About COPD: diagnosis and treatment
What is COPD?
Diagnosing COPD
Stopping smoking
Medication
Pulmonary rehabilitation
Managing exacerbations - the bad times
Non-invasive ventilation
How health professionals will work together
In 2004 the National Institute for Clinical Excellence (NICE) produced a guideline that made recommendations for the diagnosis and treatment of Chronic Obstructive Pulmonary Disease (COPD).
The guideline is for every Primary Care Trust (PCT) in England and Local Health Board (LHB) in Wales.
This booklet explains the key priorities of the guideline and and provides ways in which people with COPD can ensure they get the best treatment.
If you want to read the full guideline, please call the NHS response line on 0870 1555 455 quoting reference number N0463.
For further information about NICE please use the contact details below:
National Institute for Clinical Excellence
MidCity Place
71 High Holborn
London WC1V 6NA
e: nice@nice.nhs.uk
w: www.nice.org.uk
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COPD - Chronic (meaning long-term) Obstructive Pulmonary Disease - is a general name used to describe certain conditions where people have difficulty breathing because of long-term damage to the lungs. COPD is a name frequently used for a number of different conditions. In the past, these may have been called: chronic obstructive airways disease; chronic obstructive lung disease; and in some cases incorrectly called chronic asthma. Everyone with chronic bronchitis and emphysema has COPD, and many people will have a mixture of both.
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If you are breathless when exercising or moving around, have had a cough for a long time (with or without phlegm), if you wheeze, get chestiness and/or bronchitis, then it may be that you have COPD. You should go to your doctor and get checked out. Your doctor should assess how well you breathe by using a machine called a spirometer (pictured). The results of your spirometer test will be part of the diagnosis.
Your doctor should then tell you the result and record it in your medical records/notes. It is important to know whether you have COPD or asthma; although the symptoms of COPD and asthma may be similar, the treatments may be different. The tests you have will give a clearer picture of your condition and how best to treat it.
Your doctor may also ask you to perform another breathing test to see how quickly you can breathe out. This is called a Peak Flow test.
It is very important that you ask the doctor or nurse any questions that you want to. These may include:
- Have I got COPD or asthma?
- What exactly is COPD?
- How did I get COPD?
- Why are there two lung tests and what do they show
- Will I get better?
- Should I see a specialist?
The guideline says that you should have a proper diagnostic test. Yet many people with COPD will never have had a spirometer test. It is very important that you have one and if you are not offered this test, you should ask for one from your doctor.
It may be that your doctor asks you to go to a centre where all the tests are done, as some surgeries do not have access to the proper equipment. If these services are not available you should contact your local PCT or LHB to find out why your surgery does not have access to a spirometer.
The phone number of your local PCT or LHB is in the phone book. You can also find it on the NHS website. Go to www.nhs.uk and click on ‘local services.’
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Smoking is a major cause of COPD. If you are still smoking then the single most important way in which you can help yourself feel better is to stop. It may well be that you have already stopped smoking. If that’s the case, congratulations!
If you haven’t been able to stop yet then you should, according to the guideline, be offered help in the following ways:
- By having a fully documented history of your smoking taken, so that you can understand why and how you smoke
- By being offered help on a ‘stop smoking’ programme. Your doctor or nurse should talk you through what the programme involves. They should also explain to you why stopping smoking will help you.
You may want to ask your doctor or nurse some of the following questions:
- I’ve tried giving up before, but I couldn’t. How can you help me give up?
- How will stopping smoking help my COPD?
- How effective are the different ‘stop smoking’ programmes?
- Which one would suit me best?
- Will it be easier to stop if I am using some kind of medicinal help, like nicotine chewing gum or patches?
- What if I give up and then start smoking again?
- If I stop smoking, what difference will it make to my condition and how I feel?
If you are not offered help to stop smoking by your doctor or nurse, or if you want advice on how to get help, then you may want to contact your PCT or LHB. They should be able to tell you what services are available in your area and how you can get help.
You can also go here to order the British Lung Foundation ‘Stopping smoking’ booklet free of charge.
Useful contact:
For smokers wishing to give up, call the QUIT helpline. Freephone tel: 0800 00 22 00. Or contact QUIT at: Ground Floor, 211 Old Street, London EC1V 9NR.
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The guideline recommends that if you are breathless you should be given an inhaled medicine called a bronchodilator. These take different forms, as you can see from the table on the opposite page. Everyone with COPD should be given a short-acting bronchodilator inhaler.
The guideline also recommends that people with COPD are given a long-acting bronchodilator inhaler, if needed.
In addition to a long-acting bronchodilator, the guideline also recommends that you are considered for inhaled corticosteroids, if: you have poor lung function; and have had two or more exacerbations/chest infections in a year, which meant you had to take antibiotics or oral steroids. (An exacerbation is a time when your symptoms suddenly get much worse.)
Your doctor should try out different treatments to see which one suits you the best and has fewest side effects. Your doctor will see how well your treatment is working by assessing whether your symptoms are getting better or worse. She/he may also ask you what activities you can do now that you couldn’t before, how well you can exercise and how well your lungs are working.
If your doctor thinks that your treatment is not working, she/he may change it.
| Treatment | How it works |
| Short-acting bronchodilator inhaler. They may also be called relievers. They relieve symptoms of breathlessness. They work quickly and last for 4-6 hours. There are two types: beta-2 agonists and anticholinergics. These can also be given together. | In COPD the tunes carrying air in and out of your lungs can become narrowed. Bronchodilators reduce the narrowing, making it easier to breathe. |
| Long-acting bronchodilator inhaler If you are still having symptoms you may be given a long-acting bronchodilator inhaler. These last for 12 - 24 hours. |
| Corticosteroid inhaler If your COPD is causing problems i.e. poor lung function and you have had antibiotics or steroid tablets more than twice in a 12-month period, you should also be given a corticosteroid inhaler, either on its own or combined with a long acting bronchodilator. | Inhaled corticosteroids act to reduce airway inflammation. |
| Theophylline If you are still having symptoms you may be given another type of bronchodilator called theophyllines. These are taken in tablet form. | Reduces airway narrowing, making it easier to breathe. |
When your doctor gives you your medication, she/he may call it by a different name to those listed in the table above. Medicines can have several names and inhaled medication can also come in different colour inhalers. Always ask if you are unsure.
You may want to ask your doctor or nurse some of the following questions:
- What do my inhalers do?
- What types of inhalers are available to me?
- Why will these help?
- How long will I need to use it for?
- How often will I have to take it?
- How do I use my inhaler properly? (It can be difficult to take in the instructions the first time, so don’t worry about asking for a second or third demonstration.)
- Why do I feel no effect from some of the inhalers, and others make me feel better?
- Why should I use the ones that don’t seem to work?
- What will happen if I use the inhaler more often than I’m told to?
- What happens if I forget to take my inhaler?
- What do I do when my inhaler runs out?
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Oxygen therapy
Oxygen is not one of the key priorities in the NICE guideline. But we are including this information because you may be offered oxygen therapy.
In some cases you may be prescribed oxygen. This may be to cover long periods every day (if you’re not able to breathe in enough oxygen normally), in short bursts for breathlessness, or for short-term use in hospital for people having an exacerbation.
Your doctor will check whether you need extra oxygen if:
- The amount of oxygen in your blood is low
- There is swelling in your limbs
- Your skin has a bluish tinge
- You have high blood pressure in the blood vessels around your lungs
Home oxygen can be prescribed on the NHS in three ways:
- You may be given an oxygen cylinder for treatment with short bursts to help severe breathlessness
- You may be given a fixed supply of oxygen at home, through an oxygen concentrator. This is a machine that increases the amount of oxygen in the air. It runs off mains electricity
- Portable oxygen can be used when you are away from home. It should be prescribed if you are already having oxygen. It should also be considered if your blood oxygen drops when you do an activity.
You may want to ask your doctor or nurse some of the following questions:
- I don’t know how or when to use oxygen - who can help me?
- I feel breathless a lot - why haven’t I been offered oxygen?
- I’ve seen portable oxygen that’s much lighter/smaller than mine - where can I get it?
- Is it dangerous to smoke around someone on oxygen?
- I’m embarrassed by the nose tubes - can I take it some other way?
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Pulmonary rehabilitation is designed to help people with chronic lung problems. A typical pulmonary rehabilitation course includes:
- A physical exercise programme, carefully tailored to each individual
- Advice on lung health and coping with breathlessness
- A friendly, supportive atmosphere
Pulmonary rehabilitation helps to make you as active as possible, enjoy your life and live as independently as you want.
The guideline says that pulmonary rehabilitation should be offered to everyone who considers themselves "functionally disabled by COPD". However, pulmonary rehabilitation is not yet available everywhere, and it will be a challenge to all areas to provide enough places to meet this need.
If you are not offered a course when you feel that you could benefit from one, then you should contact your nearest British Lung Foundation Breathe Easy support group and join with them in pressing for greater access to pulmonary rehabilitation for people with COPD.
You may want to ask your doctor or nurse some of the following questions:
- How do I get in touch with my nearest Breathe Easy group?
- I get breathless going up the stairs! How can I do an exercise class?
- What is pulmonary rehabilitation and will I benefit from it?
- Where can I go to get on a course?
- Why is a course not available for me?
- Who can I complain to that there is no course available for me?
- Can I get transport to the classes?
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When you have COPD there will be bad times when you have extra symptoms, your breathlessness increases and you need more help. Your doctor may call these times exacerbations, or chest infections.
The guideline stresses how important it is to reduce the number of exacerbations, how you should be treated and how you can help prevent them, especially by having appropriate vaccinations, e.g. a flu jab.
It is very important to manage these bad times and your doctor should discuss with you how to do this. She/he may suggest having antibiotics and/or steroid tablets at home.
Most people can be treated at home if they have an exacerbation, but some will need to go into hospital. The decision about whether to go into hospital depends on factors such as: how bad the exacerbation is; the person’s COPD; general health; and how well you would be able to cope at home.
Schemes that support this are called ‘hospital-at-home’ or ‘assisted-discharge’ schemes, and they involve healthcare professionals who have experience in helping people with COPD. Your doctor should look at your individual circumstances, preference, local arrangements and resources when making a decision about what is suitable for you.
You may want to ask your doctor or nurse some of the following questions:
- Why do I get exacerbations and how should I treat them?
- How can I stop getting them?
- How do I know when to increase my bronchodilator medicine and by how much?
- Can I have some antibiotics/oral steroids at home so that I can use them when I need them?
- What vaccinations should I have?
- Will I be able to make the decision or will someone make it for me?
- How can I look after myself best and manage my illness?
- What can I do if my local health service doesn’t offer ‘hospital-at-home’ or ‘assisted-discharge’ schemes?
- When should I call a doctor/ambulance?
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NIV is an emergency treatment that you may receive if you are taken to hospital because of an exacerbation. NIV is a method of helping someone get enough oxygen into their blood. It is not the same as oxygen therapy. NIV involves wearing a mask that covers the nose and is connected to a small machine that pushes oxygen through the mask and into the lungs.
The guideline recommends that NIV is used during exacerbations after other treatments have been tried.
Now that the guideline recommends NIV, this service should be available to everyone with COPD who needs it. If this service is not available to you then you should contact your nearest British Lung Foundation Breathe Easy support group, and join with them in pressing for greater access for people with COPD.
You may want to ask your doctor or nurse some of the following questions:
- What is NIV and how will it help me?
- How is NIV different from oxygen therapy?
- How will I be able to decide whether to have NIV if I am already ill when I need it?
- How long will I be given it?
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The guideline says that all patients should have access to members of a multidisciplinary team. What does this mean? It means that there should be a variety of different people who are available to help look after you if necessary. In addition to your doctor and nurse this team could include a consultant, physiotherapist or occupational therapist.
You may want to ask your doctor or nurse some of the following questions:
- Who are the people in my team?
- What do they do?
- Why do I need them?
- How can I contact them?
- How will they help to look after me?
- Who should I contact first when I want help?
- Do they have meetings about me and if so can I attend?
- Why do my friends have more people in their team caring for them than me?
In this booklet we have covered the key priorities of the NICE guideline. For further information, NICE has produced a version of the guideline which is available from the NICE website, www.nice.org.uk, or from the NHS Response Line, 0870 1555 455 (quote ref. number N0463).
Page last medically reviewed: Oct '06
