Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.

People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction.

Typical symptoms of COPD include:

• increasing breathlessness when active
• a persistent cough with phlegm
• frequent chest infections

Read more about the symptoms of chronic obstructive pulmonary disease

Why does COPD happen?

The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer you've been smoking. This is because smoking irritates and inflames the lungs, which results in scarring.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD.

Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer.

Read more about the causes of chronic obstructive pulmonary disease

Who is affected?

COPD is one of the most common respiratory diseases in the UK. It usually only starts to affect people over the age of 35, although most people are not diagnosed until they are in their 50s.

It is thought there are more than 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. This is because many people who develop symptoms of COPD do not get medical help because they often dismiss their symptoms as a ‘smoker’s cough’.

COPD affects more men than women, although rates in women are increasing.

Diagnosis

It is important that COPD is diagnosed as early as possible so treatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms of COPD.

COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests.

Read more about diagnosing chronic obstructive pulmonary disease

Treating COPD

Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this.

Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier. Pulmonary rehabilitation may also help increase the amount of exercise you are capable of doing.

Surgery is only an option for a small number of people with COPD.

Read more about treating chronic obstructive pulmonary disease

Living with COPD

COPD can affect your life in many ways, but help is available to reduce its impact.

Simple steps such as living in a healthy way, being as active as possible, learning breathing techniques, and taking your medication can help you to reduce the symptoms of COPD.

Financial support and advice about relationships and end of life care is also available for people with COPD.

Read more about living with chronic obstructive pulmonary disease.

Can COPD be prevented?

Although COPD causes about 25,000 deaths a year in the UK, severe COPD can usually be prevented by making changes to your lifestyle.

If you smoke, stopping is the single most effective way to reduce your risk of getting the condition.

Research has shown you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, phone Quit Your Way Scotland on 0800 84 84 84 or read more about stopping smoking.

Also avoid exposure to tobacco smoke as much as possible.

Symptoms of chronic obstructive pulmonary disease (COPD) usually develop over a number of years, so you may not be aware you have the condition.

COPD does not usually become noticeable until after the age of 35 and most people diagnosed with the condition are over 50 years old.

See your GP if you have the following symptoms:

• increasing breathlessness when exercising or moving around
• a persistent cough with phlegm that never seems to go away
• frequent chest infections, particularly in winter
• wheezing

Middle-aged smokers and ex-smokers who have a persistent chesty cough (especially in the morning), breathlessness on slight exertion or persistent coughs and colds in the winter should see their GP or practice nurse for a simple breathing test.

If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe out.

While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage.

Read more about treating COPD.

Flare-ups

Symptoms of COPD are often worse in winter, and it is common to have two or more flare-ups a year. A flare-up (also known as an exacerbation) is when your symptoms are particularly bad. This is one of the most common reasons for people being admitted to hospital in the UK.

If you're experiencing a flare-up that is worse than normal day to day, you should visit your GP or call NHS 24 on 111.

Other signs of COPD

Other signs of COPD can include:

• weight loss
• tiredness and fatigue
• swollen ankles

Chest pain and coughing up blood (haemoptysis) are not common symptoms of COPD. They are usually caused by other conditions such as a chest infection or, less commonly, lung cancer.

There are several things that may increase your risk of developing chronic obstructive pulmonary disease (COPD), many of which can be avoided.

Things you can change

You can reduce your risk of developing COPD by not smoking and avoiding exposure to certain substances at work.

Smoking

Smoking is the main cause of COPD and is thought to be responsible for around 90% of cases. The lining of the airways becomes inflamed and permanently damaged by smoking and this damage cannot be reversed.

Up to 25% of smokers develop COPD.

Passive smoking

Exposure to other people’s smoke increases the risk of COPD.

Fumes and dust

Exposure to certain types of dust and chemicals at work, including grains, isocyanates, cadmium and coal, has been linked to the development of COPD, even in people who do not smoke. 

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

Air pollution

According to some research, air pollution may be an additional risk factor for COPD. However, at the moment it is not conclusive and research is continuing.

Read further information:

• stopping smoking
• treatments to help you stop smoking
• Health and Safety Executive: COPD

Things you cannot change

There are a few factors for COPD that you cannot change.

Having a brother or sister with severe COPD

A research study has shown that smokers who have brothers and sisters with severe COPD are at greater risk of developing the condition than smokers who do not.

Having a genetic tendency to COPD

There is a rare genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. This causes COPD in a small number of people (about 1%). Alpha-1-antitrypsin is a protein that protects your lungs. Without it, the lungs can be damaged by other enzymes that occur naturally in the body.

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

Read further information:

• British Lung Foundation: Alpha-1-antitrypsin
• Alpha1 Awareness UK

Chronic obstructive pulmonary disease (COPD) is usually diagnosed after a consultation with your GP, as well as breathing tests.

If you are concerned about the health of your lungs and have symptoms that could be COPD, see your GP as soon as you can.

Being diagnosed early means you will receive appropriate treatment, advice and help to stop or slow the progression of COPD.

At a consultation, your doctor will ask about your symptoms, how long you have had them, and whether you smoke, or used to smoke. They will examine you and listen to your chest using a stethoscope. You may also be weighed and measured to calculate your body mass index (BMI).

Your doctor will also check how well your lungs are working with a lung function test called spirometery.

Spirometry

To assess how well your lungs work, a breathing test called spirometry is carried out. You will be asked to breathe into a machine called a spirometer.

The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV₁) and the total amount of air you breathe out (called the forced vital capacity or FVC).

You may be asked to breathe out a few times to get a consistent reading.

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

Other tests

You may have other tests as well as spirometry. Often, these other tests will help the doctor rule out other conditions that cause similar symptoms.

Chest X-ray

A chest X-ray will show whether you have another lung condition which may be causing symptoms, such as a chest infection or lung cancer.

Blood test

A blood test will show whether your symptoms could be due to anaemia, as this can also cause breathlessness.

Further tests

Some people may need more tests. The tests may confirm the diagnosis or indicate the severity of your COPD. This will help you and your doctor plan your treatment.

Electrocardiogram (ECG) and echocardiogram

An electrocardiogram (ECG) or echocardiogram may be used to check the condition of your heart.

An ECG involves attaching electrodes (sticky metal patches) to your arms, legs and chest to pick up the electrical signals from your heart.

An echocardiogram uses sound waves to build a detailed picture of your heart. This is similar to an ultrasound scan.

Peak flow test

To confirm you have COPD and not asthma, you may be asked to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out.

Blood oxygen level

The level of oxygen in your blood is measured using a pulse oximeter, which looks like a peg and is attached to the finger. If you have low levels of oxygen, you may need an assessment to see whether extra oxygen would help you.

Blood test for alpha-1-antitrypsin deficiency

If the condition runs in your family or you developed the symptoms of COPD under the age of 35 and have never smoked, you will probably have a blood test to see if you are alpha-1-antitrypsin deficient.

Computerised tomography (CT) scan

Some people may need a CT scan. This provides more information than an X-ray and can be useful in diagnosing other lung diseases or assessing changes to your lungs due to COPD.

Other breathing tests

If your symptoms seem worse than would be expected from your spirometry results, your doctor may decide you need more detailed lung function tests. You may be referred to a hospital specialist for these tests.

Phlegm sample

The doctor may take a sample of phlegm (sputum) to check whether it has been infected.

Stop smoking

Stopping smoking is the most effective way for people with COPD to help themselves feel better and is the only proven way to reduce the rate of decline in lung function.

Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed, but giving up smoking can slow the rate at which the condition worsens.

If COPD is in the early stages and symptoms are mild, no other treatments may be needed. However, it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways.

Research has shown you are up to four times more likely to give up smoking successfully if you use NHS support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this.

Read more about stopping smoking.

Inhalers

If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check you are using it properly.

Most people learn to use an inhaler successfully, but if you are having problems, a spacer or a different type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs.

Short-acting bronchodilator inhalers

Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up.

There are two types of short-acting bronchodilator inhaler:

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

The inhaler should be used when you feel breathless and this should relieve the symptoms.

Long-acting bronchodilator inhalers

If a short-acting bronchodilator inhaler does not help relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours.

There are two types of long-acting bronchodilator inhalers:

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

Steroid inhalers

Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways.

If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler.

Medicines

Theophylline tablets

If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up.

When you have been taking theophylline tablets regularly, you may need to give a blood sample to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects.

Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline.

Mucolytic tablets or capsules

Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups.

Antibiotics and steroid tablets

If you have a chest infection, your GP may prescribe a short course of antibiotics.

Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are uncommon if steroid tablets are given for less than three weeks.

Read more about the medicines used in the chronic obstructive pulmonary disease medicines guide.

Other types of treatment

Nebulised medication

Nebulised medication can be used for severe cases of COPD if other inhaler devices have not worked effectively. A compressor is a machine that administers nebulised medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go.

You can usually choose whether to use nebulised medication with a mouthpiece or a facemask. Your GP will advise you on how to use the machine correctly.

Long-term oxygen therapy

If the oxygen level in your blood is low, you may be advised to have oxygen at home through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is helpful for some patients with persistently low oxygen levels in the blood.

You will probably be referred for more detailed assessment to see whether you might benefit from long-term oxygen therapy.

If you are prescribed long term oxygen therapy, it must be taken for at least 15 hours a day to be effective. However, the longer you use it, the more effective it is.

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

The aim of long-term oxygen therapy is to extend your life.

Do not smoke when you are using oxygen. The increased level of oxygen produced is highly flammable, and a lit cigarette could trigger a fire or explosion.

Ambulatory oxygen therapy

Part of the oxygen assessment is likely to consider if you may benefit from ambulatory oxygen – oxygen used when you walk or are active in other ways.

If your oxygen levels are normal while you are resting, but fall when you exercise, you may not need long-term oxygen therapy alongside ambulatory oxygen therapy.

Read more about home oxygen treatment.

Non-invasive ventilation (NIV)

Non-invasive ventilation (NIV) helps a person breathe using a portable machine connected to a mask covering the nose or face. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see if home NIV could help you. NIV is used to improve the functioning of your lungs.

Pulmonary rehabilitation programmes

Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence.

Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usually involves walking or cycling, and arm and strength-building exercises. It also includes education about your disease for you and your family, dietary assessment and advice, and psychological, social and behavioural changes designed to help you cope better.

A rehabilitation programme is provided by a multidisciplinary team, which includes physiotherapists, respiratory nurse specialists and dietitians.

Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms.

Pulmonary rehabilitation can greatly improve your quality of life.