Chronic Obstructive Pulmonary Disease (COPD)

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a ‘heterogeneous lung condition charaterised by chronic respiratory symptoms (dyspnoea, cough, expectoration, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction’.

Common questions about COPD

How prevalent is COPD?

COPD is the third highest cause of death globally and affects around 12% of the general population.

What are the risk factors for COPD?

Risk factors for COPD include:

• Smoking
• Ambient air pollution, including nitrogen dioxide
• A low body mass index (BMI)
• Indoor biomass burning
• Childhood asthma
• Occupational dust exposure
• Diet
• Genetic abnormalities, such as α1 antitrypsin deficiency

How is COPD diagnosed?

Spirometry is necessary to diagnose COPD by determining the ratio of forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC). A post-bronchodilator FEV₁/FVC of <0.7 indicates the presence of persistent airflow obstruction and confirms a diagnosis of COPD. Further investigation is undertaken to assess symptoms, disease severity and risk of exacerbations (ECOPD), which is defined as ‘an event characterised by dyspnoea and/or cough and sputum that worsen over <14 days’.

How can COPD be managed without pharmacological therapy?

Non-pharmacological approaches include maintaining a healthy environment to avoid active and passive smoking and limiting exposure to air pollution; maintaining a physical activity routine; and pulmonary rehabilitation programmes.

What pharmacological therapies are available for COPD?

Currently available pharmacological therapies aim to improve airflow with bronchodilators (β₂-adrenoceptor agonists or muscarinic receptor antagonists), suppress inflammation with corticosteroids or phosphodiesterase 4 (PDE4) inhibitors, or reduce exacerbations with antibiotics. Numerous therapies, including biologics that target cytokines known to be involved in type 2 inflammation, are under clinical investigation for reducing exacerbations or mortality in COPD.

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