COPD (Chronic Obstructive Pulmonary Disease)

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COPD is a chronic progressive lung condition. You can treat the symptoms of COPD with various medications including inhalers and mucolytics.


Treatments

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About

What is COPD?

COPD is chronic obstructive pulmonary disease. This means that it is a long-term condition affecting the lungs. There are two main types of COPD: emphysema and chronic bronchitis. Emphysema is a breakdown of the lung tissue that causes breathing difficulties. Whereas, in chronic bronchitis, inflammation leads to excessive mucous production, which causes problems with breathing and increases your risk of chest infections.

How COPD develops

COPD develops slowly over time. Exposure to harmful substances, such as cigarette smoke, causes inflammation to develop in your lungs. In emphysema, this inflammation causes the destruction of the small airspaces in your lungs, called alveoli. The alveoli are very important for the absorption of oxygen when you breathe. In chronic bronchitis, the inflammation causes your lungs to produce excessive amounts of mucous. This narrows your airways and makes it harder to absorb oxygen. The mucous also provides a sticky surface that makes it harder to clear infectious pathogens from your lungs, making you more susceptible to chest infections.

COPD causes

COPD is caused by long-term exposure to noxious substances, such as cigarette smoke, air pollution, dust and chemicals fumes. Over time, this causes chronic inflammation of your lungs, leading to the development of COPD. COPD can also be caused by a genetic mutation, called alpha-1 antitrypsin deficiency. This type of COPD runs in families and causes the lung tissue to lose its elasticity.

Can you get COPD without smoking?

Smoking is the most common cause of COPD, however, you can get COPD without smoking. COPD can also be caused by a genetic mutation (see below), or by exposure to other harmful substances. This could involve long term exposure to air-pollution or inhaling dust, chemicals or fumes in the workplace or home. Occupations at greater risk of developing COPD include farmers, bakers, miners, dock workers, bakers, foundry workers, petroleum workers, potters, stonemasons, welders and quarry workers. In recent years, various improvements in health and safety have been made in these professions. If required, PPE (personal protective equipment), such as protective masks, should be provided by your employer, to protect you from exposure to harmful substances and subsequent health problems.

Can COPD be hereditary?

In rare cases, COPD can be hereditary. In these cases, COPD is caused by a genetic mutation resulting in alpha-1 antitrypsin deficiency (A1AD). A1AD is responsible for maintaining the elasticity of your lung tissue. Elasticity is important for normal breathing, so people with A1AD often develop COPD. A1AD is more likely to be the cause of your COPD if you have multiple generations of COPD in your family, or if you have COPD without a history of smoking or exposure to harmful substances.

Will COPD go away?

COPD is a chronic progressive lung condition. COPD does not go away and will continue to worsen over time. COPD treatments help to alleviate the symptoms of COPD, but they do not cure the disease. The only thing that can slow the progression of COPD is quitting smoking. If you struggle to do this, even just reducing the amount you smoke can have an effect.

COPD and smoking

COPD has a strong relationship with smoking. It is thought that 85-90% of COPD cases are caused by cigarette smoking. However, if you are diagnosed with COPD, reducing smoking is the only factor that can have an impact on the progression of your disease. Ideally, you would quit smoking entirely, but if you can’t manage that, reducing the amount you smoke, can also make a difference.

What is the life expectancy of someone with COPD?

COPD is known to reduce life expectancy. In people who have never smoked, COPD has only a small impact on life expectancy. But in smokers (including former smokers), it can dramatically shorten your life. 5 years after diagnosis, only 40-70% of people with COPD will still be alive, depending upon the severity of COPD. For severe COPD, the 2-year survival rate is just 50%, meaning that half of those diagnosed with severe COPD will not be alive 2 years after diagnosis.

Symptoms

COPD early symptoms

The symptoms in the early stages of COPD can be quite mild. You may find that you have a constant dry cough or that you produce mucous. You may also experience shortness of breath, particularly during exercise. However, it is important to remember that COPD is a progressive condition, so whilst it may be mild initially, it will progress to more severe disease.

How COPD progresses

As COPD progresses, the symptoms can become more severe. You may feel breathless more easily and find it harder to undertake normal daily activities. In severe cases, even just walking across a room can cause breathlessness. The only way to slow the progression of COPD is to give up smoking, if you are a smoker, and to reduce your contact with second-hand smoke as much as possible.

How is COPD diagnosed?

If you have symptoms of COPD, such as difficulty breathing, a chronic productive cough (cough with mucus) and previous history of smoking, or exposure to other noxious substances, your doctor may recommend you have spirometry to diagnose COPD. Spirometry involves breathing into a tube, to measure how deeply you can breathe and how quickly the air moves out of your lungs. Once you have done your spirometry test, the results will be reviewed by a specialist and sent back to your doctor to discuss the results with you.

COPD exacerbation symptoms

A COPD exacerbation is a temporary worsening of your COPD symptoms. You may experience more coughing, wheezing or shortness of breath than usual. This can cause you to feel more tired, but you may experience difficulty sleeping. Most commonly, exacerbations are caused by a chest infection, especially in people with chronic bronchitis. The excess mucus produced in chronic bronchitis makes you more susceptible to chest infections. The symptoms of a chest infection include: coughing up green or yellow mucus, producing more mucus than normal and having difficulty breathing. You may also experience a fever, chest pain and muscle aches.

What does COPD do to the lungs?

COPD affects the respiratory system in several different ways depending upon whether you have emphysema or chronic bronchitis. In emphysema, delicate parts of the lungs - the alveoli - are damaged. This reduces the elasticity of the lung tissue, making it harder to breathe. It also reduces blood flow to the lungs, which means that you won’t absorb as much oxygen from the air, and more carbon dioxide may remain in your bloodstream. 

In chronic bronchitis, the lungs become inflamed and develop a thick layer of mucous. Normally your lungs produce a small amount of mucus to clear away any debris or bacteria that you inhale. However, in chronic bronchitis, the mucus is thick and sticky, so it is not easily cleared away by the lungs and it can actually trap pathogens, giving them a place to infect the lungs. This is why people with chronic bronchitis are more prone to chest infections. As in emphysema, the exchange of carbon dioxide and oxygen is also affected in chronic bronchitis, but in this case, it is due to the mucous blocking the airways.

How COPD affects daily life

COPD can have a significant impact on daily life. In the early stages of COPD, the disease can be mild, but in later stages, even limited activity, like walking across a room, can cause breathlessness. In later stages, people with COPD may need to use a wheelchair and can become dependent on oxygen.

Will COPD make you tired?

COPD can make you feel breathless and more tired than normal. This is because people with COPD generally absorb less oxygen from their lungs, which can make you feel tired or breathless, especially during physical activity.

What is the relationship of COPD to lung cancer?

COPD and lung cancer share common causes such as smoking. Therefore, COPD is considered to be a major risk factor for lung cancer. Not everyone with COPD will go on to develop lung cancer, but it does increase your risk. Approximately 1 in 100 people with COPD develop lung cancer each year.

How does COPD cause cor pulmonale?

Cor pulmonale is a condition in which the right side of the heart thickens, leading to right-sided heart failure. This tends to occur in chronic bronchitis rather than emphysema. The increased mucous levels reduce the exchange of oxygen and carbon dioxide in the lungs. The artery that supplies the lungs narrows in response to this, increasing the blood pressure inside the lungs (pulmonary hypertension). In response, the right side of the heart has to work harder to get blood into the lungs. Over time the heart muscle on the right side of the heart will thicken to compensate for the increased workload. The thickened muscle causes the heart to lose its elasticity which increases the pressure required to fill the right side of the heart. Eventually, the heart may become unable to pump sufficient blood to the lungs. 

COPD and emphysema

Emphysema is a type of COPD. In emphysema, inflammation of the lungs causes a break-down of small air sacs in your lungs called alveoli. These small air sacs provide a large surface area for the exchange of oxygen and carbon dioxide in the lungs. Damage to the alveoli reduces the gas exchange in the lungs, leading to breathlessness and other problems.

COPD and chronic bronchitis

Chronic bronchitis is one type of COPD. In chronic bronchitis, lung inflammation causes a thick layer of mucus to develop in the airways of the lungs. This can make breathing more difficult and also makes infections more likely to occur.

Treatment

Can COPD be cured?

COPD is a chronic progressive condition and unfortunately, it cannot be cured. Various treatments are used in COPD to alleviate the symptoms, but these symptoms will continue to worsen over time. The only intervention that can slow the progression of COPD is quitting smoking or reducing your use of tobacco products. Therefore, if you do smoke, it is highly recommended that you quit, to improve your life expectancy and quality of life with COPD. 

COPD when to take antibiotics

Your doctor will let you know when you should take antibiotics. It is important that you take antibiotics as prescribed to avoid developing an antibiotic-resistant infection. If you experience frequent exacerbations, you may be prescribed long-term antibiotics to reduce the number of exacerbations. Alternatively, you may be prescribed antibiotics for each exacerbation you experience. If you are prescribed antibiotics for any other purpose, you should also take them as instructed by your doctor.

Which COPD inhalers contain steroids?

Not everyone with COPD will be prescribed steroid inhalers. Steroids can be found in ‘preventer inhalers’. These are inhalers that you must take every day and they are usually brown in colour. Examples include Flixotide and Qvar inhalers. Steroids are also found in ‘combination inhalers’. Combination inhalers contain several different ingredients and they are designed to reduce the number of inhalers you need to use. Examples of combination inhalers containing steroids include: Fostair and Trimbow.

Side Effects

How does COPD affect the heart?

COPD can lead to right-sided heart failure. This is more common in chronic bronchitis than emphysema. In COPD, there is reduced area for gas exchange in your lungs. This means that you don’t take in as much oxygen and you don’t lose as much carbon dioxide. This can cause the blood vessels that supply your lungs to narrow. This increases the blood pressure in your lungs. To compensate for this, the right side of the heart works harder to pump blood through the lung tissue. Over time, the heart muscle can thicken and it won’t be able to function properly. Heart failure occurs when the heart is unable to pump blood sufficiently. This can also cause fluid to leak into other tissues in your body, causing swelling (oedema) and fluid in your lungs, which can make breathing more difficult.

Can COPD cause back pain?

Back pain is associated with COPD. Many people with COPD use muscles in their back to help them breathe, which can lead to back pain. In addition, the diaphragm, a muscle at the base of the lungs, usually moves up and down with breathing, but in COPD the lungs can be over-inflated, restricting the movement of the diaphragm. Aside from breathing, the diaphragm is also involved in stabilising the lower back, which can result in lower back pain.

Can COPD cause chest pain?

Chest pain is common in COPD, but can have various causes:

  • People with COPD are more prone to acid reflux, which can lead to a burning chest pain. 
  • COPD is an inflammatory disease. The chronic inflammation can damage the tissue that covers the lungs, known as the pleura. This can cause pain on inhalation.
  • Spasms or constriction in the small airways in the lungs can also cause chest pain.
  • Long-term overinflation of the lungs in COPD can cause damage to the joints between the ribs and the breastbone (sternum) or the ribs leading to chest pain. 
  • Muscles between the ribs can also be put under stress in COPD, resulting in chest pain.

How COPD causes pulmonary embolism

People with COPD are at a greater risk of pulmonary embolism than the general population. A pulmonary embolism is a blood clot affecting the lungs. There are several reasons that people with COPD are at an increased risk of pulmonary embolism including:

  • Immobility - people with COPD often find it difficult to move around and exercise. Sitting still for long periods of time can increase your risk of blood clots, including pulmonary embolism. 
  • Inflammation - COPD is an inflammatory condition caused by exposure to harmful substances such as cigarette smoke. Inflammation also increases your risk of blood clots.
  • Polycythemia - Polycythemia is a condition in which you have more red blood cells than normal. This occurs in COPD, because people with COPD often have lower levels of oxygen than normal. Higher levels of red blood cells causes your blood to thicken, which increases your risk of blood clots and pulmonary embolism.

Why COPD causes weight loss

COPD can cause weight loss, because breathing and other activities of daily life require much more energy than usual. If you don’t increase the amount you eat, this will cause you to lose weight, as you will use more energy than you take in from your food. When this happens, the body breaks down fat and muscle for energy instead. In addition, people with COPD can lose their appetite, due to feeling breathless whilst eating or due to depression, which is common in people with COPD.

Are COPD patients immunocompromised?

People with COPD are not immunocompromised, as their immune system continues to function as normal. However, they are more prone to respiratory infections. This is because COPD can cause a build-up of mucus in the lungs. Pathogens can stick to this mucous, causing infection.

Q&A

Are COPD and emphysema the same thing?

One type of COPD is emphysema. In emphysema delicate parts of the lung tissue (the alveoli) have broken down. This causes breathing difficulties, as the lungs lose their elasticity and surface area, which can make breathing more difficult.

Are COPD and chronic bronchitis the same thing?

There are two types of COPD: emphysema and chronic bronchitis. Chronic bronchitis is a chronic inflammation of the lungs. This causes excessive mucus production in the lungs. This excess mucus makes breathing more difficult and can give you a cough. It also provides a sticky surface that makes you more prone to lung infections.

What is the difference between COPD and asthma?

Asthma and COPD are similar conditions, but they are not the same. Both asthma and COPD involve inflammation of the airways, but in COPD, this is usually caused by exposure to toxic substances, such as cigarette smoke. COPD is a progressive disease that worsens over time, whereas, asthma can improve as you get older, and asthma attacks are generally treatable and short-lived. Therefore, COPD has a significant impact upon quality of life and life expectancy compared to asthma.

What COPD stands for

COPD stands for chronic obstructive pulmonary disease. This means that it is a long-term disease of the lungs.

Can COPD stay mild?

COPD is a progressive disease, so it will continue to worsen over time. However, if you are a smoker, quitting smoking can dramatically reduce the progression of the disease, so your COPD will remain ‘mild’ for longer.

Why COPD patients retain CO2

COPD impairs the exchange of oxygen and carbon dioxide in the lungs during breathing, leading to less oxygen being absorbed into the bloodstream and less carbon dioxide leaving the bloodstream. In emphysema, this is because the alveoli (small air sacs in the lungs) are destroyed, resulting in reduced surface area for gas exchange. In chronic bronchitis, the mucous forms a barrier, impairing gas exchange across the surface of the lungs.

COPD is it a disability?

Having a diagnosis of COPD doesn’t entitle you to disability benefits, such as the personal independence payment (PIP), however, if your COPD requires you to have care or mobility needs, prevents you from working or is causing you to think about giving up work, you may be eligible for welfare benefits in the UK. The UK government website provides more information about eligibility and how to apply. It is worth bearing in mind that you may be entitled to more assistance, as your disease progresses, so it is important to review your situation regularly.

COPD and wood-burning stoves - are they related?

The smoke from wood-burning stoves can contribute to the development of COPD or worsen pre-existing COPD. The smoke contains fine particles that can damage your lungs. Not everyone with a wood-burning stove will develop lung problems, like COPD. But children, older adults and those with pre-existing lung conditions are more vulnerable to the toxins in the smoke. There are several alternatives to wood-burning stoves including natural gas stoves and heaters, or electric heating, which do not carry the same risks.

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