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COPD Risks, Diagnosis, Management

What is COPD?

What is Chronic Bronchitis?

  • Chronic bronchitis is a constant and long-lasting irritation and swelling of the airways.
  • The main symptoms of chronic bronchitis are cough and increased secretions from the lungs such as mucus.

What is emphysema?

  • Emphysema is a condition in which air gets trapped inside the lungs. This makes it harder to breathe in again.
  • The main symptom of emphysema is breathlessness.

Asthma and COPD

Both asthma and COPD are common, and some people have both conditions. However, asthma and COPD:

  • have different causes
  • affect the body differently
  • need different treatments

Your doctor will work out if you have COPD or asthma, or both, by testing your lungs, using a ‘lung function test’, also known as spirometry.

What is Alpha 1 Antitrypsin Deficiency?

Alpha-1 antitrypsin deficiency is a genetic disorder.  People with Alpha-1 antitrypsin deficiency are at greater risk of developing COPD. Alpha-1 antitrypsin (AAT) is a substance normally present in the blood; its role is to protect the lungs from damage.  Over the course of a lifetime, the delicate tissues of the lungs are exposed daily to a variety of inhaled materials, such as pollutants, germs, dust and cigarette smoke.  AAT helps the body fight against the damage caused by these pollutants.  The estimated 1 in 2,500 Australians with a deficiency of AAT have too low a level to protect the lungs from the damaging enzymes produced by the body in reaction to the pollutants.  This puts them at greater risk of developing COPD.

Risks of COPD?

Some of the things that put you at risk for COPD include:

Smoking

COPD most often occurs in people aged 40 and over with a history of smoking. This includes people who currently smoke and people who have quit. Smoking is the most common cause of COPD1.

Environmental Exposure

COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Occupational dust exposure might be responsible for 20 – 30% of COPD. This has long been recognised in underground miners, but recently biological dust has also been identified as a risk factor, particularly in women2. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD.

Genetic Factors

In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants.

Gender Factors

Women may be at greater risk than men of COPD from exposures at work and are more susceptible to COPD due to smaller lungs and airways and more sensitive airways3.

References

  1. David K McKenzie, Michael Abramson, Alan J Crockett, Nicholas Glasgow, Sue Jenkins, Christine McDonald, Richard Wood-Baker, Peter A Frith. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2007. The Australian Lung Foundation.
  2. David K McKenzie, Michael Abramson, Alan J Crockett, Nicholas Glasgow, Sue Jenkins, Christine McDonald, Richard Wood-Baker, Peter A Frith. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2007. The Australian Lung Foundation.
  3. Petty T. The Rising Epidemic of COPD in Women: Why women are more susceptible; how treatment should differ. Women's Health in Primary Care Dec 1999; 2(12)

Symptoms of COPD

Most people who are at risk of getting COPD have never even heard of it and, in many cases, don't even realize that the condition has a name.

People with COPD can suffer from increasing shortness of breath, coughing and an increase in secretions from their lungs such as mucus. COPD is a progressive disease, which means the symptoms are likely to get worse over time.

If you can answer YES to 3 or more of these questions, you may have COPD.

  • Do you cough several times most days?
  • Do you bring up phlegm or mucous most days?
  • Do you get out of breath more easily than others your age?
  • Are you over 40 years old?
  • Are you a smoker or ex-smoker?

It's not normal to be out of breath. If you answered YES to three or more of the above questions, you should speak to your doctor about a lung function (spirometry) test.

Severity of COPD

COPD is usually classified by severity, from mild to moderate to severe.

  • If your symptoms are not affecting you much, it is called mild COPD
  • If your symptoms are getting bad, it is called moderate COPD
  • If your symptoms are very bad, it is called severe COPD

Mild COPD

In mild COPD, your only symptom may be the need to cough up mucus each morning. Some symptoms such as shortness of breath, coughing or coughing up mucus may only occur during winter or after a cold. You may also feel a little more puffed and out of breath than you used to, if you exert yourself or walk quickly.

Moderate COPD

In moderate COPD, you are likely to notice symptoms almost every day. You may:

  • cough more, and cough up mucus
  • often feel very puffed or out of breath if you exert yourself or walk quickly
  • have trouble working or doing chores because you get out of breath
  • take several weeks to recover from a cold or chest infection.

Severe COPD

In severe COPD, you may be short of breath during normal daily activities such as taking a shower or getting the mail from the letterbox. Severe COPD can have a big impact on your life.

You may:

  • find it hard to walk up stairs or across the room without getting very out of breath
  • get tired easily
  • not be able to continue to work or do chores around your home
  • be frustrated with the constant need to clear mucus from your chest
  • cough even more and cough up a lot of mucus
  • get chest infections more often
  • take several weeks to recover from a cold or chest infection

How the lungs work?

To understand what happens to the airways and lungs of people with chronic bronchitis and emphysema it is useful to know how healthy lungs work.

Each time you breathe, air is drawn, via the nose and mouth, into the windpipe or trachea. The windpipe is a tube about 10-12 centimetres long in adults and splits into two smaller tubes that go to the left and right lungs. Each of these tubes is called a bronchus. They divide into smaller and smaller airways, and together they are called bronchi. The air passes down the bronchi in each lung, dividing another 15-25 times into smaller and smaller airways called bronchioles. The smallest airways end in tiny air sacs called alveoli. It is here that the oxygen from the air is absorbed into tiny blood vessels called capillaries which criss cross the walls of the alveoli.

Once it passes into the blood stream, oxygen is carried all around the body, and at the same time a waste product, called carbon dioxide, comes out of the capillaries back into the alveoli ready to be breathed out.

If you could look inside your lungs, you would see a mass of fine tubes and air pockets, all looking rather like a giant sponge.

What happens in emphysema?

In emphysema, the alveoli or airsacs in the lungs are gradually destroyed so people have difficulty absorbing enough oxygen. The bronchi becomes floppy and narrow so that it becomes harder to breathe in and out.

These days, the most common cause of emphysema is cigarette smoking. Industrial pollutants may also cause emphysema.

What happens in chronic bronchitis?

Bronchitis means inflammation of the bronchi. As a result mucus which is normally made in the airways to keep them moist, is produced in excessive amounts. This leads to cough and sputum production. The bronchi may also become narrow and floppy (making them narrower) and therefore it is harder for air to get in and out of the lungs. Breathlessness results.

Most adults have a bout of 'acute' or short-term bronchitis at some time in their lives, lasting a week or two at the most. In chronic bronchitis, however, people produce a lot of mucus, sometimes called phlegm and they cough and are breathless for months or even years.

How do people feel?

In mild forms of these diseases, breathlessness may occur walking up hills or stairs, but in severe cases, breathlessness can occur walking slowly along flat ground. Normally daily activities become more difficult as the disease gets worse.

It is not surprising that people with chronic bronchitis and emphysema may become frustrated, anxious and depressed, making breathing problems worse. People who feel more positively toward life tend to do better.

Adapting to the limitations placed on lifestyle, together with the care and support of family and friends, can do a lot to relieve anxiety and lift depression.

Other problems

People with chronic bronchitis and emphysema are more prone to chest infections and pneumonia and occasionally require admission to hospital for intensive treatment of their disease. During these episodes they may have a low oxygen level in the blood and develop swollen ankles because of inadequacy of the pumping action of the heart.

Diagnosing COPD

The sensitivity of physical examination for detecting mild to moderate COPD is poor.1 Wheezing is not an indicator of severity of disease and is often absent in stable, severe COPD. In more advanced disease, physical features commonly found are hyperinflation of the chest, reduced chest expansion, hyperresonance to percussion, soft breath sounds and a prolonged expiratory phase.

Spirometry is the gold standard for diagnosing, assessing and monitoring COPD.

Reference

1. COPD-X Guidelines www.copdx.org.au

Spirometry

Spriometry is a type of lung function testing. Lung function tests provide an easy way of measuring the function of the lungs without the need to physically examine the lungs themselves. Lung function or breathing tests are important investigations which:

  • Help diagnose suspected lung disease;
  • Help in planning treatments and decide whether treatments should be continued, changed, or are no longer needed.

Spirometry involves taking a full breath in and blowing out as hard and fast as you can. Measurements are made which indicate the speed at which the lungs can be emptied and filled with air. The test is performed whilst seated, and usually takes 10 to 20 minutes. It is sometimes carried out before and after inhaling a reliever drug such as VentolinTM or BricanylTM to measure the effect of these drugs. In this case, your doctor may ask you not to take your usual reliever medication for a few hours prior to the test.

Living with COPD

There is a lot you can do to reduce the effect COPD has on you. If you take steps to control your COPD symptoms, you can help ensure your daily life stays enjoyable and fulfilling.

  • Stop smoking
  • Join pulmonary rehabilitation or exercise regularly
  • Protect against flare-ups (exacerbations)
  • Eat healthily
  • Take your medications as instructed
  • Understand COPD medications

STOP smoking

If you smoke, stopping smoking is the single most important thing you can do. It will improve your lung health and help to slow down worsening of COPD. If you continue smoking, your lungs are likely to get worse far more quickly than if you quit. The sooner you quit smoking the better.

Do not feel guilty about having smoked – just think about how giving up now will improve the rest of your life. If you have given up smoking or are trying to quit, well done! This is a positive step towards improving your health.

Do everything you can to give up smoking for good.

Your immediate and long-term health depends on it.

Finding help to quit

Many people need help to quit smoking. Your doctor or pharmacist can provide help and advice. Nicotine replacement therapy or prescription anti-smoking medications may help you quit.

The National Smoking Quitline provides assistance if you wish to quit smoking .You can contact Quitline by phoning 131 848 or logging on to www.quitnow.info.au

Join a pulmonary rehabilitation class or exercise regularly

Join a COPD exercise and education program, often called pulmonary rehabilitation. This one of the best treatments for COPD. Lung Foundation Australia can help you find the program nearest you. Call 1800 654 301

People with COPD who exercise regularly have better breathing, fewer COPD symptoms and maintain a better quality of life. Ideally the activity that you do should make you a little out of breath. Aim for at least 30 minutes, five times a week. You do not have to do all 30 minutes at once. Check with your doctor whether this amount of activity is recommended for you.

Do not avoid exercise or activity because you fear breathlessness. In the long run, staying inactive actually makes shortness of breath worse.

Protect against flare-ups or exacerbations

Those with COPD may be more likely to get chest infections. To protect yourself against getting an infection that might result in hospitalisation, make sure you have your flu and pneumococcal vaccines regularly.

It is also a good idea to have an Action Plan worked out with your doctor.

Eat healthily

Food group Recommended number of serves per day*
Breads and cereals 4 to 9
Vegetables and legumes 5 or more
Fruit 2 to 3
Milk and dairy products 2 to 3
Meat, poultry, fish, eggs and nuts 1 to 2

* Number of serves depends on age, gender and activity level.

For more information visit www.health.gov.au/internet/healthyactive/publishing.nsf/content/eating

Keeping a healthy weight – not overweight but not underweight either – is good for your overall health. Eating a healthy diet will help you to stay strong and have more energy. Make sure you are eating enough healthy foods each day to get good nutrition.

Take your medication as instructed

It is essential that you take your medication as instructed by your doctor, even when you feel well. Medications always work best when taken as instructed and can help prevent your COPD symptoms from getting worse in the long term. Do not be tempted to decide when and how much medication you will take, as this may result in you not getting the most benefit from your medication.

Learn how your medications work. This will help you to understand why and when you need to take them.

Understanding COPD medications

About COPD medications

Your doctor may have prescribed you medications to help control your COPD. The COPD medications you have been prescribed are tailored to you and your symptoms. Because everyone is different, other people with COPD may have different medications and/or different medication dosages.

Although medications cannot cure COPD, when used as instructed they can go a long way towards reducing your symptoms and preventing flare-ups.

Make sure that you understand the following about each medication that you are prescribed:

  • what the medication is for
  • how the medication works
  • how to take the medication
  • when the best time to take it is
  • how long the dose is effective
  • what the possible side-effects of the medication
  • are and how you can avoid or reduce them
  • whether the medication will cause problems with any other medication you are taking

Types of medication

Because COPD medications need to act on the airways and the lungs, most COPD medication is inhaled (breathed in) using a special inhaler device. That way, medication is delivered directly into the lungs, where it is needed.

There are three main types of inhaler medication:

  • reliever medication – for instant relief of sudden increased breathlessness
  • maintenance medications – for long-term regular use to control your symptoms over the long term and to help prevent flare-ups
  • preventer medication – for long-term regular use to help prevent flare-ups in more severe COPD.

Your doctor may also prescribe you medication that you swallow, sometimes for longer periods of time, sometimes only when you experience a flare-up.

Inhaler Technique

Inhalers

Reliever medication

Reliever inhalers should be used in a situation where you experience a sudden increase in your breathlessness. They are called short-acting bronchodilators (pronounced bronk-oh-dye-lay-tors) and work by relaxing the muscles around the airways. This helps to open up the airways and allows air to flow more easily out of and into the lungs when you breathe – easing your feeling of breathlessness. Relievers often work within minutes of inhalation and their effects last for several hours. Reliever medication includes inhalers such as Ventolin® , Asmol®, Airomir® and Butamol® (salbutamol) and Bricanyl® (terbutaline).

Relievers should be used when you experience a sudden increase in breathlessness. Always make sure you carry a reliever inhaler with you, just in case.

If you are using your reliever more often than prescribed, discuss this with your doctor as it may mean that your COPD is getting worse. Talk to your doctor about using your reliever inhaler before you exercise.

For more detailed information on living with COPD, see Better Living with COPD.  A copy of this publication can be purchased by emailing enquiries@lungfoundation.com.au or by calling 1800 654 301.

Using your Inhaler Device

Using an inhaler is a skill you need to learn. Inhalers are very good at delivering medication to the lungs but they must be used correctly. If you do not know the correct way to use your inhaler, you could be using it incorrectly and not get the full benefit from your medication. Make sure you know how to use your inhalers and that you are comfortable using them, even when you are very breathless.

All inhalers work in different ways. Make sure you read the instructions that come with your inhaler before you use it.

Check your inhaler technique regularly

When you have used your inhalers for a while, you may start taking short cuts or develop bad habits. To make sure that you are always using your inhaler correctly, get your technique checked regularly. Ask a healthcare provider to watch you while you use your inhaler, to make sure your technique is checked thoroughly.

People who can check your inhaler technique include:

  • your GP
  • your practice nurse
  • your pharmacist
  • someone from your pulmonary rehabilitation team such as your physiotherapist.

Make sure you keep your inhalers clean and within their use-by date. Ask your doctor or pharmacist if you are not sure how to clean your inhaler or when to replace it.

Working with your healthcare team

As well as your doctor you may have other healthcare providers or family members or friends who help you look after your health – this is your healthcare team. Among others, your team can include a nurse, pharmacist or physiotherapist. Good communication with everyone in your healthcare team (including your doctor) will help you to look after your health. The information in this section is useful when talking to any healthcare provider.

Why regular visits to your doctor are important

Seeing your doctor and other healthcare providers regularly will help you meet your treatment goals. You should go to your appointments even if you are feeling well, so together you can keep track of your health and progress.

During your regular visits you can talk about:

  • any COPD risk factors you may have been exposed to (for example smoking, dust or fumes)
  • whether your COPD is getting any worse or staying the same
  • your medications
  • flare-ups other health issues that you may have and how they may affect your COPD
  • how COPD is influencing your life
  • what you can do to stay as healthy as possible.

By seeing your doctor and other healthcare providers regularly you are taking control of your COPD and helping to prevent your COPD from getting worse.

Make sure you understand what your doctor tells you

It is easy to get flustered or confused when talking to a doctor, especially if he or she uses words or terms that you are not familiar with. It is important that you understand exactly what they are saying. It is also important that your doctor understands what is important to you.

Making sure that you understand what your doctor is saying will help you to better manage your health.

It is helpful to write down your questions and concerns before your visit to make sure you remember to ask everything you want to. You may find it useful to have a ‘special book’ (for example a diary or calendar) to keep track of your COPD symptoms.

If you do not understand what your doctor tells you, do not be embarrassed to ask them to explain the information again. They know that you have a lot to take in. Ask your doctor to write down important information and the answers to your questions, possibly in your ‘special book’. This way you can read everything after the visit and it may help you discuss things with your family or friends.

Tips when visiting your doctor

  • Make a list of questions and concerns before your visit. List these in order of priority. If you have many questions, make a longer appointment or schedule a second visit.
  • Show your list to your doctor and decide together what you will discuss during this visit.
  • Do not avoid asking questions because you are afraid or embarrassed. Your doctor is there to help you.
  • Bring a friend or family member for support.
  • Do not end the visit if you feel you do not fully understand what your doctor is saying. If something is unclear to you, ask for further explanation.
  • Ask your doctor to write answers down for you to refer to again.
  • Find out the best way to contact your doctor in case you have additional questions, or if you are concerned about symptoms or suspect a flare-up.
  • Let your doctor know if you have concerns over the costs of your COPD treatment or overall health management. They can help you find the best solution.

For further information, see the fact sheet, “Talking with your Doctor about COPD”.

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