What is the progression and outlook?

Symptoms of COPD typically begin in people aged over 40 who have smoked for 20 years or more. A ‘smoker’s cough’ tends to develop at first. Once symptoms start, if you continue to smoke, there is usually a gradual decline over several years. You tend to become more and more breathless. In time your mobility and general quality of life may become poor due to increasing breathing difficulties.

Chest infections tend to become more frequent as time goes by. Flare-ups of symptoms (exacerbations) occur from time to time, typically during a chest infection.

If the condition becomes severe then heart failure may develop. This is due to the the reduced level of oxygen in the blood and changes in the lung tissue which can cause an increase in pressure in the blood vessels in the lungs. This increase in pressure can put a strain on the heart muscle leading to heart failure. Heart failure can cause various symptoms including worsening breathlessness and fluid retention.

(Note: heart failure does not mean the heart stops beating (that is called cardiac arrest). Heart failure is when the heart does not pump blood very well.

Respiratory failure is the final stage of COPD. At this point the lungs are so damaged that the levels of oxygen in the blood are low. The waste product of breathing called carbon dioxide (CO2) builds up in the blood stream. People with end-stage COPD need palliative care to make them more comfortable and ease any symptoms.

At least 25,000 people die each year in the UK from the end stages of COPD. Many of these people have several years of ill health and poor quality of life before they die. About 8 in 10 men with mild COPD will survive for five years or more after diagnosis, compared with 7 in 10 women. The survival rate is lower in severe COPD. About 3 in 10 men and just over 2 in 10 women with severe disease will survive five years from diagnosis.

Depression and/or anxiety affect at least 6 in 10 people with COPD, and can be treated if recognised.


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