Chronic obstructive pulmonary disease (COPD)

COPD develops slowly and often doesn’t display any symptoms until the late stages of the disease, with many people not realising they have COPD until reaching their late 40s or 50s.

Symptoms of COPD can vary from person to person but may include:

• A persistent, chesty cough where you cough up clear, white, yellow or greenish mucus for three or more months for at least two years
• Difficulty breathing, such as difficulty taking a deep breath, and shortness of breath, especially when engaged in activity
• Fatigue
• Wheezing 
• Frequent chest infections
• Chest tightness

These symptoms gradually worsen over time, and can include flare-ups or exacerbation, where your symptoms suddenly worsen.

When your COPD reaches an advanced stage, you may experience the following symptoms:

• Cyanosis, where your skin has a blueish tinge to skin 
• Unexplained weight loss 
• A barrel-shaped chest due to your lungs being overfilled with air and unable to deflate properly over a long period of time 
• Swollen feet, ankles or legs caused by a build-up of fluid in your lower limbs (peripheral oedema)
• Chest pain and coughing up blood, although these are usually signs of other conditions, such as a chest infection or lung cancer
  

There are four stages of COPD: mild, moderate, severe and very severe.

Stage 1: Mild COPD

In the first stage of COPD, you’ll experience shortness of breath and an ongoing, phlegmy cough.

Stage 2: Moderate COPD

At this stage, your existing COPD symptoms worsen. You may find it harder to catch your breath than before, especially during physical activities, and may notice you cough more often.
At this stage, you may also start wheezing, start experiencing fatigue and have difficulty sleeping.

Stage 3: Severe COPD

At the severe COPD stage, your lung function will have significantly decreased, making it harder to breathe in fresh oxygen and expel carbon dioxide.
As a result, symptoms such as shortness of breath, coughing and wheezing are more intense, you may produce thicker mucus, and you may be more prone to chest infections.
At this stage, you may start to experience symptoms beyond your respiratory system, such as fatigue, weakness and swollen ankles.
You may also start to experience flare-ups, where your symptoms suddenly worsen. As these can lead to hospitalisation, watch out for:

• Breathlessness
• Coughing attacks
• Tiredness and difficulty sleeping
• Cognitive impairment, such as confusion, depression and memory lapse

Stage 4: Very severe COPD

When you reach stage 4 COPD, your lung function will be very low, and the symptoms you experienced in the third stage will be more severe and persistent. You’ll find it hard to catch your breath during everyday activities, and flare-ups can be life-threatening.

At this stage, you may also have a barrel chest, where your chest appears round and wide due to your lungs being unable to deflate properly. You may also have an irregular or fast heartbeat, and are at a higher risk of pulmonary hypertension.

The most common cause of COPD in the developed world, causing around 70% of cases, is smoking tobacco.

Other, less common causes of COPD include:

• Long-term exposure to irritating chemicals, fumes, air pollution or dust
• Exposure to second-hand smoke (passive smoking) 
• A rare genetic disorder called alpha-1 antitrypsin deficiency, responsible for 1% of COPD cases, where the lungs don’t produce enough of a protein that protects them from damage

Risk factors 

While the biggest risk factor for developing COPD is smoking, you may be more at risk if you:

• Are female 
• Are over 65 years of age
• Had frequent respiratory infections as a child 
• Have been exposed to harmful chemicals, dust, fumes or air pollution for long periods of time such as at work 
• Have alpha-1 antitrypsin deficiency 
• Have a history of asthma 

The cost of COPD treatment depends on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

At your first consultation, you’ll be seen by a consultant respiratory physician, a doctor specialising in conditions involving the lungs and airways.

Your consultant will ask you about your symptoms, general health, medical history and any medication you take regularly. They will ask you if you smoke or used to smoke and if you have a history of exposure to possible lung irritants such as chemicals, fumes or air pollution.

Your consultant will then perform a physical examination, including listening to your chest with a stethoscope. If COPD is suspected, they may arrange for you to have further tests or scans to confirm or rule out the diagnosis.

Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

At Circle Health Group, we want you to be as well-informed and comfortable as possible during your time with us, so please discuss any questions or concerns with your consultant during your appointment.

COPD is diagnosed using a combination of your symptoms, physical examination and the results of any tests or scans.

Your consultant may order a range of tests to diagnose and evaluate the severity of your COPD including: 

• Spirometry:This test involves breathing out as hard as you can into a tube called a spirometer to measure the amount of air you breathe out. You may be asked to inhale a medication called a bronchodilator to open your airways before the test. 
• Blood tests: To test for other conditions that could be causing your symptoms or to check for the genetic disorder alpha-1 antitrypsin deficiency 
• Pulse oximetry: During this non-invasive test, a device like a clothes peg is attached to your finger to measure the oxygen levels in your blood
• Imaging tests: A chest X-ray or CT scan provides detailed images of your lungs to check for abnormalities  
• Arterial blood gases: This is a blood test to measure the levels of oxygen and carbon dioxide in your blood 
• Peak flow: A simple test to measure how quickly you can blow air out of your lungs 
• Electrocardiogram (ECG): This is a non-invasive test to assess your heart function and may be used to rule out heart disease as a cause of your symptoms 
• Sputum sample: A sample of mucus (sputum) is sent to the laboratory to check for infection 

At the end of your appointment, your consultant will provide a diagnosis, explain what this means and answer any questions you may have. They will discuss the next steps and create a bespoke treatment plan tailored to your individual needs.

While there is currently no cure, COPD can be treated in a variety of ways, including lifestyle changes, medication, rehabilitation, the use of medical devices and rarely, surgery.

Treatment for COPD aims to manage and improve your symptoms and reduce exacerbations, improving your quality of life.

Your course of treatment will depend on the type and severity of your symptoms, your general health, and your expectations for treatment.

Stopping smoking 

If you smoke, stopping smoking is essential to prevent further lung damage, reduce exacerbations and slow the progression of the disease. Your consultant can offer guidance and support on quitting smoking as well as refer you to smoking cessation programmes to make it easier for you to quit.

Medication 

There are several medications available that help treat the symptoms of COPD. The medication or combination of medications you are prescribed will vary depending on your individual circumstances, but may include:

• Inhalers containing medications called bronchodilators that relax and widen your airways making breathing easier
• Theophylline, a bronchodilator in tablet form that is normally taken twice a day 
• Mucolytics, a capsule or syrup that thins the mucus in your lungs, making easier to cough up 
• Steroids, taken as a tablet or through an inhaler, to reduce inflammation in your lungs
• Antibiotics can be prescribed to treat and prevent bacterial infections in your lungs

If you have an exacerbation of your COPD and inhalers haven’t worked, you may be given your medication through a machine called a nebuliser. Nebulisers work by turning medication into a fine mist that you inhale.

Pulmonary rehabilitation

Pulmonary rehabilitation is a supervised exercise and education programme designed to strengthen your lungs and help you manage your condition.

Involving group sessions and typically lasting around six to eight weeks, pulmonary rehabilitation teaches you how to take your medication, breathing techniques, stress management, healthy eating, and how to manage an exacerbation of your COPD.

Non-invasive ventilation (NIV)

If you’re admitted to hospital following an exacerbation, you may be given non-invasive ventilation to make it easier for you to breathe until your condition has improved.

Non-invasive ventilation delivers oxygen to your lungs from a machine through a close-fitting mask over your mouth and nose. This is sometimes used as a home treatment for people with severe, but stable COPD.

Oxygen therapy

If your oxygen levels are low, your consultant may recommend home oxygen therapy to restore your oxygen levels to normal. Oxygen therapy doesn’t make breathing easier but can prevent your blood oxygen level from becoming dangerously low.

Oxygen therapy involves having oxygen piped from an oxygen cylinder through a face mask or thin plastic tubes in your nose.

You will also be given oxygen if you are hospitalised during an exacerbation. 

Surgery 

Surgery is only an option for a small percentage of people with COPD, but in rare cases, your consultant may recommend an operation to treat severe lung damage.

As these procedures carry the risk of serious complications, your consultant will only consider this option if all other treatment options are no longer proving effective.

If you don’t smoke, are strong enough for surgery and recovery, and have participated in a pulmonary rehabilitation programme, you may be eligible, and your consultant will discuss the risks and benefits of surgery with you before your operation.

There are three main surgical procedures to treat COPD:

• Lung volume reduction (LVR): a procedure where the damaged parts of your lung are removed to allow the healthy parts to work better
• Bullectomy: a procedure to remove air pockets called bullae from your lungs, allowing your lungs to work better and make breathing easier
• Lung transplant: an operation where your damaged lung is removed and replaced with one from a donor
  

Untreated COPD can cause irreversible lung damage and lead to other health complications including:

• Frequent chest infections, such as pneumonia 
• Right-sided heart failure (cor pulmonale) 
• Overproduction of red blood cells (secondary polycythaemia) 
• Respiratory failure 
• Pneumothorax (collapsed lung) 
• Lung cancer 
• High levels of carbon dioxide in your blood (hypercapnia)
• Low levels of oxygen in your blood (hypoxia)
• Pulmonary hypertension
• Depression and anxiety

If you are diagnosed with COPD, it’s important to follow your consultant’s advice regarding changes to your lifestyle, taking your medications correctly and having regular check-ups.

The best way to prevent developing COPD is to avoid smoking or quit if you already smoke. You can also help prevent COPD by avoiding exposure to irritants such as second-hand smoke, dust, air pollution, and chemical fumes.

While COPD is a chronic condition that cannot be cured, there are treatments available to help manage your symptoms, slow the progression of the disease and improve your quality of life.

To help manage your symptoms, you can:

• Avoid exposure to lung irritants and things that may exacerbate your symptoms such as cold air, second-hand smoke, dust and strong fragrances
• Eat a healthy, nutritious diet. Our expert team of registered dieticians can offer advice on what to eat and what to avoid
• Take all your medications as prescribed by your consultant, and ensure you always have sufficient medication available 
• Keep all your follow-up appointments with your consultant, physiotherapist, occupational therapist or other members of your healthcare team 
• Learn how to use your medical devices such as inhalers, nebulisers, oxygen therapy and non-invasive ventilation devices correctly 
• Be prepared for an exacerbation of your COPD by knowing what signs to look out for, what medications to take and when to go to the hospital or call an ambulance 
• Take steps to manage your mental health, including talking to loved ones, joining support groups or having counselling
• Avoid infections where possible by staying up to date with all your recommended vaccinations, washing your hands frequently, avoiding contact with people with respiratory illnesses and regularly disinfecting surfaces
  

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about COPD treatment, book your appointment online or call a member of our team today.

1. Chronic obstructive pulmonary disease (COPD), NHS
2. What is COPD? National Heart, Lung and Blood Institute
3. COPD (chronic obstructive pulmonary disease), Asthma + Lung UK
4. Chronic obstructive pulmonary disease complications, National Institute for Health and Care Excellence