Chronic Obstructive Pulmonary Disease (COPD) and Physiotherapy

Who is the leaflet for? What is its aim?

This leaflet is intended to provide information to people who have COPD, their families and carers. It explains what COPD is and how physiotherapy can play a part in its treatment.

What is COPD?

COPD is a term used to describe a group of different conditions including emphysema, chronic bronchitis, chronic asthma and bronchiectasis. Many things can cause COPD. Most commonly, long-term exposure to irritants such as tobacco smoke that damage the lungs and the airways. Inhaling second-hand smoke, air pollution, chemical fumes or dust from the environment or workplace can also contribute to the development of COPD, as can genetic factors.

Emphysema means the air sacs in your lungs have been damaged. With chronic bronchitis, there is increased production of mucus within the lungs. For people that have had asthma that has not been well controlled over many years, this can lead to long-term changes within the airways. The airways can become inflamed and narrow, making it harder for you to breathe in and out and difficulty emptying air out of your lungs. The lungs will gradually lose the ability to take in oxygen and get rid of the carbon dioxide.

The symptoms of COPD include breathless on exertion during walking or doing household activities, cough which can be continuous sometimes, wheeze or chest tightness and production of more sputum or phlegm than usual. When there is a flare up in your symptoms, known as an exacerbation, you may be more breathless than normal, have less energy and possibly have more mucus known as sputum. These symptoms usually get better once your exacerbation settles. Exacerbations can be due to a chest infection but not always.

COPD can mean that you are more at risk of chest infections. The more chest infections you have, the more likely it is that the damage to your lungs will get worse and your general health will deteriorate faster. You should learn to become aware of the symptoms related to a chest infection as early recognition and treatment is extremely important in preventing severe infections and further damage.

Signs of an infection may include:

• Increased amounts of sputum
• Thicker sputum which is more difficult to clear
• Darker coloured sputum
• Having a high temperature
• Experiencing chest discomfort
• Coughing up small amounts/streaks of blood

If you suspect that you may have an infection, it is useful to give a sputum sample to your GP or Practice Nurse to send to the labs. This will help identify which bacteria are causing your infection and which antibiotics will be most effective at treating it. The best time to do this is before you start any antibiotics.

How can physiotherapy help?

Physiotherapy can help to control and manage the symptoms like breathlessness, sputum clearance and exercises to improve strength and fitness.

Pulmonary Rehabilitation

A lot of patients with COPD benefit from completing a pulmonary rehabilitation course. This encompasses exercise alongside education sessions and is designed to help people understand and manage their condition better.

It is usually run by a respiratory physiotherapist, as well as a respiratory healthcare assistant or respiratory nurse. Initially, the physiotherapist carries out an assessment to ensure that you are appropriate for the course. The programme usually runs for six to eight weeks and the sessions are typically twice a week. The experienced staff are on hand to help and guide you, as well as answer any questions you may have.

Please speak to your healthcare provider/ consultant/ respiratory physiotherapist/ nurse/ GP to find out if you would be eligible and where your local programme is held.

Sputum clearance

Physiotherapy can be very useful in helping to manage the mucus produced in COPD. A respiratory physiotherapist will assess you in order to devise a personalised management plan for you to perform at home.

Techniques used to help clear sputum may include:

• Breathing exercises, such as the Active Cycle of Breathing (ACBT)
• Use of positioning to target the most affected portions of your lungs which is known as postural drainage
• Use of devices such as an Acapella, Aerobika or Flutter, which a physiotherapist would be able to discuss with you

You should do these techniques daily even if you are feeling well to reduce the chances of mucus getting stuck, causing further infections and leading to more damage. During an infection, you may need to increase the amount of chest physiotherapy that you do in order to control and clear the larger quantities of sputum. A respiratory physiotherapist will be able to advise you on this based on your particular presentation.

If you are admitted to hospital for your chest infection, it is important that you continue to perform your usual airway clearance. If you develop a more severe infection then more intensive treatment may be required. If you are having difficulty clearing your mucus whilst you are in hospital, please ask to be seen by a respiratory physiotherapist. They may be able to offer alternative treatments during your hospital stay.

If you wish to be seen by a respiratory physiotherapist, either when you are well or unwell, then please speak to your doctor.

Breathlessness management

Breathlessness is a sensation felt by an individual. Breathlessness is very limiting and unpleasant at times. It is a normal response to exercise and this response can be more exaggerated due to the lung condition. Small changes in the way you breathe, move and manage your breathlessness can make a positive difference to how you feel and what you can achieve.

Techniques to manage your breathlessness may include:

• Breathing control/relaxed breathing
• Positions to use when breathless
• Exercises to manage your breathlessness
• Pacing activities
• Relaxation exercises or advice

Please speak to your healthcare provider/consultant/respiratory physiotherapist/ nurse/GP to find out if you need further advice and support in managing your breathlessness.

Other ways to stay well

There are some things that all adults should do to try and keep well. These are even more important when you have COPD to prevent your condition from progressing faster.

Stop Smoking

• Smoking has many negative effects on your health, but in particular your lungs. Damage caused by smoking can make the inflammation of your airways worse and cause larger amounts of sputum, as well as making it more difficult to clear
• Talk to your local NHS Stop Smoking Service, pharmacist or GP for advice on quitting smoking

Stay Active

• Further to what is mentioned above about pulmonary rehabilitation, all adults between the ages of 19 to 64 should take part in either 150min of moderate activity (e.g. fast walking, cycling) a week or 75 minutes of vigorous activity, such as running, taking part in a sport as well as two or more sessions of strength exercises a week
• Staying active and keeping your body strong will allow your muscles to work more effectively and make it easier to cope when you have an infection. If you are fit and strong you will feel less breathless when trying to do everyday activities

Eat Well

• Eating a balanced diet will give your body the fuel and nutrients it needs to help fight off and recover from infections
• Ask to speak to a Dietician about how to improve your diet

Control Your Weight

• Being overweight puts strain on many organs in your body, including your lungs. The heavier you are the more your heart and lungs have to work to power your body
• Being underweight can put excess strain on your body and reduce your ability to cope with infections
• Staying active and eating well will help to prevent weight gain or loss.

Staying Properly Hydrated

• Not drinking enough can lead to your sputum becoming thicker and more difficult to clear. Drinking non-alcoholic drinks such as water, squash, tea and coffee regularly throughout the day can help prevent this

Have the flu jab

• All adults with a chronic lung disease should have a flu jab each year. Flu can be a very serious infection, especially if you have a chronic lung disease so it is important to protect yourself
• Speak to your GP about the flu jab

Have the pneumonia jab

• All adults over the age of 65 and those with a long-term health condition should have the pneumonia jab. It is only given once and covers you for life
• Speak to your GP about the pneumonia jab

References/Sources of Evidence

British Lung Foundation Website (opens in a new tab)