information If you need this information in another language or medium (audio, large print, etc) please contact the Patient Advice and Liaison Service (PALS) on 0800 374 208 email: pal.service@ salisbury.nhs.uk. You are entitled to a copy of any letter we write about you. Please ask if you want one when you come to the hospital. The evidence used in the preparation of this leaflet is available on request. Please email patient. information@ salisbury.nhs.uk if you would like a reference list. Author: Respiratory Team Role: Multiprofessional Team Date written: March 2005 Last revised: April 2008 Next review due: April 2012 Version: 1.2 Code: PI0165 Chronic Obstructive Pulmonary Disease - COPD (1 of 5) What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease. It is an umbrella term for chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs, causing them to become narrow and making it harder for air to get in and out of the lungs. The word chronic has nothing to do with severity; it simply means the problem is long term. What is going on in my lungs? The airways in your lungs branch out like an upside-down tree, and at the end of each branch are many small, balloon-like air sacs. In healthy lungs, each airway is clear and open, the air sacs are small and dainty, and both are elastic and springy. When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. In COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air gets out because: the airways and air sacs lose their elasticity (like an old rubber band) the walls between many of the air sacs are destroyed the walls of the airways become thick and inflamed (swollen) Your airways have a lining that produces mucus to keep the airways moist and supple. The mucus also washes away the dust and particles that you breathe in. Some people with COPD produce too much of this mucus which becomes thicker and is coughed up as sputum (phlegm). Your airways are surrounded by muscle that can hold them open or squeeze them, to make them narrow. In COPD these muscles may squeeze your airways a bit too tightly. This makes the tubes narrower and makes it harder for you to breathe. What are the symptoms of COPD? A cough is usually the first symptom to develop. It is productive with phlegm. You may think of your cough as a smokers cough Breathlessness (short of breath) and wheeze may at first only occur when you exert yourself (for example when you climb stairs). However the symptoms tend to become gradually worse
COPD (2 of 5) over the years, especially if you continue to smoke. Difficulty in breathing may eventually become distressing Sputum. The damaged airways make a lot more mucus than normal. This forms phlegm and you tend to cough up a lot of phlegm each day. Chest infections are more common if you have COPD. Phlegm usually turns yellow or green during a chest infection. How is a diagnosis made? Your medical history, physical examination and a test called spirometry will confirm the diagnosis. Spirometry gives the doctor an idea of how bad your breathing is and how damaged your lungs are. It involves you breathing in and then blowing into a tube that s connected to a machine. If you have got COPD, you can t breathe out as much as someone with healthy lungs. Other tests may also be done such as a chest X-Ray or measuring the level of oxygen in your blood. If COPD can t be cured how can I feel better? Stop smoking. The importance of this cannot be stressed enough. If you stop smoking at an early stage of the disease, it will make a huge difference. Any damage already present in your lungs cannot be reversed, but stopping smoking prevents the disease from getting much worse. Even if you have fairly advanced COPD, you are likely to benefit and prevent further progression of the disease by stopping smoking. Where can I go for help to stop smoking? We know that giving up smoking can be extremely difficult and may take several attempts. Nicotine replacement therapy, such as gum or patches, or a medicine called bupropion (also called Zyban), can improve your chances of success when trying to quit. To get the best from these medicines, support from your doctor, pharmacist, nurse or smoker s clinic is crucial. They can refer you to the Freedom From Smoking support clinic 01980 626159. You could also call the NHS Stop Smoking Helpline on 0800 169 0169 or log onto www. givingupsmoking.co.uk How is COPD treated? COPD cannot be cured. But there are things that can help stop it getting worse and make it easier to live with. The goals of COPD treatment are to: relieve your symptoms with minimal side effects from treatment slow the progress of your disease improve your ability to stay active prevent and treat complications and sudden problems
COPD (3 of 5) improve your overall health & general quality of life. There are two ways of achieving these goals. The first is through medicines that your doctor or nurse will give you, the second is through things that you can do to help yourself. Bronchodilator puffers (inhalers) and/or Nebulisers These are the main medicines for relieving the symptoms of COPD (they are also used for asthma). They make breathing easier by relaxing the muscles around the airways and making the airways wider. < < Short-acting beta agonists (for example salbutamol or eterbutaline). These 2 are best taken when your breathing is particularly bad, rather than at fixed times each day. < < Long-acting beta agonists (for example salmeterol or eformoterol). These are 2 best taken at fixed times each day. < < Antimuscarinics (for example ipratropium, tiotropium bromide or oxitropium, also known as anticholinergics). These are also best taken at fixed times each day. < < Theophylline comes as tablets rather than an inhaler. It helps reduce COPD symptoms. But, getting the dose right for each patient can be tricky. Smoking or taking other medicines can reduce how well it works or increase the side effects. Your doctor or nurse will discuss this further with you. Most people with COPD need to take at least one, and often a combination of these bronchodilator medicines. At first you will probably start with a short-acting beta 2 agonist, as and when you need it. If this doesn t work, an antimuscarinic or long-acting beta 2 agonist can be tried. Theophylline is only recommended if the other bronchodilators don t work well enough. Corticosteroids, also known as steroids A short course of steroid tablets is sometimes prescribed if you have a bad flare-up of wheeze and breathlessness (often during a chest infection). There are side effects of taking steroids and your doctor or nurse will explain these to you. Mucolytic medicines (for example carbocisteine) These help make phlegm thinner and less likely to block up the airways. They are only available on a prescription from your doctor. They come in capsules or as a liquid. Antibiotics A short course of antibiotics is often prescribed if you have a chest infection. A back-up supply of antibiotics may be useful for holidays or emergencies. Please ask your GP or hospital doctor. Oxygen This may help some people with severe symptoms. It does not help all people. If you
COPD (4 of 5) require long-term oxygen we will give you a separate information leaflet. Surgery This may be an option for a very small number of people. Your doctor or respiratory nurse will be able to discuss this with you. What can I do to help myself? ;;Get immunised ;;A yearly flu jab each autumn ;;A one off injection (Pneumovax) to prevent you getting a certain type of pneumonia ;;Try and keep as active as possible. Studies have shown that people with COPD who exercise regularly tend to improve their breathing, ease their symptoms, and have a better quality of life. Any regular exercise is good. A daily walk is a good start if you are not used to exercise. Gradually increase the time you walk, aiming to walk continuously for 20-30 minutes four times a week. ;;Healthy eating to maintain a good bodyweight. If you are breathless when or after eating, try to have smaller, more frequent meals. Ask for the leaflet Eating when you don t feel well. ;;Take your medication as prescribed by your hospital doctor or GP ;;Avoid situations that make your symptoms worse. If you find that traffic fumes, certain smells or a smoky atmosphere make you worse try to avoid them. ;;Identify a flare up (exacerbation) of your condition promptly and start treatment early. ;;Avoid stressful situations which can bring on a flare up. ;;Pulmonary rehabilitation is available. This is a course specially designed for patients with long-term lung problems. Your hospital doctor, respiratory nurses, physiotherapist or GP can refer you. Household aids As COPD progresses you may find it difficult to perform some domestic tasks. Life can be made easier with devices that have been designed to make life easier for people with COPD. Popular items include equipment to help put on socks and tights. If COPD affects you more severely, you may be considered for a stair lift and equipment for the bathroom. The occupational therapy team will be able to help you. You can contact your local team through your GP or social services or from a member of nursing staff if you are in hospital. Can I go on holiday if I have COPD? Yes you can still travel if you have COPD. Plan ahead and discuss your needs with your doctor or nurse, and travel agent.
COPD (5 of 5) How will my illness affect my partner/carer? It is inevitable that at some stage your partner and/or carer will feel anxious or frustrated about your breathing problems. It is important to talk about your 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 and active will help achieve this. Benefits There are a number of benefits you may be eligible for. For example, if you need help with personal care or getting about you may be entitled to Disability Living Allowance or Attendance Allowance 01722 315200. Further help and information British Lung Foundation 73-75 Goswell Road, London EC1V 7ER 020 7688 5555 web: www.lunguk.org NHS Direct 0845 46 47 www.nhs.co.uk NHS Direct has information on disease management & self help groups.