COPD in children

Overview

COPD (chronic obstructive pulmonary disease) is a long-term lung condition that makes it hard to breathe. In children, true COPD is very rare. When it happens, it is usually linked to a child's lungs not developing fully, a genetic condition, or severe breathing problems from early life. Unlike adult COPD, it is not caused by smoking.

COPD is very rare in children. It is far more likely that a child with breathing difficulties has asthma, allergies, or frequent infections.

COPD can affect children who were born premature, had severe lung infections as babies, have a genetic condition called alpha-1 antitrypsin deficiency, or have severe lung damage from other illnesses. It can also affect children whose lungs did not grow normally in the womb.

Symptoms

Common symptoms

• Persistent cough that is not from a cold
• Wheezing (a whistling sound when breathing)
• Shortness of breath with activity
• Frequent chest infections
• Fast or noisy breathing

Symptoms in children

• Poor weight gain and slow growth
• Tiring easily during play or feeding
• Chest retractions (skin pulling in around the ribs when breathing)
• Difficulty sleeping due to coughing or breathlessness
• Clubbing of the fingers (changes in the shape of fingertips) in severe cases

Symptoms in older adults

• In older adults, COPD is much more common and usually caused by smoking or long-term exposure to air pollution.
• Symptoms in adults often include a chronic cough with mucus, breathlessness on exertion, and frequent chest infections.
• COPD in adults is a leading cause of disability, while in children it is very rare and often has a different underlying cause.

Causes

Main causes

• Premature birth and underdeveloped lungs
• Genetic conditions like alpha-1 antitrypsin deficiency
• Severe viral lung infections in early infancy (for example, respiratory syncytial virus or RSV)
• Severe, poorly controlled asthma
• Lungs not forming normally before birth

Risk factors

• Being born prematurely or with low birth weight
• Exposure to tobacco smoke before or after birth
• A family history of lung disease or a genetic condition
• Repeated or severe respiratory infections in early childhood
• Long-term exposure to indoor air pollution or indoor allergens

When to see a doctor

See a doctor urgently if:

• If your child is having unusual breathlessness, wheezing, or a persistent cough that keeps getting worse
• If your child is struggling to breathe or is too breathless to eat or speak
• If your child has a fever that will not settle with usual care and is breathing fast

Book a routine appointment if:

• If your child has a cough that lasts more than 3 weeks
• If your child wheezes or gets breathless during everyday play
• If your child is not growing or gaining weight as expected

Diagnosis

A doctor or pediatric pulmonologist (lung specialist) will take a detailed history, listen to your child's chest, and may order tests. The diagnosis of COPD in a child is made only after careful assessment and often after ruling out more common conditions like asthma.

Tests that may be done

• Lung function tests (spirometry) if the child is old enough to blow into a tube
• Chest X-ray or CT scan to look at the lungs
• Blood tests to check oxygen levels and look for genetic conditions
• Sweat test to rule out cystic fibrosis
• Measurement of oxygen levels with a sensor on the finger

What to expect at your appointment

Your child may need to see a pediatric lung specialist. The tests are mostly painless and simple. You may be asked to answer many questions about your child's health history and home environment. The team will explain everything and ensure your child is comfortable.

Treatment

Treatment for COPD in children focuses on managing symptoms, preventing flare-ups, preserving lung function, and supporting overall growth and development. Every child's care is tailored to the underlying cause and their specific needs.

Self-care at home

• Keep your child away from tobacco smoke and other air pollutants
• Ensure your child gets regular vaccinations, including flu and whooping cough vaccines
• Support good nutrition and hydration
• Monitor your child's breathing and follow a personal action plan if provided
• Encourage low-impact physical activity as your child can tolerate it

Medical treatments

Doctors may use inhaled medications to help open the airways and reduce inflammation. Some children may need oxygen therapy at home if their blood oxygen levels are low. In more severe cases, a specialist team may offer pulmonary rehabilitation (a structured plan of exercise and education) designed for children. Any medication is always prescribed individually by a doctor — never give a child any medication without a professional prescription.

When is surgery considered?

Surgery is rarely used for COPD in children. It may be considered only in very severe cases when the lung damage is life-threatening, and decisions are made by a specialist team with the family.

Living with this condition

Living with a chronic lung condition means having a care plan. You will likely see a specialist team regularly. The goal is to keep your child active, comfortable, and developing well. Learn to spot early signs of a flare-up and know exactly what to do.

Lifestyle tips

• Create a smoke-free, clean home
• Reduce exposure to strong fumes, dust, and mould
• Help your child avoid people with active infections when possible
• Encourage regular handwashing
• Keep up to date with vaccines

Diet and exercise

A healthy, well-balanced diet helps your child grow and gives them energy. Some children may need extra calories if they are underweight. Regular exercise, like walking, swimming, or playing, can strengthen breathing muscles and improve stamina. Always check with your child's doctor before starting a new exercise program.

Mental health and emotional wellbeing

It is normal for both the child and the family to feel worried or anxious about breathlessness. Being ill can be exhausting and frustrating. It helps to talk openly, involve your child in simple decisions about their care, and reassure them that they are not alone.

Prevention

Not all cases can be prevented, especially those caused by genetic conditions or premature birth. But many lung problems in children can be avoided or reduced by not smoking during pregnancy, keeping children away from secondhand smoke, and treating asthma early.

Vaccines

Keeping up with routine childhood vaccines is important. Extra vaccines, like the annual flu vaccine, are often recommended for children with chronic lung conditions. The RSV vaccine may be given to high-risk infants — ask your doctor if it applies to your child.

Screening programmes

Screening is only offered to children with known risk factors, such as those born extremely premature or with a family history of a genetic lung condition. Talk to your doctor if you have concerns.

Complications

If left untreated

• Frequent chest infections and hospital stays
• Poor growth and delayed development
• Progressive damage to the lungs leading to more severe breathing problems
• Low blood oxygen levels that can affect the heart
• Inability to take part in normal childhood activities

Long-term outlook

With the right medical care, lifestyle changes, and a strong support team, many children with chronic lung conditions lead happy, full and active lives. The outlook depends on the underlying cause and how early care begins. It is normal to have concerns, but you do not need to face this alone — doctors, nurses, and other families can help.

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