Chronic obstructive pulmonary disease (COPD) is a group of diseases that affect your lungs and airways, causing breathing difficulties. The main cause of COPD is ongoing contact with substances that irritate and damage your lungs, most often through smoking.
Common causes of COPD include tobacco smoking, passive smoking and breathing in chemicals in the workplace or environment.
Symptoms tend to start slowly over a few years, so many people may have COPD but not realise 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 is no cure for COPD, but there are things you can do to improve your symptoms and breathe more easily, such as quitting smoking, using your inhaler medicines and being up to date with your vaccinations.
How does COPD affect your lungs?
There are two main conditions that cause COPD – 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 the air sacs. Over time, the air sacs are slowly destroyed, which makes it hard to absorb enough oxygen when you breathe.
Chronic bronchitis affects the large and small airways. They become inflamed, narrower and produce more mucus. This makes it harder to breathe.
Image credit: 123rf
What causes COPD?
COPD is caused by long-term exposure to substances that can irritate and damage your lungs, such as smoking or certain types of fumes and chemicals at work.
In 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 a person smoking or that comes from the end of a lit tobacco product. About 1 in every 4 or 5 smokers will develop COPD. This is because harmful chemicals in smoke can damage the lining of your lungs and airways. If you are 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 the risk of developing COPD in adulthood.
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. Examples of 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 the workplace and you smoke.
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 35 – particularly if you smoke. Read more about alpha-1-antitrypsin deficiency.
What are the symptoms of COPD?
It is 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 gets worse and occurs throughout the day. As COPD progresses, you may gradually find it harder to do your normal daily activities, such as gardening, hanging out the washing or carrying groceries, without feeling short of breath.
Common symptoms of COPD include the following:
Cough – ongoing cough, with or without mucus or phlegm.
Problems breathing, shortness of breath or breathlessness. At first this happens only when you exert yourself or exercise, but over time breathing becomes difficult, even when you are resting.
Wheezing or chest tightness.
Increased phlegm or mucus production, which is often thick and white or brownish in colour.
Your doctor will take a history to find out whether you are experiencing symptoms of COPD. Then they may do a range of lung function tests (spirometry), imaging tests and blood tests. Imaging tests such as X-rays are not so good at picking up COPD but may be used to rule out other possible causes of breathing problems.
Spirometry is the most commonly used test.
The spirometry test 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.
Usually, when you have COPD, you will 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 suitable for you.
Read more about spirometry (Asthma Foundation, NZ)
How is COPD treated?
There is no cure for COPD. However, 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 getting worse.
If you smoke, 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 it's never too late to stop – even people with more advanced COPD are likely to benefit from quitting. Read some tips to quit smoking.
There are a number of different medications that can help ease your symptoms and help you breathe more easily. The medicines are available mainly as inhalers. Inhalers deliver the medication directly into your lungs as you breathe in. By getting medicine directly to your lungs, smaller doses of medicine are needed and it can start working more quickly. Read more about medicines for COPD.
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 improve your symptoms, self-confidence and emotional wellbeing. Read more about pulmonary rehabilitation.
How can I care for myself with COPD?
There are several self-care steps you can take to improve your symptoms and quality of life. If you have COPD and you smoke, the most important action you can take is to stop smoking. Quitting smoking is the only thing that has been proven to stop COPD from getting worse. Other things you can do to improve your symptoms include:
have a COPD action plan
maintain good nutrition
keep your home warm and dry
get vaccinated with the flu vaccine and pneumococcal vaccine.
It can be distressing and frustrating to have breathing difficulties. You may feel guilty about not being able to do as much as you used to. Get help or find support when things are tough. Ask your GP about local support groups for COPD in your area. For more support services, see support services for COPD.
The following links have more information about COPD. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
There are many different types of COPD medicines. These are used alongside self care measures to help you breath more easily and lessen the chance of a flare or exacerbation (your symptoms suddenly worsening).
Depending on the severity of your COPD symptoms, you may have to take more than one medicine.Most COPD medicines are available as an inhaler (puffer) and some of them may be used with a spacer.
For long-term regular use to control your symptoms and prevent flare-ups. Read more about maintenance inhalers
Flare-up (exacerbation) medication
A flare-up is when your symptoms suddenly get worse. You should act quickly as soon as you realise that your symptoms are getting any worse. Most people with COPD are given a treatment plan to follow if the symptoms get any worse.
Reliever inhalers improve symptoms quickly because they deliver medication directly to your airways, causing the muscles of your airways to relax and open up. They usually start working within minutes and their effect lasts for a few hours.
Examples of quick-relievers (also called rescue inhalers)
Maintenance inhalers relax the muscles of your airways causing them to open up. Most maintenance inhalers take a little longer than relievers to start working but their effects last much longer. This means they are only need to used once or two times a day.
Inhalers with steroids
These inhalers are a combination of a steroid plus a long-acting bronchodilator in a single inhaler. They help to reduce the number of flare-ups by lessening the inflammation that causes swelling and mucus production in the airways. These inhalers are usually prescribed for people with moderate to severe COPD who have had two or more flare-ups over the previous year or for people that have both asthma and COPD.
Examples of long-acting bronchodilator inhalers with steroids
After using inhalers with steroids, is important to rinse your mouth to avoid getting thrush.
Flare-up (exacerbation) medications
A COPD flare-up is when your COPD symptoms become worse and particularly severe. A flare-up might be triggered by an infection or there may be no apparent reason. A flare-up is also called an exacerbation. Read more about what is a COPD flare-up and how to treat it.
Most COPD medication is available as inhalers, which come in different shapes and sizes, such as:
You can decide on the inhaler that suits you best by talking with your doctor or asthma educator. You may want to try a range of devices before choosing the one with which you are most comfortable. To get the most benefit from your inhaler you need to be using the correct technique and take it at the right time. Your doctor, nurse or pharmacist may check your technique with you from time to time. Read more about inhalers and things to consider when choosing an inhaler.
A spacer is a clear plastic tube with a mouthpiece or mask at one end and a hole for your inhaler at the other. A spacer is attached to the end of your inhaler to make it easier to use. It also makes the medication in the inhaler more effective because more of it is able to get into your lungs.
Spacers are good if you have trouble working your inhaler or when you get so breathless that you have trouble breathing in the medication from your inhaler. Talk to your doctor or pharmacist about how to get a free spacer, and make sure they show you how to use it correctly and how to keep it clean. Read more about spacers.
A nebuliser is a machine that turns liquid medicine into a fine mist which you can breathe easily into your lungs. The machine has a mouthpiece or face mask which you use to breathe in the medicine for between 3 and 10 minutes.
Nebulisers may be used to help you take your reliever medication when your COPD is so bad that you can’t use your inhaler as you usually do. Read more about nebulisers.
Many people think oxygen is given to treat shortness of breath. This is not the case. Being short of breath does not mean you are short of oxygen. If your body has low oxygen levels for long periods it can put a strain on your heart and lead to heart problems. Oxygen is given to prevent strain on the heart.
The tubes from the machine that delivers oxygen to your lungs are very long so you can move around your home while connected. Portable oxygen tanks are also available. It is vital not to smoke while you are taking oxygen, because of the high risk of fire.
Your doctor will decide whether you need oxygen. If your doctor thinks that your oxygen levels are low they will arrange for you to have a special blood test. You will need to be seen by a specialist respiratory doctor as well.
Self-care – what you can do to ease your COPD symptoms
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.
If you smoke, it is vital that you quit smoking. This is the only action that has been proven to slow the worsening of COPD. Quitting might also improve how your lungs work. If you smoke, your doctor or nurse can help you find ways to quit:
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 for 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 fit the 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.
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. However, the less active you are, the weaker your muscles become, making you even more short of breath.
Here are some tips for staying active
Choose an activity you enjoy, such as walking or swimming, and:
start with small amounts
begin at a comfortable pace – keep your breathing under control, so you can still talk if you wish
take as many rests as you need
go regularly and increase your time/distance as your fitness improves
aim for 30 minutes of exercise a day.
Before you start a new exercise regime talk to your doctor. They may recommend strategies like using a ‘bronchodilator’ inhaler before you exercise to help you breathe easier during exercise. Read more about home exercises for COPD.
Improve the way you breathe
Correct breathing technique involves using your lower chest muscle (diaphragm) to take slow, deep breaths. Often people with COPD have a habit of shallow breathing. This means only the top of your lungs fill with oxygen, adding to your feelings of breathlessness. Practicing correct breathing technique regularly helps you to breath more deeply and easily. Exercises can be taught by a physiotherapist or practice nurse.Learn breathing control Asthma Foundation, NZ.
Attend pulmonary rehabilitation
Pulmonary rehabilitation is a 4–12 week programme of education and exercise usually run by your local hospital. Ideally, everyone with COPD should attend as it has been shown to improve outcomes for people with COPD.
The programme is run in a group setting where you all learn more about:
Having COPD increases your chances of getting chest infections. To help you lessen this risk, get vaccinated against influenza or the ‘flu’.
Because the flu virus strains change each year, you need to get vaccinated each year to prevent getting sick over the winter. The flu vaccine is free for people with COPD. Read more about the flu vaccine.
Another vaccine that lessens your chance of getting chest infections is the pneumococcal vaccine. It protects you against a bacteria that commonly causes chest infections. Talk to your doctor or nurse about also having this vaccine. Read more about the pneumococcal vaccine.
Correct use of medicines
Medicines are used alongside self care measures to help you breathe more easily and lessen the chance of a flare-up or exacerbation. Using your medicines correctly is an important part of self-care for COPD. Read more about COPD medication and how to use it correctly.
The following stories from participants in the Rangiora Pulmonary Rehabilitation Programme, who 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. Prior to 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.
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.
COPD hospitalisation and mortality rates were lower for men than women in the 45 to 64 year age group, but higher for men in the 65+ age group. COPD rates were highest for Māori, at 3.5 times the non-MPA rate for hospitalisation and 2.2 times the rate for mortality. Pacific peoples’ hospitalisation rates were 2.7 times higher, and mortality was not significantly different from non-MPA. Both measures were lowest for Asian peoples.
There was a strong deprivation gradient, with COPD hospitalisation rates 5.1 times higher in the most deprived NZDep quintile than in the least deprived, and mortality rates 2.3 times higher. The gradient was apparent for all ethnic groups. As in the previous report, the highest DHB rates were for Whanganui and West Coast.
COPD has a major impact on quality of life, particularly as the disease progresses to the severe stage. Quality of life is also affected by poor mobility and social isolation.
Co-morbidities are common with COPD patients having higher risk of also developing heart disease, stroke, lung cancer and pneumonia. Many also develop anxiety and/or depression and patients should be screened for these at least once a year and as needed.
One of the most effective treatments for COPD is encouraging your patients to attend a pulmonary rehabilitation programme. Rates of referral are low in NZ and represent a lost opportunity to improve patient outcomes.
The COPD prescribing tool (BPAC)
Based on the Global strategy for the diagnosis, management and prevention of COPD (GOLD 2016), the COPD prescribing tool provides pharmacological treatment options for patients with COPD based on symptom severity. The tool comprises four patient categories (A, B, C or D), which correspond to the severity of the patient’s symptoms. Read more about the COPD prescribing tool.
COPD & asthma fundamentals "The most up-to-date Asthma & COPD Fundamentals course available in New Zealand. The course aligns the latest research with specific information for the New Zealand context, such as recently funded medications, treating Māori and Pacific peoples, and best practice health literacy. The course aligns with the latest NZ asthma guidelines." It includes 2 half-day workshops covering the key aspects of COPD and asthma pathophysiology, management and practice. Delivered by the Asthma & Respiratory Foundation NZ.
Non-pharmacological-management of COPD – Fiona Horwood Goodfellow Unit, 2017. "Dr Fiona Horwood talks about non-pharmacological management of Chronic Obstructive Pulmonary Disease. Fiona is Clinical Head for General Medicine and a Respiratory Physician at Counties Manukau DHB."