha-1 antitrypsin deficiency
Genetic causes should be considered particularly when COPD develops at a younger age or without a substantial smoking history.

How Is COPD Diagnosed?

COPD should be considered in people with chronic breathlessness, cough or sputum production, recurrent lower respiratory infections or relevant risk-factor exposure.

Assessment can include:

  • Medical history
  • Smoking and occupational exposure history
  • Physical examination
  • Spirometry
  • Chest X-ray when appropriate
  • CT in selected patients
  • Oxygen saturation or arterial blood gases when indicated
  • Alpha-1 antitrypsin testing when appropriate

A chest X-ray or CT scan does not independently establish the diagnosis of COPD.

What Is Spirometry?

Spirometry measures how much air a person can exhale and how quickly it can be expelled.

  • FEV1: The amount of air forcibly exhaled in the first second
  • FVC: The total amount of air forcibly exhaled after a full breath
  • FEV1/FVC: A ratio used to assess airflow obstruction
Spirometry is important for confirming COPD. In an appropriate clinical setting, a post-bronchodilator FEV1/FVC ratio below 0.70 is the key spirometric criterion for persistent airflow obstruction.

How Is COPD Severity Assessed?

COPD assessment is not based on FEV1 alone.

Clinicians also consider:

  • Severity of breathlessness
  • Impact on daily life
  • Previous exacerbations
  • Previous hospitalisations
  • Biomarkers such as blood eosinophils when relevant
  • Associated conditions such as cardiovascular disease, osteoporosis, anxiety and depression

How Is COPD Treated?

Established structural lung damage may not be fully reversible, but appropriate management can reduce symptoms, improve activity levels and lower the risk of exacerbations.

Treatment can include:

  • Smoking cessation
  • Reduction of harmful environmental and occupational exposures
  • Appropriate inhaled medicines
  • Correct inhaler technique
  • Regular physical activity
  • Pulmonary rehabilitation
  • Appropriate vaccination
  • Prevention and early treatment of exacerbations
  • Oxygen or advanced treatments in selected patients

Why Is Smoking Cessation Important?

For people with COPD who smoke, stopping smoking is one of the most important parts of treatment.

Smoking cessation can slow loss of lung function, improve respiratory symptoms and reduce health risks even after many years of tobacco use.

Which Medicines Are Used for COPD?

Bronchodilators are central to pharmacological treatment of COPD.

Long-acting treatment may include:

  • Long-acting beta-2 agonists (LABA)
  • Long-acting muscarinic antagonists (LAMA)
  • LABA + LAMA combinations

Inhaled Corticosteroids

Inhaled corticosteroids are not routinely required for everyone with COPD.

They may be used together with bronchodilators in selected patients according to exacerbation history, blood eosinophil levels and the presence of asthma.

Correct inhaler technique is an essential part of COPD treatment. If treatment appears ineffective, inhaler technique, adherence and device suitability should be reviewed.

What Is Pulmonary Rehabilitation?

Pulmonary rehabilitation is a comprehensive programme rather than simply a set of breathing exercises.

It can include:

  • Exercise training
  • Breathing strategies
  • Education
  • Nutritional assessment
  • Daily activity planning
  • Psychosocial support

Pulmonary rehabilitation can improve exercise capacity, breathlessness and quality of life.

When Is Oxygen Therapy Used in COPD?

Long-term oxygen therapy is not automatically required for every person with advanced COPD or breathlessness.

It is primarily considered in appropriately selected patients with chronic severe resting hypoxaemia.

Oxygen saturation, arterial blood gases and the overall clinical condition should be assessed before long-term oxygen is prescribed.

Breathlessness alone is not sufficient reason to prescribe long-term oxygen.

Why Is Vaccination Important in COPD?

Respiratory infections are an important cause of COPD exacerbations.

Depending on age, health status and local vaccination recommendations, vaccination may include:

  • Seasonal influenza vaccination
  • Pneumococcal vaccination
  • COVID-19 vaccination
  • Other age- or risk-appropriate adult vaccines

What Is a COPD Exacerbation?

A COPD exacerbation is an acute worsening of breathlessness, cough and/or sputum beyond the person's usual day-to-day variation.

Symptoms may include:

  • Increasing breathlessness
  • More frequent cough
  • Changes in sputum amount or characteristics
  • Increased wheezing
  • Reduced ability to perform daily activities

Treatment may include short-acting bronchodilators and, in selected patients, short courses of systemic corticosteroids or antibiotics following medical assessment.

Rapidly worsening breathlessness, inability to speak because of respiratory distress, confusion, chest pain or blue discoloration of the lips or fingers requires urgent medical assessment.

Advanced Treatments for COPD

Selected patients with severe symptoms despite optimal treatment may be assessed for more advanced interventions.

These can include:

  • Bronchoscopic lung-volume reduction
  • Lung-volume reduction surgery
  • Bullectomy
  • Lung transplantation in highly selected advanced cases

When Should You See a Doctor?

Medical assessment may be appropriate if you have:

  • Persistent cough
  • Chronic or recurrent sputum production
  • Breathlessness during activity
  • Wheezing
  • Frequent respiratory infections

This is particularly important in people with a history of tobacco use or occupational or environmental exposure.

Have Your Breathing and COPD Risk Assessed

If you have persistent cough, sputum, wheezing or shortness of breath, your lung function and COPD risk can be assessed.

Frequently Asked Questions

What is COPD?
COPD is a chronic lung condition associated with persistent airflow limitation caused by structural changes in the airways and/or lung tissue and may cause chronic breathlessness, cough or sputum production.
Does COPD only occur in smokers?
No. Smoking is a major risk factor, but occupational dusts and chemicals, air pollution, biomass smoke, early-life factors and genetic conditions such as alpha-1 antitrypsin deficiency can also contribute to COPD.
How is COPD diagnosed?
COPD is assessed using symptoms, risk factors and spirometry. In an appropriate clinical setting, a post-bronchodilator FEV1/FVC ratio below 0.70 is the key spirometric criterion supporting persistent airflow obstruction.
Can COPD be completely cured?
Established structural lung changes may not be fully reversible. However, smoking cessation, appropriate inhaled treatment, physical activity, pulmonary rehabilitation and prevention of exacerbations can substantially reduce symptoms and improve daily life.
Does stopping smoking help after COPD has developed?
Yes. Although established structural damage may not completely reverse, smoking cessation can slow the loss of lung function and improve control of symptoms and exacerbation risk. It remains beneficial even after many years of smoking.
Does everyone with COPD need a steroid inhaler?
No. Inhaled corticosteroids are not routinely prescribed to everyone with COPD. Their use is assessed according to factors such as exacerbation history, blood eosinophil level, coexisting asthma and bronchodilator treatment.
Does everyone with COPD need oxygen?
No. Long-term oxygen therapy is mainly considered for appropriately selected patients with chronic severe hypoxaemia. Breathlessness alone does not mean that long-term oxygen is required.
What is a COPD exacerbation?
A COPD exacerbation is an acute worsening of breathlessness, cough and/or sputum beyond the person's usual day-to-day variation. Exacerbations may require additional medication or hospital assessment.
Academic Hospital note: Persistent cough, sputum or breathlessness during activity should be assessed for COPD, particularly in people with tobacco, occupational or air-pollution exposure. Spirometry is an important test for confirming persistent airflow obstruction. You can book an appointment.

References

  1. Academic Hospital. Chronic Obstructive Pulmonary Disease (COPD)
  2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD – 2026 Report
  3. Global Initiative for Chronic Obstructive Lung Disease. Spirometry Quick Guide
  4. World Health Organization. Chronic Obstructive Pulmonary Disease (COPD)
  5. World Health Organization Europe. Chronic Respiratory Diseases