Chronic obstructive pulmonary disease (COPD) overview
What is COPD?
COPD is a term used to describe a group of lung problems that cause a reduction in the movement of air through the airways. The conditions included in this term are: emphysema, chronic bronchitis, bronchiectasis, poorly controlled asthma, and cystic fibrosis.
It is important to learn some medical words and see the parts of the body involved. Below is a picture of the outside and inside of the lungs. The bronchi are the large airway tubes that take oxygen to the tiny air sacs called alveoli. The alveoli or air sacs also pick up carbon dioxide from the blood. You then breathe carbon dioxide out of your body through the bronchi.
Emphysema is a disease of the air sacs. When a person with normal lungs breathes in and out, the air sacs and airways open and relax because they are like elastics.
When a person has emphysema, the air sacs collapse because they have lost elasticity. When this happens, air is trapped in the lungs. Over the years, the lungs tend to get bigger. As this happens, the diaphragm and rib muscles also stretch and do not work as well.
As emphysema gets worse, some lung tissue in the small airways and alveoli is destroyed. Small blood vessels that surround the air sacs are also destroyed. This means that there is less surface area for the exchange of oxygen and carbon dioxide.
As part of your treatment, you will learn how to do “pursed lip breathing”. This helps the trapped air move out of your lungs and allows fresh air in.
Chronic bronchitis is a disease of the airways. The bronchial tubes are lined with a thin layer of mucus. This helps trap any foreign particles you breathe in. Mucus and particles are moved out of the lungs by the action of tiny hair-like structures called cilia. Cilia work all of the time moving mucus and particles towards the mouth.
When you have chronic bronchitis, there is extra mucus in the bronchial tubes. This produces a chronic cough, sputum and shortness of breath. The extra mucus leaves less room for air to get through. Thick mucus plugs may form and close the small airways.
Swelling and narrowing of the airways also slow down the action of the cilia making it hard for them to move mucus and particles out of the lungs. This slows the flow of air in and out making it harder for oxygen to pass from the air into the blood.
In bronchiectasis, the airways are damaged by infection. Scar tissue replaces the walls of the airways.
Normally, the bronchial tubes are lined with a thin layer of mucus. This helps trap any foreign particles you breathe in. Mucus and particles are moved out of the lungs by the action of tiny hair-like structures called cilia. Cilia work all of the time moving mucus and particles towards the mouth.
When you have bronchiectasis, the cilia are destroyed. The scar tissue and airway muscles are not able to push this pooled mucus up to the throat to be coughed out. With this extra mucus and bacteria collecting, infections often happen.
People with bronchiectasis often cough up large amounts of mucus every day.
Asthma is an inflammatory condition in the airways which causes shortness of breath, chest tightness, wheezing, coughing and production of mucus. In many people, the airways are very sensitive to substances or events called triggers. The airways swell, produce mucus and the muscles in the airways tighten.
If asthma is not controlled, the airways may become permanently damaged.
Cystic fibrosis is a genetic disorder which causes an over-production of mucus. This often leads to infections that damage the airways.
A COPD flare-up is the worsening of your COPD symptoms. They can begin suddenly and unexpectedly. Everyone experiences exacerbations differently, but it may take around 30 days to return to your usual health. If you have pneumonia, you may have symptoms for about 6 weeks.
Call 911 or have someone take you to the nearest Emergency Department if…
- You have severe trouble breathing
- You have chest pain
- You have blue lips or fingers
- Your pulse oximeter readings are going down even with treatment
- You feel confused, disoriented, or have trouble speaking in full sentences
Call your family medicine team if…
- Your symptoms are worse than usual (coughing, wheezing, shortness of breath)
- The colour, thickness, or amount of mucus changes
- You feel more tired than usual for more than one day
- You have new swelling in your legs or ankles
- You have more trouble sleeping than usual
- You feel the need to increase your oxygen levels (if you are on oxygen)
- Your oxygen levels are lower than usual (if you measure your oxygen levels)
Early signs of a COPD flare-up
You can often tell when a flare-up is about to begin. You may notice increased shortness of breath, sore throat, cough, tiredness and cold symptoms.
If you catch a flare-up in time, it can be easier to treat. Treating a flare-up early can also save you from having to go to the hospital. The key is to pay attention to the early warning signs of a flare-up:
- Feeling more short of breath than usual
- Yellow, green or brown sputum
- An increase in the amount, thickness and stickiness of sputum
- A fever
- Needing to sleep sitting up instead of lying down
- Morning headaches, dizziness, trouble sleeping
- Swollen ankles or feet or feeling bloated or swollen in your abdomen – you may feel like you have to loosen your belt or waistband
- Feeling unwell
- Feel sleepy during the day or fall asleep when you did not expect to
- Have personality changes such as feeling confused, restless, agitated or forgetful
If you have any of these signs, contact your doctor or health care provider right away. Family members and friends should also watch for these signs as they may see them before you do.
Monitoring your illness
Your family medicine team will monitor you regularly. It is helpful if you record your symptoms (including whether they are better or worse), and any information such as pulse oximeter readings, temperature, pulse, and breathing rate to discuss with your healthcare provider.
How to use a pulse oximeter
If you use a pulse oximeter to measure the oxygen levels in your blood, here are some instructions that may be helpful: Information Sheet & Video
If you do not have a pulse oximeter, your family medicine team may have one available to lend you.
When you are short of breath, you need to relax and control your breathing. The sensation of breathlessness is not harmful.
Shortness of breath
Breathlessness – or shortness of breath – is very common for people with COPD. Some people feel breathless most of the time, while others are short of breath only when walking or exercising. Good nutrition, enough sleep, anxiety control, regular physical activity and healthy environment can limit your breathlessness.
Being short of breath can be scary but there are some things you can do to make it easier. Some items that may help you relieve shortness of breath include walking aids and learning breathing exercises. Some people find using a fan in front of their face helps relieve symptoms of shortness of breath. Below are types of breathing that can help you. Please speak with your healthcare provider to see if they are right for you. It is also a good idea to practice these types of breathing exercises with your respiratory educator to make sure you are doing them properly.
Managing shortness of breath
Should you become short of breath, try to follow these steps:
- Keep calm, relax your neck and shoulders
- Remove yourself from the area if there is a trigger (i.e. cat, strong order, smoke, etc.)
- Stop and rest in a comfortable position (see below)
- TRY not to gasp for air
- Breathe in slowly through your nose
- Purse your lips, breathe out slowly, like whistling
- Breathe out twice as long as you breathe in
- Once you have regained control of your breathing, continue with your activity
Pace yourself, but don’t limit your activity.
Controlling your breathing
Feeling short of breath can make you panic and breathe faster than normal. This can send your breathing out of control. In addition to pursed-lip breathing, here are some tips you can use to control your breathing if you feel shortness of breath coming on:
- Stop and rest comfortably
- Breathe through your mouth
- Breathe in and blow out as fast as necessary
- Begin to blow out longer. (Used pursed-lip method if it works for you)
- Slow down your breathing
- Begin to use your nose when breathing in
- Once your breathing is under control, try diaphragmatic breathing
When you feel better, stay in the resting position and continue pursed-lip breathing for five minutes or until you feel back to normal.
Positioning your body properly can help reduce breathlessness as well. Poor posture can make it difficult to breathe. Keeping your back straight will help.
- Place both feet on the ground
- Lean head and shoulders forward slightly.
- Rest your forearms on your thighs
- Keep your wrists and arms relaxed
You may also choose to lean forward with your forearms resting on a table for support.
- Spread your arms shoulder-width apart
- Rest forearms over a stable standing-level surface, such as a countertop, windowsill, bar, etc.
- Relax your shoulders
- Stand with one leg slightly forward, bent at the knee
- Lean your back against a wall, chair or counter
- Place your feet slightly apart
- Relax and lean your head and shoulders forward slightly
- Rest your hands lightly on your thighs or a piece of furniture
Budgeting your energy
Pace and plan your tasks so you can conserve energy wherever you can. These can be simple changes to your routine like limiting the number of times you need to walk upstairs, or sitting down while preparing supper.
Emotional stress can cause you to feel breathless. Here are some ideas for coping with anxiety to get your breathlessness under control.
- Think ahead and try to avoid situations that cause you stress
- Make plans for situations you cannot avoid. For example, this can mean arranging for a wheelchair if you are flying somewhere
- If you start feeling anxious, sit down, relax and practice pursed-lip breathing
- Talk to your friends and family about what makes you anxious. If they know, they can help you
- Consider therapy for your anxiety
- Relax and try to remember that not everything needs to be done in one day
- If you need help managing your anxiety, please speak with your primary health care team
This type of breathing helps to let out stale air and slow down your breathing. As you practice, try to exhale (breathe out) twice as long as you inhale (breathe in).
- With your mouth closed, breathe in a normal amount of air through your nose
- Purse your mouth as if you are whistling
- Keeping your lips pursed, slowly blow the air out through your mouth
The diaphragm is the main breathing muscle. If you know how to control this muscle well, it can help you with breathlessness. It is not hard.
- Relax your shoulders and sit comfortably in an easy chair
- Place your hands lightly on your stomach
- Breathe in slowly through your nose. Your stomach should rise under your hands
- Breathe out slowly through pursed lips. Your stomach should fall
Since there are many causes for COPD, there are many treatments. Your treatment will depend on your health problem. You will follow the best treatment care plan for your own problem. The goal of treatment is to improve your breathing and airflow. Members of your health care team will help you meet your goals.
Optimize your breathing
Learn how to breathe
- Slow your breathing. Make sure breathing out takes longer than breathing in. Try not to force the air out
- As you breathe out, tighten your lips as if you are breathing out through a straw. This is called pursed-lip breathing. If you have emphysema, make sure you breathe out with pursed lips
- Do not hold your breath. Breathe normally in and out when you do your daily activities such as shave, apply makeup, climb stairs, lift things and bend over
Cough and clear your sputum
- If you have sputum, you must cough it up. You should try to cough sputum up at least 4 times a day. Try taking some water before you cough.
- If you cough up blood, contact your doctor
Avoid things that affect your breathing
- If you smoke, you must stop. If you continue to smoke you will continue to damage your lungs. If you need help quitting smoking, please speak with your primary health care team
- Avoid strong smelling sprays, perfumes, fumes and things you are allergic to
- Cover your nose and mouth when you go into cold air
- Stay indoors on high pollution days
Start and maintain an exercise program
Regular exercise is very important. Muscles that are in good condition work better and produce less carbon dioxide. Exercise helps you use your oxygen better. You may learn to adjust your medication before and during exercise. For example, many people use a bronchodilator inhaler before they begin to exercise. This opens the airways to help them breathe better.
Eat a balanced diet
It is important for you to follow a balanced diet. Some people find shortness of breath makes it hard to eat enough food. If you need help with meal planning, you can speak with your primary health care team, and they can help connect you with a dietician.
Attend your clinic appointments
Please bring all of your pills, inhaled medications and devices such as an Aerochamber® to each appointment. If you can’t bring in all your medications each time, it might be helpful to have a written list of them that you can bring to your appointments.
When you come for your visits be prepared. Make sure you know:
- All of the medications you currently take
- The medications that will expire and need re-ordering by a member of your health care team
Practice good hand hygiene
It is important to wash hands often to prevent infection.
- Before and after eating
- After using a bathroom
- After coughing or sneezing
- When entering or leaving a hospital, health care centre or doctor’s office
Remind others to wash their hands too.
Steps to washing hands
- Wet hands with warm water
- Apply soap
- Rub hands together for 20 seconds. Wash fingertips, nails and between fingers
- Rinse with warm water for 10 seconds
- Dry hands with a paper towel
- Use a clean paper towel to turn taps off
Clean surfaces in your home
It is important to regularly clean surfaces in your home that people touch often to prevent infection.
Respiratory Inhaler Identification Chart by GlaxoSmithKline Inc.
COPD Inhaler Guide by Chronic Obstructive Pulmonary Disease Association
How to use a puffer with a spacer (adult)
How to use a puffer (metered dose inhaler)
How to use a HandiHaler® (dry dose inhaler)
How to use a RESPIMAT® (mist inhaler)
How to use an AeroChamber Plus® Flow-Vu® with a mouthpiece
How to use an AeroChamber Plus® Flow-Vu® with a ComfortSeal® mask
How to use an AeroChamber®
“A COPD Handbook” by Canadian Lung Association
Community rehab programs for COPD currently offered in Hamilton, ON
Compass Community Health – Caring for My COPD
Caring for My COPD is a 10- week community based pulmonary rehabilitation program for people who have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) including those recently hospitalized due to COPD.
*Currently offering both in-person and virtual care options
Meridene Haynes, BSc(Kin), RCPT(P), CRE Coordinator, Caring for My COPD Pulmonary Rehab Program COMPASS Community Health 905-523-6611 ext 3005
438 Hughson Street North Hamilton, ON L8L 4N5
Monday 8:00 am – 8:00 pm Tuesday 8:00 am – 8:00 pm Wednesday 8:00 am – 8:00 pm Thursday 8:00 am – 8:00 pm Friday 8:00 am – 4:00 pm
- Upload this referral form to EMR and then efax to center
- Accept e-referrals and they are live on the OCEAN platform to accept referrals
St. Joseph’s Healthcare Hamilton – Respiratory Rehab Program
Respiratory Rehabilitation is an education and exercise program that promotes patient self-management skills for chronic respiratory diseases.
This is an 8-week long Day outpatient Program where patients come from home three days per week.
In a small group, patients take part in class presentations and therapy taught by members of the health care team in the Respiratory Rehabilitation Program.
Tel: 905-522-1155 Ext. 35811 Fax: 905-523-5864
Firestone Institute for Respiratory Health St. Joseph’s Healthcare Hamilton 50 Charlton Avenue East Hamilton, ON
- The Firestone Ambulatory clinic accepts community referrals for assessment and consultation for admission to this program
- Family doctors and specialists complete a referral by contacting the Respiratory Rehabilitation Program Intake office at 905-522-1155 Ext. 35811
We acknowledge the information contained on this page derives from the following sources: