COPD | Mate ia tuku

• The 2 main conditions that cause COPD are emphysema and chronic bronchitis.
• The main cause of COPD is ongoing contact with substances that irritate and damage your lungs, most often through smoking.
• Symptoms tend to start slowly over a few years, so many people may have COPD but don't know they have it. Common symptoms include shortness of breath, ongoing cough and coughing up phlegm or mucus.
• People with COPD are at risk of getting chest infections and COPD is a common cause of hospital admissions.
• There's no cure for COPD, but there are things you can do to slow its progress, improve your symptoms and breathe more easily. These include quitting smoking, using your inhaler medicines and being up-to-date with your vaccinations.

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

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The 2 main conditions that cause COPD are 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.

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, or certain types of fumes, dust and chemicals at work.

Smoking

In Aotearoa New Zealand, nearly all COPD is 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.

Fumes and dust at work

Exposure to certain types of dust and chemicals at work may damage your lungs and increase your risk of COPD. Substances that have been linked to COPD include welding fumes, cadmium dust and fumes, grain and flour dust, and silica dust. The risk of COPD is even higher if you breathe in dust or fumes in your workplace and you smoke as well.

Genetics

About 1 in 100 people with COPD has a genetic tendency to develop 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. Read about COPD flare-ups and how to manage them. 

Your doctor will take a history and may do some tests, eg, 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. 

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 are 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 is also used to monitor how the condition is progressing, which is useful to help decide what treatment is best for you.

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 things you can do to help stop your condition from getting worse.

Self-care

Self-care can improve your symptoms and quality of life. For smokers, quitting smoking is the only thing that has been shown to stop COPD from getting worse. Read more about other self-care measures to help ease symptoms of COPD below. 

Video: Hints and tips for managing COPD

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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 type 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 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 doctor or specialist may prescribe home oxygen to prevent heart strain. Home oxygen isn't used to relieve shortness of breath. Read more about home oxygen therapy. 

Pulmonary rehabilitation

Pulmonary rehabilitation is a specialised programme of exercise and education to help people with lung problems such as COPD. It can help to 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 is recommended for all people with COPD. Read more about pulmonary rehabilitation. If you're interested, ask your healthcare provider about referring you. 

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.

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 any damage done to your lungs and airways can't be reversed, giving up smoking can help prevent further damage. This may be all the treatment that's needed in the early stages of COPD, but even 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 www.quit.org.nz(external link) for a free online Quit Coach, support, advice and information.

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 plan(external link) The Asthma and Respiratory Foundation, NZ	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.

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.

The following stories are from participants in the Rangiora Pulmonary Rehabilitation Programme. They describe the benefits of exercise for those living with chronic obstructive pulmonary disease (COPD).

Linda's story – positive benefits from group exercise

Linda was recommended to join the Rangiora Pulmonary Rehabilitation Programme by her doctor. Linda has COPD and emphysema. Before the programme, Linda knew little of her condition.

At the start of the 8-week programme, Linda was a smoker and extremely short of breath. After 1 week she decided to give up smoking. We know how hard this must have been for Linda but after 6 weeks, with the help of patches, Linda is still smokefree. She can taste again and is starting to feel much better. 

Exercise can be daunting. However, Linda and the other participants are really enjoying the time doing their circuit twice a week. 

Linda sums up the 8-week programme: “It was educational and beneficial; I’m really feeling the benefit of the past weeks. In fact, I don’t want the programme to end!”

Linda has made friends within the group, and would recommend this programme to people with the same conditions. See your doctor or practice nurse to be referred to a programme near you. 

Linda is feeling so much better, she is looking forward to continuing with exercise after the group finishes.

Charlotte's story – living with COPD

Tihei mauri ora, tēnā kotou katoa. My name is Charlotte Pooley and I have COPD.

I started smoking cigarettes from a young age, I suppose from peer pressure. I used to enjoy walking around the block (almost running) every day with a cigarette in my mouth.

I began to notice I was coughing a lot while walking and at night time in bed. I would go through a lot of tissues with all the phlegm I was coughing up. I went to the doctor and he told me to give the cigarettes up. I tried a few times with patches.

In 2001, I gave up for about 8 months, but in the back of my mind I had to have that one more puff. So I did. This lasted a further 6 years.

On 1 March 2007, I had 2 cigarettes left. I decided to smoke them and I have never smoked again. It has been over 9 years now since I gave up.

Not long after I gave up I got sick with chest infections and shortness of breath and ended up in hospital. My family were very worried about my health.

During this time I was working for Nurse Maude doing home care. My clients were worried about me because I was always puffing, short of breath and coughing. I decided to give up my job.

In 2011, I got very sick. Walking from my kitchen to my bedroom was a big effort. A nurse came to see me from the hospital to check my CPAP machine and was concerned about me. She rang the hospital and spoke to Dr Paul Tan. He told me on the phone to come into hospital.

I went into the emergency department and I couldn't lie on their bed. After 2 weeks I was discharged home with an oxygen concentrator. This saved my life. I use it every night while I am sleeping.

My GP referred me to the pulmonary rehab programme in my area. I became very friendly with Louise, the pulmonary rehab nurse. I went to pulmonary rehab 4 times altogether. I am now a volunteer for the Pulmonary Rehabilitation Consumer Group, which I really enjoy.

Video: Ian's story: Living with Chronic Obstructive Pulmonary Disease (COPD)

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(Lung Foundation Australia, 2017) 

Video: Tony's story - living with COPD

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(Bristol Community Health, UK, 2018)

Video: Chronic obstructive pulmonary disease (COPD) – diagnosis

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(Better Health Channel, AU, 2018)

Read more stories

Information sourced from Asthma + Respiratory Foundation NZ(external link)