COPD Treatment
WHAT YOU AND YOUR FAMILY CAN DO TO HELP SLOW
THE DAMAGE TO YOUR LUNGS.
1. Stop smoking. It is the most important thing you can do to help your lungs.
• You can stop smoking.
• Ask for help from a doctor or nurse.
Ask about pills, special gum, or special
patches for your skin to help you stop smoking.
• Set a date to quit. Tell family and friends
you are trying to quit.
Ask them to keep cigarettes out of the house.
Ask people to smoke away from home or smoke outside.
• Stay away from the places and people
that make you want to smoke.
Remove ashtrays from your home.
• Keep busy. Keep your hands busy.
Try holding a pencil instead of a cigarette.
• When the craving is bad, chew gum or a toothpick.
Snack on fruits or vegetables. Drink water.
• Think about quitting just 1 day at a time.
• If you start smoking again, don’t give up! Try to stop again.
Some people have to stop many times before they stop forever.
2. See your doctor. Take medicine the way the doctor says to take it.
Go for your checkups.
Go at least two times a year, even if you feel fine.
Ask to have your lungs tested.
Ask a doctor or nurse how to get a flu shot each year.
Talk about your medicines at each visit.
Medicine comes in many forms such as inhalers, pills, and syrup.
Ask the doctor to write down the name of each medicine,
how much to take and when to take it.
If your doctor tells you to use inhaled medicines, you will
need to learn to use an inhaler.
Bring the medicines or the list of your medicines to each checkup.
Talk about how your medicines make you feel.
After the checkup, show your family your list of medicines.
Keep the list at home where everyone can find it.
3. Go to the hospital or doctor right away if your breathing gets a lot worse.
Plan now for problems in the future.
Put the things you will need in one place so you can act fast.
• Phone numbers for the doctor, the hospital,
and people who can get you there.
• Directions to the hospital and doctor’s office.
• Your list of medicines.
• Some extra money.
Get emergency help if you see any of these danger signs.
• It is hard to talk.
• It is hard to walk.
• Lips or fingernails turn gray or blue.
• The heartbeat or pulse is very fast or irregular.
• Your medicine does not help for very long or it does not help at all.
Breathing is still fast and hard.
4. Keep the air clean at home.
Stay away from smoke and fumes that make it hard to breathe.
• Keep smoke, fumes, and strong smells out of the home.
• If you must have your home painted or sprayed for insects,
do it when you can stay somewhere else.
• Cook near an open door or window so smoke and strong smells can get out
easily. Do not cook near the place you sleep or spend most of your time.
• If you heat with wood or kerosene, keep a door or window open a little to
get rid of fumes.
• Open doors and windows when the air inside is smoky or has strong smells.
Close the windows and stay at home on days when there is a lot of pollution
or dust outside.
5. Keep your body strong. Learn breathing exercises.
Breathing exercises can help you when you are having trouble breathing.
They can strengthen the muscles you need for breathing.
Ask your doctor to explain the breathing exercises that would be best for you.
Walk and exercise regularly.
When you strengthen the muscles in your arms, legs, and body,
you can get around better.
Walking for 20 minutes is a good way to start.
These exercises help build strength in your arms, legs, and body.
There are many others.
When you start, take it slow.
When you feel short of breath, stop and rest.
Pick a place to walk or exercise that you enjoy.
Find exercises that you like to do.
Ask someone in the family
or a friend to join you.
Talk with your doctor about
the right exercise regimen for you.
Eat healthy foods. Get to a healthy weight.
Ask your family to help you buy and prepare healthy foods. Eat lots of fruit
and vegetables. Eat protein foods, like meat, fish, eggs, milk, and soy.
When you eat:
• If you are short of breath when you eat, slow down.
• Talk less when you eat.
• If you feel full easily, eat smaller meals more often.
• If you are heavy, lose weight. It is harder to breathe
and to get around if you are heavy.
• If you are too thin, take extra foods or drinks to help
gain weight and stay healthy.
6. If your COPD is severe, get the most out of each breath.
Make life as easy as possible at home.
Ask your friends and family for help and ideas.
Do things slowly. Do things sitting down.
In the kitchen, bathroom, and sleeping area,
put things you need in one place that is easy to reach.
Find very simple ways to cook, clean, and do other chores.
Use a small table or cart on wheels to move things around.
Use a pole or tongs with long handles to help reach things.
Keep your clothes loose so you can breathe.
Wear clothes and shoes that
are easy to put on.
Ask people to help you move
your things in your home
so you will not need to
climb stairs as often.
Pick a place to sit that you can
enjoy and where others can visit
Plan ahead if you want to go out or go away.
Visit or go out during the part of the day when you feel your best.
Many people feel best right after they take medicine.
Rest after you eat.
Plan to go out at a time when you can get home before
the next dose of medicine needs to be taken.
Do not go to stores at a busy time of day.
Go to places that do not have a lot of stairs.
Bring phone numbers for the doctor
and people who can help you.
Bring medicine if you do not feel well.
If you are not having a good day,
stay home.
Going out of town.
If you will travel far, or will be
gone for more than a day,
ask the doctor what to bring
if you have problems.
Treatments include:
stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
inhalers and tablets – to help make breathing easier
pulmonary rehabilitation – a specialised programme of exercise and education
surgery or a lung transplant – although this is only an option for a very small number of people
A doctor will discuss the various treatment options with you.
Stop smoking
If you smoke, stopping is the most effective way to prevent COPD getting worse.
Although any damage done to your lungs and airways cannot be reversed, giving up smoking can help prevent further damage.
This may be all the treatment that’s needed in the early stages of COPD, but it’s never too late to stop – even people with more advanced COPD will benefit from quitting.
If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to a GP about the stop smoking treatments available to you.
Find out more about stop smoking support or find a stop smoking service near you.
Inhalers
If COPD is affecting your breathing, you’ll usually be given an inhaler. This is a device that delivers medicine directly into your lungs as you breathe in.
A doctor or nurse will advise you on how to use an inhaler correctly and how often to use it.
There are several different types of inhaler for COPD. The main types include:
Short-acting bronchodilator inhalers
For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.
Bronchodilators are medicines that make breathing easier by relaxing and widening your airways.
There are 2 types of short-acting bronchodilator inhaler:
beta-2 agonist inhalers – such as salbutamol and terbutaline
antimuscarinic inhalers – such as ipratropium
Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day.
Long-acting bronchodilator inhalers
If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended.
These work in a similar way to short-acting bronchodilators, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day.
There are 2 types of long-acting bronchodilator inhaler:
beta-2 agonist inhalers – such as salmeterol, formoterol and indacaterol
antimuscarinic inhalers – such as tiotropium, glycopyronium and aclidinium
Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic.
Steroid inhalers
If you’re still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups (exacerbations), a GP may suggest including a steroid inhaler as part of your treatment.
Steroid inhalers contain corticosteroid medicines, which can help to reduce the inflammation in your airways.
Steroid inhalers are normally prescribed as part of a combination inhaler that also includes a long-acting medicine.
Tablets
If your symptoms are not controlled with inhalers, a doctor may recommend taking tablets or capsules as well.
Theophylline tablets
Theophylline is a type of bronchodilator. It’s unclear exactly how theophylline works, but it seems to reduce swelling (inflammation) in the airways and relax the muscles lining them.
Theophylline comes as tablets or capsules and is usually taken twice a day.
You may need to have regular blood tests during treatment to check the level of medicine in your blood.
This will help a doctor work out the best dose to control your symptoms while reducing the risk of side effects.
Possible side effects include:
feeling and being sick
headaches
difficulty sleeping (insomnia)
noticeable pounding, fluttering or irregular heartbeats (palpitations)
Sometimes a similar medicine called aminophylline is also used.
Mucolytics
If you have a persistent chesty cough with lots of thick phlegm, the doctor may recommend taking a mucolytic medicine called carbocisteine.
Mucolytic medicines make the phlegm in your throat thinner and easier to cough up.
Carbocisteine comes as tablets or capsules and is usually taken 3 or 4 times a day.
If carbocisteine does not help your symptoms, or you cannot take it for medical reasons, another mucolytic medicine called acetylcysteine is available.
This comes as a powder that you mix with water. Acetylcysteine powder has an unpleasant smell, like rotten eggs, but this smell should go away once you mix it with the water.
Steroid tablets
If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.
A 5-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as:
weight gain
mood swings
weakened bones (osteoporosis)
Your doctor may give you a supply of steroid tablets to keep at home to take as soon as you experience a bad flare-up.
Longer courses of steroid tablets must be prescribed by a COPD specialist. You’ll be given the lowest effective dose and monitored closely for side effects.
Antibiotics
Your doctor may prescribe a short course of antibiotics if you have signs of a chest infection, such as:
becoming more breathless
coughing more
noticing a change in the colour (such as becoming brown, green or yellow) and/or consistency of your phlegm (such as becoming thicker)
Sometimes you may be given a course of antibiotics to keep at home and take as soon as you experience symptoms of an infection.
Pulmonary rehabilitation
Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD.
It can help improve how much exercise you’re able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing.
Pulmonary rehabilitation programmes usually involve 2 or more group sessions a week for at least 6 weeks.
A typical programme includes:
physical exercise training tailored to your needs and ability – such as walking, cycling and strength exercises
education about your condition for you and your family
dietary advice
psychological and emotional support
The programmes are provided by a number of different healthcare professionals, including physiotherapists, nurse specialists and dietitians.
Improving muscle strength
If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.
This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.
Other treatments
If you have severe symptoms or experience a particularly bad flare-up, you may sometimes need additional treatment.
Nebulised medicine
Nebulised medicine may be used in severe cases of COPD if inhalers have not worked.
This is where a machine is used to turn liquid medicine into a fine mist that you breathe in through a mouthpiece or a face mask. It enables a large dose of medicine to be taken in one go.
You’ll usually be given a nebuliser device to use at home after being shown how to use it.
Roflumilast
Roflumilast is a new medicine that can be used to treat flare-ups.
It is recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers.
Roflumilast comes as tablets and the medicine helps reduce inflammation inside the lungs and airways.
Side effects of roflumilast include:
feeling and being sick
diarrhoea
reduced appetite
weight loss
headache
Long-term oxygen therapy
If COPD causes a low level of oxygen in your blood, you may be advised to have oxygen at home through nasal tubes or a mask.
This can help stop the level of oxygen in your blood becoming dangerously low, although it’s not a treatment for the main symptoms of COPD, such as breathlessness.
Long-term oxygen treatment should be used for at least 16 hours a day.
The tubes from the machine are long, so you will be able to move around your home while you’re connected. Portable oxygen tanks are available if you need to use oxygen away from home.
Do not smoke when using oxygen. The increased level of oxygen is highly flammable and a lit cigarette could cause a fire or explosion.
Find out more about home oxygen therapy.
Ambulatory oxygen therapy
Some people with COPD will benefit from ambulatory oxygen, which is oxygen you use when you walk or are active in other ways.
If your blood oxygen levels are normal while you’re resting but fall when you exercise, you may be able to have ambulatory oxygen therapy rather than long-term oxygen therapy.
Non-invasive ventilation (NIV)
If you’re taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation (NIV).
This is where a portable machine connected to a mask that covers your nose or face is used to support your lungs and make breathing easier.
Surgery
Surgery is usually only suitable for a small number of people with severe COPD whose symptoms are not controlled with medicine.
There are 3 main operations that can be done:
bullectomy – an operation to remove a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
lung volume reduction surgery – an operation to remove a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
lung transplant – an operation to remove and replace a damaged lung with a healthy lung from a donor
These are major operations done under general anaesthetic, where you’re asleep, and involve significant risks.
If your doctors feel surgery is an option for you, speak to them about what the procedure involves and what the benefits and risks are.