Progression of COPD: What to know

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COPD is a progressive disease, which means it can worsen over time. Initial symptoms may be mild and progress without detection. The Centers for Disease Control and Prevention (CDC) estimate that more than 50% of people with COPD are unaware they have it.

Some common signs and symptoms of COPD are:

• a persistent cough
• coughing that produces excess mucus
• shortness of breath
• difficulty performing physical activity
• wheezing or whistling while breathing
• chest tightness

Some people with COPD may experience more frequent colds and cases of flu than average, while others may experience a few or none of these symptoms. However, for those who do, symptoms can worsen over time and cause complications that include:

• being unable to work
• difficulty with daily activities, such as climbing stairs
• the need for a portable oxygen tank to breathe
• confusion or memory loss
• frequent visits to the hospital
• experiencing depression, anxiety, and other mental health issues
• developing other chronic conditions, such as arthritis or diabetes

GOLD guidelines and FEV1

Pulmonologists will follow the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, which use the spirometry results from the forced expiratory volume in 1 second (FEV1) to help stage the disease.

However, the FEV1 only captures one component of COPD severity. This means that two patients with the same FEV1 can have a different exercise tolerance and prognosis.

Other aspects of COPD, such as the severity of symptoms and risk of exacerbations, are also important to the patient’s overall prognosis. Newer staging systems, such as the revised GOLD classification, include these aspects. Two important results of spirometry are:

• Forced vital capacity (FVC). This is a measurement of lung capacity that tests how much air a person can exhale after breathing in as deeply as possible.
• Forced expiratory volume (FEV1). This measurement refers to how much air someone can force out of their lungs in 1 second when performing the FVC.

Doctors use the FEV1 score to determine the stage of COPD, which may be:

• mild: FEV1 above 80%
• moderate: FEV1 between 50–79%
• severe: FEV1 between 30–49%
• very severe: FEV1 below 30%

There is currently no cure for COPD. A person’s treatment plan may alleviate symptoms, slow disease progression, and help to maintain quality of life. During the early stages, treatment may begin with lifestyle changes. More severe cases are likely to require medication and other forms of treatment.

The National Heart, Lung, and Blood Institute states that quitting smoking is the most important step for treating COPD. This could involve using tobacco substitutes, joining support groups, and avoiding environments or social situations that involve pressure to smoke.

People who develop COPD from other irritants in the environment may also need to reduce their exposure to dust, chemicals, or other pollutants. In some cases, this might involve changing jobs or living environments.

These lifestyle changes may be effective for mild cases. However, other treatments may be necessary as the disease progresses, including:

• medication, such as bronchodilators that relax the airways
• vaccinations, such as flu shots to reduce the risk of serious complications from the infection
• pulmonary rehabilitation, which aims to improve lung functioning through methods such as exercise programs and counseling
• oxygen therapy, which involves breathing oxygen from a tank at certain times of the day
• surgery, such as a lung transplant in the most severe cases

The type of treatment given will depend on several factors, such as disease severity and a person’s overall health.

COPD can have a major impact on daily living, particularly in the more severe stages. Treatment can help slow the progression and manage mild to moderate symptoms enough to minimize disruptions to everyday life.

However, the disease can progress to have a more substantial impact on daily living. For example, frequent episodes of COPD exacerbations can limit or prohibit physical activity and going to work. People with COPD are also at risk of complications, such as developing pneumonia from the flu.

COPD is the result of exposure to irritants that cause damage to the airways over time. According to the CDC, tobacco smoke is the most common cause of COPD onset and progression.

The American Lung Association states that 85–90% of COPD cases result from cigarette smoking. However, nonsmokers can also develop COPD. Breathing in secondhand smoke and other irritants, such as air pollution or dust, can also contribute to COPD.

In rare cases, COPD can result from an inherited genetic condition that limits the body’s ability to produce alpha-1 antitrypsin proteins, which protect the lungs.

The CDC indicates that the following groups of people are more likely to develop COPD:

• women
• people ages 65 years and over
• unemployed people
• people with less than a high school education
• people who smoke or who previously smoked
• people with asthma
• American Indians and Alaska Natives

According to the CDC, many people have COPD without realizing it, particularly during its early stages. The disease can have a serious impact on well-being and may be fatal. An early diagnosis can improve treatment outcomes and slow disease progression.

For these reasons, anyone experiencing signs or symptoms of COPD should see a doctor for evaluation. People who smoke should be particularly aware of these signs. Doctors can diagnose COPD with spirometry, which is a simple and reliable test.

COPD is a progressive disease, which means it can worsen over time. Symptoms may be mild during the early stages but can become more severe and significantly impact daily life.

Treatment for COPD will depend on its severity and can range from lifestyle changes to oxygen therapy. Anyone experiencing signs or symptoms of COPD should see a doctor for a spirometry test.