Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that is usually progressive and not curable. It is sometimes referred to as emphysema or chronic bronchitis. COPD is most commonly caused by smoking and is seen in people over the age of 40. The disease is linked with ongoing airway limitation and inflammation. COPD causes problems with breathing, especially breathing air out of the lungs, and problems with the exchange of oxygen and carbon dioxide within the lungs. Other problems caused by the disease are changes to the breathing mechanics (pattern), breathlessness, reduced heart function, problems with skeletal muscles and lower overall fitness. The most common symptoms experienced by people are breathlessness, chronic cough and sometimes, phlegm production.
--What causes COPD?
The most common cause of COPD is cigarette smoking, however, there is a small group of people with COPD (3-11 per cent) who have never smoked. Other risk factors for developing COPD include exposure to second-hand smoke, outdoor air pollution, occupational dusts and chemicals, fumes from burning fuels, and a genetic preposition. Exposure to these agents causes inflammation and damage to the lungs. The incidence of COPD is rising due to increasing smoking rates worldwide, early diagnosis and the ageing population.
--How do I know if I have COPD?
A GP will help diagnose COPD. They will ask you to blow into a spirometer to determine if you have COPD and how severe it is. They may send you to a specialist medical doctor (respiratory physician) for assessment and treatment. COPD is diagnosed based on a history of symptoms (breathlessness, chronic cough or phlegm production), exposure to smoke or other risk factors and the results of breathing tests and chest X-ray. As COPD cannot be cured, the treatment focuses on managing the condition and preventing flare-ups. There are many things that people with COPD can do to keep healthy and minimise their symptoms including: stop smoking, optimise your medication, keep up to date with vaccinations (Fluvax) and attend pulmonary rehabilitation. For more severe cases, management may also include surgery, home oxygen or the use of breathing machines (non-invasive ventilation).
--How can physiotherapy help with COPD?
Physiotherapy is important in the management of COPD. Physiotherapy involves a variety of different treatments depending on your main symptoms. Overall, exercise is the most important part of pulmonary rehabilitation. Avoiding sedentary time and keeping up an active lifestyle is extremely important to keep fit, healthy, strong and out of hospital.
--What is pulmonary rehabilitation?
Pulmonary rehabilitation is a program for people with chronic lung disease, including COPD, that involves supervised group exercise training, self-management education and support. Joining a pulmonary rehabilitation program is the easiest way to learn about exercise and managing your disease. The programs are widely available throughout Australia. At a pulmonary rehabilitation program, your physiotherapist will measure your functional exercise capacity, your symptoms and safety for exercise. They will teach you how to do the exercises and then supervise your group exercise training, once or twice a week for six to eight weeks. The education part of the program will help you to learn how to: understand your disease, best manage your symptoms, take medications, stop smoking and eat a healthy diet. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program. Pulmonary rehabilitation is a great option for anyone diagnosed with COPD.
--How much should I exercise?
The recommendations for exercise for people with COPD are 30 minutes of aerobic exercise on at least five days of the week. Examples of aerobic exercise are brisk walking, jogging, riding on a stationary bike or swimming. It is also recommended to do strengthening exercises on two to three days of the week to keep your muscles strong. If you have had falls or poor balance, it is also recommended that you do balance exercises. Your physiotherapist will incorporate these exercises into your pulmonary rehabilitation program.
--How hard should I exercise?
The most effective exercise is normally done at a moderate intensity. This means that during exercise, your heart rate is increased slightly and you get a bit puffed, but not so puffed that you cannot talk to the person next to you. On a scale of 0 (nothing) to 10 (very, very strong), your breathing should be between 3 (moderate) to 4 (somewhat strong) while completing aerobic exercise, such as walking or cycling.
--Will exercise make my disease worse?
No, exercise is safe—it is the best thing you can do for yourself and will not make your disease worse. When you exercise, your lungs need to work harder to deliver more oxygen to your working muscles. Therefore, when you exercise, it is normal to feel a little more breathless—this is a good sign and, when you stop exercising, the breathlessness should go back to normal. However, for safety, it is recommended that you consult a physiotherapist or GP before you start exercising for the first time.
--What else can physiotherapy do?
Depending on your condition and main problems, physiotherapy may offer a number of other treatments. These may occur on the hospital ward while you are in hospital or, as an outpatient, if you are at home. A thorough assessment by your physiotherapist when you are diagnosed with COPD, and then at regular intervals, will help determine your main problems and the best treatment to assist with these.
Physiotherapy may involve breathing exercises, airway clearance techniques and inhalation therapy to help clear phlegm from the airways. This is particularly important for people who commonly experience high volumes of phlegm on a daily basis, or for people who are having trouble clearing their phlegm.
If you have trouble sleeping or breathing at night, your physiotherapist, in conjunction with your respiratory doctor, may prescribe a breathing machine to help you. This could include continuous positive airway pressure (CPAP), non-invasive positive pressure (NIV) or bilevel positive airway pressure (BiPAP).
Physiotherapy may also involve assessment and management of other conditions that can result from, or occur alongside, COPD. These include musculoskeletal problems such as spinal pain, restricted chest wall, ribs or arm movement, or poor posture; osteoporosis; and urinary incontinence (common due to chronic coughing).
Your physiotherapist will help with education about your condition, including how to use your COPD medication devices correctly to ensure you are getting the correct dose and cleaning the device correctly. There are many different types of devices, such as puffers, Turbuhalers, Autohalers and tablet devices, and they each work slightly differently.
