What Patients Need to Know About COPD

Commentary09/30/25 Robert A. Wise, MD, Johns Hopkins Asthma and Allergy Center

When people talk about the dangers of smoking, chronic obstructive pulmonary disease (COPD) is one of the conditions they’re talking about. In fact, smoking is the most important cause of COPD.

COPD is a common cause of death, accounting for about 140,000 deaths in the United States each year. It takes people with COPD longer to exhale all the air from their lungs, often because of narrowing and damage in the airways. This causes air to be trapped in the lungs. Over time, it leads to chronic cough, shortness of breath, limitations in physical activity, and an increased risk of contracting respiratory infections.

While COPD is a leading cause of death, people can take steps to control the condition. There are treatments that can improve people’s quality of life and help them live longer with COPD. Here are 4 things individuals and caregivers should know about COPD.

1. COPD encompasses other respiratory conditions

COPD is an umbrella term that includes chronic obstructive bronchitis and emphysema.

Chronic bronchitis is defined as cough that produces sputum for at least 3 months during 2 consecutive years. When chronic bronchitis involves airflow obstruction, it qualifies as chronic obstructive bronchitis. Emphysema is defined as widespread and irreversible destruction of the alveolar walls (the cells that support the air sacs, or alveoli, that make up the lungs) and enlargement of many of the alveoli. Doctors often perform lung function testing to help confirm the diagnosis.

Chronic bronchitis and emphysema can occur together in the same person. The most important determinant of how the person feels and functions is the severity of the airflow obstruction.

While often linked to environmental factors like smoking, COPD can also be hereditary. In people who develop COPD at a young age, especially when there is a family history of COPD, the level of alpha-1 antitrypsin in the blood is measured to determine whether alpha-1 antitrypsin deficiency is present. If the level is low, further genetic tests, sometimes using a buccal (cheek) swab or a fingerstick (dried blood spot), may be done to confirm whether the disorder is present. This genetic disorder is also suspected when COPD develops in people who have never smoked.

2. COPD is different from asthma

Asthma is another very common respiratory disease that can cause similar symptoms to COPD. In addition to having a cough that produces sputum, people with both asthma and chronic bronchitis can have wheezing, shortness of breath, and partially reversible airflow obstruction. Some people can also have both COPD and asthma at the same time. This is called Asthma-COPD overlap syndrome. People with both disorders are treated primarily for asthma.

One key difference between COPD and asthma is that airflow obstruction in asthma is completely reversible in most people, either spontaneously or with treatment. With COPD, although airflow obstruction due to emphysema is not typically reversible, bronchial smooth muscle spasm, inflammation, and increased secretions are all potentially reversible. Inhaled medications are available in various forms, including handheld metered-dose inhalers, dry powder inhalers, and nebulizers, and can help relax muscles in the airway and relieve symptoms of COPD.

Both COPD and asthma can have flare-ups, also known as exacerbations. Asthma flare-ups can be triggered by allergies, infection, and even exercise. On the other hand, with COPD, these flare-ups are typically triggered by a viral infection or exposure to high levels of air pollution. COPD flare-ups are characterized by worsening shortness of breath and the production of excessive yellow or green phlegm. They should be treated as soon as possible.

3. Early treatment can help

One of the biggest myths surrounding COPD is that there’s nothing that can be done about it. The reality is, there are effective treatments that can improve exercise capacity, reduce symptoms, improve overall lung function, and extend survival. COPD often takes years to progress, and the earlier individuals can take proactive steps to address it, the better.

Maintaining a generally healthy lifestyle is an important step. That includes maintaining a normal body weight, regular exercise, and a healthy diet. In addition to medications like inhaled medications, all people with COPD should receive an influenza vaccination every year. Pneumococcal vaccination as well as vaccination against COVID-19 and respiratory syncytial virus (RSV) also help.

4. It’s never too late to quit smoking

The biggest thing individuals can do to improve their health when it comes to COPD is to quit smoking. Stopping smoking when the airflow obstruction is mild or moderate often lessens cough, reduces the amount of sputum, and slows the development of shortness of breath. Stopping smoking at any point in the disease process provides some benefit.

When it comes to quitting, it’s best to try several strategies at once, including:

Committing to a specific date for quitting
Using behavioral modification techniques (making cigarettes difficult to obtain or rewarding oneself for abstaining for increasingly long periods of time)
Group counseling and support sessions
Nicotine replacement (chewing nicotine gum, wearing a nicotine skin patch, or using a nicotine inhaler, nicotine lozenge, or nicotine nasal spray).
Medications designed to decrease tobacco cravings

There are many resources for individuals with COPD to find a community and learn about the disease. The COPD Foundation provides information on COPD diagnosis and treatment and tools to support people with COPD and their caregivers. The American Lung Association’s Better Breathers Club connects people living with lung disease to education, support, and each other.

To learn more about COPD, visit the Manuals page or the Quick Facts on the topic.