COPD
Chronic obstructive pulmonary disease: long-term lung damage, mostly from smoking, that narrows the airways and makes breathing harder over years. The damage can’t be undone, but quitting, lung rehab and the right inhalers help people breathe easier and do more.
Symptoms
- Breathlessness, first with effort (stairs, hills), later with everyday tasks.
- A long-term cough, often with phlegm.
- Chest infections that are more frequent or slow to clear, and tiredness.
- Flare-ups (exacerbations): a sudden worsening, often set off by a cold or flu.
- Early on there may be no symptoms, or they’re put down to ageing or being unfit.
Causes and risk factors
- Smoking is the main cause. About 1 in 4 or 5 people who smoke develop COPD, and past smoking still counts.
- Second-hand smoke, including before birth and in childhood.
- Dust, fumes and chemicals at work (such as mining, construction, farming and manufacturing) and air pollution.
- Childhood lung problems, tuberculosis, long-standing asthma, and a rare inherited condition (alpha-1 antitrypsin deficiency).
- Rates are higher among Aboriginal and Torres Strait Islander people.
How it’s diagnosed
- A breathing test (spirometry) measures how fast you can blow air out, before and after an inhaled medicine. It’s the test that confirms COPD.
- A chest X-ray or CT scan and blood tests may look for other causes.
- Ask for a test if you’re over 35, have smoked or worked with dust or fumes, and are breathless or coughing.
The COPD ladder
Quitting smoking, lung rehab and vaccines are the base everyone stands on. Inhalers are added in steps. Most people need several rungs at once.
- Step 1 · Self-careStop smoking, completelyCounselling plus medicine gives you the best chance.
- Works
- The most important thing you can do: it stops adding new damage and slows the decline
- Cost
- Quitline free; nicotine replacement and quit medicines on the PBS
- How long
- For good; most people need several attempts
- Watch for
- A slip isn’t failure. Get back on.
Every cigarette not smoked is a breath you get to keep.
- Step 2 · Self-careVaccinesYearly flu vaccine, pneumococcal vaccine, and keep COVID-19 and other recommended vaccines up to date.
- Works
- Fewer chest infections means fewer flare-ups and hospital stays
- Cost
- Often free for people with chronic lung disease; ask your GP or pharmacist
- How long
- Flu yearly; others as advised
- Watch for
- Mild sore arm and achiness for a day or two.
Five minutes in a chair that may save you a week in a hospital bed.
- Step 3 · ProgramPulmonary (lung) rehabilitationA supervised exercise and education program, usually over 6–8 weeks, with breathing and airway-clearance techniques.
- Works
- Improves quality of life, breathlessness and walking distance (about 40 metres more in 6 minutes). After a flare-up, it lowers the chance of going back to hospital
- Cost
- Varies; many hospital and community programs cost little or nothing. Ask your GP for a referral
- How long
- 6–8 weeks, then keep exercising
- Watch for
- Start within a few weeks of a flare-up if you can.
Yes, exercise makes you breathless. That’s the point: your muscles learn to need less oxygen.
- Step 4 · PrescriptionInhalers (relievers and long-acting inhalers)A reliever for breathlessness, then one or two long-acting openers once a day. An inhaled steroid is added for people with frequent flare-ups.
- Works
- Better breathing and fewer flare-ups. With tiotropium, a common long-acting inhaler, the share of people with a flare-up in a year fell from 44% to 38%
- Cost
- Under the $25 PBS co-payment per inhaler; $7.70 concession
- How long
- Daily, long term
- Watch for
- Dry mouth, mouth thrush with steroid inhalers (rinse after). Technique matters as much as the medicine.
Good inhalers can’t help if they end up on your tongue. Get your technique checked.
- Step 5 · PrescriptionA flare-up planA written COPD action plan, with steroid tablets and sometimes antibiotics to start early when symptoms worsen.
- Works
- Treating flare-ups early can shorten them and help keep you out of hospital
- Cost
- Under the $25 PBS co-payment
- How long
- Each flare-up, about 5 days of tablets
- Watch for
- Steroid tablets raise blood sugar and can affect mood and sleep.
Plan for the storm before it arrives.
- Step 6 · SpecialistHome oxygenFor people whose blood oxygen stays low at rest. Assessed by a respiratory specialist with blood tests.
- Works
- Used at least 15 hours a day, it helps people with very low oxygen live longer: in one trial, deaths over 3 years were 45% vs 67%
- Cost
- Funding varies by state and country
- How long
- Long term, ideally 15+ hours a day
- Watch for
- Never smoke or use open flames near oxygen: it’s a serious fire risk.
Oxygen isn’t for breathlessness alone; it’s for low oxygen levels.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- “Lung detox” teas and supplementsNo good evidence they repair lung damage or improve breathing. Quitting and rehab do.
- Stem cell treatments for COPDSold privately at high prices, but not proven to help in good trials. Ask your specialist before spending.
- Oxygen for breathlessness aloneHome oxygen helps people whose blood oxygen is low. It isn’t a treatment for breathlessness when oxygen levels are normal.
What you can do
- Quit smoking: call Quitline (13 78 48) and ask your GP about quit medicines.
- Ask your GP for a referral to pulmonary rehab, then keep moving with a community class afterwards.
- Get a written COPD action plan so you know what to do when symptoms worsen.
- Ask your pharmacist to check your inhaler technique at least once a year.
- Keep up your flu and pneumococcal vaccines.
- Stay active every day; rehab teaches you how hard to push.
See your GP if
- You’re over 35, have smoked or worked with dust or fumes, and are breathless or coughing
- You’re more breathless than usual, coughing up more phlegm, or the colour has changed
- You’ve had a flare-up and haven’t done lung rehab
- Your ankles are swelling or you’re unusually tired
Call 000 (Australia) or your local emergency number for severe breathlessness that stops you talking, walking or sleeping, blue lips or fingertips, confusion or drowsiness, chest pain, or a fast or irregular heartbeat. From a mobile, 112 works in most countries.
Common questions
Is COPD the same as asthma?
No. Asthma airways narrow and widen again; in COPD the narrowing is mostly permanent. Some people have features of both, and treatment is tailored.
Can my lungs heal if I stop smoking?
The damage already done doesn’t reverse, but quitting slows further loss of lung function at any age, and many people cough less within months.
Is it safe to exercise when I’m breathless?
Yes, in stable COPD. Pace yourself and use your reliever as your plan says. Lung rehab teaches you how far to push.
Will I need oxygen?
Most people with COPD don’t. Oxygen helps when blood oxygen is low at rest, which is measured with a blood test.
Helpful resources
- Lung Foundation Australia: Pulmonary rehab and Lungs in ActionHow rehab works, how to find a program, and the Lungs in Action community classes afterwards. Free information line 1800 654 301. Australia.
- National Asthma Council: Inhaler how-to videosCorrect technique for each type of inhaler, including those used for COPD. Australia.
- Quitting smokingOur guide to what works, from Quitline to medicines. Free, from us.
Evidence and more information
- Healthdirect: COPD
- Cochrane review of pulmonary rehabilitation for COPD (NIHR summary)
- RACGP: Pulmonary rehabilitation for COPD
- Cochrane: Tiotropium versus placebo for COPD
- Journal of Thoracic Disease: Long-term oxygen therapy for COPD
- NHS (nidirect): COPD
maladywise.com/copd/