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Chronic (long-term) inflammation plays an important role in how chronic obstructive pulmonary disease (COPD) changes over time. Ongoing inflammation in the lungs and airways can damage healthy tissue and make it harder to breathe as the disease progresses.
Understanding inflammation can help explain how COPD affects your lungs and why symptoms may worsen. This article provides an overview of how COPD inflammation affects your prognosis and how COPD treatment helps by controlling inflammation.
Most changes that happen with COPD are linked to chronic inflammation. Inflammation normally helps protect your body from illness or injury, but when it continues for a long time, it can damage tissues in the lungs and airways, making it harder to breathe over time.
Here are some ways chronic inflammation can affect COPD:
Restricted Airflow Chronic inflammation in the airway can lead to scarring along the airway. Over time, this scarring and inflammation narrow the respiratory tract. With less room for air to pass through, breathing becomes more and more difficult.
Obstructed airflow from scarring can be an irreversible problem in people with COPD, even with treatment to reduce inflammation.
Worsening Symptoms Usually, worsening symptoms in COPD are linked to increasing inflammation along the respiratory tract. Symptoms tend to get worse as COPD progresses, and symptoms that are difficult to control with treatment may be a sign of chronic inflammation.
You may also experience more frequent COPD flare-ups as inflammation starts to damage your airway. Signs that COPD symptoms are getting worse because of inflammation include:
Increased COPD Complications and Related Conditions In COPD, inflammation can affect more than the lungs. This is called systemic inflammation, or inflammation throughout the body. Like in other conditions, it may contribute to COPD complications and related health problems. If you have systemic inflammation, you may be more likely to experience:
Reduced Quality of Life With more restricted airflow, more frequent and severe flare-ups, and possible complications, you may see a decline in your quality of life. Breathing becomes increasingly difficult, and you may find that you have less energy or have trouble exercising or completing daily tasks.
Inflammation in COPD often starts or gets worse when you breathe in things that irritate the lungs. In response, lung tissues release inflammatory chemicals that attract white blood cells called neutrophils (immune cells that help fight infections and respond to harmful substances). If this response continues, it can lead to ongoing inflammation and lung tissue damage.
Another type of white blood cells called eosinophils can release chemicals to cause further inflammation in the lungs and airways. This type of inflammation is less common in COPD, but people with higher levels of eosinophils may be more likely to have it.
Here are some examples of factors that can trigger these processes and increase inflammation in COPD:
Smoking is the number-one cause of COPD, but not every person with a history of smoking will develop COPD. Experts believe that individual differences may be at play when smoking causes COPD, including a person’s genetics, susceptibility to tissue damage, and immune system function. These factors might intensify inflammation from smoking.
Even if you’ve stopped smoking, inflammation from cigarette smoke can affect your lungs and airways permanently. If you’ve never smoked, secondhand smoke can have a similar effect. Scientists are still studying how smoking causes long-lasting airway inflammation, even after a person has stopped.
Even if you don’t smell or see signs of air pollution, chemicals in the air can irritate the lungs and trigger inflammation. Climate change may contribute to worsening COPD inflammation, as factors like increasing temperatures and ozone gas worsen air pollution.
Respiratory infections, including viral and bacterial infections, also trigger the release of inflammatory chemicals in the airway. COPD makes you more likely to experience repeated or chronic respiratory infections such as pneumonia and COVID-19, which contribute to chronic inflammation in the lungs and airway.
Bacterial infections are more often linked to increased neutrophils, while viral infections may increase both types of white blood cells. These changes are signs of increased inflammation in the lungs and airways.
Breathing in dust, fumes, or certain chemicals at work can irritate the lungs and contribute to ongoing inflammation. Over time, repeated exposure may worsen lung damage and COPD symptoms.
Tell your doctor if you have COPD and work around dust, chemical fumes, smoke, or other substances you may breathe in.
Anti-inflammatory treatments, or treatments that aim to reduce inflammation, aren’t usually an initial treatment for COPD. However, experts are studying how anti-inflammatory treatments may help prevent COPD flare-ups and slow COPD progression.
Corticosteroids Corticosteroids are sometimes prescribed for COPD to target and decrease inflammation in the lungs and airways during a COPD flare-up. Inhaled corticosteroids may help widen the airway by reducing active inflammation, which can make breathing easier for some people.
Corticosteroids can play different roles in COPD depending on how they are used. Inhaled corticosteroids can help reduce COPD flare-ups in some people, especially those who continue to have flare-ups while using long-acting inhaled medicines. They may be particularly helpful in people with higher levels of eosinophils.
However, inhaled corticosteroids don’t target every type of inflammation in COPD. For example, they don’t appear to reduce neutrophils in mucus from the lungs. Long-term use of oral corticosteroids is generally not recommended for stable COPD because the risks can outweigh the benefits. However, these medicines can be helpful for short periods during COPD flare-ups.
Long-term use of corticosteroids isn’t recommended. Even when they help with inflammation in COPD, they can sometimes increase the risk of respiratory infections that ultimately worsen COPD inflammation.
Antibiotics Doctors may prescribe antibiotics to treat bacterial infections that can worsen COPD. By reducing the number of bacteria in the airways, antibiotics may also help reduce inflammation for a short time.
Antibiotics aren’t right for everyone with COPD. Long-term use can increase the risk of antibiotic resistance, which can make future bacterial infections harder to treat. Short-term antibiotics may help in some cases, but their effects on inflammation can vary.
New and Emerging Treatments Scientists are researching new treatments for controlling inflammation in COPD, which may help slow COPD progression. Biologics are medications made from organic materials, like living cells. There are a few new and emerging biologics for treating COPD.
In 2024, the first biologic treatment was approved for some people with COPD. In clinical trials, it was shown to reduce flare-ups in people with COPD who had inflammation linked to high levels of eosinophils, a type of white blood cell involved in inflammation.
Experts are also studying medications called phosphodiesterase (PDE) inhibitors, which may treat COPD by targeting inflammation and relaxing the airways.
Tell your doctor if you’ve noticed signs of increased inflammation or COPD progression such as more frequent flare-ups or increased fatigue. Your doctor or pulmonologist may recommend changes to your treatment plan that can help reduce inflammation in your lungs and airways to slow COPD progression and help you breathe easier.
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