Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out. This is referred to as airflow obstruction.

Breathing difficulties are caused by long-term damage to the lungs, usually because of smoking.

How common is COPD?

COPD is one of the most common respiratory diseases in the UK. It usually affects people over the age of 35.

Around 835,000 people in the UK have been diagnosed with COPD, but it is thought that there are about 2 million people living with the disease who have not been diagnosed. This is because many people who develop the symptoms of COPD do not get medical help because they often dismiss their symptoms as a ‘smoker’s cough’.

COPD affects more men than women. However, according to the British Thoracic Society, rates of COPD in women are increasing.

The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer you've been smoking.

The effects of COPD

People with COPD have trouble breathing in and out, known as airflow obstruction. Their lungs become inflamed due to irritation, usually from cigarette smoke.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways get thicker in response to the inflammation and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs means the lungs lose their normal elasticity. It becomes much harder to breathe, especially when you exert yourself. The changes in the lungs cause the symptoms of breathlessness, cough and phlegm associated with COPD.

Although any damage that has already occurred to your lungs cannot be reversed, you can prevent COPD from developing or getting worse by making lifestyle changes.

Treatment for COPD usually involves relieving the symptoms, for example by using an inhaler to make breathing easier.

Although COPD causes about 25,000 deaths a year in the UK, severe COPD can be prevented by making changes to your lifestyle.

Want to know more?

• British Lung Foundation: COPD.

Damage to the lungs caused by smoking will gradually build up, so you may not notice the symptoms of chronic obstructive pulmonary disease (COPD) at first. However, they can get worse over time.

COPD does not usually become noticeable until after the age of 35. See your GP if you have the following symptoms:

• increasing breathlessness when exercising or moving around
• a persistent cough with phlegm that never seems to go away 
• frequent chest infections, particularly in winter

If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe in and out.

The symptoms of COPD are often worse in the winter, and it is common to have two or more flare-ups a year. A flare-up is when your symptoms are particularly bad. This is one of the most common reasons for people being admitted to hospital in the UK.

While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage.

Several factors increase your risk of developing chronic obstructive pulmonary disease (COPD).

Risk factors you can change

You can change some of the things that make COPD more likely.

Smoking

Smoking is the main cause of COPD. At least four out of five people who develop the disease are or have been smokers. The lining of the airways becomes inflamed and permanently damaged by smoking. This damage cannot be reversed. Around 10-25% of smokers develop COPD.

Passive smoking

Exposure to other people’s smoke increases the risk of COPD. 

Fumes and dust

Exposure to certain types of dust and chemicals at work, including grains, isocyanates, cadmium and coal, has been linked to the development of COPD, even in people who do not smoke. The risk of COPD is higher if you breathe in dust or fumes in the workplace and you smoke.

Air pollution

According to some research, air pollution may be an additional risk factor for COPD. However, at the moment it is not conclusive and research is continuing.

Want to know more?

• NHS Smokefree.
• Health and Safety Executive: COPD.

Risk factors you cannot change

There are a few factors for COPD that you cannot change.

Having a brother or sister with severe COPD

A research study has shown that smokers who have brothers and sisters with severe COPD are at greater risk of developing the condition than smokers who do not.

Having a genetic tendency to COPD

There is a rare genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. This causes COPD in a small number of people (about 1%). Alpha-1-antitrypsin is a protein that protects your lungs. Without it, the lungs can be damaged by other enzymes that occur naturally in the body.

People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 35.

Want to know more?

• British Lung Foundation: Alpha-1-antitrypsin.
• Alpha1 Awareness UK.

If you are concerned about the health of your lungs and have symptoms that could be chronic obstructive pulmonary disease (COPD), see your GP as soon as you can. Being diagnosed early means you will receive appropriate advice, help and treatment to stop or slow the progression of COPD.

To find out if you have COPD, your doctor will ask you about your symptoms and how long you have had them, and whether you smoke or have smoked in the past. They will examine you and listen to your chest using a stethoscope. Your doctor will also check how well your lungs are working with a lung function test called spirometery.

Spirometry

To assess how well your lungs work, a breathing test called spirometry is carried out. You will be asked to breathe into a machine called a spirometer.

The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV₁) and the total amount of air you breathe out (called the forced vital capacity or FVC).

You may be asked to breathe out a few times to get a consistent reading.

The readings are compared with normal measurements for your age, which can show if your airways are obstructed.

Other tests

You will have other tests as well as spirometry. Often, these other tests will help the doctor rule out other conditions that cause similar symptoms.

Chest X-ray

A chest X-ray will show whether you have another lung condition which may be causing symptoms, such as lung cancer.

Blood test

A blood test will show whether your symptoms could be due to anaemia, as this can also cause breathlessness.

Further tests

Some people may need more tests. The tests may confirm the diagnosis or indicate the severity of your COPD. This will help you and your doctor plan your treatment.

Peak flow test

To confirm that you have COPD and not asthma, your doctor might ask you to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out.

Blood oxygen level

The level of oxygen in your blood is measured using a pulse oximeter, which looks like a peg and is attached to the finger. If you have low levels of oxygen, you may need an assessment to see whether extra oxygen would help you.

Blood test for alpha-1-antitrypsin deficiency

If the condition runs in your family or you developed the symptoms of COPD under the age of 35 and have never smoked, you will probably have a blood test to see if you are alpha-1-antitrypsin deficient.

CT scan

Some people may need a CT scan. This provides more information than an X-ray and can be useful in diagnosing other lung diseases or assessing any changes to your lungs because of COPD.

Other breathing tests

If your symptoms seem worse than would be expected from your spirometry results, your doctor may decide you need more detailed lung function tests. You may be referred to a hospital specialist for these tests.

Heart tests

You may have an electrocardiogram (ECG) or an echocardiogram to investigate whether your heart has been affected by COPD.

Phlegm sample

The doctor may take a sample of phlegm to check whether it has been infected.

Blood test

During a blood test, a sample of blood is taken from a vein using a needle so it can be examined in a laboratory.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Stop smoking

Stopping smoking is the main way for people with COPD to help themselves feel better and the only proven way to reduce the rate of the decline in lung function in people with COPD.

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 prevents it from getting worse.

If COPD is in the early stage and symptoms are mild, no other treatments may be needed. But it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways.

Research has shown that you are up to four times more likely to give up smoking successfully if you use NHS support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this or go to the NHS Smokefree website.

Want to know more?

• Find your local stop-smoking service.

Inhalers

If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check that you are using it properly. Most people learn to use an inhaler successfully, but if you are having problems, a spacer or a different type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs.

Short-acting bronchodilator inhalers

Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up. They also prevent hyperinflation (over expansion) of your lungs.

There are two 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 and this should relieve the symptoms.

Long-acting bronchodilator inhalers

If a short-acting bronchodilator inhaler does not help relieve 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 two types of long-acting bronchodilator inhalers:

• beta-2 agonist inhalers, such as salmeterol and formoterol
• antimuscarinic inhalers, such as tiotropium

Steroid inhalers

Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways.

If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler.

Medicines

Theophylline tablets

If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up.

When you have been taking theophylline tablets regularly, you will need to give a blood sample. This is to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects.

Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline.

Mucolytic tablets or capsules

Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups.

Antibiotics and steroid tablets

If you have a chest infection, your GP may prescribe a short course of antibiotics.

Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are not usual if steroid tablets are given for less than three weeks.

Other types of treatment

Nebulisers

A nebuliser can be used for severe cases of COPD if other inhaler devices have not worked effectively. A nebuliser is a machine that administers medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go.

You can usually choose whether to use the nebuliser with a mouthpiece or a facemask. Your GP will advise you on how to use the nebuliser correctly.

Before you start this treatment, your GP or COPD specialist will test to make sure that the nebuliser is suitable for you.

Long-term oxygen therapy

If the oxygen level in your blood is low, you may need to take oxygen through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is needed for some patients with persistently low oxygen levels in the blood.

Your GP or nurse may do a test called pulse oximetry, which checks the levels of oxygen in your blood. You will probably be referred for more detailed assessment at the hospital to see whether you might benefit from long-term oxygen therapy.

Oxygen must be taken for at least 15 hours a day. The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home.

Do not smoke when you are using oxygen. The increased level of oxygen that is produced is highly flammable, and a lit cigarette could trigger a fire or an explosion.

For more information, read our page on Home oxygen treatment.

Non-invasive ventilation (NIV)

Non-invasive ventilation (NIV) helps a person breathe artificially. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see if you are suitable for NIV. It works by pushing air into your lungs through a mask covering the nose or face.

Pulmonary rehabilitation programmes

Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence.

Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usually involves walking or cycling, and arm and strength-building exercises. It also includes education about your disease for you and your family, dietary assessment and advice, and psychological, social and behavioural changes designed to help you cope better. A rehabilitation programme is provided by a multidisciplinary team, which includes respiratory nurse specialists, physiotherapists and dietitians.
Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms. Pulmonary rehabilitation can greatly improve your quality of life.

Surgery

Lung surgery may be an option for some people with certain types of COPD. This may involve removing a section of the lung that's no longer working, called lung volume reduction surgery (LVRS), to give the remaining lung more room to work. Surgery works best in people who have disease that is worse in the upper lobes of their lungs.

Most people who have this surgery should do better than people not having surgery for at least three years. However, about one person in four gets no benefit from the operation, and about one person in twenty dies during or shortly after surgery.

Lung transplantation is a realistic option for only a very small number people with COPD. It is a high-risk operation and you will need to take anti-rejection medication for the rest of your life.

Treating a flare-up

A flare-up is when your symptoms are particularly bad. If you have a flare-up of your COPD symptoms, you may be advised to increase the dose of the treatments you usually take. For example, you may need to increase the dose of your inhalers or tablets. Some people may need to use a spacer or a nebuliser for their inhaled therapy.

You may also need to take extra treatments during the flare-up, such as adding a further inhaler or tablet to what you usually take. It is common to take a short course of antibiotics or steroid tablets during a flare-up.

Some people need to go into hospital for more intensive treatment during a flare-up. Other people are treated with ‘hospital at home’ schemes, where experienced health professionals come to their home regularly. Your healthcare team will recommend the type of care that is best for you.

Research has shown that 'hospital at home' works as well as hospital admission in improving people's condition, and that people with COPD prefer it.

Hospitalisation

If you are having a very bad flare-up, you may have to go into hospital.

In hospital, you are likely to receive oxygen, antibiotics (if necessary) and a nebuliser to help ease your symptoms.

People with COPD who have severe breathing difficulties during a flare-up and who are admitted to hospital may need non-invasive ventilation (NIV) through a mask to help them breathe more easily. In the most severe cases, admission to an intensive care unit for treatment with an artificial breathing machine (ventilator) may be necessary.

Recovery

Everyone should see or talk to a healthcare professional after they have recovered from a flare-up, to check on their current condition and review their treatment options. It may take up to three months to complete your recovery and your cough and phlegm may take a few weeks to settle, even after any infection has been treated.

Self-management plan

If you have frequent flare-ups, you may be given a self-management plan by your healthcare team. This is a written plan of action, agreed by you and your doctor, for what to do as soon as a flare-up develops. For example, it may contain advice on how to increase the dose of inhalers.

Some patients may be given steroid tablets or antibiotics to have ‘on standby’ so that they can start taking them as soon as a flare-up starts.

Your doctor may also arrange for emergency appointments or telephone prescriptions when you have a flare-up.

Want to know more?

• British Lung Foundation: COPD self-management plan.

Give up smoking

Smoking is by far the biggest risk factor for COPD. If you smoke, stopping is the single most effective way to reduce your risk of getting the condition.

If you already have COPD, stopping smoking can halt its progression and reduce your risk of dying from it.

Research has shown that you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, call the NHS Smoking Helpline on 0800 022 4332 or go to the NHS Smokefree website.

Also avoid exposure to tobacco smoke as much as possible.

Want to know more?

• Find your local stop-smoking service. 
• Map of Medicine: Stopping smoking.

Healthy living

Exercise

People with COPD who exercise or keep active regularly have improved breathing, less severe symptoms and a better quality of life.

For most people with COPD who are disabled by their breathlessness, a structured programme of pulmonary rehabilitation provided by experienced healthcare professionals does the most good. Getting breathless is unpleasant but it isn't harmful. Every patient should exercise as much as they can, however limited that may be, twice a day. Even chair-bound people can do some arm and upper-body movements.

Research shows that pulmonary rehabilitation improves exercise tolerance, breathlessness and health-related quality of life. It results in people seeing doctors less often and spending less time in hospital.

Maintain a healthy weight

Carrying extra weight can make breathlessness worse. Therefore, it is good a good idea to lose some weight if you are overweight. This can be difficult because the breathlessness caused by COPD can make it hard to exercise.

However, some people with COPD find that they lose weight because they use up so much energy breathing. Eating food that is high in protein and taking in enough calories is important to maintain a healthy weight.

Research has shown that people with COPD who are underweight will have fewer COPD symptoms if they increase their weight.

Want to know more?

• Healthy weight calculator
• Live Well: Healthy eating.

Breathing techniques

There are various breathing techniques that some people find helpful for breathlessness. These include breathing control, which involves breathing gently, using the least effort, with the shoulders supported. This can help when people with COPD feel short of breath.

Breathing techniques for people who are more active include:

• relaxed, slow deep breathing 
• breathing through pursed lips, as if whistling 
• breathing out hard when doing an activity that needs a big effort
• paced breathing, using a rhythm in time with the activity, such as climbing stairs

Want to know more?

• British Lung Foundation: Living with COPD.
• British Lung Foundation: Coping with breathing problems.

Talk to others

If you have questions, your GP or nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who have COPD, either at a local support group or in an internet chat room.

Want to know more?

• British Lung Foundation: Breathe Easy support network.
• Blogs: COPD.

Relationships and sex

Relationships with friends and family

Having a chronic illness such as COPD can put a strain on any relationship. Difficulty breathing and coughing can make people with COPD feel very tired and depressed. It is also inevitable that their spouse, partner or carer will feel anxious or frustrated about their breathing problems. It is important to talk about your worries together.

Being open about how you feel and what your family and friends can do to help may put them at ease. But do not feel shy about telling them that you need some time to yourself, if that is what you want.

Your sex life

As COPD progresses, the increasing breathlessness can make it difficult to take part in activities. The breathlessness may occur during sexual activity, which may mean that your sex life can suffer. But it may not all be due to COPD. Some sexual changes happen as we get older. Slower erections and delayed orgasms are normal in middle and later life.

Communicate with your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special.

Want to know more?

• Live Well: Sex as you get older. 
• British Lung Foundation: Breathe Easy support network.

Flying

If you have chronic obstructive pulmonary disease (COPD) and you are planning to fly, go to your GP for a fitness-to-fly assessment. This involves checking your breathing using spirometry and measuring your oxygen levels.

Before travelling, remember to pack all your medication, such as inhalers, in your hand luggage.

If you are using oxygen therapy, tell your travel operator and airline before you book your holiday, as you may need to get a medical form from your GP. If you are using long-term oxygen therapy, arrange to take an adequate oxygen supply with you abroad.

Want to know more?

• British Lung Foundation: Going on holiday with a lung condition.

Money and financial support

People with COPD often have to give up work because their breathlessness stops them from doing what they need to do for their job. This can cause financial pressure.

There are several benefits for which people with COPD may be eligible:

• If you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer.
• If you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance.
• If you are caring for someone with COPD, you may be entitled to Carer’s Allowance.
• You may be eligible for other benefits if you have children living at home or if you have a low household income.

Want to know more?

• British Lung Foundation: Welfare benefits for people living with a lung condition.
• Directgov: Benefits and financial support. 
• Carers Direct: Benefits for carers and benefits for the person you care for. 
• Find your nearest Citizens Advice Bureau.

End of life care

COPD is a serious condition. At least 25,000 people die each year from the end stages of COPD. As with other conditions that cannot be reversed or cured, it is important to receive good care at the end of life. Talking about this and planning it in advance can be helpful. This is called palliative care. It can be difficult to talk about dying with your doctor and, particularly, with family and friends, but many people find that it helps. Support is also available for your family and friends.

It may be helpful to discuss which symptoms you may have as you become more seriously ill, and the treatments that are available to reduce these.

As COPD progresses, your doctor should work with you to establish a clear management plan based on your and your carer's wishes. This will include whether you would prefer to go to hospital, a hospice or be looked after at home as you become more ill.

You may want to discuss drawing up an advance decision, also called a living will, which sets out your wishes for treatment if you become too ill to be consulted. This might include whether you want to be resuscitated if you stop breathing, and whether you want artificial ventilation to be continued.

Want to know more?

• British Lung Foundation: Coping with the final stages of a chronic lung disease.
• Live Well: End of life care.
• Directgov: How to make a living will.

Lynn Ashton, 46, was having a happy Christmas dinner until a candle set her plastic tablecloth alight.  

“We were taking a break after the main course when one of my children said she could smell something funny,” says Lynn.

"I rushed into the dining room to find the plastic tablecloth and the dining room in flames. I threw the tablecloth on to the patio, but by then I had inhaled a lot of toxic fumes.”

She sat outside trying to get her breath. Initially, she didn’t go to the doctor. But over the next few weeks, her breathing got worse. She was already an asthmatic and smoked around 15-20 cigarettes a day.

“I spent the next four months in and out of hospital with chest infections,” says Lynn. “At times, my breathing was so bad I could barely bend down to tie my shoelaces.”

Lynn was diagnosed with COPD and bronchiectasis, an abnormal widening of the air sacs in the lungs. It was a shattering blow and she stopped smoking immediately. Lynn was determined to stay strong. Her daughter was pregnant with her first grandchild.

“My prognosis wasn’t good at first,” she says. "I thought, I can either sit around and be miserable or I can live life to the full. I wanted to see my grandchild grow up. I wanted to help other people with COPD. I believe things happen for a reason.” 

Lynn is on a treatment regimen which includes six different drugs and a nebuliser. Two years ago, she had a small catheter fitted which passes from the lower neck into the windpipe and delivers oxygen directly into her lungs. It’s held on by a discreet chain around her neck. “I clean it several times a day and it’s wonderful,” she says.

Lynn now helps other people who have COPD. She joined a local support group in Huntingdon called Hunts Breathe for Life, which she now chairs, and started to raise money for the cause.

“I started off doing some short walks. Then it occurred to me that I’d love to do the London Marathon. I called the British Lung Foundation and they were very enthusiastic and offered me a place. But when I told them I had COPD and was on oxygen, they were rather worried.”

Lynn started her training by walking for just one minute on a treadmill at her local gym. Gradually, under the supervision of her nurse, she increased the time until last year, she was ready to realise her dream.

“It took me five days to finish the marathon,” she says. “I had a trolley to help me walk and had my oxygen with me at all times. Every afternoon I’d go back to the hotel and rest. It was a wonderful experience. I raised over £14,000.” Her next target is the Great North Run.

Lynn believes in living life to the full. “There was a time when I was very angry and that’s normal. I still have bad days. But when I look around, I see that there’s always someone worse off than me.”

With a little help, Eddie Brownlow realised he could manage his COPD and get on with life.

Having served in the navy and the army as a paratrooper, Eddie Brownlow was fit when he left the forces aged 47. However, he had smoked about 15 cigarettes a day for most of his life.

“It was the done thing back then. It relaxed me after a parachute jump,” says Eddie.

After retiring from a second career as a sales manager, Eddie was getting breathless whenever he had to lift something heavy or exert himself. He ignored the fact that he was feeling a “bit puffy” all the time and carried on.

However, by 1998, he couldn't ignore it any more. “We were in Mexico on holiday and I had booked a marlin fishing trip," says Eddie. "But when I woke up, I could hardly breathe. Luckily I recovered, but when I got back home I picked up a chest infection.”

He went to his GP, who referred him to hospital. He was diagnosed with COPD. He followed a rehabilitation programme, which he describes as excellent. He learned about his medication, how to exercise and how to improve his diet.

Eddie says, “I realised there was no need to panic. You just need to learn to manage your condition. There's advice available.”

One important thing Eddie knew he had to do was give up smoking. It took him quite a while, but with patches, advice and support from his wife, he finally kicked the habit.

He also got involved with his local British Lung Foundation group, Breathe Easy, a voluntary organisation that supports people with breathing conditions such as COPD. Within a few months of joining, he took over his group and built up the membership.

Eddie now makes it his job to raise awareness of breathing conditions and, through his efforts, the town's mayor selected his branch of Breathe Easy as his chosen charity recently.