What is COPD?

Chronic obstructive pulmonary disease (COPD) is a long term condition which causes persistent airway obstruction (limitation of airflow into the lungs). ‘COPD’ covers conditions such as emphysema and chronic bronchitis. With emphysema, the air sacs in the lungs are gradually destroyed, making it more difficult to absorb oxygen. With chronic bronchitis, the airways may also become inflamed, narrower and produce more mucus.

How many people are affected?

COPD is common in older age groups. Although often undiagnosed, it affects about one in seven adults aged over 45 years (at least 200,000 New Zealanders).

How COPD affects the lungs

Normal lung	In COPD
Normally the spongy tissue of the lung, which is made up of tiny air sacs, holds small airways open.	In COPD the air sacs are much larger and weaker. As a result small airways tend to collapse.

What causes COPD?

The causes of COPD include:

• smoking (nearly all COPD is smoking-related)
• airborne irritants and pollutants (eg, industrial dusts)
• inherited factors (eg, alpha-1 anti-trypsin deficiency)
• chest infections.

Do I have COPD?

Continuing bouts of the symptoms below are signs you might have COPD. The diagnosis is usually made based on your past and present symptoms. Your doctor may also check your lung function using a spirometer, a device you blow into to measure airflow. This can confirm COPD and can also be used to track your progress over the years. X-rays are not so good at picking up COPD but may be used to rule out other possible causes of breathing problems.

Common symptoms of COPD:

• cough
• becoming short of breath or exhausted when active
• mucus (sputum/phlegm) production
• wheezing
• being susceptible to chest infections.

Managing your COPD: (Stop) Smoking

It is vital to stop smoking; it is the only treatment proven to slow the worsening of COPD. Quitting might also improve how your lungs work.

If you smoke, your doctor or nurse can help you find ways to quit:

• Quit Card – a discount voucher for nicotine replacement patches, gum or lozenges
• Quitline – phone 0800 778 778 for free advice and support
• visit www.quit.org.nz – for free online Quit Coach, support, advice and information.

Managing your COPD: Medicines

The main medicines for COPD are inhalers (‘puffers’). Some people also require antibiotics and oxygen. Correct use of your medicines can help ease your breathing and stabilise your condition (meaning it is less likely to worsen as much in the future).

Inhalers
Bronchodilator inhalers help to relieve wheeze and shortness of breath – they work well in some people with COPD but not in everyone.

• With mild COPD, you may only need a short-acting bronchodilator, as required, before exercise.
• With moderate COPD, you may require one or two regular bronchodilators. These can be combined in one inhaler for convenience.
• With severe COPD, you may need to add a long-acting bronchodilator and possibly a steroid inhaler.

TIP: Rinse your mouth and spit it out after inhaling a steroid.
TIP: A spacer is a plastic container that makes an inhaler easier to use. It helps much more of the drug get to where it is needed. Ask your doctor about a free spacer.
Also see: Puffers and other devices

Regular review
To keep your COPD under the best possible control and to prevent complications, a regular review with your doctor of your medicines and your lung function is recommended.

Antibiotics
Antibiotics may be needed for COPD exacerbations.
TIP: A change in mucus colour may signal a chest infection, and you should contact your doctor.

Oxygen therapy
Long term oxygen therapy is used by some people with more severe COPD (and who do not smoke). It is not used for the usual breathlessness experienced by most.

Managing your COPD: Stay active

Pulmonary rehabilitation is a six-week programme of education and exercise usually run by your local hospital. Ideally, everyone with COPD should attend as it helps to reduce symptoms, increase day-to-day functioning and improve quality of life for those with COPD. Ask your doctor about a programme.

Regular exercise is important. When you exercise your muscles (including your breathing muscles), they learn to do more work with less oxygen, meaning you can do more.
TIP: See your doctor before you start to exercise. A ‘bronchodilator’ inhaler used beforehand can help you breathe easier during exercise.

Choose something you enjoy (eg, walking, swimming) and:

• start with small amounts
• begin at a comfortable pace – keep your breathing under control, so you can still talk if you wish
• take as many rests as you need
• go regularly and increase your time/distance as your fitness improves
• aim for 30 minutes of exercise a day.

Managing your COPD: Breathing control

Correct breathing technique means deep breathing using the diaphragm (a lower chest muscle). Often with COPD, a habit of shallow breathing means only the top of the lungs fill with oxygen, adding to the feelings of breathlessness. By practicing good breathing, it may feel easier. Exercises can be taught by a physiotherapist or practice nurse.
Also see: COPD - Breathing control

Other things that can help

In addition to quitting smoking and the other factors mentioned above, the following measures are also helpful:

• the annual influenza vaccine (flu jab) can halve the risk of severe chest complications
• avoid a cold, damp home
• avoid smoky or polluted situations
• eat a healthy diet and get adequate rest
• avoid contact with people with colds or influenza (the flu)
• consider a MedicAlert bracelet.
  

Dealing with exacerbations

At times, COPD can suddenly get worse (an exacerbation) due to infections, air pollution or unknown reasons. If not managed well, it can result in a hospital stay. The effects can be minimised if you learn to recognise exacerbations, try to prevent them and help yourself get over them.

Signs you might have an exacerbation:

• more breathlessness
• more mucus (thicker and perhaps green/yellow)
• wheezing
• sometimes swollen ankles.

You should ring your doctor or practice nurse if you think your condition is getting worse.

Discuss a Self Management Plan with your doctor so you know what action you need to take if you feel you are getting worse. This should be written down for you to refer to.

For Emergencies

• Keep the phone and important numbers (including that of your GP and support person) handy. Dial 111 for an ambulance if there is an emergency situation.
• If living alone, arrange regular contacts with a friend or neighbour, or develop a support system whereby people can check that you are okay.

Related topics

Also see: COPD and stress and COPD - energy saving tips

Original material provided by everybody. Updated November 2011.