NEW PATIENT/PUBLIC SUMMARY ARTICLE No.1 (pilot): Chronic obstructive pulmonary disease
Summary
We are currently piloting the production of plain English ‘Patient/Public’ summaries of original clinical review articles published on the BTMH website in order to increase public access to, and understanding of, the clinical content of these articles. Please access this short Patient/Public summary of Dr Albert and Professor Calverley’s overview of chronic obstructive pulmonary disease and complete the short survey at the end of this article in order to provide us with your feedback. (Image - © istockphoto.com)
Key Points
- Chronic obstructive pulmonary disease is a chronic lung disease that arises from airflow obstruction. Previously people with COPD may have been labelled as having emphysema or chronic bronchitis.
- Smoking is the main cause of COPD, although work-related exposure to chemicals can also contribute to its development.
- Symptoms may not appear until the disease is advanced and include breathlessness, chronic cough, wheeze, frequent winter bronchitis and coughing up lots of phlegm.
- Diagnosis involves measuring the volume of air breathed out in one second after taking a deep breath.
- Treatment can help patients to breathe more easily, but cannot repair existing damage, and centres on the use of inhalers. People with COPD should also be encouraged to stop smoking in order to reduce symptoms and to slow disease progression.
- All patients with COPD should be offered tailored programmes of exercise and education to help them cope with the disease.
Declaration of interests: No conflict of interests declared
Patient/public version of article
Chronic Obstructive Pulmonary Disease
(Adapted from the original clinical article By Dr Paul Albert and Professor Peter Calverley. Dr Paul Albert is a Clinical Research Fellow and Peter Calverley is Professor of Respiratory and Rehabilitation Medicine at University Hospital in Liverpool.)
Background
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease and a major cause of illness, disability and death. It affects 10–11% of people in the UK. Although common, it is believed to be significantly under-diagnosed and has been described as a ‘neglected’ disease.
Chronic obstructive pulmonary disease essentially stops people being able to breathe in and out properly. It results from an airflow obstruction that cannot be fully reversed. Previously, people with COPD may have been labelled as having emphysema or chronic bronchitis.
Treatment can help patients breathe more easily, but cannot repair existing damage.
Causes, prevalence and costs to the NHS
Smoking is the main cause of COPD, although other factors, including work-related exposure to chemicals, can contribute. The disease arises from inflammation of the airways and lungs.
Symptoms might not appear until the disease is advanced, so it is difficult to tell how many people may have it. A recent study suggests that COPD affects 10% of men and 11% of women.
Rates have levelled out in men, but are rising in women. In the UK, 27,478 people died of COPD in 2004 (5% of all deaths) and in 2002 it caused 110,000 hospital admissions.
Chronic obstructive pulmonary disease costs the NHS an estimated £490 million each year.
Symptoms and diagnosis
Symptoms include breathlessness, especially after exercise; chronic cough; wheeze; frequent winter bronchitis and the coughing up of lots of phlegm (sputum). Doctors should consider a diagnosis in patients aged over 35 who are, or have been, smokers and have one or more of these symptoms.
Diagnosis relies on spirometry – a test to see how much air can be breathed out in one second after taking a deep breath (known as FEV1 – forced expiratory volume in one second). Other investigations, including chest X-ray and blood tests, should also be carried out.
Management and treatment
Stopping smoking
Patients with COPD should be encouraged to stop smoking as this can help control symptoms and slow the progression of the disease. Patients who quit smoking cough and wheeze less and have lower chronic phlegm production.
Treatment
Treatment focuses on the use of different types of inhalers (known as bronchodilators). These may be short or long-acting, or, in more severe cases, steroid inhalers. Other treatment, such as oxygen, may be considered. Some patients may have surgery including lung transplants.
Pulmonary rehabilitation
All patients whose lives are impaired by COPD should be offered pulmonary rehabilitation. This is a personalised programme of exercise and education to keep patients as fit as possible and help them cope with the disease.
Other issues
Patients with COPD, particularly those with severe and disabling symptoms, can feel socially isolated and are at risk of anxiety or depression. Health professionals should be aware of this and treat where appropriate. Likewise, many patients with COPD can be underweight because they do not eat enough; all patients should be given dietary advice.
Preventing COPD from getting worse
Patients should be supported to manage their condition themselves as far as possible, in partnership with their GP, and see specialists when needed. They should be reviewed at least once a year.
From time to time the condition may get worse (doctors describe this as an exacerbation). Exacerbations can be treated with antibiotics, a short course of steroids and increased inhaler use in most cases. Patients should also be offered annual flu vaccinations.
Having COPD can increase the risk of dying from other conditions, especially heart disease, and both patients and health professionals should be aware of this.
Further information
American Lung Association: COPD fact sheet
British Lung Foundation: COPD COPD: diagnosis and treatment COPD: living with chronic obstructive pulmonary disease
National Institute for Health and Clinical Excellence: COPD: Information for the Public
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