Understanding COPD: A Comprehensive Guide for Better Lung Health

Understanding COPD: A Comprehensive Guide for Better Lung Health

By Naeem Mustafa

PharmaServePK Blog

December 25, 2025

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition that makes breathing increasingly difficult over time. It affects millions worldwide and is a leading cause of morbidity and mortality. In Pakistan, where air pollution, smoking, and indoor biomass fuel exposure are significant concerns, COPD poses a particular challenge to public health.

Understanding COPD

What is COPD?

COPD is an umbrella term for lung diseases that cause airflow blockage and breathing-related problems. It primarily includes:

Emphysema: Damage to the air sacs (alveoli) in the lungs, reducing oxygen exchange.

Chronic Bronchitis: Long-term inflammation of the bronchial tubes, leading to mucus production and coughing.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 report, COPD is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases.

Causes and Risk Factors

The primary cause of COPD is prolonged exposure to irritants that damage the lungs and airways. Key risk factors include:

Tobacco Smoking: The leading cause globally, responsible for most cases.

Air Pollution: Outdoor pollution and indoor smoke from biomass fuels (common in rural Pakistan).

Occupational Exposure: Dust, chemicals, and fumes in workplaces like textile mills or mining.

Genetics: Rare conditions like alpha-1 antitrypsin deficiency.

Infections and Age: Repeated respiratory infections and aging increase vulnerability.

In Pakistan, studies indicate a prevalence of around 2.1% in adults over 40 years, though underdiagnosis is common due to limited access to spirometry testing.

Symptoms of COPD

Symptoms often develop slowly and worsen over time:

Persistent cough with mucus (sputum)

Shortness of breath, especially during physical activity

Wheezing and chest tightness

Frequent respiratory infections

Fatigue and unintended weight loss in advanced stages

Early symptoms are often dismissed as "smoker's cough" or aging, delaying diagnosis.

Diagnosis

Diagnosis involves:

Medical history and symptom assessment

Spirometry: A lung function test measuring airflow. The GOLD 2025 guidelines emphasize pre-bronchodilator spirometry, where a FEV1/FVC ratio ≥ 0.7 can rule out COPD in most cases, with post-bronchodilator confirmation of < 0.7 for diagnosis.

Imaging: Chest X-rays or CT scans to rule out other conditions

Blood tests: To check for eosinophil levels or genetic factors

Early diagnosis is crucial for better management.

Treatment and Management

While COPD is not curable, treatments can significantly improve quality of life, slow progression, and reduce exacerbations (flare-ups).

Pharmacological Options

Bronchodilators: The cornerstone of treatment. Inhaled medications relax airway muscles.

Short-acting (e.g., albuterol) for quick relief.

Long-acting (LABA or LAMA) for maintenance.

Dual Therapy: LABA + LAMA combinations are recommended as initial treatment for most patients (GOLD 2025).

Inhaled Corticosteroids (ICS): Added for patients with frequent exacerbations and high blood eosinophils (triple therapy: LABA/LAMA/ICS).

Other: PDE4 inhibitors (e.g., roflumilast) for severe cases; new options like ensifentrine (dual PDE3/PDE4 inhibitor) and biologics for specific phenotypes with chronic bronchitis and high eosinophils.

Proper inhaler technique is essential for effective delivery of medication.

Non-Pharmacological Approaches

Smoking Cessation: The most impactful intervention.

Pulmonary Rehabilitation: Exercise, education, and nutrition advice.

Oxygen Therapy: For severe cases with low blood oxygen.

Vaccinations: Annual flu shots, pneumococcal, and others as recommended.

Lifestyle Changes: Avoid pollutants, maintain a healthy diet, and stay active.

Prevention and Outlook

The best way to prevent COPD is to avoid smoking and reduce exposure to lung irritants. Quitting smoking at any stage can slow disease progression.

With proper management, many people with COPD can lead active lives. However, early detection and adherence to treatment are key.