COPD (Chronic Obstructive Pulmonary Disease)
COPD is a serious, progressive lung disease characterised by persistent airflow limitation that worsens over time. It is one of the leading causes of death and disability worldwide, yet it remains significantly underdiagnosed — largely because it develops slowly and people often attribute early symptoms to "normal" ageing or being unfit. With appropriate treatment and lifestyle changes, however, its progression can be substantially slowed and quality of life considerably improved.
What causes COPD?
Tobacco smoking — including current and former smoking — is by far the most important risk factor, accounting for around 90% of cases in high-income countries. Long-term exposure to occupational dusts and chemicals (such as those encountered in mining, construction, and agriculture) and indoor air pollution from biomass fuel burning are significant causes in other parts of the world. A small proportion of cases occur in non-smokers and are related to genetic factors, the most important of which is alpha-1 antitrypsin deficiency.
What happens in COPD?
The disease affects the airways and the lung tissue itself. Chronic inflammation damages the bronchial tubes, causing them to narrow and produce excess mucus, leading to chronic bronchitis. It also destroys the alveoli — the tiny air sacs responsible for gas exchange — leading to emphysema. The result is progressive breathlessness, air trapping, and reduced oxygen delivery.
Symptoms
The classic triad of COPD symptoms is persistent breathlessness that worsens with exertion, a chronic cough (often productive of sputum, particularly in the mornings), and recurrent chest infections. People with COPD may also experience wheeze, chest tightness, fatigue, and weight loss in advanced disease. COPD also features episodes called exacerbations — acute worsening of symptoms triggered by infections or environmental exposures — which accelerate disease progression and require prompt treatment.
Diagnosis
The cornerstone of COPD diagnosis is spirometry — a simple breathing test that measures how much air a person can exhale and how quickly they can do so. A ratio of FEV1/FVC below 0.7 (post-bronchodilator) confirms the presence of airflow obstruction. Chest X-ray, CT scanning, blood tests, and pulse oximetry contribute to a full assessment.
Treatment
Smoking cessation is the single most important intervention and slows decline in lung function dramatically at any stage of disease. Inhaled bronchodilators — both short-acting for relief and long-acting for maintenance — form the backbone of pharmacological treatment. Inhaled corticosteroids are used in those with frequent exacerbations. Pulmonary rehabilitation — a structured programme of exercise training and education — consistently improves exercise capacity and quality of life. Long-term oxygen therapy benefits those with severely reduced oxygen levels. In carefully selected patients, surgical or bronchoscopic lung volume reduction may be considered.
Choosing where to be treated
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