What is COPD?

Chronic obstructive pulmonary disease (COPD) is the medical term used to describe a lung condition that causes the airways to narrow and become obstructed which in turn makes breathing difficult.[1]

When the term is broken down, you can see how the definition gets its meaning:

Chronic: a long-term and ongoing condition that won’t go away

Obstructive: the airways in your lungs have narrowed and become obstructed or blocked, making it difficult for them to move air out

Pulmonary: a condition that affects your lungs

Disease: a recognized medical condition 

COPD can be described as a disease of the airways (chronic bronchitis) and/or a disease of the air sacs (emphysema).

  • Chronic bronchitis is diagnosed when someone has symptoms of cough for a long time (many months or years) and coughs up phlegm, which is also called sputum or mucus. It is most often caused by smoking, but people who have never smoked who also work or live in places where they breathe dust, biomass fuels (e.g., firewood), chemical fumes, or domestic heating and cooking can also have chronic bronchitis. Gastroesophageal reflux disease (commonly called GERD) is also associated with this diagnosis. 

Chronic bronchitis is a result of irritation and inflammation of the bronchial tubes (airways) – the tubes responsible for carrying air through the lungs. The tubes swell and produce a build-up of mucus along the lining. Tiny hair-like structures in the tubes called cilia normally help move the mucus out of the airways, but sometimes they don’t work well. This causes build-up of mucus plugs that are hard to cough up and sometimes make it harder to get air in and out of the lungs. People with chronic bronchitis can also have symptoms of chest or abdominal pain.  

  • Emphysema is only diagnosed by lung imaging tests (like a CT scan) that show damage to the walls of the tiny air sacs in the lung at the end of the bronchial tubes – called alveoli – this damage makes them enlarged. The alveoli normally play a key role in transferring oxygen into your blood and filtering carbon dioxide back out. Emphysema develops over time, and not everyone with early emphysema has symptoms, but having emphysema can make it difficult to breathe because the enlarged air sacs trap air in the lung. Air trapping is diagnosed using lung function tests.

Approximately 380 million people worldwide are affected by COPD. It is the third leading cause of death behind heart disease and stroke.[2]

If you have chronic obstructive pulmonary disease, it gradually becomes harder to breathe. COPD is progressive, meaning the damage to your lungs can’t be reversed and may progress. Treatment, medication, and lifestyle adjustments can help you learn to manage it more effectively, control your symptoms, and may slow down the progression of COPD. 

The main symptoms include:

  • Getting easily breathless (a common term used for breathlessness is dyspnea) 
  • A persistent cough with phlegm
  • Frequent chest infections 
  • Wheezing, especially in cold weather

The symptoms might occur all the time, or they may get worse at certain times, such as when you have an infection or breathe in secondhand smoke, polluted air, or fumes.  These are called exacerbations, or flare-ups, of your COPD. It’s also possible to experience other symptoms with COPD, especially when the disease becomes more severe or you have other health issues (comorbidities) too. 

Some examples of other symptoms include:

  • Tiredness and lack of energy 
  • Swollen ankles, legs and feet, which is caused by a build-up of fluid (this is known as edema)
  • Losing weight unintentionally 
  • Experiencing chest pressure or pain
  • Coughing up blood – although this can be a sign of something else, so more tests may be required to rule out other conditions

If you have COPD and your symptoms worsen, or you’re unsure if a symptom is linked to COPD, contact your doctor or healthcare provider.

COPD develops due to long-term damage to the lungs that causes them to become inflamed or damaged, obstructed, and narrowed. Smoking is the main cause of COPD. However, not all smokers, even heavy smokers, develop COPD, and at least 20-30 percent of people with COPD are never smokers.[3]  

It is important to know that COPD can be prevented! Whether or not a person develops COPD in their lifetime is influenced by a complex mix of their environment and genetic makeup. For example, recent research suggests that having small airways relative to the size of the lungs could predispose people to a lower breathing capacity and an increased risk of COPD. Early life events like infection or a mother who smokes can put someone at risk for developing COPD.

Risk factors for COPD include:

  • Environmental contributors
    • Cigarette smoking or a history of smoking
    • Occupational (work) exposure to dust, fumes, or chemicals
    • Air pollution
  • Genetic risk factors (i.e., alpha-1 antitrypsin deficiency, a rare condition which makes people susceptible to COPD at a younger age)
  • Lung development and aging factors
  • Chronic infections (for example, HIV is associated with COPD)
  • Social and economic considerations
  • Frequent childhood chest infections or poor lung development

Smoking

As mentioned before, smoking is the main cause of COPD. Although not all people who smoke develop the condition, smoking cessation is highly recommended as a treatment given the link between smoking and cancer, heart disease, and other serious chronic diseases. There are several evidence-based methods and approaches to help in quitting smoking. Nicotine replacement therapies and medications have been shown to help.[4] Several organizations also offer support groups and coaches trained to support people quitting smoking. 

It is still too early to understand the long-term risks of vaping and early studies suggest that vaping is associated with lung disease.[4] The COPD medical and advocacy community generally discourages use of e-cigarettes and vaping, whether in place of tobacco smoking or as a smoking cessation tool. Talk to your healthcare team about what might work best for you.

Fumes and dust in the workplace

Nearly 24% of the global impact of COPD is caused by workplace exposure.[5] According to the UK’s National Health Service, some occupational dust and chemicals may cause COPD, especially if you breathe them in, including:[6]

  • Cadmium dust and fumes.
  • Grain and flour dust.
  • Silica dust.
  • Welding fuels.
  • Isocyanates.
  • Coal dust.

Air pollution

Household air pollution affects billions globally. Burning fuel on open fires for cooking and heating in poorly ventilated homes can be one of the main causes. This may put people in many developing countries – particularly women, who carry out the majority of cooking duties – at greater risk of COPD. Wood burning fireplaces and heaters also increase indoor air pollution.

We know that poor air quality in towns and cities can be harmful to our lungs, especially for people who already have heart or respiratory conditions. However, it’s not clear how that affects our chances of developing COPD, as more research is needed.[7]

Genetics

If you have a rare genetic condition called alpha-1-antitrypsin deficiency (AATD), you’re more likely to develop COPD. About 3.4 million people globally have AATD,[8] which is more common in people of European ancestry.[9] 

Alpha-1-antitrypsin is a chemical normally produced in the liver that protects our lungs from harmful substances and infections. People with AATD lack alpha-1 antitrypsin, and this can lead to developing COPD. You also might have COPD at a younger age and your COPD might progress more rapidly,[10] especially if you smoke.[11] If you smoke, it is therefore even more important to stop. Ask your doctor or healthcare provider what other health and lifestyle measures you can take and seek out support communities of others with Alpha-1.

People with COPD may have different types of inflammation that can be identified by measuring immune cells (for example, neutrophils or eosinophils) or proteins in sputum or different measures in exhaled air (FeNO). Recent improved understanding of these inflammation subtypes helps providers and drug developers target the best treatment approach.  

In most people with COPD, the most common type of inflammation is neutrophilic inflammation, especially people who are or were smokers. But 20–40% have Type 2 inflammation that is associated with high eosinophils.[12] In clinical trials, people with higher eosinophil levels responded better to treatment with inhaled steroids.[13]

If you experience persistent symptoms of COPD – such as increased breathlessness, a cough that won’t go away, wheezing, or frequent chest infections – regardless of your age or history of smoking, see your doctor or healthcare provider. 

Prevalence

How common is COPD? Worldwide, around 380 million people have COPD. In Europe, more than 36 million people have COPD – that’s four times the population of London.[14] COPD is both underdiagnosed and misdiagnosed. This is partly because COPD develops slowly over the years, so many people only start to recognize symptoms in their 50s.[15] Lack of access to appropriate testing and inconsistency in use of guidance related to diagnosis also contribute to this issue.[16]

COPD often impacts those with lower levels of education, income, and employment and is seen at higher rates in low- to middle-income countries. Researchers and the COPD advocacy community are working to address these inconsistencies.

The diagnostic process

How is COPD diagnosed? Several steps are involved in making a diagnosis of COPD. Your doctor will ask you about your symptoms and how they affect your daily life:

  • Breathlessness – is it persistent, has it worsened over time, is it worse if you exercise or do physical activity, does it happen at night or at other times?
  • Cough – does it come and go, does it produce phlegm, do you also wheeze?
  • Chest infections – how often do you get these?
  • Family/childhood history – do any of your close relatives have respiratory problems, how was your health as a baby and child?
  • Risk factors or exposures – are you a smoker or ex-smoker, does your job or home life bring you into contact with airborne pollution (e.g. dusts, vapours, fumes, gases, chemicals, smoke from home cooking, or heating fuels)?
  • Other symptoms – have you had any weight loss, ankle swelling, fatigue, chest pain or coughing up blood? These are less common, especially in mild COPD, and might point to a different diagnosis.

They’ll also listen to your chest with a stethoscope, take into account your age, and calculate your body mass index (BMI) from your height and weight. 

If your doctor suspects you have COPD, you will need a test called spirometry.

Spirometry measures your lung capacity and how quickly you can breathe air out. A result called forced expiratory volume in 1 second (FEV1) will measure how much air you force out of your lungs. This and other results can help your doctor tell if your lungs are obstructed or blocked. 

Spirometry is the current gold standard of testing for COPD; it can also help rule out other lung conditions, such as asthma (a chronic lung disease that inflames and narrows the airways). You may also have a chest X-ray, CT scan, or blood test to rule out other conditions and diagnose COPD. Regarding CT scans:

  • Annual low-dose CT scan (LDCT) is recommended for lung cancer screening in people with COPD due to smoking, according to recommendations for the general population.
  • Annual LDCT is not recommended for lung cancer screening in people with COPD that is not related to smoking, due to insufficient data to establish benefit over harm.

Important points:

What are “stages” of COPD? When diagnosed, you will hear about the severity of airflow limitation defined using lung function test grades GOLD 1 (mild)-4 (very severe), and whether you have emphysema. These definitions help your healthcare providers recommend the best treatment options for you.

It is not unusual to be unaware that you have COPD. COPD usually develops slowly over many years, so it’s not unusual to not know you have it. Some people assume that early symptoms – such as shortness of breath – are due to age, being out of shape, or having asthma, when in fact the cause could be COPD that can be treated early.

Therefore, most people are diagnosed with COPD in their 60s, but adults can have COPD at any age.

It is also important to know that after noticing symptoms, many people try to reduce their activities rather than seek medical advice. But as COPD can worsen, it is important to see your healthcare provider sooner rather than later. With the right treatment plan, people with COPD can live a full life. 

COPD is sometimes misdiagnosed as there are other lung conditions with similar symptoms, such as bronchiectasis and/or asthma or heart disease. But some people with COPD also have these conditions while having COPD as the risks for developing them are similar. 

Overview of Treatments

How is COPD treated? Although there is no cure for COPD, with the right treatment, it can be managed and treated to stop further damage to your lungs, improve your symptoms, and prevent flare-ups. Your clinical team will work closely with you to develop a personalized self-management plan to cover daily living and steps to take if you start to feel worse.

There are a variety of treatments available for COPD. Your doctor may prescribe:

  • Pulmonary rehabilitation will provide support on your journey to better health and helping you with guidance on best exercise, nutrition, and tools for smoking cessation. 
  • Inhaled medicines called bronchodilators, which relax the muscles around the airways, or other inhaled medicines taken through an inhaler or nebulizer.
  • Steroids given via an inhaler, to reduce swelling in your airways.
  • In some cases, medications to thin mucus are recommended for people who need help coughing up thick mucus/phlegm.
  • In some cases, you will get antibiotics or anti-inflammatory pills to reduce the risk of flare-ups (exacerbations).
  • In some situations, you may need surgery that can improve your symptoms.
  • In some cases, oxygen therapy via a home unit or small portable tank. 
  • In some situations related to flare-ups (exacerbations), breathing support through the form of non-invasive ventilation (NIV) or high flow nasal therapy (HFNT) will be provided.

It can sometimes be confusing to understand your devices or remember how and when to take medications. You are not alone; this is very common. It is most important to check in with your doctor or healthcare team, including your pharmacist, and ask any questions you have. Show them how you use your inhaler or nebulizer and talk through the steps; ask them to correct anything you might unknowingly be doing incorrectly. Remember too that supplemental (extra) oxygen is a prescribed medicine. With any medication, if you forget information about how much or how often to take it, ask for help. If you feel your inhaler or device is not a good fit for your needs, let your clinician know. Your healthcare team wants your treatment to provide you with the most benefit and can help you stay on track. 

Pulmonary rehabilitation

Pulmonary rehabilitation is an exercise, education, and support program. You will work with a respiratory professional to help you learn to exercise safely, live well with COPD, and breathe more easily. It is the most impactful approach for reducing hospitalization improving survival and reducing symptoms in people with COPD.[17,18] Pulmonary rehabilitation is also a source of social support and can help you avoid isolation. To attend a pulmonary rehabilitation program, either in person or virtually, you must have a prescription from your healthcare provider. 

Consider learning more about programs like Harmonicas for Health® which can help you to strengthen the muscles used for breathing, improve your quality of life, and connect you with a community of people who understand your experience with a lung condition.

Treating COPD exacerbations (flare-ups) 

How are COPD exacerbations treated? COPD flare-ups can be managed with an action plan – an approach decided upon by you and your doctor. Depending on your individual symptoms and treatment needs, your plan may include taking antibiotics or steroids to reduce your symptoms. With severe flare-ups, hospitalization may be needed. Following your healthcare team’s advice for treatment and management can help you to avoid flare-ups and keep your COPD stable. You can read more about action plans later on this page.

Treating Severe COPD

What is the best treatment for severe COPD? is a question asked often. There’s no single best treatment for severe COPD – the treatment your doctor recommends will depend entirely on your individual symptoms and circumstances, and your treatment will be tailored to your requirements. For severe COPD, you’re likely to require a combination of treatments, rather than a single treatment.

In severe cases of COPD due to emphysema, surgery is sometimes required to remove damaged parts of the lung, allowing the healthier parts to work better. In a small number of cases, a lung transplant may be an option.

Valve surgery

Endobronchial valve surgery is a newer procedure aimed at people who have severe emphysema. It involves putting tiny valves in the airways to block off the parts of the lungs that are damaged. This procedure can help reduce the pressure on your diaphragm, help the healthier parts of your lungs to work more efficiently and reduce breathlessness.

As with any chronic illness, it’s important that you stick to the prescribed routine and schedule of medications your doctor prescribes. This will give you the best chance of easing symptoms and avoiding flare-ups and possible hospitalization.

Future treatments

What are the newest treatments for COPD? Research in COPD is ongoing and as new treatments are found, they gradually become available to try. It takes time for new treatments to be approved, although you may be able to access a clinical trial. Speak to your doctor about what is available in your region and whether you are a suitable candidate. Patient advocacy groups often post clinical trials that are recruiting participants. There are a number of biologics and other novel medications in development.

Working with your doctor or other healthcare provider to manage your COPD can help slow its progression, reduce the risk of flare-ups, and keep symptoms under control. There are practical steps you can take to change your lifestyle habits and self-manage your symptoms. These may include:

  • Practicing breathing exercises. 
  • Quitting smoking. 
  • Taking regular exercise.
  • Maintaining a healthy weight and eating a healthy, balanced diet.
  • Taking medication as prescribed.
  • Staying up to date on vaccinations.
  • Attending to your emotional wellbeing.
  • Avoiding potential triggers such as traffic fumes, tobacco smoke, and dust.
  • Using a damp cloth to wet dust your home and remove dust particles. 

Let’s discuss some of these in more detail.

Breath management exercises

Breathing techniques and breath management exercises can help you manage breathlessness. Exercises such as pursed lip or diaphragmatic techniques are worth practicing regularly. They can help strengthen the muscles you use for breathing and boost your self-confidence, so you’ll know how to handle things if your breathlessness temporarily worsens. Some studies have found that combining the techniques and practicing several methods can improve COPD symptoms and quality of life.[18]

Pursed lip breathing 

Pursed lip breathing is simple to learn. It helps slow down your breathing, making it easier for the lungs to function, and helps keep your airways open for longer. It can be practiced at any time and used to help regulate your breathing when exercising.

  • Sit or stand and breathe in slowly through your nose.
  • Purse your lips, as if you were about to whistle.
  • Breathe out as slowly as you can through your pursed lips and aim to blow out for twice as long as you breathed in – it may help to count as you do this.
  • Repeat the exercise five times, building up over time to doing 10 repetitions.

Diaphragmatic breathing

  • Diaphragmatic breathing is a technique where you aim to breathe from your diaphragm, rather than your upper chest. It’s often also called ‘breathing from your belly’. Sit or lie down comfortably and relax your body as much as possible.
  • Place one hand on your chest and one on your stomach.
  • Inhale through your nose for up to five seconds, feeling the air move into your abdomen and your stomach rise. Ideally, you should be able to feel your stomach move more than your chest does.
  • Hold it for two seconds, then breathe out again for up to five seconds through your nose.
  • Repeat the exercise five times.

Breathing out hard or the ‘blow-as-you-go’ method 

The breathing out hard method is another to use when you’re being active. It can make it easier to do tasks that require effort.

  • Before you make the effort (such as standing up), breathe in.
  • While you are making the effort, breathe out hard. You may find it easier to breathe out hard while pursing your lips.

Exercising with COPD

When you’re diagnosed with COPD, it can be easy to fall into a cycle of inactivity. You may avoid activities that make you feel breathless or worry about coping if you experience breathing difficulties while exercising. However, exercise has been shown to help relieve COPD symptoms and improve your quality of life. Exercise can also help improve your physical strength and endurance, as well as build up the muscles you use to breathe. When these muscles are stronger, you won’t need to use so much oxygen, which will help reduce your breathlessness in daily life.

There is no single best exercise for someone with COPD, but there are plenty of good options you can try. People with COPD may find walking, tai chi, cycling (outdoors or on a stationary bicycle), using hand weights, or stretching to be helpful. If you need help staying with activity, find an exercise buddy or a friend with whom you can walk. Having company can help distract you from the fact that you are exercising and may boost your confidence if you’re concerned about being out of breath while on your own.

Before starting a new exercise program, speak to your medical practitioner for advice. They may even recommend a structured pulmonary rehabilitation program to help you exercise, learn more about your COPD, and connect with others who have lung conditions.

Although exercise is important, it’s not good to push yourself to exercise when you’re not feeling well or you are experiencing a flare-up. Talk to your doctor about using an oximeter (a device that measures oxygen in your blood) when exercising to check the oxygen level in your blood. Be sensible and, if you have any concerns about your symptoms, consult a medical practitioner.

Nutrition

Like many other health conditions, eating a healthy diet is beneficial. Combining a nutritious diet with regular exercise can help you to maintain a healthy weight — one that is neither too low nor too high for you. It can be difficult to determine what constitutes a healthy diet and what weight range is ideal for you. If you are unsure what is best for you to eat, ask your doctor or healthcare team for guidance. If available to you, a nutritionist can help you identify healthy foods and meals and achieve a balance that works for your lifestyle.

Emotional wellbeing

Living with COPD can put a strain on your mental and emotional wellbeing and that of your family and friends. Living with a chronic illness can wear you out and leave you feeling anxious, depressed, or low. In turn, this can make you less likely to be active, which can have an impact on your COPD.

It is important to look after yourself and take time to practice self-care. Make time to focus on yourself and do activities that are important to you. Talk to your doctor about the things you would like to be able to do. Explain to other people how you feel and consider joining a local or online support group or talking to a counselor. You do not need to manage COPD alone.

Vaccinations

COPD can also put you at higher risk of getting seriously ill from influenza (flu), respiratory syncytial virus (RSV), pneumonia, and COVID-19. It’s important to have the vaccinations that are recommended by your doctor and available in your country (e.g., an annual flu jab, pneumococcal vaccination, tDap, as well as COVID-19, RSV, and herpes zoster/shingles vaccinations, where available). Ask your doctor what vaccination schedule is right for you. It will also help to avoid crowded places, wear a face covering, keep your distance, and wash your hands often to reduce your risk. 

COPD management plans

A COPD management or COPD action plan is a guide to how to manage your condition on a day-to-day basis. This plan should be developed by you and your doctor specific to your personal goals and symptoms. Your plan should include prescribed medications, breathing exercises, diet and exercise, and emotional support. Another key part of a COPD management plan is to avoid potential triggers where possible (for example, exposure to air pollution, secondhand smoke, traffic fumes, smoking tobacco, and dust). If you currently smoke, quit smoking. Taking these steps can help reduce the risk of symptoms worsening or causing flare-ups. 

You will also agree with your doctor or healthcare team on what steps to take should your symptoms get worse. Be sure to revisit your plan regularly – at least every six months – so it is up to date. 

It is most important to know that with proper treatment, management, nutrition, exercise, pulmonary rehabilitation, and regular consultation with your doctor or healthcare team, you can improve your symptoms and live well with COPD. 

What is the life expectancy of people with COPD? This is a common question. There are many factors involved in life expectancy and there are no set numbers for people with COPD or any chronic condition. A person with COPD can see an improvement in their symptoms and have fewer flare-ups (exacerbations), especially if COPD is diagnosed early, and further lung damage can be prevented. Rather than focusing on a clock, TAKE CHARGE of managing your condition and work with your healthcare team to put together a COPD management plan that can be updated as your needs change. Connect with other patients by joining a community that provides support online or in your area. The Resources section below contains links to organizations that offer community support.  

Helpful Resources

References

1. GOLD. Global Strategy for Prevention, Diagnosis and Management of COPD: 2024 Report. GOLD webpage. Published November 2023. Accessed November 28, 2023. https://goldcopd.org/2024-gold-report/

2. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10(5):447-458. doi:10.1016/S2213-2600(21)00511-7

3. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet. 2022;400(10356):921-972. doi:10.1016/S0140-6736(22)01273-9

4. GOLD. Global Strategy for Prevention, Diagnosis and Management of COPD: 2024 Report. GOLD webpage. Published November 2023. Accessed November 28, 2023. https://goldcopd.org/2024-gold-report/

5. Syamlal G, Kurth LM, Dodd KE, Blackley DJ, Hall NB, Mazurek JM. Chronic Obstructive Pulmonary Disease Mortality by Industry and Occupation — United States, 2020. MMWR Morb Mortal Wkly Rep 2022; 71:1550–1554. DOI: http://dx.doi.org/10.15585/mmwr.mm7149a3.

6. NHS. Chronic Obstructive Pulmonary Disease (COPD) Causes. NHS Website. Updated April 11, 2023. Accessed November 8, 2023. https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/causes/

7. Ramírez-Venegas A, Velázquez-Uncal M, Aranda-Chávez A, Guzmán-Bouilloud NE, Mayar-Maya ME, Pérez Lara-Albisua JL, Hernández-Zenteno RJ, Flores-Trujillo F, Sansores RH. Bronchodilators for hyperinflation in COPD associated with biomass smoke: clinical trial. Int J Chron Obstruct Pulmon Dis. 2019 Aug 6;14:1753-1762. doi: 10.2147/COPD.S201314. 

8. Brantly M, Campos M, Davis AM, et al. Detection of alpha-1 antitrypsin deficiency: the past, present and future. Orphanet J Rare Dis. 2020;15(1):96. Published 2020 Apr 19. doi:10.1186/s13023-020-01352-5

9. Alpha-1 Foundation. What is Alpha-1? Alpha-1 Foundation website. Accessed 8 November 2023. https://alpha1.org/what-is-alpha1/

10. Stockley JA, Stockley RA, Sapey E. There is no fast track to identify fast decliners in Alpha-1 antitrypsin deficiency by spirometry: a longitudinal study of repeated measurements. Int J Chron Obstruct Pulmon Dis. 2021;16:835–840. doi:10.2147/COPD.S298585

11. Franciosi AN, Alkhunaizi MA, Woodsmith A, Aldaihani L, Alkandari H, Lee SE, Fee LT, McElvaney NG, Carroll TP. Alpha-1 Antitrypsin Deficiency and Tobacco Smoking: Exploring Risk Factors and Smoking Cessation in a Registry Population. COPD. 2021 Feb;18(1):76-82. doi: 10.1080/15412555.2020.1864725. Epub 2021 Feb 9. 

12. Rabe KF, Rennard S, Martinez FJ, et al. Targeting Type 2 Inflammation and Epithelial Alarmins in Chronic Obstructive Pulmonary Disease: A Biologics Outlook. Am J Respir Crit Care Med. 2023;208(4):395-405. doi:10.1164/rccm.202303-0455CI

13. GOLD. Global Strategy for Prevention, Diagnosis and Management of COPD: 2024 Report. GOLD webpage. Published November 2023. Accessed November 28, 2023. https://goldcopd.org/2024-gold-report/

14. Tarín-Carrasco P, Im U, Geels C, Palacios-Peña L, Jiménez-Guerrero P. Contribution of fine particulate matter to present and future premature mortality over Europe: A non-linear response. Environ Int. 2021;153:106517. doi:10.1016/j.envint.2021.106517

15. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet. 2022;400(10356):921-972. doi:10.1016/S0140-6736(22)01273-9

16. Ho T, Cusack RP, Chaudhary N, Satia I, Kurmi OP. Under- and over-diagnosis of COPD: a global perspective. Breathe (Sheff). 2019;15(1):24-35. doi:10.1183/20734735.0346-2018

17. Lindenauer PK, Stefan MS, Pekow PS, et al. Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries. JAMA. 2020;323(18):1813-1823. doi:10.1001/jama.2020.4437

18. Bogachkov, YY. Pulmonary Rehabilitation Eases Symptoms, Improves Quality of Life. COPD News Today. Published 3 March 2022. Accessed 8 November 2023. https://copdnewstoday.com/news/pulmonary-rehabilitation-eases-copd-symptoms-improves-life-quality/

19. Yun R, Bai Y, Lu Y, Wu X, Lee SD. How Breathing Exercises Influence on Respiratory Muscles and Quality of Life among Patients with COPD? A Systematic Review and Meta-Analysis. Can Respir J. 2021 Jan 29;2021:1904231. doi: 10.1155/2021/1904231. 

This page was reviewed by GAAPP clinical and scientific experts in January 2024