What is COPD?

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterised by progressive airway inflammation and changes, which permanently damages the lungs and affects a person’s ability to breathe.

COPD is a complex disease that causes persistent and progressive obstruction to air flowing in and out of the lungs.

The permanent damage and changes in the lungs, results in symptoms such as progressive shortness of breath, cough, wheeze, and fatigue, all of which significantly impact a person’s quality of life1.

COPD affects about 480 million people and the global number of cases is expected to rise to 600 million people by 20502.

How inflammation affects lung function

COPD is characterised by persistent inflammation in the airways and lung tissue, largely due to long-term exposure to harmful substances such as chemicals, cigarette smoke or air pollution.

These substances activate the immune system, which in COPD causes excess inflammation. This results in damage to the lung’s air sacs, and narrows the airways, making it harder for the lungs to fully inhale and exhale3. This excess inflammation also damages the lining of the lungs, causing extra mucus production, making breathing more difficult4.

In COPD, there are three main types of inflammation. The majority of people with COPD have Type 1 and Type 3 inflammation which is caused by inflammatory cells called neutrophil cells. A minority of people ( 20%-40%)5, have Type 2 inflammation caused by inflammatory cells known as eosinophil cells.

COPD patients often experience episodes where their symptoms suddenly become worse. These episodes are known as ‘exacerbations’ or ‘flares’. With each exacerbation there is an increased risk of hospitalisation, with some patients progressing to respiratory failure or death6. Even in patients who don’t need hospitalisation, exacerbations cause lasting lung damage and can take weeks to months to recover from7.

Flares can be triggered by various factors like respiratory infections, allergies, chemicals or dust that cause some cells in the lungs to release molecules called alarmins which contribute to acute inflammation. These three types of COPD inflammation can cause flares7.

COPD symptoms become more severe over time and patients may experience8:

  • Chronic cough

  • Shortness of breath (dyspnoea)

  • Mucus (sputum) production

  • Wheezing/chest tightness

  • Fatigue

Patients with COPD often suffer from other health conditions such as anxiety, weight/muscle loss, osteoporosis, heart failure, and smoking-related cancers9.

Some people will dismiss their symptoms as a consequence of ageing,10,11 and many with a history of smoking may feel stigmatised by the disease being labelled as a “smoker's cough”.

COPD can affect a patient’s daily life in many ways including their ability to work, move around, complete daily chores, or manage personal care12. Many COPD patients who experience more severe symptoms rely on support from family and friends for care related to their illness13.

Caregivers of COPD patients have reported fatigue, social isolation, confusion, loss of personal freedom, relationship difficulties, resentment, sleep disturbances, guilt and boredom because of their caregiving role13.

The global healthcare cost of COPD is high and is predicted to cost the global economy $4.3 trillion between 2020 and 205014. COPD is one of the leading causes of emergency hospitalisations in many countries15, and one in five people with the condition will die within a year of their first hospitalisation16.

While tobacco smoke is the most common cause of COPD, between 25-45% of people living with COPD have never smoked 17. There are other factors that may increase the risk of developing COPD including:

  • Environmental

    • Evidence has shown that exposure to air pollution and biomass fuel smoke can increase risk 8.

  • Genetic predisposition

  • Age and sex

    • COPD is more likely to occur in middle-to-older aged patients18 and studies have reported greater COPD prevalence and mortality in men versus women4. However, the number of female cases is projected to increase by 47.1% (vs a 9.4% increase for males) by 20502.

  • Socioeconomic status  

    • The number of cases in low- and middle-income regions is expected to be more than double that of high-income regions by 20502.

  • Infections

COPD is often not diagnosed until the disease is more advanced due to an under-recognition of respiratory symptoms.

Between 65–80% of people who have COPD remain undiagnosed19. People who are diagnosed with COPD late are almost 70% more likely to have a flare-up compared with those diagnosed early20.

If you have any COPD symptoms, or if you believe that you may be at risk of developing COPD, it is important to speak to your doctor about testing your lung function. This is done through a non-invasive test, known as a spirometry test, which measures the volume of air you can exhale in one forced breath.

To diagnose COPD, a person’s symptoms are assessed, and their diagnosis is confirmed through a spirometry test. COPD severity is graded by a system that classifies airflow obstruction from Grade 1 – Mild to Grade 4 – Very Severe8.

Some COPD symptoms can also be improved with lifestyle changes, such as stopping smoking (if they are a smoker at all) and increasing physical activity.

Each person’s COPD management and treatment will be different depending on the severity of their disease, their current symptoms; their previous history of exacerbations; and any other health conditions they currently have8.

Currently, standard COPD treatments such as inhaled corticosteroids and/or bronchodilators, focus on relieving symptoms, however many COPD patients still struggle with inadequate symptom control11.

Mild COPD exacerbations may be managed by increasing the dose and/or frequency of standard treatment. Additional treatment with corticosteroids and/or antibiotics at home or in hospital may be required for moderate and severe COPD exacerbations.

There remains a large unmet need for treatment that addresses the underlying cause of COPD.

References

  1. Gundry S. COPD 1: pathophysiology, diagnosis and prognosis. Nursing Times. 2019; 116(4), 27-30.

  2. Boers, E., Barrett, M., Su, J. G., Benjafield, A. V., Sinha, S., Kaye, L., Zar, H. J., Vuong, V., Tellez, D., Gondalia, R., Rice, M. B., Nunez, C. M., Wedzicha, J. A., & Malhotra, A. Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA network open, 6(12).

  3. American Thoracic Society. Chronic Obstructive Pulmonary Disease (COPD); [updated 2021, cited 31 October 2024]. Available from:

  4. Guo-Parke H, Linden D, Weldon S, Kidney JC, Taggart CC. Mechanisms of Virus-Induced Airway Immunity Dysfunction in the Pathogenesis of COPD Disease, Progression, and Exacerbation. Frontiers in Immunology. 2020; (11).

  5. Rabe, K. F., Rennard, S., Martinez, F. J., Celli, B. R., Singh, D., Papi, A., Bafadhel, M., Heble, J., Radwan, A., Soler, X., Jacob Nara, J. A., Deniz, Y., & Rowe, P. J. (2023). Targeting Type 2 Inflammation and Epithelial Alarmins in Chronic Obstructive Pulmonary Disease: A Biologics Outlook. American journal of respiratory and critical care medicine, 208(4), 395–405.

  6. Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M ET AL.. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respiratory Research. 2024;18;11(1).

  7. Hurst JR, Skolnik N, Hansen GJ, Anzueto A, Donaldson GC, Dransfield MT et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. European Journal of Internal Medicine. 2020; 3 (73):1-6.

  8. GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report). https://goldcopd.org/2024-gold-report/. Accessed 31 October 2024.

  9. Skajaa N, Laugesen K, Horváth-Puhó E, et al. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respiratory Research. 2023;10(1).

  10. Stolz D, Mkorombindo T, Desiree M Schumann et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet. 2022; 10356 (400): 921-972.

  11. Curtis J.R. Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal. 2008; 32(3):796-803.

  12. Miravitlles, M., Ribera, A. Understanding the impact of symptoms on the burden of COPD. Respiratory Research. 2017; 18 (67).

  13. Mansfield E, Bryant J, Regan T, Waller A, Boyes A, Sanson-Fisher, R. Burden and Unmet Needs of Caregivers of Chronic Obstructive Pulmonary Disease Patients: A Systematic Review of the Volume and Focus of Research Output. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2016; 13(5): 662–667.

  14. Bloom DE, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum; 2011. Available at: https://world-heart-federation.org/wp-content/uploads/2017/05/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf. Accessed 31 October2024.

  15. Rehman AU, Hassali MAA, Muhammad SA, Shah S, Abbas S, Ali IABH et al. The economic burden of chronic obstructive pulmonary disease (COPD) in the USA, Europe, and Asia: results from a systematic review of the literature. Expert Review of Pharmacoeconomics & Outcomes Research, 2019; 20(6): 661–672.

  16. Bakthavatsalu B, Walshe C, Simpson J. The experience of hospitalization in people with advanced chronic obstructive pulmonary disease: A qualitative, phenomenological study. Chronic Illness. 2023; 19(2):339-353.

  17. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009;374:733–743. doi: 10.1016/S0140-6736(09)61303-9.

  18. Ho TW, Tsai YJ, Ruan SY, Huang CT, Lai F, Yu CJ. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12).

  19.   Yale Medicine. Chronic Obstructive Pulmonary Disease (COPD); [updated 2024; cited 31 October 2024]. Available from:

  20. Jensen HH, Godtfredsen NS, Lange P, Vestbo J. Potential misclassification of causes of death from COPD. European Respiratory Journal. 2006; 28(4): 781-5.

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