COPD

The biggest single cause of COPD is cigarette smoking. Once you give up smoking, you gradually reduce your chances of getting COPD - and you slow down its progress if you already have it.

Typically, COPD affects people over the age of 35 who are, or who have been, heavy smokers. It can also result from chronic severe asthma. There are other causes, but they are rare:

• Exposure to air pollution.
• Exposure to fumes or particles at work, for example welding fumes or coal dust.
• Alpha-1-antitrypsin deficiency, a genetic condition.

The symptoms of COPD vary depending on how bad it is, and how people have adapted to their problems. Symptoms include:

• long-term, chesty cough
• wheeze
• phlegm
• breathlessness
• anxiety and sometimes depression

In mild cases, symptoms like a cough, phlegm and shortness of breath may only be present during the winter or after a cold. In more severe cases, you may be short of breath every day. With more severe COPD, because of breathlessness, normal activities can become more difficult.

COPD can lead to feelings of anxiety because of breathlessness. People with COPD may reduce their activities to avoid becoming breathless. But by reducing activity levels you become less fit and therefore get breathless even sooner when you try to do any activity. People with COPD may adapt their lifestyles to reduce breathlessness - but keeping as fit as possible is important.

Some hospitals run pulmonary rehabilitation courses. These programmes involve exercise and education. Pulmonary rehabilitation improves your exercise performance, your health and your quality of life. Your doctor/nurse can tell you more.

Care and support from family and friends can do a lot to relieve anxiety and depression. Our helpline or network of Breathe Easy support groups can also help.

If you are breathless when exercising or moving around, have had a cough for a long time (with or without phlegm), if you wheeze, feel chesty or have bronchitis, then it may be that you have COPD.

You should go to your doctor and get checked out. Your doctor should assess how well you breathe by using a machine called a spirometer. The results of your spirometer test will be part of the diagnosis.

Your doctor should then tell you the result and record it in your medical records/notes. It is important to know whether you have COPD or asthma; although the symptoms of COPD and asthma may be similar, the treatments may be different. The tests you have will give a clearer picture of your condition and how best to treat it.

Your doctor may also ask you to perform another breathing test to see how quickly you can breathe out. This is called a Peak Flow test.

It is very important that you ask the doctor or nurse any questions that you want to. These may include:

• Have I got COPD or asthma?
• What exactly is COPD?
• How did I get COPD?
• Why are there two lung tests and what do they show?
• Will I get better?
• Should I see a specialist?

The National Institute for Health and Clinical Excellence (NICE) guidelines for the diagnosis and treatment of COPD says that you should have a proper diagnostic test. These guidelines apply in England and Wales, but are also relevant for people in Northern Ireland and Scotland who have COPD.

Yet many people with COPD will never have had a spirometer test. It is important that you have one and if you are not offered this test, you should ask for one from your doctor.
It may be that your doctor asks you to go to a centre where all the tests are done, as some surgeries do not have access to the proper equipment.

There are several ways to treat COPD and manage the condition.

The National Institute for Health and Clinical Excellence (NICE) has produced guidelines that make recommendations for treating COPD. These guidelines apply in England and Wales, but are also relevant for people in Northern Ireland and Scotland who have COPD.

Stopping smoking


Smoking is a major cause of COPD. If you are still smoking then the single most important way in which you can help yourself feel better is to stop. If you have already stopped, well done.
If you haven’t been able to stop yet then you should, according to guidelines from NICE, be offered help in the following ways:

• By having a fully documented history of your smoking taken, so that you can understand why and how you smoke
• By being offered help on a ‘stop smoking’ programme. Your doctor or nurse should talk you through what the programme involves. They should also explain to you why stopping smoking will help you.

You may want to ask your doctor or nurse some of the following questions:

• I’ve tried stopping before, but I couldn’t. How can you help me give up?
• How will stopping smoking help my COPD?
• How effective are the different ‘stop smoking’ programmes?
• Which one would suit me best?
• Will it be easier to stop if I am using some kind of medicinal help, like nicotine chewing gum or patches?
• What if I give up and then start smoking again?
• If I stop smoking, what difference will it make to my condition and how I feel?

Medication


If you are breathless you should be given an inhaled medicine called a bronchodilator. These take different forms. Everyone with COPD should be given a short-acting bronchodilator inhaler.

The NICE guidelines also recommend that people with COPD are given a long-acting bronchodilator inhaler, if needed.
In addition to a long-acting bronchodilator, you may also need inhaled corticosteroids, if you have poor lung function and have had two or more exacerbations/chest infections in a year, which meant you had to take oral steroids or antibiotics. An exacerbation, or ‘lung attack’ is a time when your symptoms suddenly get much worse.

Your doctor should try out different treatments to see which one suits you the best and has fewest side-effects. Your doctor will see how well your treatment is working by assessing whether your symptoms are getting better or worse. They may also ask you what activities you can do now that you couldn’t before and how well you can exercise to see how well your lungs are working.

If your doctor thinks that your treatment is not working, they may change it.

When your doctor gives you your medication, they may call it by a different name to those listed in the table above. Medicines can have several names and inhaled medication can also come in different coloured inhalers. Always ask if you are unsure.

You may want to ask your doctor or nurse some of the following questions:

• What do my inhalers do?
• What types of inhalers are available to me?
• Why will these help?
• How long will I need to use it for?
• How often will I have to take it?
• How do I use my inhaler properly? (It can be difficult to take in the instructions the first time, so don’t worry about asking for a second or third demonstration.)
• Why do I feel no effect from some of the inhalers, and others make me feel better?
• Why should I use the ones that don’t seem to work?
• What will happen if I use the inhaler more often than I’m told to?
• What happens if I forget to take my inhaler?
• What do I do when my inhaler runs out?

Oxygen therapy


In some cases you may be prescribed oxygen. This may be to cover long periods every day (if you’re not able to breathe in enough oxygen), in short bursts for breathlessness, or for short-term use in hospital for people having an exacerbation.
Your doctor will check whether you need extra oxygen if:

• The amount of oxygen in your blood is low
• There is swelling in your limbs
• Your skin has a bluish tinge
• You have high blood pressure in the blood vessels around your lungs.

Oxygen for use at home can be prescribed on the NHS in following ways:

• You may be given a fixed supply of oxygen at home, through an oxygen concentrator. This is a machine that increases the amount of oxygen in the air. It runs off mains electricity
• Portable oxygen can be used when you are away from home. It should be prescribed if you are already having oxygen. It should also be considered if your blood oxygen drops when you do an activity
• Treatment involving short bursts of oxygen is sometimes recommended for episodes of severe breathlessness.

You may want to ask your doctor or nurse some of the following questions:

• I don’t know how or when to use oxygen - who can help me?
• I feel breathless a lot - why haven’t I been offered oxygen?
• I’ve seen portable oxygen that’s much lighter/smaller than mine - where can I get it?
• Is it dangerous to smoke around someone on oxygen?
• I’m embarrassed by the nose tubes - can I take it some other way?

Pulmonary rehabilitation


Pulmonary rehabilitation is designed to help people with chronic lung problems. A typical pulmonary rehabilitation course includes:

• A gentle physical exercise programme, carefully tailored to each individual
• Advice on lung health and coping with breathlessness
• A friendly, supportive atmosphere.

Pulmonary rehabilitation helps to make you as active as possible, enjoy your life and live as independently as you want.

The NICE guidelines say that pulmonary rehabilitation should be offered to all patients with COPD who feel they have difficulty doing usual day to day activities. This is known in the guidelines as being ‘functionally disabled by COPD’.

If you are not offered a course when you feel that you could benefit from one, then you should contact the British Lung Foundation Helpline on 03000 030 555 for advice on how you might be able to access pulmonary rehabilitation.
You may want to ask your doctor or nurse some of the following questions:

• I get breathless going up the stairs! How can I do an exercise class?
• What is pulmonary rehabilitation and will I benefit from it?
• Where can I go to get on a course?
• Why is a course not available for me?
• Who can I complain to that there is no course available for me?
• Can I get transport to the classes?

Managing exacerbations – the bad times


Even though COPD is a long-term illness, you may still have times when your symptoms get suddenly worse. Doctors and nurses call these 'exacerbations'. It's very important that you should know what to do.

First of all, you need to know your symptoms on a daily basis, so you know when they change. This might be:

• You are coughing up more phlegm.
• A change in the colour or thickness of your phlegm.
• You have a temperature.
• You find normal activities more difficult.
• You are more breathless.

It is very important to manage these exacerbations and your doctor should discuss with you how to do this. They may suggest having steroid tablets/and or antibiotics at home.
Most people can be treated at home if they have an exacerbation, but some will need to go into hospital. The decision about whether to go into hospital depends on factors such as: how bad the exacerbation is; what your COPD is normally like; general health; and how well you would be able to cope at home.

Schemes that support this are called ‘hospital-at-home’ or ‘assisted-discharge’ schemes, and they involve healthcare professionals who have experience in helping people with COPD. Your doctor should look at your individual circumstances, preference, local arrangements and resources when making a decision about what is suitable for you.
You may want to ask your doctor or nurse some of the following questions:

• Why do I get exacerbations and how should I treat them?
• How can I stop getting them?
• How do I know when to increase my bronchodilator medicine and by how much?
• Can I have some oral steroids/antibiotics at home so that I can use them when I need them?
• What vaccinations should I have?
• Will I be able to make the decision or will someone make it for me?
• How can I look after myself best and manage my illness?
• What can I do if my local health service doesn’t offer ‘hospital-at-home’ or ‘assisted-discharge’ schemes?
• When should I call a doctor/ambulance?
   

Non-invasive ventilation (NIV)


NIV is an emergency treatment that you may receive if you are taken to hospital because of an exacerbation. NIV is a method of helping someone get enough oxygen into their blood. It is not the same as oxygen therapy. NIV involves wearing a mask that covers the nose and is connected to a small machine that pushes oxygen through the mask and into the lungs.

The NICE guidelines recommend that NIV is used in some specific circumstances during exacerbations after other treatments have been tried.

You may want to ask your doctor or nurse some of the following questions:

• What is NIV and how will it help me?
• How is NIV different from oxygen therapy?
• How will I be able to decide whether to have NIV if I am already ill when I need it?
• How long will I be given it?

COPD can affect every aspect of day-to-day life. You will probably have to make a number of changes to your lifestyle.

There are some things you should cut out and some things you should take up.

If you, or someone you know has COPD, the tips and information on this page can help to make daily life more enjoyable and fulfilling.

Be careful what you breathe

Because your lungs are more sensitive, you need to take care about what and where you breathe:

• Try to avoid infections - stay away from people (including babies!) who have colds, flu, sinus infections or a sore throat. And ask them to stay away from you too. You should also have a flu jab every year and make sure you are vaccinated against pneumonia.
• If you know of places where there are regular traffic jams, or where there are lots of exhaust fumes (e.g. underground car parks), try to stay away.
• If you work in a dusty or smoky environment, then you might need to change departments - talk with your employer and explain the problem.
• Only use strong-smelling products (like cleaning products) when there's lots of ventilation.
• Don't go to smoky places, and ask people not to smoke around you.
• Don't use air freshener plug-ins or sprays, or scented candles.
• Try to keep the air in your house at a constant temperature.
• If you're going outside on a cold or windy day, cover your nose and mouth with a scarf.
• Don't use hair spray, and avoid perfume.

Help people to help you - they won't know unless you explain it to them. But they will want to help if they understand your problems.

Treatment and medication

It's important that you go and see your doctor or nurse regularly so that they can check how you are. You should go even if you're feeling well. This is the only way the doctor or nurse can make sure you are taking the right medication, or see if you should be using other medicines or therapies.
Always take your medicine
If you are prescribed medicine, the doctor or nurse believes that it will help you. So you should make sure you take it as instructed. It won't get any less effective if you use it regularly, because it is designed to work this way.

You should also be sure that you use your inhaler correctly - a lot of people don't. Ask the nurse to check your technique. And if you are using other equipment, like a spacer, or a nebuliser, you should make sure you clean and maintain it properly.

Take exercise and go to pulmonary rehabilitation

Many people with COPD stop taking exercise because it makes them breathless. But not exercising makes things worse. You can't do yourself harm by over-exertion, because breathlessness will stop you. Try to walk, even if it's just around the house or up and down the garden.

See if there are pulmonary rehabilitation classes in your area - these are individually tailored classes to help you increase your lung fitness, and can be very valuable.

Relax, and conserve your energy

Stress and anxiety may make your symptoms worse. So make sure you talk with your friends, family or health professional - let people know how you are feeling and share your concerns. And try to avoid situations you know will worry you.

And while it's important to stay active, save your energy for when you really need it. You might not need the tips below - it depends on how serious your symptoms are - but here are things you can try if you do need to save energy:

• Organise the space around you so that what you need is near at hand.
• Keep your reliever inhaler with you.
• Sit down as much as you can - in the shower, cleaning your teeth, peeling potatoes.
• Pace yourself - slow and steady will get you there.
• Avoid unnecessary activity - put on a toweling robe instead of drying yourself with a towel.
• Try to avoid bending down - wear slip-on shoes, or use long-handled tools in the garden.
• Don't worry about getting a little breathless - if you do, take a break to get your breath back, then start again.
• If you can, sleep under a quilt rather than sheets and blankets.
• Give yourself a treat every day.

And... ask for help if you need it!

Eat well, drink well

Having COPD means that you use up a lot of energy in breathing, which is why many people with COPD lose weight.
It's really important for you to eat a healthy diet. Eating little and often will stop you getting breathless during long meals and feeling bloated. You should aim for food that is high in protein and make sure that you are taking in enough calories. 

Use fast and easy recipes. When you have the energy, cook more meals than you need and freeze them for a bad day. And if you can, share the cooking with someone else.

It's also important to drink a lot of water (unless your doctor has told you not to). It keeps the lining of the airways moist and your sputum will be thinner.

Sleep well

It's vital to get enough rest every day. Take time to relax before going to bed. Make sure your bed is comfortable and that your medicine is where you can reach it if you need to. Some people prefer to prop themselves into a more upright position to sleep, or to sleep on their side.

Sex

Having an illness like COPD can upset any relationship. It will also make you feel tired. And it can also make you feel anxious and depressed. Also, COPD sufferers will experience breathlessness during sexual activity at some stage, which can be worrying. All of this means that your sex life can suffer.
Things to remember:

• Avoid sex immediately after a heavy meal and after drinking alcohol.
• Some changes in your sex life are just because you're getting older - not because of COPD. Slower erections and delayed orgasms are normal in middle and later life.
• Conserve energy.
• Learn about how your disease and your medicines might affect you.
• Let your medicine work for you.
• Communicate with your partner and stay open-minded.
• Explore what you both like sexually.
• Remember that simply touching, being touched and being close to someone helps a person feel loved, special and a true partner in a relationship.

Find out more or ask your GP or nurse for advice if you have problems.

Breathing techniques

There are various techniques for coping with breathlessness. If you practice these and use them every day, they will help you when you are active and getting breathless. They will also help you manage if you get short of breath suddenly.

Breathing control

This is helpful if you are generally short of breath. Breathing control means breathing gently, using the least effort, with your shoulders supported and relaxed. Use one of the positions below.

In a comfortable, supported position, relax your shoulders, arms and hands. Breathe in gently through your nose and breathe out through your nose or mouth. Try to feel more relaxed and calmer each time you breathe out.

Techniques for when you are more active:

• Try all of these gently - don't force yourself.
• You can combine these techniques - they're all helpful for when you're short of breath.
• If you feel wheezy or tight-chested, try taking your 'reliever' inhaler. And remember, never hold your breath - you need the oxygen!

1. Relaxed slow deep breathing


Gently slow down your breathing. Breathe more deeply. Breathe in through your nose and breathe out through your mouth.

2. Pursed lips breathing


Breathe out with your lips pursed, as if you're whistling. This slows your breathing down and helps to make your breathing more efficient.

3. 'Blow as you go!'

• stretching your arms above your head
• reaching for something on a shelf
• bending down
• going up a step or stair
• standing up
• or during the hardest part of any action BLOW as you GO!

• breathe in when on the stair, and breathe out as you go up a stair (blow as you go!), or
• breathe in for one stair and out for one stair, or
• breathe in for one stair and out for two, or
• breathe in for two stairs and out for three

Positions
The best positions are the ones which need the least energy or effort. If you tense your shoulders and grip onto things when you are breathless, you're wasting energy (and oxygen).

      Figure 1                               Figure 2                      Figure 3

• To ease your breathing when standing up, lean from the hips, with your forearms resting on something at the right height (figure 1). Chairs, window sills, garden walls or kitchen work surfaces are often of a suitable height.
• When you're standing or walking, try putting your hands on your hips, in your pockets, or stick your thumbs into your belt loops to support your arms without gripping. If you carry a shoulder bag, you can rest your arms on it.
• Sitting uses less energy than standing up. You may find it useful to lean forwards, resting your forearms on your knees, or on the arms of a chair or table (figure 2).
• Using a walking aid (walking stick, or a frame with wheels at the back and front) can help you find one of these comfortable postures when you are out and about. Most people feel better pushing a supermarket trolley - it works the same way.
• You can rest your head and arms on pillows on a table when you're really short of breath (figure 3).
• Try lying on your side, propped up with lots of pillows.

Try all these positions and decide which ones are best for you. Different ones will suit different situations.

How will my condition affect my spouse/partner/carer?

It is inevitable that at some stage your spouse/partner/carer will feel anxious or frustrated about your breathing problems.
It is important to talk about worries together. Your partner may react by doing everything for you, but this isn't always the best approach. It is important that you remain as active as possible and continue to enjoy things together. Keeping fit will help achieve this.

Find out more information for friends, families and carers.

The COPD Assessment Test (CAT) is a questionnaire for people with COPD. It is designed to measure the impact of the condition on a person’s life, and how this changes over time. The CAT is very simple to administer, and aims to help doctors and nurses better manage a patient’s COPD.

Take the test here