COPDChronic Obstructive Pulmonary Disease

A quick and easy guide to the lung disease COPD for patients

RESP-11-76 The opinions expressed in this leaflet are the authors’ own and not necessarily those of the company. This leaflet has been produced in collaboration with Digital Context AB and doctors Eva Pilman of Helsingborg and Bo-Anders Paradis of Kristianstad.

Boehringer Ingelheim AB Liljeholmsstranden 3 Box 47608 117 94 Stockholm Sverige 08-721 21 00

© Digital Context AB 2011 ISBN 978-91-979771-1-1 Design Digital Context AB Tryckt i Malmö Tryckfolket

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COPDIn brief

You have an illness known as chronic ob-structive pulmonary disease, or COPD, which means that the function of your lungs is impaired. The most common cause of COPD is smoking. The lungs be-come inflamed and the airways narrow, making it harder to exhale fully, often with increased production of phlegm. The alveoli where oxygen is absorbed into the bloodstream are also damaged. Many smokers suffer from undiagnosed COPD.

The damage to the lung tissue is irrever-sible, but extensive studies have shown that modern medicines can have an ef-fect on lung function, quality of life, exa-cerbations (flare-ups) and mortality.COPD generally develops after many years of smoking, which is why it’s ge-nerally seen in those over the age of 40. COPD and continued smoking lead to gradual deterioration in lung function, causing more and more pronounced breathlessness and impaired uptake of oxygen. The first and most common symptom to appear is shortness of breath following physical exertion. Other early symptoms are coughing (with or without phlegm), tiredness and repeated and prolonged infections of the airways. ”Smoker’s cough” can be an early sign of COPD. Most COPD patients have a mild or moderate form of the disease.

It’s important to detect the disease early and to distinguish it from asthma. Many of those diagnosed with asthma actually have COPD. A COPD diagnosis requires a lung function test using a spirometer, which can be performed at most health centres in Sweden.

The main treatment for COPD is to stop smoking. It’s vitally important that you quit! You’ll feel better, and your progno-sis will improve. It’s never too late to give up smoking, however severe your illness! A mildly affected person who stops smo-king, leads a physically active life and takes the prescribed medicines can look forward to many more rewarding years of life.

There are two main types of medicine for improving lung function in COPD: bronchodilators and anti-inflammatories. Under national guidelines in Sweden, the first-line treatment for symptoma-tic COPD is long-acting anticholinergics. These medicines are generally taken using inhalers. The medication helps the airways to widen, making it easier to breathe, and reduces the number of exa-cerbations. There are also combination products which contain both a broncho-dilator and an anti-inflammatory.

Another important step is vaccination against influenza and pneumonia. Regu-lar exercise and a high-energy diet also make a big difference. Check out the ex-ercise tips towards the back of this leaflet.

Healthy bronchus

Diseased bronchus

Healthy alveoli Diseased alveoli

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What is COPD?What happens to the lungs?

COPD leads to impaired lung function. The airways become narrower and infla-med. There are two main components of the disease: chronic bronchitis/bronchio-litis and emphysema. Chronic bronchioli-tis is a lasting inflammation of the bron-chioles, the small airways in the lung, which results in coughing and phlegm. Emphysema means that the lung tissue is damaged and the alveoli are destroy-ed, leading to less efficient absorption of oxygen from the lungs into the blood-stream.

In COPD, the inflammation in the airways is constant and the lungs never function normally. This differs from asthma, where there are symptom-free periods and where lung function is often normal and is more variable. It’s important to distin-guish between asthma and COPD, becau-se both treatment and prognosis differ.

Trachea

Bronchi

Bronchial tree

Alveoli

Bronchioles

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What is COPD?The structure of the lungs

The lungs consist of lung tissue, airways (bronchi) and air sacs (alveoli). The in-ner walls of the bronchi are lined with a mucus membrane containing tiny hairs (cilia) which capture and remove dirt par-ticles.

The windpipe (trachea) divides into two main bronchi, one going to each lung. The bronchi then split into smaller and smaller airways – the bronchial tree.

The smallest airways are called bronchio-les. The leaves on the bronchial tree are the alveoli, where oxygen and carbon di-oxide are exchanged.

In COPD, the airways are inflamed, resul-ting in increased production of mucus/phlegm and narrowing of the airways.

In emphysema, the alveoli break down to form large cavities. This impairs the exchange of gases, leading to shortness of breath following physical exertion. The lungs’ elasticity and support structures are affected as well, which also makes breathing harder.

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How is COPD detected?From its symptoms

COPD creeps up slowly and may not be symptomatic for many years. The disease is divided into four stages: I, II, III and IV.

Shortness of breath The most common initial symptom is shortness of breath. This develops slowly and is generally first noticed after strong physical exertion. In time this breathless-ness also follows more moderate exer-tion. Patients often adapt their activity in response to this, so it can be some time before they become aware of their symp-toms. This makes it hard to detect the di-sease at an early stage.

CoughCoughing is another common symptom. It’s often worst in the morning and can

produce a lot of phlegm. This phlegm is normally white or grey; if it’s green or brown, this can be a sign of infection. COPD patients often have prolonged and repeated flare-ups, or exacerbations. The-se bring increased shortness of breath, coughing and phlegm production. Exa-cerbations are a sign of a less favourable prognosis. Tiredness and wheezing are other common symptoms of COPD.

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How is COPD detected?Using spirometry

A lung function test is required to make a diagnosis of COPD. This can be carried out at your health centre using a spiro-meter. The test is needed not only to di-agnose COPD but also to see how badly your lungs are affected.

The test is generally performed by a spe-cially trained nurse and takes around 20 minutes. You blow repeatedly into a tube attached to a device which measures your lung volume. Your doctor can then assess the results and see what stage the disease is at (I, II, III or IV).

FEV1 > 80% – Normal lung function

FEV1 60–79% – Mild COPD

FEV1 40–59% – Moderate COPD

FEV1 < 40% – Severe COPD

Volume (l)

Flow (l/s)

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How is COPD detected?Spirometry results

FEV1 is a measure of how severely your lung function is affected. It measures how many litres of air you can exhale in one second when blowing out hard. There are tables for normal values depending on gender, age, height and ethnic origin. Your FEV1 is stated as a percentage of the predicted normal value.

Pulse oximetry is used to measure the amount of oxygen in your blood, which is important to monitor in COPD. The more severe the disease, the greater the risk of low blood oxygen levels, especially in case of infection or exacerbation. A COPD patient in a stable phase should have an oxygen reading above 92%.

Non-smoker

Quit smok-ing at 45

Smoker

Incapacitation

Death

Age (years)

Lung function (%)

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TreatmentSmoking cessation

Smoking cessation is the most important treatment for COPD. If you stop smoking, you’ll feel better and your prognosis will improve.

• Ifyouhaveasmoker’scough,thiswillclearup!

• IfyouhaveCOPD,you’llfeelbetteranditwon’tgetanyworse!

• Italwayspaystostopsmoking!

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TreatmentSmoking cessation aids

Products are available both on prescrip-tion and over the counter to help you stop smoking. Nicotine replacement th-erapy improves your chances of quitting, and active support from someone like a nurse while you’re giving up is very im-portant and further increases the chan-ces of success.

Some health centres and many hospitals have smoking cessation clinics.

Nicotine replacement therapies such as gums, patches and nasal sprays can make giving up easier. Up to 15% of people are still smoke-free after 12 months.

There are also prescription medicines which use various mechanisms in the brain to reduce your cravings for nicotine.

Counselling and behaviour modifica-tion techniques have also been shown to improve the results of medicinal th-erapies. Half of those who quit smoking start again within a year. People gene-rally make three or four serious attempts to give up before they succeed. The more attempts to stop smoking you make, the greater your chances of succeeding. After all, it’s the end-result – being smoke-free – that counts!

Other techniques such as hypnosis and acupuncture may help in some cases.

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Most medicines for COPD come in inha-lers. All are used to ease the symptoms, above all shortness of breath.

They can be divided into two groups: bronchodilators and anti-inflammatories.

Bronchodilators Bronchodilators are the most important treatment for COPD. They reduce breathlessness and can be either short-acting or long-acting. There are two ty-pes of bronchodilators that work in two different ways: beta-2 agonists and an-ticholinergics. The Swedish Medical Pro-ducts Agency’s recommendations state that short-acting medicines are suitable for use on demand. Long-acting medici-nes are suitable for regular use, and long-acting anticholinergics are recommen-ded in the first instance. An additional effect can be obtained by combining a long-acting anticholinergic with a long-acting beta-2 agonist.

Anti-inflammatories The anti-inflammatories used are gene-rally corticosteroids and come in an in-haler. Inhaled steroids are very effective against asthma and can be of value to some COPD patients, especially those with severe COPD (less than 50% of pre-dicted value) and repeated exacerba-tions. Some studies of inhaled steroids have shown increased quality of life and a reduced number of exacerbations. In-haled steroids are also included in com-bination products which can be used on the same basis as inhaled steroids, in oth-er words by patients with severe COPD and those with repeated exacerbations. These combination products contain both steroids and bronchodilators.

TreatmentMedication

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TreatmentOther treatments

VaccinationCOPD patients should be vaccinated against influenza every year and against pneumonia every five years.

ExerciseExercise helps COPD patients to do more and have a better quality of life. Physioth-erapists can help with straightforward ex-ercises (see also the exercise tips towards the back of this leaflet). Nordic walking is ideal!

Physiotherapists can also help patients develop a good breathing technique.

Occupational therapists can help you try out various aids for things like pulling on socks. They can also adapt your home so that you can get about more easily and with less effort – by putting hand-les on the bath or removing thresholds, for example.

DietMany patients with severe COPD beco-me undernourished. A dietitian can help with dietary advice and prescribe nu-trient drinks.

Oxygen Oxygen therapy may be appropriate for patients with severe COPD and low blood oxygen levels.

Surgery Surgery may be an option for patients with severe COPD and emphysema to re-move damaged tissue.

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TreatmentExercise tips

“Pursed-lip breathing” is a good techni-que for breathing more calmly, deeply and efficiently. Breathe in gently through your nose and breathe out through pur-sed lips – as though you were whistling. Repeat for several breaths until you feel that your breathing is settling. Ideally you should use this technique not only when resting but also when active.

“Huff coughing” is a way of clearing phlegm more easily. After breathing in, breathe out sharply with your mouth open, as though cleaning a pair of glas-ses. You can also try humming, which ge-nerates a slight vibration in the airways, making it easier for phlegm to be coug-hed up.

Good posture is important for your brea-thing. Straighten your spine and hold your arms behind your back. Breathe gently and stretch any tight muscles across your chest. You may find that brea-thing is easier in this position.

Exercising the upper body can help mus-cles to relax and make you more aware of the difference between tense and re-laxed muscles. Stand with your feet firm-ly planted on the floor and gently twist your upper body round from side to side. It should feel as though you were wrap-ping yourself around a pipe. Let your arms hang loosely and sway naturally as you move.

When you’re relaxed, your breathing will be easier and take less effort. Lean with your hands against some kind of sup-port, like a windowsill or railing. Try not to hunch your shoulders, and keep your shoulders and arms as relaxed as pos-sible. Use pursed-lip breathing as descri-bed above.

Touch your shoulders with your fingers and gently draw circles with your elbows while doing pursed-lip breathing.

Lie on your back with knees bent and feet flat to the floor. Now reach your hands towards your knees, squeeze your lower back towards the floor and tuck your chin towards your chest. Breathe out through pursed lips as you reach forwards and breathe in again as you relax back down to the floor.

There are many other activities that can help improve your fitness. These include Nordic walking, swimming and cycling. Going for walks will also make you fitter.

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Effects of treatment

It is important to assess the effects of treatment after two to three months. Medication can be expected to ease the symptoms. It should reduce shortness of breath above all, but your cough should also improve.

Medication can also help patients enjoy a better quality of life. You’ll have the en-ergy to do things that you didn’t do be-fore. Some medicines enable you to exert yourself more, making it easier to climb stairs or do the vacuuming. You quite simply feel fitter and stronger. The num-ber of exacerbations may also fall, and so-metimes spirometry will show improved lung function.

It’s important to stress that most people with COPD have a mild or mo-derate form which, correctly treated, will allow them to lead a normal

or near-normal life. A mildly affected person who stops smoking, leads a physically active life and takes the prescribed medicines can look

forward to many more rewarding years of life.

Föreliggande häfte är framtaget i samarbete med Eva Pilman, Distriktsläkare, Helsingborg och Bo-Anders Paradis, läkare och

verksamhetschef, Näsby Vårdcentral, Kristianstad.

Syftet är att ge lättillgänglig och översiktlig information om lungsjukdomen KOL.

Boehringer Ingelheim AB, Box 47608, 117 94 Stockholm, Tel: 08-721 21 00, Fax: 08-710 98 84

www.boehringer-ingelheim.se www.kol.se