Chronic obstructive pulmonary disease (COPD)

COPD is a chronic inflammatory disease of the lungs that develops gradually. The inflammatory process affects two key areas of the respiratory system: 

• The lower airways (bronchi and bronchioles): the bronchial walls thicken and excessive mucus is produced, leading to a narrowing of the bronchi and causing breathlessness.
• The alveoli: these small sacs, which are the distal ends of the airways where gas exchange takes place, are gradually damaged. The walls thin and then break down, meaning that these areas no longer participate in transporting oxygen to the pulmonary capillaries. This is known as emphysema

COPD often begins insidiously. Symptoms appear gradually, which explains why many people unconsciously adapt their lifestyle to avoid shortness of breath, thus delaying medical consultation.
The most common symptom is dyspnoea, a feeling of shortness of breath, initially limited to exertion, which over the years can become present even at rest. Some patients also suffer from chronic coughing and sputum production, often mistakenly perceived as benign consequences of smoking. Wheezing, chest tightness, unusual fatigue, and unintentional weight loss may also be present in advanced forms.

During exacerbations, symptoms worsen acutely: the cough becomes more intense, bronchial secretions become more abundant or coloured, and breathing becomes more difficult. These episodes can last several days or even weeks and often require urgent medical attention.

Active smoking is the main cause of COPD in developed countries. It is responsible for more than 75% of cases, due to the toxic substances inhaled that cause chronic inflammation of the bronchi and damage the small bronchi and alveoli. Tobacco smoke, in addition to being a direct irritant, impairs the lung's defence mechanisms and promotes respiratory infections. Other causes exist, although they are rarer. Among them, a genetic abnormality called alpha-1 antitrypsin deficiency can cause early emphysema, even in the absence of tobacco exposure. This deficiency affects approximately 1% of patients with COPD. 

Finally, COPD can also result from prolonged exposure to agents that irritate the respiratory tract.

Other factors contribute to the risk of developing the disease:

• Occupational exposure: dust, fumes and chemicals inhaled in the workplace (e.g. mines, construction sites, factories) increase the risk even in non-smokers.
• Domestic pollution: the use of wood, coal or other solid fuels in poorly ventilated homes, particularly in developing countries, is a significant risk factor.
• Early respiratory history: severe lung infections in childhood, poorly controlled asthma, premature birth, impaired lung growth or parental smoking can alter lung development and accelerate functional loss.

The combination of these factors, especially when prolonged over time, promotes the development of irreversible lung damage.

The diagnosis of COPD is based on a rigorous clinical approach, combined with a respiratory function test: spirometry. This test measures the volume of air a person can exhale in the first second of forced inspiration and at the end of exhalation.
The diagnosis is based on the presence of irreversible bronchial obstruction (or obstructive ventilatory disorder). This test also allows the severity of the disease to be staged according to the decrease in the predicted value of the volume exhaled in the first second.
However, many people with COPD are unaware that they have the disease. They unconsciously adjust their activity level to avoid shortness of breath. This is why a detailed medical history is essential. It aims to identify warning signs: persistent cough, mucus production, wheezing, frequent lung infections, history of exposure to lung irritants.
Standardised questionnaires, such as the mMRC dyspnoea scale or the CAT (COPD Assessment Test), can be used to assess the severity of symptoms on a daily basis. These tools are useful for monitoring the progression of the disease and adapting treatments.
It is important to note that diagnosis is not based on a simple chest X-ray, although this can be used to rule out other conditions.

The management of COPD is based on several therapeutic pillars, the aim of which is to reduce symptoms, prevent exacerbations and improve quality of life.
The first and undoubtedly most effective measure is to stop smoking. Quitting smoking is the only way to significantly slow the progression of the disease, in other words, to reduce COPD-related mortality. In some patients with mild obstructive ventilatory disorders, these disorders may be reversible after quitting smoking.
In terms of medication, treatment is based on the use of long-acting bronchodilators, administered by inhalation. There are two main types: long-acting beta-2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs). A combination of the two substances (LABA/LAMA) is recommended in cases of significant dyspnoea. Some patients also benefit from the addition of inhaled corticosteroids, for example in cases of a history of asthma, allergies or frequent acute exacerbations.
Respiratory rehabilitation is strongly recommended for the majority of patients with COPD. This structured programme includes physical exercises supervised by respiratory physiotherapists (with the addition of oxygen during exercise if necessary), therapeutic education, and nutritional and psychological support. It has proven effective in improving endurance, reducing dyspnoea, limiting the frequency of exacerbations and reducing anxiety in patients.
In cases of significant chronic hypoxaemia, long-term home oxygen therapy can also improve survival. More specific treatments, such as the insertion of endobronchial valves or lung volume reduction surgery, are reserved for specific cases of severe emphysema.

Annual flu vaccination and vaccination against pneumococcus and respiratory syncytial virus (RSV) are strongly recommended for patients with COPD.

COPD is a chronic disease that progresses at a rate that varies from patient to patient. In cases of persistent smoking, the decline in lung capacity will be even more rapid. Patients with frequent acute exacerbations also experience a more rapid functional decline. Subjectively, patients experience worsening dyspnoea and a marked deterioration in their quality of life.
One of the classic complications, generally after several years of progression, is chronic respiratory failure. This occurs when the lungs are no longer able to oxygenate the blood properly or eliminate carbon dioxide (CO2). This failure can lead to symptoms such as excessive fatigue/drowsiness and headaches upon waking.
However, the damage is not limited to the respiratory system. COPD is now recognised as a systemic disease involving multiple organs. Patients have an increased risk of cardiovascular disease, osteoporosis, lung cancer, metabolic syndrome, anxiety and depression, and cognitive impairment, all of which are linked to chronic hypoxemia.
These extrapulmonary manifestations worsen the prognosis and justify a comprehensive and personalised approach to care

The best strategy against COPD is prevention, because once established, the disease is mostly irreversible. It is therefore essential to take early action by addressing modifiable factors.
Avoiding tobacco remains the most effective measure. This means not only avoiding smoking, but also limiting exposure to second-hand smoke, especially in children and adolescents, whose lungs are still developing.
At home, the use of less polluting cooking systems and proper ventilation of living spaces are recommended, especially in regions where cooking with wood or coal is still common.
Prevention of respiratory infections also plays an essential role. These infections can trigger severe, even fatal, exacerbations. More generally, promoting a healthy lifestyle, including regular physical activity and a balanced diet, helps to maintain good physical condition in the long term.

When faced with an insidious disease such as COPD, knowing when to seek medical advice is essential to limit its impact and improve the prognosis.
It is advisable to see a doctor as soon as persistent respiratory symptoms appear: chronic cough, shortness of breath on exertion, regular mucus production or wheezing. These signs, which are often dismissed as trivial, may in fact indicate the onset of COPD.
For someone who has already been diagnosed, it is essential to seek medical advice promptly if their usual symptoms worsen: a stronger cough, thicker or discoloured secretions, increased shortness of breath or the onset of fever. These signs may indicate an exacerbation requiring an adjustment in antibiotic and/or corticosteroid treatment, or even hospitalisation for oxygen therapy, rest and respiratory physiotherapy. Finally, regular monitoring is recommended, even in the absence of worsening symptoms, in order to adapt treatment to the progression of the disease and the patient's needs

At Hôpital de La Tour, the care of patients with chronic obstructive pulmonary disease is part of a multi-disciplinary andpersonalised approach.
The hospital has a highly specialised acute care infrastructure, including an experienced pulmonology department, state-of-the-art technical facilities and a continuous care unit adapted to the needs of patients with chronic respiratory diseases (intermediate care, intensive care, respiratory physiotherapy department).
The management of COPD includes:

• A complete functional assessment, with spirometry, plethysmography, walking test, imaging (chest X-ray, chest CT scan), pulmonary stress test and other additional tests as required.
• Appropriate therapeutic guidance, including optimisation of inhaled treatment, management of comorbidities and therapeutic education.
• An outpatient pulmonary rehabilitation programme, supervised by specialist physiotherapists, aimed at improving exercise capacity and independence in daily life.
• Smoking cessation support
• Regular, personalised outpatient follow-up, allowing for continuous treatment adjustment and prevention of exacerbations.
• Innovative techniques such as virtual reality hypnosis.

Is COPD a rare disease?

No. It affects around 10% of adults over the age of 40 and is one of the leading causes of death worldwide.

Can COPD be cured?

There is currently no cure, but appropriate treatment can slow its progression, reduce symptoms and improve quality of life.

What is a COPD exacerbation?

It is an acute worsening of the usual symptoms (shortness of breath, coughing, sputum production) that may require a change in treatment or hospitalisation.

How does respiratory rehabilitation work?

It is a personalised programme that includes supervised physical exercise, therapeutic education, and nutritional and psychological support.

When should you seek medical advice?

As soon as you experience a persistent cough, unusual shortness of breath, or exposure to a risk factor (smoking, pollution, occupational dust).

Can you live a normal life with COPD?

Yes, with proper treatment, appropriate support, and a healthy lifestyle, many people are able to remain active and independent.