Chronic obstructive pulmonary disease

  • Definition
    • Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe.

      There are two main forms of COPD:

      • Chronic bronchitis, which involves a long-term cough with mucus
      • Emphysema, which involves damage to the lungs over time

      Most people with COPD have a combination of both conditions.

  • Alternative Names
    • COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

  • Causes
    • Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD.

      In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.


      Other risk factors for COPD are:

      • Exposure to certain gases or fumes in the workplace
      • Exposure to heavy amounts of secondhand smoke and pollution
      • Frequent use of a cooking fire without proper ventilation
  • Symptoms
    • Symptoms may include any of the following:

      • Cough, with or without mucous
      • Fatigue
      • Many respiratory infections
      • Shortness of breath (dyspnea) that gets worse with mild activity
      • Trouble catching one's breath
      • Wheezing

      Because the symptoms develop slowly, some people may not know that they have COPD.

  • Exams and Tests
    • The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away.


      Using a stethoscope to listen to the lungs can also be helpful. But sometimes, the lungs sound normal, even when a person has COPD.

      Imaging tests of the lungs, such as x-rays and CT scans, can be helpful. With an x-ray, the lungs may look normal, even when a person has COPD. A CT scan will usually show signs of COPD.

      Sometimes, a blood test called arterial blood gas may be done to measure the amounts of oxygen and carbon dioxide in the blood.

  • Treatment
    • There is no cure for COPD. But there are many things you can do to relieve symptoms and keep the disease from getting worse.

      If you smoke, now is the time to quit. This is the best way to slow lung damage.

      Medicines used to treat COPD include:

      • Inhalers (bronchodilators) COPD -- quick-relief drugs to help open the airways
      • Inhaled COPD -- control drugs or oral steroids to reduce lung inflammation
      • Anti-inflammatory drugs to reduce swelling in the airways
      • Certain long-term antibiotics

      In severe cases or during flare-ups, you may need to receive:

      • Steroids by mouth or through a vein (intravenously)
      • Bronchodilators through a nebulizer
      • Oxygen therapy
      • Assistance from a machine to help breathing by using a mask, BiPAP, or through the use of an endotracheal tube

      Your health care provider may prescribe antibiotics during symptom flare-ups, because an infection can make COPD worse.

      You may need oxygen therapy at home if you have a low level of oxygen in your blood.

      Pulmonary rehabilitation does not cure COPD. But it can teach you to breathe in a different way so you can stay active and feel better.


      You can do things every day to keep COPD from getting worse, protect your lungs, and stay healthy.

      Walk to build up strength:

      • Ask the provider or therapist how far to walk.
      • Slowly increase how far you walk.
      • Avoid talking if you get short of breath when you walk.
      • Use pursed lip breathing when you breathe out, to empty your lungs before the next breath.

      Things you can do to make it easier for yourself around the home include:

      • Avoid very cold air or very hot weather
      • Make sure no one smokes in your home
      • Reduce air pollution by not using the fireplace and getting rid of other irritants
      • Manage stress in your mood

      Eat healthy foods, including fish, poultry, and lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a provider or dietitian about eating foods with more calories.

      Surgery may be used to treat COPD. Only a few people benefit from these surgical treatments:

      • Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some people with emphysema
      • Lung transplant for a small number of very severe cases

      Test Your Knowledge of COPD Triggers

      1. People with COPD should take care to avoid getting a cold or the flu.

        1. A. True
        2. B. False

        The correct answer is true. Getting a cold or the flu can trigger a flare-up of symptoms. Reduce your risk of infection by washing your hands often and avoiding people with a cold or the flu. You should also get a flu vaccine each year and get a pneumococcal vaccine -- ask your doctor how often.

      2. The air quality outside can affect your COPD symptoms.

        1. A. True
        2. B. False

        The correct answer is true. Pollution and other materials in the air can trigger COPD symptoms. You can check the air quality index (AQI) each day to see how clean the air is in your area. Look for the AQI posted in your local newspaper or on the TV or radio.

      3. Secondhand smoke doesn't affect people with COPD.

        1. A. True
        2. B. False

        The correct answer is false. Secondhand smoke can trigger a flare-up of COPD symptoms. To limit your exposure, avoid places where people smoke. Also ask family and friends not to smoke near you or in or around your home.

      4. Smoke from a wood-burning stove can trigger a flare-up.

        1. A. True
        2. B. False

        The correct answer is true. If you can't avoid using a wood-burning stove, choose one that is EPA-emission certified. Also, make sure to have the stove, fireplace, and chimney cleaned each year, and only burn wood that has been dry for many months.

      5. Painting your living room can trigger COPD symptoms.

        1. A. True
        2. B. False

        The correct answer is true. Paint is just one household product that contains volatile organic compounds (VOCs). When inhaled, VOCs can cause your COPD symptoms to get worse. To limit your contact, use a fan to vent rooms when using paint or cleaning products.

      6. You can reduce your exposure to pollen by:

        1. A. Staying inside when the pollen count is high
        2. B. Using an air conditioner to filter air
        3. C. Removing indoor plants
        4. D. A and B
        5. E. All of the above

        The correct answer is all of the above. Pollen is another possible trigger of COPD symptoms. Staying indoors when the pollen count is high helps prevent flare-ups. Pollen counts are highest between 5 AM and 10 AM on hot, dry, windy days. Remove indoor plants if they trigger symptoms.

      7. You can keep mold out of your home by controlling moisture.

        1. A. True
        2. B. False

        The correct answer is true. Mold is another COPD trigger. It grows in places that are moist. Limit mold in your home by keeping the indoor humidity low. You can do this by using an air conditioner or dehumidifier.

      8. Dust mites are common in dry areas of your home.

        1. A. True
        2. B. False

        The correct answer is false. Dust mites live in dust particles, but they thrive in humid locations. Dust mite droppings can trigger COPD. You can limit dust mites by dusting with a damp cloth, vacuuming often, washing bedding once a week in hot water, and using an air conditioner in warm weather.

      9. Which of the following can cause a flare-up?

        1. A. Pet dander
        2. B. Pet skin flakes
        3. C. Pet urine
        4. D. Pet saliva
        5. E. All of the above

        The correct answer is all of the above. Pets can trigger COPD symptoms, but you don't have to get rid of your furry friend. Reduce your contact with triggers by keeping pets out of your bedroom and off of carpets, bed linens, and upholstered furniture. If possible, choose pets without fur or feathers.

      10. Your appliances can cause indoor pollution.

        1. A. True
        2. B. False

        The correct answer is true. Any appliance that uses gas, oil, propane, natural gas, or kerosene can produce fumes that can trigger COPD symptoms. To reduce this risk, have your furnace and other heating and cooling systems cleaned and inspected each year.

  • Support Groups
    • You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

  • Outlook (Prognosis)
    • COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking.

      If you have severe COPD, you will be short of breath with most activities. You may be admitted to the hospital more often.

      Talk with your provider about breathing machines and end-of-life care as the disease progresses.

  • Possible Complications
    • With COPD, you may have other health problems such as:

  • When to Contact a Medical Professional
    • Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath.

  • Prevention
    • Not smoking prevents most COPD. Ask your provider about quit-smoking programs. Medicines are also available to help you stop smoking.

  • References
    • Anderson B, Conner K, Dunn C, et al. Institute for Clinical Systems Improvement. Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). 9th edition. Updated March 2013. Accessed July 21, 2015.

      Celli BR, Zuwallack RL. Pulmonary rehabilitation. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 105.

      Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015;147(4):894-942. PMID: 25321320

      Han MK, Lazarus SC. COPD. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.