Chronic obstructive pulmonary disease (COPD)
COPD describes a number of long-term lung conditions that cause breathing difficulties. COPD tends to get progressively worse and is most commonly caused by smoking.
Although the exact prevalence of the disease is not known in Hong Kong, a local study suggested 9% of the elderly above the age of 70 are its victim. From statistics of the Hospital Authority, COPD was the cause of 4% of all urgent hospital admissions in 1997 and contributed 5.8% of all deaths in the same year.
The term COPD has replaced the previously separate conditions of chronic bronchitis and emphysema.
Bronchitis affects the lining of your bronchi - the main airways that lead from your windpipe (trachea) to your lungs. The lining becomes irritated and inflamed if you have chronic bronchitis and produces excess mucus that blocks the airways.
Emphysema affects your alveoli - the tiny air sacs where oxygen passes into the blood. Emphysema damages the structure of the alveoli causing the walls to break down.
The effects of COPD mean less oxygen passes into your blood.
Symptoms of COPD
At first, you may not notice any symptoms of COPD. The condition progresses gradually, starting with either a phlegmy cough or breathlessness. Many people developing COPD dont see their GP at this stage, but the earlier you get treatment the better.
As the disease progresses symptoms can vary but they include:
- chronic cough (often the first symptom)
- a gradual increase in breathlessness with physical exertion
- regularly coughing up phlegm
- weight loss
- waking up at night as a result of breathlessness caused by lying flat
- feeling tired
It is rare to get chest pains or cough up blood if you have COPD - if this happens you may either have a different disease or another disease as well as COPD.
You may find that your symptoms are worse in winter. It is common to have two or more flare-ups a year. This is when your symptoms are particularly severe.
Causes of COPD
The biggest single cause of COPD is smoking. Between 10 and 20 in 100 of all smokers develop COPD.
If you stop smoking, your chances of developing COPD begin to fall. If you already have COPD, stopping smoking can lead to an improvement in your symptoms and mean it progresses more slowly.
You are also more likely to get COPD:
- if your job exposes you to certain dusts or fumes
- from environmental factors, such as air pollution
- from inherited problems - an inherited shortage of a protein called alpha antitrypsin that helps protect your lungs from the effects of smoking may increase your risk, but fewer than one in 100 people with COPD have this
Allergies and asthma have also been suggested to increase your chances of getting COPD, but the evidence is not conclusive.
Diagnosis of COPD
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your GP thinks you have COPD, he or she will ask you about the problems you have had with your chest and how long you have had them. He or she will usually examine your chest with a stethoscope, listening for noises such as wheezing or crackles.
Your GP may also perform a lung test called a spirometry test. You will be asked to blow into a device that measures how much and how fast you can force air out from your lungs. Different lung problems produce different results so this test helps to separate COPD from other chest conditions such as asthma.
Other tests you might have include:
- a blood test to look for anaemia or signs of infection
- a chest X-ray to see if your lungs show signs of COPD, and to exclude other lung diseases
- a CT scan to build up a three-dimensional picture of your lungs to rule out other diseases
- an electrocardiogram (ECG) to measure the electrical impulses from your heart to check if you have heart and/or lung disease
- an echocardiogram to see if your heart is working as it should
- a pulse oximeter to monitor the oxygen concentration in your bloodstream to see if you need oxygen therapy
- an antitrypsin deficiency test - you may need this if your COPD developed when you were 40 or younger or if you dont smoke
Treatment of COPD
There is not a cure or a way to reverse the damage to your lungs but there are things you can do to stop COPD from getting worse. The most important treatment is to stop smoking. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if youve had it for a long time. If you have mild COPD, stopping smoking may get rid of your symptoms completely.
There are other steps you can take to stop COPD getting worse and to ease your symptoms, including:
- keeping up your fluid levels by drinking enough water and using steam or a humidifier to help keep your airways moist - this can help reduce the thickness of mucus and phlegm that are produced
- exercising to keep moving and eating a healthy diet to help your heart and lungs
- having a flu vaccination each year, as COPD makes you particularly vulnerable to the complications of flu, such as pneumonia (bacterial infection of the lungs)
- having a vaccination for the Streptococcus pneumoniae bacterium that causes pneumonia
Ask your GP about pulmonary rehabilitation. These are programmes consisting of exercise, education about COPD, advice on nutrition and psychological support. Pulmonary rehabilitation has been shown to help people with COPD.
There are various medicines that may help to ease your symptoms. Some help to control flare-ups. Discuss with your GP which treatment is best for you.
These treatments, commonly used for asthma, may help to relieve wheezing and breathlessness by relaxing your lungs (bronchodilation) so that air flows into them more easily. They are available as short-acting or long-acting inhalers or as tablets.
Steroid treatments may help if you have more severe COPD. They are usually used if bronchodilators are not effective and are available as inhalers or as tablets.
Steroid tablets may be prescribed as a short course for one or two weeks if you have a bad flare-up. They work best if you take them as soon as possible after the flare-up starts.
Mucolytics break down the phlegm in your lungs, making it easier for you to cough it up. Your GP may prescribe you a mucolytic if you have a chronic, phlegm-producing cough. Mucolytics may also reduce the number of flare-ups you have although more research is needed to prove this.
If your COPD becomes severe, you may develop low blood oxygen levels. Oxygen therapy can help relieve this. You inhale the oxygen through a mask or small tubes (nasal cannulae) that sit beneath your nostrils.
The oxygen is provided in large tanks for home use, or in smaller, portable versions for outside the home. An oxygen concentrator - a machine that uses air to produce a supply of oxygen-rich gas - is an alternative to tanks.
It is particularly important to give up smoking if you have oxygen therapy for COPD because there is a serious fire risk. Oxygen therapy can either be short-term, long-term - where you use it all the time at home - or ambulatory - when its used for exercise or when outdoors.
If you have severe COPD, your GP may recommend surgery to remove diseased areas of your lung. This can help your lungs to function more effectively. However, this is only carried out in certain circumstances - ask your GP for more advice.
Rarely, having a lung transplant may be an option. This is usually only if your life expectancy is under two years.
Prevention of COPD
You have the best chance of preventing COPD if you dont smoke.
If your job exposes you to dusts or fumes, its important to take care at work and use any relevant personal protective equipment, such as face masks, to help prevent you from inhaling any harmful substances.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
1. Should I exercise if I have COPD?
It's important to try to do as much exercise as you can if you have COPD, even if it makes you feel a little out of breath.
If you have COPD, you may feel as if you don't want to do anything that will make you get even more out of breath. Many people with COPD reduce how much activity they do because they worry that getting breathless can be dangerous. However, this isn't true. In fact, reducing the amount of activity you do can make things worse, as this will decrease your fitness and you will become breathless more quickly when you're active.
Taking regular, light exercise and gradually building up the amount you do can help to improve your breathing and make you feel better. It's safe to become a little short of breath, but don't overstrain yourself.
Try to adapt your lifestyle to keep as active as possible. If you're able to walk, try to walk for 20 to 30 minutes, three to four times a week. Try taking short walks, even if it's just around the house or up and down the garden. Don't worry if you get a little breathless, just take a break to get your breath back then start again. If you can't walk, your GP or the physiotherapist can teach you exercises to do at home to help clear mucus. These are likely to involve upper body exercises, such as twisting and arm stretches.
Ask your GP if there are any pulmonary rehabilitation schemes in your area that he or she can refer you to.
It's worth trying to keep as active as possible, as even a small amount of exercise can help if you have severe lung problems.
2. Why is diet important for people with COPD?
It's important to eat a healthy diet and maintain a healthy weight to help your heart and lungs. It's common to lose weight if you have COPD. Being underweight can make you feel weak and make it harder to fight off infections. On the other hand, if you're overweight, this means your heart and lungs have to work harder to supply oxygen to your body, making it harder to breathe.
If you have COPD you're likely to lose weight. There can be a number of reasons for this including:
- using up a lot of the energy you get from food with the increased effort of breathing
- not feeling like eating much if you feel breathless
- absorbing less nutrients than usual from your food
Being underweight can make you feel weak and tired, and put you at greater risk ofchest infections. Therefore, it's more important than ever to maintain a healthy weight if you have COPD. The following tips can help if you're finding it hard to eat enough food.
- Eat little and often so you don't get breathless and to reduce the feeling of bloatedness.
- Choose food that is high in protein such as meat, fish and dairy products, but try not to eat sugary foods and foods that are high in fat.
- If you have lost your appetite, try to vary the types of food you eat or have a high energy drink if you find it hard to eat anything.
- When cooking, make more food than you need and freeze the extra so you have a meal ready for days when you don't feel like cooking.
- Drink plenty of water, unless advised not to by your GP. This will help to keep the lining of your airways moist and the mucus thinner.
If you're very underweight, your GP may give you nutritional supplements to help bring you back up to a healthy weight. Ask your GP for advice if you're unsure about your weight.
If you're overweight, try to eat smaller portions and increase the amount of exercise you do. It may not be good for you to lose weight too quickly so ask your GP or dietitian for advice.
3. Is there anything I can do to help when I feel breathless?
Yes. There are various breathing techniques that can help you to cope if you get short of breath suddenly.
If you get short of breath, the key thing is to try to relax and keep calm. Find a comfortable, supported position where you can relax your shoulders, arms and hands. This may mean sitting down, or finding something you can lean against and that will support you, such as a chair, wall or windowsill.
Focus on breathing in gently through your nose and out through your nose or mouth. If you find you get out of breath when you're more active, try the following techniques.
- Focus on taking deep, slow breaths - in through your nose and out through your mouth.
- Purse your lips (as if you're whistling) - this slows your breathing down and helps to make your breathing more efficient.
- Breathe out whenever you do something that takes a lot of effort, such as going up a stair or step, bending down, standing up or reaching for something.
- Adjust your breathing so it's in time with whatever activity you're doing (for example, going up the stairs or walking). For instance, breathe in when you're on a stair and out as you step up to the next one.
- A physiotherapist can teach you more about breathing control and exercises.
4. What do the results of my spirometry test mean?
Your GP will measure how much air you can blow out in one breath, and also how quickly you blow it out. This will help to find out if you have COPD or any other breathing problems.
The measurements that your GP takes during the spirometry test are called the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC).
- The FEV1 is the amount of air you can blow out in one second.
- The FVC is the total amount of air that you can blow out in one breath.
Your GP will use these measurements to work out the proportion of your total breath that you can blow out in one second. This is the FEV1 divided by FVC (FEV1/FVC).
The three measurements can help your GP to find out whether you have COPD or any other breathing problems. He or she will compare the values you get with those that would be expected for someone of your age, height and sex.
If you have COPD, you won't be able to blow air out as quickly as someone who doesn't have the disease. This means that your:
- FEV1 will be lower than normal (below 80 percent of what would be expected) as you can't blow out as much air in one second
- FEV1/FVC will be low (below 0.7, when the highest number you can have is 1) as you can only breathe out a small proportion of the total amount of air in your lungs in one second
- The smaller your values for FEV1 and FEV1/FVC, the more severe your COPD is likely to be. If you have any questions about your spirometry test results, ask your GP to explain what they mean.