Chronic obstructive pulmonary disease COPD

What is COPD?

Chronic obstructive pulmonary disease – often abbreviated to COPD – is the term for a group of lung diseases that cause difficulty breathing.

COPD refers to long-term respiratory conditions that are not fully reversible. These include emphysema and chronic bronchitis.

Emphysema affects your air sacs, while bronchitis causes inflammation in the airways. Both conditions narrow your airways, making it harder to breathe air in and out.

This makes it harder for your lungs to take in oxygen as well as expelling carbon dioxide.

It is thought that around 3 million people in the UK suffer from COPD, but that only around a third of cases are diagnosed. This means about 2 million Brits are thought to have COPD without realising it.

The condition mainly affects smokers and mainly those in their 40s or above.

What causes COPD?

COPD develops when your airways become inflamed and the air sacs in your lungs are damaged. This narrows your airways and makes it harder for you to breathe.

The most common risk factor is smoking, though it is possible to develop the condition if you have never smoked.

For example, some people develop COPD due to long-term exposure to dust or harmful fumes.

Other people are genetically predisposed to lung problems.

There is some evidence to suggest that long-term exposure to air pollution can also contribute, however research is not yet conclusive.

Still, smokers are by far the most commonly affected. The more you smoke and the longer you smoke for, the more your risk of COPD increases.

What are the symptoms of COPD?

People often ask about the early warning signs of COPD, however many sufferers do not have noticeable symptoms until they are in their 40s or 50s.

Chronic obstructive pulmonary disease develops slowly over many years, meaning changes to your breathing get gradually worse and some people don’t notice.

The main symptoms of COPD are:

• Increasing breathlessness or shortness of breath, especially during and after activity
• A persistent chesty cough, often accompanied by phlegm
• Frequent chest infections that may be hard to shake
• Wheezing

People with COPD may experience symptoms consistently or they may have flare ups, where things get suddenly worse.

The sooner you seek advice the better. If you don’t get treatment, it’s likely that the symptoms will continue to deteriorate.

How is COPD diagnosed?

If you are experiencing any of the above symptoms and think you may have COPD, you should speak to your GP. This is especially important if you are over 35 and a smoker or ex-smoker.

Your doctor will discuss your symptoms with you as well as your lifestyle and family medical history. They’ll also listen to your breathing using a stethoscope.

If they think you may have the condition, they will do a number of tests that can diagnose COPD as well as identifying or ruling out other potential issues and lung conditions.

Common tests include:

• A spirometry, which gauges lung function
• A chest X-ray
• Blood tests

Sometimes these will be followed by further tests to confirm the diagnosis or the extent of the disease.

What are the four stages of COPD?

You might have heard people talk about the different stages of COPD or even specifically the four stages of COPD.

‘Four stages’ is a little misleading, as it’s generally felt that COPD is not a ‘one-size-fits-all’ disease and that each case should be treated individually.

Still, the COPD Foundation does use the results of patients’ spirometry tests to define grades of severity:

• 0 – Normal
• 1 – Mild
• 2 – Moderate
• 3 – Severe
• U – Undefined

These are used as a broad guide rather than a definitive classification. Your doctor will work with you to decide on the best course of treatment for your individual needs.

How can I reduce my risk of developing COPD?

Chronic obstructive pulmonary disease is considered a largely preventable condition.

The most effective way to reduce your risk of the condition is not to smoke. If you are a smoker, stopping smoking can prevent further damage to your lungs.

Even if you have smoked for a long time, quitting now could stop symptoms developing.

Can a person with COPD get better?

COPD is different for everyone. It can’t be cured or reversed but many people are able to manage the condition if they get the right treatment.

So, with the right treatment you may find your symptoms improve, or at least slow down.

Unfortunately, for some people the disease continues to progress despite treatment and can become detrimental to their quality of life, even leading to life-threatening problems.

What treatments are available for COPD?

Chronic obstructive pulmonary disease is caused by irreversible damage to the lungs and airways, meaning there is no curative treatment.

However, there are a number of options that can slow the progression of the condition as well as helping people to manage the symptoms and their impact on daily life.

The most common treatments include:

Stopping smoking

If you smoke and you have COPD, you should stop immediately.

Stopping smoking is the best thing you can do to prevent your symptom

If you are in the early stages, this may even be all that’s recommended. It is the best way to stop further damage.

Inhalers

If COPD is giving you difficulty breathing you will probably be given an inhaler. Inhalers allow you to breathe medicine directly into your lungs.

There are various different inhalers available, which work in different ways. For example, some work by relaxing and widening your airways, while others work to reduce inflammation.

Some offer long-lasting relief (12 hours or more) and are best suited to people whose symptoms occur regularly throughout the day.

If you are more prone to occasional bouts of breathlessness, a different type of inhaler will be prescribed.

For these reasons, it’s important to discuss your symptoms at length with your doctor so that they can offer the best inhaler for your individual needs.

Tablets

Some people will be prescribed tablets to take alongside their inhaler (normally if the inhaler is not enough to manage your symptoms).

The main pills prescribed for COPD in the UK are:

Bronchodilators

A bronchodilator is a medicine that works by dilating your bronchi and bronchioles (parts of the lung). They can help to reduce inflammation and relax your airways.

The most commonly prescribed is theophylline, though in some cases doctors might prescribe aminophylline instead.

Mucolytics

Mucolytics work by thinning your phlegm, making it easier for you to cough up.

The most commonly prescribed of these is carbocisteine. If this does not help your symptoms or if you can’t take it for some reason, you might be recommended acetylcysteine.

Steroid tablets

Steroid tablets can help if you have a particularly bad flare-up caused by inflammation in your airways.

You’ll probably only be given a short course as steroids can have side effects if taken over long periods of time.

Antibiotics

If you are becoming more breathless, coughing more or producing more phlegm, it might be that you have a chest infection.

In this case you may be prescribed a course of antibiotics.

If you frequently develop chest infections, you may even be given antibiotics to keep at home and take in the case one develops.

Pulmonary rehabilitation

Pulmonary rehabilitation is the name for a specialised programme designed to help people with lung problems such as COPD. It involves both education and exercise.

You’ll normally do a course or programme of pulmonary rehab, which might include:

• Education about the condition, which may also be offered to your loved ones
• Training in certain exercises tailored to your needs and ability
• Dietary advice
• Emotional or psychological support

The programme has two main aims:

• To increase your ability to take part in physical activity before your symptoms become too much or your breathing becomes too laboured
• To help you protect your confidence and mental wellbeing while dealing with COPD

Further COPD treatment 

There are other treatments available for COPD if you are living with the disease at advanced stages. These include medicines, oxygen therapy and even surgery.

However, these are more intrusive and can have more serious side effects. It is always best to seek treatment as early as possible and start managing your COPD before it progresses too far.

What is it like to live with COPD?

As with any illness, chronic obstructive pulmonary disease affects everyone differently. One person’s experience will not be the same as another’s.

COPD can have a significant impact on your quality of life, affecting your health and wellbeing both physically and mentally.

Because of this, it’s important that you take steps to manage your condition. This can manage symptoms and reduce the risk of COPD flare-ups (also known as ‘COPD attacks’).

As well as the medication and treatments described above, there are certain lifestyle changes you can make to improve your quality of life and help manage your symptoms.

What triggers a COPD flare-up?

An ‘attack’ or ‘flare-up’ of COPD is when your symptoms get worse, generally causing very restricted breathing. This can be both distressing and dangerous.

A flare-up might involve some or all of the below:

• Coughing, wheezing or struggling to breathe more than normal
• Fever
• Feeling very tired
• Change in colour, consistency or levels of phlegm
• Headaches or dizziness
• Raised heart rate

These instances are normally caused by an infection in your lungs or sometimes elsewhere in your body. Infections can be either bacterial or viral, and it’s possible to develop both at once.

There are other things that are thought to be triggers but the evidence is not conclusive:

• Changes in the weather
• Overexertion
• Not getting enough sleep
• Stress or anxiety

Sometimes, you may experience an ‘attack’ and the cause will be unclear.

The best way to avoid flare-ups is to stick to your prescribed treatment plan, look after yourself and – if needed – stop smoking.

What can you do to manage your COPD?

The things you do yourself to take control of your condition can have a big impact.

The first step is to seek professional diagnosis and get advice on whether you need medication. After this, look to educate yourself as much as possible not just about COPD as a condition but also about your own symptoms and medication.

Keep track of your flare-ups, noting any triggers, and speak to a doctor or physiotherapist about the best ways to deal with them.

Crucially, you should commit to taking care of yourself. Staying active, learning how to control your breathing, eating well and protecting your mental health can all have a huge impact on the quality of your life.

COPD exercises

Although you might want to avoid exercise as something that exacerbates your breathlessness, exercising more and being more active in general can actually improve your breathing.

The more fit you are, the less quickly you will become breathless through activity.

Pulmonary rehabilitation can teach you the best ways to get fit and exercise at the right level for you.

Breathing exercises for COPD

Certain techniques can help you to manage your breathing better. There may also be certain positions that help when you’re feeling short of breath.

Speak to a specialist physiotherapist about what techniques can work for you.

Healthy eating and a healthy weight can help reduce symptoms

Whether you are suffering with COPD or not, eating well and maintaining a healthy weight are two of the most important things you can do to look after yourself.

If you have respiratory issues, being overweight can exacerbate them. It can also make it harder for you to move around and stay active, meaning your fitness will suffer.

Speak to a doctor or nurse for advice on a healthy weight for you.

When it comes to eating healthily, the most important thing is to eat a balanced diet covering the main food groups. If you are unsure where to start, a dietary consultation could put you on the right track.

What foods should be avoided with COPD?

There is no ‘COPD diet’ – you should simply try to eat as healthily as possible.

However, certain foods can exacerbate symptoms in some people, so you might want to avoid:

• Salt – this can cause water retention, which can make breathing more difficult, so try not too consumer too much
• Dairy – if you are having a flare-up, dairy products can potentially encourage the production of phlegm
• Fried or overly processed foods – these can cause bloating, exacerbating breathing issues
• Speak to your doctor before cutting out anything from your diet. They will advise whether these steps are necessary or healthy for you.

COPD management: remember to take care of your mental wellbeing too

Living with a long-term physical condition can have a serious impact on your mental health.

With COPD, you may find that the physical symptoms make you feel tired and that being less active increases stress and anxiety.

A number of people also find that chronic illness can lead to depression.

Take the time to look after yourself emotionally as well as physically.

And remember, speaking about how you are feeling is one of the most important steps towards feeling better. There are many options available to you, both privately and through the NHS. You should also speak to your loved ones, who will want to help you however they can.

Although living with COPD can be psychologically difficult, it is possible to treat the mental health issues that come with it. Do not hesitate to seek professional help if you need it.

The British Lung Foundation has support groups across the UK for people living with lung conditions. These can help connect you with other people living with COPD.