COPD – patient information

COPD (chronic obstructive pulmonary disease) – patient information

In this article we will describe information for patients on COPD.

Key points

• Smoking cigarettes is the most common cause of COPD
• COPD gives you a cough and shortness of breath
• You may need inhalers and tablets to relieve your symptoms
• If you have severe COPD, you may need to take other medicines, use oxygen, or undergo pulmonary (lung) rehabilitation, or lung surgery
• Stopping smoking can help improve COPD.

1. What is the definition of COPD?

COPD (chronic obstructive pulmonary disease) is common, affecting 2% of the population, and about 5% of those who are over 40 years.

There is no single agreed definition, partly as there are different types (see below). Either way, it is a long term lung disease where you cough, and slowly become more short of breath. There is initially a dry cough but later it has with sputum with it. You may have recurrent lung infections in which the COPD gets worse, and have to come into hospital.

For most patients it is caused by smoking.

COPD includes 2 lung disorders: chronic obstructive bronchitis and emphysema. Many people have both disorders.

Chronic obstructive bronchitis means a cough where you bring up sputum for at least 3 months total over 2 or more years in row. Emphysema means damage to the air sacs in your lungs.

2. What are the causes of COPD?

• Tobacco exposure from active smoking, or passive exposure to second-hand smoke
• Occupational exposure to dusts, fumes or chemicals
• Indoor air pollution: biomass fuel (e.g. wood, animal dung, crop residue) or coal is frequently used for cooking and heating, in low- and middle-income countries – leading to high levels of smoke exposure
• A genetic tendency (that is, you have a family history of COPD). This is rare.

3. What are the symptoms of COPD?

COPD takes years to develop and get worse.

In your 40s or 50s, you may have:

• A mild cough that is dry initially then later you will bring up clear sputum, usually in the morning
• Shortness of breath when you exercise or move around.

In your 60s, you may have:

• Shortness of breath more of the time
• Pneumonia and other lung infections that may require hospital admissions
• Weight loss
• Morning headaches
• Swelling of your legs
• Coughing up blood (rare, this may be a sign of lung cancer, that should be looked for).

After you have had COPD for a long time, you may notice:

• Your chest is bigger because air is trapped in your lungs
• Your skin has a blue tint because the oxygen in your blood is low
• You are short of breath even when you are not doing anything.

Symptoms of exacerbations of COPD (flare-ups)
An exacerbation (or flare-up) of COPD is a worsening of your symptoms. This can happen over hours or day. Flare-ups can happen at any age. They are caused by getting a cold, flu, or other lung infection that affects your breathing. See your doctor right away if you have these symptoms:

• Cough that may produce more yellow or green sputum
• Worsening shortness of breath, especially when you are resting
• Fever, chills or body aches.

A serious flare-up can lead to a dangerously low level of oxygen in your blood (a condition called acute respiratory failure). This may lead to the need for a ventilator (breathing machine) or something called Non-Invasive Ventilation (NIV; similar to CPAP) on the intensive care unit (ICU).

So. Go to A&E right away if you have these symptoms:

• Severe shortness of breath (feeling like you are drowning)
• Anxiety or confusion
• Sweating
• Bluish skin caused by low oxygen in your blood.

4. How do you diagnose COPD?

Doctors will usually suspect COPD based on your symptoms. They will do a chest x-ray and tests to find out how well your lungs are working (PFTs, pulmonary function tests). Doctors may check if the level of oxygen in your blood is low using a sensor placed on a fingertip.

Chest x-ray of advanced COPD

If you are young, have never smoked, and have a family history of COPD, doctors may do other tests to see if your symptoms are caused by a different problem, e.g:

• A blood test to see if COPD runs in your family
• An ECG and/or echocardiography (sound picture of the heart) to see if you have any heart problems that are causing your shortness of breath.

5. What is the treatment for COPD?

Doctors cannot fix the damage in your lungs and airways.

If you are a smoker, you need to stop smoking to keep COPD from getting worse. Doctors may give you medicines to help you stop, such as nicotine gum or a patch.

Doctors may also give you inhalers and tablets to increase airflow and make it easier to breathe. Some medicines and inhalers are also used to prevent symptoms. Some COPD medicines are given through an inhaler. This allows you to breathe medicine directly into your lungs.

You may also need oxygen therapy to increase the amount of oxygen in your blood. Oxygen is usually given through prongs worn in your nose.

Doctors may suggest you go to pulmonary rehabilitation to help improve your quality of life.

To treat serious COPD symptoms or flare-ups, you may need to stay in the hospital. If an infection has caused the flare-up, you may need antibiotics.

6. What is the role of surgery in COPD?

Bullectomy
COPD can make the tiny air sacs in your lungs get larger. They are then called bullae. It’s not too common, but they can grow big enough to get in the way of your breathing. A surgeon can remove them to help you breathe more easily.

Lung volume reduction surgery (LVRS)
For some people, this operation to remove parts of your lungs, can improve breathing and quality of life. You also need to quit smoking and show that you can stick to your pulmonary rehabilitation plan.

Lung transplant
This is when you get a healthy lung from a donor. It has serious risks. For instance, your body may reject the new lung. Doctors typically suggest this surgery for people who have severe lung damage due to COPD but no other health problems.

7. What can I do to help myself if I have COPD?

• Stop smoking. COPD is a progressive disease (i.e. it tends to get worse over time). At any stage of COPD, quitting smoking can prevent further worsening of your breathing. It can improve your breathing, reduce coughing and chest tightness, and reduce the number of infections
• Lifestyle changes. And it is also a good idea to keep trim, exercise and keep your alcohol intake down
• Signs of deterioration. It is also important to recognise danger signs – for example, more laboured breathing and changes in the colour of your sputum. If this happens, seek medical help, to avert a serious episode. Chest pain and blood in the sputum are unusual in COPD and these should be also reported to your doctor
• New treatments and monitoring equipment. Talk to the health professionals below about these. Respiratory care is changing all the time, with new drugs, inhalers, operations and procedures appearing.

8. What can the NHS do to help my COPD?

• GP. Many patients can be looked after by an NHS GP alone. But if things are not settling you should be referred to a hospital respiratory (lung) consultant
• Hospital respiratory consultant. Ask your GP to refer you to the local hospital respiratory unit (there will be one). Then when you see a consultant (or their deputy, called a registrar) or a specialist nurse – who all specialise in lung diseases, only let them discharge you when you feel your COPD is stable. In the meantime, ask for review every 3-6 months – this can be virtual
• Right doctor. Many respiratory doctors subspecialise, e.g. COPD, lung cancer, pulmonary fibrosis and asthma. Make sure you are under the care of the right one. Ask them. To make the diagnosis you will need a breathing test called spirometry. A few patients require a CT scan of the chest, if the diagnosis is unclear – so we do not miss an alternative cause of shortness of breath
• Dietitian. The hospital team can also get you to see a hospital (or community based) dietitian if needed.
• GP Practice Nurse. Many GPs have a practice nurse that runs a ‘long-term condition’ clinic. Ask for three monthly review there. Some of them work with a clinical pharmacist who can fulfil a similar role
• Pulmonary rehabilitation classes. Find out if there are local ones and join them. They are invaluable source of education, exercise routines that can be done at home, information about your condition, breathing techniques, and an opportunity to share experiences with other patients. This is a video about classes in Scotland.

9. Should COPD patients have vaccination?

Yes, very much so. All patients should have COVID-19 vaccinations, a pneumococcal vaccine and annual influenza vaccine.

10. What is the outlook (prognosis) for COPD? 

The exact length of time you can live with COPD depends on your age, health, symptoms and its severity. Especially if your COPD is diagnosed early, and you have mild stage COPD, you may be able to live for up to 20 years after diagnosis.

For example, one study found that people who were diagnosed with mild stage COPD, had no shorter life expectancy than healthy people. People with severe COPD will lose about 8-9 years of life expectancy on average.

Summary

We have described information for patients on COPD. If you do all of the above, you will get better care – and your breathing and other symptoms of COPD should improve.