Chronic obstructive pulmonary disease (COPD) is a long-term condition that causes inflammation in the lungs, damaged lung tissue and a narrowing of the airways, making breathing difficult.
There are many different types of the condition, although little is known about what causes this variation and the best way to manage the different versions of the disease.
The symptoms of COPD are breathlessness and chronic cough, with or without phlegm. Fatigue, anorexia and weight loss can also occur over time. A key characteristic of the condition is periods of worsening symptoms, known as exacerbations. This can be triggered by infections or exposure to high amounts of air pollution. Symptoms of COPD get worse over time and exacerbations can speed up this decline.
People with COPD often suffer from other conditions, known as co-morbidities. These conditions may share similar risk factors, such as smoking, and they often contribute to the severity of the condition.
The most common conditions that occur alongside COPD include heart disease, anxiety and depression, osteoporosis, gastro-oesophageal reflux, skeletal muscle dysfunction, anaemia, lung cancer, diabetes and metabolic syndrome.
COPD is caused by factors that trigger inflammation in the lungs. These include:
This is the main risk factor for COPD. About 40-50% of lifelong smokers will develop COPD, compared with 10% of people who have never smoked. Not all smokers will develop the condition, which suggests that genetics also play a part in making some people more susceptible than others.
Around 15-20% of COPD cases are associated with exposures to occupational dust, chemicals, vapours or other airborne pollutants in the workplace that can trigger COPD. Find out more about occupational risk factors.
Outdoor and indoor air pollution
People with COPD are at a high risk of their symptoms worsening with high levels of outdoor air pollution. Indoor air pollution from using biomass fuels for cooking and heating is also a risk factor for the development of COPD. Find out more about outdoor and indoor air pollution.
Research has shown that the risk of developing COPD is associated with lower educational and income levels. Experts believe this is due to factors such as nutrition, overcrowding and air pollution.
Early life and environmental factors
Lung infections in early life and mothers who smoke are important risk factors for COPD.
The make-up of a person’s genes can mean they are more susceptible to developing COPD. The most researched genetic problem linked with COPD is a condition called alpha-1 antitrypsin deficiency; an inherited condition where a person lacks a protein known as alpha-1 antitrypsin.
Identifying the risk factors, and preventing exposure to these factors, is the most important step in preventing the disease. This includes:
- Encouraging people to quit smoking
- Preventing exposure to passive smoke for unborn babies and infants
- Reducing exposure to indoor air pollution from biomass fuels in developing countries
- Preventing COPD exacerbations
COPD is diagnosed via a spirometry test. This test involves breathing into a device called a spirometer, which measures the amount of air in the lungs and how fast a person can breathe out. If the test shows that the amount of air a person breathes out is low, it may indicate a narrowing of the airways and the early stages of COPD.
There is no known cure for COPD but it can be effectively managed to ease the impact of the symptoms on quality of life. Management of the condition includes;
- Reducing exposure to risk factors, including smoking and air pollution
- Improving exercise ability to help relieve symptoms
- Medical treatment with bronchodilators to help prevent exacerbations
- Oxygen therapy to help ease breathlessness
People with COPD can be referred onto exercise programmes known as pulmonary rehabilitation. These focus on improving a person’s ability to exercise and providing education to help a person manage their own condition.
COPD is a major burden to individuals, societies and healthcare systems across the world. This is partly due to the continued exposure to risk factors, such as smoking and air pollution, and partly due to an ageing population. People who live longer are more likely to experiences the consequences of long-term exposure to COPD risk factors.
- Countries with a higher smoking rate have an increased level of COPD mortality
- In 1997, COPD was the cause of death in 4.1% of men and 2.4% of women
- The average hospital admission rates for COPD are about 300 per 100,000 people per year
- In the adult population aged over 40 years, moderate and severe COPD is prevalent in 5-10% of the population, and including mild cases, the prevalence is 15-20%
- COPD prevalence is higher in men than women
- COPD prevalence increases with age: In people aged over 70, the prevalence of moderate and severe COPD is about 20% in men and 15% in women
- There are 300,000 deaths in Europe from COPD each year – the equivalent of 3 Hiroshima bombs
Mortality rate for COPD. Data from World Health Organization World and Europe Mortality Databases, November 2011 update. Data for some countries are missing because mortality data for asthma and COPD are not reported separately
Current and Future Needs
There is a great deal of room for improvement of care for people with COPD. To achieve this experts recommend improvements in the following areas:
- More studies on current prevention, education, medication, treatment and care are needed to drive higher standards across Europe
- More research on the effectiveness of current managements techniques for the condition
- New therapies to slow the progression of the condition
- More effective smoking cessation strategies
- More awareness amongst governments, industry and the general public about the high burden of COPD in Europe
- More research is needed on the different variations of COPD and their economic burden on European societies
- There is a lack of reliable data on incidence of COPD – Member States should improve reporting