What causes COPD?
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 or full lung function tests 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.
Biologic treatments for COPD
Biologics are targeted antibody medicines that offer an additional option for a selected group of people with COPD. Some people have an inflammatory pattern involving eosinophils, a type of white blood cell, which can drive repeated flare-ups. Biologics act on this inflammation. They do not repair established emphysema, replace inhalers or treat an acute flare-up.
Two medicines are currently recommended by NICE as add-on treatment for eligible adults:
- Dupilumab, which blocks the IL-4/IL-13 pathway, injected every two weeks (NICE TA1142).
- Mepolizumab, which targets IL-5, injected every four weeks (NICE TA1166).
Eligibility generally requires a raised blood eosinophil count (for dupilumab, at least 300 cells per microlitre) and continued flare-ups – for example two moderate or one severe exacerbation in the previous year – despite appropriate inhaled treatment, usually triple therapy. In the main trials, flare-ups fell by about a fifth to a third compared with placebo. Response varies and is reviewed regularly.
Dr Knight regularly manages patients receiving biologics for both asthma and COPD, including confirming the diagnosis, optimising existing treatment, assessing eligibility and reviewing response. Depending on your insurance, funding and eligibility, treatment may be provided privately or through an NHS specialist service.
Read our detailed guide to biologics in COPD, including the clinical trial evidence.
When to get urgent help
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.
Sources and further information
This guide gives general information for adults and does not replace individual medical advice.