World COPD Day Takes Place Annually on November 20

Definition and Characteristics of COPD

COPD is a chronic respiratory disease in which the airways narrow, impeding normal airflow. The term "obstructive" in the name reflects the essence of the process – obstruction means airway narrowing. The disease is called chronic because it is incurable and lifelong in nature.

Most patients don't suspect COPD in early stages, so the disease is often diagnosed when symptoms become pronounced and affect quality of life.

How COPD Develops

The Global Allergy and Airways Patient Platform GAAPP identifies four stages of COPD:

1. Mild stage: Weak cough and small amount of sputum appear, respiratory system function is within normal limits; symptoms are often unnoticed.
2. Moderate stage: Cough becomes more frequent, dyspnea intensifies with physical exertion, forced expiratory volume in one second (FEV1) decreases to 50–80%.
3. Severe stage: Cough and dyspnea occur even at rest, disease exacerbations are frequent, lung function significantly declines.
4. Very severe stage: Respiratory failure develops, cardiac problems occur, severe bronchial obstruction, exhaled air volume less than 30%.

In initial stages, inflammatory processes and respiratory infection risk predominate; as progression occurs, emphysema, respiratory failure, and chronic cor pulmonale develop.

Why COPD Develops

Causes of COPD development include several key mechanisms and risk factors. Among them are partial destruction of lung tissue; obliteration of airways by mucus; inflammation and edema of airway mucosa. COPD results from long-term exposure to harmful factors combined with individual characteristics, progressing slowly but invariably worsening respiratory function and patient quality of life.

Major risk factors:

• active and passive smoking, including electronic cigarettes;
• exposure to dust, smoke, chemical substances at work;
• indoor air pollution, especially use of biomass- and coal-based fuel in low- and middle-income countries;
• early childhood factors: intrauterine developmental disorders, prematurity, frequent or severe respiratory infections;
• childhood asthma (asthma-COPD phenotype exists);
• rare genetic factors, particularly alpha-1 antitrypsin protein deficiency leading to early COPD development (alpha-1 antitrypsin is produced in the liver and enters the bloodstream to protect the lungs. Its deficiency can cause liver disease, lung disease, or both).

COPD Symptoms

Main manifestations:

• dyspnea, especially during physical exertion;
• wheezing in the chest – patients and surrounding people can hear them without special equipment;
• chest tightness, labored breathing;
• chronic cough with sputum that may be clear, white, yellow, or greenish;
• frequent respiratory infections;
• constant fatigue, lack of energy;
• unexplained weight loss – in later disease stages;
• swelling of feet, ankles, and lower legs.

Signs are nonspecific, so for a long time a person may attribute everything to excess weight, heart problems, or age.

How to Suspect COPD in Yourself

Note which of the following signs you have:

1. Cough several times daily.
2. Coughing up sputum.
3. Dyspnea more often than others of the same age.
4. Age over 40 years.
5. Current or past smoking.

If three or more of these signs are present, see a doctor.

Disease symptoms often don't manifest until lungs are severely damaged; the condition usually worsens over time, especially if the person continues smoking. The earlier COPD is detected, the greater the chance of stopping further lung damage.

COPD Exacerbations

People with COPD may experience episodes called exacerbations. During these times symptoms worsen, with deterioration persisting for at least several days. For example, a person may note intensified cough, changed sputum, or more difficult breathing.

Exacerbations may be triggered by respiratory infection, air pollution, or other factors. In any case, immediate medical attention is important.

Severe COPD exacerbation is like myocardial infarction in coronary heart disease. It can leave irreversible lung function decline and in some cases lead to death. Disease treatment is primarily aimed at reducing exacerbation frequency.

The period of usual disease course is called remission. Without treatment, symptoms typically progress, exacerbations become more severe and frequent. People with COPD also have higher risk of other health problems. For example, they more frequently develop pneumonia, heart disease, and depression. COPD also increases lung cancer risk.

COPD patients who contract COVID-19 face high mortality: fatality rates among them reach 15% compared to 4% in patients without COPD. These patients more frequently experience severe disease course, increased need for hospitalization and intensive care, and higher probability of death.

COPD Diagnosis: From First Symptoms to Confirmed Diagnosis

COPD diagnosis is a multi-stage process based on international clinical guidelines (GOLD). Its goal is not only to confirm disease presence but also to determine its stage, exclude other pathologies, and develop an effective treatment plan.

Reason for consulting a pulmonologist typically involves characteristic symptoms: progressive dyspnea, chronic cough, and decreased exercise tolerance. At the initial appointment, the physician conducts comprehensive patient assessment.

In addition to history-taking and examination, instrumental screening tests play a major role:

• Pulse oximetry – noninvasive measurement of blood oxygen saturation. Testing is conducted at rest and in some cases during physical exertion (e.g., walking or stair climbing), allowing detection of hidden oxygen deficiency. Persistent saturation decline below 88% is grounds for prescribing oxygen therapy.
• 6-minute walk test – objective assessment of exercise tolerance. During the test, pulse rate, respiratory rate, and saturation are monitored.
• Specialized questionnaires (e.g., mMRC, CAT) help standardize assessment of dyspnea severity and other symptoms, as well as their impact on patient quality of life.

The main method without which COPD diagnosis cannot be definitively established is spirometry with bronchodilator test.

During the study, the patient performs forced exhalations into the device tube, allowing measurement of key lung function indicators: forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). The test is conducted before and after bronchodilator medication inhalation.

Post-bronchodilator Tiffeneau index (FEV1/FVC) < 0.70 confirms presence of persistent bronchial obstruction.

COPD Treatment

COPD cannot be completely cured, but modern treatment methods help patients at all disease stages significantly improve well-being and lead active lives. With proper therapy, good symptom control and reduced comorbidity risks are achievable.

Main COPD treatment directions include:

• Smoking cessation (including vaping) and elimination of harmful environmental factors – this slows disease progression.
• Pharmacological therapy using inhaled bronchodilators (short- and long-acting), inhaled glucocorticosteroids, phosphodiesterase-4 inhibitors, and other agents aimed at airway dilation and inflammation reduction.
• Oxygen therapy in severe disease forms.
• Pulmonary rehabilitation including breathing exercises, physical activity, and restorative measures to increase exercise tolerance.
• In rare and severe cases, surgical intervention is possible, including lung volume reduction or transplantation.

Effective treatment helps reduce clinical manifestations, prevent exacerbations, improve quality of life, and reduce mortality.

COPD Patient Care Services in Russia

In Russia, 2.4 million people suffer from COPD. According to the Center for Expertise and Quality Control of Medical Care of the Russian Ministry of Health, approximately 193,000 hospitalizations due to COPD exacerbation are registered annually, exceeding in days those of patients with cardiovascular diseases. The annual economic damage from COPD to the country's economy is estimated at approximately 400 billion rubles.

Russia officially has no government program devoted exclusively to combating COPD, but conditions are being created for a systematic approach to helping patients with this disease in national and regional programs for non-communicable chronic diseases and pulmonology. Key initiatives include launching early screening programs, dispensary observation, and improving medical care delivery to patients with chronic respiratory diseases; as well as expanding COPD treatment financing using proceeds from nicotine-containing product licensing; including patients in subsidy programs.

Under the "Zdravookhranenie" national project from 2019 to 2024, over 660 billion rubles were allocated to primary care modernization and equipping regional medical organizations. A significant portion of these funds was invested in purchasing modern equipment for pulmonology departments and functional diagnostics offices. More than 5,000 units of spirometers, breathing trainers, and non-invasive lung ventilation (NIPPV) devices were delivered to regional centers, improving accessibility and quality of early diagnosis and basic therapy. By 2024, the number of lung volume reduction surgeries (LVRS) and bullectomies performed under mandatory health insurance increased 3.5-fold compared to 2015.

The patient diagnostic and monitoring system is improving with implementation of modern technologies. In leading federal centers such as the Research Institute of Pulmonology of FMBA of Russia and the National Medical Research Center for Therapy and Preventive Medicine, AI algorithms are applied for analyzing lung CT data, allowing more accurate assessment of emphysema degree and disease course prediction. The FuzzyGuard system developed at Tolyatti State University using machine learning methods analyzes patient cough sound and lung CT images, combining data using neuro-fuzzy networks. This allows not only diagnosing COPD with high accuracy but also predicting disease development, significantly improving early diagnosis and treatment personalization.

Medical rehabilitation is one of the key treatment stages and is offered at major Russian resorts such as Belokurikha (Altai Territory) and Kislovodsk (Stavropol Territory). Rehabilitation programs include biofeedback devices for respiratory muscle training, robotic systems for restoring walking function and exercise tolerance, and individualized speleotherapy and climatotherapy complexes based on unique natural factors.

Despite achievements, potential for developing Russia's COPD treatment system remains. Since 2005, the standardized respiratory disease mortality rate has declined; however, COPD prevalence remains high, related to late diagnosis.

An advanced direction is expanding use of monoclonal antibodies for treating severe bronchial asthma – a disease often comorbid with COPD. These biologics are already registered and used in Russia, opening possibilities for personalized therapy of complex cases.