Chronic obstructive pulmonary disease (COPD)

What COPD is

COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (breathlessness, cough, sputum) arising from abnormalities of the airways (chronic bronchitis, bronchiolitis) and/or of the alveoli (emphysema), which cause persistent, usually progressive, obstruction of airflow. The mechanism involves chronic inflammation of the bronchi, narrowing and fibrosis of the small airways, excess mucus production and destruction of the alveolar walls, which removes the elasticity of the lung. Air remains trapped (hyperinflation), the chest works at a mechanical disadvantage and the patient feels breathless, especially on exertion.

COPD is not confined to the lungs: it comes with systemic effects, such as loss of muscle mass and weight, increased risk of cardiovascular disease, osteoporosis, depression and lung cancer. Care is therefore often shared with cardiology and other specialties.

What the symptoms are

• Shortness of breath, at first on exertion and later also with light activity.
• Persistent cough, often with sputum, especially in the morning.
• Wheezing when breathing.
• Repeated respiratory infections or episodes of worsening.
• Reduced ability to do usual activities, fatigue, sometimes weight loss.

The cough should not be dismissed as simply “smoker’s cough”: it is often the first symptom of the disease and deserves assessment. People often adapt their activities without realizing, and regard breathlessness as “normal with age”, so the disease is diagnosed late.

What the risk factors are

Smoking is the most important cause; the risk rises with the amount and the years of smoking. Exposure to dusts, gases or smoke at work and at home also contributes (including burning solid fuels for heating or cooking), as does air pollution. In certain cases there is a genetic predisposition, such as alpha-1 antitrypsin deficiency, which should be looked for in young patients or those with a family history. Poor lung development in childhood and poorly controlled asthma are also factors.

COPD can also appear in people who have never smoked. The history of exposures matters in the assessment.

How it is diagnosed

Symptoms and risk factors raise suspicion, but the diagnosis requires an objective assessment of breathing. Spirometry is performed at the clinic: COPD is confirmed when, after a bronchodilator, the FEV₁/FVC ratio remains below 0.70, that is, the obstruction is not fully reversible. This is the main difference from asthma, where obstruction varies and often normalizes.

The severity of the limitation is classified by FEV₁ as a percentage of the predicted value (from mild to very severe), but the decision on treatment is also based on symptoms (standardized breathlessness questionnaires) and on the number of exacerbations in the past year. As appropriate, tests (blood count, eosinophils, alpha-1 antitrypsin) or imaging outside the clinic are recommended to look for other diseases (cancer, bronchiectasis, heart disease). A single chest X-ray neither confirms nor excludes COPD.

How it is treated

Treatment aims to reduce symptoms, lower the frequency of exacerbations and slow progression. It includes:

• Stopping smoking, the only measure that changes the natural course of the disease; the doctor can help with counselling and medicines.
• Long-acting inhaled bronchodilators (anticholinergics LAMA and beta-2 agonists LABA, often combined). In selected patients, with frequent exacerbations or high eosinophils, an inhaled corticosteroid is added. Checking inhaler technique is part of every visit.
• Pulmonary rehabilitation: a structured program of exercise, education and nutritional support, which improves exercise tolerance and quality of life.
• Vaccination against influenza, pneumococcus, COVID-19 and, by age, respiratory syncytial virus.
• Long-term oxygen therapy, used only when defined criteria are met (a persistently very low oxygen level at rest); it is not needed in every patient with breathlessness.
• In advanced cases, specialized procedures (lung volume reduction, transplantation) at specialized centers.

Follow-up includes regular check-ups every 6 months to a year, or sooner when the doctor considers it reasonable, with spirometry, assessment of symptoms and exacerbations, and review of coexisting diseases.

How exacerbations are recognized

An exacerbation is an acute worsening of symptoms: increased breathlessness, cough or sputum, or sputum that becomes purulent. It calls for prompt contact with the doctor. The cause is often infection (viral or bacterial), but it may also be pollution, heart failure, pulmonary embolism or another condition. Each exacerbation accelerates the decline in lung function, so preventing them is a core aim of treatment.

Keep a written plan for exacerbations. Do not start antibiotics, corticosteroids or oxygen, and do not change your oxygen flow, on your own; these decisions are made by the doctor. For severe signs, call 127.

Care at Tirana Polyclinic: we offer pulmonology consultation, spirometry, interpretation of imaging performed at other clinics and guidance for follow-up. As appropriate, care is coordinated with cardiology and other specialties.