Chronic obstructive pulmonary disease (COPD)

What causes COPD?

Causes of COPD include:

• genetics (COPD-G)
• abnormal lung development, early life events, premature birth, low birth weight, neonatal ventilation (COPD-D)
• smoking including in utero (from before birth), passive smoking, vaping, cannabis (COPD-C)
• pollution from outdoor air, wildfire smoke, occupational hazards, household pollution (COPD-P)
• infections (COPD-I)
• unknown cause (COPD-U)

The main cause of COPD is smoking. The more you smoke, and the longer you’ve been smoking, the more likely you are to develop COPD. This is because smoking irritates and inflames the lungs, and prevents them functioning normally, which results in scarring. Passive (second-hand) smoke can also cause COPD.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more phlegm is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD.

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COPD needs to be picked up as early as possible, so your doctor will usually start with a few simple checks. They may ask about your symptoms and whether you smoke or have smoked before, listen to your chest with a stethoscope, and weigh you to work out your BMI. A breathing test called spirometry shows how well your lungs are working, and you may also have a chest X-ray or blood test to rule out other conditions.

If these point to COPD, further tests can confirm the diagnosis or show how severe it is. You might have an ECG or echocardiogram to check your heart, and a peak flow test to see how fast you can breathe out and rule out asthma. A small clip-like device called a pulse oximeter can check your blood oxygen level, to see whether extra oxygen would help you. A blood test can show if you have a genetic tendency to COPD known as alpha-1-antitrypsin deficiency, and a CT scan can pick up changes in your lungs. You may be sent to a hospital for more detailed lung function tests than spirometry, and a phlegm sample can be checked for infection.

Treatment for COPD

There is currently no cure for COPD. But the sooner treatment is started, the less chance there is of complications and flare-ups. Damage to your lungs that has already happened cannot be reversed. But you can slow COPD down and feel better with treatment, especially by stopping smoking.

NHS Scotland recommends you get the coronavirus (COVID-19) vaccine, flu vaccine and pneumococcal vaccine when offered them.

Treatments for COPD usually involve relieving the symptoms with medication. For example, by using an inhaler to make breathing easier. Pulmonary rehabilitation may also help increase the amount of exercise you can do.

Surgery is only an option for a small number of people with COPD and lung transplant for people under 60.

Stop smoking

Stopping smoking is the best way for people with COPD to help themselves feel better.

Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed. But giving up smoking can slow the rate at which the condition worsens.

Inhalers

If an inhaler is prescribed for you, your healthcare professional can explain how to use it.

Watch Asthma + Lung UK’s videos on how to use your inhaler

Short-acting bronchodilator inhalers give a small dose of medicine directly to your lungs. This causes the muscles in your airways to relax and open up.

There are 2 types of short-acting bronchodilator inhaler:

• beta-2 agonist inhalers, such as salbutamol and terbutaline
• antimuscarinic inhalers, such as ipratropium

The inhaler should be used when you feel breathless to relieve the symptoms.

If a short-acting bronchodilator inhaler does not help your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours.

There are 2 types of long-acting bronchodilator inhalers:

• beta-2 agonist inhalers, such as salmeterol, formoterol, vilanterol and indacaterol
• antimuscarinic inhalers, such as tiotropium, glycopyrronium and aclidinium

You’ll usually be given a combination of these.

Steroid inhalers, also called corticosteroid inhalers, can help to reduce the frequency of exacerbations or flare ups in some people with COPD.

There is no recycling scheme available for used inhalers. You should return all your used or expired inhalers to your community pharmacy for safe disposal. Spacers should be replaced each year if used regularly. Old spacers go into the household bin.

Using your preventer inhaler correctly and keeping your symptoms under control is good for your health and the environment. Some inhalers have a lower carbon footprint and are better for the environment than others. The best inhaler is one that works well for you. Speak to your healthcare professional about whether lower global warming potential inhalers would be right for you.

Medicines

You may be prescribed medicines such as:

• mucolytic tablets or capsules to make your phlegm easier to cough up – these are good for people with lots of thick phlegm or who have frequent or bad flare-ups
• antibiotics if you have a chest infection
• steroid tablets if you have a bad flare-up

Other types of treatment

Other types of treatment include:

• nebulised medication (for severe cases where inhalers have not worked) – a large dose of medicine is taken through a mouthpiece or a face mask
• oxygen therapy (if your oxygen levels are low) – taking oxygen through tubes in your nose or through a mask
• non-invasive ventilation (NIV) – helps you breathe using a portable machine connected to a mask covering the nose or face
• pulmonary rehabilitation programmes – exercise and education to help people with chronic lung problems, you can ask your healthcare professional if this is available