A Basic Guide to Chronic Obstructive Pulmonary Disease (COPD)
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is a general term that encompasses two conditions, chronic bronchitis and emphysema. There is obstruction to air flow in the airways of the lungs and both are common long-term lung conditions of adults.
Causes & Risks
Tobacco smoking is the main culprit in causing COPD and it damages the lining of airways in the lungs.
Pollution, including occupational exposure to a variety of environmental pollutants, also greatly increases this risk and makes the disease worse.
In rare cases, people who are deficient in alpha-1 antitrypsin (a protein that protects the lung) are at an increased risk of emphysema.
Symptoms
COPD usually causes no or mild symptoms at first. As the disease progresses, symptoms usually worsen. The most common symptoms include:
• Coughing and excessive phlegm (mucus)
• Wheezing (a whistling or squeaking noise as you breathe)
• Shortness of breath with activity and even at rest as disease progresses
• Bluish coloration of skin due to lack of oxygen
• Ankle, feet and leg swelling
• Fatigue
• Dizziness
Diagnosing COPD
Your doctor will diagnose COPD based on the symptoms and signs, medical and family history and test results. You may need one or more of the following investigations to confirm the diagnosis and guide treatment.
• Lung function test that measures airway obstruction. It is required to diagnose COPD and is also useful for monitoring your progress over time to review the effectiveness of treatment. You will be asked to blow forcefully into a machine called a spirometer.
• Radiological investigations including chest X-ray or Computer Tomography (CT) Scan
• Arterial blood gas, a blood test that measure the oxygen level in the blood
Treatment Approach 1. Stop smoking
The single and most important step to take in treating COPD is to stop smoking. While the existing damage to your airways cannot be reversed, you can prevent further progression of the condition if you quit smoking.
2. Medications in the form of inhalers
Inhaler is a device that delivers the medications to your lungs. It is important to use it correctly.
Bronchodilators keep the airways open and possibly, reduce secretions. They are classified into either short or long acting bronchodilators and usually come in the form of inhalers.
Inhaled corticosteroids may be recommended to reduce airway inflammation and prevent exacerbation in severe cases. It may be prescribed in combination with a long acting bronchodilator.
You may be prescribed more than 1 inhaler type to manage your condition.
3. Vaccines
People with COPD are at risk of worsening symptoms as a result of respiratory infections. People with COPD should have pneumococcal vaccinations which help prevent certain types of pneumonia, and annual influenza vaccinations to prevent flu.
4. Oxygen Therapy
People with severe COPD can have low oxygen levels in their blood. They may be placed on oxygen therapy to improve survival and quality of life. Oxygen therapy can be delivered via home oxygen concentrator. Your doctor will assess whether oxygen therapy will be useful for you.
If prescribed, you will need to be on oxygen therapy for at least 15 hours a day for it to be beneficial. Regular use can decrease symptoms and prolong life. Do not smoke when on oxygen therapy.
5. Pulmonary Rehabilitation
Pulmonary rehabilitation is a comprehensive, structured programme that includes education, exercise training, psychosocial support and instruction on breathing technique that can ease symptoms of breathlessness.
Approach our care team to know more about Pulmonary Rehabilitation Program in Yishun Health.
6. Surgery
In rare cases, surgery may benefit some people who have severe symptoms that have not improved from medical therapy.
7. Nutrition
People with severe COPD may have poor appetite as a result of their symptoms (shortness of breath, fatigue). Not eating well can lead to malnutrition which can make symptoms worse. Rest before meals and eat small, frequent meals with nutrient dense food if your body mass index (BMI) is low.
Managing Exacerbations
Even with continued treatment, you may experience occasions when symptoms become worse for days or weeks. This is called an acute exacerbation which requires prompt treatment. Exacerbations may be caused by air pollution, respiratory infection or other triggers of inflammation.
Symptoms include increased coughing, change in mucus or increased breathing difficulties.
8. Planning
Ahead (for advanced COPD)
Planning ahead for end-of- life circumstances is necessary if you have advanced COPD. Discuss endof-life concerns with your doctor and family members.
• Corticosteroid pills (short course) are sometimes prescribed for acute worsening of symptoms
• Antibiotics may be prescribed for acute episodes to treat underlying infections.
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.