Diagnosis, Treatment, and Living with Chronic Obstructive Pulmonary Disease (COPD)

This article is based on the scientific publication “GOLD 2023: Highlights for Primary Care,” published in npj Primary Care Respiratory Medicine (2023), with lead author Prof. Alvar Agustí (Cátedra Salud Respiratoria, Hospital Clínic, University of Barcelona, Spain), co-authored by Dr. Antoni Sisó-Almirall, Dr. Miguel Román, and Prof. Klaus F. Rabe, together with the expert team from the GOLD (Global Initiative for Chronic Obstructive Lung Disease) Scientific Committee. The team includes leading specialists in pulmonary diseases, primary care, and research from across Europe and the world.

In the following sections, you’ll find key questions and answers that summarize the most up-to-date scientific understanding of COPD, according to the GOLD 2023 report. The goal is to help patients better understand their condition and treatment options.

“COPD is a common, preventable, and treatable disease, but extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment.”

The Experts Speak

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common and socially significant diseases globally. Yet, it often goes unrecognized or is incorrectly treated. Patients and their families frequently feel confused about the causes, diagnosis, and most effective therapies. Modern scientific studies and consensus guidelines like GOLD 2023 provide clarity on key issues important to both doctors and patients. The following sections present current expert opinions and quotes to help you better understand COPD, ask the right questions of your healthcare provider, and receive the best possible care.

1. What exactly is COPD and how is it diagnosed?

Expert opinion:

“GOLD 2023 defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction (FEV1/FVC < 0.7).”

Explanation:

COPD is not just a smoker’s disease or something that only affects older adults—it refers to a group of lung conditions that lead to chronic and progressive airflow limitation. Diagnosis requires a spirometry test, which measures how well the lungs function. Without this simple yet essential test, a COPD diagnosis cannot be confirmed accurately. Anyone experiencing symptoms such as shortness of breath, chronic cough, sputum production, or frequent lower respiratory infections should seek medical advice and undergo spirometry.

2. Is smoking the only cause of COPD? What are the other risk factors?

Expert opinion:

“COPD is actually the end-result of a series of dynamic, cumulative and repeated gene (G)–environment (E) interactions over the lifetime (T) that damage the lungs and alter their normal development/aging processes.”

Explanation:

While smoking remains a major risk factor, a significant number of people with COPD have never smoked. Exposure to indoor air pollution (especially in homes that use wood, coal, or animal dung for heating and cooking), occupational hazards (chemicals, dust), childhood respiratory infections, secondhand smoke, and even poor nutrition early in life are serious contributors. Genetic predisposition also plays a role, especially for individuals with alpha-1 antitrypsin deficiency.

3. Can COPD affect younger people and women?

Expert opinion:

“COPD is similarly prevalent in men and women, and can be diagnosed in young individuals and even in never smokers... females report more dyspnea and cough, have a steeper decline in lung function over time and have worse outcomes than males in terms of hospitalizations, respiratory failure, and death.”

Explanation:

Recent research shows that COPD occurs almost equally in both men and women, and is not limited to the elderly. Women are particularly vulnerable if exposed to household smoke. Those born prematurely, with low birth weight, or who experienced chronic respiratory infections during childhood are also at risk. Lung development issues starting in the womb or early childhood can set the stage for COPD later in life.

4. What are the new recommendations for COPD treatment?

Expert opinion:

“For symptomatic patients, a LABA-LAMA therapy in a single inhaler is recommended as initial therapy. The combination of LABA-ICS is no longer recommended in patients with COPD. Triple therapy (LABA-LAMA-ICS) is recommended in COPD patients who still suffer exacerbations of the disease despite LABA-LAMA therapy, if blood eosinophil levels are higher than 100 cells/μl.”

Explanation:

Current treatment approaches emphasize personalized inhaler therapy, starting with two bronchodilators (LABA and LAMA) in a single inhaler. Steroid combinations (LABA-ICS) are no longer recommended as a standard first-line treatment, except in cases involving high eosinophil counts or frequent flare-ups. Medication is always combined with non-drug interventions such as quitting smoking, physical activity, vaccinations, and managing other health conditions.

5. How are COPD exacerbations (ECOPD) identified and treated?

Expert opinion:

“ECOPD is an event characterized by increased dyspnea and/or cough and sputum that worsens in <14 days which may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by infection, pollution, or other insults to the airways.”

Explanation:

An exacerbation is a sudden worsening of usual symptoms within less than two weeks, often due to infections or air pollution. Mild to moderate cases may be treated with short-acting bronchodilators, short courses of corticosteroids, and antibiotics if there’s a bacterial infection. Severe exacerbations might require hospitalization, oxygen therapy, or non-invasive ventilation. After such an episode, therapy and prevention plans should be reassessed to reduce future risks.

Q&A Section

1. What does it mean to have “pre-COPD” or PRISm, and why does it matter?

Answer:

According to GOLD 2023, some individuals don’t yet show airway obstruction (i.e., FEV1/FVC > 0.7) but already have symptoms, lung changes on CT scans, or other functional abnormalities. These conditions are called pre-COPD and PRISm (Preserved Ratio with Impaired Spirometry).

“Some patients without airflow obstruction… may present symptoms and/or other functional abnormalities… and/or structural lung abnormalities… that may eventually progress (or not) to COPD... Likewise, GOLD 2023 recognizes… patients with preserved FEV1/FVC ratio with reduced FEV1; these patients are named PRISm…”

Early detection of these states allows for timely intervention, lifestyle changes, and better control of the disease process before it becomes irreversible.

2. What is the role of comorbidities—other diseases that often occur with COPD?

Answer:

GOLD 2023 emphasizes that COPD almost always appears alongside other chronic conditions (multimorbidity), complicating patient care.

“COPD almost invariably coexists with other chronic diseases (multimorbidity) that affect the patient’s clinical condition… comorbidities should be treated per usual standards regardless of the presence of COPD.”

This means that if you also have heart disease, diabetes, depression, or osteoporosis, they should be treated according to standard protocols regardless of COPD. Ignoring co-existing conditions can worsen your overall health and quality of life.

3. Why is non-pharmacological treatment important, and what does it include?

Answer:

Managing COPD involves more than just inhalers and medications.

“Non-pharmacological treatment is a key part of the adequate management of COPD… It includes one or more of the following: education and supported self-management, smoking cessation, vaccination, physical activity, nutritional and psychosocial assessment and support, pulmonary rehabilitation, oxygen therapy and ventilatory support, surgical and endoscopic lung volume reduction, and end of life and palliative care.”

Key actions: quit smoking, stay physically active, get vaccinated against flu, pneumococcus, and COVID-19, maintain good nutrition, and seek mental health support. Pulmonary rehabilitation programs have been proven to improve symptoms and quality of life.

4. What should I know about treatment during exacerbations (ECOPD)—when is hospitalization needed?

Answer:

Not every flare-up requires hospitalization, but there are clear criteria:

“The following are indications for hospitalization: (1) severe symptoms such as sudden worsening of resting dyspnea, high respiratory rate, oxygen saturation ≤92%, confusion, drowsiness; (2) acute respiratory failure; (3) onset of new physical signs (e.g., cyanosis, peripheral edema); (4) failure to respond to initial medical management; (5) presence of serious comorbidities (e.g., heart failure, newly occurring arrhythmias, etc.); and, (6) insufficient home support.”

If you experience severe shortness of breath, low oxygen levels, confusion, swelling, or do not improve with standard treatment, you should seek immediate medical care.

5. Can I reduce the risk of future exacerbations, and what does new research show?

Answer:

Yes! Recent studies show that triple inhaler therapy (LABA, LAMA, and an inhaled corticosteroid), for patients with frequent exacerbations and eosinophil counts above 100 cells/μl, lowers overall mortality.

“This is important since two recent large randomized clinical trials have shown that triple therapy in patients with frequent exacerbations reduce all-cause mortality.”

Additionally, regularly checking your inhaler technique, choosing the right device for your needs, and strictly following medical advice significantly lowers your risk of worsening.

Conclusion

The latest GOLD 2023 guidelines, presented by the international team led by Agustí and colleagues, make it clear that effectively managing COPD requires more than just understanding the disease and its risk factors—it demands active patient participation in the entire treatment process. Early detection of pre-COPD states, proper management of comorbidities, personalized therapy choices, and most importantly, a healthy lifestyle and good communication with healthcare providers are all key to living a longer, better life with this condition. The information provided here aims to give patients and their families greater confidence and clarity on the path to better health.

Source: Agustí, A. et al., "GOLD 2023: Highlights for Primary Care," npj Primary Care Respiratory Medicine (2023) 33:28; https://doi.org/10.1038/s41533-023-00349-4