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Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) describes a number of long-term lung conditions that cause breathing difficulties.

It’s estimated that about one million people in the UK have COPD and that there are many more who haven’t been diagnosed. It’s the fifth most common cause of death in England and Wales with about 28,000 people dying as a result of it every year. You’re more likely to develop the condition as you get older. COPD is usually caused by smoking and tends to get progressively worse over time. 

The term COPD describes a number of conditions but the most common are chronic bronchitis and emphysema.

  • Chronic bronchitis is caused by inflammation of your bronchi – these are the main airways that lead from your windpipe (trachea) to your lungs. This inflammation can lead to excess mucus that may block your airways.
  • Emphysema is the term used to describe damage to the walls of your alveoli. These are tiny air sacs in your lungs where oxygen passes into your blood.

The damage to your lungs means that less oxygen passes into your blood to be transported around your body to your tissues, including your brain. This contributes to symptoms such as having difficulty breathing and tiredness.

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How chronic obstructive pulmonary disease (COPD) develops
COPD is one of a number of long-term lung conditions that cause breathing difficulties
Image showing the changes to the bronchioles and alveoli in COPD

Details

  • Symptoms Symptoms of COPD

    At first, you may not have any symptoms of COPD or they may be very mild. The condition may start with either a persistent, phlegmy cough or breathlessness. Many people don’t see their GP at this early stage, but the earlier you get advice and treatment the better.

    As COPD progresses symptoms can vary but may also include:

    • persistent cough
    • breathlessness with physical exertion
    • regularly coughing up phlegm
    • wheezing
    • weight loss
    • extreme tiredness
    • waking up at night as a result of breathlessness
    • swollen ankles

    You may find your symptoms are worse in the winter months.

    These symptoms aren’t always caused by COPD but if you have them, see your GP.

    It isn’t usual to get chest pains or cough up blood if you have COPD. If this happens, you may either have something other than COPD or another condition as well as COPD.

  • Diagnosis Diagnosis of COPD

    Your GP will ask about your symptoms and will ask to examine you. He or she is likely to ask you if you smoke and if there are any other reasons why you may be at risk of COPD. Your GP may ask to listen to your chest with a stethoscope to see if you have any wheezing or crackling sounds when you breathe.

    There is no single test that can confirm COPD. If your GP thinks you may have it, he or she may advise you to have a lung spirometry test. This tests how well your lungs are working. Your GP will ask you to blow into a device that measures how much and how quickly you can force out air from your lungs. Different lung problems produce different results so this helps to separate COPD from other chest conditions. For more information see our frequently asked questions.

    Other tests you may be offered are listed below.

    • A chest X-ray to see if your lungs show signs of COPD, and to exclude other lung diseases.
    • A blood test to look for anaemia or signs of infection.

    If you’re diagnosed with COPD, your doctor may advise you to have further tests. These will help to determine the best treatment for you.

    • A CT (computed tomography) scan to produce three-dimensional images of your lungs.
    • An ECG (electrocardiogram) to measure the electrical impulses from your heart to see how well it’s working.
    • An echocardiogram to look at the structure and function of your heart.
    • Pulse oximetry to monitor the amount of oxygen in your blood to see if you need oxygen therapy.
    • An alpha-1 antitrypsin test to see if you have a lack of this protein. You may need this if your COPD developed when you were 40 or younger, or if you don’t smoke.
  • Treatment Treatment of COPD

    There are a number of treatment options for COPD, as described below. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    There isn’t a cure for COPD and it isn’t possible to reverse the damage to your lungs. However, there are ways to treat the symptoms and prevent COPD from getting worse. If you smoke, the most important thing you can do is stop. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if you have had it for a long time. Speak to your GP about ways to give up smoking.

    Treatment for COPD will vary depending on how severe your condition is. You may be able to manage your condition with self-help measures. However, if it’s more severe or progresses, you may be offered medicines or oxygen therapy.

    Self-help

    There are other steps you can take to try to prevent COPD from getting worse and to ease your symptoms. Some examples are listed below.

    • Make sure you drink enough fluid as this can help to reduce the thickness of mucus that your lungs produce.
    • Try to exercise regularly, even if you feel tired. Walking for 20 to 30 minutes at least three times a week is recommended. If you can’t move around, exercise by stretching out your arms and twisting your upper body. See our frequently asked questions for more information.
    • Make sure you eat a healthy, balanced diet. It’s important that you eat enough as this will help to prevent your symptoms from getting worse. Your GP may recommend that you take nutritional supplements. See our frequently asked questions for more information.
    • Have a flu vaccination each year, and have the vaccination for the Streptococcus pneumoniae bacterium that causes pneumonia.

    Pulmonary rehabilitation

    This is a scheme that involves exercise, education about COPD, advice on nutrition and psychological support. Pulmonary rehabilitation aims to help reduce your symptoms and make it easier for you to do everyday activities. It’s a good idea to ask your GP about pulmonary rehabilitation and whether there is a programme in your area.

    Medicines

    There are various medicines that may help to ease your symptoms or control flare-ups. Discuss with your GP which medicine is best for you. You may be advised to take more than one. Some of these medicines are also used to treat asthma.

    Bronchodilators

    These medicines are commonly used to treat COPD. They widen your airways so air flows through them more easily and can relieve wheezing and breathlessness. They are available as short-acting or long-acting inhalers. There are many different types of bronchodilators – examples include salbutamol, salmeterol and tiotropium.

    Steroids

    Steroid medicines may help if you have more severe COPD or if a bronchodilator hasn’t helped. Steroids work by reducing inflammation of your airways. They are available as inhalers or tablets. You’re likely to be offered an inhaler if you need to take steroids frequently. Generally you will only be advised to take these tablets for a limited period of time, for example to treat a flare-up. This is because they can cause side-effects if taken regularly.

    You’re unlikely to be offered a steroid inhaler if your condition is mild. This is because they may increase the risk of pneumonia in some people.

    Mucolytics

    Mucolytics break down the phlegm and mucus produced by your lungs, making it easier for you to cough it up. Your GP may advise you to take a mucolytic if you develop a persistent, phlegm-producing cough.

    Oxygen therapy

    If your COPD becomes severe, you may develop a low blood oxygen level. Oxygen therapy can help to relieve this and improve symptoms in some people. You inhale oxygen through a mask or small tubes (nasal cannulae) that sit beneath your nostrils.

    The oxygen is provided in cylinders for you to use at home or in smaller, portable versions for outside the home. If you need oxygen for long periods of the day (over eight hours), you may be offered an oxygen concentrator. This is a machine that filters out oxygen from the air in the environment and stores it for you to use.

    You must not smoke if you have oxygen therapy for COPD because there is a serious fire risk. You may not be prescribed oxygen therapy if you haven’t given up smoking. Oxygen therapy can be short-term, long-term (you use it all the time at home) or ambulatory (you use it for exercise or when you’re outdoors). You will probably only be offered oxygen after an appointment with a doctor who specialises in respiratory medicine (identifying and treating conditions of the lungs).

    You may also need additional oxygen if you travel by air. It’s important to speak to your GP if you have COPD and are considering travelling by plane.

    Surgery

    If you have severe COPD, your doctor may recommend surgery to remove diseased areas of your lungs. This can help your lungs to function better. However, it’s only carried out in certain circumstances – speak to your doctor for more advice.

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  • Causes Causes of COPD

    The biggest single cause of COPD is smoking. If you stop smoking, your risk of developing COPD begins to fall. If you already have COPD, stopping smoking means your symptoms progress more slowly.

    Other less common causes of COPD include:

    • passive smoking
    • being exposed to certain chemicals or fumes
    • environmental factors, such as air pollution

    There are likely to be a number of genetic factors that may increase your risk of COPD but more evidence is needed. It’s known that inheriting a shortage of a protein called alpha-1 antitrypsin, which helps protect your lungs, can increase your risk of COPD. However, fewer than one in 100 people with the condition have this shortage.

    Smoking also exacerbates the effect of other causes on your risk of developing COPD.

  • Prevention Prevention of COPD

    You have the best chance of preventing COPD if you don’t smoke.

    If your job exposes you to dust or fumes, it’s important to take care at work and use any relevant protective equipment. For example, you may need to wear a face mask to help prevent you from inhaling any harmful substances.

  • FAQs FAQs

    Are asthma and COPD the same?

    Answer

    Asthma and COPD cause similar symptoms. The main difference is that asthma symptoms usually come and go whereas COPD tends to be irreversible and the symptoms are persistent.

    Explanation

    If you have asthma, your airways become irritated and inflamed at certain times, for example if you’re exposed to dust or when exercising. This causes them to narrow, which makes it more difficult for you to breathe. However, if you have COPD, the inflammation in your airways is permanent and therefore your symptoms are constant.

    COPD usually develops in people over the age of 40, whereas asthma often starts in childhood. The most common cause of COPD is smoking, but you’re also at a slightly increased risk if you have asthma.

    Although asthma and COPD cause similar symptoms, asthma symptoms come and go. They tend to occur in response to certain triggers and may vary in severity. You’re more likely to get breathlessness and wheezing that wakes you at night if you have asthma. You may find you get a chronic cough and produce more mucus if you have COPD.

    Speak to your GP if you’re concerned that you have symptoms of asthma or COPD. He or she will ask you about your symptoms and will ask to examine you. He or she may advise you to have some breathing tests, such as a spirometry test, to find out if you have asthma or COPD. A reversibility test can sometimes be helpful in telling the difference between the two. This involves checking your breathing before and after using an inhaler.

    Is there anything I can do to help when I feel breathless?

    Answer

    Yes, there are various breathing techniques that can help you to cope if you get short of breath.

    Explanation

    If you get short of breath, it’s important that you try to relax and keep calm. Find a comfortable position so that your back is supported and where you can relax your shoulders, arms and hands. This may mean sitting down, or finding something you can lean forwards against and that will support you, such as a chair or table. Focus on breathing in gently through your nose and out through your nose or mouth.

    If you find you get out of breath when you’re more active, try the following techniques.

    • Focus on taking deep, slow breaths – in through your nose and out through your mouth.
    • Purse your lips (as if you’re whistling) as you breathe out. This slows down your breathing and helps to make it more efficient.
    • Breathe out whenever you do something that takes a lot of effort, such as walking up stairs or standing up.
    • Adjust your breathing so it’s in time with the activity you’re doing, such as walking up stairs. Breathe in when you’re on a stair and out as you step up to the next one.

    Your physiotherapist can teach you more about breathing control and exercises.

    Should I exercise if I have COPD?

    Answer

    Yes, try to do as much exercise as you can if you have COPD, even if it makes you feel a little out of breath.

    Explanation

    If you have COPD, you may feel that you don’t want to do anything that will make you get even more out of breath. You may think that you need to reduce how much activity you do because you’re worried about getting breathless. However, this isn’t true. Reducing the amount of activity you do can make things worse, because it reduces your fitness meaning you become breathless more quickly when you’re active.

    Taking regular, light exercise and gradually building up the amount you do can help to improve your breathing and make you feel better. If you’re anxious or haven’t exercised in a while, start with short walks – you don’t even need to leave the house. If you’re able to walk, try to walk for 20 to 30 minutes, three to four times a week.

    Don’t worry if you get slightly breathless – take a break to get your breath back and then start again. If you can’t walk, a physiotherapist can teach you exercises to do at home. These exercises might involve twisting your upper body and stretching out your arms.

    It’s important to keep as active as possible. Even a small amount of exercise can help if you have severe lung problems.

    Exercise is an important part of pulmonary rehabilitation programmes. Ask your GP if there are any in your area that he or she can recommend

    What do the results of my spirometry test mean?

    Answer

    Your GP or nurse will ask to measure how much air you can blow out in one breath, and how quickly you blow it out. This is known as a spirometry test and will help to find out if you have COPD or any other breathing problems.

    Explanation

    You will have two measurements taken during a spirometry test. These are the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC).

    • The FEV1 is the amount of air you can blow out in one second.
    • The FVC is the total amount of air that you can blow out in one long breath.

    Your GP will work out the proportion of your total breath that you can blow out in one second. This is your FEV1 divided by FVC (FEV1/FVC). These three measurements can help your GP to find out whether you have COPD or any other breathing problems. He or she will compare the values you get with those that would usually be expected for someone of your age, height and sex.

    If you have COPD, you won’t be able to blow air out as quickly as someone who doesn’t have the condition. Your FEV1 will be lower than normal (below 80 percent of what would be expected) because you blow out less air in one second.

    Your FEV1/FVC will be low (below 0.7 when the highest number you can have is 1). This is because you can only breathe out a small amount of the total air in your lungs in one second.

    The lower the values for FEV1 and FEV1/FVC, the more severe your COPD is likely to be. Ask your GP if you have any questions about your spirometry test results.

    Why is diet important for people with COPD?

    Answer

    It’s important to eat a healthy, balanced diet and maintain a healthy weight if you have COPD.

    Explanation

    It’s common to lose weight if you have COPD. You may use up a lot of energy with the increased effort of breathing. Being underweight can negatively affect the outcome of COPD. However, it’s also important not to be overweight as this can also increase problems related to COPD.

    If you have COPD, the following healthy eating tips may help.

    • Eat little and often, and eat your meals slowly. This will mean you’re less likely to get breathless.
    • Choose food that is high in protein such as lean meat, fish and pulses. Try not to eat too much sugary food. If you have been advised to gain weight, you may need to increase the amount of fat in your diet. This is because fat contains the most calories.
    • When cooking, make a big batch and freeze the extra so you have a meal ready for when you don’t feel like cooking. Choose foods that don’t take much preparation.
    • Make sure you drink enough water. This can help to make your mucus thinner. Speak to your GP for more information about this. He or she will be able to advise you on how much water to drink.

    If you’re very underweight, your GP may recommend that you see a dietitian. He or she may suggest taking nutritional supplements to help bring you back up to a healthy weight. Ask your GP for advice if you’re concerned about your weight.

    If you’re overweight, try to lose excess weight. The most effective way is to eat smaller portions and increase the amount of exercise you do. It may not be good for you to lose excess weight too quickly so ask your GP or dietitian for advice.

  • Resources Resources

    Further information


    Sources

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    • Chronic obstructive pulmonary disease (COPD). Health and Safety Executive. www.hse.gov.uk, published October 2012
    • COPD. BMJ Best Practice. www.bestpractice.bmj.com, published December 2012
    • Bronchitis. Medscape. www.emedicine.medscape.com, published October 2013
    • Emphysema. Medscape. www.emedicine.medscape.com, published September 2012
    • Chronic obstructive pulmonary disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2010
    • Chronic obstructive pulmonary disease (COPD). The Merck Manuals. www.merckmanuals.com, published June 2013
    • Laniado-Laborín R. Smoking and chronic obstructive pulmonary disease (COPD). Int J Environ Res Public Health 2009; 6:209–24. doi:10.3390/ijerph6010209
    • COPD – suspected. Map of Medicine. www.eng.mapofmedicine.com, published October 2012
    • Alpha-1 antitrypsin deficiency. The Merck Manuals. www.merckmanuals.com, published June 2013
    • Spirometry. European Lung Foundation. www.european-lung-foundation.org, published May 2011
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    • What are the signs and symptoms of COPD? American Thoracic Society. www.thoracic.org, accessed 23 October 2013
    • Chronic obstructive pulmonary disease. Medscape. www.emedicine.medscape.com, published October 2013
    • Stable COPD. Map of Medicine. www.eng.mapofmedicine.com, published October 2012
    • Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 October 2013
    • What are corticosteroid (anti-inflammatory) medications? American Thoracic Society. www.thoracic.org, accessed 23 October 2013
    • Use of oxygen therapy in COPD. Patient Plus. www.patient.co.uk, published January 2011
    • Why do I need oxygen therapy? American Thoracic Society. www.thoracic.org, accessed 23 October 2013
    • Ahmedzai S, Balfour-Lynn IM, Bewick T, et al. Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations. Thorax 2011; 66 (supplement 1). doi:10.1136/thoraxjnl-2011-200295
    • Lung volume reduction surgery for advanced emphysema. National Institute for Health and Care Excellence (NICE), February 2005. www.nice.org.uk
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    • Fat. British Nutrition Foundation. www.nutrition.org.uk, published July 2012
    • Obesity in adults. BMJ Best Practice. www.bestpractice.bmj.com, published August 2013
    • Chronic obstructive pulmonary disease. National Institute for Health and Care Excellence (NICE), June 2010. www.nice.org.uk
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    • Chronic obstructive pulmonary disease (COPD). Centers for Disease Control and Prevention. www.cdc.gov, published April 2013
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    Reviewed by Polly Kerr, Bupa Health Information Team, November 2013.

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