Severe COPD

Chronic obstructive pulmonary disease (COPD) affects different people in different ways. Some people with the condition have only mild lung damage and few symptoms. Others have very damaged lungs and can be especially limited by breathlessness – these people would be considered to have a severe case of COPD. Over time COPD does tend to get worse – how fast this happens varies from person to person. If you smoke, quitting is the main thing that can slow this progress down.

The most common use of the term severe COPD is if:

• You have severe or very severe airflow obstruction. This is measured using a breathing test called spirometry where you blow out as hard and as fast as you can. If the lung damage means that the amount of air you can blow out in one second is less than 50% of what it should be, it is classed as “severe”. If it less than 30% that is classed as “very severe”. Severe or very severe airflow obstruction is sometimes described as GOLD grade 3 or GOLD grade 4.

But COPD affects different people in different ways and the link between lung function test results and how you feel doesn’t always match up. So, you might have “severe COPD” if:

• You have been admitted to hospital in the past because of an acute flare-up (exacerbation) of your lung condition.
• You are very limited by breathlessness – this means that even walking normally at your own pace you have to stop after 100 yards or a few minutes on level ground. Health care professionals sometimes use a measure called the MRC score to assess a person’s breathlessness.
• You have multiple medical conditions – many people with COPD have other medical conditions, such as heart disease.
• You need to use oxygen therapy at home.
• You need to use non-invasive ventilation at home – this is usually a mask connected to a machine, sometimes called BiPAP, to support your breathing at night.

The severity of your COPD can depend on a number of factors:

• If you smoke – quitting smoking is the most important thing you can do to slow the progress of your COPD.
• The type of COPD you have – some people with COPD have mostly got airway disease (bronchitis), some have damage to the lung tissue (emphysema), and many have both.
• Your overall fitness - the fitter a person is, the better they can cope with having a lung problem. Pulmonary rehabilitation (PR) can help with this.
• If you have other medical conditions – for example, many people with COPD also have heart disease. Heart disease can also cause breathlessness, so someone with both conditions may have more challenges.
• If you experience anxiety or other mental health conditions - anxiety can make breathlessness worse, so it is important to seek help for your mental health.

The key things you can do are:

• Get help to quit smoking if you are a smoker.
• Ask your health care professional to refer you to pulmonary rehabilitation (PR).
• Complete our COPD Passport checklist to make sure you’re getting the correct COPD care you’re entitled to.
• Make sure you take your medication regularly and correctly.
• If you’re having frequent chest infections, tell your health care professional to see if they can do anything to help.
• Be prescribed oxygen therapy if your blood oxygen levels are low.
• Be prescribed non-invasive ventilation at home - this helps if you have breathing problems at night (obstructive sleep apnoea) or too much carbon dioxide in your bloodstream (hypercapnia).
• Ask about lung volume reduction procedures which can be very effective if you have emphysema.
• Talk to your health care professional about ways to look after your mental wellbeing -anxiety and depression can be common in people with long-term conditions, like COPD – but there is support and treatment available to help.