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1 COPD The basics

2 Why should I read this booklet? This booklet contains information for people who have recently been told by their doctor that they have a condition called Chronic Obstructive Pulmonary Disease or COPD for short. It will help you to understand more about COPD and what to expect living with this condition. COPD is a condition that can affect all parts of your life, although there is a lot you can do to look after your health and wellbeing. Learning as much as you can about what you can do to manage COPD will help you feel more in control of your health and your life. If you have any questions about your health or about COPD, it is important that you talk to your doctor or other healthcare provider. People with COPD who take steps to manage their condition have reported positive effects, such as feeling less breathless, feeling more in control of things and needing fewer visits to the doctor or hospital. Taking steps now to manage your condition can reduce the impact of COPD on your life both now and in the future. For more information about COPD or to find support services, contact Lung Foundation Australia by: phoning (free call) ing enquiries@lungfoundation.com.au logging on to

3 Contents About COPD...2 How to manage the influence of COPD on your life...6 Things you can do now to slow the progression of your COPD...8 Understanding COPD medicines...11 How you use your inhaler is important...17 Working with your healthcare team...18 I just thought I was getting older and suffering the effects of years of smoking. I didn t realise there was a name for what I have and that there was something I could do to feel better. Donna, 45 years COPD The Basics 1

4 About COPD What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease. It is a long-lasting disease of the lungs. If you have been diagnosed with COPD it means that you have damage to the small airways in your lungs. Damage to the airways means they become narrower, making it harder for air to get in and out of the lungs. This damage and narrowing causes the symptoms of COPD which are: increasing shortness of breath coughing increased mucus production by your lungs. COPD is a long-term disease. Although it gets worse over time you can take steps NOW to control the symptoms and slow down damage to your lungs. Asthma and COPD Both asthma and COPD are common, and some people have both conditions. However, asthma and COPD: have different causes affect the body differently need different treatments. Your doctor will work out if you have COPD or asthma, or both, by testing your lungs, using a lung function test, also known as spirometry. 2 Lung Foundation Australia

5 COPD is an umbrella term for a group of disorders that includes emphysema, chronic bronchitis and chronic asthma that is not fully reversible. People with COPD can have one or more of these conditions. What is emphysema? Emphysema is a condition in which air gets trapped inside the lungs. This makes it harder to breathe in again. The main symptom of emphysema is breathlessness. What is chronic bronchitis? Chronic bronchitis is a constant and long-lasting irritation and swelling of the airways. The main symptoms of chronic bronchitis are cough and increased secretions from the lungs such as mucus. What is chronic asthma? Asthma is a condition that affects the small airways. When you have asthma symptoms the muscles in the airways tighten and the lining of the airways swells and produces sticky mucus. These changes cause the airways to become narrow, so that there is less space for the air to flow into and out of your lungs. Usually, medicines reverse this process and open the airways. However, for some people (usually older people), the medicines do not fully open the airways. This is known as chronic asthma that isn t fully reversible and becomes categorised as COPD. COPD The Basics 3

6 What symptoms do people with COPD have? People with COPD can suffer from increasing shortness of breath, coughing and an increase in secretions from their lungs such as mucus. COPD is a progressive disease, which means the symptoms are likely to get worse over time. If your symptoms are not affecting you much, it is called mild COPD. If your symptoms are getting bad, it is called moderate COPD. If your symptoms are very bad, it is called severe COPD. Can COPD be cured? At present, there is no cure for COPD as the damage to your lungs cannot be reversed. However, COPD symptoms are treatable. You can take steps NOW to control your symptoms and slow down further damage to your lungs. COPD is a progressive disease, which means the symptoms are likely to get worse over time. Doing all that you can to look after yourself and your lungs will slow down the rate of this worsening so that you can continue to enjoy your life. If you are a smoker, stopping smoking is the most important thing you can do for your health. 4 Lung Foundation Australia

7 Mild COPD In mild COPD, your only symptom may be the need to cough up mucus each morning. Some symptoms such as shortness of breath, coughing or coughing up mucus may only occur during winter or after a cold. You may also feel a little more puffed and out of breath than you used to, if you exert yourself or walk quickly. Moderate COPD In moderate COPD, you are likely to notice symptoms almost every day. You may: cough more and cough up mucus often feel very puffed or out of breath if you exert yourself or walk quickly have trouble working or doing chores because you get out of breath take several weeks to recover from a cold or chest infection. Severe COPD In severe COPD, you may be short of breath during normal daily activities such as taking a shower or getting the mail from the letterbox. Severe COPD can have a big impact on your life. You may: find it hard to walk up stairs or across the room without getting very out of breath get tired easily not be able to continue to work or do chores around your home be frustrated with the constant need to clear mucus from your chest cough even more and cough up a lot of mucus get chest infections more often take several weeks to recover from a cold or chest infection. COPD The Basics 5

8 How to manage the influence of COPD on your life COPD can eventually influence every aspect of your day-to-day life and may also affect how you think and feel about yourself. Learning more about your condition and using services such as special exercise/education classes (pulmonary rehabilitation) and support groups will help you realise that there are steps that you can take NOW to help control symptoms and slow down damage to your lungs. Education and reassurance for you and your family and friends will help you to manage your condition better. You can ask one or more of your family or friends to become part of your healthcare team. With their support and by taking the right steps you can continue to enjoy life. Flare-ups A flare-up of COPD symptoms = a worsening of breathlessness, coughing and/or secretions from the lungs, such as mucus, that happens fairly quickly over a few days. Your doctor may use the word exacerbation (pronounced ex-ass-er-bay-shon) instead of flare-up. Flare-ups can be common in COPD; they may occur several times a year. Flare-ups can be unpleasant because they reduce your enjoyment of life and restrict what you are able to do, and if you have repeated flare-ups you may need to go to hospital. Flare-ups can cause permanent damage to your lungs. By preventing a flare-up you can help to prevent your COPD symptoms getting worse. 6 Lung Foundation Australia

9 Dealing with a flare-up If your symptoms get worse fairly quickly over a few days, always see your doctor for treatment as soon as you can. If you have already prepared a COPD Action Plan with your doctor, this may tell you exactly what to do if you have a flare-up. If you have a flare-up your doctor may prescribe a few days of steroid medicines and/or antibiotics. By getting treatment early you can help to reduce the severity of your flare-up and may prevent the need to go to hospital. Talk to your doctor if you are not sure what to do when you have a flare-up. Avoiding flare-ups Take your medicine regularly as instructed by your doctor; this can help reduce flare-ups. Protect yourself against chest infections by having a flu injection each autumn. Try to stay away from people (including babies) who have colds, flu, sinus infections or sore throats. Avoid things that can make your symptoms worse such as fumes, dust or cold or very humid air. COPD The Basics 7

10 Things you can do now to slow the progression of your COPD There is a lot you can do to reduce the effect COPD has on you. If you take steps to control your COPD symptoms, you can help ensure your daily life stays enjoyable and fulfilling. STOP smoking If you smoke, stopping smoking is the single most important thing you can do. It will improve your lung health and help to slow down worsening of COPD. If you continue smoking, your lungs are likely to get worse far more quickly than if you quit. The sooner you quit smoking the better. Do not feel guilty about having smoked just think about how giving up now will improve the rest of your life. If you have given up smoking or are trying to quit, well done! This is a positive step towards improving your health. Do everything you can to give up smoking for good. Your immediate and long-term health depends on it. Finding help to quit Many people need help to quit smoking. Your doctor or pharmacist can provide help and advice. Nicotine replacement therapy or prescription anti-smoking medicines may help you quit. The National Smoking Quitline provides assistance if you wish to quit smoking. You can contact Quitline by: phoning logging on to 8 Lung Foundation Australia

11 Exercise regularly People with COPD who exercise regularly have better breathing, fewer COPD symptoms and maintain a better quality of life. Ideally the activity that you do should make you a little out of breath. Aim for at least 30 minutes, five times a week. You do not have to do all 30 minutes at once. Check with your doctor whether this amount of activity is recommended for you. Do not avoid exercise or activity because you fear breathlessness. In the long run, staying inactive actually makes shortness of breath worse. It is highly recommended to attend formal Pulmonary Rehabilitation Programs. These programs are generally 8 weeks long and combine exercise/education and strategies to help reduce the symptoms of COPD and keep you well and out of hospital. I was suffering from shortness of breath and when I started trying off the waiting list for lung reduction surgery. to get fit I couldn t get around the block. Any minor incline was a challenge. Now I m running 30 to 40 km a week since I stopped smoking. And I just don t cough as much. Roy, 51 years Pulmonary rehabilitation made such a difference for me that my doctor took me And I am now back at work two days a week. John, 61 years COPD The Basics 9

12 Eat healthily Keeping a healthy weight not overweight but not underweight either is good for your overall health. Eating a healthy diet will help you to stay strong and have more energy. Make sure you are eating enough healthy foods each day to get good nutrition. The table below shows the types of food you should have each day. Food group Breads and cereals 3 to 6 Vegetables and legumes 5 to 6 Fruit 2 Milk and dairy products 2.5 to 4 Meat, poultry, fish, eggs and nuts 2 to 3 *Number of serves depends on age, gender and activity level. Refer to for more information. Recommended number of serves per day* Take your medicine as instructed It is essential that you take your medicine as instructed by your doctor, even when you feel well. Medicines always work best when taken as instructed and can help prevent your COPD symptoms from getting worse in the long term. Do not be tempted to decide when and how much medicine you will take, as this may result in you not getting the most benefit from your medicine. Learn how your medicines work. This will help you to understand why and when you need to take them. 10 Lung Foundation Australia

13 Understanding COPD medicines About COPD medicines Your doctor may have prescribed you medicines to help control your COPD. The COPD medicines you have been prescribed are tailored to you and your symptoms. Because everyone is different, other people with COPD may have different medicines and/or different medicine dosages. Although medicines cannot cure COPD, when used as instructed they can go a long way towards reducing your symptoms and preventing flare-ups. Make sure that you understand the following about each medicine that you are prescribed: what the medicine is for how the medicine works how to take the medicine when the best time to take it is how long the dose is effective what the possible side-effects of the medicine are and how you can avoid or reduce them whether the medicine will cause problems with any other medicine you are taking. COPD The Basics 11

14 Types of medicine Because COPD medicines need to act on the airways and the lungs, most COPD medicines are inhaled (breathed in) using a special inhaler device. That way, medicine is delivered directly into the lungs, where it is needed. There are three main types of inhaler medicine: reliever medicine for instant relief of sudden increased breathlessness maintenance medicines for long-term regular use to control your symptoms over the long term and to help prevent flare-ups combination medicine for long-term regular use to help prevent flare-ups in more severe COPD. Your doctor may also prescribe you medicine that you swallow, sometimes for longer periods of time, sometimes only when you experience a flare-up. Relievers SABA SAMA Ventolin MDI Asmol MDI #Airomir MDI Airomir Bricanyl Atrovent Autohaler Turbuhaler MDI Spacers are recommended to be used with puffers 12 Lung Foundation Australia

15 Inhalers Reliever medicines Reliever inhalers should be used in a situation where you experience a sudden increase in your breathlessness. They are called short-acting bronchodilators (pronounced bronk-oh-dye-lay-tors) and work by relaxing the muscles around the airways. This helps to open up the airways and allows air to flow more easily out of and into the lungs when you breathe easing your feeling of breathlessness. Relievers often work within minutes of inhalation and their effects last for several hours. Reliever medicines includes inhaler such as Ventolin, Asmol, Airomir and Atrovent (salbutamol) and Bricanyl (terbutaline). Relievers should be used when you experience a sudden increase in breathlessness. Always make sure you carry a reliever inhaler with you just in case. If you are using your reliever more often than prescribed, discuss this with your doctor as it may mean that your COPD is getting worse. Talk to your doctor about using your reliever inhaler before you exercise. Maintenance Medicines Maintenance inhalers are bronchodilators too, since they open up the airways by relaxing the muscles around the airway the same way relievers do. Maintenance bronchodilators usually take a little longer than relievers to start working, but once you have taken them, their effects last for much longer than relievers. Maintenance medicines include Spiriva (tiotropium bromide), Oxis and Foradile (eformoterol), Serevent (salmeterol), Atrovent (ipratropium) Seebri (glycopyrronium bromide), Bretaris (aclidinium bromide), Incruse (umeclidinium), Onbrez (indacaterol), Ultibro (glycopyrronium/indacterol) and Anoro (umeclidinium/vilanterol). COPD The Basics 13

16 Maintenance medicines will help to reduce your COPD symptoms in the long term and can help to prevent flare-ups. All maintenance inhalers work in one of two different ways to relax the muscles around the airways. You can be prescribed one type alone, or may receive a combination of two types. To get the most benefit out of these medicines you should take them each day, as instructed by your doctor. Used daily, they will help to reduce your COPD symptoms in the long term. By using maintenance inhalers as instructed you can also reduce your risk of flare-ups and improve your overall health. Maintenance LAMA LAMA/LABA LABA Spiriva HandiHaler Spiriva Respimat Ultibro Breezhaler Spiolto Respimat Onbrez Breezhaler *Foradile Aerolizer Incruse Ellipta Seebri Breezhaler ICS/LABA Anoro Ellipta Brimica Genuair *Oxis Turbuhaler ICS (For patients with COPD and Asthma) *Serevent Accuhaler Bretaris Symbicort Genuair Breo Ellipta Turbuhaler *Flixotide MDI *Flixotide Accuhaler *Alvesco MDI ICS/LABA Symbicort Rapihaler Seretide Accuhaler Seretide MDI *QVAR MDI *Pulmicort Turbuhaler *Flutiform MDI 14 Lung Foundation Australia

17 Combining medicines in one inhaler Some inhalers contain two types of bronchodilator in the one device e.g. Ultibro (glycopyrronium bromide/indacaterol) and Anoro (umeclidinium/vilanterol). Bronchodilators containing steroids Some inhalers contain steroids. In more severe COPD they help to reduce the number of flare-ups you may experience. Your doctor can prescribe a steroid inhaler when: your COPD symptoms are not controlled with maintenance medicine alone, or you have regular flare-ups even though you take your other medicine as instructed. Steroids might be prescribed on their own if you have asthma. Steroids work by reducing inflammation which causes swelling and mucus production in your airways. They help to make the airways less sensitive to things that can cause swelling and mucus production (for example dust or smog). Steroid inhalers include Flixotide (fluticasone), Pulmicort (budesonide), Qvar (beclomethasone) and Alvesco (ciclesonide). Just like maintenance medicine, steroid inhalers must be taken every day to be effective. It may take a couple of weeks for you to start noticing their effect. Steroids are combined with a bronchodilator in one device for use in COPD. Combining medicine like this can help to reduce the number of flare-ups you may experience, which in turn improves your lung function and overall health. In addition, combined medicine is easier to use since you only have to use one inhaler to take two different medicines. Combination inhalers include Symbicort (budesonide and eformoterol) and Seretide (fluticasone and salmeterol) and Breo (fluticasone furoate/vilanterol). My condition can t be reversed but it can be controlled. Roy, 51 years COPD The Basics 15

18 Flare-up medicines Steroid tablets can be prescribed for a short period of time to help treat a flare-up. Your doctor will normally prescribe a course for 5 10 days to start with. When you are taking steroid tablets do not stop taking them suddenly without consulting a doctor. It is also important that you take them at the time instructed by your doctor. Antibiotics will not help manage COPD from day to day but can be useful if you have a flare-up as a result of an infection. When the colour, amount and/or texture of the mucus that you cough up changes, it is often a sign that you have an infection. If you have prepared a COPD Action Plan with your doctor, it may advise you to start using the antibiotics your doctor has prescribed when you feel a flare-up coming on. Make sure you take all the antibiotic tablets that your doctor has prescribed, even if you start to feel better. COPD ACTION PLAN (Chronic Obstructive Pulmonary Disease) For more information refer to 'Writing a COPD Action Plan' Date: (Ask your doctor to review each year with your care plan) Patient Name: Date of Birth: GP Name: GP Phone: A/H: Health Worker Name: Health Worker Phone: Feeling your usual self I can do my usual daily activities Sleeping as usual Taking usual medicine Usual amount of phlegm ACTION: Continue taking your usual medicines as listed below. Annual Influenza Immunisation - Date: Last Pneumococcal Immunisation - Date: Feeling harder to breathe/feeling sick FeeLINg harder TO breathe ThAN usual More phlegm or thicker than usual My FEV1 is: ACTION: Follow plan below for extra medicines. Plan your day, get rest, relax, use breathing techniques, huff and cough to clear phlegm as required. FeeLINg sick Taking reliever medicine 3-4 hourly, but not getting adequate relief ACTION: Start taking prednisolone. Contact your Health Worker/Nurse or Doctor. * GP to fill in if prescribed. Not feeling good (trouble breathing and/or wheezing) Very short of breath at rest Confused, slurring of speech High fever Drowsy More coughing Loss of appetite Not sleeping well Not much energy Things to talk about with the Health Worker, Nurse or Doctor Know your baseline... Relievers Ventolin MDI Maintenance Asmol MDI What you do to stay well Don t smoke Check your inhaler technique regularly Walk daily/keep active Attend lung rehab Get flu and pneumonia immunisations REsouRcEs For patient resources please contact: Lung Foundation Australia Your nearest Support Group contact person: Your nearest Pulmonary Rehabilitation Program: Your nearest Lungs in Action class: #Airomir MDI Your baseline is when you are feeling your usual self How breathless are you? How far can you walk? How well do you sleep and eat? What is the colour of your phlegm? How much phlegm do you cough up? SABA SAMA LAMA/LABA My extra medicine Colour of device How many puffs or tablets How often Prednisolone* Strength Tablets each day No. of days Difficulty sleeping/woken easily Blood in your phlegm Swollen ankles Ultibro Breezhaler Spiolto Respimat Anoro Ellipta Brimica Genuair LABA A change in colour and/or volume of phlegm Fever ACTION: Start taking antibiotics as well as prednisolone. Contact your Health Worker/ Nurse or Doctor. Chest pain Afraid/scared CAuTION! Ambulance/Paramedics: Oxygen supplementation to maintain SpO2 92% max (exceeding 92% risks hypercapnia) CO 2 Retainer: Yes No Unknown My usual medicines Colour of device How many puffs or tablets How often Oxygen: Yes/No: Setting or l/min: hrs/day: Antibiotics* Strength Tablets each day No. of days ACTION: Contact Doctor ACTION: Phone an Ambulance 000 Show them this plan. LAMA Onbrez *Foradile *Oxis *Serevent Breezhaler Aerolizer Turbuhaler Accuhaler Notes: Handihaler, Breezhaler and Aerolizer devices require a capsule to be loaded into the device. All other devices are preloaded. Spacers are recommended to be used with metered dose inhalers (MDI) ICS monotherapy is not indicated for COPD without asthma #Not PBS listed *PBS listed for asthma only Airomir Bricanyl Atrovent Autohaler Turbuhaler MDI Spiriva Respimat Incruse Ellipta Seebri Bretaris Breezhaler Genuair Symbicort Rapihaler ICS/LABA Flare up Medicines Breo Ellipta Seretide Accuhaler ICS (For patients with COPD and Asthma) *Flixotide Accuhaler Symbicort Turbuhaler Seretide MDI *Flixotide MDI *QVAR MDI ICS/LABA *Pulmicort *Alvesco Turbuhaler MDI *Flutiform MDI 1. Antibiotics 2. Oral steroids (Prednisone, Prednisolone) I am coping more with household jobs, and enjoying life with my family and friends. There are still limitations, but I don t feel as restricted. Gay, 56 years 16 Lung Foundation Australia

19 How you use your inhaler is important Using an inhaler is a skill you need to learn. Research shows that up to 90% of people don t use an inhaler correctly. Inhalers are very good at delivering medicine to the lungs but they must be used correctly. Correct inhaler technique will ensure you get full benefit from your medicine. Make sure you know how to use your inhalers and that you are comfortable using them, even when you are very breathless. All inhalers work in different ways. Make sure you read the instructions that come with your inhaler before you use it. Check your inhaler technique regularly. Our C.O.P.E COPD.Online.Patient.Education program also has videos on using devices. For further information please go to Check your inhaler technique regularly When you have used your inhalers for a while, you may start taking short cuts or develop bad habits. To make sure that you are always using your inhaler correctly, get your technique checked regularly. Ask a healthcare provider to watch you while you use your inhaler, to make sure your technique is checked thoroughly. People who can check your inhaler technique include: your GP your practice nurse your pharmacist someone from your pulmonary rehabilitation team such as your physiotherapist. Make sure you keep your inhalers clean and within their use-by date. Ask your doctor or pharmacist if you are not sure how to clean your inhaler or when to replace it. COPD The Basics 17

20 Working with your healthcare team As well as your doctor you may have other healthcare providers or family members or friends who help you look after your health this is your healthcare team. Among others, your team can include a nurse, pharmacist or physiotherapist. Good communication with everyone in your healthcare team (including your doctor) will help you to look after your health. The information in this section is useful when talking to any healthcare provider. Why regular visits to your doctor are important Seeing your doctor and other healthcare providers regularly will help you meet your treatment goals. You should go to your appointments even if you are feeling well, so together you can keep track of your health and progress. During your regular visits you can talk about: any COPD risk factors you may have been exposed to (for example smoking, dust or fumes) whether your COPD is getting any worse or staying the same your medicines flare-ups other health issues that you may have and how they may affect your COPD how COPD is influencing your life what you can do to stay as healthy as possible. By seeing your doctor and other healthcare providers regularly you are taking control of your COPD and helping to prevent your COPD from getting worse. 18 Lung Foundation Australia

21 Make sure you understand what your doctor tells you It is easy to get flustered or confused when talking to a doctor, especially if he or she uses words or terms that you are not familiar with. It is important that you understand exactly what they are saying. It is also important that your doctor understands what is important to you. Making sure that you understand what your doctor is saying will help you to better manage your health. It is helpful to write down your questions and concerns before your visit to make sure you remember to ask everything you want to. You may find it useful to have a special book (for example a diary or calendar) to keep track of your COPD symptoms. If you do not understand what your doctor tells you, do not be embarrassed to ask them to explain the information again. They know that you have a lot to take in. Ask your doctor to write down important information and the answers to your questions, possibly in your special book. This way you can read everything after the visit and it may help you discuss things with your family or friends. I now have regular check-ups and although I can t reverse the damage to my lungs, by maintaining a healthy lifestyle I can slow it down. Donna, 45 years COPD The Basics 19

22 Tips when visiting your doctor Make a list of questions and concerns before your visit. List these in order of priority. If you have many questions, make a longer appointment or schedule a second visit. Show your list to your doctor and decide together what you will discuss during this visit. Do not avoid asking questions because you are afraid or embarrassed. Your doctor is there to help you. Bring a friend or family member for support. Do not end the visit if you feel you do not fully understand what your doctor is saying. If something is unclear to you, ask for further explanation. Ask your doctor to write answers down for you to refer to again. Find out the best way to contact your doctor in case you have additional questions, or if you are concerned about symptoms or suspect a flare-up. Let your doctor know if you have concerns over the cost of your COPD treatment or overall health management. They can help you find the best solution. 20 Lung Foundation Australia

23 Where to get additional information about COPD Your doctor can provide you with more information about COPD. Although useful information can be found on the internet, it cannot always be trusted to provide you with quality information. Ask your doctor about reliable places to get more information. About Lung Foundation Australia Lung Foundation Australia can provide you with a range of information on COPD and how to live better with COPD. We can also link you up with a range of support services in the community such as: exercise / education classes (pulmonary rehabilitation) patient support groups. Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide Second Edition November 2012 (Updated chapter 15) Better Living with Chronic Obstructive Pulmonary Disease: A Patient Guide is a useful guide with a lot of information about COPD and the important steps you can take to manage your condition. This publication can be found on Lung Foundation Australia s website at or you can request a printed copy by contacting Lung Foundation Australia. Queensland Health C.O.P.E COPD.Online.Patient.Education program provides lots of information, videos and links, visit You can contact Lung Foundation Australia by: phoning (free call) ing enquiries@lungfoundation.com.au logging on to

24 This resource is one of a series produced by Lung Foundation Australia to provide information on lung disease, its treatment and related issues. The information published by the Lung Foundation is designed to be used as a guide only. It is not intended or implied to be a substitute for professional medical treatment and is presented for the sole purpose of disseminating information to reduce lung disease. Please consult your healthcare professional if you have further questions relating to the information contained in this booklet. If you would like to support Lung Foundation Australia in its important work, please call for details on how you can make a donation or visit All donations over $2 are tax deductible. This booklet is based on the content from Save Your Breath booklet that was produced in 2010 with an unrestricted educational grant from Boehringer Ingelheim Pty Ltd and Pfizer Australia Pty Ltd. Lung Foundation Australia Toll Free: Address: Level 2, 11 Finchley Street, Milton Qld 4064 Postal address: PO Box 1949, Milton Qld enquiries@lungfoundation.com.au ISBN Lung Foundation Australia supports and encourages the dissemination and exchange of information. However, the material in this booklet is protected by copyright. Lung Foundation Australia has no objection to this material being reproduced, or being made available on line or electronically, provided that Lung Foundation Australia is recognised as the owner and that the material remains unaltered.

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