Overview
COPD (Chronic Obstructive Pulmonary Disease) is a progressive and preventable disease in which airflow in the lungs is permanently restricted. Chronic bronchitis and emphysema are the two main components of COPD.
There are more than 3 million COPD patients in our country. It is the 3rd leading cause of death in the world. The main cause is smoking. It cannot be completely cured but its progression can be slowed and quality of life improved.
Symptoms
Symptoms develop slowly; become noticeable after age 40:
- Shortness of breath (first with exertion, then even at rest)
- Chronic cough (heavy in the morning)
- Plenty of sputum production (especially white, yellow, or green)
- Wheezing
- Chest tightness
- Extreme fatigue
- Frequent respiratory infections
- Unexplained weight loss (in advanced stages)
- Ankle swelling
- Bluish lips or nails
Exacerbation (attack) symptoms:
- Sudden worsening of symptoms
- Darker, more abundant sputum
- Severe shortness of breath
- Confusion
Causes
Smoking (85-90% of COPD):
- Active smoking
- Secondhand smoke
- Hookah, pipe, cigar
Other causes:
- Occupational exposure (coal, grain dust, chemicals)
- Indoor air pollution (especially in women — dung, wood fires)
- Outdoor air pollution
- Genetics (alpha-1 antitrypsin deficiency — rare)
- Past childhood respiratory infections
- Asthma (long-term)
Risk Factors
- Smoking
- Secondhand smoke
- Age (over 40)
- Occupational exposure
- Air pollution
- Genetics (alpha-1 antitrypsin deficiency)
- Frequent respiratory infections in childhood
- Asthma
Complications
- Respiratory infections
- Lung cancer risk
- Heart disease (right heart failure, cor pulmonale)
- Pulmonary hypertension
- Depression, anxiety
- Osteoporosis
- Muscle wasting, malnutrition
- Respiratory failure
- COPD exacerbation (can be life-threatening)
When to See a Doctor
Routine visit:
- Frequently recurring cough, sputum
- Progressive shortness of breath
- Difficulty breathing with exertion
- Those over 40 with a smoking history
- History of occupational exposure
Emergency:
- Severe shortness of breath
- Confusion
- Purple lips, nails
- Inability to speak
- Palpitations
- Febrile exacerbation
Diagnosis and Treatment
Diagnosis:
- Spirometry (pulmonary function test) — gold standard
- FEV1/FVC < 0.70 post-bronchodilator indicates COPD
- Chest X-ray, CT
- Arterial blood gas analysis (advanced stage)
- Alpha-1 antitrypsin level
- Evaluation of exacerbation causes
Staging (GOLD):
- GOLD 1 (mild): FEV1 ≥ 80%
- GOLD 2 (moderate): FEV1 50-79%
- GOLD 3 (severe): FEV1 30-49%
- GOLD 4 (very severe): FEV1 < 30%
Treatment:
1. Smoking cessation (most important):
- Nicotine replacement therapy
- Varenicline, bupropion
- Behavioral change
2. Inhaled medications (mainstay):
- Short-acting bronchodilators: Salbutamol, ipratropium (rescue)
- Long-acting antimuscarinics (LAMA): Tiotropium, glycopyrronium
- Long-acting beta-2 agonists (LABA): Salmeterol, formoterol
- Inhaled corticosteroids (ICS): Budesonide, fluticasone (especially in those with frequent exacerbations)
- Combination inhalers: LABA+LAMA, LABA+ICS, triple
3. Exacerbation treatment:
- Intensive bronchodilators
- Systemic corticosteroids (short-term)
- Antibiotics (if infection)
- Oxygen therapy
- Non-invasive ventilation (NIV) or intubation in hospital
4. Other treatments:
- Pulmonary rehabilitation
- Long-term oxygen therapy
- Vaccines (flu, pneumococcal)
- Nutritional support
- Surgery (volume reduction surgery, lung transplant — in selected patients)
Prevention
Most effective protection: Do not smoke!
- Never start
- If you smoke, quit (benefit at any age)
- Avoid secondhand smoke
- Take advantage of smoking cessation programs
Other recommendations:
- Avoid heavily polluted environments
- Use protective masks for occupational exposure
- Annual flu and pneumococcal vaccines
- Regular exercise
- Healthy eating, normal weight
- Avoid respiratory infections
- Get pulmonary function tests if you are in a risk group
- Ventilate indoor spaces
- Use modern heating systems instead of wood, dung