Chronic Obstructive Pulmonary Disease

Our trained respiratory nurses review patients with Chronic Obstructive Pulmonary Disease (COPD) in nurse-led clinics. If you are concerned about your breathing condition please make an appointment to see a respiratory nurse.

COPD is a spectrum of conditions: chronic asthma, chronic bronchitis and emphysema. It is attributed to 30,000 deaths in the United Kingdom every year, with an estimated 3 million people in the UK suffering from the disease.

COPD is characterised by long-standing airflow obstruction. Symptoms are typically breathlessness on exertion, chronic cough, wheeze and regular sputum production. People with COPD often suffer frequent episodes of “bronchitis” or “chest infections”.

Unlike asthma, symptoms do not vary over time, in many cases are progressive, and are not reversible with medication. In the Western world, cigarette smoking is the predominant cause.

A diagnosis of COPD is based on the presence of symptoms and signs and confirmed by a lung function test (spirometry). This investigation is conducted by our own nurses in a respiratory clinic.

CLINICAL FEATURES DIFFERENTIATING COPD AND ASTHMA
	COPD	ASTHMA
SMOKER OR EX-SMOKER	NEARLY ALL	POSSIBLY
SYMPTOMS UNDER AGE 35	RARE	OFTEN
CHRONIC PRODUCTIVE COUGH	COMMON	UNCOMMON
BREATHLESSNESS	PERSISTENT AND PROGRESSIVE	VARIABLE
NIGHT TIME WAKING WITH BREATHLESSNESS AND OR WHEEZE	UNCOMMON	COMMON
SIGNIFICANT DAY TO DAY VARIABILITY OF SYMPTOMS	UNCOMMON	COMMON

MANAGEMENT OF COPD

Smoking cessation
Smoking cessation may reduce the rate of disease progression and improves mortality. Nicotine replacement therapy can improve smoking cessation success.

Influenza and Pneumococcal Vaccination
Pneumococcal vaccination and annual influenza vaccination is recommended.

Exercise
Regular exercise is recommended within limits of breathlessness.
Referral to local pulmonary rehabilitation programme for patients with disability.

Diet
Weight loss if advised if overweight (BMI >25).
Underweight patients (BMI <20) have increased mortality and need referral to a community dietician.

Medication
Intermittent breathlessness can be relieved by a short acting bronchodilator delivered via an inhaler. Persistent breathlessness is treated with long acting bronchodilators given once or twice daily. For patients with more severe disease or those with 2 or more exacerbations in the previous year, an inhaled corticosteroid in combination with a long acting bronchodilator is indicated.

EXACERBATION OF COPD

A sustained worsening of symptoms from usual stable state which is beyond normal day to day variations and acute in onset.

Self Management
In an exacerbation, the earlier treatment is started, the better: Take maximal bronchodilator therapy. Oral steroids are indicated if symptoms persist despite increased bronchodilators. Antibiotics are indicated if sputum goes yellow or green.

ACTION PLAN

FIRST
Check the colour of your sputum:
Cough sputum onto a white tissue. If your sputum colour has changed from clear or pale to a darker shade e.g. yellow or green: Start antibiotics.

THEN Look at the table:

SYMPTOMS	OK	CAUTION	ACTION
BREATHLESSNESS	NORMAL/USUAL	WORSE THAN USUAL	MUCH WORSE THAN USUAL
COUGH	NORMAL/USUAL	MORE THAN USUAL	MUCH MORE THAN USUAL

If all of your symptoms are in Column 1 (OK), continue usual treatment.

If any of your symptoms are in Column 2 (CAUTION), you should:

Increase your RELIEVER TREATMENT; take regular doses up to the maximum allowed. Keep a close eye on your symptoms: if you improve within 2 days resume your usual treatment. If there is NO improvement start PREDNISOLONE.

If any of your symptoms are in Column 3 (ACTION), you should take the maximum allowed dose of reliever treatment and START PREDNISOLONE IMMEDIATELY.

WARNING

At any time if you get:
Severe symptoms: If you have symptoms as shown is Column 3 (ACTION) and you’ve tried medication and you are not getting any better, please contact your doctor/nurse for an urgent appointment.

EMERGENCY
If you have any of the following: Very short of breath, Chest pains, High fever, feeling of agitation, fear, drowsiness or confusion then:
DIAL 999 FOR AN AMBULANCE

More Information:

Stopping Smoking
QUIT: An independent charity offering help with stopping smoking http://www.quit.org.uk
NHS Stop Smoking Helpline: http://www.givingupsmoking.co.uk

Patient information
British Lung Foundation: Registered charity (charity no. 326730) offering help, support and information for patients and carers on all aspects of lung disease http://www.lunguk.org