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Introduction

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties.

It includes:

  • emphysema - damage to the air sacs in the lungs
  • chronic bronchitis - long-term inflammation of the airways

COPD is a common condition that mainly affects middle-aged or older adults who smoke. Many people don't realise they have it.

The breathing problems tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control.

This page covers:

Symptoms

When to get medical advice

Causes

Treatments

Outlook

Prevention

Symptoms of COPD

The main symptoms of COPD are:

  • increasing breathlessness, particularly when you're active
  • a persistent chesty cough with phlegm - some people may dismiss this as just a "smoker's cough"
  • frequent chest infections
  • persistent wheezing

Without treatment, the symptoms usually get slowly worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation.

Read more about the symptoms of COPD.

When to get medical advice

See your GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke.

Don't ignore the symptoms. If they're caused by COPD, it's best to start treatment as soon as possible, before your lungs become significantly damaged.

Your GP will ask about your symptoms and whether you smoke or have smoked in the past. They can organise a breathing test to help diagnose COPD and rule out other lung conditions, such as asthma.

Read more about how COPD is diagnosed.

Causes of COPD

COPD occurs when the lungs become inflamed, damaged and narrowed. The main cause is smoking, although the condition can sometimes affect people who have never smoked.

The likelihood of developing COPD increases the more you smoke and the longer you've smoked.

Some cases of COPD are caused by long-term exposure to harmful fumes or dust, or occur as a result of a rare genetic problem that means the lungs are more vulnerable to damage.

Read more about the causes of COPD.

Treatments for COPD

The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition.

Treatments include:

  • stopping smoking - if you have COPD and you smoke, this is the most important thing you can do
  • inhalers and medications - to help make breathing easier
  • pulmonary rehabilitation - a specialised programme of exercise and education
  • surgery or a lung transplant - although this is only an option for a very small number of people

Read more about how COPD is treated and living with COPD.

Outlook for COPD

The outlook for COPD varies from person to person. The condition can't be cured or reversed, but for many people treatment can help keep it under control so it doesn't severely limit their daily activities.

But in some people COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems.

Preventing COPD

COPD is largely a preventable condition. You can significantly reduce your chances of developing it if you avoid smoking.

If you already smoke, stopping can help prevent further damage to your lungs before it starts to cause troublesome symptoms.

If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to your GP about the stop smoking medications available.

Read more about advice about stopping smoking or find a stop smoking service near you.


'I thought, I can either be miserable or I can live life to the full'

Lynn Ashton was having a happy Christmas dinner until a candle set her plastic tablecloth alight.

"We were taking a break after the main course when one of my children said she could smell something funny," says Lynn.

"I rushed into the dining room to find the plastic tablecloth and the dining room in flames. I threw the tablecloth on to the patio, but by then I had inhaled a lot of toxic fumes."

She sat outside trying to get her breath. Initially, she didn't go to the doctor. But over the next few weeks, her breathing got worse. She was already an asthmatic and smoked around 15 to 20 cigarettes a day.

"I spent the next four months in and out of hospital with chest infections," says Lynn. "At times, my breathing was so bad I could barely bend down to tie my shoelaces."

Lynn was diagnosed with COPD and bronchiectasis, an abnormal widening of the air sacs in the lungs. It was a shattering blow, and she stopped smoking immediately.

But Lynn was determined to stay strong. Her daughter was pregnant with her first grandchild.

"My prognosis wasn't good at first," she says. "I thought, I can either sit around and be miserable or I can live life to the full. I wanted to see my grandchild grow up. I wanted to help other people with COPD. I believe things happen for a reason."

Lynn is on a treatment regimen which includes six different drugs and a nebuliser. Two years ago she had a small catheter fitted, which passes from the lower neck into the windpipe and delivers oxygen directly into her lungs. It's held on by a discreet chain around her neck. "I clean it several times a day and it's wonderful," she says.

Lynn now helps other people who have COPD. She joined a local support group in Huntingdon called Hunts Breathe for Life, which she now chairs, and started to raise money for the cause.

"I started off doing some short walks. Then it occurred to me that I'd love to do the London Marathon. I called the British Lung Foundation and they were very enthusiastic and offered me a place. But when I told them I had COPD and was on oxygen, they were rather worried."

Lynn started her training by walking for just one minute on a treadmill at her local gym. Gradually, under the supervision of her nurse she increased the time until she was ready to realise her dream.

"It took me five days to finish the marathon," she says. "I had a trolley to help me walk and had my oxygen with me at all times. Every afternoon I'd go back to the hotel and rest. It was a wonderful experience. I raised over 14,000."

Lynn believes in living life to the full. "There was a time when I was very angry, and that's normal. I still have bad days. But when I look around, I see that there's always someone worse off than me."


'When I woke up, I could hardly breathe'

With a little help, Eddie Brownlow realised he could manage his COPD and get on with life.

Having served in the navy and the army as a paratrooper, Eddie Brownlow was fit when he left the forces aged 47. But he had smoked about 15 cigarettes a day for most of his life.

"It was the done thing back then. It relaxed me after a parachute jump," says Eddie.

After retiring from a second career as a sales manager, Eddie was getting breathless whenever he had to lift something heavy or exert himself. He ignored the fact he was feeling a "bit puffy" all the time and carried on.

But by 1998 he couldn't ignore it any more. "We were in Mexico on holiday and I had booked a marlin fishing trip," says Eddie. "But when I woke up I could hardly breathe. Luckily I recovered, but when I got back home I picked up a chest infection."

He went to his GP, who referred him to hospital. He was diagnosed with COPD. He followed a rehabilitation programme, which he describes as excellent. He learned about his medication, how to exercise and how to improve his diet.

Eddie says: "I realised there was no need to panic. You just need to learn to manage your condition. There's advice available."

One important thing Eddie knew he had to do was give up smoking. It took him quite a while, but with patches, advice and support from his wife he finally kicked the habit.

He also got involved with his local British Lung Foundation group, Breathe Easy, a voluntary organisation that supports people with breathing conditions like COPD. Within a few months of joining he took over his group and built up the membership.

Eddie now makes it his job to raise awareness of breathing conditions and, through his efforts, the town's mayor selected his branch of Breathe Easy as his chosen charity recently.


Symptoms

Chronic obstructive pulmonary disease (COPD) makes breathing increasingly more difficult. But it develops slowly over many years and you may not be aware you have it at first.

Most people with COPD don't have any noticeable symptoms until they reach their late 40s or 50s.

Main symptoms

Common symptoms of COPD include:

  • increasing breathlessness - this may just occur when exercising at first, and you may sometimes wake up at night feeling breathless
  • a persistent chesty cough with phlegm that never seems to go away
  • frequent chest infections
  • persistent wheezing

The symptoms will usually get gradually worse over time and make daily activities increasingly difficult, although treatment can help slow the progression.

Sometimes there may be periods when your symptoms get suddenly worse - known as a flare-up or exacerbation. It's common to have a few flare-ups a year, particularly during the winter.

Other symptoms

Less common symptoms of COPD include:

These additional symptoms only tend to occur when COPD reaches a more advanced stage.

When to get medical advice

See your GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke.

There are several conditions that cause similar symptoms, such as asthma, bronchiectasis, anaemia and heart failure. A simple breathing test can help determine if you have COPD.

Read more about tests for COPD.

While there's currently no cure for COPD, the sooner treatment begins, the less chance there is of severe lung damage.

Read more about how COPD is treated.


Causes

Chronic obstructive pulmonary disease (COPD) occurs when the lungs and airways become damaged and inflamed.

It's usually associated with long-term exposure to harmful substances such as cigarette smoke.

Things that can increase your risk of developing COPD are outlined below.

Smoking

Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases.

The harmful chemicals in smoke can damage the lining of the lungs and airways. Stopping smoking can help stop COPD getting worse.

Some research has also suggested that being exposed to other people's smoke (passive smoking) may increase your risk of COPD.

Fumes and dust at work

Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD.

Substances that have been linked to COPD include:

  • cadmium dust and fumes
  • grain and flour dust
  • silica dust
  • welding fumes
  • isocyanates
  • coal dust

The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke.

The Health and Safety Executive has more information about occupational causes of COPD.

Air pollution

Exposure to air pollution over a long period can affect how well the lungs work and some research has suggested it could increase your risk of COPD.

But at the moment the link between air pollution and COPD isn't conclusive and research is continuing.

Genetics

You're more likely to develop COPD if you smoke and have a close relative with the condition, suggesting some people's genes may make them more vulnerable to the condition.

Around 1 in 100 people with COPD has a genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, the lungs are more vulnerable to damage.

People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 35 - particularly if they smoke.

The British Lung Foundation has information about alpha-1-antitrypsin deficiency. The charity Alpha-1 Awareness UK also provides information and advice.


Diagnosis

See your GP if you have persistent symptoms of chronic obstructive pulmonary disease (COPD).

Your GP may:

  • ask about your symptoms
  • examine your chest and listen to your breathing with a stethoscope
  • ask whether you smoke or used to smoke
  • calculate your body mass index (BMI) using your weight and height
  • ask if you have a family history of lung problems

They may also carry out or arrange for you to have a breathing test called spirometry and some of the other tests described below.

Spirometry

A test called spirometry can help show how well your lungs are working.

You'll be asked to breathe into a machine called a spirometer after inhaling a medication called a bronchodilator, which helps widen your airways.

The spirometer takes two measurements: the volume of air you can breathe out in one second, and the total amount of air you breathe out. You may be asked to breathe out a few times to get a consistent reading.

The readings are compared with normal results for your age, which can show if your airways are obstructed.

Chest X-ray

A chest X-ray can be used to look for problems in the lungs that can cause similar symptoms to COPD.

Problems that can show up on an X-ray include chest infections and lung cancer, although these don't always show up.

Blood tests

A blood test can pick up other conditions that can cause similar symptoms to COPD, such as low iron levels (anaemia) and a high concentration of red blood cells in your blood (polycythaemia).

Sometimes a blood test may also be carried out to see if you have alpha-1-antitrypsin deficiency. This is a rare genetic problem that increases your risk of COPD.

Further tests

Sometimes more tests may be needed to confirm the diagnosis or determine the severity of your COPD.

This will help you and your doctor plan your treatment.

These tests may include:

  • an electrocardiogram (ECG) - a test that measures the electrical activity of the heart
  • an echocardiogram - an ultrasound scan of the heart
  • a peak flow test - a breathing test that measures how fast you can breathe out, which can help rule out asthma
  • a blood oxygen test - a peg-like device is attached to your finger to measure the level of oxygen in your blood
  • a computerised tomography (CT) scan - a detailed scan that can help identify any problems in your lungs
  • a phlegm sample - a sample of your phlegm (sputum) may be tested to check for signs of a chest infection

Treatment

Stop smoking

If you smoke, stopping is the most effective way to prevent COPD getting worse.

Although any damage done to the lungs and airways can't be reversed, giving up smoking can help prevent further damage.

This may be all the treatment that's needed in the early stages of COPD, but it's never too late to stop - even people with more advanced COPD are likely to benefit from quitting.

If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to your GP about the stop smoking medications available.

Read more about stop smoking support or find a stop smoking service near you.

Inhalers

If your COPD is affecting your breathing, you'll usually be given an inhaler. This is a device that delivers medication directly into your lungs as you breathe in.

Your doctor or nurse will advise how to use your inhaler correctly and how often to use it.

There are several different types of inhaler for COPD. The main types are described below.

Short-acting bronchodilator inhalers

For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.

Bronchodilators are medications that make breathing easier by relaxing and widening your airways.

There are two types of short-acting bronchodilator inhaler:

  • beta-2 agonist inhalers - such as salbutamol and terbutaline
  • antimuscarinic inhalers - such as ipratropium

Short-acting inhalers should be used when you feel breathless, up to a maximum of four times a day.

Long-acting bronchodilator inhalers

If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended instead.

This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day.

There are two types of long-acting bronchodilator inhaler:

  • beta-2 agonist inhalers - such as salmeterol, formoterol and indacaterol
  • antimuscarinic inhalers - such as tiotropium, glycopyronium and aclidinium

Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic.

Steroid inhalers

If you're still getting breathless when taking long-acting inhalers or have frequent flare-ups (exacerbations), your GP may suggest including a steroid inhaler as part of your treatment.

Steroid inhalers contain corticosteroid medication, which can help reduce the inflammation in your airways.

Steroid inhalers are normally prescribed as part of a combination inhaler that also includes one of the long-acting medications mentioned above.

Medication

If your symptoms aren't controlled with inhalers, your doctor may recommend taking tablets or capsules as well.

The main medications used are described below.

Theophylline tablets

Theophylline is a tablet that relaxes and opens up the airways. It's usually taken twice a day.

You may need to have regular blood tests during treatment to check the level of medication in your blood.

This will help your doctor work out the best dose to control your symptoms while reducing the risk of side effects.

Possible side effects include:

Sometimes a similar medication called aminophylline is also used.

Mucolytic tablets or capsules

If you have a persistent chesty cough with lots of thick phlegm, your doctor may recommend taking a mucolytic medication called carbocisteine.

Mucolytic medications make the phlegm in your throat thinner and easier to cough up.

They're taken as a tablet or capsule, usually three times a day.

Steroid tablets

If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.

A 7 to 14-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as:

Your doctor may give you a supply of steroid tablets to keep at home and take as soon as you start to experience a bad flare-up.

Longer courses of steroid tablets must be prescribed by a COPD specialist. You'll be given the lowest effective dose and monitored closely for side effects.

Antibiotics

Your doctor may prescribe a short course of antibiotics if you have signs of a chest infection, such as:

  • coughing up yellow or green phlegm
  • a high temperature (fever)
  • a rapid heartbeat
  • chest pain or tightness
  • feeling confused and disorientated

Sometimes you may be given a course of antibiotics to keep at home and take as soon as you experience symptoms of an infection.

Pulmonary rehabilitation

Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD.

It can help improve how much exercise you're able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing.

Pulmonary rehabilitation programmes usually involve two or more group sessions a week for at least six weeks.

A typical programme includes:

  • physical exercise training tailored to your needs and ability - such as walking, cycling and strength exercises
  • education about your condition for you and your family
  • dietary advice
  • psychological and emotional support

The programmes are provided by a number of different healthcare professionals, including physiotherapists, nurse specialists and dietitians.

The British Lung Foundation has more information about pulmonary rehabilitation.

Other treatments

If you have severe symptoms or experience a particularly bad flare-up, you may sometimes need additional treatment.

Nebulised medication

Nebulised medication may be used in severe cases of COPD if inhalers haven't worked.

This is where a machine is used to turn liquid medication into a fine mist that you breathe in through a mouthpiece or a face mask. It enables a large dose of medicine to be taken in one go.

You'll usually be given a nebuliser device to use at home after being shown how to use it.

Long-term oxygen therapy

If your COPD results in a low level of oxygen in your blood, you may be advised to have oxygen at home through nasal tubes or a mask.

This can help stop the level of oxygen in your blood becoming dangerously low, although it's not a treatment for the main symptoms of COPD, such as breathlessness.

Long-term oxygen treatment should be used for at least 16 hours a day.

The tubes from the machine are long, so you will be able to move around your home while you're connected. Portable oxygen tanks are available if you need to use oxygen away from home.

Don't smoke when using oxygen. The increased level of oxygen is highly flammable and a lit cigarette could cause a fire or explosion.

Read more about home oxygen treatment.

Ambulatory oxygen therapy

Some people with COPD will benefit from ambulatory oxygen - oxygen used when you walk or are active in other ways.

If your blood oxygen levels are normal while you're resting but fall when you exercise, you may be able to have ambulatory oxygen therapy rather than long-term oxygen therapy.

Non-invasive ventilation (NIV)

If you're taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation (NIV).

This is where a portable machine connected to a mask covering your nose or face is used to support your lungs and make breathing easier.

Surgery

Surgery is usually only suitable for a small number of people with severe COPD whose symptoms aren't controlled with medication.

There are three main operations that can be done:

  • bullectomy - an operation to remove a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
  • lung volume reduction surgery - an operation to remove a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
  • lung transplant - an operation to remove and replace a damaged lung with a healthy lung from a donor

These are major operations carried out under general anaesthetic, where you're asleep, and involve significant risks.

If your doctors feel surgery is an option for you, speak to them about what the procedure involves and what the benefits and risks are.

living-with

Looking after yourself

It's important to take good care of yourself if you have COPD.

Some of the main things you'll be advised to do are outlined below.

Take your medication

It's important to take any prescribed medication, including inhalers, as this can help prevent bad flare-ups.

It's also a good idea to read the information leaflet that comes with your medication about possible interactions with other medicines or supplements.

Check with your care team if you plan to take any over-the-counter remedies, such as painkillers or nutritional supplements. These can sometimes interfere with your medication.

Also speak to your care team if you have any concerns about the medication you're taking or you're experiencing any side effects.

Stop smoking

If you smoke, stopping can help slow down or prevent further damage to your lungs.

Help is available from your GP and NHS stop smoking services.

Read advice about stopping smoking.

Exercise regularly

Exercising regularly can help improve your symptoms and quality of life.

The amount of exercise you can do will depend on your individual circumstances. Exercising until you're a little breathless isn't dangerous, but don't push yourself too far.

It's a good idea to speak to your GP for advice before starting a new exercise programme if your symptoms are severe or you haven't exercised in a while.

You may be advised to participate in a pulmonary rehabilitation programme, which will include a structured exercise plan tailored to your needs and ability.

Read about treatments for COPD for more information about pulmonary rehabilitation.

Maintain a healthy weight

Carrying extra weight can make breathlessness worse, so it's a good idea to lose weight through a combination of regular exercise and a healthy diet if you're overweight.

Alternatively, some people with COPD find that they lose weight. Eating food high in protein and taking in enough calories is important to maintain a healthy weight.

You may see a dietitian as part of a pulmonary rehabilitation programme if necessary.

Get vaccinated

COPD can put a significant strain on your body and mean you're more vulnerable to infections.

Everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service.

Check the weather

Cold spells and periods of hot weather and humidity can cause breathing problems if you have COPD.

It's a good idea to keep an eye on the weather forecast and make sure you have enough of your medication to hand in case your symptoms get temporarily worse.

The Met Office has cold weather alerts during the winter, which can warn you about cold spells.

Watch what you breathe

There are certain things that should be avoided if possible to reduce COPD symptoms and the chances of a flare-up, including:

  • dusty places
  • fumes, such as car exhausts
  • smoke
  • air freshener sprays or plug-ins
  • strong-smelling cleaning products (unless there's plenty of ventilation)
  • hairspray
  • perfume

The British Lung Foundation has a leaflet about living with COPD (PDF, 721kb).

Regular reviews and monitoring

You'll have regular contact with your care team to monitor your condition.

These appointments may involve:

  • talking about your symptoms - such as whether they're affecting your normal activities or are getting worse
  • a discussion about your medication - including whether you think you might be experiencing any side effects
  • tests to monitor your health

It's also a good opportunity to ask any questions you have or raise any other issues you'd like to discuss with your care team.

Contact your GP or care team if your symptoms get suddenly worse or you develop new symptoms between your check-ups.

Breathing techniques

There are various breathing techniques that some people find helpful for breathlessness.

These include breathing control, which involves breathing gently using the least effort, with the shoulders supported. This can help when people with COPD feel short of breath.

Breathing techniques for people who are more active include:

  • relaxed, slow, deep breathing
  • breathing through pursed lips, as if whistling
  • breathing out hard when doing an activity that needs a big effort
  • paced breathing, using a rhythm in time with the activity, such as climbing stairs

If you have a chesty cough that produces a lot of phlegm, you may be taught a specific technique to help you clear your airways called the active cycle breathing technique.

The British Lung Foundation has more information about breathing control techniques for COPD.

Talk to others

If you have questions about your condition and treatment, your GP or nurse may be able to reassure you.

You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have information about these.

Some people find it helpful to talk to other people who have COPD, either at a local support group or in an internet chat room.

Want to know more

Relationships and sex

Relationships with friends and family

Having a long-term illness such as COPD can put a strain on any relationship.

Difficulty breathing and coughing can make you feel tired and depressed.

Your spouse, partner or carer may also have a lot of concerns about your health. It's important to talk about your worries together.

Being open about how you feel and what your family and friends can do to help may put them at ease. But don't feel shy about telling them that you need some time to yourself, if that's what you want.

Your sex life

As COPD progresses, the increasing breathlessness can make it difficult to take part in strenuous activities. The breathlessness may occur during sexual activity, which may mean your sex life can suffer.

Talk to your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special.

Your doctor, nurse or physiotherapist may also be able to suggest ways to help manage breathlessness during sex.

Want to know more

Flying with COPD

If you have COPD and are planning to fly, go to your GP for a fitness-to-fly assessment. This involves checking your breathing using spirometry and measuring your oxygen levels.

Before travelling, remember to pack all your medication, such as inhalers, in your hand luggage.

If you're using oxygen therapy, tell your travel operator and airline before you book your holiday, as you may need to get a medical form from your GP.

If you're using long-term oxygen therapy, you'll need to make sure you have an adequate oxygen supply for your flight as well as for your time abroad.

Airlines generally don't allow you to bring oxygen cylinders with you, but may permit portable oxygen concentrator devices.

Want to know more

Money and financial support

People with COPD often have to give up work because their breathlessness stops them doing what they need to do for their job.

If you're unable to work, there are several benefits you may be eligible for:

You may be eligible for other benefits if you have children living at home or if you have a low household income.

Want to know more

End of life care

COPD is a serious condition that can eventually reach a stage where it becomes life threatening.

Talking about this and planning your end of life care, also called palliative care, in advance can be helpful.

It can be difficult to talk about dying with your doctor, and particularly with family and friends, but many people find it helps. Support is also available for your family and friends.

It may be helpful to discuss which symptoms you may have as you become more seriously ill, and the treatments available to reduce these.

As COPD progresses, your doctor should work with you to establish a clear management plan based on your wishes. This will include whether you would prefer to go to hospital or a hospice, or be looked after at home as you become more ill.

You may want to discuss drawing up an advance decision, also called a living will, which sets out your wishes for treatment if you become too ill to be consulted.

This might include whether you want to be resuscitated if you stop breathing, and whether you want artificial ventilation to be continued.

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