Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. It includes:

• Emphysema - damage to the air sacs in the lungs
• Chronic bronchitis - long-term inflammation of the airways

COPD is a common condition that mainly affects middle-aged or older adults who smoke. Many people don't realise they have it. The breathing problems tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control. Symptoms of COPD The main symptoms of COPD are:

• Increasing breathlessness, particularly when you're active
• A persistent chesty cough with phlegm - some people may dismiss this as just a "smoker's cough"
• Frequent chest infections
• Persistent wheezing

Without treatment, the symptoms usually get slowly worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation. When to get medical advice See your GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke. Don't ignore the symptoms. If they're caused by COPD, it's best to start treatment as soon as possible, before your lungs become significantly damaged. Your GP will ask about your symptoms and whether you smoke or have smoked in the past. They can organise a breathing test to help diagnose COPD and rule out other lung conditions, such as asthma. Causes of COPD COPD occurs when the lungs become inflamed, damaged and narrowed. The main cause is smoking, although the condition can sometimes affect people who have never smoked. The likelihood of developing COPD increases the more you smoke and the longer you've smoked. Some cases of COPD are caused by long-term exposure to harmful fumes or dust, or occur as a result of a rare genetic problem that means the lungs are more vulnerable to damage. Treatments for COPD The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition. Treatments include:

• Stopping smoking - if you have COPD and you smoke, this is the most important thing you can do
• Inhalers and medications - to help make breathing easier
• Pulmonary rehabilitation - a specialised programme of exercise and education
• Surgery or a lung transplant - although this is only an option for a very small number of people

Outlook for COPD The outlook for COPD varies from person to person. The condition can't be cured or reversed, but for many people treatment can help keep it under control so it doesn't severely limit their daily activities. But in some people COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems. Preventing COPD COPD is largely a preventable condition. You can significantly reduce your chances of developing it if you avoid smoking. If you already smoke, stopping can help prevent further damage to your lungs before it starts to cause troublesome symptoms. If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to your GP about the stop smoking medications available. Read more about advice about stopping smoking or find a stop smoking service near you. Symptoms Chronic obstructive pulmonary disease (COPD) makes breathing increasingly more difficult. But it develops slowly over many years and you may not be aware you have it at first. Most people with COPD don't have any noticeable symptoms until they reach their late 40s or 50s. Main symptoms Common symptoms of COPD include:

• Increasing breathlessness - this may just occur when exercising at first, and you may sometimes wake up at night feeling breathless
• A persistent chesty cough with phlegm that never seems to go away
• Frequent chest infections
• Persistent wheezing

The symptoms will usually get gradually worse over time and make daily activities increasingly difficult, although treatment can help slow the progression. Sometimes there may be periods when your symptoms get suddenly worse - known as a flare-up or exacerbation. It's common to have a few flare-ups a year, particularly during the winter. Other symptoms Less common symptoms of COPD include:

• Weight loss
• Tiredness
• Swollen ankles from a build-up of fluid (oedema)
• Chest pain and coughing up blood - although these are usually signs of another condition, such as a chest infection or possibly lung cancer

These additional symptoms only tend to occur when COPD reaches a more advanced stage. When to get medical advice See your GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke. There are several conditions that cause similar symptoms, such as asthma, bronchiectasis, anaemia and heart failure. A simple breathing test can help determine if you have COPD. While there's currently no cure for COPD, the sooner treatment begins, the less chance there is of severe lung damage. Other Causes of COPD Chronic obstructive pulmonary disease (COPD) occurs when the lungs and airways become damaged and inflamed. It's usually associated with long-term exposure to harmful substances such as cigarette smoke. Things that can increase your risk of developing COPD are outlined below. Smoking Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases. The harmful chemicals in smoke can damage the lining of the lungs and airways. Stopping smoking can help stop COPD getting worse. Some research has also suggested that being exposed to other people's smoke (passive smoking) may increase your risk of COPD. Fumes and dust at work Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD. Substances that have been linked to COPD include:

• Cadmium dust and fumes
• Grain and flour dust
• Silica dust
• Welding fumes
• Isocyanates
• Coal dust

The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke. The Health and Safety Executive has more information about occupational causes of COPD. Air pollution Exposure to air pollution over a long period can affect how well the lungs work and some research has suggested it could increase your risk of COPD. But at the moment the link between air pollution and COPD isn't conclusive and research is continuing. Genetics You're more likely to develop COPD if you smoke and have a close relative with the condition, suggesting some people's genes may make them more vulnerable to the condition. Around 1 in 100 people with COPD has a genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, the lungs are more vulnerable to damage. People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 35 - particularly if they smoke. Diagnosis See your GP if you have persistent symptoms of chronic obstructive pulmonary disease (COPD). Your GP may:

• Ask about your symptoms
• Examine your chest and listen to your breathing with a stethoscope
• Ask whether you smoke or used to smoke
• Calculate your body mass index (BMI) using your weight and height
• Ask if you have a family history of lung problems

They may also carry out or arrange for you to have a breathing test called spirometry and some of the other tests described below. Spirometry A test called spirometry can help show how well your lungs are working. You'll be asked to breathe into a machine called a spirometer after inhaling a medication called a bronchodilator, which helps widen your airways. The spirometer takes two measurements: the volume of air you can breathe out in one second, and the total amount of air you breathe out. You may be asked to breathe out a few times to get a consistent reading. The readings are compared with normal results for your age, which can show if your airways are obstructed. Chest X-ray A chest X-ray can be used to look for problems in the lungs that can cause similar symptoms to COPD. Problems that can show up on an X-ray include chest infections and lung cancer, although these don't always show up. Blood tests A blood test can pick up other conditions that can cause similar symptoms to COPD, such as low iron levels (anaemia) and a high concentration of red blood cells in your blood (polycythaemia). Sometimes a blood test may also be carried out to see if you have alpha-1-antitrypsin deficiency. This is a rare genetic problem that increases your risk of COPD. Further tests Sometimes more tests may be needed to confirm the diagnosis or determine the severity of your COPD. This will help you and your doctor plan your treatment. These tests may include:

• An electrocardiogram (ECG) - a test that measures the electrical activity of the heart
• An echocardiogram - an ultrasound scan of the heart
• A peak flow test - a breathing test that measures how fast you can breathe out, which can help rule out asthma
• A blood oxygen test - a peg-like device is attached to your finger to measure the level of oxygen in your blood
• A computerised tomography (CT) scan - a detailed scan that can help identify any problems in your lungs
• A phlegm sample - a sample of your phlegm (sputum) may be tested to check for signs of a chest infection

Treatment Stop smoking If you smoke, stopping is the most effective way to prevent COPD getting worse. Although any damage done to the 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 it's never too late to stop - even people with more advanced COPD are likely to benefit from quitting. If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to your GP about the stop smoking medications available. Inhalers If your COPD is affecting your breathing, you'll usually be given an inhaler. This is a device that delivers medication directly into your lungs as you breathe in. Your doctor or nurse will advise how to use your inhaler correctly and how often to use it. There are several different types of inhaler for COPD. The main types are described below. Short-acting bronchodilator inhalers For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. Bronchodilators are medications that make breathing easier by relaxing and widening your airways. There are two types of short-acting bronchodilator inhaler:

• beta-2 agonist inhalers - such as salbutamol and terbutaline
• antimuscarinic inhalers - such as ipratropium

Short-acting inhalers should be used when you feel breathless, up to a maximum of four times a day. Long-acting bronchodilator inhalers If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended instead. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day. There are two types of long-acting bronchodilator inhaler:

• beta-2 agonist inhalers - such as salmeterol, formoterol and indacaterol
• antimuscarinic inhalers - such as tiotropium, glycopyronium and aclidinium

Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic. Steroid inhalers If you're still getting breathless when taking long-acting inhalers or have frequent flare-ups (exacerbations), your GP may suggest including a steroid inhaler as part of your treatment. Steroid inhalers contain corticosteroid medication, which can help reduce the inflammation in your airways. Steroid inhalers are normally prescribed as part of a combination inhaler that also includes one of the long-acting medications mentioned above. Medication If your symptoms aren't controlled with inhalers, your doctor may recommend taking tablets or capsules as well. The main medications used are described below. Theophylline tablets Theophylline is a tablet that relaxes and opens up the airways. It's usually taken twice a day. You may need to have regular blood tests during treatment to check the level of medication in your blood. This will help your doctor work out the best dose to control your symptoms while reducing the risk of side effects. Possible side effects include: • feeling and being sick • headaches • difficulty sleeping (insomnia) • noticeable pounding, fluttering or irregular heartbeats (palpitations) Sometimes a similar medication called aminophylline is also used. Mucolytic tablets or capsules If you have a persistent chesty cough with lots of thick phlegm, your doctor may recommend taking a mucolytic medication called carbocisteine. Mucolytic medications make the phlegm in your throat thinner and easier to cough up. They're taken as a tablet or capsule, usually three times a day. Steroid tablets If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways. A 7 to 14-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as:

• weight gain
• mood swings
• weakened bones (osteoporosis)

Your doctor may give you a supply of steroid tablets to keep at home and take as soon as you start to experience a bad flare-up. Longer courses of steroid tablets must be prescribed by a COPD specialist. You'll be given the lowest effective dose and monitored closely for side effects. Antibiotics Your doctor may prescribe a short course of antibiotics if you have signs of a chest infection, such as:

• Coughing up yellow or green phlegm
• A high temperature (fever)
• A rapid heartbeat
• Chest pain or tightness
• Feeling confused and disorientated

Sometimes you may be given a course of antibiotics to keep at home and take as soon as you experience symptoms of an infection. Pulmonary rehabilitation Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD. It can help improve how much exercise you're able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing. Pulmonary rehabilitation programmes usually involve two or more group sessions a week for at least six weeks. A typical programme includes:

• Physical exercise training tailored to your needs and ability - such as walking, cycling and strength exercises
• Education about your condition for you and your family
• Dietary advice
• Psychological and emotional support

The programmes are provided by a number of different healthcare professionals, including physiotherapists, nurse specialists and dietitians. Other treatments If you have severe symptoms or experience a particularly bad flare-up, you may sometimes need additional treatment. Nebulised medication Nebulised medication may be used in severe cases of COPD if inhalers haven't worked. This is where a machine is used to turn liquid medication into a fine mist that you breathe in through a mouthpiece or a facemask. It enables a large dose of medicine to be taken in one go. You'll usually be given a nebuliser device to use at home after being shown how to use it. Long-term oxygen therapy If your COPD results in a low level of oxygen in your blood, you may be advised to have oxygen at home through nasal tubes or a mask. This can help stop the level of oxygen in your blood becoming dangerously low, although it's not a treatment for the main symptoms of COPD, such as breathlessness. Take your medication It's important to take any prescribed medication, including inhalers, as this can help prevent bad flare-ups. It's also a good idea to read the information leaflet that comes with your medication about possible interactions with other medicines or supplements. Check with your care team if you plan to take any over-the-counter remedies, such as painkillers or nutritional supplements. These can sometimes interfere with your medication. Also, speak to your care team if you have any concerns about the medication you're taking or you're experiencing any side effects. Stop smoking If you smoke, stopping can help slow down or prevent further damage to your lungs. Help is available from your GP and NHS stop smoking services. Exercise regularly Exercising regularly can help improve your symptoms and quality of life. The amount of exercise you can do will depend on your individual circumstances. Exercising until you're a little breathless isn't dangerous, but don't push yourself too far. It's a good idea to speak to your GP for advice before starting a new exercise programme if your symptoms are severe or you haven't exercised in a while. You may be advised to participate in a pulmonary rehabilitation programme, which will include a structured exercise plan tailored to your needs and ability. Maintain a healthy weight Carrying extra weight can make breathlessness worse, so it's a good idea to lose weight through a combination of regular exercise and a healthy diet if you're overweight. Alternatively, some people with COPD find that they lose weight. Eating food high in protein and taking in enough calories is important to maintain a healthy weight. You may see a dietitian as part of a pulmonary rehabilitation programme if necessary. Get vaccinated COPD can put a significant strain on your body and mean you're more vulnerable to infections. Everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination. You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service. Check the weather Cold spells and periods of hot weather and humidity can cause breathing problems if you have COPD. It's a good idea to keep an eye on the weather forecast and make sure you have enough of your medication to hand in case your symptoms get temporarily worse. The Met Office has cold weather alerts during the winter, which can warn you about cold spells. Watch what you breathe There are certain things that should be avoided if possible to reduce COPD symptoms and the chances of a flare-up, including:

• Dusty places
• Fumes, such as car exhausts
• Smoke
• Air freshener sprays or plug-ins
• Strong-smelling cleaning products (unless there's plenty of ventilation)
• Hairspray
• Perfume

Regular reviews and monitoring You'll have regular contact with your care team to monitor your condition. These appointments may involve:

• Talking about your symptoms - such as whether they're affecting your normal activities or are getting worse
• A discussion about your medication - including whether you think you might be experiencing any side effects
• Tests to monitor your health

It's also a good opportunity to ask any questions you have or raise any other issues you'd like to discuss with your care team. Contact your GP or care team if your symptoms get suddenly worse or you develop new symptoms between your check-ups. Breathing techniques There are various breathing techniques that some people find helpful for breathlessness. These include breathing control, which involves breathing gently using the least effort, with the shoulders supported. This can help when people with COPD feel short of breath. Breathing techniques for people who are more active include:

• Relaxed, slow, deep breathing
• Breathing through pursed lips, as if whistling
• Breathing out hard when doing an activity that needs a big effort
• Paced breathing, using a rhythm in time with the activity, such as climbing stairs

If you have a chesty cough that produces a lot of phlegm, you may be taught a specific technique to help you clear your airways called the active cycle breathing technique. Talk to others If you have questions about your condition and treatment, your GP or nurse may be able to reassure you. You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have information about these. Some people find it helpful to talk to other people who have COPD, either at a local support group or in an internet chat room. Your sex life As COPD progresses, the increasing breathlessness can make it difficult to take part in strenuous activities. The breathlessness may occur during sexual activity, which may mean your sex life can suffer. Talk to your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special. Your doctor, nurse or physiotherapist may also be able to suggest ways to help manage breathlessness during sex. Flying with COPD If you have COPD and are planning to fly, go to your GP for a fitness-to-fly assessment. This involves checking your breathing using spirometry and measuring your oxygen levels. Before travelling, remember to pack all your medication, such as inhalers, in your hand luggage. If you're using oxygen therapy, tell your travel operator and airline before you book your holiday, as you may need to get a medical form from your GP. If you're using long-term oxygen therapy, you'll need to make sure you have an adequate oxygen supply for your flight as well as for your time abroad. Airlines generally don't allow you to bring oxygen cylinders with you, but may permit portable oxygen concentrator devices. End of life care COPD is a serious condition that can eventually reach a stage where it becomes life threatening. Talking about this and planning your end of life care, also called palliative care, in advance can be helpful. It can be difficult to talk about dying with your doctor, and particularly with family and friends, but many people find it helps. Support is also available for your family and friends. It may be helpful to discuss which symptoms you may have as you become more seriously ill, and the treatments available to reduce these. As COPD progresses, your doctor should work with you to establish a clear management plan based on your wishes. This will include whether you would prefer to go to hospital or a hospice, or be looked after at home as you become more ill. You may want to discuss drawing up an advance decision, also called a living will, which sets out your wishes for treatment if you become too ill to be consulted. This might include whether you want to be resuscitated if you stop breathing, and whether you want artificial ventilation to be continued.

What can I expect from asthma treatment? The aim of asthma management is to control of the disease, which means symptoms are well-controlled and have little to no impact on daily life. Complete control is defined as: o No daytime symptoms. o No night-time waking due to asthma. o No need for rescue medication. o No asthma attacks. o No limitations on activity including exercise. o Normal lung function (FEV1 and/or PEF > 80% predicted or best). o Minimal side-effects from medication.

1. If you have asthma you should have a review of your symptoms every year, to see if any adjustments need to be made to your treatment. This can be done through your own surgery or by speaking to one of our doctors [here]. You can take the Asthma Control Test to see how well controlled your symptoms are. [link] 2. Getting your inhaler technique right is very important to ensure the medication reaches the right part of your lungs. Asthma UK has some useful videos to help you check your technique 3. A personalised action plan can help you stay in control of your asthma. Asthma UK has a template which you can talk through with a doctor [click here to book an appointment] 4. If you have asthma you are entitled to a free annual flu vaccination. This is important in protecting you from catching flu which could make your breathing worse 5. It is helpful to understand the things that trigger your asthma or make it worse, such as air pollution, smoke, pollen and other allergens or medications such as beta blockers and NSAIDs (e.g. aspirin/ibuprofen) 6. Stopping smoking is really important if you have asthma. Our doctors can help you with this or see www.smokefree.gov 7. If you are overweight, losing weight can also help with your breathing. 8. If you feel your asthma is getting you down or making you feel anxious, we can help. Talk to one of our doctors or your own GP for further advice.

1. If you have COPD you should have a review of your symptoms every year, to see if any adjustments need to be made to your treatment. This can be done through your own surgery or by speaking to one of our doctors [here]. You can take the COPD assessment test to see how well your symptoms are controlled [link to COPD assessment test] 2. Stopping smoking is really important if you have COPD. Our doctors can help you with this or see www.smokefree.gov 3. If you have COPD you are entitled to a free annual flu vaccination. This is important in protecting you from catching flu which could make your breathing worse or lead to a serious chest infection 4. Getting your inhaler technique right is very important to ensure the medication reaches the right part of your lungs. Asthma UK has some useful videos to help you check your technique 5. A personalised action plan can help you stay in control of your COPD. Asthma UK has a template which you can talk through with a doctor [click here to book an appointment]. It often involves having a ‘rescue pack’ of antibiotics and steroids at home and knowing when to use them to nip a chest infection in the bud 6. If you are overweight, losing weight can also help with your breathing. 7. It is helpful to understand the things that make your COPD worse, such as air pollution, smoke, pollen and other allergens or medications such as beta blockers and NSAIDs (e.g. aspirin/ibuprofen) 8. Evidence shows that people with long-term health conditions such as COPD are more likely to experience low mood, depression and anxiety. If you feel your condition is getting your down, we can help. Book an appointment with a doctor today.