Chronic obstructive pulmonary disease (COPD): key points

• COPD is a long term lung disease that causes cough and breathlessness. COPD is the current term for conditions that were previously referred to as chronic bronchitis or emphysema. It is a progressive disease that not only affects breathing but also causes weight loss, nutritional disturbances and muscle problems.
• The most significant risk factor for COPD is cigarette smoking. Despite a considerable decline in smoking rates over the past 25 years, morbidity and mortality from COPD in Scotland remain high. Sex also seems to be a factor in the development of COPD; women develop the condition with lower exposure to smoking than men.
• The incidence of COPD in Scotland (measured using hospital admissions data and death records) dropped sharply during the COVID-19 pandemic. Latest figures indicate that whilst rates have increased in 2021/22 for both males (97.6 cases per 100,000 people) and females (97.3 cases per 100,000 people) they remain around 25% lower than the pre-pandemic period.
• During 2021 the annual mortality rate from COPD for both males and females has continued to decrease slightly (1.6% and 2.5% respectively).  
• Whilst the burden of COPD has historically been greater in males, over the past 25 years females in Scotland have had:
  • dramatic increases in the rate of deaths attributed to COPD (compared with a decrease in males)
  • a slower rate of decline in smoking rates compared with men.
• The ageing of Scotland's population does not fully account for these trends, which may be explained by the fact that COPD rates fall many years after declines in smoking rates. Thus the current burden of COPD in Scotland may, in part, be due to the high smoking rates seen 30 - 40 years ago. Increased awareness of COPD and its inclusion in the primary care quality and outcomes framework (QOF) may also have contributed to increased diagnoses.
• The burden of COPD is widely recognised to be underestimated with as many as two thirds of cases undiagnosed.