COPD

Chronic obstructive pulmonary disease (COPD) is a term for a group of lung conditions (for example, chronic bronchitis and emphysema) and can lead to damaged, 'obstructed', airways. The symptoms are usually a combination of:

• Increased breathlessness, especially when moving around
• Persistent cough and phlegm
• Frequent chest infections, especially in winter
• Wheezing
• Cigarettes

The main cause of COPD is smoking, but there can be other causes, for example, occupational factors such as coal dust and, in a few cases, it is hereditary. There is also research being undertaken into whether pollution may be a cause.

The quicker it is diagnosed, the more likely it is to slow down the disease's progression, which is why it is so important to get COPD diagnosed as soon as possible and to start treatment straight away.

At the COPD, PR and Oxygen Service, we have specially trained COPD nurses and physiotherapists whose main aim is to help the patient manage their symptoms and lead a normal life.

How the service can help

The COPD nurses based at the service are able to help patients with:

• Information about their condition
• Information about inhalers and inhaler technique
• Information and assessment for nebulisers
• What to do when a patient has a flare up (exacerbation) and how to spot the early warning signs of an infection
• Support with their COPD
• Optimising their medication
• Can refer to other health care professionals and to Pulmonary Rehabilitation if appropriate

The COPD nurses are available Monday to Friday 9am until 5pm to take calls and answer any queries or concerns in regards to a patient's COPD. If there isn't a nurse available when the patient calls, the nurse will always call back.

What is an exacerbation?

An exacerbation is a flare up of COPD symptoms. The signs can include:

• Increased breathlessness (more than usual)
• Reduced walking distance
• Increase in coughing
• Changes in the amount/colour/thickness of phlegm
• Chest feeling tight
• New or increased wheeze

If there two or more of these symptoms are present in the patient, they need to act quickly to treat the flare up. Treatment is usually with antibiotics and steroids, increased use of reliever inhalers and/or nebulisers, to help their chest to recover from the exacerbation.

The patient must take it easy when they have a flare up and balance out activity with periods of rest.

Most patients will be encouraged to have a self management plan and a 'stand-by' or 'rescue' pack of antibiotics and prednisolone that they can start taking when they have these symptoms. However, if none of these measures are in place, then the GP or practice nurse must be contacted as soon as possible to arrange for a review and appropriate treatment.

More serious symptoms that may need emergency medical attention are:

• Difficulty in breathing
• The patient is no better after two days of treatment
• The patient is drowsy, confused or agitated
• There is chest pain
• There is a high fever
• The patient has increased swelling of the ankles
• The patient feels they cannot cope at home
• Emergency medical attention may come in the form of an urgent consultation with a GP or calling 999 for an ambulance.

If the patient has any concerns in regards to their symptoms, they can contact the service.

Received an appointment from us?

GPs, practice nurses, community nurses and hospital staff are the main people who will ask us to see patient's with COPD for help and advice. This will usually be discussed with you before the referral is made.

Many patient's with COPD have been admitted to hospital with an exacerbation and the hospital may automatically 'alert' us of this. If this happens we will be in touch to offer an appointment with the specialist nurse or physiotherapist for an assessment to see if we can help with treatment or advice to try and prevent another admission.

If any patient receives an appointment and is not sure why, please call us.

COPD Early Supported Discharge

Patients who are admitted with an exacerbation (flare up) of COPD will be assessed to see if they could be discharged earlier from hospital with the support at home of the specialist COPD team.  The new scheme will initially run for 6 months and will be closely monitored to see how effective and acceptable it is to patient's.  As this is not a hospital admission avoidance service we do not accept A&E or community referrals.

The scheme is available from 9am-5pm Monday to Friday and patients will be seen at home until their symptoms have improved.  The service will also optimise COPD treatment, undertake further assessment if needed and encourage and support self-management and referral to Pulmonary Rehabilitation.