Inflammation in COPD: What You Need to Know

This article was written by Arnelle Konde, MPH, CHES.

COPD symptoms do not always stay the same. Some people notice that their breathing gets worse over time. Others have flare-ups that happen more often or feel more serious. If your symptoms seem harder to control, inflammation may be one reason why.

Inflammation is part of your body's immune response¹. It helps protect you from infection or injury. However, in COPD, inflammation in the lungs can become long-lasting and may damage your airways over time.

Understanding what is happening in your body can help you take the next step in your care.

When COPD Symptoms Get Worse

Worsening COPD can look different for everyone. Some people notice small changes over time, while others experience sudden flare-ups.

Worsening COPD can include:

• More shortness of breath
• More coughing
• Thicker or more mucus
• More flare-ups or exacerbations
• Feeling more tired during everyday activities

One factor that may contribute to worsening symptoms is inflammation inside your lungs.

Types of Inflammation in COPD

Type 1 Inflammation (Neutrophilic)

Type 1 inflammation is the most common type seen in COPD. It mainly involves neutrophils; a type of white blood cell that helps fight infection.

Irritants such as cigarette smoke, pollution, or other environmental exposures can trigger the lungs to release chemicals that attract neutrophils into the airways.¹ Once there, these cells release enzymes and inflammatory substances that can damage lung tissue.

Over time, this process may lead to:

• Narrowed airways
• Increased mucus production
• Lung tissue damage
• Reduced airflow

This type of inflammation is often linked to the long-term airway damage that occurs in COPD.¹

Type 2 Inflammation (Eosinophilic)

Type 2 inflammation is less common but important to recognize. It involves eosinophils, another type of white blood cell involved in immune responses. When eosinophils build up in the airways, they release proteins that can irritate and inflame the lung lining. This can lead to swelling, mucus buildup, and breathing difficulty.² Some people with COPD have higher levels of eosinophils in their blood, which may cause this type of inflammation. Research shows that people with eosinophilic inflammation may respond differently to certain treatments, including inhaled corticosteroids.²

Understanding which type of inflammation may be present can help guide treatment choices.

Signs Inflammation May Be Causing Your Symptoms

Sometimes inflammation may play a bigger role in COPD symptoms than you think. Talk to your health care provider if you notice:

• Frequent flare-ups
• Symptoms that do not improve with usual treatment
• Needing oral steroids more often
• Sudden symptom changes without a clear infection
• Blood tests showing higher eosinophil levels

Your provider may review your symptoms, medical history, and sometimes blood tests to better understand what may be driving your COPD.

COPD is not the same for everyone. Different types of inflammation can affect symptoms in different ways.

Learning more about the inflammation involved in your COPD may help you and your provider:

• Better understand why symptoms are getting worse
• Adjust medications if needed
• Find treatments that may work best for you
• Reduce future flare-ups

The more you understand your condition, the better prepared you can take an active role in your care.

To learn more about inflammation and how it affects COPD, listen to the latest episode of The Lung Health Champion podcast. In this episode, we explain the different types of inflammation in COPD and how to recognize when your symptoms may be getting worse.

Understanding inflammation is a major step in taking control of your COPD and protecting your lung health.