Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition causing progressive airflow limitation, most commonly resulting from long-term exposure to tobacco smoke or indoor air pollution from cooking fires.

• Chronic cough, often with sputum production
• Progressive shortness of breath, especially on exertion
• Wheeze and chest tightness
• Frequent chest infections
• In advanced disease: weight loss and reduced exercise tolerance

• Long-term tobacco smoking is the leading cause.
• Prolonged exposure to indoor air pollution from biomass cooking fires is an important cause, particularly among women in settings with poor kitchen ventilation.
• Occupational exposure to dust or fumes can also contribute.

• Diagnosed based on a history of chronic respiratory symptoms and significant exposure (such as smoking or biomass smoke) together with evidence of persistent airflow limitation on spirometry where available.
• Chest X-ray may be used to assess for complications or to rule out other conditions.
• Assessed for severity based on symptom burden and frequency of exacerbations.

Stopping smoking (or reducing indoor smoke exposure) is the single most effective measure to slow disease progression and should be addressed at every visit.

An inhaled bronchodilator, such as salbutamol, is used for symptom relief; a long-acting bronchodilator is added for ongoing maintenance in more persistent disease.

An inhaled corticosteroid may be added in patients with frequent exacerbations, similar to asthma management.

Acute exacerbations (worsening cough, sputum, and breathlessness) are treated with increased bronchodilator use, a short course of oral corticosteroids, and an antibiotic if there are signs of bacterial infection, with oxygen and hospital admission for severe exacerbations.

Pulmonary rehabilitation and vaccination against influenza and pneumococcal disease help reduce exacerbations and improve quality of life.

• Avoid smoking and support smoking cessation if already a smoker.
• Reduce indoor air pollution by improving kitchen ventilation or using cleaner cooking fuels where possible.
• Stay up to date with influenza and pneumococcal vaccination.
• Seek prompt treatment for chest infections to prevent complications.