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 What is COPD? ( Chronic Obstructive Pulmonary Disease)
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COPD (Chronic
Obstructive Pulmonary Disease) is a general term which
includes the conditions chronic bronchitis and emphysema.
• Chronic means that it is persistent and long term.
• Bronchitis is inflammation of the bronchi (the airways of the lungs).
• Emphysema is damage to the smaller airways and air sacs (alveoli) of
the lungs.
• Pulmonary means 'affecting the lungs'. |
Chronic bronchitis or emphysema can cause obstruction
(narrowing) of the airways. Chronic bronchitis
and emphysema commonly occur together. The term COPD is used to describe
airways which are
narrowed
due to chronic bronchitis, emphysema, or both.
How Common
is COPD?
COPD is common in the UK. It usually affects
people over the age of 40. A flare-up (exacerbation)
of COPD is one of the commonest
reasons for admission
to hospital.
What causes COPD?
Smoking is the most common cause of COPD.
The lining of the airways become damaged and inflammed with smoking.
Environmental pollution and exposure to polluted conditions through
occupation may play a part, or make the disease worse. However,
people who have
never smoked rarely develop COPD.
Symptoms of COP
• Cough is usually the first symptom to develop. It is productive
with phlegm (sputum). It tends to be sporadic at first, and then
gradually becomes more persistent (chronic). People often think that
their “Smokers Cough” is part and parcel of being a smoker
but when symptoms of breathlessness occur is when concerns usually
begin.
• Breathlessness ('short of breath') and wheeze may occur only when you
exert yourself at first, going up stairs and hills. These symptoms tend to become
gradually worse over the years if you continue to smoke. Difficulty with breathing
may eventually become quite distressing.
• Sputum. The damaged airways make considerably more mucus than normal.
This forms sputum (phlegm). Patients with chronic bronchitis tend to cough up
a lot of sputum each day which normally would be white in
colour.
• Chest infections are more common if you have COPD. Wheezing with cough
and breathlessness may become worse than usual if you have a chest infection.
Sputum usually turns yellow or green during a chest infection. |
What’s the difference between COPD and asthma?
Asthma and COPD cause similar symptoms. However, they are different
diseases.
• In COPD there is permanent damage to
the airways. The narrowed airways are 'fixed',
and so symptoms are chronic (persistent) and tend
not to vary much from one week to the next and
do not vary between different seasons. Treatments
that are taken to 'open up the airways' have a
more limited effect.
• In asthma there is inflammation in the airways which causes muscles in
the airways to constrict. This causes the airways to narrow. The symptoms tend
to be much more variable than with COPD and may vary from one week to the next
and may be worse at different times of year.
• Asthma can be triggered by various stimulants eg- exposure to allergens
such as pollen dust animal dander or may be triggered by exercise/weather conditions
etc Treatment to reduce inflammation and to 'open up the airways' usually works
well. |
A person with asthma who is also a persistent smoker may go on
to develop COPD. Both asthma and COPD are common, and some people
have both conditions.
What tests may be necessary?
Spirometry is often performed to confirm
the diagnosis. This test measures how much air you blow into a machine.
A low value
indicates that you
have narrowed airways. The test may be repeated after
you take an inhaler which 'opens up
the airways'. If there is a significant improvement in
the result after taking the inhaler indicates that asthma is causing
some
or all of the symptoms.
COPD
is likely if there is little or no improvement after
taking the inhaler.
What is the progression and outlook of COPD?
Symptoms usually begin in people aged over 40 who have smoked for 20 years
or more. A 'smokers cough' tends to develop at first. Once symptoms start,
if you continue to smoke, there is usually a gradual decline over several
years to increasing breathlessness. Chest infections tend to become more
frequent as time goes by. A flare-up of symptoms (exacerbation) occurs from
time to time, typically during a chest infection.
As the disease becomes more severe, insufficient oxygen may get
into the lungs through the narrowed airways. A reduced amount of oxygen then
passes into the bloodstream. This can cause heart failure as the heart needs
a good oxygen supply.
At least 25,000 people die each year in the UK alone from severe
COPD. Many of these people have several years of ill health and poor quality
of life before they die. Chronic ill health and death due to COPD is preventable
in most cases (see below).
What can I do to help?
Stop smoking. This is the most important factor that can make
a difference. Especially if you stop smoking at an early stage after developing
the condition.
Any damage already done to your airways cannot be reversed, but
stopping smoking prevents the disease from getting much worse. It is never
too late to stop at any stage of the disease. Even if you have fairly advanced
COPD, you are likely to benefit and prevent further worsening of the condition.
If you have a cough it may seem worse for a while after you have
given up and this is quite hard for people to understand. It will usually
ease within a few weeks.
It is important at this time to resist temptation to want to
smoke to help the cough.
See a practice nurse or doctor if you have difficulty in stopping
smoking. Help is available. For example, stop smoking clinics, nicotine replacement
therapy (nicotine gum patches etc), or a tablet treatment may help you give
up.
How is COPD Treated?
Stop smoking
This is the most important treatment.
Bronchodilator inhalers – Reliever inhalers
An inhaler with a bronchodilator medicine is often prescribed. They work
by relaxing the muscles in the airways to open up them up as wide as possible.
They include:
• beta agonist inhalers. For example, salbutamol and terbutaline
which are short acting relievers lasting approximately 6 hours. There
are also long acting inhalers such as salmeterol and formoterol which
have a 12 hourly action and are taken twice daily.
• anticholinergic inhalers. For example, oxitropium and ipratropium. Again
there are long and short acting ones. Tiotropium is a relatively newly available
long acting inhaler the effect lasting approximately 24 hours.
• Combination Inhalers. There are also inhalers which contain both of the
above inhaler types which can complement each other when taken together as they
work on the airways in different ways.
Inhalers work well for some people, but not so well in others. Some people with
mild or intermittent symptoms only need an inhaler 'as required' for when breathlessness
or wheeze occur. Some people need to use inhalers regularly. The different types
of inhalers work in different ways. A combination of two different inhalers may
help some people. |
Bronchodilator Tablets
These contain medicines that 'open the airways'. Side effects
are quite common and inhalers are usually better. However, some people find
inhalers difficult to use, and tablets are an alternative or may be an add
on treatment if symptoms are not adeqautely controlled.
Steroid Inhalers
Some people with COPD are prescribed a steroid inhaler in addition
to a bronchodilator inhaler. Steroids reduce inflammation of the airways.
There are several different steroids inhalers. People with COPD who also
have some asthma benefit most from a steroid inhaler.
If you do not have any 'asthma tendency', the role of steroid
inhalers is controversial. Some studies suggest that they may help. For example,
one large study showed that there was a slower decline in health, and less
flare-ups of symptoms in people with moderate or severe COPD who took a regular
steroid inhaler.
Steroid Tablets
A short course of steroid tablets is sometimes prescribed if
you have a bad flare-up of wheeze and breathlessness (often during a chest
infection). They help by reducing the extra inflammation in the airways caused
by infections. Taking steroid tablets long term is not advised due to the
serious side effects which can develop.
Mucolytic Medicnes
A mucolytic medicine makes the sputum less thick and easier to
cough up. This may also have a knock-on effect of making it less easy for
bacteria (bugs) to infect the mucus and cause chest infections. The number
of flare-ups of symptoms (exacerbations) tends to be less in people who take
a mucolytic. It needs to be taken regularly, and is most likely to help if
you have moderate or severe COPD and have frequent or bad flare-ups.
Antibiotics
A short course is often prescribed if you have a chest infection.
Oxygen
This may help some people with severe symptoms. It does not help
in all cases. A specialist usually does some breathing tests to assess whether
oxygen will help. If found to help, oxygen needs to be taken for at least
15 hours a day to be of benefit.
Surgery
This is an option in a very small number of cases. For example,
removing a section of lung that has become useless may improve symptoms.
Lung transplantation is being studied, but is not a realistic option in most
cases.
What can be done to help?
• Get immunised. Two immunisations are advised.
FLU JAB yearly 'flu jab' each autumn protects against possible chest damage from
influenza.
PNEUMONIA JAB Immunisation against pneumococcus (a bacteria that can cause serious
chest infections). This is a 'one off' injection and not yearly like the 'flu
jab'.
• Keep fit. Studies have shown that people with COPD who exercise regularly
tend to improve their breathing, ease symptoms, and have a better quality of
life. Any regular exercise is good. A daily walk is a good start if you are not
used to exercise.
• Lose weight if you are overweight. Carrying extra weight can make breathlessness
worse. |
Remember
• COPD is usually caused by smoking.
• Symptoms usually worsen with continued smoking.
• Symptoms are unlikely to get much worse if you stop smoking.
• Treatment with inhalers often eases symptoms, but no treatment can reverse
the damage to the airways.
• A flare-up of symptoms, often during a chest infection, may be helped
by a short course of steroid tablets and/or antibiotics.
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 This information has been generously supplied to BioTrax by the :
Medicines Evaluation Unit
Medical research studies may be conducted and are carefully designed to answer specific medical questions while protecting participants´ safety. Well conducted medical trials are the fastest and safest way to find improved treatments and preventions for diseases. Clinical trials or interventional trials determine whether experimental preventions, treatments, or new ways of using known therapies are safe and effective under controlled conditions. Observational or natural history studies examine health issues and disease development in groups of people or populations. For more information on current medical trials or to register on the BioTrax database, view the study section at www.biotrax.com .
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