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COPD (Chronic Obstructive Pulmonary Disease) is a very common
condition in the UK. It accounts for more time off work than any other
illness. COPD is a general term which includes the conditions Chronic
Bronchitis and Emphysema.
What do the medical words mean?
* Chronic means ongoing and persistent.
* Pulmonary means 'affecting the lungs'.
* Bronchitis means inflammation of the airways of the lungs (the
breathing tubes).
* Emphysema is damage to the smaller airways of the lungs.
Either chronic bronchitis or emphysema can cause a obstruction
(narrowing) of the airways. In many people a degree of both chronic
bronchitis and emphysema are present. This is why the general term
COPD is used to describe airways that are narrowed due to chronic
bronchitis, emphysema or a combination of them both.
What causes COPD?
The lining of the airways becomes inflamed and damaged. Smoking causes
this inflammation and damage in the vast majority of people with COPD.
There is no doubt about this. About 3 in 20 one-pack-per-day and 1 in
4 two-pack-per-day smokers develop COPD if they continue smoking. Air
pollution and polluted work conditions may play a part or make the
disease worse. However, people who have never smoked rarely develop
COPD.
What are the symptoms of COPD?
* Cough - this is often the first symptom to develop. It is usually
productive with phlegm (sputum). It tends to come and go at first
and then gradually becomes more persistent (chronic). The cough is
often thought of as a 'smokers cough' in the early stages of the
disease. It is when the breathlessness begins that people often
become concerned.
* Breathlessness and wheeze - these may only be noticed after
exertion at first. As time goes by breathlessness may develop even
when resting. The decline in the breathing can be very gradual
over a number of years if smoking continues. Eventually it can
become quite serious and distressing in some people.
* Sputum - the damaged airways produce a lot more mucus than normal
which forms sputum. People with COPD often cough up a lot of
sputum each day.
* Chest infections - people with COPD are prone to chest infections.
Wheezing with cough and breathlessness may become worse than usual
when chest infections occur. There is often an increased amount of
sputum (phlegm) which may turn yellow or green.
What is the progression and outlook of COPD?
The symptoms described above usually take years to progress. Symptoms
usually begin in people aged over 40 who have smoked for 20 years or
more. Typically, there is a very gradual decline over several years
from an irritating 'smokers cough' to increasing breathlessness. There
may at first be the occasional chest infection. Chest infections may
then become more frequent as time goes by. If smoking continues, COPD
usually becomes worse over time. Some people eventually become
breathless and wheezy all the time. In some people the narrowed
airways and increased breathlessness reduce the amount of oxygen
passed from the lungs into the bloodstream. This may affect the heart
which needs a good oxygen supply and cause heart failure. About 25,000
people die each year in England and Wales from the end stages of COPD.
For many of these people there are several years of ill health and
poor quality of life before death.
How can the course of the COPD be altered?
Stop smoking - this cannot be stressed enough. Stopping smoking will
not reverse any damage already done to the lungs but it will greatly
help to stop the disease getting worse. If this is done early on in
the disease it will make a huge difference. When the condition first
develops and symptoms are mild, some people deceive themselves (and
others) and say that they have just a 'smokers cough'. If smoking is
stopped at this stage it is unlikely that COPD will progress to a
severe illness. However, it is never too late to stop at any stage of
the disease. Even people with fairly advanced COPD will benefit and
prevent further progression of the disease.
Some people do give up smoking for a while but find their cough
becomes worse. This often happens as the lining of the airways 'come
back to life'. Resist the temptation to restart smoking to ease the
cough. Any increase in cough after stopping smoking usually settles in
a few weeks.
What are the treatments for COPD?
* Inhalers that open the airways (bronchodilators) are often
prescribed. These work by relaxing the muscles in the airways to
try and open up them up as wide as possible. These include beta
agonist inhalers such as salbutamol and terbutaline and
anticholinergic inhalers such as ipratropium or atrovent. Inhalers
work well for some people with COPD. In other people they may not
work so well because of the damaged and thickened airways. Some
people with mild or intermittent symptoms may 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 and a combination of two inhalers may be
beneficial for some people.
* Steroid inhalers are useful for some people in addition to
bronchodilator inhalers. Steroid medication 'dampens down'
inflammation. To see if a steroid inhaler will help, a short
course of steroid tablets may be prescribed. An improvement in
symptoms or in breathing tests after a course of steroid tablets
shows that a steroid inhaler may help. It is people with COPD who
have an 'asthma tendency' who benefit from steroid inhalers most.
* Bronchodilator tablets which contain similar medicines that are in
inhalers are sometimes prescribed. Inhalers are usually better and
they also cause less side effects. However, some people find
inhalers difficult and tablets may be an alternative.
* Steroid tablets are sometimes prescribed for a short course when
very wheezy and breathless (often during a chest infection). They
help by damping down the extra inflammation in the airways caused
by infections.
* Antibiotics - chest infections are more common in people with
COPD. These may be treated with short courses of antibiotics.
* Oxygen - in people with severe symptoms, regular oxygen may help.
What can I do to help?
* Get immunised - a yearly 'flu jab' each autumn protects against
possible chest damage from influenza. Immunisation against
pneumococcus (a germ that can cause serious chest infections) may
also be advised. This is one injection and not needed yearly like
the 'flu jab'.
* Keep fit - people with COPD who exercise regularly tend to improve
their breathing capacity. Any regular exercise is good. A daily
walk is a good start for people not used to exercise.
* Lose weight - if overweight. Carrying extra weight can make
breathlessness worse.
In summary
* For most people, COPD is caused by smoking.
* Many people with mild COPD slowly become worse because they
continue to smoke.
* If smoking is stopped, the progression of COPD can be slowed
drastically. A much better quality of life can be expected for the
coming years than if smoking were to continue.
* The earlier smoking stops, the better. However, it is never too
late to stop to have a beneficial effect on the disease.
* Treatments with inhalers may help with symptoms but no treatment
can reverse the damage to the airways.
* Flare-ups of symptoms and chest infections may be helped by short
courses of steroids and/or antibiotics.
Further help and information
British Lung Foundation, 78 Hatton Garden, London, EC1N 8JR
Tel: 0171 831 5831 Web:
www.lunguk.org/index.htm
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