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COPD: Causes, Spirometry Staging & Treatment

COPD is a chronic, progressive lung condition causing irreversible airflow obstruction. It's largely caused by smoking but highly manageable with the right treatment plan.

Written by Suman Konda, PharmD, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last updated: · How we check our content

UK prevalence
~1.2 million diagnosed
Smoking causes
~85% of COPD cases
Spirometry defines it
FEV₁/FVC <0.70 post-bronchodilator
Pulmonary rehab
Most effective non-drug intervention

COPD Staging (GOLD Classification)

GOLD StageSeverityFEV₁ (% predicted)Typical Symptoms
GOLD 1Mild≥80%Cough, mild breathlessness on exertion
GOLD 2Moderate50–79%Increased breathlessness; may limit activities
GOLD 3Severe30–49%Significant breathlessness; frequent exacerbations
GOLD 4Very severe<30%Very severe breathlessness; poor quality of life

Treatment Ladder

  • Stop smoking: the only intervention that slows disease progression
  • SABA (salbutamol) or SAMA (ipratropium): short-acting bronchodilators for relief
  • LABA + LAMA (dual long-acting bronchodilator): e.g. tiotropium + olodaterol
  • Triple therapy: LABA + LAMA + ICS, for frequent exacerbations, high eosinophil count
  • Pulmonary rehabilitation: 8–12 weeks; reduces hospitalisations and improves QoL
  • Long-term oxygen therapy (LTOT): for resting SpO₂ <92% on air for >15 hours/day
Pulmonary Rehab Is as Effective as DrugsNHS pulmonary rehabilitation reduces breathlessness, improves exercise tolerance, and reduces hospital admissions by 30–50%. It's free on the NHS: ask your GP for a referral.
COPD Exacerbation Warning SignsIncreased breathlessness, change in sputum colour (green/yellow = infection), worsening cough. Action plan: rescue antibiotics and prednisolone at home if trained. Hospital if SpO₂ <88% or not improving.
Is COPD the same as emphysema?
Emphysema is one component of COPD: destruction of alveoli reducing gas exchange surface. COPD also includes chronic bronchitis (airway inflammation with productive cough). Most patients have both.
Can you get COPD without smoking?
Yes. Alpha-1 antitrypsin deficiency (genetic), occupational exposure (dust, chemicals), and biomass fuel exposure (cooking fires) cause COPD in non-smokers. About 15% of COPD occurs in never-smokers.
What relieves COPD breathlessness?
Inhaled bronchodilators (LABA/LAMA), pulmonary rehabilitation, breathing techniques (pursed-lip breathing, pacing), oxygen if hypoxic, and low-dose opiates (morphine) for refractory dyspnoea.
How is a COPD exacerbation treated?
Increased bronchodilator use; prednisolone 30 mg for 5 days; antibiotics if sputum is purulent. Hospital if severe (SpO₂ <88%, confusion, unable to complete sentences, failure to respond to home treatment).
BreathlessnessLung causes

References

The clinical information on this page is based on peer-reviewed sources indexed in PubMed, the biomedical literature database of the US National Library of Medicine.

  1. MacLeod M, Papi A, Contoli M, et al.. Chronic obstructive pulmonary disease exacerbation fundamentals: diagnosis, treatment, prevention and disease impact. Respirology. 2021;26(6):532-551. doi:10.1111/resp.14041 · PMID 33893708

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Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.