Author Archives: Jackie Aim

During the visit

When you see the specialist, he or she will make a full assessment including:

How you feel from day to day and what causes you problems (your symptoms).
How far you can walk at a normal pace (to work out your breathlessness score – the MRC scale).
Your inhaler technique should be checked to make sure you are using them correctly.
If you have smoked – How much you have smoked.
What jobs you have done in the past.
Other health problems you have and treatment you are taking for these.
A physical examination, to look for changes in your body from the normal which suggest COPD or other different diseases.
You may be asked if COPD is affecting other aspects of your life such as your sleep, mood or how you are coping with daily tasks.

Get ready for your appointment

It may be useful to take all your inhalers and medicines with you. You may be asked to demonstrate how you are taking your inhalers to get the maximum effect from them. Note when and how often you take them. Have you had any side effects?
If you have a diary with your symptoms take this with you. This can be really useful to spot any changes in your COPD.
Think about how your COPD has been affecting you. Not only your breathing but tiredness, changes in routines, things you would like to be able to do but can’t any more.
What do you want to ask? Never be afraid to ask questions. Perhaps take a list of important questions with you to ask when you see the specialist.
Having someone with you at the appointment can be helpful, especially if you have difficulty hearing or understanding instructions. It can be difficult for anyone to take everything in the first time.
Take a note pad and pen with you. You can write down important information or ask the specialist to write down the names of terms or medicines.

What happens when you go to see a chest specialist

Female patient breathing into a spirometry tube, wearing nose clips
Usually your GP will have referred you. Sometimes you may have been admitted as an emergency to hospital.

Before seeing the specialist you are likely to have had some basic breathing tests including Peak flow and or Spirometry. You may also be asked to go for more detailed breathing tests. This will be explained to you at the time.

The appointment should be a two way process. You will have questions and they will ask you questions about your COPD. In order to manage your COPD on a daily basis, it is important you understand your symptoms, medicines and treatment.

This is your chance to ask the health care professionals any questions but remember you are the person living with COPD and how it affects you. It is important that you tell your specialist about any concerns which are affecting your daily life living with COPD.

For more information see:
Moving on together: Managing your time with people who provide health and social care section [.pdf, 6.08MB]
CHSS: COPD [.pdf]

Moving on Together (MoT): A self-management workbook by NHS Ayrshire & Arran.

Other tests you may have

Person blowing into a peak flow meter

Some basic tests can be done at your GP surgery.

One of these is called a peak flow test You will be asked to take a full deep breath in, close your lips around the mouthpiece to form a seal and then blow as hard and fast as you can into mouth piece. Usually three readings are done to get an accurate score. You might be asked to take a peak flow meter home and keep a diary for a few days to check if there are certain times of the day when you get most symptoms. You can find out more about this in the Peak flow section on this website.

You may also have a test called spirometry. This test is more accurate as it measures how your lungs are working and the results are compared to what would be expected from someone of your age, size and ethnic group. You can find out more about this in the Spirometry section on this website.

Your emotional health

A person sitting on a park bench with her head in her hands. Expression of despair. Mental health and state of mind.

Being diagnosed and living with any chronic illness can be stressful and lead to lots of unexpected changes in your life. People with lung diseases can experience increased worries, anxiety, low mood or depression. Your emotional health is just as important as your physical health and being diagnosed with COPD can be stressful. Your doctor or nurse may use a screening questionnaire to assess your mood.

It is important that you seek advice and support if you are feeling low in mood or anxious. Sometimes just talking about your feelings can help. You may have been worrying about your health when you don’t need to or a simple change to your treatment or lifestyle could make a big difference. Speaking with your doctor or other healthcare professionals about your concerns and worries, will allow them to support you and ensure you get the right treatment.

Don’t be afraid to ask for help from family and friends or your respiratory nurse could put you in touch with a local support group of people who really understand what it is like to live with COPD.

Remember there are lots of different things that may help you and sharing your concerns with someone is the first step in getting the right help.

For more information on your emotions see:
Moving on together: Managing challenging emotions section [.pdf, 6.08MB]
Moving on Together (MoT): A self-management workbook by NHS Ayrshire & Arran.

COPD Assessment Test (CAT)

Example of CAT score assessment. Select to view full size [.pdf].

This is a patient-completed questionnaire assessing all aspects of the impact of COPD (cough, sputum, breathlessness, chest tightness, confidence, activity, sleep and energy levels)

There are 8 questions on a 1 to 5 point scale.

This will help your respiratory specialist nurse or doctor decide the best treatment for you.

If you would like to see the full CAT test click on the link below. You can also print the test or download it.

CAT score assessment

Medical Research Council dyspnoea (breathlessness) scale

During your appointment your doctor or nurse will assess your breathlessness to see how it affects your day to day living by asking a series of questions such as;

How far you can walk before you get breathless?
How fast you can walk on level ground or going up a hill?
How quickly you get breathless when you are walking?

These questions are part of an assessment known as the CAT score and the MRC score.

In the table below you can see the MRC score

1	2	3	4	5

You are not troubled by breathlessness except on strenuous exercise.	You are short of breath when hurrying on the level or walking up a slight hill.	You walk slower than most people on the level, stop after a mile or so, or stop after 15 minutes walking at own pace.	You stop for breath after walking about 100 yards (60 metres) or after a few minutes on level ground.	You are too breathless to leave the house, or breathless when dressing or undressing.

Source: The MRC breathlessness scale adapted from Fletcher C.M, Discussion on the Diagnosis of Pulmonary Emphysema J R Soc Med September 1952 45: 576-586

Smoking and emphysema

This animation shows the long term effect of smoking which can lead to emphysema.

Repeated irritation by smoke causes inflammation and leaves chemical deposits in the very delicate and vulnerable alveoli.

Eventually the thin cell walls in the alveoli are destroyed. This is where oxygen and carbon dioxide are exchanged so breathing becomes much harder.

Please note there is no audio for this animation.

Emphysema

Please note there is no audio for this animation.

In emphysema exposure to an irritant over many years causes an inflammation in the lungs which causes the following changes:

Loss of elasticity of the lungs. These changes cause the air sacs (alveoli) to close before you have fully exhaled. As a result, air gets trapped in the lungs and the lungs get bigger (hyper inflated). The big hyper inflated lungs flatten and the main muscle of breathing, the diaphragm, cannot work as well as it should. Your breathing muscles then have to work harder to get air in and out of your lungs. This is why you may be feeling breathless. However, this does not mean that your oxygen levels are low because the breathing muscles around the chest are working harder to compensate.This extra effort can make you feel very tired.
The alveoli become permanently damaged.
The amount of breathlessness you experience may get worse with activity. This is because you breathe faster when you are active. More air gets trapped in the lungs and your breathing muscles have to then work even harder to get air in and out of your lungs. This may also make you feel very tired.
It is important to know that you should not stop being active because you are breathless. You need to keep active because your other large muscles such as those in your legs can quickly become weaker or deconditioned. The less you do, the less you will be able to do. The key to keeping active is to pace yourself. Your health care team can help you manage the level of activity and exercise which is suitable for you. See our section Pacing on this website for more information.

Chronic Bronchitis

In chronic bronchitis exposure to an irritant over many years causes inflammation in the lungs which leads to the following changes:

The smooth muscle in the airway becomes thicker and narrows the breathing tubes (airways). The narrowing is permanent and cannot be reversed. You may feel breathless because your lungs and muscles are working harder to move air in and out. However, this does not necessarily mean that your oxygen levels are low (because the breathing muscles around your chest are compensating for the narrowing). You may also experience wheeze due to narrowed breathing tubes.
Because the breathing muscles are working harder, this is why you may feel more tiredness and fatigue.
The mucus glands get bigger and secrete more sputum and the brush lining (cilia) is damaged. Thicker sputum is harder for the damaged brush lining to clear. This might make you prone to a flare up of symptoms, which is sometimes called an exacerbation.
Germs thrive in warm, moist environments so this could cause a flare-up or an infection.