As a respiratory specialist, I’ve encountered countless patients over the years struggling to breathe—some wheezing with every step, others simply fatigued from tying their shoes. But few conditions trouble me more than chronic obstructive pulmonary disease, commonly known as COPD.
What worries me most isn't just the damage it does, but how invisible it remains until the damage is already done.
In the United States, COPD has quietly become the third leading cause of death, yet it's also one of the most underdiagnosed. According to the American Lung Association, over 16 million Americans have been diagnosed with COPD—but the actual number may be nearly double that, because many people don’t realize they have it until it’s far advanced.
What makes COPD particularly insidious is that it's not a single disease. It’s a group of progressive lung conditions, most notably emphysema and chronic bronchitis. In both, airflow becomes increasingly obstructed, making it harder and harder to breathe over time.
Yet symptoms often begin subtly: a persistent cough in the morning, shortness of breath while climbing stairs, or just a general sense of fatigue. Many patients dismiss these early signs as part of aging, or “just a smoker’s cough,” never realizing the lungs are silently deteriorating.
And indeed, smoking is the primary culprit. An estimated 80 to 90 percent of COPD cases in the U.S. are linked to smoking, either active or secondhand. Though national smoking rates have declined, the legacy of decades of tobacco use still lingers. In my clinic, I see this every day—especially in patients over 50 who smoked heavily in their youth and now rely on inhalers or oxygen tanks to get through the day.
Take, for example, a patient of mine—Mary, a 67-year-old retired nurse from St. Louis, Missouri. She never smoked a cigarette in her life. But her husband did—for over 30 years. Mary spent decades inhaling secondhand smoke in their home. Over time, she began feeling winded while gardening and needed to rest just from cooking a meal.
Eventually, she was diagnosed with moderate COPD. Her story isn’t unusual. In fact, long-term exposure to secondhand smoke, air pollution, or workplace dust and chemicals can all cause or worsen COPD.
By the time most people are diagnosed, the disease is already in its moderate or severe stage. At that point, it’s not uncommon for patients to depend on daily medication, supplemental oxygen, and in some cases, hospitalization for sudden flare-ups. According to the CDC, the U.S. spends more than $50 billion annually on COPD-related healthcare costs and lost productivity.
But there is hope. While COPD cannot be cured, it can be managed, often quite effectively. The most common treatments include bronchodilators—medications that help open airways—inhaled corticosteroids to reduce inflammation, and combination inhalers that improve lung function. For patients with low oxygen levels, home oxygen therapy has been shown to not only relieve symptoms but also extend life expectancy.
More promisingly, pulmonary rehabilitation is gaining traction in places like eastern Kentucky and West Virginia—regions hit hard by COPD due to smoking and industrial exposure. These rehab programs aren’t just about exercise. They combine physical therapy, nutrition counseling, breathing techniques, and psychological support. Studies show that patients who participate in these programs have lower hospital readmission rates and significantly better quality of life.
Still, nothing is more important than quitting smoking. Even in advanced stages of COPD, quitting smoking can slow disease progression, reduce flare-ups, and improve treatment outcomes. I’ve seen patients who could barely walk a block before quitting, return to hiking or biking within a year of giving up cigarettes. Resources like the national quitline (1-800-QUIT-NOW), nicotine patches, and group therapy programs have helped thousands of Americans make that life-saving choice.
Diet also plays a bigger role in COPD than many people realize. The lungs require a great deal of energy to function, especially under strain. That’s why patients with COPD often benefit from high-protein, nutrient-rich meals. At the Cleveland Clinic, one study found that patients who received nutritional guidance as part of their care had better lung function and fewer exacerbations. Avoiding excessive salt, processed foods, and carbonated beverages can also help reduce bloating and make breathing easier.
There’s another concern worth mentioning—the link between COPD and lung cancer. People with COPD are two to four times more likely to develop lung cancer than those without, especially if they are or were smokers. Chronic inflammation, damaged lung tissue, and reduced immune defenses all contribute. That’s why low-dose CT screening is now recommended for high-risk groups, including anyone over 50 with a history of smoking or long-term respiratory symptoms.
Public awareness remains one of our greatest tools in the fight against COPD. Fortunately, national initiatives like the CDC’s Tips from Former Smokers campaign, and local outreach programs in high-risk areas, are starting to change the narrative. More people are recognizing the signs early, getting tested, and taking steps to protect their lungs.
COPD doesn’t come overnight—and it doesn’t have to steal your life, either. It is a slow-burning disease, often taking decades to reach its full intensity. But when left unchecked, it can strip away the very breath we take for granted. The good news is: with the right awareness, treatment, and lifestyle changes, many people with COPD live long, meaningful lives.
If you’re over 40, have a history of smoking, or find yourself out of breath more often than you used to, consider getting a simple spirometry test. It might be the most important breath you ever take.