COPD – living with it, and slowing it down
Lung damage from smoking, indoor smoke or old TB does not reverse — but the decline can be slowed dramatically, and most of that is not medication.
What it is, and why South Africa has a lot of it
Chronic obstructive pulmonary disease is long-term narrowing and damage to the airways and air sacs. Air gets in but does not come out easily, so the lungs stay partly inflated and breathing becomes hard work.
Smoking is the biggest cause worldwide. South Africa has two more that are easy to overlook: smoke from indoor cooking and heating with wood, coal or paraffin, and lung damage left behind by previous TB — a very common cause here and one that affects people who never smoked at all. Occupational dust exposure, particularly from mining, adds a third.
COPD is not asthma
- Asthma usually starts young, varies day to day, and responds well and quickly to a reliever inhaler.
- COPD usually starts after 40, is persistent rather than episodic, and gets slowly worse over years.
- Asthma airway narrowing is largely reversible; COPD damage is largely not.
- Both can exist in the same person, which is why the inhalers overlap.
The distinction matters because the treatments and the expectations differ. A breathing test — spirometry — is what separates them, and it is worth asking for rather than accepting a label.
What actually slows it
- Stop smoking. This is not one item among several — it is the only thing shown to change the rate of decline, and it works at any stage and any age.
- Get away from the smoke source: ventilate when cooking or heating indoors, and move a brazier or paraffin stove outside.
- Have the influenza and pneumococcal vaccines. A chest infection in damaged lungs is what causes the step-downs that never fully recover.
- Keep moving. Pulmonary rehabilitation — a structured exercise programme — improves breathlessness and quality of life more than most medicines do.
- Learn your inhaler technique properly and have it rechecked. Poor technique is extremely common and means the medicine never reaches the lungs.
- Have a written plan for a flare-up, so you know when to start treatment and when to go in.
Inhalers and medicines used in COPD, all prescribed:
Salbutamol (Inhaler) — Ventolin, Asthavent, Cipla Salbutamol, Aerolin
Asthma (reliever); COPD (reliever); acute bronchospasm
Ipratropium — Atrovent, Ipvent
COPD (maintenance); acute asthma (adjunct to salbutamol)
Tiotropium — Spiriva, Spiriva Respimat
COPD maintenance; severe asthma (add-on)
Budesonide / Formoterol — Symbicort
Asthma (maintenance and reliever therapy — MART); COPD maintenance
Prednisone — Trolic, Meticorten, Adco-Prednisone, Panafcort
Asthma exacerbations; COPD exacerbations; inflammatory and autoimmune conditions
Flare-ups, and when to go in
A flare-up is a sustained worsening of breathlessness, cough or sputum beyond your usual day-to-day variation. Each significant one can leave lung function slightly lower than before, which is why treating them promptly matters rather than riding them out.
Common questions
- Is it too late to stop smoking once I have COPD?
- No — and this is the most important thing on the page. Stopping does not repair existing damage, but it slows further loss immediately, at any stage. Someone who stops after a diagnosis has a meaningfully different next decade from someone who does not.
- I never smoked. How can I have COPD?
- In South Africa, previous TB, long-term exposure to indoor cooking and heating smoke, and occupational dust are all significant causes. Non-smokers with COPD are common here and are frequently misdiagnosed as having asthma.
- Will I end up on oxygen?
- Most people with COPD never need home oxygen. It is used for a specific subgroup with persistently low blood oxygen, based on testing rather than on how breathless someone feels.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Adult Primary Care guideNational Department of Health, South Africa
Last reviewed 4 August 2026.