Chronic obstructive pulmonary disease (COPD)

Overview

Chronic obstructive pulmonary disease (COPD) is a long-term (chronic) lung condition. The airways, the tubes that carry air in and out of the lungs, become swollen and narrow, and the tiny air sacs at the end of the airways can be damaged (emphysema). Air cannot flow out of the lungs easily, and this blockage usually does not go back to normal. People have breathlessness, a cough that does not go away, often with phlegm (mucus coughed up from the chest), and tiredness. Symptoms usually start in middle age and get slowly worse over the years.

COPD is very common and very serious. The World Health Organization reports that it was the third leading cause of death in the world in 2023, causing about 3.4 million deaths. Almost 9 in 10 COPD deaths in people under 70 happen in low- and middle-income countries such as Pakistan. Smoking is the main cause, but in these countries smoke from burning wood, animal dung, crop waste or coal for cooking and heating is also a major cause, especially for women.

The lung damage cannot be reversed, but a lot can be done. Stopping smoking, avoiding smoke, inhaled medicines that open the airways, vaccines and an exercise and education programme called pulmonary rehabilitation help people breathe more easily, stay active and have fewer flare-ups (sudden periods when symptoms get worse).

Symptoms

• Shortness of breath, at first only during activity such as walking or climbing stairs, later even with light effort
• A cough that keeps going for a long time, usually bringing up phlegm
• Wheezing (a whistling sound when breathing)
• Frequent chest infections
• Tiredness and low energy
• Waking at night feeling breathless
• In advanced disease, weight loss and swollen ankles from fluid build-up (oedema)
• Flare-ups, when breathlessness, cough or phlegm suddenly get worse over a few days, often after a chest infection

Causes and risk factors

Causes

• Smoking tobacco, the main cause; the risk grows with how much and how long a person has smoked, and breathing other people's smoke also adds to the risk
• Smoke from burning wood, animal dung, crop waste or coal indoors for cooking and heating (household air pollution)
• Breathing in dust, fumes or chemicals at work over many years
• Lungs that did not grow fully, for example after poor growth before birth, being born early or severe chest infections in childhood
• A rare inherited condition called alpha-1 antitrypsin deficiency, which makes the lungs easier to damage

What makes it more likely

• Being a current or former smoker, especially over the age of 35
• Cooking for many years over a wood, dung or coal fire, particularly in a poorly ventilated kitchen
• Living with someone who smokes indoors
• Working in dusty or smoky jobs where fumes or chemicals are breathed in
• Outdoor air pollution
• Asthma in childhood
• Being born early or having had severe chest infections as a child
• A family history of alpha-1 antitrypsin deficiency

Complications

COPD raises the risk of chest infections, including pneumonia, and of lung cancer. It is also linked with heart disease, weak muscles, thin and brittle bones (osteoporosis), and depression and anxiety. Acid reflux (GERD) is common and is linked to more flare-ups. Each flare-up can take four to six weeks to recover from, and some people never get back to how they were before. In severe disease the lungs may not be able to keep enough oxygen in the blood, and some people need oxygen at home or a breathing machine in hospital. Over time the disease can seriously limit daily life and can be life-threatening.

Diagnosis

A doctor should think of COPD in anyone with breathlessness, a long-lasting cough or phlegm, or repeated chest infections, especially if they are over 35 and smoke or used to smoke, or have breathed in smoke from cooking fires or dust at work. The doctor asks about symptoms, smoking and other exposures, and examines the chest.

The diagnosis is confirmed with spirometry, a simple breathing test in which you blow out as hard and fast as you can into a machine. The test is repeated after a reliever inhaler. If the airflow is still blocked after the reliever, this confirms COPD. Spirometry also helps to tell COPD apart from asthma; other conditions such as bronchiectasis, anaemia and heart failure can cause similar symptoms. The doctor also assesses how breathless you are, how COPD affects your daily life and how many flare-ups you have had. If symptoms continue despite treatment, further lung tests, exercise tests or scans may be arranged. In many low- and middle-income countries spirometry is not easy to get, so COPD is often missed; ask whether a breathing test is available.

Treatment

1. Stop smoking. This is the most important step for anyone with COPD who smokes. Nicotine replacement, other stop-smoking medicines and counselling all make quitting more likely to succeed. Also avoid second-hand smoke, cooking smoke and other air pollution as much as possible
2. Get vaccinated against influenza, pneumococcal disease (a common cause of pneumonia) and COVID-19, and other vaccines your doctor advises
3. Use inhaled bronchodilators (medicines that open the airways): a short-acting reliever for quick relief, and usually one or two long-acting bronchodilators taken every day. The doctor chooses the medicines and device based on your symptoms, flare-up risk, side effects, other illnesses, cost and how well you can use the inhaler, and should check your inhaler technique regularly
4. Join a pulmonary rehabilitation programme if one is available. Supervised exercise with education about COPD improves breathing, fitness and quality of life at every stage of the disease
5. If flare-ups keep happening despite long-acting bronchodilators, and a blood test shows raised eosinophils (a type of white blood cell), the doctor may add an inhaled corticosteroid (steroid inhaler)
6. During a flare-up, extra short-acting inhalers or nebulised medicine are used; the doctor may prescribe a short course of steroid tablets for a severe flare-up and antibiotics when an infection is likely. Daily long-acting treatment should be started or continued as soon as possible afterwards
7. In severe disease, long-term oxygen at home helps people whose blood oxygen is very low at rest, and a small number of people may benefit from surgery or a lung transplant. Other conditions such as heart disease, osteoporosis, depression and reflux are treated as usual

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Antibiotics for flare-ups when the doctor thinks a bacterial infection is likely (the doctor chooses which one), Nicotine replacement therapy and other stop-smoking medicines prescribed by a doctor, Long-term oxygen therapy at home for people with very low blood oxygen at rest, Non-invasive ventilation (breathing support through a mask) in hospital for severe flare-ups, and at home for some people with severe disease

Self-care and prevention

Self-care

• Stop smoking completely and keep your home and car smoke-free; ask your doctor or pharmacist for help to quit
• Use your daily inhalers every day, even when you feel well, and ask your pharmacist or doctor to check your inhaler technique
• Cut down smoke in the kitchen: where possible cook with gas or a cleaner stove instead of wood, dung or coal, and keep the kitchen well ventilated
• Stay as active as you can and join pulmonary rehabilitation if it is offered
• Keep your vaccines up to date, including the flu vaccine every year
• Learn the early signs of a flare-up and agree with your doctor what to do when they happen
• Avoid dusty or smoky places and heavy outdoor air pollution when you can
• Tell your doctor if you feel low or anxious; depression and anxiety are common with COPD and can be treated

Prevention

• Do not start smoking, and if you smoke, stop; quitting at any stage prevents further lung damage
• Use cleaner cooking fuel such as gas, an improved cookstove or better ventilation to reduce indoor smoke
• Protect yourself from dust, fumes and chemicals at work
• Keep children away from tobacco smoke and cooking smoke, as their growing lungs are easily harmed
• If you already have COPD, vaccines, daily inhalers and pulmonary rehabilitation help prevent flare-ups

Common questions

Can COPD be cured?

No. The lung damage in COPD is permanent and there is no cure. But stopping smoking, avoiding smoke, inhaled medicines, vaccines and pulmonary rehabilitation can ease symptoms, reduce flare-ups and help people stay active. Starting treatment early gives the best chance of slowing the damage.

Can someone who has never smoked get COPD?

Yes. In low- and middle-income countries, tobacco explains only about a third of COPD cases. Smoke from cooking with wood, dung, crop waste or coal, dust and fumes at work, outdoor air pollution, poor lung growth in early life and a rare inherited condition can all cause COPD in non-smokers.

Is COPD the same as asthma?

No, although the two can look alike and sometimes overlap. A breathing test (spirometry) helps the doctor tell them apart: in COPD the airflow stays blocked even after a reliever inhaler. The right treatment depends on which condition you have, so an accurate diagnosis matters.

Is it worth stopping smoking after COPD has been diagnosed?

Yes. Stopping smoking is the single most important thing a smoker with COPD can do, because it prevents further lung damage. Nicotine replacement, stop-smoking medicines and counselling make success more likely. E-cigarettes have not been shown to be a safe or effective way to quit.

Which vaccines should a person with COPD have?

Guidelines recommend vaccines against influenza, pneumococcal disease and COVID-19. Depending on age and local advice, vaccines against RSV, shingles and whooping cough (as part of the Tdap vaccine) may also be offered. Chest infections are a common trigger for flare-ups, so vaccines are an important part of care.

Sources

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Health Care Professionals (2025 Edition) (2025).
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2025 Report) (2025).
3. World Health Organization. Chronic obstructive pulmonary disease (COPD) (2026).
4. NHS (UK). Chronic obstructive pulmonary disease (COPD) - Symptoms - NHS (accessed 2026).
5. nidirect (Northern Ireland government, adapted from NHS content). Chronic obstructive pulmonary disease (COPD) (2026).
6. Environmental Science and Pollution Research (Springer), University of Essex repository. The state of indoor air quality in Pakistan - a review (Colbeck I, Nasir ZA, Ali Z. Environmental Science and Pollution Research 17(6):1187-1196, doi:10.1007/s11356-010-0293-3) (2010).
7. Rawal Medical Journal. Effect of biomass fuel and natural gas combustion on pulmonary function tests (PFTs) of females living in Karachi, Pakistan (Rashid MN et al. Rawal Medical Journal 39(2):163-166) (2014).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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