The information outlined below on common respiratory conditions and allergies is provided as a guide only and it is not intended to be comprehensive. Discussion with Dr O'Hickey is important to answer any questions that you may have. For information about any additional conditions or treatments not featured within the site, please contact us for more information.
COPD describes a group of lung conditions that make it difficult to empty air out of the lungs because your airways have been narrowed. This information explains what it is, what the symptoms are, and how it’s diagnosed and treated.
Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because your airways have been narrowed.
Two of these lung conditions are persistent bronchitis and emphysema, which can also occur together.
• Bronchitis means the airways are inflamed and narrowed. People with bronchitis often produce sputum, or phlegm.
• Emphysema affects the air sacs at the end of the airways in your lungs. They break down and the lungs become baggy and full of holes which trap air.
These processes narrow the airways. This makes it harder to move air in and out as you breathe, and your lungs are less able to take in oxygen and get rid of carbon dioxide.
The airways are lined by muscle and elastic tissue. In a healthy lung, the tissue between the airways acts as packing and pulls on the airways to keep them open. With COPD, the airways are narrowed because:
• the lung tissue is damaged so there is less pull on the airways
• the elastic lining of the airways flops
• the airway lining is inflamed
There are treatments to help you breathe more easily, but they can’t reverse the damage to your lungs – so it’s important to get an early diagnosis.
COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution.
CAUSES of COPD
Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD.
You’re most likely to develop COPD if you’re over 35 and are, or have been, a smoker. Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher. A rare genetic condition called alpha-1-antitrypsin deficiency makes people very susceptible to develop COPD at a young age.
The symptoms of COPD include:
SYMPTOMS of COPD
• getting short of breath easily when you do everyday things such as going for a walk or doing housework
• having a cough that lasts a long time
• wheezing in cold weather
• producing more sputum or phlegm than usual
You might get these symptoms all the time, or they might appear or get worse when you have an infection or breathe in smoke or fumes.
If you have severe COPD, you can lose your appetite, lose weight and find that your ankles swell.
With COPD, your airways have become narrowed permanently – inhaled medication can help to open them up to some extent. With asthma, the narrowing of your airways comes and goes, often when you’re exposed to a trigger – something that irritates your airways – such as tobacco smoke, dust or pollen. Inhaled medication can open your airways fully, prevent symptoms and relieve symptoms by relaxing your airways. So, if your breathlessness and other symptoms are much better on some days than others, or if you often wake up in the night feeling wheezy, it’s more likely you have asthma.
What’s the difference between COPD and asthma?
Your doctor will ask if your breathlessness is brought on by anything, how your daily life is affected and other questions about your general health.
They’ll ask if you’ve smoked and if you’ve been exposed to dust, fumes or chemicals. Your doctor can check how well your lungs work by arranging a simple test called spirometry. This involves blowing hard into a machine which measures your lung capacity and how quickly you can empty your lungs. This is called the forced expiratory volume in one second, often shortened to FEV1.
Your doctor will use spirometry to measure how narrow your airways are. But this only covers one aspect. Someone with slightly narrowed airways can be more breathless than someone with very narrow airways depending on their level of fitness and the exact way COPD has damaged their lungs.
Other tests for COPD
Your doctor should arrange for you to have a blood test and a chest X-ray to rule out other causes of your symptoms. Your doctor will calculate your body mass index (BMI) to find out if you’re a healthy weight for your height. This is important because you can deal with your COPD better if you’re not underweight or overweight.
You may do more tests to give a better picture of your condition, covering:
• how well your lungs are functioning
• how often you have symptom flare-ups or chest infections
• how short of breath you feel during everyday activities
• whether your oxygen level is significantly lower
Your health care professional can prescribe several types of medicine or combinations of medications to improve symptoms like breathlessness and to help prevent a flare-up. You can also do things to help manage your condition yourself. Keeping active and doing exercise can make a big difference – many people find this helps them more than inhaled drugs.
Treatments for COPD
If you smoke, the most effective treatment for COPD is to stop. Your health care professional and pharmacist can help you find ways that make it easier for you. You’re four times as likely to quit with help from support services and medication. Have a look at the NHS Smokefree website to find out more.
Have a plan
It’s important you have a plan to help you manage your COPD that’s agreed with your doctor or nurse. You should also have regular check-ups with your health care professional – at least once a year.
Your doctor will decide with you which medications to use depending on how severe your COPD is, how it affects your everyday life, and any side effects that you may have experienced.
Your health care team may send you to a specialist to see if oxygen can help you. Oxygen is only useful as a treatment for people with a low oxygen level. It’s not a treatment for breathlessness, which in COPD is usually caused by difficulty moving air in and out as you breathe, rather than by a low oxygen level.
If you’re admitted to hospital with a severe flare-up of your condition, you may be offered non-invasive ventilation. This involves wearing a nasal cannula ( a soft tube inserted into your nose) or face mask connected to a machine that pushes air into your lungs. Non-invasive ventilation supports your breathing to give your muscles a rest and gently helps with each breathe you take. This increases your oxygen level and helps you breathe out more carbon dioxide. If you regularly wake up with a headache, tell your doctor. It can be a sign your breathing is shallow at night and you might benefit from non-invasive ventilation at home.
Lung volume reduction surgery
Some people with emphysema may benefit from surgery to remove the worst affected areas of the lung. This allows the remaining healthier parts of your lung to work better. If you’ve been through a pulmonary rehabilitation programme and are still limited by breathlessness, ask your doctor if you might be eligible for this sort of treatment. Bronchoscopic techniques for lung volume reduction are also becoming available. You may be considered for these instead of surgery as part of the assessment process for surgery.
If you have very severe COPD and have not got better with treatment, you might be a candidate for a lung transplant depending on your age, other illnesses and test findings. Lung transplant is a high-risk operation and is only suitable for a small number of people. There are also few suitable organ donors.
If you have a long-term condition like COPD, you’ll feel better if you self-manage your condition and take some control of your life. “If you have a lung condition, you can’t sit around and wait for other people to take care of you – you need to take care of yourself! I fully believe you get out of it what you put in” Knowing all you can about your condition, your symptoms, your medications and how to cope with flare-ups will make your day-to-day life easier.
How can I manage my COPD better?
Exercise and pulmonary rehabilitation
If you have COPD, being active and exercising can help you to improve your breathing, your fitness and your quality of life. Don’t avoid activities that make you breathless: you’ll get less fit and out of breath more easily. Regular exercise can help reverse this by strengthening your muscles. Exercise also benefits your heart and blood pressure, and makes you less likely to develop conditions such as diabetes and osteoporosis (fragile bone disease).
The best way to learn how to exercise at the right level for you is to take part in pulmonary rehabilitation. Ask your doctor to refer you. Pulmonary rehabilitation or PR is a programme of exercise and education designed for people living with COPD. It combines physical exercise sessions with advice and discussions about your lung health.
There is strong evidence that people with COPD benefit from PR and exercise more generally. Most people find PR improves their ability to exercise and their quality of life. The impact of PR is often bigger than the impact of taking inhaled medications. By combining the two approaches, you’re likely to get the most benefit.
Controlling your breathing
There are techniques to help you reduce breathlessness. Try to practise them every day. They can also help if you get out of breath suddenly. Being in control of your breathing means breathing gently, using the least effort, with your shoulders supported and relaxed.
Different things work best for different people. We've put together some techniques and positions to try.
Top tips for managing breathlessness
• Use a towelling robe after showering or bathing, as you’ll use less energy than drying off with a towel.
• Hold a handheld battery fan near your face if it helps you to feel less breathless.
• Plan your day in advance to make sure you have plenty of opportunities to rest.
• Find simple ways to cook, clean and do other chores. You could use a small table or cart with wheels to move things around your home, and a pole or tongs with long handles to reach things.
• Put items that you use frequently in easy-to-reach places.
• Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.
• Use a wheeled walking frame to help improve your breathlessness.
Eating well and keeping a healthy weight It’s important to eat a balanced diet and maintain a healthy weight. Your doctor or nurse can help you to work out what your healthy weight should be and can refer you to a dietician or local scheme to help you.
• If you’re overweight it will be harder for you to breathe and move around.
• If you’re losing too much weight because eating makes you feel breathless, or find it difficult to shop and prepare meals, try to eat little and often.
Make sure you get your flu jab every year to protect you against the flu viruses likely to be going round over the winter. The NHS offers it for free to people living with long-term conditions like COPD.
Your doctor should also offer you a vaccination against pneumococcal infection – a bacterial infection that can cause pneumonia and other illnesses. You only need to have this once.
You can also avoid infections by staying away from people – including babies – who have colds, flu, sinus infections or a sore throat. If you do get an infection, make sure you treat it quickly.
A flare-up – sometimes called an exacerbation – is when your symptoms become particularly severe.
You should have an action plan that you’ve agreed with your health care professional so you know what to do if you have a flare-up. Your plan may include a rescue pack of drugs (antibiotics and steroid tablets) that you keep at home.
Remember, if you smoke, stopping smoking is the best thing you can do.
What else can I do to manage my COPD better?
Make sure you sleep well and get enough rest every day. This will help with your energy levels. If you have trouble sleeping, try to exercise each day and don’t have tea, coffee or alcohol before bed time. Talk to your doctor if that doesn’t help.
Ask your doctor about ways you can adapt your home to help you move around more easily. An occupational therapist and your local council can help you with this. If your ankles swell, tell your doctor. Medicines can reduce this. But many people with COPD have other conditions, and leg swelling can be a sign of a heart condition. It’s important to talk to your doctor or nurse about longer-term treatments and advance care planning. This means thinking about what you would like to happen if your condition gets worse, or you experience more severe flare-ups, to help your family and your doctor to understand your wishes.