COPD in older adults: symptoms, flare-ups, treatment and self-management

Asthma + Lung UK breaks the term down: chronic means long term, obstructive means narrowed airways that make it harder to breathe out quickly so air gets trapped, pulmonary means lungs. COPD includes chronic bronchitis (long-term inflammation of the airways) and emphysema (damage to the air sacs), and many people have a mixture of both.

The charity says that in COPD the airway narrowing is permanent, and inhaled medicines can open the airways only to some extent, whereas in asthma the narrowing comes and goes and inhalers can often open the airways fully. It is sometimes difficult to tell the two apart because symptoms are similar, people with asthma can develop COPD later, and some people have both. If symptoms are much better on some days, or you wake at night with them, asthma may be involved.

The NHS lists shortness of breath particularly when active, a persistent chesty cough with phlegm that some people dismiss as a "smoker's cough", frequent chest infections and persistent wheezing. Asthma + Lung UK stresses breathlessness often comes on gradually, so you may notice you are breathless doing things that used to be easy, such as walking quickly or going uphill.

Because gradual breathlessness is easy to blame on age or being unfit, both sources say not to ignore it. The NHS advises seeing a GP for persistent symptoms, particularly if over 35 and smoking now or in the past, and says starting treatment early, before the lungs are significantly damaged, is best. Asthma + Lung UK adds having worked with dust, fumes or chemicals or having had chest trouble when younger as reasons to be checked.

The NHS says the main cause is smoking, and risk increases with how much and how long you smoked, though people who never smoked can be affected. Long-term exposure to harmful fumes or dust is another cause, and a rare genetic problem can make the lungs more vulnerable.

• Second-hand smoke, pipes, cigars and cannabis smoke can all raise risk (Asthma + Lung UK).

• Silica dust, welding fumes and cleaning products are examples of workplace exposures.

• Indoor air pollution, such as from wood or coal burning, and outdoor air pollution.

• Family history, asthma, and problems with lung development in early life.

• Alpha-1-antitrypsin deficiency, an inherited condition that makes lungs much more sensitive to smoking damage.

The NHS says a GP asks about symptoms and smoking, then can organise a breathing test to help diagnose COPD and rule out other conditions such as asthma. Asthma + Lung UK explains that the test is spirometry, which measures how much air you can blow out and how quickly, and that the airflow obstruction is described in four stages: mild, moderate, severe and very severe.

The charity adds that the stage is only one part of how severe COPD is. Other aspects include how breathless you are (assessed using the Medical Research Council scale), how much cough and phlegm you have (using the COPD Assessment Test), how often you have flare-ups or hospital admissions, whether you need home oxygen or non-invasive ventilation, other long-term conditions such as heart disease or anxiety, and overall fitness, including being underweight or frail. In older people, frailty and other conditions often matter as much as the lung test.

The NHS lists stopping smoking, inhalers and medicines to make breathing easier, pulmonary rehabilitation (a specialised programme of exercise and education), and, for a very small number of people, surgery or lung transplant. Asthma + Lung UK also describes lung volume reduction procedures for some people. Inhaler technique matters: the charity recommends checking that you use inhalers correctly, and asking your healthcare professional about pulmonary rehabilitation and whether you need to see a lung specialist.

Vaccines are part of care: Asthma + Lung UK advises getting offered flu, COVID-19, RSV and pneumococcal vaccines. A COPD self-management plan sets out what to do day to day and in a flare-up, and the charity provides a Patient Passport checklist of best care.

A flare-up (exacerbation) is when symptoms suddenly get worse: more breathlessness than usual, more coughing, more phlegm or a change in its colour, more wheeze, tiredness, confusion or swollen ankles. Asthma + Lung UK says less severe flare-ups can be treated at home following the self-management plan, usually with a reliever inhaler and sometimes oral steroids and antibiotics, which may be supplied as a "rescue pack". It warns oral steroids can have side effects and taking antibiotics too often can cause resistance, so you should tell your healthcare professional whenever you use a rescue pack.

More severe flare-ups may need hospital treatment, which can include nebulised reliever medicine, steroids, antibiotics, non-invasive ventilation, emergency oxygen and tests such as a chest X-ray, ECG and blood tests. Some areas offer "virtual wards", where hospital-level care is given at home. A GP follow-up should happen after any flare-up.

Asthma + Lung UK says to call 999 or go to A&E immediately if you are finding it very hard to breathe (gasping, choking, unable to speak), your chest feels tight or heavy, pain spreads to the arms, back, neck or jaw, lips or skin turn very pale or blue, or you suddenly feel confused. Coughing up blood is described as a very serious symptom that always requires action.

On outlook, the charity explains that COPD is progressive, that frequent and severe flare-ups raise risk, and that around 1 in 10 people admitted to hospital with a flare-up are thought to die within 90 days while around 4 in 10 are readmitted within 90 days. Preventing flare-ups by managing COPD well can improve both life expectancy and quality of life. For people with more severe COPD it advises thinking about what you would want if your condition worsens and discussing longer-term treatment with your healthcare professional.