Chronic Obstructive Pulmonary Disease (COPD)

What is chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease, commonly referred to as COPD, is an umbrella term which is used to describe a collection of conditions and illnesses that affect the lungs, including chronic bronchitis, emphysema and chronic obstructive airways disease. Chronic indicates that a condition is long-term. Chronic bronchitis occurs when the bronchi become inflamed, which causes increased production of mucus and causes people to cough up phlegm. Emphysema occurs when the airways become narrower as a result of alveoli losing a degree of elasticity.

COPD is one of the most common respiratory diseases and more than 800,000 cases of COPD have been diagnosed in the UK, but it is estimated that up to 2 million more people could be living with the condition. It is thought that many people do not bother seeing their doctor when COPD symptoms arise, as they assume that they just have a smoker’s cough. COPD tends to affect middle aged and older people and it is often linked with smoking.

What causes COPD?

The major cause of COPD is smoking and at least four out of five people who develop COPD smoke and between 10% and 25% of smokers will develop the condition. Smoking causes the lining of the airways to become inflamed, which contributes to permanent damage.

Other risk factors for COPD include:

• Passive smoking.
• Inhaling fumes, dust or smoke.
• Family history: if you smoke and you have a sibling with COPD, you have a higher risk of developing COPD than a smoker who does not have a brother or sister with the condition.
• Genetic tendency: a rare genetic tendency known as alpha-1 antitrypsin deficiency can increase the risk of COPD.

There is also a belief that pollution may contribute to an increased risk of COPD but this has not been confirmed.

What are the symptoms of COPD?

In many cases, people do not develop symptoms for some time, as smoking causes gradual damage to the lungs. Most people do not develop symptoms of COPD until the age of at least 35 and symptoms tend to get worse as you get older. Symptoms tend to get worse in the winter months, with most people experiencing at least 2 flare-ups per year coupled with worsening symptoms. You should see your GP if you experience the following symptoms:

• A persistent cough and coughing up phlegm.
• Frequent chest infections (most people tend to develop infections more frequently in the winter).
• Finding it difficult to breathe, especially after moving about or doing exercise.

As the condition progresses, it becomes more difficult to breathe in and out as a result of damage to the alveoli.

How is COPD diagnosed?

If you have any of the symptoms listed above, you should see your GP. It is important that COPD is diagnosed and treated early, as it will get progressively worse and lead to organ damage.

When you see your GP they will ask you about your symptoms and your lifestyle, and they will most likely want to know whether you smoke and, if so, how much you smoke. Your GP will examine you and listen to your breathing using a stethoscope and determine how well your lungs are working. This is done using a spirometry lung function test, which involves using a machine called a spirometer. This measures how much air you can breathe out in one second (known as the FEV1- forced expiratory volume in one second) and the total amount of air you can breathe out (known as the FVC- forced vital capacity).

Other tests may also be carried out, including:

• Blood tests.
• Chest X-ray.
• Peak flow.
• Heart tests.
• CT scan.
• Phlegm sample.

Treatment for COPD

There is currently no cure for COPD, though there are treatments that can be used to ease symptoms. Self-help techniques can also be very beneficial. These include:

• Stopping smoking.
• Eating a healthy, balanced diet.
• Exercise: even gentle exercise will be beneficial.
• Having a flu vaccination.

Treatments include:

• Steroids: steroids are effective if you suddenly find that you are short of breath or your symptoms get worse. Sometimes, doctors recommend taking a long-term course of steroids.
• Medication: medication may be prescribed to combat an infection or ease symptoms. For example, antibiotics may be prescribed to treat a chest infection.
• Oxygen therapy: this is used for people who have low blood oxygen levels. Oxygen therapy does not help breathlessness, but it can make a huge difference to people who have abnormally low levels of oxygen in their blood.
• Nebulisers: nebulisers are used for people with severe COPD when other inhalers have not been effective.
• Inhalers: these may be short-acting or long-acting bronchodilator inhalers.

If you have been diagnosed with COPD it is really important that you look after yourself. This means eating well, living a healthy lifestyle and taking medication and treatments in line with your doctor’s advice. It is also advisable to have a flu vaccination every autumn and to attend regular reviews with your healthcare team.

What is the outlook for COPD?

If COPD is diagnosed and treated early, it can be managed effectively. However, there is no cure and symptoms do tend to get worse over time. COPD causes around 25,000 deaths per year.

Preventing COPD

The most effective way of preventing COPD is to avoid smoking. If you do smoke you should try to give up, as this will reduce your risk of many serious illnesses, including cancer, strokes and heart disease, in addition to COPD. The NHS provides a great deal of free support for people who want to give up smoking, including quit smoking packs and group support sessions. If you want help with giving up, contact your GP or visit the NHS website. Keeping fit and healthy by eating a balanced diet and exercising on a regular basis will also help to reduce your risk of developing COPD.