COPD and self management

What is chronic obstructive pulmonary disease?

Chronic Obstructive Pulmonary Disease (COPD) is a condition affecting the airways of the lungs. COPD is a general term which includes the conditions chronic bronchitis and emphysema. COPD is the preferred term.

Chronic bronchitis or emphysema can cause obstruction (narrowing) of the airways. Chronic bronchitis and emphysema commonly occur together. The term COPD is used to describe airflow obstruction due to chronic bronchitis, emphysema, or both.

Chronic means persistent.

Bronchitis is inflammation of the bronchi (the airways of the lungs).
Emphysema is damage to the smaller airways and air sacs (alveoli) of the lungs.
Pulmonary means ‘affecting the lungs’.

Symptoms

  • Chronic cough
  • Breathlessness on exertion
  • Regular sputum production
  • Frequent winter ‘bronchitis’
  • Wheeze

Treatments

  • Medications
  • Pulmonary Rehabilitation
  • Self-management

COPD exacerbations (Infection)

An exacerbation (infection) of COPD is a sustained worsening of symptoms from your usual stable state, which is beyond normal day-to-day variations, and is sudden in onset. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production, and change in sputum colour, which requires treatment, often with oral corticosteroids, antibiotics, or both (NICE 2004, 2014).

Manage exacerbations

The frequency of infections can be reduced by

  • Regular use of your inhaled medication and having your vaccinations.
  • Identifying and responding promptly to the symptoms of an infection
  • Starting treatment with oral steroids and/or antibiotics
  • Referring patients for non-invasive ventilation when indicated
  • Supporting patients with hospital-at-home or virtual ward schemes

Self-management Action plans

A major problem associated with COPD is the occurrence of infections and the periodic worsening of symptoms. Self-management support teaches patients to effectively manage their symptoms and condition, this can include using a ‘rescue pack’ of antibiotics and oral corticosteroids The National Institute of Clinical Excellence (NICE 2004, 2014) encourages patients to use self-management plans so that you can respond promptly to the symptoms of an exacerbation

Stop smoking

It is important to encourage and support all patients with COPD who are current smokers to stop smoking regardless of the stage of their COPD. Stopping smoking can help to reduce the frequency of infections

Inhaled therapy

While there’s no cure for COPD, your inhaled medications can help. They can improve symptoms and quality of life. Inhaled medicine can be taken using an inhaler or with a nebuliser. There are different types of inhalers available and it is important that you are taught the correct way to use your inhaler in order to get the most benefit from your inhaled medicines.

There are some fantastic videos describing the correct technique for inhalers available here.  These videos have been produced as part of a Greater Manchester project in association with the Wessex Academic Health Science Network.

Pulmonary rehabilitation

Pulmonary rehabilitation is an exercise and education programme which is available for patients with COPD. Studies show that patients who attend Pulmonary Rehabilitation programmes have better symptom control in terms of infections

Use non-invasive ventilation

Non-invasive ventilation (NIV) is a treatment option for some patients, during an infection, who do not respond to usual inhaled and oral therapy. It it is usually provided within a hospital by specially trained staff.

Nutrition

It is important that you have a healthy well balanced diet that contains all food groups. Patients with COPD require more energy for breathing compared with people who do not have COPD and this can put you at risk of significant weight loss which can result in muscle wastage. For this reason you may need to increase your calorie intake through a varied and energy rich diet in order to maintain your weight within a normal range. The evidence also suggests that a poor diet may be linked to increased infections. It is also advisable for you to drink plenty of none caffeinated drinks. Increasing fluid intake helps to keep the mucus produced by the lungs thin; this will make coughing up this mucus easier (expectorating).

Rest

It is important for you to get adequate rest and conserve your energy. There are many ways to conserve energy and these include planning activities ahead to allow for rest periods, getting a good night’s sleep, not planning activities for directly after a meal and not over stretching yourself on days when you are not feeling at your best