COPD and Smoker’s Lung: Symptoms and Lung Function Tests

Many people in Bangladesh live for years with a cough, phlegm and shortness of breath. They often think it is just a normal part of smoking or getting older. Some people brush it off as a “smoker’s cough”, but it may be a lung disease called COPD. Many people with COPD do not know they have it. There is no cure, but treatment can help, and the NHS says that the sooner treatment starts, the less chance there is of severe lung damage. This article covers the symptoms, how a breathing test confirms COPD, when to get urgent help and which doctor to see.

What is COPD?

COPD stands for chronic obstructive pulmonary disease. “Chronic” means long-lasting. “Obstructive” means the airways are narrowed, so it is harder to move air in and out of the lungs. “Pulmonary” means it affects the lungs.

The NHS (UK National Health Service) says COPD includes two conditions you may also hear about:

Emphysema: damage to the tiny air sacs in the lungs. This reduces the amount of oxygen that reaches the blood.
Chronic bronchitis: long-term swelling (inflammation) of the breathing tubes. People with it often cough up phlegm.

“Smoker’s lung” is an everyday name, not a medical diagnosis. Smoking is a major cause of COPD, but people who have never smoked can get it too. The World Health Organization (WHO) says that in low- and middle-income countries, tobacco smoking accounts for only 30–40% of COPD cases, and household air pollution is a major risk factor.

How common is it?

According to the WHO COPD fact sheet (updated June 2026), COPD was the third leading cause of death worldwide in 2023. It caused 3.4 million deaths, about 6% of all deaths worldwide. Nearly 90% of COPD deaths in people under 70 happen in low- and middle-income countries.

In Bangladesh, a systematic review of local studies published in January 2019 (Sutradhar and colleagues, in the journal Cureus) estimated that about 12.5% of adults had COPD. It was more common in men, in people with lower incomes, in people living in rural areas and in people who use biomass fuel for cooking.

What causes it?

COPD develops slowly over many years. The main risk factors include:

Tobacco smoke: smoking cigarettes or bidis. Breathing in other people’s smoke (second-hand smoke) can also trigger flare-ups in people who already have COPD. According to the Global Adult Tobacco Survey (GATS) Bangladesh 2017, 35.3% of adults aged 15 and over used some form of tobacco: 18.0% smoked tobacco and 20.6% used smokeless tobacco. This is still the figure WHO Bangladesh cited in its 2025 report on tobacco control.
Smoke from cooking fires (household air pollution): the WHO says this is a major risk factor in low- and middle-income countries. Examples are burning wood, cow dung or crop waste indoors. In the 2019 Bangladesh review, COPD was more common among people who used biomass fuel.
A rare inherited condition called alpha-1 antitrypsin deficiency, which makes people more likely to get COPD at a young age.

Symptoms

Symptoms start slowly and usually get worse over time. Most people do not notice symptoms until their late 40s or 50s. The NHS lists these common symptoms:

Shortness of breath. At first it may happen only when you are active, and you may sometimes wake up at night feeling breathless.
A chesty cough with phlegm (mucus) that does not go away. Some people find the phlegm is worse in the morning.
Frequent chest infections.
Wheezing that does not go away (a whistling sound when you breathe).

Feeling tired is also common. In advanced COPD, people may also lose weight or get swollen ankles. As the condition gets worse, daily activities such as walking can become very difficult.

Flare-ups

A flare-up (doctors call it an exacerbation) is when symptoms suddenly get worse than usual. MedlinePlus, a US government health service, says a flare-up means the worse symptoms last 2 days or more and are stronger than your usual symptoms. Signs include more breathlessness, noisy or wheezy breathing, and more coughing, sometimes with more phlegm or a change in its colour. Chest infections and breathing in smoke can trigger flare-ups. A severe flare-up may need hospital care.

Lung function tests: how COPD is diagnosed

A doctor will ask about your symptoms and whether you smoke or used to smoke. It also helps to tell them what fuel you cook with and what work you do. To confirm COPD, you need a breathing test called spirometry.

What happens during spirometry

Spirometry is the most commonly used lung function test. It measures how much air you can breathe out and how fast you can blow it out. You may be asked to breathe in a medicine that opens the airways (a bronchodilator) before or during the test. For COPD, doctors use the result measured after this medicine.

Getting ready for the test

MedlinePlus advises:

Do not smoke for 4 to 6 hours before the test.
Do not eat a heavy meal before the test.

You will be told if you need to stop using any inhaler before the test. Do not stop or change any medicine unless your doctor or the test centre tells you to.

Understanding the numbers

Term	What it means
FEV1	Forced expiratory volume in 1 second: how much air you can blow out in the first second
FVC	Forced vital capacity: the total amount of air you can blow out in one full breath
FEV1/FVC ratio	The share of your breath that comes out in the first second

In COPD, narrowed airways slow the air down, so the ratio is lower. The international GOLD committee (Global Initiative for Chronic Obstructive Lung Disease) says that, along with matching symptoms, a ratio below 0.7 measured after the bronchodilator is needed to diagnose COPD. Your doctor will look at the results together with your symptoms.

Other tests your doctor may use

Other lung function tests: these measure how much air your lungs can hold, and how well your lungs pass oxygen into your blood.
Phlegm (sputum) test: if you cough up a lot of phlegm, it may be tested for infections such as pneumonia or tuberculosis (TB).

Several other conditions cause similar symptoms, such as asthma, bronchiectasis, anaemia and heart failure. Spirometry helps tell COPD apart from conditions such as asthma. If you have symptoms, ask your doctor whether a spirometry test is possible.

Treatment in general

There is no cure, but treatment can help with symptoms and help you stay active. Your doctor will decide what is right for you. Treatment generally includes:

Stopping smoking and avoiding smoke: avoiding smoke is the best way to slow down damage to your lungs. Ask your doctor for help with quitting.
Inhalers: these deliver medicine straight into the lungs to help with breathlessness and swelling in the airways. They work only if used correctly, so ask your doctor or nurse to check how you use yours.
Pulmonary rehabilitation: a programme of exercise, breathing training and advice on healthy eating.
Vaccines: MedlinePlus advises people with COPD to get their recommended vaccines, including those against flu and pneumococcal infection (pneumonia). Ask your doctor which ones you need.
Oxygen or surgery: oxygen at home may be needed if your blood oxygen level is low. Some people with severe disease may be offered surgery or other procedures.

Do not start, stop or change any medicine on your own. Discuss any changes with your doctor.

Warning signs: get urgent medical care

Go to the nearest hospital emergency department straight away if you, or a family member with COPD, has any of these:

Severe difficulty breathing, such as gasping, choking or not being able to speak in full sentences
Lips, fingertips or skin turning blue, grey or very pale. On brown or black skin, this may be easier to see on the palms of the hands.
Chest pain, or a tight or heavy feeling in the chest, or pain that spreads to the arms, back, neck or jaw
Sudden confusion or unusual sleepiness
Coughing up blood while very unwell or very breathless

Get medical advice from a doctor the same day if:

You are more breathless than usual, or your symptoms have not improved within 48 hours or keep getting worse even after you follow your doctor’s plan
You have a fever, you are coughing up dark phlegm, or you have more phlegm than usual
You cough up any blood
You have a racing, skipping or irregular heartbeat, or pain or swelling in one leg
You need to lean forward when sitting to breathe easily, or your ankles or legs are swelling

For health advice from a doctor at any time, you can call the government’s Shasthyo Batayon health helpline on 16263, which is open 24 hours a day. IEDCR’s page about the helpline says calls cost Tk 0.60 per minute. The helpline gives advice. It does not replace emergency care.

Which doctor should you see?

First visit: see a general practitioner (GP) or a medicine specialist (internal medicine doctor) if you have been coughing for 3 weeks or more, you get out of breath doing things that used to be easy, or you keep getting chest infections.
Specialist: a respiratory medicine specialist, also called a pulmonologist or chest disease specialist, diagnoses and manages COPD, arranges lung function tests and plans long-term care.
Other doctors: a cardiologist (heart specialist) may be involved if the heart is affected. COPD can lead to other health problems, such as an irregular heartbeat, heart failure, thinning of the bones, pneumonia, anxiety and depression.

When you visit, bring a list of your medicines and any old test reports and X-rays. Tell the doctor about your smoking history, your cooking fuel and your type of work.

Key points

A cough with phlegm and breathlessness that last a long time are not “normal” for smokers. Get them checked.
Spirometry is a simple breathing test that is needed to confirm COPD.
Smoke from cooking fires is a major risk factor in low- and middle-income countries, so people who have never smoked can also get COPD.
Stopping smoking, avoiding smoke and getting the right treatment can help you breathe and live better.

Find a doctor

Browse Chest Diseases doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.