What is COPD?

COPD is a respiratory disease largely caused by smoking, with 9 out of 10 cases being attributed to smoking.

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease, where airflow to the lungs is limited due to constricted airways, resulting in shortness of breath and other breathing difficulties. It is commonly associated with smoking, and can be prevented and improved in most cases by not smoking.

What causes COPD?

COPD occurs due to the inflammation of the lungs. The airways become inflamed, causing them to become thicker. The tissue in the lungs where the exchange of oxygen usually takes place is destroyed and loses its elasticity. Therefore, oxygen levels in the body decrease.

Emphysema and chronic bronchitis are usually responsible for the onset of COPD. Emphysema occurs when the alveoli at the end of the bronchioles are damaged by the chemicals found in cigarettes and other substances. Bronchitis is when the lining of the bronchial tubes becomes inflamed, thus they are unable to transport enough oxygen.

What are the signs and symptoms of COPD?

Symptoms of COPD may include:

• Breathlessness that becomes worse over time. Breathlessness is usually induced at first by physical activity, and then can occur without any activity, such as whilst you are sleeping.
• Tightness in the chest.
• Recurring chest infections.
• A consistent chesty cough, with phlegm. The phlegm is usually green or yellow, but can also be white or transparent.
• Wheezing.
• Swollen legs, feet or ankles.
• Weight loss.
• Low energy.

The difference between COPD and asthma

COPD is often mistaken for asthma, due to the similarity in symptoms. Both respiratory conditions display symptoms of wheezing, breathlessness and coughing. Both conditions use inhalers. Additionally, many people with COPD also have asthma.

Asthma, however, is usually detected and diagnosed in childhood, whereas symptoms of COPD occur in adults, usually above the age of 40, with a history of smoking. Furthermore, the causes of asthma are not always known. It is thought that factors that trigger asthma include genetics, allergens, dust, mould, pet fur, smoke, cold climates, chest infections, physical activity, as well as some medications.

COPD is known to be caused by smoking and industrial fumes. Both conditions have similar risks, including high blood pressure, sinusitis, insomnia and cancers, and asthma in childhood is thought to increase the risk of developing COPD later in life.

Who is at risk of COPD?

• Everybody that smokes is at risk of developing COPD. The harmful chemicals released from cigarettes can cause the lungs to be inflamed, making the air passages that supply oxygen become narrower due to the swelling of the tubes. Chemicals can also damage and destroy air sacs. These all play a part in developing COPD. People who have smoked are 12 times more likely to die from complications caused by COPD than people who have not smoked.
• Nevertheless, everybody is at risk of developing COPD. Long-term exposure to air pollution, chemicals and fumes, second-hand smoke inhalation and even dust can all trigger COPD.
• Rarely, COPD can be triggered by a genetic condition, Alpha-1 deficiency-related emphysema. The condition impacts the body’s production of the Alpha-1 protein, which is used to provide the lungs with protection.
• Repeated respiratory infections in childhood, such as pneumonia, are thought to increase the risk of developing COPD.

Can COPD be prevented?

The most effective way to prevent COPD from developing is to never smoke tobacco products. If you do not smoke, it is highly unlikely that you will develop the condition. If you have already been diagnosed with COPD, you can limit any further damage by stopping smoking. Your GP can offer advice on different ways to stop smoking.

Living with COPD

Living with COPD can be challenging. Severe COPD can be dramatically life changing, as it means relying on additional oxygen support for the foreseeable future. There are ways to help improve your quality of life. Taking your medication as instructed is important, as the medicines prescribed for COPD can be very effective. This can be difficult to maintain where there are uncomfortable side effects, but your healthcare advisers will be able to support you and offer you alternative medications, or additional medications that can subside unwanted side effects.

Whilst even the slightest addition of exercise may be painful and leave you breathless, overall, exercise will gradually improve symptoms of COPD. Exercise is beneficial for lung function and maintaining a healthy weight. Your exercise schedule can be organised by your GP – it is likely that you will be put on a referral scheme for assisted exercise if your COPD is severe, after your pulmonary rehabilitation programme. If you become slightly breathless, this is normal. Exercise should be halted immediately if you are struggling to breathe or experiencing chest pains.

Another important way to remain healthy when living with COPD is to make sure that you are up to date with all your vaccines, as infections can severely affect the body. Avoid chemical toxins, dust and even perfumes, which can all trigger the worsening of symptoms.

Living with COPD doesn’t just affect the body physically, it can have an impact on a person’s mental wellbeing. People with COPD can become depressed, and you may feel that you cannot socialise or participate in activities that you may have done before. It can be difficult to have very serious conversations about end-of-life care, and it can be hard for people close to you to see you in poor health.

You may not be able to work due to breathlessness, and may have to claim sick pay or an allowance from the government. Additionally, it can affect intimate relationships, particularly as breathlessness can impact your ability to engage in sexual activity. This may change the way you and your partner interact.

How is COPD diagnosed?

If you suspect that you have COPD, or any complications related to the lungs, you should visit your GP immediately. The GP will ask you to give an account of your symptoms and will examine your chest and lungs. They will enquire about your smoking history and your family history and take measurements of your weight and height.

There are different examinations that can detect COPD:

• Chest X-rays can uncover lung issues, showing infections, inflammation and even lung cancer, though deeper imaging such as MRI scans are needed to confirm the presence of such ailments.
• A spirometry test measures your lung capacity by measuring how much air you can exhale in one second, and how much air you can breathe out in general. The measurement is then compared to the average reading for your age group.
• Blood tests can indicate different conditions that are associated with COPD, including low iron level.

There are other tests that can give more information about how severe the COPD is:

• An ECG (electrocardiogram) and an echocardiogram monitor the heart’s activity, looking for irregular patterns.
• A peak flow test records the rate of airflow that can be expended from the lungs. This test is used to exempt the patient from other conditions such as asthma.

How is COPD treated?

Stopping smoking

There are various programmes available to help you stop smoking. Usually, your GP will suggest that you attend one-to-one sessions with a specialist, but group services are also available. These might take place in a surgery, or a local pharmacy. Some sessions are held in a mobile van, or on a video call.

Research has shown that you are more likely to stop smoking indefinitely if you use special sessions in conjunction with different therapies.

Pulmonary rehabilitation 

A commonly used form of therapy is pulmonary rehabilitation, which is a programme that typically lasts around six weeks. The programme aims to help people who have lung issues to exercise, which can help them with their lung function.

The sessions are usually conducted in groups, and include the following elements:

• An exercise programme that is specifically designed to cater to what you can and can’t do. These are not usually strenuous, and include walking and small amounts of cardio.
• Information about how to live with and manage COPD, including diet.
• Support for your psychological and emotional wellbeing.
• Your programme may also include some muscle training therapy, which can be done by attaching electrodes to your skin to send electrical pulses. Strengthening your body muscles can help with your ability to perform exercise overall.

Surgery

Surgery may include:

• A bullectomy. This is a surgical procedure that aims to remove air from one of the lungs, to help it to function better and make it easier to breathe.
• Lung volume reduction surgery. This is a surgical procedure where parts of the lung that are badly damaged are removed to improve the function of the healthier parts, which can make breathing easier.
• Lung transplant. This is a surgical procedure to remove a badly damaged or non-functional lung and replace it with a healthier lung.

All surgeries of these kinds come with major risks, and are often not offered. There may be other procedures and therapies that can help.

Oxygen therapy

There are two kinds of oxygen therapy, long-term and ambulatory. Long-term oxygen therapy is given when the COPD causes there to be a low level of oxygen in the blood. Long-term oxygen treatment involves inhaling oxygen through nasal tubes or a mask for at least 16 hours a day. Tubes are designed so that you can use them whilst you walk around your house, but you will need to have a portable tank if you want to leave the house.

Ambulatory oxygen therapy is used when you are walking or exercising. This is usually for people who can maintain a normal oxygen level until they exercise.

Medication

• Roflumilast is used to help reduce the inflammation of the lungs and the airways, though it has uncomfortable side effects, including nausea, sickness, weight loss and diarrhoea.
• Theophylline or aminophylline tablets may be prescribed to lessen the inflammation of the airways, and the muscles surrounding them. These are bronchodilators, taken twice a day, and may have side effects which include nausea, insomnia and an irregular heartbeat.
• Antibiotics may be prescribed for the presence of an infection.
• Mucolytics are prescribed when you have a phlegmy cough. Mucolytics such as carbocisteine or acetylcysteine help to make the phlegm thinner, so that it leaves the body more easily.
• In some cases, especially when symptoms of COPD are severe, you may be prescribed steroidal medication, for short-term use. Side effects of steroids can be severe, and could include weight gain and mood changes.

Inhalers

People with COPD will be given inhalers, of which there are three types:

• A bronchodilator inhaler is the primary course of treatment, which makes it easier to breathe by broadening the airways. With short-acting bronchodilators there are two different types containing different medications. The beta-2 agonist inhaler contains salbutamol and terbutaline, and the antimuscarinic inhaler contains ipratropium. Short-acting bronchodilators are to be used when you feel breathless, no more than four times a day.
• Long-acting bronchodilators are for people who experience symptoms consistently throughout the day. They are taken twice a day, as doses last for 12 hours. Beta-2 agonist inhalers contain salmeterol, formoterol or indacaterol, and antimuscarinic inhalers contain tiotropium, glycopyrronium or aclidinium.
• Steroidal inhalers contain corticosteroids, which help to reduce inflammation. These are prescribed when bronchodilators are not effective by themselves.
• If inhalers are ineffective, the doctor may prescribe medicine to be taken through a nebuliser. This is when a machine converts the liquid form of the medicine into a mist that can be inhaled.

Who can support people with COPD?

• Asthma + Lung UK supports people with lung diseases, providing information and advice, and working towards cleaner air in the UK.
• The Breathing Charity offers information about different lung conditions that affect respiration, and the treatments available.
• The NHS website offers advice on how to stop smoking, and access to online communities, various helplines, and assistance to create a personal plan to quit smoking.