( For 'COPD Pathyway' - see further below )

What is COPD?

Chronic Obstructive Pulmonary Disease, shortened to COPD, is an umbrella term for a group of conditions which cause long-term damage to the airways. COPD includes:

  • Chronic bronchitis
  • Emphysema
  • Lung damage which is caused by chronic asthma

COPD causes the airways to narrow so air cannot flow freely in and out of your lungs.

There is no cure for COPD but there are many things that you can do to manage your condition.

 

Typical symptoms of COPD

COPD tends to creep up on you. You may have put up with symptoms for many years before going to your doctor, like when a chest infection won’t go away or gets worse. So when a diagnosis of COPD is made it can sometimes seem sudden.

The 4 main symptoms of COPD are:

  • Coughing
  • Producing sputum (phlegm)
  • Breathlessness
  • Wheezing

You may have noticed other symptoms such as repeated chest infections, weight loss and tiredness. Your doctor will ask about your smoking history as this is often (but not always) the cause of COPD.

 

What tests will be needed?

Your doctor will examine you by looking and listening to your chest. In addition your doctor will check other parts of your body (such as your fingers and ankles) to exclude any other conditions that may be causing your symptoms.

You may need some of the following tests and investigations:

  • Sputum specimens
  • Chest x-ray
  • Heart tests (e.g. ECG, Echocardiogram)
  • Lung function or breathing tests
  • Blood tests
  • CT scan

  

What causes COPD?

In COPD your airways are damaged, usually through constant irritation.

For example:

  • Smoking
  • Working in an occupation that creates dust
  • Unhealthy living conditions and / or poor air quality
  • Chronic asthma
  • Genetic factors

 

What is the treatment for COPD?

The most common way to treat COPD is by using inhalers. Inhalers allow drugs to be delivered directly to your lungs.

You may already be using inhalers.

The three main groups of inhalers used for COPD are:

  • Relievers – these are called bronchodilators, they open up the airways in your lungs to make breathing easier. Relievers act quickly and can be used during an episode of breathlessness. 
  • Long-acting relievers – these are also bronchodilators. These should be used regularly to give longer lasting relief. They do not act as quickly as relievers.
  • Preventers – these contain a bronchodilator and a steroid. The steroid reduces inflammation in your airways. You should use your preventer regularly even if you do not feel unwell.

 

Other drug treatment

You may need steroids and/or antibiotics if you have a flare up.

 

What can I do to help myself?

Know how to take your inhaler correctly.

  • Stop smoking
  • Be physically active
  • Monitor your symptoms and know when to see the doctor
  • Protect yourself from getting ill

  

Are you taking your inhalers correctly?

Having the correct medication is only half of the battle. The other half is making sure you are using the device correctly so that medication gets into your lungs. Ask your nurse or other healthcare professional to check your inhaler technique.

 

Where can I get help to stop smoking?

If you smoke, stopping smoking is the most important thing you can do to help yourself. The damage caused by smoking is irreversible. However, the moment you stop smoking the risks to your health start to go down.

Options to help you stop smoking are:

  • Internet, phone, text, one-to-one or group support
  • Nicotine replacement therapy
  • Other medication to help control cravings
  • Ask your doctor or pharmacy about what support is available in your area and /or contact Smokeline.
  • Smokeline will tell you about your nearest free stop smoking service, can provide access to specialist counsellors, and provide further information.
  • Smokeline 0800 84 84 84: Free helpline 9am–9pm
  • On-line information and support, text phone support and live on-line chat with a Smokeline advisor: canstopsmoking.com

You are four times more likely to quit smoking with professional support and nicotine replacement therapy than on your own.

 

What does ‘being active’ mean?

Some people think that being active is the same as being fit, but it’s not. There are many types of physical activity:

  • Walking,
  • Housework,
  • Gardening,
  • Sport,
  • Play and dance

There are many benefits of being active. It can help your heart, circulation, bones, muscle, your mood and much more. People with COPD can improve their breathing by being active.

 

What is pulmonary rehabilitation?

Pulmonary rehabilitation (PR) is a structured programme of exercise, information and emotional support for people with chronic chest conditions It also allows you to ask questions and get more information about living with COPD.

  • PR can lead to significant improvements in your quality of life and ability to exercise as well as improving symptoms such as breathlessness. 
  • Individual programmes may differ, e.g. what exercises are used, duration of programme, amount of home exercise.
  • Some programmes are run in hospitals but many are based in the community, where it may be easier for you to attend, such as community and leisure centres or church halls.
  • If there is a class in your area ask your GP, nurse, physiotherapist or hospital consultant to refer you.

 

When do I need to see the doctor?

Sometimes in COPD your condition can worsen quite quickly. This is called a flare up or exacerbation.

  • It is important that you report any sudden changes in your symptoms to your doctor or nurse.
  • Early treatment with antibiotics and/or steroids can often prevent you going into hospital. 
  • Ask your healthcare professional how you can help yourself.
  • For example a ‘self-management plan’ and CHSS’s ‘COPD Traffic Lights’ can help you with this.
  • You should also have a review with your doctor at least once a year to discuss how you are managing your COPD.

  

How can I protect myself from getting ill?

  • Ask your GP for yearly flu injection to reduce the risk of infection and avoid a hospital stay/hospital admission.
  • Ask your GP for a pneumonia vaccine. You will only need this once.
  • Learn what triggers your breathlessness such as the weather, air quality or smoky environments.
  • Join the CHSS free Air Quality and Weather Text Service. The Advice Line nurses will send free text alerts when poor air quality or bad weather are likely to affect you.
  • Eat a healthy, balanced diet. A good diet helps you to keep strong, fit and healthy. You will be better at avoiding and fighting infections
  • Keeping your lungs clear to help avoid infections. This can also help you to breath more easily. Ask a physiotherapist to show you how to do this.

 


COPD Pathway

1) PUBLIC AWARENESS

QUALITY ACCESSIBLE INFORMATION, SIGNPOST TO GP, FAMILY, FRIENDS AND CARERS, SCREENING

Raising awareness of COPD is vital if the vast numbers of people who are undiagnosed are to get the help and assistance they need. Patients, their family, friends and carers need access to quality-assured information so that they can make informed choices and for professionals, screening and case-finding needs greater priority. Throughout this pathway there are links like the ones below to information and guidance that may assist you with your journey with COPD.

 

2) SYMPTOM RECOGNITION

The symptoms of COPD vary depending on how severe it is, and how people have adapted to their problems. Symptoms include: 

  • long-term, chesty cough
  • wheeze
  • phlegm
  • breathlessness
  • anxiety and sometimes depression

In mild cases, symptoms like a cough, phlegm and shortness of breath may only be present during the winter or after a cold. In more severe cases, you may be short of breath every day. With more severe COPD, because of breathlessness, normal activities can become more difficult.

 

3) PNEUMONIA & FLU VACCINE 

The flu vaccine is strongly recommended for people of all ages with COPD and especially for older people. This is because you are particularly at risk of getting more serious problems if you catch flu. You can get a free flu vaccine from your GP and it advisable to have it before the flu season starts, usually in November.

Pneumonia is an inflammation of the lungs usually caused by an infection, which can make it harder for the lungs to pass oxygen into the bloodstream. This can be serious for people with COPD. It is therefore important to know about the causes of pneumonia, its symptoms, treatment and prevention.

 

4) DIAGNOSIS

GP, nurses and clinical will assess and discuss / how to diagnosis.

a) SMOKING CESSATION

For patients: everyone knows that smoking isn’t good for you, especially if you have COPD, but we also know how incredibly difficult it is to give up smoking.  Most people who successfully give up smoking have had help and support and the good news is there’s lots of help and support available. Just ask your GP, nurse or your pharmacist.

People with COPD: if you smoke regularly you will be encouraged to stop and offered support to stop smoking.

b) DIAGNOSIS CONFIRMED 

For patients:  if you have symptoms of COPD you should have your diagnosis confirmed by a spirometry test (blowing into a special machine). This is carried out by a health care professional, usually a nurse, who is trained in the use of the machine and understanding the results of the test.

People with COPD: you may have COPD if you have at least one of the symptoms, for example breathlessness, long-lasting cough or often coughing up phlegm. However the diagnosis will need to be confirmed by a trained health care professional using specialist equipment to test how well your lungs work.

c) TIMELY, SENSITIVE

DIAGNOSTIC COMPETENCIES, UNDERSTANDING SEVERITY

As a person living with COPD the sooner you are diagnosed and treatment begins, the less chance of severe damage to your lungs. Therefore it makes sense from your point of view and that of your doctors to try and get a diagnosis as early as possible.

 

5) SIGNPOSTING

Whether you are a patient or carer, if you don’t know who to turn to – professional people like qualified nurses and specialist advisers who can help you with a range of both clinical and social issues.

a) SUPPORT IN THE COMMUNITY

Different organisations do have support groups to support everyone with lung disease and have COPD.  Groups provide mutual support often over tea or coffee as well as information in the form of talks from health care professionals and access to our leaflet library.

b) SELF-HELP OPPORTUNITIES 

Complementary therapies as the name suggests, are treatments which complement or work together with more mainstream therapies. They do not replace mainstream therapies. If you are thinking about using a complementary therapy you should always discuss it with your doctor or nurse first and keep taking your prescribed medication.

c) SIGNPOSTING OUTSIDE THE NHS 

There are a range of organisations outside the NHS that can help you if you are a patient or a professional with a wide variety of problems.  We know health problems are often accompanied by a range of other issues associated with things like housing, employment or family relationship problems.

  

6) ANXIETY AND DEPRESSION

Living with COPD can affect many aspects of your life. As well as physical symptoms it can also affect how you feel and how you cope so it is no surprise that many people feel anxious.

Having COPD can also affect your confidence. Whilst it is normal to feel sad or upset about how your life has been affected by COPD, it is important to try not to let yourself feel trapped by negative feelings because this can make it more difficult to cope with your illness.

 

7) PSYCHOLOGICAL ISSUES

Health care professionals need to recognise that patients with COPD and particularly those with co-morbidities require emotional and psychological support. Any effective COPD respiratory care pathway should allow for patients to be referred to appropriate psychological support services.

 

8) SELF-MANAGEMENT

For patients: it’s important to be able to manage your condition yourself and everyone is different, so your self-management plan needs to be individual to you. You should have the best information and educational materials about your condition available. Of course this needs to be relevant to the symptoms you are trying to manage, the medication you are using and the health and social care services you are accessing.

People with COPD: you should have an up-to-date, individually tailored care plan, which includes information and advice about your condition and how it will be managed, relevant to your stage of the disease.

 

9) KNOW YOUR NORMALS

Patients with COPD are usually best placed to know how they are feeling and when they are beginning to feel unwell. Patients who have previously suffered an exacerbation (or flare-up) are particularly likely to know when the onset of symptoms for a chest infection as a precursor to a flare-up occurs.  This is referred to by some of our patients as ‘knowing your normals’ or more importantly knowing when your ‘normal’ significantly changes.

Talk to your doctor about a prescription of ‘rescue medication’ and how best to use this as part of your self-management plan.

 



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