Lifestyle Modification for COPD

Overview

COPD or Chronic Obstructive Pulmonary Disorder is a widely occurring chronic lung condition. COPD can be managed with a variety of lifestyle modifications, including smoking cessation, physical activity, and environmental adaptations. It may seem overwhelming to make all of these changes at first, but with the right support, you can make improvements. Please continue reading to explore these lifestyle modifications in more detail.

Introduction

Chronic Obstructive Pulmonary Disorder (COPD) is one of the most common diseases, with approximately 3 million people affected in the UK.^1,2 COPD is a chronic lung condition and it consists of two main conditions called chronic bronchitis and emphysema. Chronic bronchitis is a condition with inflammation of the airway, whereas emphysema is a condition with damage to the air sacs (alveoli) in the lung.

The presence of these conditions means oxygen cannot be transferred as effectively and this can result in breathlessness. The most common cause of COPD is smoking and so many cases are preventable.^3,4 Other causes of COPD include environmental exposure to fumes and genetic conditions such as alpha-1-antitrypsin deficiency.

Many of those with COPD are not diagnosed until they present acutely with a worsening of the condition. An exacerbation can be due to environmental factors or infection and result in worsening of symptoms.⁵ Common symptoms include:

• Shortness of breath
• Cough
• Frequent infections
• Sputum production
• Wheeze

Diagnosis is made by spirometry, which is a test to measure the amount of air you can exhale in one go. You will be asked to breathe out as hard and fast as possible, which will provide healthcare professionals with a measurement of your lung function. This will allow them to recognise the type of lung condition you have. Additional scans such as echocardiogram and CT scan can help determine the severity of COPD and rule out other causes of breathlessness.

COPD cannot be reversed but there are many treatments to help with the progression of the disease.³ Treatment will consist of inhalers or medications that can help relax the airway to help with breathing. Along with this, lifestyle modification is extremely important to help control the symptoms of COPD. This article will focus on specifically the lifestyle modifications that can help, including:

• Smoking cessation
• Pulmonary rehabilitation
• Physical activity 
• Nutrition
• Vaccinations
• Environmental adaptations
• Health monitoring
• Wellbeing support

Smoking cessation

Smoking is the biggest cause of COPD with over 70% of cases attributed to tobacco smoke in high-income countries. Smoking can also increase your risk of other conditions such as lung cancer, heart disease and stroke. Although the effects of smoking cannot be reversed, quitting smoking can help slow the progression of COPD and is therefore one of the most important lifestyle changes.^1,4

Quitting smoking can be challenging but there are many resources out there to help. One can reach out to their GP who will be able to help with nicotine replacement, social support and referral to NHS Stop Smoking services. These services can provide people with one-to-one or group support to help them quit smoking for good. Additionally, there are many resources online that can help such as the NHS ‘Quit smoking’ page and the Asthma and Lung page ‘How to quit smoking’.

Pulmonary rehabilitation

Pulmonary rehabilitation is a formal exercise programme designed for those with respiratory conditions. Pulmonary rehabilitation is run by a range of health professionals including physiotherapists and nurses. It usually consists of 2 sessions a week for around 6-8 weeks.

Sessions will have both exercise and educational elements. The exercise parts of the session will help you become confident exercising with your respiratory condition. Exercises will also include breathing techniques to help with relaxation and sputum control. Educational advice includes how to recognise exacerbations of COPD and how to seek additional help when unwell.

Pulmonary rehabilitation is an extremely effective intervention with 90% of people having improved exercise and quality of life. Despite the benefits, currently, only the most severe cases of COPD get a referral to pulmonary rehabilitation. Patients with COPD can be referred by a nurse, GP, or respiratory team.

The NHS Long Term Plan sets out an aim to increase the number of pulmonary rehabilitation facilities available across the UK. This will allow more people to benefit from pulmonary rehabilitation services in both digital and face-to-face formats. 

Physical activity and nutrition

Physical activity and nutrition are essential to keep a healthy weight and maintain fitness.^5,6 Exercise can include walking, cycling, lifting weights or swimming depending on what you enjoy the most. Exercise should be gradually increased and may need to be modified depending on your level of breathlessness.

 Pulmonary rehabilitation is a structured exercise plan aimed at people with respiratory conditions but you can also complete your exercise at home. If you need some inspiration, there are plenty of resources online including the NHS home workout videos and the Asthma and Lung exercise handbook. Additionally, exercise can help with your mental wellbeing to reduce stress and anxiety levels.

If you are overweight, losing weight through dietary changes can help with breathlessness. A healthy, balanced diet includes plenty of fruit and vegetables, protein and fish while keeping dairy and sugar intake lower. Drinking plenty of water and cutting down on alcohol is also useful. NHS Better Health has lots of tips and tricks on dietary changes to help you lose weight. Others with COPD may find they lose weight with excessive muscle use. In these cases, it is important to eat lots of protein. Your GP or respiratory team may refer you to a dietician for additional nutritional advice. 

Vaccinations

It is important to stay on top of your vaccinations to help prevent you from getting unwell from infections.⁷ Those with COPD are eligible for a one-off pneumococcal vaccine, yearly flu vaccinations and COVID boosters under the NHS. Vaccinations allow your body to prepare to fight these infections, so if in the future you are exposed to it, the symptoms will be less severe. 

Environmental considerations

Make sure you are aware of any environmental triggers for your COPD and avoid these when possible. Some common environmental triggers include:

• Dust 
• Cold air
• Humidity
• Smoke fumes 
• Cleaning products
• Perfumes

It may not be obvious what triggers your symptoms and you may find it useful to keep a note of your symptoms in a symptom diary. Symptom diaries are often included in self-management plans, which are discussed below.

Health monitoring

Be proactive in your health management and ensure you get regular check-ups, monitor your symptoms and adhere to your recommended medication. A self-management plan allows you to keep all your details handy, including your diagnosis, current medication, symptom diary and advice for any acute exacerbations These can be completed together with your health professional to make sure they are personalised to your condition. If you have any new symptoms or they get worse, it is important to recognise this and seek extra help.

Wellbeing support

Living with COPD can impact your daily activities and may put stress on your ability to work or maintain relationships.^7,8 It can be frustrating living with a chronic condition and may make you feel low in mood or anxious. Anxiety can also cause worsening shortness of breath, which may put you in a vicious cycle of breathlessness.

If you are feeling this way, it is important to reach out for mental health support, whether this be through your friends, family, GP, A&E or charities such as Samaritans. You may find relaxation techniques are beneficial to reduce anxiety levels. Additionally, you may find COPD support groups useful to help discuss your worries with others experiencing the same thing.

If your symptoms mean you are unable to work, you will be eligible for statutory sick pay or an employment and support allowance. If you have a family or friend helping care for you, they will be entitled to a carer's allowance. Speak with your GP if you require extra support at home and they can discuss your social support options in more detail.

Summary

Many lifestyle modifications help the symptoms of COPD including smoking cessation, recognising environmental triggers, exercise and pulmonary rehabilitation. Effective use of these techniques can help reduce the severity of your symptoms and reduce the progression of the disease. Healthcare professionals can help support you with smoking cessation with medication and psychological techniques. Additionally, it may be beneficial to speak with physiotherapists and nutritionists to get more guidance on exercise techniques and diet.

Self-management is crucial to ensure you are looking after both your physical and mental well-being. Recognising your symptoms can help you reach out for extra support and medications at the times you need them.