COPD Causes and Symptoms: What You Need to Know

As the name suggests, COPD, or chronic obstructive pulmonary disease, is a long-term respiratory disease that restricts the flow of air into and out of the lungs. This group of lifelong ailments includes emphysema, chronic bronchitis and severe asthma that doesn't respond to treatment (called refractory asthma).

If you find yourself short of breath during everyday activities or dealing with a persistent cough, you're not alone. COPD affects millions of Americans, but recognizing the symptoms early can make a significant difference in managing the condition and maintaining your quality of life.

Key Takeaways: COPD

• COPD affects 1 in 10 Americans. Approximately 10-14% of the U.S. population has COPD, with 16 million diagnosed cases and many more undiagnosed.
• Non-smokers can develop COPD. While smoking causes most cases, one in six COPD patients never smoked. Workplace pollutants, air quality, and genetic factors (like alpha-1 antitrypsin deficiency) also contribute.
• Early symptoms are subtle and often dismissed. Persistent cough, phlegm production, reduced stamina and shortness of breath during normal activities may appear after age 40 but aren't a normal part of aging.
• COPD is treatable, and it's never too late to act. While lung damage isn't reversible, quitting smoking, medications, pulmonary rehabilitation, and lifestyle changes can slow COPD progression and significantly improve quality of life.

How Common Is COPD?

According to the National Heart Lung and Blood Institute, about 16 million people in the U.S. have been diagnosed with COPD and many more millions likely have it and don't know it.

"Currently the prevalence is in United States, anywhere between 10 to 14%," said Faisal Khan, MD, a Greenwood interventional pulmonologist who chooses to practice at Franciscan Health Indianapolis. "So you can imagine one out of 10 individuals have it."

How Does COPD Impact Your Lungs?

"What happens is that there's narrowing of the air tubes that deliver the air to the lung," explained Dr. Khan. "That then manifests as symptoms like cough, shortness of breath, wheezing, tightness and phlegm production."

Most cases of COPD are related to smoking or inhaling secondhand smoke. In response to the smoke, the lungs produce mucus, which eventually becomes so thick that it hampers breathing. In patients with COPD, smoking scars lung tissue and makes it easier for infections to settle in.

Over time, smoking also damages the air sacs in the lungs. The air sacs normally expand and contract like balloons, moving air in and out of the lungs. But with COPD, they lose their elasticity and can't work properly, making it hard to breathe.

Who Is At Risk For COPD?

Smoking is the cause of many cases of chronic obstructive pulmonary disease. Many people with COPD, in fact, have smoked at least 20 cigarettes a day for 20 or more years.

"Smoking being the number one reason for it, especially in the generation that's above 50 right now," Dr. Khan said. "The smoking prevalence rate was higher than the current, younger-gen demographics. That's why the number is about 10 to 14%."

But one in six people with COPD have never smoked.

Can You Get COPD Without Smoking?

You can get COPD without smoking. Other COPD risk factors can increase the likelihood of developing these lung diseases.

Pollutants

Exposure to air pollutants such as industrial chemicals, fumes and dust in the workplace over a long period of time can compromise lung health. Certain jobs, including mining, steel-working and automotive careers, increase the risk of developing COPD. Some substances that irritate the lungs, like air pollution, dust or industrial chemicals, also may contribute to COPD.

"As people smoke or as they go through certain occupations, the damage is happening," Dr. Khan said.

But COPD can strike people who never smoked or inhaled air pollutants. That's probably due to another factor: genetics.

Genetics

The genes you inherit from your family can make you more likely to develop certain diseases, including COPD. So far, researchers have pinpointed a variation in one specific gene (alpha-1 antitrypsin) that can cause a deficiency.

This gene abnormality can cause lung damage and emphysema, even without smoking or breathing irritants. If COPD runs in your family, consider genetic testing for the alpha-1 antitrypsin anomaly.

But besides the alpha-1 gene, there may be more than 100 genetic differences that can make you more susceptible to COPD. The more of these gene variations you have, the higher your risk.

What Are Symptoms Of COPD?

Not everyone with COPD has symptoms. For those who do have symptoms, they may start as a nagging cough or feeling short of breath during your regular activities.

Common symptoms of COPD include:

• Shortness of breath
• Constant and ongoing cough
• Wheezing
• Tightness in chest
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss
• Shortness of breath, especially with mild exercise
• Blueness of the lips or fingernails (cyanosis)
• Chronic cough with mucus

Early symptoms of COPD

Since COPD symptoms most often appear after the age of 40, you might be tempted to chalk it up to getting older.

"People may not get symptoms till they start feeling subtle symptoms and signs like cough, persistent cough flam or phlegm production, chest tightness or wheezing," Dr. Khan said. "Folks may notice that their level of activity or stamina is not the same and they get breathless more quickly with the same amount of activity they used to be able to do. So those are the few subtle early signs."

Later signs of COPD

COPD symptoms aren't a normal part of aging. Lung disease symptoms typically creep up over time.

"As the disease progresses, then it basically, they're two dominant categories of symptoms," Dr. Khan said. "If the air tubes are primarily involved, then those will be manifested more as a cough with a lot of phlegm production and wheezing, tightness in the chest. If it's primarily emphysema, which basically means the destruction of the lung tissue itself, then that manifests as decreased stamina and just shortness of breath with minimal exertion. And they may not have a lot of cough and congestion, but just mainly short of breath."

People with COPD are likely to have times when their symptoms worsen and persist for days or longer, called exacerbations.

When to see a doctor for COPD symptoms

If you have any COPD symptoms or risk factors such as smoking or poor workplace air quality, talk to your family doctor. Your doctor may recommend you see a pulmonologist, a doctor who specializes in lung health or pulmonary medicine.

How Is COPD Diagnosed?

A simple breathing test called spirometry can help doctors diagnose COPD. The earlier you find out that you have chronic obstructive pulmonary disease, the sooner you can start treatment to slow the progression of the disease.

"Talk to your physician because these symptoms are not only specific to lung disorders," Dr. Khan said.

"You can have similar symptoms in asthma. You can have similar symptoms in heart disease or blood disorders. So the first thing would be go and talk about your symptoms.

"Any primary care physician will be well-versed in dealing with it. They will assess your history, your risk factor, your exposure, the quality and nature of your symptoms, and they probably will subject you to a breathing test called pulmonary function test. That assesses the airflow through the lungs, the lung capacity and the efficiency of lung oxygen exchange. And then they may want to, depending on the symptoms, do a chest X-ray or other workup."

How Is COPD Treated?

Although there is no cure for chronic pulmonary obstructive disease, COPD symptoms can be treated, and your quality of life can be improved. The first step is to stop smoking and to avoid any environments with smoke or air pollutants. Additional lifestyle changes, including a healthy diet, regular exercise and stress management, are recommended.

Medications for COPD

COPD medications can prevent flare-ups and quickly open up airways when breathing becomes difficult.

Your doctor may prescribe medications such bronchodilators, anti-inflammatory drugs, steroids, oxygen, theophylline, phosphodiesterase-4 inhibitors and antibiotics. Finally, there are other therapies such as supplemental oxygen therapy and pulmonary rehabilitation.

These medications are delivered through a fine mist that you inhale, using either:

• Inhaler: a device that sprays the medication in your mouth
• Nebulizer: a machine that turns liquid medicine into a mist you inhale through a face mask

Pulmonary rehabilitation for COPD

Participating in a pulmonary rehabilitation program can also improve quality of life. These programs give you a better understanding of COPD and help you adjust to living with the disease. Pulmonary rehabilitation specialists provide tips on breathing techniques, safe ways to exercise, proper nutrition and how to cope with anxiety.

Lifestyle changes for COPD

People living with COPD can also take steps at home to maintain optimal health, including:

• Stop smoking
• Exercise regularly
• Maintain a healthy weight
• Get flu and pneumonia shots

Zephyr valve for COPD

A device called the Zephyr valve helps many COPD patients breathe easier. It works like a one-way door, letting trapped air and mucus out, but doesn't let new air into the damaged part of the lung. That means the unhealthy parts shrink, giving the healthier part of the lung more room to expand and work better. Learn more about the Zephyr valve and other surgical treatment options for advanced COPD.

How Can I Reduce COPD Flare-Ups?

Dr. Khan recommended these tips to reduce the frequency of COPD flare-ups:

• Stop smoking
• Make sure you're immunized against common viruses that impact the respiratory system
• Wear masks if you're around a population that is sick and during travel

"The damage is done, the majority of it's not reversible," Dr. Khan said. "If someone is an active smoker and quit smoking, they can reduce the rate of decline of the lung function going forward. So that does add to the life expectancy. The message I want to give is it's never too late."