COPD - Emphysema / Chronic Bronchitis

COPD at Dartmouth

Emphysema & Chronic Bronchitis are now known by doctors as COPD - Chronic Obstructive Pulmonary Disease. We have approximately 150 people in Dartmouth Medical Practice known to have COPD, but the likelihood is that there are 2-3 times as many more people who smoke or used to or who have had exposure to smoke whom we do not know about yet.

 COPD is the fourth leading cause of death in the USA behind heart failure, stroke and pneumonia. In addition, low mood can be a major problem for those whose activity is limited by shortness of breath and who have frequent problems with coughs and chest infections.

Do I have COPD

If you have chest infections every winter and are troubled by regular phlegm in the morning and feel less able to do work than before due to shortness of breath please come and see us. Any of the GPs or our respiratory nurse Jackie Cleaves would be happy to see you. There are some relatively easy breathing tests called spirometry which we can do at the practice which can confirm if there is something we can help with.

How Can We Help?

If you smoke the most important thing is to stop and WE CAN HELP WITH THIS - SO TRY US!!.

In addition there are various inhalers which either help open the airways (reducing wheeze) or help reduce inflamation and phlegm.

We can also discuss with you how best to treat likely chest infections as easily as possible, In some cases people may have a supply of tablets at home just in case.

Everyone can benefit from immunisation advice against influenze and pneumonia. Some people may find that their breathing problems can lead to feeling really down and low. If you feel this is you or it is true for your friend / partner, it can often help to raise this as an issue with the nurse / GP.

Other Options

- Torbay Hospital
Some people may benefit from assesment by a consultant, particularly if they are severe, to be considered for nebulizers or oxygen therapy - either for regular use or just a supply for when out and about.

- Respiatory Rehabilitation Course
Jackie Cleaves currently runs an 8 week course aimed at encouraging people to be as active as possible. Studies have shown this can considerably reduce a persons risk of being breathless.

Medications

Short Acting Airway Openers / Relievers

1. Salbutamol / Ipatropium
Usually it is much more effective to use either of these with a 'spacer' device between the inhaler and your mouth. If you do not have one raise this with the nurse / GP as your next visit.

2. Combivent
This is a combination of salbutamol and ipatropium and shoud be used 2 puffs, 4 times a day as a general rule. If neccesary salbutamol can be used inbetween if you have agreed this at some time with the nurse / GP.

Long Acting Preventers

Airway Openers

1. Salmeterol
This is a long acting form of salbutamol and has been shown to reduce exacerbations and admissions. You should also be on a steroid inhaler if you are on this (see below). The usual dose is 2 puffs two times a day. Again, better through a 'spacer'.

2. Tiotropium
This is a long acting form of Ipatropium and has similarly been shown to reduce exacerbations and admissions. It has its own inhaler device which is easy to use. We will usually suggest a 6-8 week trial of this. If you do not feel it helps, it can be stopped.

3. Steroid Inhaler - Reduces secretions / mucus.
There is evidence that a reasonable dose of steroid inhaler is important for reducing excerbations of COPD for those with moderate or severe disease. Please do discuss this with us if you are not using one.

There are other forms of medication which can dilate the airways or attempt to reduce phlegm which are helpful for a few people.

Spacer use
A spacer provides an air chamber within which the droplets of your inhaler can disperse and become finer before being breathed in. As a result the droplets can get further into your lungs and help more. (It is easier to use than just the inhaler on its own).

It is best to pump one spray into the spacer and take 10 deep breaths from it, then pump again and take another 10 breaths. If you are unsure about this, please discuss with the nuse.

Oral Steroid Tablets / Antibiotics
If you have a worsening of your shortness of breath, your GP / Nurse will often advise you to have a course of steroid tablets and antibiotics. It is worth asking if you might have a supply at home to start as soon as you feel any wheeze worsening if your phegm has also turned a yellow / green colour.

Management Plans
We are increasing trying to ensure that those patients with severe COPD have a written instructions leaflet for times when they think they are worsening. This guides them about the use of any home supply of antibiotics and/or steroids.

Dr J Uhr Delia