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NIH MedlinePlus the Magazine, Trusted Health Information from the National Institutes of Health

The Challenge of COPD

What Causes COPD?

Dr. James Kiley

James Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute at NIH
Photo Courtesy of NHLBI

Chronic obstructive pulmonary disease, COPD, kills more than 130,000 people a year. It's the third-leading cause of death in this country. There are as many as 24 million people that have this disease, and as many as half of those people don't know that they have COPD. That means that COPD affects someone you know.

When NHLBI launched the Learn More Breathe Better® campaign in 2007, we had very little information or awareness of COPD. Now, we can say with confidence that many, many Americans know what those four letters stand for. I'm very happy to say that today, all 50 states in the U.S. have COPD awareness programs.

Providers need to know we have tools, such as spirometers, bronchodilators, inhaled steroids, and pulmonary rehabilitation. We can control symptoms like chronic cough, shortness of breath, wheezing, excess sputum, and difficulty breathing.

The patient needs to know that if they don't talk to the doctor, they're not going to be able to get the doctor to provide them the information and help they need.

COPD is a preventable disease. If we take steps toward identifying people early, those at risk, and we provide them the educational materials, open a dialogue, and treat them, they will live a better life, and they'll breathe better.

Man blowing into spirometer, assisted by nurse

A spirometer measuring the amount of air a patient can blow out.
Photo: Getty Images

Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)

More rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.

Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.

Getting Tested

Everyone at risk for COPD who has cough, sputum production, or shortness of breath, should be tested for the disease. The test for COPD is called spirometry.

Spirometry can detect COPD before symptoms become severe. It is a simple, non-invasive breathing test that measures the amount of air a person can blow out of the lungs (volume) and how fast he or she can blow it out (flow). Based on this test, your doctor or healthcare provider can tell if you have COPD, and if so, how severe it is. The spirometry reading can help them to determine the best course of treatment.

How Spirometry Works

Spirometry is one of the best and most common lung function tests. The test is done with a spirometer, a machine that measures how well your lungs function, records the results, and displays them on a graph. You will be asked to take a deep breath, then blow out as hard and as fast as you can using a mouthpiece connected to the machine with tubing. The spirometer then measures the total amount exhaled, called the forced vital capacity or FVC, and how much you exhaled in the first second, called the forced expiratory volume (FEV) in one second. Your doctor or healthcare provider will read the results to assess how well your lungs are working and whether or not you have COPD.

Pulmonary Rehab

"Pulmonary rehabilitation is a breathing program based on the highest level of scientific evidence that can improve patients' lives. We need to improve the quality of life of COPD patients now and not wait decades for a cure. My husband, Ted, and I have used our resources to locate other partners to help establish pulmonary rehabilitation centers where there are none. There are not enough pulmonary rehab centers and, where they do exist, it’s in the big cities." —Grace Anne Koppel
(Read her interview, here.)

Take Action

There are many things people at risk for COPD can do:

Quit Smoking

If you smoke, the best thing you can do to prevent more damage to your lungs is to quit. To help you quit, there are many online resources and several new aids available from your doctor or healthcare provider. The National Cancer Institute has information on smoking cessation ( or call 1-800-QUIT NOW), as does the American Lung Association ( and the Centers for Disease Control and Prevention (

Avoid Exposure to Pollutants

Try to stay away from other things that could irritate your lungs, like dust and strong fumes. Stay indoors when the outside air quality is poor. You should also stay away from places where there might be cigarette smoke.

Visit Your Doctor or Healthcare Provider on a Regular Basis

See your doctor or healthcare provider regularly, even if you are feeling fine. Make a list of your breathing symptoms and think about any activities that you can no longer do because of shortness of breath. Be sure to bring a list of all the medicines you are taking to each office visit.

Healthcare professional giving flu shot in patient’s left arm

Take Precautions Against Seasonal Flu

Get the seasonal flu shot to protect against viruses predicted to cause disease in the winter season. Do your best to avoid crowds during flu season. In addition to avoiding people with the flu, remembering to wash and sanitize your hands can be one of the best ways to guard against getting sick. It is also a good idea to get a flu shot every year, since the flu can cause serious problems for people with COPD. You should also ask your doctor or healthcare provider about the pneumonia vaccine.

(See more about seasonal flu in "Time to Get Your Seasonal Flu Shot" here.)

Am I at Risk?

Most people who are at risk for getting COPD have never even heard of it and, in many cases, don’t even realize that the condition has a name. Some of the things that put you at risk for COPD include:


COPD most often occurs in people age 40 and over with a history of smoking (either current or former smokers), although as many as one out of six people with COPD never smoked. Smoking is the most common cause of COPD. It accounts for as many as nine out of 10 COPD-related deaths.

Environmental Exposure

COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD.

Top COPD Diagnosis Barriers Health Care Providers Encounter. 48% Patient does not fully report symptoms; 35% Patient doesn't fully report smoking history; 30% Patient has more immediated health issues

Genetic Factors

In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. While very few people know they have AAT deficiency, it is estimated that close to 100,000 Americans have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants.

For additional information on COPD, visit the NHLBI's Health Topics, MedlinePlus, or the American Lung Association's COPD information section.

COPD Learn More Breathe Better® Program

To Find Out More

The COPD Learn More Breathe Better® program seeks to:

  • Bridge the gap between research and practice to:
    • Educate healthcare providers on the benefits of early diagnosis and appropriate selection of treatment options.
  • Provide empowering calls to action to:
    • Encourage people at risk for COPD to get a simple breathing test and talk to their healthcare provider about optimal treatment options.
    • Motivate those diagnosed with COPD to take personal ownership and responsibility for their overall care and treatment plans.
Read More "The Challenge of COPD" Articles

Q&A: Grace Anne Koppel, Living Well with COPD / What is COPD? / What Causes COPD? / COPD Quiz

Fall 2014 Issue: Volume 9 Number 3 Page 5-8