In short: COPD is a chronic obstructive lung disease, caused mainly by smoking. It cannot be cured, but it can be slowed, breathing can be eased, and exacerbations and hospital admissions can be prevented. Early diagnosis makes a difference.
Symptoms
Shortness of breath on exertion that worsens slowly, cough and phlegm in the mornings, and recurrent chest infections in winter. Many people put this down to age or fitness, so the disease is usually diagnosed late.
How it is diagnosed
The diagnosis is made with spirometry after a bronchodilator, which shows airway obstruction that does not resolve and grades its severity. As needed, a CT scan, lung volume and diffusion (DLCO) tests and a blood eosinophil count are added, as well as testing for alpha-1 antitrypsin deficiency, which is recommended once for everyone diagnosed.
If needed, spirometry can also be done at the clinic during the visit.
Treatment
- Stopping smoking: the single step with more impact than any other treatment
- Long-acting bronchodilator inhalers, such as tiotropium (Spiriva) or dual bronchodilator combinations (Anoro, Ultibro, Spiolto)
- For people with repeated exacerbations, particularly with raised blood eosinophils, a triple inhaler that also contains a steroid, such as Trelegy or Trimbow
- Checking that the inhaler suits you and training in how to use it, including a demonstration during the visit
- Pulmonary rehabilitation and tailored physical activity
- Vaccinations: influenza, pneumococcal, RSV and COVID-19, and, depending on age, pertussis (Tdap) and shingles
- For some patients who have repeated exacerbations despite full inhaled therapy and have raised blood eosinophils, biologic therapy is now also available, such as dupilumab (Dupixent) or mepolizumab (Nucala)
- Home oxygen or advanced treatments, only when indicated
Exacerbations
An exacerbation is a period of several days in which breathlessness, cough or phlegm get worse. Exacerbations can speed up the decline in lung function, so an important part of treatment is a clear action plan: what to do at home, and when to contact your doctor.
Frequently asked questions
What is the difference between COPD and asthma?
Both are obstructive diseases, but asthma usually starts at a younger age and responds well to treatment, while COPD is mainly linked to smoking and to more fixed obstruction. Some patients have features of both, and treatment is then tailored accordingly.
I've stopped smoking. Is it still worth being tested?
Yes. Spirometry detects the disease at an early stage, and former smokers may also be eligible for lung cancer screening with low-dose CT.
Related topics
General information only; it does not replace a medical consultation. עברית