Condition
COPD: slowing it down is the whole game
COPD is airflow obstruction that does not fully reverse. It cannot be undone, but how fast it progresses is very much open to change, and breathlessness responds to treatment far more than most people expect.
What it is
Chronic obstructive pulmonary disease is long-term narrowing of the airways, usually from years of tobacco smoke, biomass and cooking smoke, or occupational dust. Unlike asthma, the obstruction does not fully reverse with a bronchodilator.
It is the third leading cause of death worldwide, and it is badly under-diagnosed: most people put the breathlessness down to age or weight and only arrive once they have lost a good deal of lung function. It is worth testing early, because the earlier the exposure stops, the flatter the rest of the curve.
This page is general information about the condition, written for patients. It is not a diagnosis, and it is no substitute for being examined.
Measuring it
How we find out, rather than assume
Each of these is done on site at the Tirupati centre, which is why most patients leave the first visit with an answer.
Post-bronchodilator spirometry
The test that makes the diagnosis. Airflow measured after a bronchodilator, which is what distinguishes COPD from asthma. No one should be labelled with COPD without it.
Six-minute walk test
How far you can walk in six minutes, and what your oxygen does while you do it. It measures the thing you actually care about.
HRCT chest
Shows emphysema, bronchiectasis and scarring that a plain X-ray misses, and answers whether something else is running alongside.
Arterial blood gas and oximetry
Tells us whether oxygen or ventilatory support is needed, rather than guessing from how you look.
Treatment
What care looks like
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1
Stopping smoking is the only intervention that changes the slope of the decline. Everything else treats symptoms; this treats the disease. The cessation clinic exists because willpower alone has a poor success rate and structured support roughly doubles it.
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2
Inhaled long-acting bronchodilators, chosen by how severe the obstruction is and how often you have flare-ups, together with pulmonary rehabilitation - the structured exercise and breathing programme that improves walking distance more reliably than any inhaler.
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3
Vaccination against influenza and pneumococcus, prompt treatment of flare-ups, home oxygen where it is genuinely indicated, and follow-up that continues between the bad spells rather than only during them.
Questions
Asked most often
Answered the way we would answer them in the room. If yours is not here, ring the clinic and ask.
Related services
Is COPD reversible?
The airflow obstruction is not, but a great deal else is. Breathlessness, exercise capacity and the number of flare-ups a year all improve with treatment, and stopping smoking slows the loss of lung function at any age and any stage.
Is COPD the same as asthma?
No. Both narrow the airways, but asthma varies and largely reverses, while COPD is persistent. Spirometry before and after a bronchodilator separates them, and some people have features of both, which changes the treatment.
Will I end up on oxygen?
Most people with COPD never need home oxygen. It is prescribed on measured blood oxygen levels, not on how breathless someone feels, and it is assessed properly rather than assumed.
I have smoked for thirty years. Is it too late to stop?
No. Lung function lost does not come back, but the rate of further loss falls towards that of a non-smoker within a few years of stopping, at any age. Cough and breathlessness usually improve within months.