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Chronic obstructive pulmonary disease (COPD)


Expert reviewer, Dr Richard Russell, Respiratory Consultant
Next review due March 2022

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that makes you feel breathless. It’s the name given to a group of conditions that affect how well your lungs and airways work — including chronic bronchitis and emphysema. Most people with COPD aren’t diagnosed until they’re in their 50s or older.

About COPD

If you have COPD, your airways and lungs become inflamed. This is usually as a result of exposure to toxic substances (most often, cigarette smoke). COPD is an umbrella term that covers several different types of lung damage, but the two most common forms of COPD are:

  • chronic bronchitis — this is when the small airways (bronchioles) in your lungs become narrower
  • emphysema — this is when the tiny air sacs (alveoli) at the end of your airways become damaged and break down

The damage to your lungs in COPD makes it more difficult for them to take in air, and so harder for you to breathe.

Image showing the changes to the bronchioles and alveoli in COPD

Causes of COPD

The biggest cause of COPD is cigarette smoking. The vast majority of people with COPD are smokers or ex-smokers — but if you stop smoking, your risk of developing COPD begins to fall. Although cigarette smoking is the biggest risk factor for COPD, smoking nicotine in any form (including pipes and cigars) and smoking marijuana are also risk factors.

Other things that can increase your risk of developing COPD, include:

  • passive smoking
  • exposure to certain chemicals or fumes at work
  • environmental factors such as air pollution
  • having an inherited condition called alpha-1 antitrypsin deficiency

If you smoke, the impact of these other risk factors is increased even further.

Symptoms of COPD

COPD is a long-term condition that usually gets worse slowly over time. The main symptoms you may notice at first include:

  • a persistent cough — this is usually a phlegmy (chesty) cough that you’ve had for some time
  • getting out of breath when you’re active (you may start to get breathless most of the time as the condition gets worse)
  • wheezing

You might notice these problems affect you more during the winter.

Other symptoms of COPD include:

  • losing weight without trying
  • feeling very tired
  • waking up at night because you’re breathless or coughing
  • swollen ankles

These symptoms can be caused by a number of different conditions, not just COPD. Whatever the cause, it’s important to see your GP if you have any new or persistent symptoms.

If you have COPD, you might experience flare-ups, also known as ‘exacerbations’. This is when your symptoms become significantly worse than normal for a period of time. You may be able to manage a flare-up yourself by increasing your normal medication but if it’s particularly bad, you may need to seek medical help.

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Diagnosis of COPD

Seeing your GP

Your GP will ask about your symptoms and examine you. They’ll ask if you smoke (or used to) and about other factors that could increase your risk of COPD. These could include exposure to dust or fumes at work. Your GP may listen to your chest to see if you have any wheezing or crackling sounds when you breathe.

Your GP may ask you to do a test called a spirometry. This measures how well your lungs are working. First, you’ll be asked to take a medicine called a bronchodilator, which helps to widen your airways. Then, you’ll be asked to take a deep breath and blow into a small device (called a spirometer) as hard as you can. The measurement will tell your GP if your symptoms are likely to be due to COPD.

Your GP will also arrange for you to have:

  • a chest X-ray to see if your lungs show signs of COPD and to rule out other lung diseases
  • a blood test to look for anaemia or signs of an infection

Further tests

If you’re diagnosed with COPD, you may be asked to have further tests. These may include:

  • full lung function tests — these are a set of tests, including peak flow measurement (how hard you can breathe out), that assess how well your lungs are working
  • a CT scan to check the condition of your lungs in more detail
  • an ECG or echocardiogram to check on your heart
  • a blood test to check whether or not you’re deficient in alpha-1 antitrypsin
  • a test on any phlegm that you’re coughing up, to check for infection

Self-help for COPD

There are several things that you can do yourself to manage your condition and keep well. When you’re first diagnosed with COPD, your doctor will put together a self-management plan which will include advice specific to you. It’s likely to include some of the following points.

Giving up smoking

If you smoke, the most important thing you can do is to stop. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if you’ve had it for a long time. Your GP will discuss ways in which they can help you to give up. These may include offering you nicotine replacement therapy or medicines to help you stop smoking, and recommending support programmes you can join.

Keep as active as you can

Although it can be hard to imagine if you’re very breathless, exercising can be really beneficial for people with COPD. If you’re able to move around, aim to walk for between 20 to 30 minutes, three to four times per week. it’s ok to get a little bit out of breath, but don’t overexert yourself and always take things at your own pace. Build it up gradually if you need to.

If you can’t move around, keep active by stretching out your arms and twisting your upper body. If you’re really limited in what you can do, your doctor may refer you to a pulmonary rehabilitation programme. For more information on this, see our Treatment section below.

Eat a healthy, balanced diet

It’s important to eat a healthy diet and maintain a healthy weight if you have COPD. If you’re overweight, it can make it even harder for you to breathe and move around. If you’re struggling to eat or prepare food though, you may lose weight and start to lack certain nutrients. Try to eat little and often. Your GP may recommend that you take nutritional supplements or refer you to a specialist for advice on your diet.

Vaccinations

Make sure you have all the recommended vaccinations, including an annual flu jab and vaccination against pneumonia. This can help to prevent flare-ups of your COPD.

Managing flare-ups

Your healthcare team will give you advice on how to recognise if you’re having a flare-up and how to deal with it. They may give you certain medicines to keep at home for use when your symptoms are worse. They may also give you advice on breathing techniques that can help when you feel breathless. For more information, see our FAQ on managing breathlessness below.

Treatment of COPD

There isn’t a cure for COPD and damage to your lungs can’t be reversed. But treatments for COPD can manage your symptoms, help you feel as well as possible and help to stop your COPD from getting worse.

You’re likely to be under the care of a team of healthcare professionals who can advise you on treatments that will help you.

Inhalers

Inhaled medicines for COPD usually include a type of medicine called a bronchodilator. Bronchodilators open your airways so air flows through them more easily to relieve wheezing and breathlessness. The two main types of bronchodilator are beta-2 agonists and antimuscarinics.

To start with, you’ll probably have a short-acting bronchodilator. If you still get breathless, your GP may add one or two types of long-acting bronchodilator to your treatment, sometimes with a steroid medicine.

Devices for inhaled medicines

There are a number of different devices that can be used to take your inhaled medicines. The main types of device are listed below.

  • MDIs (metered dose inhalers). These are the most common type of inhaler. You press the top of these inhalers to release the medicine in a short sharp puff. They’re often used with a spacer – a plastic tube with a mouthpiece – which you attach to your inhaler. This can help make it easier for you to breathe in the medicine.
  • Dry-powder inhalers. The technique for these differs depending on the particular device you have. But it always involves breathing in deeply to release the medicine.
  • Nebulisers. These are small machines that turn liquid medicine into an aerosol or fine mist, which you breathe in through a mouthpiece or mask. They can deliver higher doses of medicine than you’d get through an inhaler. Your doctor may suggest a nebuliser if your breathlessness is severe and stops you going about your daily life.


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. As well as helping with your cough, mucolytics may help to reduce the number of flare-ups you have.

Antibiotics

If you have a flare-up of symptoms and your GP thinks it might be due to a bacterial chest infection, they may give you antibiotics. Sometimes, your GP may give you a course of antibiotics to keep at home so you can start them as soon as you realise you’ve got an infection. In certain circumstances, if you keep getting flare-ups, your GP may recommend you take regular antibiotics.

Steroid tablets

If you have a flare-up of COPD, your doctor may suggest a short course of steroid tablets. You only take these for a short time because they can cause side-effects. If you’re used to managing your COPD, your GP may give you a course of steroid tablets to keep at home, so that you can start them as soon as you recognise the signs of a flare-up.

Other medicines

If you’re still getting symptoms despite using inhalers, your GP may refer you to a specialist. They may offer you other medicines in addition to your inhalers, including theophylline and roflumilast.

Pulmonary rehabilitation

This is a specialised programme of exercise and education about COPD, which is individually tailored to you. Your doctor may refer you if your COPD is starting to stop you doing things or if you’ve recently been admitted to hospital following a flare-up.

The programme includes physical training in a safe environment and can help you to increase the amount of exercise you can do. It aims to help you understand and manage your condition better, and to give you any support you need with nutrition or mental wellbeing. Sessions are usually held two or three times a week for six weeks.

Oxygen therapy

If you’re still getting COPD symptoms despite taking other medicines, your GP may refer you to specialist services to see if oxygen therapy would help. Oxygen therapy can make it easier for you to do things that you’re finding difficult. But it’s something that you’ll need to take continuously, over the long term. If it’s found that you would benefit from oxygen therapy, your nurse or therapist will talk through the best type of equipment for you. You may have oxygen cylinders or a machine called an oxygen concentrator to use at home, which you’ll need to use for 15 hours or more a day. You inhale the oxygen through a face mask or through small tubes that continuously deliver the gas into your nostrils (nasal cannulae). You can get portable concentrators to use when you’re out and about.

You’ll be told not to smoke if you have oxygen therapy, because there’s a serious fire risk. You may not be prescribed oxygen therapy if you haven’t given up smoking.

You might also be given oxygen in hospital if you’re admitted due to a flare-up of COPD.

Surgery

If you have severe COPD and have tried all other treatments, your doctor may recommend a review to assess if surgery on your lungs may help. There are several different options, depending on the particular problem in your lungs.

  • A bullectomy removes one dilated air space in the lung.
  • Lung volume reduction surgery removes the most damaged section of each lung.
  • Endobronchial valve insertion stops air from going into the worst affected sections of your lungs.
  • A lung transplant completely replaces your diseased lung.

Frequently asked questions

  • No, but they do cause similar symptoms. The main difference is that asthma symptoms usually come and go, whereas COPD symptoms tend to be persistent and gradually get worse.

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

    People who have COPD are usually older (50s or above) and have a history of smoking. Asthma often starts in childhood, and there’s often a history of allergy-related conditions in the family.

    You’re more likely to get breathlessness and wheezing that wakes you at night if you have asthma. With COPD, you’re more likely to have a chronic, chesty cough.

    Speak to your GP if you’re concerned that you have symptoms of asthma or COPD. They’ll talk to you about your symptoms and your history. If there’s any uncertainty, they may see how you respond to certain asthma medications to confirm your diagnosis.

  • Breathlessness can be frightening, but there are techniques you can learn to get your breathing under control. They can also help you to keep calm when you’re feeling particularly short of breath. They include techniques such as:

    • relaxed, slow, deep breathing
    • pursed-lips breathing — having your lips pursed as if you were whistling, when you breathe out
    • blowing out when you’re doing something that requires effort
    • paced breathing — where you time your breathing to a particular activity

    A physiotherapist can help you work out what’s best for you. If you’re feeling breathless, it can also help if you sit or stand leaning forward — on the back of a chair or table, for example.


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Related information


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    • Poole P, Chong J, Cates CJ. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2015, Issue 7. doi: 10.1002/14651858.CD001287.pub5
    • Oxygen therapy – how is oxygen delivered. British Lung Foundation. www.blf.org.uk, last reviewed February 2018
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  • Reviewed by Pippa Coulter, Freelance Health Editor, March 2019
    Expert reviewer, Dr Richard Russell, Respiratory Consultant
    Next review due March 2022



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