COPD | Mate ia tuku

Chronic obstructive pulmonary disease (COPD or chronic wheezy lung disease) is a group of diseases affecting your lungs and airways causing you to have problems with breathing.

Symptoms tend to start slowly over a few years, so many people may have COPD but don't yet know they have it. Common symptoms include shortness of breath, wheezing, ongoing cough and coughing up phlegm or mucus.

If you have COPD you’re at risk of getting chest infections and COPD is a common cause of hospital admissions. Māori whānau generally are more affected by COPD itself and by related hospital admissions.

Video: What is COPD? Animated explanation video – Health Sketch

COPD includes 3 main conditions – chronic asthma, emphysema and chronic bronchitis. They affect your lungs in different ways.

Your lungs, airways (bronchial tubes) and air sacs (alveoli) are elastic and stretchy. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

• Emphysema affects your air sacs. Over time, the air sacs are slowly destroyed, which makes it hard to take in as much oxygen when you breathe.
• Chronic bronchitis affects your large and small airways. They become inflamed, narrower and produce more mucus. This makes it harder for you to breathe and can cause air to get trapped in your lungs.
• Asthma means your airways are sensitive and react to certain triggers such as:
  • allergens (substances that cause an allergic reaction)
  • viruses
  • cold or humid weather
  • exercise
  • air pollutants such as cigarette smoke.

Image credit: National Heart, Lung and Blood Institute, US, via Wikimedia Commons

COPD is caused by long-term exposure to chemicals or particles that can irritate and damage your lungs, eg, smoking, certain types of fumes, dust and chemicals at work, or triggers of an allergic asthma reaction.

Smoking

In Aotearoa New Zealand, a lot of COPD is still caused by breathing in tobacco smoke, either directly (by smoking) or indirectly (from second-hand smoke). Second-hand smoke is smoke that has been breathed out by another person smoking.

About 1 in every 4 smokers will develop COPD. This is because harmful chemicals in smoke can damage the lining of your lungs and airways. If you're an ex-smoker, you remain at risk and should watch out for symptoms of breathlessness. Smoking and second-hand smoke exposure during your childhood and teenage years can slow lung growth and development. This can increase your risk of developing COPD as an adult.

Vaping tends to cause less lung irritation than smoking, but it's not safe.  

Fumes and dust at work

Exposure to certain types of dust and chemicals at work or at home may damage your lungs and increase your risk of COPD. Substances that have been linked to COPD include several inhaled dusts and chemicals such as welding fumes, cadmium dust and fumes, grain and flour dust, and silica dust among others. The risk of COPD is even higher if you breathe in dust or fumes in your workplace and you smoke as well. There are other dust-related lung diseases, eg, interstitial lung disease. 

Genetics

A family history and genetic factors are important for the development of COPD. If a close member of your whānau has had a diagnosis of COPD your own risk increases.

About 1 in 100 people with COPD lack a specific gene and this means they have a high risk of developing COPD. This is called alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, your lungs are more vulnerable to damage. People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 40 years of age, particularly if they smoke. Read more about alpha-1-antitrypsin deficiency(external link).

It may be difficult to notice the symptoms of COPD at an early stage as they can be mild and may not occur all the time. The first symptoms of COPD tend to come on slowly, and people often mistake them as signs of ageing, lack of fitness or asthma. You may cough up mucus in the mornings or feel more short of breath than usual. Over time, the cough may get worse and occur throughout the day.

As COPD progresses, you may gradually find it harder to do your normal daily activities (eg, gardening, hanging out the washing or carrying groceries) without feeling short of breath.

Common symptoms of COPD

• Ongoing cough, with or without mucus or phlegm.
• Problems breathing, shortness of breath or breathlessness, at first only when you exert yourself, but over time even when resting.
• Wheezing or chest tightness.
• Increased phlegm or mucus, often thick and white or brownish in colour.
• More chest infections.
• Weight loss.
• Fatigue and tiredness.

If you have COPD and your symptoms become worse suddenly and particularly severe, this is known as a flare-up or exacerbation. Read about COPD flare-ups and how to manage them. 

Your healthcare provider will take a history and should do some tests such as lung function tests (spirometry) and blood tests. Imaging tests such as X-rays may be used to rule out other possible causes of breathing problems. However, a chest X-ray isn't enough to diagnose COPD, spirometry is the most commonly used test to diagnose COPD.

Image credit: Canva

• Spirometry measures the amount of air you are able to breathe in and out of your lungs, as well as how quickly you're able to breathe air out.
• If you have COPD, you will usually take longer to breathe all the air out of your lungs as the airways become narrower.
• Spirometry will determine whether, or by how much, a reliever medication can improve your lung function. The test needs to be done twice – before and after you've inhaled a reliever medication.
• Spirometry is also used to monitor how the condition is progressing, which is useful to help decide what treatment is best for you.
• A spirometry test may be done by your healthcare provider or you may need to be referred to your local hospital.

Read more about spirometry.

There's no cure for COPD, but early diagnosis and treatment can help control your symptoms and prevent further permanent lung damage. There are also many things you can do to help stop your condition from getting worse.

Self-care

Self-care can improve your symptoms and quality of life. This includes daily exercise and dealing with flare-ups early – ideally by using a COPD action plan.

For smokers, quitting smoking is the most important action that's been shown to slow down the loss of lung function. It will lessen your exposure to irritating chemicals and also to carbon monoxide (CO). CO makes your blood less able to carry oxygen to your organs and tissues. Using e-cigarettes is less irritating than smoking but vaping isn't safe. 

Read more about other self-care measures to help ease symptoms of COPD below. 

Video: Hints and tips for managing COPD

Medicines

Medicines can help ease your symptoms so you breathe more easily, they can also prevent flare-ups of COPD and improve your quality of life. The main medicines used to treat COPD are inhalers. Inhalers deliver medicine directly into your lungs. This allows the medicine to start working quickly and where it's needed. There are different types of inhalers, eg, relievers or preventers. Read more about medicines for COPD.

People with COPD can get lung infections more easily and may sometimes need antibiotics. It is also important to be up-to-date with all your vaccinations. 

Severe COPD can cause low oxygen levels. Low oxygen levels over months or years can put a strain on your heart, leading to heart problems. Your healthcare provider may need to refer you to a lung specialist service which may prescribe home oxygen to prevent heart strain. Home oxygen isn't used to relieve shortness of breath as such. Read more about home oxygen therapy. 

Pulmonary rehabilitation

Pulmonary rehabilitation is a programme of exercise and education to help people with lung problems such as COPD. It teaches you what to do each day to keep well and stay on top of things. Pulmonary rehab can help to gradually increase the amount of exercise you can do before you feel out of breath, as well as improving your symptoms, self-confidence, emotional wellbeing and quality of life. It's recommended for all people with COPD. Read more about pulmonary rehabilitation. If you're interested, ask your healthcare provider about referring you. If there isn't a programme near you, on-line programmes are available.

Video: World COPD Day – how pulmonary rehabilitation classes help those with COPD

Surgery or a lung transplant

Very rarely, people with COPD may benefit from surgery to remove part of the damaged lungs or get a lung transplant. This can only be done at Auckland City Hospital and only after pulmonary rehabilitation and a very comprehensive assessment. A referral by your regional lung specialist is required. Middlemore Hospital in Auckland also provides highly specialised bronchoscopic procedures (via a camera tube in your wind pipe). 

Chronic obstructive pulmonary disease (COPD) can affect many aspects of your life. However, learning as much as you can about your condition, and getting the right help and support, can help you manage your condition and get the most out of life with COPD.

Find out how to take care of yourself so you can ease your COPD symptoms.

Quit smoking

The best way to prevent COPD getting worse is to quit smoking. Although damage done to your lungs and airways can't be reversed, giving up smoking can help prevent further damage and improve your breathing now. This may be all the treatment that's needed in the early stages of COPD but everybody, and in particular people with more advanced COPD, can benefit from quitting. Read some tips to quit smoking.

There are medicines available to help you quit smoking, eg, nicotine replacement therapy. There are also smoking cessation support services available to help you quit smoking if you need them. Talk to your healthcare team to find out what's available in your area. 

• Quit card – a discount voucher for nicotine replacement patches, gum or lozenges.
• Quitline – phone 0800 778 778 for free advice and support.
• Visit the Quitline website(external link) for a free online Quit Coach, support, advice and information.

Using e-cigarettes will be less irritating, and therefore less bad than smoking, but vaping is not safe and the goal should be to stop smoking and vaping. If you don't smoke, don't start vaping as it may be bad for your lung health.

Have a COPD action plan

Ask your doctor or nurse to help you fill in a COPD action plan. An action plan is a written document that provides you with instructions and information on how to manage your COPD on a daily basis and also how to recognise and cope with worsening symptoms (flare-ups or exacerbations).

You can develop your COPD action plan with your healthcare provider and make a plan to suit the severity of your COPD and your preferences. At each visit with your healthcare provider you can review the plan and make adjustments as needed. Here are 2 examples of COPD action plans – choose the one that suits you.

COPD action plan(external link)	Blue card regional COPD action plan
(external link)	(external link)
COPD action plans(external link) Asthma and Respiratory Foundation, NZ in English(external link), te reo Māori(external link), Samoan(external link), Tongan(external link) and simplified Chinese(external link).	Blue card regional COPD action plan [PDF, 355 KB] District Health Boards, NZ, 2019

Stay active

Regular exercise is important. When you exercise your muscles, including your breathing muscles, they learn to do more work with less oxygen. Often when people try to exercise and become short of breath, they stop exercising. However, the less active you are, the weaker your muscles become, making you even more short of breath over time – the more active you are the better. It's a matter of learning how to pace yourself and developing the confidence that you'll be okay.

Here are some tips for staying active

It can be distressing and frustrating to have breathing difficulties. Get help or find support when things are tough. Ask your healthcare provider about local support groups for COPD in your area. For more support services, see support services for COPD.

You can read some personal stories from people living with COPD on the New Zealand Asthma Foundation(external link) website.

Video: Ian's story: Living with chronic obstructive pulmonary disease (COPD)

(Lung Foundation Australia, 2017) 

Video: Tony's story – living with COPD

(Bristol Community Health, UK, 2018)

Video: Chronic obstructive pulmonary disease (COPD) – diagnosis

(Better Health Channel, Australia, 2018)