chronic lung disease needs early treatment
by Jenny Bryan
Derry Cunningham ignored his coughing and breathlessness for eight years before he sought help from his doctor. A lifelong smoker he, like thousands of others who can't give up their cigarettes, thought his breathing problems were only to be expected and he didn't ask for sympathy. It wasn't until he collapsed at the 18th hole of his golf course that he was forced to accept there was something really wrong.
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'Today, I couldn't walk the length of one hole, never mind a whole course. I'm all right when I'm sitting down, it's when I try to do anything that it's so difficult. I feel so helpless. Two ladies in their 80s offered to help me the other day, and they're 20 years older than me,' Derry explains.
He has chronic obstructive pulmonary disease – COPD for short. COPD is a blanket term which covers the 'cough and spit' of chronic bronchitis and the gradual destruction of the air sacs and fine tubing in the lungs which occurs with emphysema. The result is a progressive narrowing of the airways, making it increasingly hard to breathe.
COPD is making its relentless way up the international league tables of ill health. Ten years ago, it was the sixth leading cause of death around the world. Today, it has reached number five and, by 2020, it is expected to rank third amongst the leading causes of death, just behind cancer and heart disease.
too embarrassed to seek help
Most, though not all, people with COPD are smokers, and this is the secret of the disease's success. Smokers don't tend to complain about the early symptoms of COPD because they assume that their coughs and chestiness go with the territory and, by the time their lives are seriously affected by their diseased lungs, it's too late.
'COPD is a spectrum of disease from mild to severe and the challenge is to get people before it becomes severe and we can't reverse it,' explains Professor Robert Stockley, from Queen Elizabeth Hospital, Birmingham.
'We all lose some lung function as we get older, but this is greatly accelerated with COPD. People put an awful lot of things down to ageing and it's only when people find it hard to walk upstairs or get washed in the morning that the penny drops and they seek help. But we need to see them before they reach this disabling stage,' he adds.
A recent international telephone survey revealed just how stoic the British public is when it comes to COPD. Nearly 70% of COPD patients who took part reported coughing and breathless, but nearly a third hadn't even had a proper diagnosis.
'Some of these people were breathless just talking to the interviewers, but they weren't complaining, which is one reason why COPD hasn't attracted the attention it deserves,' says Professor Peter Calverly, from University Hospital Aintree, Liverpool.
what can be done?
There is no magic cure for COPD, even in the early stages. Smokers are encouraged to give up their cigarettes because it is the toxic chemicals in tobacco smoke which irritate and damage the airways so that they become stiff and tight. Stopping smoking isn't easy, but you can improve your chances of success by checking out your local smoker support programme (see how to quit smoking in the drugs section).
Bronchodilator drugs (see the abc of body under 'bronchodilator') can relax the airways and keep them open. These drugs don't work as well as they do in asthma (see the abc of body under 'asthma') because the airway narrowing which occurs in COPD is less reversible than in asthma. But some relaxation of the airways may not only help with breathing, it may also improve the clearance of mucus from the lungs which in turn reduces the risk of a chest infection.
It is recurrent infection and worsening of symptoms – called exacerbations – which doctors like Professor Stockley are trying so hard to prevent.
'Most people get over a chesty cold without too much trouble but these episodes can be very serious for someone with COPD, and the more exacerbations they have, the worse their lung function becomes,' he says.
treating exacerbations
Exacerbations of COPD are treated with a course of steroid tablets, usually for 1-2 weeks. These drugs damp down the swelling and mucus which has built up in the airways and made breathing so difficult.
Whether people with COPD should regularly take inhaled steroids, like many of those with asthma, is hotly debated. Recent research has suggested that some people with COPD do benefit from daily doses of inhaled steroids, particularly those with severe disease who have had several exacerbations. More studies are underway to try to produce a definitive answer over who should take inhaled steroids.
making a good recovery
Exercises and physiotherapy can make a big difference to recovery for someone who has an exacerbation. A programme of activities specifically tailored to the individual needs of someone with COPD can help them do just that little bit more than they thought they could – whether it's getting to the shops, walking to a friend's house or getting up to make a cup of tea. Services vary but it's well worth finding out what community or hospital-based support is available in your area.
getting the most out of life
At all stages of COPD, treatment should be geared to enabling you to get as much out of life as possible. Specialists are aware that they sometimes focus too much on trying to improve the results of lung function tests and not enough on helping people achieve the goals which matter to them. So it's important to tell your doctor what your priorities are.
Dr Darryl Freeman, a GP from Leicester, lists five questions whose answers can help people with COPD tell her how well they are doing:
- Has your treatment made a difference?
- Is your breathing easier in any way?
- Can you do some things now that you couldn't do before?
- Can you do the same things as before but are now less breathless when you do them?
- Has your sleep improved?
'We have to be aware of the symptoms and problems which people have in their everyday lives, not just use lung function tests to define our success. Our patients' way of defining success may be quite different from our own, and we need to be aware of what it is,' she says.
help and info
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organisations
British Lung Foundation
73-75 Goswell Road
London EC1V 7ER
Tel: 020 7688 5555 (Mon-Fri 9am-5.30pm)
E-mail: enquiries@blf-uk.org
Website: www.lunguk.org
The only charity funding research in the prevention, diagnosis, treatment and cure of all lung diseases. Runs the Breathe Easy Club which offers information and support to people with lung diseases (including COPD) and has approximately 20,000 members and over 120 groups. See the website for more details about the Breathe Easy Club, and information on COPD.
Quit
211 Old Street
London EC1V 9NR
Quitline: 0800 00 22 00 (every day 9am-9pm)
E-mail: stopsmoking@quit.org.uk
Website: www.quit.org.uk
Aims to help smokers to stop smoking by offering confidential help and advice about every stage of quitting – whether you are just thinking about stopping, have quit for just a short time or are an ex-smoker trying to stay stopped. Can also provide callers with details of local Stop Smoking groups and clinics. Website contains helpful guides, tips, and questions and answers on how to stop smoking.
NHS Stop Smoking Services
Helpline: 0800 169 0 169 (every day 7am-11pm)
Pregnancy Smoking Helpline: 0800 169 9 169 (12-9pm)
E-mail: Go onto the website to e-mail the 'Ask an Expert' service or to receive help from the E-mail Motivator.
Website: www.givingupsmoking.co.uk
Information and support for anyone concerned about smoking. Offers help and advice to those who want to give up.
websites
British Thoracic Society
www.brit-thoracic.org.uk
National representative body for specialist thoracic medicine in the UK. Aims to further the interests of patients with lung diseases. Members include doctors, nurses, physiotherapists, respiratory and lung function technicians. Website has information on respiratory (lung) diseases, including chronic obstructive pulmonary disease.
ASH (Action on Smoking and Health)
www.ash.org.uk
ASH is at the frontline of the anti-tobacco lobby. The site contains lots of information on the history and politics of the tobacco industry, plus more on health and giving up.
Don't Give Up Giving Up
www.givingupsmoking.co.uk
NHS website with lots of information on the risks of smoking plus practical help for people who want to give up.
reading
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The Chronic Bronchitis and Emphysema Handbook by Dr Francois Haas and Dr Sheila Sperber Haas (John Wiley and Sons, 2000) |
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Chronic Obstructive Pulmonary Disease by P John Rees and Peter Calverley (Martin Dunitz, 2001) |
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Chronic Obstructive Pulmonary Disease: Practical, medical, and spiritual guidelines for daily living with emphysema, chronic bronchitis, and combination diagnosis by Mark Jenkins (Hazelden Information & Educational Services, 1999) |
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Coping with Bronchitis and Emphysema by Tom Smith (Sheldon Press, 1994) |
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(November 2001, resources updated January 2005)
