The 2 main conditions that cause COPD are emphysema and chronic bronchitis.
The main cause of COPD is ongoing contact with substances that irritate and damage your lungs, most often through smoking.
Symptoms tend to start slowly over a few years, so many people may have COPD but not realise it. Common symptoms include shortness of breath, ongoing cough and coughing up phlegm or mucus.
People with COPD are at risk of getting chest infections and COPD is a common cause of hospital admissions.
There is no cure for COPD, but there are things you can do to improve your symptoms and breathe more easily, eg, quitting smoking, using your inhaler medicines and being up-to-date with your vaccinations.
During the COVID-19 outbreak, if you use corticosteroid inhalers or courses of oral corticosteroids as part of your COPD plan, you should continue to do so. It is important that you manage your COPD as well as you can by continuing to use them – even if you test positive for COVID-19.
How does COPD affect your lungs?
The 2 main conditions that cause COPD are emphysema and chronic bronchitis. They affect your lungs in different ways.
Your lungs, airways (bronchial tubes) and air sacs (alveoli) are elastic and stretchy. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.
Emphysema affects the air sacs. Over time, the air sacs are slowly destroyed, which makes it hard to take in enough oxygen when you breathe.
Chronic bronchitis affects the large and small airways. They become inflamed, narrower and produce more mucus. This makes it harder for you to breathe.
Image credit: Wikimedia
What are the causes of COPD?
COPD is caused by long-term exposure to substances that can irritate and damage your lungs, such as smoking or certain types of fumes, dust and chemicals at work.
In Aotearoa New Zealand, nearly all COPD is caused by breathing in tobacco smoke, either directly by smoking or indirectly from second-hand smoke. Second-hand smoke is smoke that has been breathed out by a person smoking or that comes from the end of a lit tobacco product.
About 1 in every 4 smokers will develop COPD. This is because harmful chemicals in smoke can damage the lining of your lungs and airways. If you are an ex-smoker, you remain at risk and should watch out for symptoms of breathlessness. Smoking and second-hand smoke exposure during your childhood and teenage years can slow lung growth and development. This can increase the risk of developing COPD when you are an adult.
Fumes and dust at work
Exposure to certain types of dust and chemicals at work may damage your lungs and increase your risk of COPD. Substances that have been linked to COPD include welding fumes, cadmium dust and fumes, grain and flour dust, and silica dust. The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke as well.
About 1 in 100 people with COPD has a genetic tendency to develop COPD. This is called alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, your lungs are more vulnerable to damage. People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 40, particularly if they smoke. Read more about alpha-1-antitrypsin deficiency.
What are the symptoms of COPD?
It is difficult to notice the symptoms of COPD at an early stage as they can be mild and may not occur all the time. The first symptoms of COPD tend to come on slowly, and people often mistake them as signs of ageing, lack of fitness or asthma. You may cough up mucus in the mornings or feel more short of breath than usual. Over time, the cough gets worse and occurs throughout the day.
As COPD progresses, you may gradually find it harder to do your normal daily activities, such as gardening, hanging out the washing or carrying groceries, without feeling short of breath.
Your doctor will take a history and may do some tests such as lung function tests (spirometry) and blood tests. Imaging tests such as x-rays may be used to rule out other possible causes of breathing problems.
Spirometry is the most commonly used test to diagnose COPD.
Spirometry measures the amount of air you are able to breathe in and out of your lungs, as well as how quickly you are able to breathe air out.
If you have COPD, you will usually take longer to breathe all the air out of your lungs as the airways become narrower.
Spirometry is also used to monitor how the condition is progressing, which is useful to help decide what treatment is best for you.
There is no cure for COPD. However, early diagnosis and treatment can help control your symptoms and prevent further permanent lung damage. There are also things you can do to help stop your condition from getting worse.
Medicines can help ease your symptoms so you breathe more easily, they can also prevent flare-ups of COPD and improve your quality of life. The main medicines used to treat COPD are inhalers. Inhalers deliver medicine directly into your lungs. This allows the medicine to start working quickly. There are different type of inhalers such as relievers or preventers. Read more about medicines for COPD.
People with COPD can get lung infections more easily and may sometimes need antibiotics. It is also important to be up-to-date with your vaccinations.
Severe COPD can cause low oxygen levels. Low oxygen levels over months or years can put a strain on your heart, leading to heart problems. Your doctor or specialist may prescribe home oxygen to prevent heart strain. Home oxygen is not used to relieve shortness of breath. Read more about home oxygen therapy.
Pulmonary rehabilitation is a specialised programme of exercise and education to help people with lung problems such as COPD. It can help to increase the amount of exercise you can do before you feel out of breath, as well as improving your symptoms, self-confidence, emotional wellbeing and quality of life. It is recommended for all people with COPD. Read more about pulmonary rehabilitation.
Surgery or a lung transplant
Very rarely, people with COPD may benefit from surgery to remove part of your damaged lungs.
How can I care for myself with COPD?
Self-care can improve your symptoms and quality of life. For smokers, quitting smoking is the only thing that has been shown to stop COPD from getting worse. Other things you can do to improve your symptoms include to:
have a COPD action plan
keep active – 30 minutes, 5 days a week. It is recommended that you walk until you are too breathless to continue, then stop for a short rest, then resume walking.
It can be distressing and frustrating to have breathing difficulties. Get help or find support when things are tough. Ask your GP about local support groups for COPD in your area. For more support services, see support services for COPD.
The following links have more information about COPD. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Dr Sharon Leitch is a general practitioner and Senior Lecturer in the Department of General Practice and Rural Health at the University of Otago. Her area of research is patient safety in primary care and safe medicine use.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Sharon Leitch, GP and Senior Lecturer, University of Otago
Last reviewed: 19 Nov 2020
Self-care – what you can do to ease your COPD symptoms
Chronic obstructive pulmonary disease (COPD) can affect many aspects of your life. However, learning as much as you can about your condition, and getting the right help and support, can help you manage your condition and get the most out of life with COPD.
The best way to prevent COPD getting worse is to quit smoking. Although any damage done to your lungs and airways can't be reversed, giving up smoking can help prevent further damage. This may be all the treatment that's needed in the early stages of COPD, but even people with more advanced COPD can benefit from quitting. Read some tips to quit smoking.
There are medicines available to help you quit smoking if you need, such as nicotine replacement therapy. There are also smoking cessation support services available to help you quit smoking if you need them. Talk to your healthcare team to find out what's available in your area.
Quit card – a discount voucher for nicotine replacement patches, gum or lozenges.
Quitline – phone 0800 778 778 for free advice and support.
Visit www.quit.org.nz for a free online Quit Coach, support, advice and information.
Have a COPD action plan
Ask your doctor or nurse to help you fill in a COPD action plan. An action plan is a written document that provides you with instructions and information on how to manage your COPD on a daily basis and also how to recognise and cope with worsening symptoms (flare-ups or exacerbations).
You can develop your COPD action plan with your healthcare provider and make a plan to suit the severity of your COPD and your preferences. At each visit with your healthcare provider you can review the plan and make adjustments as needed. Here are 2 examples of COPD action plans – choose the one that suits you.
Regular exercise is important. When you exercise your muscles, including your breathing muscles, they learn to do more work with less oxygen. Often when people try to exercise and become short of breath, they stop exercising. However, the less active you are, the weaker your muscles become, making you even more short of breath over time.
Here are some tips for staying active
Choose an activity you enjoy, such as walking or swimming, and:
start with small amounts
begin at a comfortable pace – keep your breathing under control, so you can still talk if you wish
take as many rests as you need
go regularly and increase your time/distance as your fitness improves
aim for 20–30 minutes of exercise a day.
Before you start a new exercise regime talk to your doctor. They may recommend strategies like using a ‘bronchodilator’ inhaler before you exercise to help you breathe easier during exercise. Read more about home exercises for COPD.
Maintain a healthy weight
Losing weight if you are overweight or obese helps to remove extra pressure on your breathing muscles so that you can breathe more easily. Talk to your healthcare team to find out how much weight you should lose. On the other hand, if you are underweight, you will need better nutrition to provide more energy to help you breathe. Talk to your healthcare team, your doctor or your dietitian to find out what is needed in your diet.
Improve the way you breathe
Correct breathing technique involves using your lower chest muscle (diaphragm) to take slow, deep breaths. This is called diaphragmatic breathing. Often people with COPD have a habit of shallow breathing. This means only the top of your lungs fills with oxygen, adding to your feelings of breathlessness. Practicing correct breathing technique regularly will help you to breathe more deeply and easily.
Your nurse or a respiratory physiotherapist can teach you how to do breathing exercises. Ask your doctor for a referral to a respiratory physiotherapist or read more about breathlessness strategies for COPD.
Some people may have excessive phlegm from COPD. A respiratory physiotherapist can also teach you techniques on how to clear your phlegm effectively. These techniques help improve quality of life and your ability to exercise.
Attend pulmonary rehabilitation
Pulmonary rehabilitation is a group education and exercise programme usually run by your local hospital for 4–12 weeks. The programme aims to reduce your symptoms, increase your day-to-day functioning and improve your quality of life.
Having COPD increases your chances of getting chest infections. To help you lessen this risk, make sure you are up-to-date with your vaccines.
For vaccines like the flu vaccine, you will need to get vaccinated each year as the flu viruses change every year. The vaccine will stop you getting sick over the winter. The vaccine is free for people with COPD. Read more about the flu vaccine.
Another vaccine that reduces your chance of getting chest infections is the pneumococcal vaccine. It protects you against a bacteria that causes chest infections. Talk to your doctor or nurse about having this vaccine also. Read more about the pneumococcal vaccine.
Medicines are used alongside self-care measures to help you breathe more easily and lessen the chance of a flare-up. Using your medicines correctly is an important part of self-care for COPD. Read more about COPD medicines and how to use them correctly.
Visit your healthcare team regularly
There are lots of people who want to support you so you can look after your COPD well. As part of your COPD management, it is important to visit your doctor, nurse or other healthcare team members regularly. This lets them check your disease progression and answer any questions you may have along your journey. They can support you to look after your COPD well. Learn more about support services.
The following stories are from participants in the Rangiora Pulmonary Rehabilitation Programme. They describe the benefits of exercise for those living with chronic obstructive pulmonary disease (COPD).
Linda's story – positive benefits from group exercise
Linda was recommended to join the Rangiora Pulmonary Rehabilitation Programme by her doctor. Linda has COPD and emphysema. Before the programme, Linda knew little of her condition.
At the start of the 8-week programme, Linda was a smoker and extremely short of breath. After 1 week she decided to give up smoking. We know how hard this must have been for Linda but after 6 weeks, with the help of patches, Linda is still smokefree. She can taste again and is starting to feel much better.
Exercise can be daunting. However, Linda and the other participants are really enjoying the time doing their circuit twice a week.
Linda sums up the 8-week programme: “It was educational and beneficial; I’m really feeling the benefit of the past weeks. In fact, I don’t want the programme to end!”
Linda has made friends within the group, and would recommend this programme to people with the same conditions. See your doctor or practice nurse to be referred to a programme near you.
Linda is feeling so much better, she is looking forward to continuing with exercise after the group finishes.
Tihei mauri ora, tēnā kotou katoa. My name is Charlotte Pooley and I have COPD.
I started smoking cigarettes from a young age, I suppose from peer pressure. I used to enjoy walking around the block (almost running) every day with a cigarette in my mouth.
I began to notice I was coughing a lot while walking and at night time in bed. I would go through a lot of tissues with all the phlegm I was coughing up. I went to the doctor and he told me to give the cigarettes up. I tried a few times with patches.
In 2001, I gave up for about 8 months, but in the back of my mind I had to have that one more puff. So I did. This lasted a further 6 years.
On 1 March 2007, I had 2 cigarettes left. I decided to smoke them and I have never smoked again. It has been over 9 years now since I gave up.
Not long after I gave up I got sick with chest infections and shortness of breath and ended up in hospital. My family were very worried about my health.
During this time I was working for Nurse Maude doing home care. My clients were worried about me because I was always puffing, short of breath and coughing. I decided to give up my job.
In 2011, I got very sick. Walking from my kitchen to my bedroom was a big effort. A nurse came to see me from the hospital to check my CPAP machine and was concerned about me. She rang the hospital and spoke to Dr Paul Tan. He told me on the phone to come into hospital.
I went into the emergency department and I couldn't lie on their bed. After 2 weeks I was discharged home with an oxygen concentrator. This saved my life. I use it every night while I am sleeping.
My GP referred me to the pulmonary rehab programme in my area. I became very friendly with Louise, the pulmonary rehab nurse. I went to pulmonary rehab 4 times altogether. I am now a volunteer for the Pulmonary Rehabilitation Consumer Group, which I really enjoy.
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
On this page:
NZ COPD guidelines 2021
Continuing professional development
Regional HealthPathways NZ
NZ COPD guidelines 2021
The latest NZ COPD guideline provides simple, practical, evidence-based recommendations for the diagnosis, assessment, and management of chronic obstructive pulmonary disease (COPD) in clinical practice.
COPD and asthma fundamentals "The most up-to-date Asthma & COPD Fundamentals course available in New Zealand. The course aligns the latest research with specific information for the New Zealand context, such as recently funded medications, treating Māori and Pacific peoples, and best practice health literacy. The course aligns with the latest NZ asthma guidelines." It includes 2 half-day workshops covering the key aspects of COPD and asthma pathophysiology, management and practice. Delivered by the Asthma & Respiratory Foundation NZ.
Non-pharmacological-management of COPD – Fiona Horwood Goodfellow Unit, 2017. "Dr Fiona Horwood talks about non-pharmacological management of Chronic Obstructive Pulmonary Disease. Fiona is Clinical Head for General Medicine and a Respiratory Physician at Counties Manukau DHB."
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: