Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic lung condition affecting people in their 50s and 60s. The main cause is thought to be smoking, but it may be that other elements such as being exposed to pollution, fumes and dust contribute.
COPD can creep up on you. Patients tell me they start by noticing they’re more prone to winter chest infections and that these tend to last longer and drag on with a persistent cough. Over the years, they may start to get breathless at the top of a hill and notice that the distances they can walk are getting shorter. Then the penny drops.
Many people come to see me because a diagnosis has been made but the condition is not as well controlled as they would like. Others are worried about other conditions such as lung cancer even if their symptoms are not typical for this.
It’s common to panic when you’re fighting for breath, so my approach is to reassure you and put you at ease. I like to have two of you in the room – you and a partner or a friend. It’s reassuring to have someone with you and it means you both hear the same message.
When you arrive, we’ll talk about what has happened so far and your medical history. Much of the first appointment is about information gathering, although I will also examine your chest and listen to your heart.
If you have already had a diagnosis, going through this information in detail will help me to make sure that the diagnosis is secure.
If the diagnosis is sound it’s then a case of optimising your treatment. If I have enough information I may not need to do any further tests and I can give you advice there and then. I will write to your GP explaining the diagnosis and treatment and copy you into the letter.
If the diagnosis is insecure, I’ll need to start from scratch by doing some tests. These may include sending you for breathing tests (at the Royal United Hospital) or a CT scan (imaging test) at Circle Bath to pick up anything that was missed or to determine the extent of the damage. I’ll arrange to see you for a second clinic appointment to discuss the results.
The breathing test, if needed, involves breathing into a machine that measures how much air you breathe in and out. The results are checked against normal results to see if there’s any obstruction in your lungs. This is called a spirometry test. These are often done at your general practice, so you may have already undergone this. In addition, I may go on to request more detailed breathing tests that provide me with more information about how well your lungs work. In some cases, I also organise other tests, such as an exercise test.
I may also send you for a CT scan if I need to check your diagnosis is sound, to rule out any other chest conditions, and to measure the extent of the COPD.
A scan will see your lungs in greater detail than an X-ray. You may be asked to put on a gown, then you’ll lie on a flat bed, while the radiographer operates the scanner. The scanner isn’t enclosed. It looks like a ring doughnut that rotates around your chest as you take deep breaths and pass through. It will last about 15 minutes.
You’ll come back to see me once we have the test results, so we can make sure you’re on the correct treatment regime.
The main treatment is to stop smoking and keep active – I often recommend referral to your local pulmonary rehabilitation programme where you will attend weekly exercise classes for eight or nine weeks to allow you to make better use of your lungs. I will also review what medications you are on – the mainstay of drug therapy in COPD involves using inhalers. There are three different groups of drugs that I use, which can come in a wide range of inhaler devices. The huge variety on offer can sometime cause confusion, so we’ll discuss together which ones may work best for you.
What we hope to do is stop the disease from progressing and get you more active.
You can manage COPD with lifestyle changes. A lot of people who see me have lost confidence in their lungs and don’t exercise. They become socially isolated, which can become a bit of a vicious circle. Exercising, even walking very short distances two or three times a day, treating infections properly and getting the right inhalers, can all make a huge difference. Clearly tackling ongoing smoking, if relevant, is also hugely important.
Antibiotics have a role to play but the main idea is to prevent infections from happening in the first place.
Occasionally patients can benefit from very specialist interventions for their COPD. This is often not the case, but I tend to keep all options open.