Chronic Obstructive Pulmonary Disease (COPD)

Overview

What is COPD (chronic obstructive pulmonary disease)?

COPD is an umbrella term for a range of progressive lung diseases. Chronic bronchitis and emphysema both can result in COPD. A COPD diagnosis means you may have one of these lung-damaging diseases or symptoms of both. COPD can progress gradually, making it increasingly difficult to breathe over time.

Chronic bronchitis

Chronic bronchitis irritates your bronchial tubes, which carry air to and from your lungs. In response, the tubes swell and mucus (phlegm or “snot”) builds up along the lining. The buildup narrows the tube’s opening, making it hard to get air in and out of the lungs.

Small, hair-like structures on the inside of the bronchial tubes (called cilia) normally move mucus out of the airways. But the irritation from chronic bronchitis and/or smoking damages them. The damaged cilia can’t help clear mucus.

Emphysema

Emphysema is the breakdown of the walls of the tiny air sacs (alveoli) at the end of the bronchial tubes, in the “bottom” of the lung. The lung is like an upside down tree. The trunk is the windpipe or “trachea,” the branches are the “bronchi,” and the leaves are the air sacs or “alveoli .” The air sacs play a crucial role in transferring oxygen into your blood and carbon dioxide out. The damage caused by emphysema destroys the walls of the air sacs, making it hard to get a full breath.

How common is COPD?

COPD affects nearly 16 million Americans, or about 6% of the U.S. population.

Who gets COPD?

The primary cause of COPD is smoking. But not all smokers develop the disease. You may be at higher risk if you:

  • Are a woman.
  • Are over the age of 65.
  • Have been exposed to air pollution.
  • Have worked with chemicals, dust or fumes.
  • Have alpha-1 antitrypsin deficiency (AAT), a genetic risk factor to develop COPD.
  • Had many respiratory infections during childhood.

Symptoms and Causes

What causes COPD?

Smoking tobacco causes up to 90% of COPD cases. Other causes include:

  • Alpha-1 antitrypsin (AAT) deficiency, a genetic disorder.
  • Secondhand smoke.
  • Air pollution.
  • Workplace dust and fumes.

Smoking

Tobacco smoke irritates airways, triggering inflammation (irritation and swelling) that narrows the airways. Smoke also damages cilia so they can’t do their job of removing mucus and trapped particles from the airways.

AAT deficiency

AAT (alpha-1 antitrypsin deficiency) is an uncommon, inherited disorder that can lead to emphysema. Alpha-1 antitrypsin is an enzyme that helps protect lungs from the damaging effects of inflammation. When you have AAT, you don’t produce enough of the enzyme, called alpha-1 antitrypsin. Your lungs are more likely to become damaged from exposure to irritating substances like smoke and dust.

What are signs of chronic obstructive pulmonary disease (COPD)?

  • Cough with mucus that persists for long periods of time.
  • Difficulty taking a deep breath.
  • Shortness of breath with mild exercise (like walking or using the stairs).
  • Shortness of breath performing regular daily activities.
  • Wheezing.

If I am having chronic obstructive pulmonary disease symptoms, how do I determine when I need to call my doctor?

If you are having any of the symptoms described below, don't wait for your next appointment to call your doctor. Report these symptoms promptly, even if you don't feel sick. DO NOT wait for symptoms to become so severe that you need to seek emergency care. If your symptoms are discovered early, your doctor might change your treatment or medications to relieve your symptoms. (Never change or stop taking your medications without first talking to your doctor).

Note: Remember that warning signs or symptoms might be the same or different from one flare-up to another.

Non-emergency care

Talk to your doctor on the phone within 24 hours if you have these changes in your health:

  • Shortness of breath that has become worse or occurs more often. Examples:
    • Unable to walk as far as usual
    • Need more pillows or have to sit up to sleep because of breathing difficulty
    • More tired because you're working harder to breathe
    • Need breathing treatments or inhalers more often than usual
    • Wake up short of breath more than once a night
  • Sputum (mucus) changes including:
    • Changes in color
    • Presence of blood
    • Changes in thickness or amount (more than you usually have or more than you are able to cough out)
    • Odor
  • More coughing or wheezing
  • Swelling in your ankles, feet, or legs that is new or has become worse and doesn't go away after a night's sleep with your feet up
  • Unexplained weight loss or gain of 2 pounds in a day or 5 pounds in a week
  • Frequent morning headaches or dizziness
  • Fever, especially with cold or flu symptoms
  • Restlessness, confusion, forgetfulness, slurring of speech, or irritability
  • Unexplained, extreme fatigue or weakness that lasts for more than a day

Diagnosis and Tests

How is chronic obstructive pulmonary disease (COPD) diagnosed?

To assess your lungs and overall health, your healthcare provider will take your medical history, perform a physical exam and order some tests, like breathing tests.

Medical history

To diagnose COPD, your provider will ask questions like:

  • Do you smoke?
  • Have you had long-term exposure to dust or air pollutants?
  • Do other members of your family have COPD?
  • 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?

Physical exam

To help with the diagnosis, your provider will do a physical exam that includes:

  • Listening to your lungs and heart.
  • Checking your blood pressure and pulse.
  • Examining your nose and throat.
  • Checking your feet and ankles for swelling.

Tests

Providers use a simple test called spirometry to see how well your lungs work. For this test, you blow air into a tube attached to a machine. This lung function test measures how much air you can breathe out and how fast you can do it.

Your provider may also want to run a few other tests, such as:

  • Pulse oximetry to measure the oxygen in your blood.
  • Arterial blood gases (ABGs) to check your oxygen and carbon dioxide levels.
  • Electrocardiogram (ECG or EKG) to check heart function and rule out heart disease as a cause of shortness of breath.
  • Chest X-ray or chest CT scan to look for lung changes that are caused by COPD.
  • Exercise testing to determine if the oxygen level in your blood drops when you exercise.

What are the stages of COPD?

COPD can gradually get worse. How fast it progresses from mild to severe varies from person to person.

Mild COPD (stage 1 or early stage)

The first sign of COPD is often feeling out of breath with light exercise, like walking up stairs. Because it’s easy to blame this symptom on being out of shape or getting older, many people don’t realize they have COPD. Another sign is a phlegmy cough (a cough with mucus) that’s often particularly troublesome in the morning.

Moderate to severe COPD (stages 2 and 3)

In general, shortness of breath is more evident with more advanced COPD. You may develop shortness of breath even during everyday activities. Also, exacerbations of COPD – times when you experience increased phlegm, discoloration of phlegm, and more shortness of breath – are generally more common in higher stages of COPD. You also become prone to lung infections like bronchitis and pneumonia.

Very severe COPD (stage 4)

When COPD becomes severe, almost everything you do can cause shortness of breath. This limits your mobility. You may need supplemental oxygen from a portable tank.

Management and Treatment

How is chronic obstructive pulmonary disease (COPD) managed?

COPD treatment focuses on relieving symptoms, such as coughing and breathing problems, and avoiding respiratory infections. Your provider may recommend:

  • Bronchodilators: These medicines relax airways. Delivered through a mist you inhale, bronchodilators help you breathe easier.
  • Anti-inflammatory medications: Doctors commonly prescribe steroids to lower inflammation in the lungs. You inhale steroids in a mist form (nebulizer or inhaler) or take them by swallowing a pill.
  • Supplemental oxygen: If you have low blood oxygen (hypoxemia), you may need a portable oxygen tank to improve your oxygen levels.
  • Antibiotics: COPD makes you prone to lung infections, which can further damage your weakened lungs. Your doctor may prescribe antibiotics to stop a bacterial infection.
  • Vaccinations: Respiratory infections are more dangerous when you have COPD. It’s especially important to get shots to prevent flu and pneumonia.
  • Rehabilitation: Rehabilitation programs focus on teaching effective breathing strategies to lessen shortness of breath and on conditioning. When maintained, fitness can increase the amount you can do with the lungs you have.
  • Anticholinergics relax the muscle bands that tighten around the airways. This action opens the airways, letting more air in and out of the lungs to improve breathing. Anticholinergics also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can therefore be coughed out more easily. Anticholinergics work differently and more slowly than fast-acting bronchodilators.
  • Leukotriene modifiers might be used. Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles, and production of mucus and fluid. These newer drugs work by blocking the chemicals and decreasing these reactions. These medications help improve airflow and reduce symptoms in some people.
  • Expectorants thin mucus in the airways so it can be coughed out more easily. Take these medications with about 8 ounces of water.
  • Antihistamines relieve stuffy heads, watery eyes, and sneezing. Although effective at relieving these symptoms, antihistamines can dry the air passages, making breathing difficult, as well as causing difficulty when coughing up excess mucus. Take these medications with food to reduce upset stomach.
  • Antivirals might be prescribed to treat or prevent illnesses caused by viruses, most frequently to treat or prevent influenza ("the flu"). Influenza is particularly dangerous for people who have COPD.

For severe COPD, your provider may suggest you consider a clinical trial (tests of new treatments) or lung surgery, if you’re a candidate.

Prevention

How can I avoid COPD?

The best thing you can do to avoid developing COPD is to not smoke. If you’d like to quit, smoking cessation programs can help you. Also, avoid any environment that has poor air quality — air that has particles like dust, smoke, gases and fumes.

Why should people with COPD (chronic obstructive pulmonary disease) watch for signs of infection?

People with COPD have difficulty clearing their lungs of bacteria, dusts and other pollutants in the air. This makes them at risk for lung infections that may cause further damage to the lungs.

Therefore, it is important to watch for signs of infection and follow these tips to help prevent infections. You will probably not be able to avoid infections entirely, but these tips will help you prevent infections as much as possible.

What are warning signs of an infection, especially if I have COPD (chronic obstructive pulmonary disease)?

Warning signs of infection

While most infections can be successfully treated, you must be able to recognize an infection's immediate symptoms for proper and effective care.

  • Increased shortness of breath, difficulty breathing or wheezing
  • Coughing up increased amounts of mucus
  • Yellow- or green-colored mucus (may or may not be present)
  • Fever (temperature over 101°F) or chills (may or may not be present)
  • Increased fatigue or weakness
  • Sore throat, scratchy throat or pain when swallowing
  • Unusual sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones

If you have any of these symptoms, contact your physician right away, even if you do not feel sick.

What can I do to prevent infections, especially if I have COPD (chronic obstructive pulmonary disease)?

Hand washing

Frequently wash your hands with soap and warm water, especially before preparing food, eating, taking medications or breathing treatments; and after coughing or sneezing, using the bathroom, touching soiled linens or clothes, and after you've been around someone with a cold or the flu as well as after you've been at a social gathering. It is also good to carry waterless hand sanitizers with you to use when necessary.

Visitors

If visitors have cold or flu symptoms, ask them not to visit until they are feeling well.

Environment
  • Keep your house clean and free from excess dust. Keep your bathrooms and sinks free from mold or mildew.
  • Do not work in or visit any form of construction site. Dust can be harmful. If you absolutely must go near this type of area, wear a mask provided by your doctor.
  • Avoid air pollution, including tobacco smoke, wood or oil smoke, car exhaust fumes and industrial pollution which can cause inhaled irritants to enter your lungs. Also avoid pollen.
  • Make sure your cooking vent is working properly so cooking fumes can be drawn out of the house.
  • If possible, try to stay away from large crowds in the fall and winter when the flu season is at its peak.
Equipment care
  • Keep breathing equipment clean.
  • Do not let others use your medical equipment, including: oxygen cannula, metered dose inhaler (MDI), MDI spacer, nebulizer tubing and mouthpiece.
Diet
  1. Try to eat a balanced diet. Good nutrition is important to help the body resist infection. Eat foods from all the food groups.
  2. Drink plenty of fluids—at least 6 to 8 eight-ounce glasses per day (unless your doctor gives you other guidelines). Water, juices and sports drinks are best.
Other general health guidelines
  • Do not rub your eyes, as this can transmit germs to your nasal passages via the tear ducts.
  • Quitting smoking and avoiding second-hand smoke (the smoke from a burning cigarette or cigar and the smoke exhaled by a smoker) are important steps you can take to protect your lungs from infection.
  • Follow your doctor's medication guidelines.
  • Get enough sleep and rest.
  • Manage your stress.
  • Talk to your doctor or healthcare provider about getting a flu shot every year and get the pneumonia vaccine if you have not had one.
  • Be careful to avoid infection when traveling. In areas where the water might be unsafe, drink bottled water or other beverages (order beverages without ice). Swim only in chlorinated pools.

Outlook / Prognosis

What is the outlook?

COPD progresses at a different rate for every person. Once it progresses, the lung damage from COPD can’t be reversed but, by following a healthy lifestyle and getting treatment as early as possible, you can manage symptoms and feel much better.

Living With

How can I manage COPD at home?

You can take several steps to make breathing easier and slow the progression of the disease:

  • Quit smoking.
  • Avoid air polluted by chemicals, smoke, dust or fumes.
  • Take prescribed medications as directed by your provider.
  • Ask your doctor about a pulmonary rehabilitation program, which teaches you how to be active with less shortness of breath.
  • Maintain a healthy weight.
  • Get an annual flu shot.

The good news about COPD is that the symptoms can be managed. You’ll breathe easier if you take the necessary steps to support your lung capacity and fight lung irritation. By getting treatment early, you’ll have the best shot at continuing to do the things you love.

When should I call my doctor if I have COPD (chronic obstructive pulmonary disease) and I might have an infection?

Call your doctor if you experience any of the warning signs of an infection. Also call your doctor if you have any symptoms that cause concern.

Avoiding irritants

The lungs of people with COPD are sensitive to certain irritating substances in the air, such as: cigarette smoke, exhaust fumes, strong perfumes, cleaning products, paint/varnish, dust, pollen, pet dander and air pollution. Extreme cold or hot weather conditions can also irritate your lungs.

You can avoid some of these irritants by:

  • Asking those around you not to smoke.
  • Sitting in non-smoking sections of public places.
  • Requesting smoke-free hotel rooms and rental cars.
  • Avoiding underground parking garages.
  • Avoiding high traffic or industrialized areas.
  • Not using perfumes, scented lotions or other highly scented products that may irritate your lungs.
  • Using non-aerosol cleaning or painting products in well-ventilated areas and wearing a mask or handkerchief over your mouth when cleaning (dusting, vacuuming, sweeping) or working in the yard.
  • Reducing exposure to dust by regularly changing filters on heaters and air conditioners and using a dehumidifier.
  • Keeping pets out of the house, especially if you wheeze.
  • Using an exhaust fan when cooking to remove smoke and odors.
  • Staying indoors when the outside air quality is poor and pollen counts are high.
  • Following weather reports and avoiding extreme weather. During cold weather, cover your face when going outdoors. During extreme humidity, try to stay in air conditioned areas.

Last reviewed by a Cleveland Clinic medical professional on 05/18/2020.

References

  • American Lung Association. Accessed 5/19/2020.The Basics of Pulmonary Rehabilitation. (https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/pulmonary-rehab)
  • American Lung Association. Accessed 5/19/2020.Chronic Bronchitis. (https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-bronchitis)
  • American Lung Association. Accessed 5/19/2020.Emphysema. (https://www.lung.org/lung-health-diseases/lung-disease-lookup/emphysema)
  • American Lunch Association. Accessed 5/19/2020. COPD. (https://www.lung.org/lung-health-diseases/lung-disease-lookup/emphysema)
  • Centers for Disease Control and Prevention. Accessed 5/19/2020.Chronic Obstructive Pulmonary Disease (COPD). (https://www.cdc.gov/copd/index.html)
  • Global Initiative for Chronic Obstructive Lung Disease. Accessed 5/19/2020.Pocket Guide to COPD Diagnosis, Management, and Prevention. (https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf)
  • Merck Manual. Accessed 5/19/2020.Chronic Obstructive Pulmonary Disease COPD. (https://www.merckmanuals.com/home/lung-and-airway-disorders/chronic-obstructive-pulmonary-disease-copd/chronic-obstructive-pulmonary-disease-copd)

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy