Chronic obstructive pulmonary disease
Introduction
Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.
The main symptom of chronic obstructive pulmonary disease (COPD) is an inability to breathe in and out properly. This is also referred to as ‘airflow obstruction’.
Airflow obstruction is caused by long-term damage to the lungs, usually as a result of smoking.
How common is COPD
COPD is one of the most common respiratory diseases in the UK. It usually affects people who are over 40 years of age.
Around 900,000 people in the UK have been diagnosed with COPD, but it is thought that another 450,000 may have the condition without realising it. COPD causes 30,000 deaths a year.
COPD affects more men than women. But, according to the British Thoracic Society, the rate of COPD among women is increasing.
The main cause of the condition is smoking. The likelihood of developing COPD increases the more you smoke and the longer you've been smoking.
The effects of COPD
The condition builds up over a number of years, causing the airways of your lungs (bronchioles) to narrow and permanently damaging your air sacs (alveoli). As the condition progresses, breathing in and out will become increasingly difficult. You may find it hard to do normal activities, such as walking to the shops. If not enough oxygen is getting through the narrowed airways to your heart you may also be at risk of heart failure.
The symptoms of COPD can seem similar to those of asthma. However, whereas asthma can be controlled with treatment, COPD causes permanent damage to the lungs. Treatment for COPD usually involves relieving the symptoms; for example, by using an inhaler to make breathing easier.
Although in the UK COPD causes about 30,000 deaths a year, severe COPD is preventable by making some basic changes to your lifestyle.
See the ‘prevention’ section for information and advice about how to prevent COPD developing, and how to alleviate the symptoms.
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Symptoms
If you smoke, you have an increased risk of getting chronic obstructive pulmonary disease (COPD). The condition can build up over a number of years, as your lungs are gradually damaged more and more by smoking.
However, COPD does not usually become noticeable until after the age of 40. Symptoms include:
- early morning ‘smoker’s cough’,
- persistent coughing,
- mucus and phlegm,
- wheezing,
- tight chest,
- difficulty breathing,
- shortness of breath, and
- repeated lung and chest infections.
If you have COPD, your bronchioles (airways of the lungs) become inflamed and narrowed. As your lungs’ alveoli (air sacs in the lungs) become permanently damaged, it will become increasingly difficult for you to breathe in and out.
The symptoms of COPD are often worse in the winter, and it is common to have two, or more, ‘flare-ups’ a year. A flare-up is when your symptoms are particularly bad.
Daily life
If you have COPD, you may feel anxious about your condition, and this can leave you feeling depressed and isolated.
If you are finding it hard to get air in and out of your lungs, the amount of oxygen reaching your heart and other muscles is restricted. This can make you feel very tired. This can affect your work, ability to exercise, social life, and personal relationships. It can also have a negative impact on your sex life, as you may feel too tired to have sex, or experience breathing difficulties during sex.
If you have severe COPD, carrying out simple tasks and daily activities can become increasingly difficult.
COPD and your weight
If you are having difficulties breathing, you may be using up a lot more energy than usual. You may also find that feeling breathless is making it hard to eat as much as you would normally. This can lead to weight loss and muscle wasting.
Severe weight loss can eventually result in serious complications, such as heart failure (a weakened, inefficient heart).
If you are losing a significant amount of weight, speak to your GP for advice about ways to help keep your weight up.
However, not everyone with COPD loses weight. If you are overweight, try not to put weight on. Obesity can also make COPD worse and lead to serious health conditions, such as heart disease and diabetes.
Whether you are under or over weight, eating a healthy, well-balanced diet is essential.
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Causes
Smoking is the primary cause of COPD
Smoking is the main cause of chronic obstructive pulmonary disease (COPD).It is responsible for around 80% of cases. The likelihood of developing the condition increases the more that you smoke, and the longer you have been smoking.
Between the age of 35-45, everyone’s lung function begins to gradually decline. For smokers, this loss of lung function speeds up to around three times the normal rate.
COPD is not curable, but if you quit smoking you can slow down the effects of the condition.
Other much less common causes of COPD include:
- passive smoking,
- pollution,
- fumes and dust.
- being born more susceptible to the condition.
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Diagnosis
If you have chronic obstructive pulmonary disease (COPD) you will often be short of breath, have a persistent cough and a build up of mucus and phlegm in your throat
The following tests can be carried out to help diagnose COPD and also to eliminate other conditions, such as asthma:
- Spirometry
Spirometry is usually used to diagnose COPD. It involves breathing in and out of a tube that is connected to a machine, so that your GP can assess whether or not your airways have narrowed.
- Chest Radiography.
Chest radiography is a type of X-ray that will show any hyperinflation (over expansion) of your lungs.
- Computerised tomography (CT) scan.
A CT scan is more sensitive than a chest radiograph (X-ray) and is particularly useful in diagnosing lung diseases.
- Blood test.
A full blood test may be carried out to check for anaemia (low iron levels in the red blood cells) that can make the symptoms of COPD worse.
A blood test may also be used to look for polycythaemia (an excess of red blood cells). If you have polycythaemia, your body may not be getting enough oxygen as a result of your lungs being damaged.
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Treatment
There is no cure for chronic obstructive pulmonary disease (COPD). Treatment is mainly used to relieve any symptoms that you have.
After assessing your condition, your GP may recommend a course of treatment for you, and closely monitor how well you respond to it. The effectiveness of treatment for COPD can vary from considerably from person to person. If the first type of treatment that you are given does not improve your symptoms of COPD, other treatment options will be considered.
Inhalers
If an inhaler is prescribed for you, your GP will explain how to use it.
Short-acting bronchodilator inhalers
Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up (bronchodilate). They also prevent hyperinflation (over expansion) of your lungs.
There are two types of short-acting bronchodilator inhalers:
- Beta-2 agonist inhalers - such as salbutamol and terbutaline, and
- Anticholinergic inhalers - such as ipratropium and oxitropium.
For people with mild COPD symptoms, one bronchodilator inhaler used ‘as needed’ (as and when you feel breathless) may be sufficient to relieve the symptoms.
For other people, it may be necessary to use one of each type of bronchodilator - a beta-2 agonist and an anticholinergic inhaler - four times a day.
Your GP, or COPD specialist, will recommend which inhaler to use.
Long-acting bronchodilator inhalers
If a short acting bronchodilator inhaler does not help to relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. These work in a similar way to the short-acting bronchodilators, but each dose lasts for at least 12 hours.
There are two types of long-acting bronchodilator inhalers:
- Beta-2 agonist inhalers - such as salmeterol and formoterol, and
- Anticholinergic inhalers - such as tiotropium.
Corticosteroid inhalers
Corticosteroids are similar to a natural hormone (cortisol) that is produced by your body. Corticosteroid inhalers all work in the same way; they reduce the inflammation in your airways.
If you have moderate, or severe COPD, and you are not getting adequate relief from bronchodilator inhalers, your GP may suggest that you have a four-week trial using a long-acting bronchodilator and a corticosteroid inhaler. The trial will only be continued if it helps to control your symptoms.
If you have very severe COPD, your GP may recommend that you use a corticosteroid inhaler without having a four-week trial. This is because there is some evidence to suggest that corticosteroids prevent flare-ups in those with very severe COPD.
There are several types of corticosteroid inhalers:
- beclometasone,
- budesonide,
- fluticasone, and
- mometasone.
Medicines
Theophylline tablets
If you are not getting adequate relief from the symptoms of COPD by using bronchodilator inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up.
Theophylline also increases the strength of your diaphragm (the large muscle at the base of the chest that is used when breathing) and speeds up how quickly you clear mucus and phlegm from your lungs. This helps you to breathe more easily.
Before taking theophylline tablets, you will need to give a blood sample. This is to measure the amount of theophylline in your blood and help your GP to prescribe the appropriate dose of theophylline tablet. As well as enabling the correct dose of theophylline to be prescribed, imeasuring the amount of theophylline in your blood will also reduce the likelihood of side effects.
Due to the risk of potential side effects, such as increasing your heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried first, before theophylline .
Mucolytic tablets or capsules
Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with moderate and severe COPD, who have frequent, or bad, flare-ups.
Antibiotics and steroid tablets
If you have a chest infection, your GP may prescribe a short course of antibiotics.
Steroid tablets may also be prescribed as a short course for one or two weeks if you have a bad flare-up. They work best if taken as the flare-up starts, so your GP may give you a stand-by course to keep at home.
Nebulisers
A nebuliser can be used for very severe cases of COPD. A nebuliser is a machine that administers medicine through a mouthpiece, or a face mask. The medicine is in a liquid form, and is converted into a fine mist. This enable a large dose of medicine to be taken in one go.
You can usually choose whether you would prefer to use the nebuliser with a mouthpiece, or a facemask. Your GP will advise you about how to use the nebuliser correctly.
Before starting this treatment, your GP or COPD specialist will test to make sure that the nebuliser is suitable for you.
Other types of treatment
Long-term oxygen therapy
In extreme cases of COPD, when the oxygen in your blood is very low, you may need to take oxygen from an electronically operated ‘oxygen concentrator’ through nasal tubes, or a mask.
This must be taken for at least 15 hours a day. The tubes from the machine are very long so you will be able to move around your home while you are connected.
Portable oxygen tanks are also available and liquid oxygen may be available in the future.
Do not smoke when you are using an oxygen concentrator. The increased level of oxygen that is produced is highly flammable, and a lit cigarette could trigger a fire, or an explosion.
Pulmonary rehabilitation programmes
Pulmonary rehabilitation programmes are a form of therapy that aims to improve your respiratory symptoms and sleep, and can increase your exercise capacity, mobility, and self-confidence.
The programme involves:
- education,
- exercise,
- psychological support,
- smoking cessation advice, and
- nutritional assessment.
Pulmonary rehabilitation takes place in a group setting, and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms. Pulmonary rehabilitation can greatly improve your quality of life.
Hospitalisation
In rare cases, hospitalisation may be necessary if you are having an exacerbation of COPD (a particularly severe attack).
In hospital, you are likely to receive oxygen, antibiotics (if necessary) and a nebuliser to help ease your symptoms. If your COPD is very severe, a stay in hospital is nearly always more effective than resting at home because your condition can be constantly monitored by medical professionals.
Lung transplantation
Lung transplantation is rare in cases of COPD and it is usually only suggested if your life expectancy is less than two years.
Although lung transplantations are usually very successful, you will need to take anti-rejection medication for the rest of your life. The medication will help your body to accept the new organ, but it can have unpleasant side effects, such as headaches and high blood pressure (hypertension).
Lung volume reduction surgery (LVRS)
Lung volume reduction surgery (LVRS) is when the damaged parts of your lung are removed during surgery. This can help to improve your symptoms, but may put you at increased risk of catching pneumonia, or developing an air leak where the lung is re-sealed.
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Prevention
There are several aspects of your lifestyle that you can change in order to reduce your risk of developing COPD, or to help ease your symptoms.
Give up smoking
Not smoking is the best way to prevent chronic obstructive pulmonary disease (COPD). If you smoke, and you have COPD, you should give up as soon as possible because quitting can slow down the progress of the condition.
If your symptoms of COPD are mild, stopping smoking may be all that is needed to significantly improve them. It is also important for you to avoid other people’s smoke and smoky environments.
Your GP can refer you to a smoking counselling service, or you can call the Stop Smoking Wales helpline on telephone number 0800 085 2219.
Get regular exercise
Regular exercise will help to strengthen your heart and lungs, and improve your breathing. You should aim to do a minimum of 30 minutes of exercise a day, at least five times a week.
Losing weight, if you are overweight, can also be beneficial because extra weight can make your breathlessness worse.
Eat a balanced diet
Eating a healthy, balanced diet is very important for keeping your immune system strong and healthy. Eat plenty of fruit and vegetables (at least five portions a day), and reduce the amount of fat, sugar, and salt, in your diet.
Drink plenty of fluids
Drinking plenty of fluids will help to reduce the amount of mucus and phlegm in your throat and lungs. Water is a particularly good.
Use a steam inhalator or humidifier
A steam inhalator, or humidifier, can be used at home to help to reduce excess mucus and phlegm. They can also reduce the feeling of being ‘blocked up’ and being unable to breathe properly.
Physiotherapy
Physiotherapy can also help to clear excess mucus and phlegm. A physiotherapist will be able to teach you exercises to do at home, such as arm exercises.
Get vaccinated
If you have COPD, you are at greater risk of catching other illnesses, such as influenza (flu). You should therefore have an annual flu jab every autumn ( between September and November).
A vaccination against pneumococcus (a bacterium that can cause serious chest infections) is also recommended, as a ‘one-off’ injection.
However, if you have ephritic syndrome (kidney damage), splenic (injury to your spleen), or asplenic dysfunction (no spleen) additional vaccinations may be required.
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Recommendations
COPD and flying
If you have chronic obstructive pulmonary disease (COPD) and you are planning to fly, you should see your GP to have a ‘fitness-to-fly’ assessment. This involves measuring your oxygen levels and checking your spirometry (breathing test) results. See the ‘diagnosis’ section for more details about spirometry.
Before travelling, remember to pack all of your medication, such as inhalers, in your hand luggage.
If you are using oxygen therapy, you should inform your travel operator and airline before booking your holiday, as you may need to get a medical form from your GP. If you are using long-term oxygen therapy, you should arrange to take an adequate oxygen supply with you abroad.
Some airlines may charge a fee for taking oxygen onboard. Since February 2006, UK oxygen suppliers have a duty to ensure that you can get oxygen while you are abroad. See the ‘selected links’ section for more information about oxygen
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