COPD – chronic obstructive pulmonary disease

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COPD is a disease that affects the lungs and airways. The disease makes you more difficult to breathe and can cope less. COPD develops slowly over several years and is mainly caused by tobacco smoking. Treatment usually reduces the hassle.

Symptoms of chronic obstructive pulmonary disease

At COPD several of the following symptoms are common:

  • You become breathless as you exert yourself.
  • You feel tired and less able.
  • You increasingly need to cough up mucus.
  • You have wheezing, rattling or wheezing, especially during exertion.
  • You often get respiratory tract infections.
  • You lose weight and get swollen feet.

The problems with COPD come slowly and you may not always see them as a sign that you are ill. Many people who smoke, for example, get used to coughing up mucus, which is one of the most common symptoms of COPD. You may also consider it as normal aging that your lungs function poorly and that you cope less and less as you exert yourself.

COPD can be similar to asthma

It is sometimes difficult to distinguish COPD from asthma. Both COPD and asthma are common diseases.

The respiratory distress at COPD is developing slowly, over many years. In the case of asthma, however, you usually notice clearly when asthma begins and you also have more frequent attacks of shortness of breath. Allergic diseases are also more common among people with asthma than those with COPD.

When and where should I seek care?

Contact a health care center if you think you have COPD or if you have COPD and have an airway infection. You can contact many receptions by logging in.

If you have COPD and find it difficult to breathe in spite of treatment at home, contact a health care center or an on-call reception immediately. If closed, seek medical attention at an emergency room

What is COPD?

COPD is largely caused by tobacco smoking. In tobacco smoke, there are a number of toxic substances that can cause inflammation in the trachea. The inflammation causes changes in the tissues of the lung that are typical of COPD.

If you have never smoked

It is unusual to get COPD if you have not been a smoker. Then the disease may be due to the lack of a protective substance, alpha-1-antitrypsin. It increases the risk of COPD.

Even passive smoking, dust and gases in some environments for a very long time can cause COPD in people who have never smoked.

COPD is a common disease

It is difficult to say exactly how many people have COPD. Based on studies, it is estimated that between 400,000 and 700,000 people in some parts of Europe have COPD.

The disease is unusual in people under 40. Among people who have smoked for many years, about half have COPD at the age of 75.

Surveys

Often it may be enough to describe your symptoms to a doctor to make them suspect you have COPD. Then a body examination is done.

There is usually nothing particularly noticeable in the body examination if you have a mild form of COPD. However, there are often clear signs if you have had the disease for a long time and have a more severe form of COPD. For example, it may be one or more of the following symptoms:

  • You breathe quickly and with prolonged exhalation even with lighter effort.
  • You have received an enlarged chest.
  • You have lost a lot of weight.
  • Your feet and lower legs have swelled.

Spirometry and reversibility test

A spirometer is a device that measures how your lungs work. A spirometry measurement shows how much air you can blow out and how fast you can blow out the air.

The examination is done after you have inhaled a drug that dilates the trachea. It’s called reversibility testing.

The examination proceeds as follows: First, you may inhale an airway dilating agent. Then you breathe in everything you can. Then you breathe out as much as you can and as quickly as you can in the device.

Blood tests exclude other illness

At the beginning of the investigation, you will be given blood samples. It is mainly done to exclude other diseases. There is no specific blood test to show if you have COPD or not.

You may have a more severe COPD early if you are deficient in the protein alpha-1-antitrypsin and at the same time are smokers. The level of alpha-1 antitrypsin in the blood can be measured in a blood sample.

Your lungs are x-rayed

You will also be examined for a pulmonary x-ray if the doctor suspects you have COPD. It is mainly to exclude other lung diseases. Pulmonary x-rays may show signs suggestive of COPD, but the diagnosis can never be determined solely by X-ray.

Sometimes a layer X-ray of your lungs needs to be done, a so-called computed tomography. On this one, it is seen in more detail how different parts of the lungs have been altered by the disease.

A layer X-ray is sometimes done for the doctor to be able to make a more accurate diagnosis. It can also be done if your doctor thinks you would feel better about having pulmonary emphysema.

ECG examination

It is common for you to be examined with ECG. The purpose is to detect heart disease, which can sometimes cause symptoms very similar to those of COPD. In addition, the ECG examination can show whether COPD has affected the heart.

Different stages of COPD

COPD is divided into the following four stages, depending on how the spirometer examination showed that the lungs were functioning:

  • Stage 1, preliminary stage for COPD.
  • Stage 2, mild COPD.
  • Stage 3, moderate COPD.
  • Stage 4, severe COPD.

COPD can cause different problems in different people. Therefore, the classification above is supplemented by a further scale. It describes how much trouble you have and any deterioration periods. That scale also consists of four stages: A, B, C, and D.

Treatment at COPD

The damage that has already been done to the lungs cannot be repaired. Therefore, the treatment at COPD is to try to prevent further deterioration. The earlier you seek help, the better treatment you have.

If you have severe COPD, a large part of your care is about finding ways to make your everyday life work as well as possible. 

Most important to stop smoking

The most common thing is that the disease is due to smoking and then it is absolutely important to quit smoking and not start again later. Smoking cessation is the only thing that can stop the development of the disease.

Most people feel better when they have stopped smoking. There is a good support to get if you need help to quit.

Help quit smoking

Healthcare has resources and methods to help people quit smoking. If there are special smoking cessation centers near you, you can contact them.

Nurses and doctors at a health center can help and guide you when you stop smoking. It may be easier to quit if you have the opportunity to talk to an experienced person about expectations and problems with smoking cessation.

You may also need to use some medicine to quit smoking  The drugs reduce the craving for nicotine or block the positive effects of nicotine.

Medicines can relieve

None of the drugs used in COPD can stop the disease itself. The drugs are mainly used to reduce the daily problems.

Sometimes you can also get medicines to reduce the number of periods when you feel worse. The periods are called exacerbations. They often cause severe problems and are a major problem for some people with COPD. The deterioration periods are usually due to respiratory tract infections.

You usually do not notice any problems if you have a mild form of COPD. Then you do not need to take any medicine at all except those used for smoking cessation.

The different types of drugs used in COPD are as follows:

  • bronchodilator drug
  • cortisone
  • special medicines for periods of deterioration
  • oxygen.

Respiratory widening agents

You usually get a bronchodilator drug if you have mild to moderate COPD and only notice the symptoms sometimes. You inhale the drug through an inhaler. It may suffice to use a fast-acting bronchodilator drug when needed.  

If you have major problems with COPD, you will often also need to inhale one or two respiratory widening medicines that are long-lasting. 

Cortisone can help when the disease becomes more severe

You sometimes need cortisone in combination with drugs that widen the trachea if you have moderate to severe COPD and have recurring periods of deterioration. The cortisone is inhaled through an inhaler.

You may receive cortisone in tablet form as a short-term treatment during periods of deterioration. The treatment can shorten such periods. However, you should avoid using cortisone tablets regularly as the side effects can be severe.

Other medicines for periods of deterioration

You may sometimes be able to use a drug with the active substance roflumilast if you have moderate or severe COPD and have periods of aggravation with a lot of trouble with mucus. The drug is called Texas.

Acetylcysteine ​​is a water tablet that dissolves in water. Acetylcysteine ​​has long been considered to have an expectorant effect, but no such effect is proven when taken as a tablet. In some people, however, acetylcysteine ​​can protect against deterioration periods. Therefore, you can sometimes get to try the drug.

You evaluate the results with the doctor

It is important that you, together with your doctor, make an evaluation of each drug that you get to try. Examination with spirometry can provide some guidance, but most important is how you feel yourself.

Help from physiotherapists and occupational therapists

The more physically active you are, the slower the disease develops. It applies no matter how much your lungs are affected.

A physical therapist or physiotherapist can give you advice and help with physical activity and exercise. Together you can make a plan for how often and in what way you should exercise or move.

A physiotherapist or physiotherapist also provides advice on breathing techniques and how to most effectively get mucus from the airways. They can also help you with techniques to take your medicines.

An occupational therapist can advise you on how to best manage your energy to cope with what you want to do. They can also assess which aids can help you at home.

Oxygen in a hospital or at home

You may need oxygen treatment for COPD in hospitals if you get worse and get temporary oxygen deficiency in your blood.

You may need oxygen treatment at home if you have severe COPD with constant oxygen deficiency in your blood. Home oxygen treatment can only be used if you do not smoke.

A vaccine can prevent deterioration

A virus infection like the flu can be very serious if you have COPD. Therefore, you should vaccinate yourself against the flu every year. You should also vaccinate yourself against pneumococci to reduce the risk of getting severe pneumonia. 

COPD admissions and treatment plan

At many health centers and hospitals, there are special COPD clinics. They usually belong to asthma clinics. At a COPD reception, there are usually doctors, nurses, physiotherapists, occupational therapists, dieticians, and curators.

The team at the reception educates you about the disease and gives advice on how to live as well as possible with COPD. You can also get a treatment plan, which includes information on smoking cessation, diet, exercise and the signs of deterioration that you should be vigilant about.

Pay attention to your inconvenience

Learn to recognize the signs that you are heading into a deterioration period. Then you can prepare early and adjust your treatment. If necessary, contact your healthcare provider. Hopefully you can then shorten the period you are feeling worse. You may need to go to an emergency room and get treatment if your breathing becomes difficult.

What can I do to feel better?

There are several things you can do yourself to feel better.

Important with physical activities

You feel better and can reduce the feeling of shortness of breath if you move physically. It can feel awkward to move when it is difficult and heavy to breathe. But too little physical movement makes you feel even less, which leads to even worse fitness and even more breath.

It is therefore important to try to keep going in a way that feels fun. It can be in the form of everyday activities, such as walking, walking on stairs or cycling. Many can also handle a lighter gym. Sometimes just getting up from time to time from a sitting position can be effective if you have severe COPD. Be sure to adjust the pace of the workout or activities so that you can breathe out between the breaths.

Physical training with a physical therapist is important. This also applies if you have more severe problems.

Many people are helped by practicing different relaxation exercises. A physical therapist can give you tips on various exercises.  

Eat energy-rich foods so as not to lose weight

It is common for you to lose weight when the disease has been going on for a long time. Then you need to eat energy-rich food. You may also need to get dietary advice from a dietician before you have lost so much weight that you have gained weight.

You may find it harder to breathe when you eat a lot and you can also be measured very quickly if you have severe COPD. One tip then is to eat several smaller meals instead of a few large meals.  

Facilitate breathing

When it feels heavy to breathe, try breathing out with half-closed lips. This creates a back pressure that facilitates breathing.

You often have to use extra muscles to get enough air in you, usually the muscles around your shoulders. Then it can be nice to have support for the arms. For example, you can support the elbows on a table.

Try to avoid infections

Try to avoid close contact with people you know have an infection. Wash your hands frequently. It can reduce the risk of you being infected by an infection.

Was out in the sun

Many people with COPD have a low level of vitamin D in their blood. Among other things, it increases the risk of osteoporosis. Being out in the sun is an effective way to increase the body’s ability to form vitamin D.

Learn more about the disease

It is good if you acquire knowledge of the disease so that you can be more active in your treatment. Use the resources available at COPD, and learn what you can do to live as well as you can. 

Most COPD receptions hold group training courses for people with COPD. Ask if there is any such training where you will receive your treatment. 

Living with COPD

Many people have COPD at an early stage when they are diagnosed. Then the inconvenience can be quite small, especially if you have succeeded in quitting smoking. But being informed of a chronic illness like COPD can still mean that you get a crisis reaction.

Knowing that the disease is strongly linked to smoking also causes many to feel shame for having caused their problems themselves. You can get call support from a trustee or other healthcare professional if you feel you need help.

Everyday life can be affected

Many people live a good life even though they have COPD, but some have more difficult problems that affect everyday life more. Then even a smaller body effort can mean that you get severe respiratory distress and need to rest and recover for a long time afterward.

It can feel difficult if you can no longer participate in the activities you previously appreciated. But try to think of what works and do what you can to feel as good as possible.

Through patient organizations, you can connect with others with the disease and share experiences and thoughts. You can also get support from a trustee and other professional groups in health care.

Sequelae

Heart disease is common in people with COPD. During your COPD investigation, it is important that you have your heart examined and that any heart problems are treated.  

You are also more likely to get osteoporosis. This is partly because you are not so physically active. Side effects of cortisone may be another contributing cause. You usually get preventative drugs to reduce the risk of osteoporosis. It is also important that you move, be out in the sun and do not smoke.

It is not uncommon for you to get depression if you are very ill with COPD. You can get support calls and other help through the care. You may also need antidepressants.

What happens in the body of COPD?

As you breathe in, the air passes through the ever-smaller trachea and eventually ends up in the lung bladders, the alveoli. In the lungs are several hundred million lung blisters. There is a network of small blood vessels around each lung bladder. They allow the blood to absorb oxygen from the air you breathe. At the same time, they cause carbon dioxide and other gases to leave the blood. These gases disappear out of the body with the air as you exhale. It is called gas exchange.

Emphysema is formed

At COPD, the lungs receive pathological changes in both the pulmonary vesicles and the smaller airways. Over time, the walls of the pulmonary vesicles are destroyed and larger cavities are formed so-called pulmonary emphysema. There the gas exchange between air and blood stops working. The emphysema makes the lungs function worse and you become more easily breathable.

Sometimes the emphysema is present in large parts of both lungs. Sometimes the emphysema is limited to certain areas of the lungs.

The mucosa is inflamed

COPD causes inflammation of the airways in the airways. Then it becomes swollen and irritated easily. The cells that produce mucus become more and produce more mucus. When the trachea is swollen, it becomes more difficult for the air to come down to the lungs.

In the respiratory tract, there are also fine flickers. Their task is to transport the mucous upwards towards the trachea. The cobwebs are largely destroyed when you have COPD. This makes transport of the mucus worse and you have to cough up much more to get the mucus up.

Greater risk of infections

In COPD, the defense against lower respiratory tract infections is not as powerful as when you are completely healthy. The risk is that infection goes deeper into the airways. Then you get more coughing and harder to breathe.

The lungs and trachea become less resilient

A healthy lung is elastic. It is needed to keep the smaller pipes open so that the air can pass. COPD affects the lungs so that they become less elastic.

There are elastic connections between pulmonary vesicles and trachea. When the lung blisters are destroyed, the connections break. This causes the smallest trachea to collapse as you exhale.

This means, among other things, that certain parts of the lungs are not completely emptied of air. Even in a healthy person, there is air left in the lungs after maximum exhalation. If you have COPD, the number of trapped air increases.

This means that you have to widen your chest and lungs very much to get enough air in you. You may feel like you have to fight to get new air.

The increased amount of trapped air will, over time, increase the size of the chest. Also, the lungs often increase in volume.  

Breathing takes a lot of energy

When you have healthy lungs, breathing work at rest consumes about two to three percent of the body’s entire energy intake. Breathing requires a lot more energy in those with severe COPD. In severe COPD, breathing can require so much energy that you lose weight.

Influence and participate in your care

You can seek care at any medical center or open specialist clinic you want throughout the country. Sometimes a referral to the open specialized care is required.

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare staff . Ask questions if you don’t understand. For example, you should receive information about treatment options and how long you may have to wait for care and treatment.

You have the opportunity to get help from an interpreter. You also have the opportunity to get help from an interpreter if you have a hearing loss. If you need tools, you should get information about what is available and how to get it.

You can get regular health care contact

If you have contact with many different people within the care, you can have a permanent care contact. It is a person who among other things helps to coordinate your care.

More information

The patient version of the National Board of Health and Welfare’s national guidelines for care at COPD

The National Board of Health and Welfare has developed national guidelines for how COPD and a number of other chronic diseases should be investigated and treated. The guidelines contain recommendations to the healthcare system about certain examinations and treatments that may be relevant to treating you with COPD.

In the area there are also examinations and treatments that are done more routinely. They are not included in the guidelines.

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