What is COPD?

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterised by progressive airway inflammation and changes, which permanently damages the lungs and affects a person’s ability to breathe.

COPD is a complex disease that causes persistent and progressive obstruction to air flowing in and out of the lungs. 

The permanent damage and changes in the lung, results in symptoms such as progressive shortness of breath, cough, wheeze, and fatigue, all of which significantly impact a person’s quality of life3.

COPD affects about 400 million people and is currently the third leading cause of death globally1. The global number of COPD cases is expected to rise to 600 million people by 20502.

The lungs can be irritated by bacteria or viral infections, allergies, chemicals or dust which causes proteins (called antigens) to be released. These proteins cause inflammation, which helps the body’s immune system to fight infections4.  

In COPD, the signals that release these proteins do not work as they should, causing too much inflammation in the lungs, which damages the air sacs and narrows the airways, making it harder for the lungs to fully inhale and exhale5. This excess inflammation also damages the lining of the lungs, causing extra mucus production, making breathing more difficult6. 

COPD patients often experience episodes where their symptoms suddenly become worse. These episodes are known as ‘exacerbations’ or ‘flares’. With each exacerbation there is an increased risk of hospitalisation, with some patients progressing to respiratory failure or death7. Even in patients who don’t need hospitalisation, exacerbations cause lasting lung damage and can take weeks to months to recover from8.

Immune response in the lungs

COPD symptoms become more severe over time and patients may experience:9

  • Chronic cough

  • Shortness of breath (Dyspnoea)

  • Mucus (sputum) production

  • Wheezing/chest tightness

  • Fatigue

Patients with COPD often suffer from other health conditions such as anxiety, weight/muscle loss, osteoporosis, heart failure, and smoking-related cancers.10

Some people will dismiss their symptoms as a consequence of ageing,19,20 and many with a history of smoking may feel stigmatised by the disease being labelled as a “smoker's cough”.

COPD can affect a patient’s daily life in many ways including their ability to work, move around, complete daily chores, or manage personal care11. Many COPD patients who experience more severe symptoms rely on support from family and friends for care related to their illness12. 

Caregivers of COPD patients have reported fatigue, social isolation, confusion, loss of personal freedom, relationship difficulties, resentment, sleep disturbances, guilt and boredom because of their caregiving role12.

The global healthcare cost of COPD is high and is predicted to cost the global economy $4.3 trillion between 2020 and 205013. COPD is one of the leading causes of emergency hospitalisations in many countries14, and one in five people with the condition will die within a year of their first hospitalisation15.

While tobacco smoke is the most common cause of COPD, there are other factors that may increase the risk of developing COPD including:

  • Environmental

    • Evidence has shown that exposure to air pollution and biomass fuel smoke can increase risk.9

  • Genetic predisposition

  • Age and sex

    •  COPD is more likely to occur in middle-to-older aged patients16 and studies have reported greater COPD prevalence and mortality in men versus women.6 However, the number of female cases is projected to increase by 47.1% (vs a 9.4% increase for males) by 2050.2

  • Socioeconomic status  

    • The number of cases in low- and middle-income regions is expected to be more than double that of high-income regions by 2050.2

  • Infections

COPD is often not diagnosed until the disease is more advanced due to an under-recognition of respiratory symptoms.

Between 65–80% of people who have COPD remain undiagnosed17. People who are diagnosed with COPD late are almost 70% more likely to have a flare-up compared with those diagnosed early18.

To diagnose COPD, a person’s symptoms are assessed, and their diagnosis is confirmed through a non-invasive spirometry test, which measures the volume of air they can exhale in one forced breath.

COPD severity is graded by a system that classifies airflow obstruction from Grade 1 – Mild to Grade 4 – Very Severe9.

Some COPD symptoms can also be improved with lifestyle changes, such as stopping smoking and increasing physical activity.

Each person’s COPD management and treatment will be different depending on the severity of their disease, their current symptoms; their previous history of exacerbations; and any other health conditions they currently have9.

Currently, standard COPD treatments such as inhaled corticosteroids and/or bronchodilators, focus on relieving symptoms, however many COPD patients still struggle with inadequate symptom control21.

Mild COPD exacerbations may be managed by increasing the dose and/or frequency of standard treatment. Additional treatment with corticosteroids and/or antibiotics at home or in hospital may be required for moderate and severe COPD exacerbations.

There remains a large unmet need for treatment that addresses the underlying cause of COPD.

References

  1. World Health Organization. Chronic obstructive pulmonary disease (COPD); [updated 2023; cited 01 July 2024]. Available from:

  2. Boers E, Barrett M, Su JG, Benjafield AV, Sinha S, Kaye L, et al. Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Network Open. 2023; 1;6(12).

  3. Gundry S. COPD 1: pathophysiology, diagnosis and prognosis. Nursing Times. 2019; 116(4), 27-30.

  4. Gabryelska A,  Kuna P, Antczak A,  Białasiewicz P, Panek M. IL-33 Mediated Inflammation in Chronic Respiratory Diseases-Understanding the Role of the Member of IL-1 Superfamily. Frontiers in Immunology. 2019;  692 (10).

  5. American Thoracic Society. Chronic Obstructive Pulmonary Disease (COPD); [updated 2021, cited 02 July 2024]. Available from:

  6. Guo-Parke H, Linden D, Weldon S, Kidney JC, Taggart CC. Mechanisms of Virus-Induced Airway Immunity Dysfunction in the Pathogenesis of COPD Disease, Progression, and Exacerbation. Frontiers in Immunology. 2020; (11).

  7. Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M ET AL. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respiratory Research. 2024;18;11(1).

  8. Hurst JR, Skolnik N, Hansen GJ, Anzueto A, Donaldson GC, Dransfield MT et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. European Journal of Internal Medicine. 2020; 3 (73):1-6.

  9. GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report). Accessed 03 July 2024.

  10. Skajaa N, Laugesen K, Horváth-Puhó E, et al. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respiratory Research. 2023;10(1).

  11. Miravitlles, M., Ribera, A. Understanding the impact of symptoms on the burden of COPD. Respiratory Research. 2017; 18 (67).

  12. Mansfield E, Bryant J, Regan T, Waller A, Boyes A,  Sanson-Fisher, R. Burden and Unmet Needs of Caregivers of Chronic Obstructive Pulmonary Disease Patients: A Systematic Review of the Volume and Focus of Research Output. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2016; 13(5): 662–667. 

  13. Chen S, Kuhn M, Prettner K, et al. 2023. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health 11(8): e1183-e93.

  14. Bakthavatsalu B, Walshe C, Simpson J. The experience of hospitalization in people with advanced chronic obstructive pulmonary disease: A qualitative, phenomenological study. Chronic Illness. 2023; 19(2):339-353. 

  15. Ho TW, Tsai YJ, Ruan SY, Huang CT, Lai F, Yu CJ. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12).

  16. Yale Medicine. Chronic Obstructive Pulmonary Disease (COPD); [updated 2024; cited 02 July 2024]. Available from: D

  17. Diab N, Gershon AS, Sin DD, et al. 2018. Underdiagnosis and overdiagnosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 198(9): 1130-39.

  18. Kostikas K, Price D, Gutzwiller FS, et al. 2020. Clinical Impact and Healthcare Resource Utilization Associated with Early versus Late COPD Diagnosis in Patients from UK CPRD Database. Int J Chron Obstruct Pulmon Dis 15: 1729-38.

  19. Jensen HH, Godtfredsen NS, Lange P, Vestbo J. Potential misclassification of causes of death from COPD. European Respiratory Journal. 2006; 28(4): 781-5.

  20. Stolz D, Mkorombindo T, Desiree M Schumann et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet. 2022; 10356 (400): 921-972.

  21. Curtis J.R. Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal. 2008; 32(3):796-803.

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