COPD (chronic obstructive pulmonary disease): symptoms, causes and treatment

The NHS says there is currently no cure for COPD, but treatment can help slow the progression of the condition and control symptoms. The main treatments are stopping smoking, inhalers and tablets, pulmonary rehabilitation and, for a very small number of people, surgery or a lung transplant.

If you smoke, the NHS says stopping is the most effective way to prevent COPD getting worse. Any damage already done to your lungs and airways cannot be reversed, but giving up can prevent further damage, and this may be all the treatment needed in the early stages.

The NHS says COPD develops slowly over many years, you may not be aware you have it at first, and most people do not have any noticeable symptoms until they reach their late 40s or 50s. Common symptoms are below.

Without treatment the symptoms usually get progressively worse, and there may be periods when they suddenly get worse, known as a flare-up or exacerbation. Less common symptoms that tend to happen at an advanced stage include weight loss, tiredness and swollen ankles from fluid build-up. The NHS says chest pain and coughing up blood are usually signs of another condition, such as a chest infection or possibly lung cancer.

• Shortness of breath. This may only happen when exercising at first, and you may sometimes wake up at night feeling breathless.

• A persistent chesty cough with phlegm that does not go away. Some people dismiss this as a "smoker's cough".

• Frequent chest infections.

• Persistent wheezing.

The NHS describes COPD as the name for a group of lung conditions that cause breathing difficulties. It includes emphysema, which is damage to the air sacs in the lungs, and chronic bronchitis, which is long-term inflammation of the airways.

It is a common condition that mainly affects middle-aged or older adults who smoke, and the NHS says many people do not realise they have it. COPD happens when the lungs become inflamed, damaged and narrowed.

The NHS says smoking is the main cause and is thought to be responsible for around 9 in every 10 cases. The chance of developing COPD increases the more you smoke and the longer you have smoked. Some research suggests passive smoking may also increase risk.

Other causes and risk factors listed by the NHS are below.

• Fumes and dust at work. The NHS names cadmium dust and fumes, grain and flour dust, silica dust, welding fumes, isocyanates and coal dust, and says the risk is even higher if you also smoke.

• Air pollution, although the NHS says the link is not conclusive and research is continuing.

• Genetics. You are more likely to develop COPD if you smoke and have a close relative with it. People with alpha-1-antitrypsin deficiency, a rare genetic problem, can develop COPD, usually at a younger age, particularly if they smoke.

No cause the NHS lists for COPD is an infection that spreads from person to person. The NHS describes COPD as arising from lungs becoming inflamed, damaged and narrowed, mainly through smoking, workplace fumes and dust, and sometimes a rare genetic problem.

People with COPD are more vulnerable to chest infections. The NHS says COPD can put a significant strain on your body and mean you are more vulnerable to infections, so everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

The NHS says a GP may ask about your symptoms and whether you smoke or used to smoke, examine your chest and listen to your breathing with a stethoscope, calculate your body mass index and ask about family history of lung problems. They may also do or arrange a breathing test called spirometry.

In spirometry you breathe into a machine after inhaling a bronchodilator medicine. The spirometer measures the volume of air you can breathe out in a second and the total amount of air you breathe out, and the readings are compared with normal results for your age to show whether your airways are obstructed.

The NHS says a flare-up is a period when symptoms suddenly get worse, and it is common to have a few a year, particularly in winter. Signs of a chest infection include becoming more breathless, coughing more and a change in the colour or thickness of phlegm.

The NHS says that for a bad flare-up you may be prescribed a short course of steroid tablets, and your doctor may give you steroid tablets or antibiotics to keep at home to start as soon as you notice a flare-up. If you are taken to hospital, you may be given non-invasive ventilation (NIV), where a machine connected to a mask supports your lungs.

Roflumilast tablets are recommended by the NHS for people whose symptoms have suddenly become worse at least 2 times over the past 12 months and who are already using inhalers.

The NHS lists practical steps for looking after yourself. It says to take your prescribed medicines, including inhalers, as this can help prevent bad flare-ups; to stop smoking; and to exercise regularly, which can help improve symptoms and quality of life. Exercising until you are a little breathless is not dangerous, but you should not push yourself too far.

On diet, the NHS says carrying extra weight can make breathlessness worse, while some people with COPD unintentionally lose weight. Eating foods high in protein and taking in enough calories is important to maintain a healthy weight, and you may see a dietitian as part of pulmonary rehabilitation if necessary.

The NHS also suggests watching the weather, as cold spells and hot, humid periods can cause breathing problems, and avoiding things that can trigger symptoms: dusty places, fumes such as car exhausts, smoke, air freshener sprays, strong-smelling cleaning products, hairspray and perfume. Breathing techniques such as pursed-lip breathing and paced breathing can help some people with breathlessness.

The NHS says that if COPD causes a low level of oxygen in your blood you may be advised to have oxygen at home, which should be used for at least 15 hours a day. It is not a treatment for breathlessness itself, and you must not smoke when using oxygen because it is highly flammable. Some people benefit from ambulatory oxygen used when walking or active.

Surgery is usually only suitable for a small number of people with severe COPD whose symptoms are not controlled with medicine. The NHS names bullectomy, lung volume reduction surgery and lung transplant as the three main operations.

The NHS says to see a GP if you have persistent symptoms of COPD, particularly if you are over 35 and smoke or used to smoke, and not to ignore them. It says several conditions cause similar symptoms, such as asthma, bronchiectasis, anaemia and heart failure.

For breathlessness in general, the NHS says to call 999 or go to A&E immediately if you have severe difficulty breathing (gasping, choking or not able to get words out), a tight or heavy chest, pain that spreads to your arms, back, neck or jaw, lips or skin turning very pale, blue or grey, or sudden confusion. It says to contact NHS 111 if you are more short of breath than usual, are coughing up blood or feel sick or are being sick.

On the NHS, COPD is diagnosed and monitored by your GP practice, often with a practice nurse and regular reviews, and referral to pulmonary rehabilitation or a respiratory specialist where needed. The NHS says you will have regular contact with your care team to monitor your condition.

Some people choose a private respiratory consultation for quicker access to spirometry, scans or specialist review. In either setting, stopping smoking, taking inhalers correctly and getting vaccinated matter most, so make sure your GP is told about any changes to your treatment.