Dr. Jafar Mahdizadeh
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COPD, chronic bronchitis and emphysema

This text is awaiting the doctor's approval and may change.

COPD is the name for a group of long-term lung conditions that limit airflow; emphysema and chronic bronchitis are part of it. This page explains the symptoms, when to be seen, what spirometry does, what treatment generally looks like and what to do when things suddenly get worse.

What is COPD?

COPD (chronic obstructive pulmonary disease) is the name for a group of conditions that make breathing difficult. The NHS says the group includes emphysema, in which the air sacs of the lungs are damaged and lose their stretch, and chronic bronchitis, in which the airways stay inflamed and full of phlegm for a long time. Most people with COPD have some of both.

The condition usually affects middle-aged and older people. The NHS says many people do not know they have it, and symptoms slowly get worse over years.

The main cause is smoking, but the NHS reminds us it is sometimes found in people who have never smoked. The more and the longer you smoke, the higher the risk. WHO also lists indoor air pollution (for example smoke from wood and charcoal used for cooking and heating), dust and fumes and chemicals at work, and a rare genetic deficiency called alpha-1 antitrypsin as risk factors.

If you have never smoked and have a cough and breathlessness, you do not necessarily have COPD. Asthma, heart disease and infection give the same symptoms.

Symptoms

  • Breathlessness, especially with activity.
  • A cough that has become long-lasting and sometimes brings up phlegm.
  • Constant wheezing.
  • Frequent chest infections.

These symptoms usually get worse gradually. A sudden worsening is called a flare-up and should be taken seriously.

Who should be seen?

The NHS says that if you have ongoing symptoms, especially if you are over 35 and you smoke or used to smoke, do not ignore them and see a doctor. Earlier diagnosis and treatment are possible before serious lung damage.

If you smoke hookah, take the same advice. Hookah is not harmless (CDC).

How is it assessed?

  • History and examination: the doctor asks about symptoms, smoking, work and family history, and listens to your chest.
  • Spirometry: the NHS and WHO regard this test as important for confirming the diagnosis. In general, after a deep breath you blow into a device that measures how much air you breathe out and how fast. It may be repeated after you breathe in a bronchodilator medicine. The NHS says the result is compared with normal values for your age and shows whether there is a blockage in your airways. Read about preparation and how the test goes in the guide “Lung tests and imaging”.
  • Chest X-ray and CT scan: to look for other conditions that give similar symptoms. The NHS says these conditions are not always seen on a plain X-ray.
  • Blood tests for conditions with similar symptoms such as anaemia, and if needed alpha-1 antitrypsin deficiency.
  • Other tests such as measuring blood oxygen with a finger sensor, an ECG, a heart ultrasound and a phlegm sample, if needed.

What does treatment generally look like?

The NHS says the condition cannot be reversed, but treatment can slow its progress and control symptoms. The aim is to control symptoms, reduce flare-ups and keep your strength. Things your doctor may include in your plan:

  • Stopping smoking (and stopping hookah): the NHS and CDC regard it as the most important part of treatment.
  • Bronchodilator inhalers: a short-acting reliever for when you have symptoms and, if needed, long-acting types. Sometimes a steroid inhaler is added. Your doctor sets the type and schedule.
  • Pulmonary rehabilitation: exercise, education and support. The NHS says it is usually several sessions a week over at least six weeks.
  • Vaccines: the CDC and WHO regard flu, pneumococcal and COVID vaccines as useful to prevent infections that make COPD worse. Ask your doctor which ones you need.
  • In a flare-up: a short course of steroid tablets or antibiotics is sometimes needed. The NHS says some patients keep a supply of these at home. Antibiotics only on a doctor’s advice. Do not start, reduce or stop steroid tablets on your own either.
  • Oxygen if the blood oxygen is low, and in special cases surgery or a transplant, which is only for a small number of severe patients (NHS).

What can you do yourself?

  • Stop smoking cigarettes and hookah and stay away from other people’s smoke. Get help; the NHS recommends stop-smoking services.
  • Use your inhalers correctly and on schedule, even when you feel well, and do not stop until your doctor says so.
  • Stay active. Agree rehabilitation or gradual walking with your doctor.
  • Keep home air clean: smoky heaters and stoves, and smoking in the house.
  • Learn the signs of a flare-up and ask for a written plan. For COPD, the ALA describes a personal written plan for managing flare-ups.
  • Keep your medicine list with you.

When to get urgent help

  • Call 115 (Iran’s emergency number) if breathing is very hard, you cannot finish a sentence, your lips and nails have turned blue or grey, you suddenly feel confused or drowsy, you have chest pain or you are coughing up a lot of blood.
  • See a doctor the same day if your breathlessness, cough or phlegm has suddenly got worse, you have a fever, or your reliever inhaler is no longer enough.
  • If you cannot reach your doctor, go to the emergency department of the nearest hospital.

See the full list in the guide “When to call urgently”.

Frequently asked questions

A morning cough is normal for smokers, isn't it?

The NHS says a cough with phlegm is sometimes called a "smoker's cough" and brushed aside, but it can be a sign of COPD and should not be ignored. Earlier diagnosis leads to earlier treatment.

Does COPD get better?

The NHS and CDC say COPD cannot currently be cured and the damage to the lungs cannot be reversed. But treatment can reduce symptoms and slow its progress. The NHS says that in many patients treatment keeps the condition under control so that daily life is not greatly limited. Even so, in some people the disease progresses despite treatment.

I have smoked for years. Is there any point in stopping now?

Yes. The NHS says stopping smoking is the most effective way to prevent COPD getting worse, and it helps even in advanced COPD. WHO also says stopping is beneficial at any stage, even after decades of smoking. Stopping is hard, and help from a doctor or a stop-smoking service is useful; we do not see this as blame, only to say that help exists.

Isn't hookah less harmful than cigarettes?

No. The CDC says hookah is not a safe alternative to cigarettes, the water does not filter the smoke, and hookah smoke is at least as toxic as cigarette smoke. Hookah charcoal also produces carbon monoxide and cancer-causing compounds.

Are inhalers addictive? Can I stop them once I feel better?

COPD inhalers are largely the same kinds of medicine as asthma inhalers, and the Allergy & Asthma Network says these asthma medicines are not addictive. WHO says bronchodilator inhalers are the most important COPD medicines and long-acting types are used every day. The decision to stop or change any medicine is for your doctor. Do not stop steroid tablets on your own either.

What is pulmonary rehabilitation? Do I need it?

The NHS describes it as a structured programme of exercise, education, nutrition advice and emotional support, usually with several group sessions a week over at least six weeks. The CDC and WHO also include it as part of treatment. Whether you are suited to the programme and where it is done is for your doctor to say.

What is a sign of a sudden worsening (flare-up)?

The NHS says that in a flare-up symptoms suddenly get worse, and in its treatment section it takes more breathlessness and cough, or a change in phlegm, as a sign of a chest infection. WHO says these episodes usually last several days. If you have a warning sign, see the section "When to get urgent help" and contact your doctor.

Sources

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