Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) describes a group of obstructive lung diseases characterized by long-term breathing problems and poor airflow.
Two of these lung conditions are long-term (or chronic) bronchitis and emphysema, which can often occur together.
- Bronchitis means the airways are inflamed and narrowed. People with bronchitis often produce sputum, or phlegm.
- Emphysema affects the tiny air sacs at the end of the airways in your lungs, where oxygen is taken up into your bloodstream. They break down and the lungs become baggy and full of bigger holes which trap air.
COPD is a common condition that mainly affects middle-aged or older adults who smoke and many people do not 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.
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 progressively worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation.
Less common symptoms of COPD include:
- weight loss
- swollen ankles from a build-up of fluid (oedema)
- chest pain and coughing up blood – although these are usually signs of another condition, such as a chest infection or possibly lung cancer
These additional symptoms only tend to happen when COPD reaches an advanced stage.
When to get medical advice
See a GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke.
Find out 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.
COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution. Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD. You’re also more likely to develop COPD if you’re over 35 and are, or have been, a smoker or had chest problems as a child.
Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher.
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 prevent COPD from getting worse.
Some research also suggests that being exposed to other people's cigarette 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
- coal dust
The Health and Safety Executive has more information about occupational causes of COPD.
Exposure to air pollution over a long period can affect how well the lungs work and some research suggests it could increase your risk of COPD. But at the moment the link between air pollution and COPD is not conclusive and research is continuing.
You're more likely to develop COPD if you smoke and have a close relative with the condition, which suggests some people's genes might make them more vulnerable to the condition.
Around 1 in 100 people with COPD has a genetic tendency to develop the condition, 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 – particularly if they smoke.
There are also 2 charities for people affected by alpha-1-antitrypsin deficiency:
The British Lung Foundation has more information about alpha-1-antitrypsin deficiency.
What’s the difference between COPD and asthma?
With COPD, your airways have become narrowed permanently – inhaled medication can help to open them up to some extent. With asthma, the narrowing of your airways comes and goes, often when you’re exposed to a trigger – something that irritates your airways – such as dust, pollen or tobacco smoke. Inhaled medication can open your airways fully, prevent symptoms and relieve symptoms by relaxing your airways.
So, if your breathlessness and other symptoms are much better on some days than others, or if you often wake up in the night feeling wheezy, it may be that you have asthma.
Because the symptoms are similar and because people who have asthma as children can develop COPD in later life, it is sometimes difficult to distinguish the two conditions. Some people have both COPD and asthma.
Your health care professional will ask if you have a cough, if you have a lot of sputum and if your breathlessness is brought on by anything. They’ll also ask how your daily life is affected and other questions about your general health.
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 medicine called a bronchodilator, which helps widen your airways.
The spirometer takes 2 measurements:
- the volume of air you can breathe out in a 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.
A chest X-ray can be used to look for problems in the lungs that can cause similar symptoms to COPD. Problems that can be shown by an X-ray include chest infections and lung cancer, although these do not always show.
A blood test can show other conditions that can cause similar symptoms to COPD, such as a low iron level (anaemia) and a high concentration of red blood cells in your blood (polycythaemia). Sometimes a blood test may also be done to see if you have alpha-1-antitrypsin deficiency.
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 blow air out of your lungs, 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 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
The core care options for COPD is:
- having treatment and support to stop smoking
- having a flu jab every year and a one-off pneumonia vaccination
- an exercise programme called pulmonary rehabilitation if your breathlessness stops you doing things
- having your own self-management plan
- identifying and managing your other health problems, because most people with COPD also have other long-term conditions
- taking medicine or combinations of medications to improve breathlessness and help prevent flare-ups
Further care options for COPD:
- Oxygen therapy
- non-invasive ventilation
- lung volume reduction procedures for emphysema
- a lung transplant
Living with COPD and Managing Flare-Ups
COPD can affect many significant aspects of your life - such as your ability to eat, sleep and exercise. But there are some ways to help reduce its impact. Taking good care of yourself is very important if you have COPD.
Take your medicine
It's important to take any prescribed medicine, 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 medicine 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 medicine. Also speak to your care team if you have any concerns about the medicine you're taking or you're experiencing any side effects.
If you smoke, stopping can help slow down or prevent further damage to your lungs. Help is available from a GP and NHS stop smoking services.
Find about more about how to stop smoking.
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 is not dangerous, but do not push yourself too far.
It's a good idea to speak to a GP for advice before starting a new exercise programme if your symptoms are severe or you have not 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.
Find out more about treatments for COPD, including 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. Some people with COPD find that they unintentionally lose weight. Eating foods that are 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.
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 medicine to hand in case your symptoms get temporarily worse.
The Met Office issues cold weather alerts during 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
- air freshener sprays or plug-ins
- strong-smelling cleaning products (unless there's plenty of ventilation)
The British Lung Foundation has more information about indoor air pollution.
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
- talking about your medicine – 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 checkups.
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 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 do not 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 happen during sexual activity. 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 medicine, 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 away. Airlines generally do not 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:
- if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer
- if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
- if you are caring for someone with COPD, you may be entitled to Carer's Allowance
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 the symptoms you may have as you become more seriously ill, and the treatments available to manage 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 writing 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.
COPD App: myCOPD
MyCOPD helps people with chronic obstructive pulmonary disease to better manage their condition. You can use it to perfect your inhaler technique, improve your breathing, reduce exacerbations, track your medication and more.
The price is currently set at £39.99, however it is free in some areas.
Who is it suitable for?
MyCOPD is suitable for all COPD patients at any stage of their condition.
How does it work?
The app will help you manage your COPD independently and reduce your reliance on GP and hospital appointments. MyCOPD has been shown to correct 98% of inhaler errors without any other clinical intervention, resulting in an improvement in quality of life.
Once logged in, you will have access to a dashboard of self-care tools and educational resources, including:
- inhaler videos
- breathing exercises
- medication diary
- symptom tracker
Clinicians can also use myCOPD to check in with their patients remotely, track their condition, update medication and improve their overall care.
How do I access it?
The mymhealth app is available to download from the App Store, Google Play and the developer's website. You can then purchase a myCOPD licence for a one-off payment of £39.99.
Alternatively, contact your GP, COPD healthcare team or clinical commissioning group (CCG), to find out if myCOPD is available as a free NHS service in your area.
Once downloaded, the app can be accessed on any device that connects to the internet, such as a computer, smartphone or tablet.
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