Having a health condition that affects your breathing can be an unsettling experience. It can also significantly limit the things you’re able to do and the activities you enjoy. Maybe you have trouble breathing when you’re exercising. Or perhaps it’s a more constant presence in your daily life.

There are many things, both temporary and long-term, that can cause difficulty breathing, and one of the most common conditions is COPD. According to the Centers for Disease Control and Prevention (CDC), COPD affects 16 million Americans, making it one of the most prevalent health conditions in the country.

So, how is COPD different from asthma and other lung conditions? And can it be improved? We’ll cover COPD symptoms, causes, treatment and prevention, as well as the best first steps to take if you find you’re having trouble breathing.

What is COPD?

COPD (short for chronic obstructive pulmonary disease) is a progressive inflammatory lung condition that slowly restricts airflow, making it harder to breathe over time.

COPD affects millions of people in the US, and there are millions more who don’t know they have it. Women make up more than half of people with COPD, and according to the CDC, it’s one of the country’s leading causes of disabilities and mortality. COPD can also contribute to other health complications, including frequent respiratory infections, heart problems, high blood pressure in lung arteries and depression.

COPD is a chronic (long-term) disease, but there are ways to help prevent it – primarily by not smoking or quitting smoking. While it isn’t possible to reverse the lung damage caused by COPD, there are ways to help manage the symptoms and improve your quality of life, including lifestyle changes and medication options.

The two types of COPD

The two main forms of COPD are chronic bronchitis and emphysema. The majority of people with COPD have both types, although the severity of each of them varies by person.

Chronic bronchitis

Chronic bronchitis is a condition that results from repeated irritation in the lungs’ airways (called bronchial tubes or bronchioles). That irritation causes inflammation (tissue that’s swollen or inflamed), and thick mucus forms in the airways, making it hard for air to travel to the lungs. Chronic bronchitis causes shortness of breath, coughing, excess mucus and other pulmonary symptoms.

Emphysema

Inside our lungs are tiny air sacs (called alveoli) that act like balloons. They inflate with air when you breathe in and deflate when you breathe out. For someone with emphysema, those air sacs are damaged and lose their natural elasticity. The inner walls of the alveoli weaken and rupture, which creates larger air spaces in the lungs. The surface area of the lungs is reduced, and so is the amount of oxygen that makes it to the bloodstream, causing shortness of breath, coughing and other respiratory symptoms.

What’s the difference between asthma and COPD?

Asthma and COPD are both lung diseases that make it hard to breathe. But while the two can have similar symptoms (and do sometimes overlap) they are distinct conditions.

COPD is the term for two progressive respiratory conditions, chronic bronchitis and emphysema. COPD gets worse over time, even with treatment, and it’s primarily caused by smoking or pollutants in someone’s environment.

Asthma is a condition that causes the lungs’ airways to become inflamed and narrower (often triggered by allergens, infections like the common cold, exercise or cold air), making it hard to breathe. Symptoms of asthma include wheezing, shortness of breath, coughing and producing extra mucus. Asthma can be a lifelong condition, but its severity typically goes through cycles of worsening symptoms followed by improvement. There’s no cure, but it can be successfully managed with medications and other methods to maintain a good quality of life.

Asthma can have multiple causes, including genetics or environmental factors. Like COPD, asthma can be worsened by poor air quality in one’s environment or workplace.

Symptoms of COPD

Signs of COPD vary from person to person, but the main symptoms typically include:

  • Chronic (long-term) cough
  • Mucus that comes up when you cough
  • Shortness of breath (especially during physical activity)
  • Wheezing
  • Frequent respiratory infections
  • Weakness
  • Weight loss due to lack of appetite (in later stages)

Signs that COPD may be getting worse

As COPD progresses, even doing simple tasks like getting dressed or making dinner can cause shortness of breath. When it gets harder to eat or exercise, the body needs to use more energy for breathing, causing weakness and unintended weight loss from low appetite.

Note: Serious or sudden symptoms of difficulty breathing may require emergency medical care. If you’re experiencing trouble breathing, sudden shortness of breath, chest pain, lightheadedness, nausea, mental fogginess, or have a bluish tint to your lips, fingers or toes, call 911.

What does COPD feel like?

Someone in the early stages of COPD may notice that they get tired or out of breath more quickly when using the stairs, and that they have a cough that just won’t seem to go away.

More advanced COPD gives someone those same symptoms but with more intensity. They’ll notice that their breathing problems are beginning to limit their quality of life and the activities they’re able to do.

For those with severe COPD, shortness of breath and a wet (producing mucus), hacking cough are almost constantly present. The mucus and inflammation are significantly blocking those bronchial airways and breathing becomes labored. The extra energy needed for breathing can cause weight loss and weakness, making even simple physical efforts very difficult.

What causes COPD?

COPD can have several causes, but the majority of people develop it from inhaling irritants like tobacco smoke, dust or chemical fumes that damage their lungs. The biggest offender of these is smoking, but it could also happen from poor air quality and other irritants in someone’s environment. Still, 30% of COPD cases happen to people who have never smoked. And there are many smokers who never end up developing the disease. Let’s look at the different causes of COPD more closely.

COPD and smoking

Smoking is by far the most common cause for COPD, and also a common trigger for COPD flare-ups. An estimated 30-40% of smokers develop COPD. When someone inhales smoke, they’re pulling dangerous chemicals into each of their tiny airways. Over time (and it doesn’t take long for even minor damage and irritation to begin) that lung pollution begins to irritate and harm bronchioles, air sacs and the lining of the lungs.

Many people wonder, Can COPD get better if you quit smoking? The answer is yes. COPD is a progressive disease, so while quitting smoking won’t cure it, taking that step can make significant improvements to your health. Quitting smoking when you have COPD can reduce irritation and inflammation, improve coughing and chest tightness, and prevent further damage and depletion of lung function.

If you’re ready to quit smoking, your primary care doctor can work with you to help make that happen. They can connect you with health coaches, quitting aids and other resources so you have support behind you as you make this important change.

Alpha-1 deficiency

Some people have a rare genetic form of COPD where the body doesn’t make sufficient amounts of a protein that protects the lungs called alpha-1-antitrypsin (AAt). AAt is made by the liver and its job is to protect the lungs. Only 1% of COPD patients have an AAt deficiency, but it can cause liver or lung disease, and sometimes both.

AAt deficiency is hereditary and can be screened for using a blood test, which may be a good idea if you have a family history of COPD or if you develop early onset COPD.

Environmental factors

Certain things in your immediate environment (whether at work or home) can lead to COPD if you’re exposed to them frequently. These irritants include secondhand smoke, dust, chemical fumes or vapors, and pollution. COPD is often considered an occupational hazard because people who are in contact with irritants like these daily or for long periods are at a higher risk for developing the disease.

How is COPD diagnosed?

If you think you may have signs of COPD, talking to a primary care doctor is a great first step toward finding out what’s going on. The doctor will take a well-rounded look at your health, including your symptoms, your medical history, your lifestyle habits (such as whether you smoke, or have in the past), what you do for work, and the air quality in your daily environment.

Next, they’ll do a physical examination, which often involves taking your blood pressure, listening to your heart and lungs, and examining your legs and ankles for any swelling.

There are also several tests doctors use to help them form a diagnosis when someone is experiencing shortness of breath and other lung symptoms.

  • Pulmonary function tests – A full set of pulmonary function tests tend to provide the best diagnosis. This involves going into a clear box to measure lung capacity volumes and the lung’s ability to pick up oxygen.
  • Spirometry – For this test, you blow air into a tube that’s attached to a machine. It measures the amount of air you can exhale, and how fast you can do it.
  • Pulse oximetry – This simple test measures the amount of oxygen in your blood. A pulse oximeter device is a small, painless clamp that’s placed over one finger for a few seconds to get a reading.
  • Arterial blood gases (ABGs) – For these tests, a sample of blood is taken from an artery (usually from your wrist or arm) to look for carbon dioxide retention in the blood. This type of testing is usually done when someone is extremely overweight or appears to have severe COPD symptoms.
  • Chest X-ray or CT scan – These imaging tests help doctors look for changes in the lungs that may be caused by COPD (or another condition).

Managing symptoms: Living with COPD

While there’s no cure for COPD, there are a variety of treatment methods doctors use to help manage the condition and improve quality of life. These treatments focus on relieving symptoms like coughing and shortness of breath, as well as preventing respiratory infections that can make COPD worse.

  • Quit smoking – For smokers, the first step in treatment is to quit smoking.
  • Avoid environmental irritants – Avoid environments with poor air quality, including smoke, secondhand smoke, chemicals and other irritants at work or at home.
  • Medications – Certain medicines can be used to improve symptoms like coughing, wheezing and shortness of breath. Doctors also prescribe antibiotics to fight infections.
  • Careful prevention and treatment of respiratory infections – Lung infections can create serious complications for people with COPD. It’s important to avoid them as much as possible and treat them early if they do happen. And vaccines for illnesses like COVID-19, the flu and pneumonia are extra important if you have COPD.
  • Supplemental oxygen – For those with consistently low blood oxygen levels, it may be necessary to have a portable oxygen tank on hand.
  • Pulmonary rehabilitation – During pulmonary rehabilitation, a combination of exercise, lifestyle education and nutritional counseling can be used to improve your ability to breathe, as well as other symptoms.

Prevention: How can I avoid COPD?

The number one way to avoid developing COPD is to not smoke. This includes cigarettes, tobacco pipes, marijuana and vapes. And if you currently smoke, know that quitting smoking can help you prevent COPD or significantly improve your COPD symptoms and lung health if you have it.

Aside from smoking, the next biggest way to prevent COPD is to avoid environments with poor air quality. Poor air quality means air with dust, smoke, gasses, high pollution, chemicals or fumes. Anything that irritates your lungs when you breath it.

Every now and then we might experience poor air quality for a short time – for example, breathing in smoke from a campfire when the wind changes direction. But frequent exposure to damaging irritants can be very harmful to your lungs and many other areas of your health. And lung pollution can begin at any age, so it’s important for parents to protect their kids’ health by ensuring they live in an environment with good air quality.

Talk to a doctor about shortness of breath

If you’re experiencing shortness of breath, even if you don’t have other signs of illness, make an appointment with your primary care doctor.

Your primary care doctor can help you understand what you might be experiencing. They may recommend some tests to diagnose what’s causing your breathing trouble, or if additional expertise is needed, they can connect you with a pulmonologist (lung health specialist) for more specialized care if needed.