The Chest Clinic
COPD: symptoms and treatment
What is COPD?
Chronic obstructive pulmonary disease causes persistent limitation of airflow. It includes emphysema and chronic bronchitis, which often occur together. Smoking is a major cause, but other exposures and, occasionally, inherited factors can contribute.
Symptoms
Breathlessness with activity, a long-standing cough, sputum and repeated chest infections are common. Symptoms can worsen during an exacerbation (flare-up). Breathlessness should not automatically be attributed to COPD: other conditions, including heart disease, may contribute.
How is it diagnosed?
Diagnosis combines your symptoms and exposure history with spirometry after a bronchodilator, a medicine that opens the airways. A chest X-ray, blood tests or additional investigations may help assess other causes and complications. A scan finding of emphysema should prompt clinical assessment rather than being used alone to diagnose COPD.
How is it treated?
Support to stop smoking, appropriate vaccinations, physical activity and pulmonary rehabilitation are important. Inhalers are chosen according to symptoms, flare-ups and other clinical features. Technique and regular review matter. Inhaled steroids help selected patients but are not suitable for everyone and can increase pneumonia risk.
Some people require additional specialist treatment. Oxygen is prescribed after assessment of low oxygen levels; it is not a routine treatment for breathlessness alone. Nutritional, psychological and self-management support can also help.
Biologics for selected people with COPD
Adults with ongoing exacerbations despite optimised treatment and raised blood eosinophils may be considered for add-on biologic injections such as dupilumab or mepolizumab, subject to current NICE criteria. They are not suitable for everyone and are not treatments for an acute attack. Most patients who need biologics transfer to NHS specialist care, where eligibility, access, prescribing and monitoring are confirmed.
NICE: dupilumab | NICE: mepolizumab | Conditions and treatment pathways
Managing flare-ups
Agree an action plan with your clinician. A flare-up may need extra treatment, sometimes including steroid tablets or antibiotics following assessment. Seek prompt advice for worsening symptoms. Call 999 for severe breathing difficulty, blue or grey lips, sudden confusion or chest pain suggesting an emergency.
Routine appointment contacts | Breathlessness information
Sources and further information
NICE NG115: COPD diagnosis and management
Asthma + Lung UK: living with COPD
General information for adults; investigation and treatment are tailored to you.