Frequently asked questions

What is the difference between COPD and asthma?

COPD is similar to asthma, but it is not the same disease. Medicines can usually reverse the affects of asthma, but COPD is progressive disease, and medicines cannot reverse the effects of COPD.

The only way to be sure you have COPD rather than asthma is to have a breathing test called a spirometry test.

What treatments are available for COPD and what are they?

Treatments available for COPD concentrate on slowing the disease progression, controlling the symptoms and reducing complications.

Bronchodilators make breathing easier by opening up the airways to the lungs. They are usually taken with an inhaler or similar device, which delivers the drug directly to the lungs. There are several different categories of bronchodilators:

• Beta-2 agonists work by stimulating muscles of the airways to increase in width. Beta-2 agonists are divided into short-acting beta-2 agonists (salbutamol, fenoterol and terbutaline) and long-acting beta-2 agonists (salmeterol and formoterol). Short-acting drugs are usually taken to relieve symptoms, whereas long-acting drugs are taken to prevent symptoms
• Anticholinergic drugs prevent the airways from contracting. They include the short-acting ipratropium and oxitropium and the long-acting tiotropium
• Methylxanthines are another category of drugs that are bronchodilators. They include aminophylline and theophylline
  
  

Corticosteroids are used to help control inflammation. They are taken tablets or as inhaled corticosteroids. There are many different types of inhaled corticosteroids, including: budesonide, beclomethasone, fluticasone. Tablet steroids include: betamethasone, dexamethasone, methylprednisolone, prednisolone, prednisone, and triamcinolone.

Combination therapies combining corticosteroids and long-acting beta-2 agonists are also available for treatment in COPD.

My inhaler is not relieving my breathlessness. Is there anything else I can do?

You should see your doctor who may be able to change your treatment to something that can help.

If this change has been sudden, you should seek emergency medical care, as you may be having an exacerbation. Ensure you are familiar with the signs of an exacerbation under How do I know I am having an exacerbation?

You should also look at the pages on How to reduce indoor pollution.

Should I expect any side effects from my treatment?

Generally speaking bronchodilators and inhaled corticosteroids do not have severe side-effects, and if you experience any unexpected side-effects from your medication you should see your doctor.

Some inhaled corticosteroids cause a mild hoarseness. Anticholinergic therapies can cause a dry mouth, and some beta-2 agonists can cause a fine tremor.

I have been told I have to take my bronchodilator every day, whether I feel chest tightness or not. Is it right to continue with treatment when I’m not getting any symptoms?

You should always take your medicines as instructed by the doctor.
If you have been told to take your bronchodilator every day, it is because you need ongoing treatment. Your bronchodilator will prevent your airways from tightening, and if you stop taking it, you could be putting yourself at risk of an exacerbation.

How will I know if I am having an exacerbation?

When your COPD is under control, your symptoms will be more or less the same from day to day. When you are having an exacerbation, the symptoms will worsen, and these changes are often extremely rapid.

You may not experience all the symptoms listed below, and you may not experience them all at the same time. You may experience:

• Increased breathlessness
• Wheezing
• Chest tightness
• Confusion
• Increased cough, and excessive mucus when you cough
• A change in the colour of your mucus
• Fever
• Excessive sleepiness (as known as somnolence). This is a sign of a possibly fatal carbon dioxide intoxication
• Blue lips or fingernails
  
  

Exacerbations can be life-threatening, and you are likely to need immediate medical assistance.

If you have been diagnosed with COPD and you experience confusion or excessive sleepiness, you should seek emergency care immediately. These are signs that the levels of carbon dioxide in the blood are dangerously high, and could be fatal. For this reason, you will need help from a carer, friend, relative or neighbour who can stay with you until you receive medical assistance.

Sometimes (but not always) people are unable to move around or exercise as much as they would like in the few days before an exacerbation. You will probably feel generally unwell and very tired.

Will I have to change my diet, or are there any special foods that can help?

You should eat sensible, healthy food that is freshly prepared to ensure that you stay in good health.

Many people with COPD find that breathing becomes more difficult if they eat a heavy meal, so try to eat ‘little and often’ throughout the day. If you are losing weight you should try vitamin fortified high protein drinks. These are available from pharmacies.

Try to cut down on caffeine-containing drinks (tea and coffee) if you are having difficulty sleeping.

How often should I see my GP?

You should see your GP at least every six months.

Additionally, you should see your GP immediately if your medicine stops working as well as it did in the past, or if you have any sudden worsening of your condition.

If you think you are having an exacerbation, and you cannot see your GP immediately, you should seek emergency care.

Are there any over-the-counter medicines that I should avoid?

You should speak to the pharmacist when you are buying over-the-counter medicines. They will be able to tell you whether the medicines that you want to purchase are suitable for you.

You should avoid taking cough medicines on a regular basis, as coughing has an important protective role, and you should also avoid taking any painkillers than contain codeine, which can reduce your ability to breathe deeply and properly.

How do I cough the right way?

Inhale deeply, and hold your breath for two seconds. While keeping your mouth slightly open, cough twice. The first cough will loosen your mucus, the second will move it up the throat.

I’ve been told I should check my mucus when I cough. How do I do this?

You should spit the mucus into a piece of tissue. Healthy mucus should be transparent, perhaps with a slightly creamy tinge. If it is yellow, green or red, this could be a sign of infection, and you should see your doctor.

How will my COPD change over time?

COPD is a progressive disease, which means it gets worse over time. Usually these changes are gradual, but sometimes they happen very quickly, and this is known as an exacerbation.

There are a lot of things you can do to reduce the risks of having an exacerbation, such as avoiding pollution, making sure the air quality in your house is good, and avoiding things that might irritate your lungs such as chemicals or tobacco smoke.

Some of the treatments that are prescribed by the doctor may also reduce your chances of having an exacerbation, as well as reducing your symptoms on a day-to-day basis.

If I get breathless when I’m taking exercise,
is it okay to continue?

Your body will only get fitter if you stretch yourself occasionally. Although you may find it hard at first, in the long term exercise will make you less short of breath.

If you are taking exercise you should feel challenged but not totally out of breath, and as long as you are not having breathing difficulties, it is okay to continue. The best guide on exercise is to stop if your pulse gets more than 20 beats per minute higher than it is at rest.

To take your pulse, place your first and second fingers on the inside of your wrist:

• Count the number of beats in 15 seconds
• Multiply that number by 4
• This is your heart rate in beats per minute

What forms of exercise are okay?

Walking, dancing, stretching exercises are all good forms of exercise. Before you start an exercise programme you should think carefully about whether you are exposing yourself to pollution. For example, if you are going for a walk, make sure it is not by the side of a polluted road, and if you are going dancing, check that the venue will be a non-smoking one.

Do I need to have any tests before I start an exercise programme?

Your doctor will want to do spiroergometry tests before you start an exercise programme. This involves using a specially adapted exercise bicycle, while measurements are taken of how much oxygen is used, how much carbon dioxide is emitted, as well as measurements such as heart rate.

I’ve been told I’m at high risk of a genetic form of COPD. What does this mean?

Most cases of COPD result from the damage caused by smoking, or environmental pollution. However there is a very rare genetic disorder called alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a small protein found in the body, which stops enzymes such as trypsin from doing damage to the body. If you are short of alpha-1 antitrypsin, the trypsin in your body will, over time, do damage to your lungs, and this damage can result in COPD.

Is there anything I can do to reduce my chances of getting COPD?

If you are a smoker, the best thing you can do is to stop smoking. If you are not a smoker, or have already given up, try to avoid smokey places where you may be exposed to tobacco smoke, which can damage your lungs.

Do children get COPD?

Very rarely. COPD in children is only associated with alpha-1 antitrypsin deficiency (see above).