Dr. Rajesh Vandra
Chest Physician/ Pulmonologist


COPD or Chronic Obstructive Pulmonary Disease is caused due to limitation of airflow to the lungs; this can also result from exposure to toxic substances. COPD can be related to prolonged exposure to harmful substances such as poisonous materials and fumes, or cigarette smoke. Such exposure causes chronic inflammation, which leads to narrowing of the airway tube. The inflammation occurs along the lining of bronchial tubes that act as a passageway for air to reach the lungs. Chronic obstructive pulmonary disease is often associated with shortness of breath, sputum production, and cough.  COPD is a group of diseases and conditions that produces an inflammatory response in the lungs. Although this disease can cause irreversible damage to the airways, appropriate treatment and prevention strategies can minimise further damage to the lungs.

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The two most common COPD diseases are chronic bronchitis or emphysema.

Chronic bronchitis: It is clinically described as a consistent cough with sputum or phlegm that lasts for over three months.
Emphysema: In this disease, the lung tissue is damaged over time and results in shortness of breath or wheezing.

The two forms of COPD aren’t mutually exclusive and can happen together.


There are four stages of COPD-

Stage 0: The patient is at risk but has normal spirometry findings.

Stage 1: This is a mild stage of COPD. In this stage, the FEV1/FVC ratio <70 per cent. Therefore, FEV1 is at least 80 per cent of the expected value, and the patient may experience the symptoms.

Stage 2: This moderate stage is characterised by the FEV1/FVC ratio less than 70 per cent, FEV1 50 to less than 80 per cent of standard value. The patient may experience chronic symptoms.

Stage 3: Severe phase. The patient has an FEV1/FVC ratio of less than 70 per cent. FEV1 is as low as 30 per cent to less than 50 per cent of the predicted value. A patient may experience chronic symptoms.

Stage 4: This phase is referred to as a very severe phase. FEV 1/FVC ratio is < 70 per cent. FEV1 is < 30% of normal value. A patient has severe chronic symptoms.


Initially, COPD may report only mild or no symptoms. However, as the disease progresses, you might experience several symptoms such as:

  • Consistent or chronic Cough (with phlegm)

  • Shortness of breath (especially while exercising and moving)

  • Wheezing

  • Tightness of chest

  • Difficulty in breathing

  • Weight loss 

  • Weakness

  • Frequent lung infections

In some cases, you may experience sudden flare-ups of symptoms known as COPD exacerbation, which might be life-threatening. A patient suffers from exacerbation more often as the disease progresses. During the end stage of COPD, the patient experiences a severely limited performance of the lungs due to severe airflow limitation and systemic complications. Pulmonary respiratory failure usually leads to fatality in the patients. Specific extrapulmonary effects such as nutritional abnormalities, muscle atrophy and weight loss are related to COPD.

Causes And Risk Factors


Several factors can cause COPD, such as:

Smoking: It is the most common cause of COPD because long-term inhaling of tobacco smoke destroys the lung tissues and irritates the airways.

Pollution: If you are exposed to chemical fumes, dust or air pollution, and even second-hand smoking for a long time, you may damage your lungs.

Weak immunity: Naturally, if your immunity is low, you’ll be prone to recurring viral and bacterial infections of the respiratory system, increasing your chances of suffering from COPD.

Lung diseasesIf you have suffered from severe lung infections during your childhood days, you would likely suffer from COPD.

Risk Factors

One of the principal risk factors for chronic obstructive pulmonary disease is cigarette smoking. Prolonged environmental and occupational exposure to dust, chemical fumes, and other lung toxins can be related to COPD development. Another factor that can cause COPD is alpha-1 antitrypsin deficiency. This is a rare cause of COPD, which can develop in individuals before 40 years of age.


Prevention or minimisation of exacerbations in the patients can be achieved by routine use of bronchodilators to prevent and relieve symptoms associated with obstructive pulmonary disease.


Early detection of symptoms is an effective way to slow down the disease’s progression. The patient's physical examination can reveal specific symptoms, such as excessive sputum production, shortness of breath, and cough. When these symptoms are related to the history of environmental and occupational exposure to pollutants or cigarette smoking, it can lead to COPD. Screening for the symptoms and history of cough, dyspnoea, smoking and cough can require further evaluation.

If you show symptoms of COPD, your doctor will recommend the following tests, followed by physical examination and asking questions about your medical and lifestyle history (clinical health, exposure to pollutants and whether you smoke). These include:

Spirometry: It is a simple test to check the efficiency of the functioning of your lungs. This test requires you to breathe into a tube connected to a machine that measures the amount of air you can breathe in and the force with which you can blow it out.

Chest X-ray: It can diagnose lung disease (chronic bronchitis and respiratory problems) early and help confirm the exact cause and symptoms.

Arterial blood gas analysis: This test shows decreased oxygen concentration in the blood, thereby aiding in the detection of COPD.


Although there is no cure for COPD, getting treated for the condition slows down the progression of the disease and aids in relieving the symptoms. The treatment plan involves lifestyle changes, medications and vaccination. However, in some cases, rehabilitation program also helps in the management of the disease.

Medicines: Depending upon the severity of the disease and the extent of inflammation, your doctor will recommend medications. These drugs can help you breathe easier, reduce flare-ups of symptoms and provide relief. The commonly prescribed medicines to treat COPD include bronchodilators, anti-inflammatory drugs, antibiotics, beta-agonists and anticholinergics. 

The primary goal of treatment is to improve the quality of life, control symptoms and reduce exacerbations and fatalities. The non-drug therapy approach includes pulmonary rehabilitation and smoking cessation.

  • Beta2-agonist acts on smooth muscles in the airways. Long-acting Beta2-agonist (LABA) and short-acting beta-2 agonist (SABA) are used in the treatment of chronic obstructive pulmonary disease. SABA gives immediate relief, while LABA is used for maintenance therapy.

  • Antimuscarinics activate the mechanism for blocking the M3 muscarinic receptor, thereby avoiding bronchoconstriction. In addition, long-acting antimuscarinic agents provide maintenance therapy.

  • Another agent used in the therapy is Methylxanthines. Methylxanthines act by relaxing smooth muscles in the airways and preventing bronchoconstriction. Inhibition of phosphodiesterase III and IV is the probable mechanism of action. An example of methylxanthines is theophylline. 

  • Inhaled corticosteroids, in combination with SABAs and LABAs, can reduce inflammation. Oral glucocorticoids should be reserved for the management of acute exacerbations instead of long-term use. Azithromycin has proved its action on reducing the number of exacerbations in COPD patients in recent studies. 

  • Management of acute exacerbation in mild cases can be treated with bronchodilators, antibiotics and corticosteroids. Inpatient management is essential for moderate to severe COPD cases. Long-acting bronchodilators are a choice of therapy for stable patients. In the case of suspected bacterial infections, antibiotic initiation should be considered.

  • Pulmonary rehabilitation is a comprehensive strategy that involves exercise training, behavioural changes and the patient’s education.

Vaccination: People suffering from COPD are at an increased risk of getting lung infections. Hence, vaccination plays a key role in preventing various health-related complications associated with COPD. In case you are suffering from COPD, get a shot of flu vaccine and for pneumonia. 

Rehabilitation program: A lung rehabilitation program teaches you how to live well with COPD, exercise, breathe easier and eat well, along with providing support and counselling.


Lifestyle changes: One of the most effective ways to prevent the worsening of COPD is to quit smoking. Apart from this, there are a few things that people suffering from COPD need to follow. These are:

  • Regular exercising

  • Eating a healthy and nutrient-rich diet

  • Stay away from pollutants (and things that irritate your lungs)

Prognosis And Complications


People with COPD have to live with the condition for the rest of their lives. However, you can prevent the condition from worsening by leading a healthy life, taking medications as recommended by your doctor and getting yourself checked by the doctor from time to time.


COPD can lead to the following complications: 

  • Acute and/or chronic respiratory failure

  • Cor pulmonale

  • Acute exacerbation of COPD

  • Bacterial infections

  • Pulmonary hypertension

  • Adverse reactions to glucocorticoids

  • Weight loss


  1. Stat Pearls- NCBI Bookshelf. Chronic Obstructive Pulmonary Disease [Internet] [Updated on February 5, 2021] Available at

  2. American health and drug benefits. Chronic Obstructive Pulmonary Disease: An Overview [Internet] [Updated on September 2008] Available at


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