1

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

LOOK AFTER YOUR LUNGS

2

CONTENTSAbout this guide 3

What is COPD? 4

What can cause COPD? 6

Diagnosing COPD 7

Why do I need an Action Plan? 9

Managing COPD 10

The COPD Action Plan 17

More information 23

We’ll help find a healthier youIt’s our purpose that makes us different — we want our members to live longer, healthier, happier lives. We offer more than health cover. Our expertise extends to health assessments and health coaching, wellness programs, optical care, aged care and international health cover. We offer information and tools to help you manage your health. And as a member, you’ll enjoy access to great value travel, home, car and life insurance.

A commitment to our members We’re part of a global family, who reinvests our profits to provide better services for our members. We proudly offer affordable, high-quality health cover to more than three million Australians.

3

ABOUT THIS GUIDEThis guide offers practical advice, current research and information to help people living with chronic obstructive pulmonary disease (COPD). It may also be a useful resource for family and friends who want to know more about COPD and how they can help.

Inside this guide, you’ll find:

° information about COPD and how to help reduce its impact on your health and everyday life.

° an Action Plan that you can prepare together with your doctor.

Take this guide with you when you next visit your doctor so you can get started on making your Action Plan together.

4

WHAT IS COPD?Chronic obstructive pulmonary disease (COPD) is a common, often preventable and treatable disease of the airways. It’s when the small airways become inflamed and narrowed in a way that isn’t fully reversible, making it hard for you to breathe.

Common conditions that can result in COPD include a group of lung diseases such as emphysema and chronic bronchitis. In this guide we concentrate on these conditions but there can be some overlap between asthma and COPD.

To understand COPD, it’s important to know how your lungs work. When you breathe, air travels in and out of your lungs through small-to-moderate sized airways called bronchi (singular is bronchus). Each lung has clusters of tiny air sacs called alveoli (singular is alveolus).

The di�erent parts of the lung

healthybronchiole

alveolus

bronchus

right lung

trachea

5

In healthy lungs, the alveoli are inflated like tiny balloons with the air you breathe in. The oxygen from that air then passes from the alveoli into tiny blood vessels called capillaries. The capillaries channel this freshly oxygenated blood through other blood vessels to the rest of your body via the heart. The cells of your body use oxygen to make energy while releasing waste products such as carbon dioxide and water for the blood to carry away back to the lungs. Unwanted carbon dioxide in the capillaries passes back into the alveoli to be blown out when exhaling.

Emphysema is when alveoli are damaged, reducing the surface area available for the vital exchange of oxygen and carbon dioxide. This can result in low oxygen and high carbon dioxide levels in the blood and you have to breathe harder to get enough oxygen.

Chronic bronchitis is when the bronchioles become inflamed and thickened, and the number and size of mucus-producing cells increases. Excessive mucus can block the airways that connect to the alveoli, causing you to cough as you try to clear your lungs. You’re considered to have chronic bronchitis if you’ve had a persistent cough and bringing up mucus for at least three months a year in the past two years.

6

Common symptoms include shortness of breath, cough and bringing up mucus. Some people also experience chest tightness, wheezing and re-occurring respiratory infections.

WHAT CAN CAUSE COPD?There are a number of causes of COPD. The major one is cigarette smoke. About half of all smokers develop some breathing problems even if they don’t develop COPD.

Genes can also play a role. COPD is common in people with a rare, hereditary condition called alpha-1-antitrypsin (AAT) deficiency (or ‘familial emphysema’).

Other causes of COPD include exposure to occupational dust and chemicals (vapours, irritants and fumes) as well as air pollution but this is less common in Australia.

COPD usually develops slowly.

Many people with mild to moderate COPD have little to no symptoms and often only during strenuous exercise. However, because COPD is a chronic (long-term) condition, you may notice that the symptoms get worse as it progresses and experience symptoms more frequently — known as an ‘exacerbation’. This is more likely to happen if you are exposed to triggers like cigarette smoke or have a respiratory infection, though sometimes symptoms worsen for no obvious reason.

7

DIAGNOSING COPDInitially, your doctor will examine you, listen to your lungs and ask questions about your breathing, smoking status and general health. They may also go over your family and medical history, and ask about any lung irritants you’ve been exposed to (eg cigarette smoke, dust, chemicals).

Your doctor will also be on the lookout for signs that show how severe your condition is, whether it’s getting worse, and any side effects or complications you might have. This can help ensure you get the appropriate treatment.

Things your doctor might look for when deciding how to treat your COPD include:

° your exposure to risk factors such as smoking;

° your past medical history such as asthma, allergy, sinusitis, childhood chest infections or other respiratory diseases;

° any pattern of symptoms such as ‘winter colds’ or repeated chest infections;

° family history of COPD or other chronic respiratory diseases;

° if you have other diseases such as heart disease and osteoporosis; and

° social and family support.

8

Your doctor may run lung or pulmonary function tests after the medical history and physical examination to help diagnose COPD. These tests can indicate the extent of your lung damage and help you and your doctor decide on appropriate treatment.

Spirometry is an easy and painless test which can show how well your lungs are working. It involves taking a deep breath then breathing out hard into a large hose connected to a machine called a spirometer. This measures how much air you can take in and how fast your lungs fill and empty. The test can detect if you have COPD before you experience significant symptoms, and also assists in grading the severity of the disease.

Your doctor may also perform post-bronchodilator spirometry. This is a test using the spirometer after you have taken a medicine called a bronchodilator. This medicine relaxes tightened muscles around the airways, opening them up to ease breathing. The results of this test can help your doctor determine if your lung problems are being caused by another lung condition such as asthma instead of COPD.

There are other lung function tests your doctor may perform to rule out any other conditions. Your doctor may also order various tests to confirm the diagnosis of COPD. These may include a chest X-ray to see if another disease, like heart failure, is causing your symptoms; or an arterial blood gas test that shows the oxygen level in your blood, often used to see if you need oxygen treatment. The doctor may repeat some of these tests on your following visits to check the progress of the disease or any complications you may have developed.

9

WHY DO I NEED AN ACTION PLAN?Although there is no known cure for COPD and the damage it causes to your airways and lungs is likely to be permanent, there are a number of ways you can help slow down the progress of further lung damage and reduce your risk of long-term complications such as osteoporosis.

Work with your doctor to develop a personalised, written Chronic Obstructive Pulmonary Disease Action Plan. This can include a combination of smoking cessation advice, medication, physical exercise and other therapies.

Having a written Action Plan to record important information can help you stay up-to-date with your medication and health checks, monitor symptoms and manage your COPD to stay well and feel better.

10

MANAGING COPDUsually management of COPD requires a combination of different treatments including medication, pulmonary rehabilitation and healthy lifestyle habits. Your doctor may involve the help of a team of health care professionals including lung specialists or respiratory physicians, physiotherapists, dietitians, pharmacists, home and community nurses and others.

The goals of COPD management are to:

° relieve your symptoms, particularly breathlessness, with minimal side effects

° slow the progress of the disease

° prevent complications

° improve your overall health and quality of life.

Treatment for COPD is different for each person, depending on its cause and severity. However, there are some steps all people living with COPD can take to slow down the progress of this disease and prevent complications while improving overall health.

If you smoke, quit. This is the single most important thing you can do to slow the progress of this disease. Giving up smoking is the only intervention that has been shown to prevent or slow the progress of COPD. Secondhand or passive exposure to smoking can also increase the risk of people around you developing COPD.

If you’ve made the decision to quit, there are options available to help you boost your chances of staying smoke-free. Start by getting advice and support to stay motivated, from Quitline (www.13QUIT.org.au). They can also help you come up with a plan to prepare you for ‘trigger’ situations that might tempt you to smoke, as well as battling nicotine cravings and other nicotine withdrawal symptoms. Talk to your doctor or pharmacist about ways to give up smoking with nicotine replacement therapy (NRT) or medication to help tame the urge to smoke.

11

Keep up-to-date with important immunisations. Respiratory (lung and chest) infections can cause serious problems in people with COPD. Immunisations against common infections can help reduce your chance of getting these infections and related complications. Have an influenza (flu) vaccination every year ideally before flu season starts. It’s also a good idea to have a three-dose course of pneumococcal vaccine to help prevent pneumonia, and it’s likely you’ll need to have a revaccination with the pneumococcal vaccine every five years. Talk to your doctor if you have any concerns about these immunisations.

Eat well to maintain a healthy weight. It’s important to keep an eye on your weight and let your doctor know if you notice any significant changes, as it can affect your condition or be a sign that your COPD is worsening. If you are losing weight, it might be due to the work your body has to do to breathe. If you are carrying excess weight, this can make your breathlessness worse so try to reach and maintain a healthier weight. Your doctor or a dietician can help you with your individual nutrition and weight loss needs.

12

Keep fit and active. Studies have shown that people living with COPD who exercise regularly tend to have improved breathing, fewer symptoms and a better quality of life. Any regular moderate-intensity exercise is good, and it’s recommended you aim for at least 30 minutes most days of the week. A daily walk is a good start if you are not used to exercising.

Pulmonary rehabilitation. This involves an individually tailored care program designed to optimise your health and help you carry out your day-to-day activities by helping to improve your ability to exercise, prevent complications and reduce the frequency of exacerbations. The program may include exercise training, nutritional advice and education about your condition. You may also learn breathing exercises that strengthen the muscles needed for breathing to help reduce breathlessness.

While pulmonary rehabilitation is recommended for all people who find that COPD causes significant disability, it may not be suitable for patients who have other health conditions such as angina. Talk to your doctor about whether pulmonary rehabilitation is an appropriate option for you.

Participating in support networks. Joining a local support group may assist you in developing and maintaining a positive attitude to self-management and exercise. Contact the Australian Lung Foundation (1800 654 301 or www.lungfoundation.com.au) to find if there’s a Patient Support Group near you.

13

MEDICATIONS FOR COPDMedications that help treat COPD and manage your symptoms may vary depending on the cause and severity of your condition. Treatment will be more effective if it’s tailored to your individual needs. Some trial and error may be required before you and your doctor find the right medication or combination of medications that work best for you. Make sure you understand how your medications work and tell your doctor or pharmacist if you are experiencing any side effects.

On the following pages, you’ll find some information on medications.

Be sure to always check with your doctor and pharmacist before taking any medications as they may cause side effects. Sometimes prescribed or over-the-counter medications can interact with each other or drinking alcohol can cause an adverse reaction with COPD medication. If you’re experiencing side effects or symptoms that might be caused by medication, contact your doctor or pharmacist as soon as possible.

14

BronchodilatorsBronchodilators work by relaxing the muscles around the airways, to help open them quickly and make breathing easier. They are used for symptom relief on an ‘as needed’ basis, regularly to prevent symptoms and to increase your ability to exercise without getting breathless.

Short-acting bronchodilators (such as salbutamol, terbutaline and ipratropium bromide) are generally used only when needed for quick relief of symptoms such as breathlessness, cough and wheezing.

If short-acting bronchodilators aren’t providing adequate control of symptoms, a long-acting bronchodilator (such as tiotropium bromide, eformoterol and salmeterol) can be added. These are normally used daily to help reduce frequency of exacerbations and improve quality of life.

Corticosteroids Corticosteroid medication can be inhaled to help reduce inflammation (swelling) in your airways. They may help reduce the frequency of exacerbations but are not be suitable for some people with COPD.

If you have an acute exacerbation, your doctor may prescribe you a short course (up to 14 days) of oral corticosteroids (as a tablet or capsule taken by mouth rather than inhaled). This can help you return to previous lung function and help manage symptoms faster.

There are a number of unwanted side effects associated with long-term oral corticosteroid use, including osteoporosis — so they are generally prescribed only for short periods.

15

MucolyticsSome people with COPD will have excess mucus production that causes the airways to contract, blocking the flow of air. Mucolytics can help treat this by breaking up mucus and enabling it to be cleared more easily. Although mucolytics may work for some people, particularly those with symptoms of coughing to bring up mucus, they may not be effective in all cases.

AntibioticsAntibiotics are not used routinely in treating COPD. They will generally be used only for acute exacerbations, to help reduce the amount of mucus produced.

16

Oxygen If you have advanced COPD and very low levels of oxygen in your blood, your doctor may recommend that you have oxygen therapy. Usually, oxygen will be delivered through a flexible tube that is taped into one of your nostrils, known as a nasal cannula. You may need extra oxygen some (intermittent therapy) or all of the time (continuous therapy). Both portable and non-portable options are available — your doctor can help you decide what’s right for you.

Using your medication devicesMany of the medications for COPD are inhaled, so they go directly into your lungs where they are needed. There are many ways of inhaling these medications, from different kinds of inhalers to a nebuliser which diffuses the medication in steam. It’s important you know how to use your inhalation devices correctly. And if you’re using a metered dose inhaler there are also devices called spacers which can help you inhale your medication more effectively. If you are unsure about your inhaler technique, or how to use any of the devices, ask your doctor or pharmacist to show you.

Will I need surgery?Most patients with COPD have their symptoms managed with lifestyle changes and optimal use of medication. For a small group of people with severe COPD who continue to experience breathlessness and interference with day-to-day life despite optimal management, they may need a medical procedure to treat the condition. The procedures available can improve exercise capacity and quality of life, but have not been shown to increase survival rates.

17

1918

Pre-bronchodilator % pred Post-bronchodilator Reversibility* (%)

FEV1

FVC

FEV1/FVC

Spirometry test

Use this table to record your spirometry results.

Forced Expiratory Volume (FEV1) measures the volume of air that can be forced out in one second after taking a deep breath.

Forced Vital Capacity (FVC) measures the total volume of air that can be forced out after taking a deep breath.

The ratio of the FEV1 to the FVC demonstrates the proportion of air forced out in one second as compared with total volume expired. The ratio in normal healthy lungs is about 70%. When obstruction is present, this ratio is reduced; the lower the ratio, the greater the airway obstruction.

COPD is diagnosed when post-bronchodilator FEV1/FVC is < 80%:

60–80% mild

40–59% moderate

<40% severe

The COPD ACTiOn PlAn

Checks and reviews by doctor or health professional

Check/review Minimum recommended frequency Date Date Date

Smoking status Every routine visit / / / / / /

Weight Every routine visit / / / / / /

Diet and appetite Every routine visit / / / / / /

Exercise Every routine visit / / / / / /

Sleeping patterns Every routine visit / / / / / /

CO2 retainer Every routine visit / / / / / /

General health Every routine visit / / / / / /

Information/support needs Every routine visit / / / / / /

2120

COPD under control (breathe easier)

Medication record

My usual medication Strength Colour of device how much do i use? (e.g. no. of inhalations or tablets) how often

1

2

3

4

COPD getting worse (harder to breathe)

Medication record

My extra medications Strength Colour of device how much do i use? (e.g. no. of inhalations or tablets) how often

1

2

3

4

extra medications* Strength Route how much do i use? (e.g. no. of tablets) how often how many days?

Prednisolone

Antibiotic

*GP to fill in if prescribed.

Symptoms Actions required Continue taking your usual medicines as listed below. Annual influenza (flu) immunisation – date: Last pneumococcal immunisation – date:

°

° °

°

° Wheezy/breathless

° Coughing with more phlegm than usual

° Change in colour of phlegm

° Loss of appetite

° Taking more reliever medication than usual

° Not sleeping well

° Unable to perform normal activities eg dressing and bathing

° Fever/chills

° Swelling in the ankles

° Very short of breath at rest

° Chest pain

° Drowsiness

° Confused, slurred speech

Symptoms Actions required Follow plan for extra medicines. Get rest, relax, use breathing techniques, cough to clear phlegm as required. Consider contacting your GP or other healthcare professionals.

Actions required

° Dial 000 for an ambulance immediately

° Take your COPD Action Plan to show the emergency team

if symptoms get worse (trouble breathing)

Symptoms

22

23

The information in this brochure has been developed and reviewed for Bupa Australia Pty Ltd and its related entities (‘Bupa’) by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It is intended to be a guide only and should not be relied upon as a substitute for professional medical advice. The mention of specific products, services, tests, doctors, specialists or other health care professionals, procedures or opinions does not constitute or imply a recommendation or endorsement by Bupa, unless specifically stated as such. Bupa makes no warranties or representations regarding the completeness or accuracy of the information and is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health or wish to discuss your individual symptoms or circumstances.

The information in this brochure does not represent which products and services may or may not be covered under your level of cover.

WHERE CAN I GET FURTHER INFORMATION?For more information and support, contact:

° Your GP

° Australian Lung Foundation on 1800 654 301 (freecall) or www.lungfoundation.com.au

° Quitline on 13 Quit (7848) (local call cost) for help to give up smoking

Sources

1. Abramson M, McKenzie D, Crocket A, Glasgow N, Jenkins S, McDonald C, et al. The COPD-X plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease. The Australian Lung Foundation. 2011;V2.30.

2. Australian Lung Foundation. COPD Action Plan. [online] Available from: http://www. lungfoundation.com.au

3. Lokke A Lange P Scharling H et al. Developing COPD: a 25 year follow up study of the general population. Thorax. 2006; 61: 935-939.

4. Rodriguez-Roisin R, Anzueto A, Bourbeau J, DeGuia T, Hui D, Martinez F. Global strategy for the diagnosis, management and prevention of COPD. Global Initiative For Chronic Obstructive Lung Disease (GOLD) [Internet]. 2011 [cited 2012 June 13]. Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf.

5. Respiratory Expert Group. Therapeutic Guidelines: Respiratory. Version 4. Melbourne: Therapeutic Guidelines Limited. 2009.

6. Rossi S (ed). Australian Medicines Handbook 2012. Adelaide, South Australia: Australian Medicines Handbook. 2012.

7. Zwar N Richmond R Borland R et al. Supporting smoking cessation: a guide for health professionals. [online] 2011. [accessed 16 Jan 2012] Available from: http://www.racgp.org.au

24

Bupa PO Box 14639 MELBOURNE VIC 8001

Bupa Australia Pty Ltd ABN 81 000 057 590

Effective September 2014 09616-09-14S

FOR MORE INFORMATION

134 135

bupa.com.au

Visit your local Bupa centre

The World of Bupa

Health CoverHealth Coaching & ProgramsInternational Health CoverCorporate Health SolutionsOptical Products & ServicesDental ServicesAged CareMedical servicesTravel, Home & Car InsuranceLife Insurance