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Chronic obstructive pulmonary disease - COPD


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Chronic obstructive pulmonary disease (COPD) is a general name used to describe a variety of conditions that affect the lungs, including chronic bronchitis, emphysema, small airways disease and smoker's cough that make breathing difficult.

COPD is a serious lung disease that becomes progressively more common with age. It is rare for it to appear in people under the age of 35. In the UK, it claims the lives of over 30,000 people each year and is estimated to cost the NHS at least £500 million each year.
COPD is often caused by smoking. Inhaling tobacco smoke damages and breaks down the tissues in the lungs. The more tobacco smoked and the longer the person has been a smoker, the greater the risk of developing COPD. Passive smoking, by inhaling other people's exhaled tobacco smoke, also increases the risk of COPD.

Other causes of COPD include the inhalation of fumes or particles, as well as some pollutants. In addition, inherited factors may be involved.

When the airways are damaged by smoke or other harmful substances, they become swollen and narrow. Large amounts of sticky mucus are produced in the airways, narrowing them still further. The narrowed airways and excess sticky mucus lead to an obstruction that restricts the flow of air in and out of the lungs and so breathing becomes difficult. Over a long period, especially if the person continues to smoke, the lungs become irreversibly damaged.
Symptoms of COPD vary according to the amount of damage that has been caused to the lungs. Usually, the first symptom to appear is a cough, often first thing in the morning. The cough may occur just now and again, but then becomes persistent, occurring during both day and night. The cough usually produces mucus or phlegm.

As lung function gets worse, the person may first begin to experience breathlessness when exercising or doing something strenuous. Eventually, the person's ability to do normal everyday activities, such as climbing the stairs, gets more restricted. Symptoms may vary on a day-to-day basis, sometimes for no obvious reason, but almost invariably getting worse during the cold, winter months. Chest infections become common.

An inability to breathe properly leads to a lack of oxygen in the body, leaves the person feeling exhausted and can eventually lead to serious complications such as heart failure.

There is a tendency for people to ignore the first symptoms of COPD, simply blaming the cough on a cold or on a smoker's cough. Later, as symptoms get worse, people tend to restrict their activities to avoid becoming breathless. They may assume their breathlessness and reduced activity are just signs of ageing. These symptoms should not be ignored, damage to the lungs increases as time goes by, particularly if the person does not stop smoking, eventually reaching a point where lung function is not adequate.
The best way to avoid COPD is to prevent it from happening in the first place. As smoking is responsible for many cases of COPD, never starting to smoke is the best way of avoiding the disease. Parents should set a good example to children by not smoking and by warning their children about the dangers of smoking. If parents do not smoke or do not smoke in the presence of their children it also reduces the risk of passive smoking on their children.

For those who smoke, every effort should be made to stop the habit. Even though the damage already caused to the lungs can not be reversed, the rate of decline in lung function can be slowed if the lungs are no longer exposed to tobacco smoke. There are many products to help, such as patches, chewing gum, lozenges and nasal sprays, available to purchase over the counter or on prescription that can help reduce the craving to smoke while giving up. Whichever products are used, they will only help if the person is committed to stop smoking, and work best if the person also has counselling and support while trying to give up.
If a person does develop symptoms of COPD, a lot can be done to relieve symptoms and improve the quality of life experienced by those with the disease. Many doctors' surgeries now have a respiratory team to care for patients with COPD. The respiratory team will ensure that the person is on the right medicines and will regularly review the person's symptoms to check that the medicines are continuing to provide relief.(See also 'Living with COPD' below)

Bronchodilators The main treatments for COPD include inhaled bronchodilators, which relax and open up the airways and make breathing easier. Short-acting bronchodilators, also called 'relievers', are used for the relief of symptoms of breathlessness. There are two main types, the short-acting beta2 agonists such as salbutamol and terbutaline and the short-acting anticholinergic agent ipratropium. These drugs work quickly, relieving symptoms in minutes, and they continue to work for about 4 to 6 hours.

If symptoms are more severe or occur more frequently and are not controlled by relievers, long-acting bronchodilators can be used to prevent or reduce symptoms. Long-acting bronchodilators include the long-acting beta2 agonists formoterol and salmeterol, and the long-acting anticholingergic agent tiotropium. These drugs are taken regularly and should be used everyday, even when feeling well. These drugs are slower to produce their effect than the short-acting agents and therefore they should not be used as relievers.

Inhaled corticosteroids Inhaled corticosteroids include beclometasone, budesonide and fluticasone. They help to reduce swelling in the airways and make breathing easier. If symptoms are particularly severe, steroid tablets such as prednisolone may be prescribed. Other drugs and drug combinations Often, combinations of long-acting bronchodilators and inhaled corticosteroids may be used together to help improve the control of symptoms. Another drug called theophylline, which also relaxes the muscles in the airways, may be added to these combinations to increase their effect.

Other drugs called mucolytics to help break down the sticky mucus and make it easier to be coughed out of the lungs, or antibiotics to treat bacterial chest infections are also often needed.

If breathing is very difficult, the person may need to inhale oxygen through a face mask, the oxygen being supplied either from cylinders of the gas or by means of a device called an oxygen concentrator.
When to consult your pharmacist
Talk to your pharmacist is you want help to stop smoking. There are many products that are available from your local pharmacy without the need for a prescription. Your pharmacist will be able to advise you about the different types of product and will be able to tell you where you can get support when giving up.

As COPD is a long term condition that will require treatment for years, it is worth registering with your pharmacist for the repeat dispensing of your prescriptions. By doing so, your pharmacist will get to know you and the medicines that you are taking and will always be available to offer advice. At regular intervals, your pharmacist may suggest that he or she reviews the medicines that you are taking to ensure that you are using them properly and that they remain right for you. It also provides an opportunity for you to discuss any doubts about what your medicine is for and how it should be used. If your pharmacist considers that your COPD is not being controlled, you will be advised to visit your doctor, practice nurse or respiratory team.
When to consult your doctor
If you smoke or if you used to smoke and you have a cough that produces mucus, if your chest wheezes or if you become breathless when walking or climbing the stairs, then you may have COPD and it is important that you visit your doctor.

Your doctor will examine you, ask you to describe your symptoms, and may use an instrument called a spirometer to test how well your lungs are working. Another instrument, called a peak flow meter, may be used to test how fast you can breathe out. If COPD is diagnosed, treatment will depend on the severity of your symptoms and the results of your breathing tests.

If you are a smoker, your doctor will advise that you give up and will offer counselling and medicines to help you quit.

If your breathlessness restricts your activities, your doctor may suggest a series of gentle exercises to help you become as active as possible.

The practice nurse should give you an injection against pneumonia and will arrange that you have an injection each year against influenza.

It is important to see your doctor regularly to keep a check on your condition, particularly if:
  • You feel your medication is not providing relief
  • You need to use your reliever more often than usual
  • Your symptoms are getting worse
  • You experience an increase in coughing
  • Your cough produces more mucus, or the mucus changes colour
  • You are still smoking and wish to quit

Questions you may want to ask
Ask your doctor, nurse or respiratory team about:
  • Whether you would benefit from a pneumococcal vaccine to protect against pneumonia. *The majority of people with COPD benefit from having this vaccination and it is recommended by the Department of Health.
  • Reviewing your inhaler technique regularly - to make sure you are using your inhaler correctly and getting the most benefit from your medicine
  • A self management plan - to record your medication and lung function to recognise your symptoms and to know what to do if your symptoms get worse (exacerbations)
  • Pulmonary rehabilitation courses - these are courses that will help you carry out normal daily activities, stay healthy and promote well-being
  • Oxygen treatment - an oxygen concentrator is a device that can be used in the home and helps restore oxygen levels in the blood
Living with COPD
If you have already been diagnosed with COPD:
  • See your doctor regularly to keep a check on your condition
  • Always take your medicine as your doctor or pharmacist has advised
  • Learn to relax, try not to worry and get plenty of sleep
  • Learn breathing techniques to cope with breathlessness
  • Learn sitting and standing positions that make breathing easier
  • Try to remain as active as you possibly can
  • Confide in your partner, family, friends or respiratory team to share any worries you have
  • Ask for help and advice as soon as you need it
What to do in an emergency
You should go to the hospital straight away if your breathing quickly gets a lot worse. Get urgent medical help if you suddenly find it hard to walk or talk, your lips or fingertips turn grey or blue, your heartbeat or pulse is irregular, or your medicine does not work for very long, or does not work at all.
Where to go for further help and advice
British Lung Foundation runs a Breathe Easy support network offering information and advice

SPI/SPV2236 Date of Prep: December 2009