Living With COPD
What You Need to Know About This Silent Lung Disease
Chronic Obstructive Pulmonary Disease—better known as COPD—is one of the most common chronic illnesses affecting adults, particularly older adults, worldwide. And yet, it remains underrecognized until it’s well-advanced. In this post, we’ll break down what COPD is, how it develops, who’s at risk, what symptoms to watch for, how it’s treated, and what living with the disease may look like over time.
What Causes COPD?
At its core, COPD is an inflammatory condition that narrows the airways and damages the alveoli (the tiny air sacs in the lungs). The disease typically results from long-term exposure to lung irritants. Here are the main culprits:
- Smoking (cigarettes, cigars, pipes) – the #1 cause
- Occupational hazards – coal dust, fumes, silica, grain dust
- Indoor air pollution – wood-burning stoves, biomass fuel
- Outdoor pollution – especially in cities or industrial zones
- Genetics – especially a rare condition called alpha-1 antitrypsin deficiency
Most people who develop COPD are over age 40 and have a history of smoking, but it’s not exclusive to smokers.
How COPD Develops
In people with COPD, years of exposure to irritants cause chronic inflammation in the airways. This leads to:
- Swelling and narrowing of the air passages
- Destruction of alveolar walls (especially in emphysema)
- Increased mucus production (as seen in chronic bronchitis)
- Air trapping in the lungs, reducing oxygen exchange
It’s a slow and irreversible process. By the time symptoms appear, significant lung damage may have already occurred.
Symptoms: What to Watch For
COPD symptoms often sneak up gradually and are easy to ignore or misattribute to aging. Common signs include:
- Persistent cough (especially one that produces phlegm)
- Shortness of breath (especially on exertion)
- Wheezing or noisy breathing
- Chest tightness
- Frequent respiratory infections
- Fatigue or lack of stamina
- Bluish lips or fingertips in later stages (a sign of low oxygen)
Episodes where these symptoms suddenly worsen are called exacerbations—and they can be serious.
How COPD is Diagnosed
The gold standard for diagnosis is a spirometry test.
What’s the FEV1/FVC Ratio?
This simple lung test measures how much air you can force out in one second (FEV1) and the total amount you can exhale after a deep breath (FVC). If your FEV1/FVC ratio is less than 0.70, that’s a strong sign of airflow obstruction—a hallmark of COPD.
Normal: FEV1/FVC ≥ 0.75–0.80
COPD: FEV1/FVC < 0.70
Doctors may also order chest X-rays, blood oxygen tests, or CT scans to rule out other conditions or assess lung damage.
Treating COPD: What’s Possible?
There’s no cure—but treatment can help you feel better, breathe easier, and live longer. Here’s how it’s managed:
1. Stop Smoking
This is the most important intervention. Quitting smoking slows progression—no matter what your stage.
2. Inhalers (Bronchodilators)
These help open narrowed airways. There are short-acting types for quick relief and long-acting types for daily control.
3. Inhaled Steroids
Used to reduce inflammation and prevent flare-ups, especially for people who have frequent exacerbations.
4. Pulmonary Rehab
A supervised program that includes exercise training, nutrition advice, and education. Proven to improve quality of life.
5. Oxygen Therapy
Recommended if blood oxygen is low. Some people need it 24/7; others only during activity or sleep.
6. Surgical Options
Rarely, procedures like lung volume reduction or lung transplants are used in severe cases.
How COPD Progresses
The GOLD system stages COPD into four levels based on spirometry and symptom severity:
| Stage | FEV1 % Predicted | Description |
| I | ≥80% | Mild |
| II | 50–79% | Moderate |
| III | 30–49% | Severe |
| IV | <30% | Very Severe |
As COPD worsens, daily tasks like climbing stairs, shopping, or even talking can become exhausting. Exacerbations may increase in frequency and severity.
What’s the Outlook?
COPD is a chronic, lifelong condition. But the prognosis varies:
- If caught early and managed well, many people live long, active lives.
- If left untreated, it can lead to respiratory failure, heart problems, and frequent hospitalizations.
- Advanced cases can progress to Cor pulmonale (right-sided heart failure) which may develop due to chronic low oxygen levels and pulmonary hypertension.
- Respiratory failure can occur in advanced stages, requiring mechanical ventilation.
Doctors sometimes use a tool called the BODE Index to estimate risk. It includes:
- Body mass index (low BMI = worse outlook)
- Obstruction (how bad the lung damage is)
- Dyspnea (breathlessness level)
- Exercise tolerance (walking distance)
The Bottom Line
COPD is common, serious, and often preventable. If you have a chronic cough, get winded easily, or have a history of smoking or exposure to lung irritants, talk to your doctor about spirometry testing.
Lifestyle changes, especially quitting smoking, make the biggest difference. Medications and rehabilitation programs can dramatically improve your quality of life.
Early action matters—and it’s never too late to start breathing better.
References
- CDC COPD Facts https://www.cdc.gov/copd/index.html
- NIH – National Heart, Lung, and Blood Institute https://www.nhlbi.nih.gov/health/copd
- GOLD COPD Guidelines https://goldcopd.org/
The Harmful Grip of Cigarette Smoking
By John Turley
On October 24, 2024
In Commentary, Medicine
Addiction, Health Risks, and the Benefits of Quitting
Cigarette smoking remains one of the leading causes of preventable death worldwide. In the more than 65 years since the US Surgeon General first required health warnings to be placed on cigarette packs, significant progress has been made in reducing the rates of smoking. In 1965 about 45% of US adults were smokers and today fewer than 12% smoke on a regular basis. Youth smoking rates have also declined dramatically. In recent years fewer than 5% of high school students report smoking on a regular basis. In my high school class (1966) the smoking rate was probably closer to 30%. As encouraging as these numbers are, there is no acceptable rate of smoking, and I hope those of you who don’t smoke will pass this article on to family or friends who do.
The Power of Nicotine Addiction
Nicotine, the primary addictive substance in cigarettes, is remarkably potent. When inhaled, it travels to the brain within seconds, where it stimulates the release of dopamine, a neurotransmitter that creates a feeling of pleasure and relaxation. Over time, the brain rewires itself, craving nicotine to maintain these pleasurable effects, leading to dependency.
The addictive nature of nicotine makes quitting extremely difficult, as withdrawal symptoms, including irritability, anxiety, difficulty concentrating, and intense cravings, can deter many smokers from quitting. Nicotine also increases heart rate and blood pressure, contributing to the stress-relief paradox: although many smokers feel cigarettes help them relax, the substance actually exacerbates stress on the cardiovascular system.
Smoking can be tied to our daily routines. Some people have commonly have a cigarette with morning coffee or after meals. Other people reach for a cigarette when they’re on the telephone. Social settings and peer influence can make quitting difficult. Attending social gatherings where smoking is common can reignite cravings. A smoker who decides to quit can feel surrounded by the temptations to resume smoking.
There are a number of other factors also that make it difficult to quit smoking. There’s a lack of immediate health benefits noted. Improvements like better lung function, reduced cancer risk or long terms outcomes are not noted right away. Some smokers fear weight gain more than they fear the effects of smoking and will delay any attempts at cessation because of that. Some smokers also feel frustration because after a few days without a cigarette they think “I don’t feel any better, what’s the point?”
Health Risks: Nicotine and Smoke by-products
Cigarette smoke contains over 7,000 chemicals, many of which are toxic. Among these are tar, carbon monoxide, formaldehyde, and heavy metals like cadmium and lead. Some chemicals are carcinogens, contributing to the development of cancer, while others damage tissues and organs in less visible but no less harmful ways.
The Benefits of Quitting Smoking
It’s never too late to quit smoking, and the benefits begin almost immediately after quitting.
The Deceptive Appeal of Vaping
Unfortunately, the rise of e-cigarettes, also known as vaping, has emerged as an alternative to smoking among many people. E-cigarettes deliver nicotine through vapor rather than smoke. While they eliminate some of the harmful byproducts like tar and carbon monoxide, vaping is not without risks. Some vaping products contain toxic materials not contained in tobacco. Especially custom or self-blended cartridges for vape pens that may have carcinogenic or otherwise harmful additives not readily obvious to the user. Unfortunately, many adolescents and young adults who have never smoked cigarettes have developed a nicotine addiction through e-cigarette use.
Conclusion
There is no safe level of use of tobacco or other forms of nicotine. Quitting smoking improves quality of life, reducing the frequency of respiratory infections and improving overall energy levels. For long-time smokers, the prospect of reversing years of damage may seem daunting, but research consistently shows that health outcomes improve at any point, even decades after quitting. If I could give my smoking patients only one piece of medical advice it would be: “Quit smoking and quit now”. And I know how hard it is. I quit smoking 53 years ago and for many years afterwards it remained a daily struggle. But eventually, with the help and support of my family I was able to get past my tobacco cravings.