Author Archives: Jackie Aim

Normal lung defences/spit clearance

Please note there is no audio for this animation.

‘Cilia’ line your airways. These are tiny hairs forming brush-like structures. There are mucous producing cells in the larger airways known as goblet cells. This mucous may also be referred to as spit, phlegm or sputum. This mucous forms a moist layer on top of the cilia which helps to trap germs and small particles which are present in the air that you may have breathed in. The sweeping action of the brush-like cilia then carries this mucous, containing any germs and small particles to your mouth where it is either swallowed away into your stomach, or coughed up and spat out. This is the normal process for everyone.

Some people with COPD may find it difficult to clear their airways, specialist physiotherapy techniques may help with this.

Q. Is it harmful to swallow my spit?

A. No. When you swallow your spit it goes into your stomach and not into your lungs. Your stomach acid will destroy any germs in your spit. However, should you be producing a lot of spit, swallowing it can make you feel a bit sick. It is also useful to see your spit to check if it is changing colour or showing any signs of infection. Take care to spit into a seal-able container or use disposable tissues to prevent spread of infection. Wash your hands regularly and thoroughly or try using antiseptic hand gel.

How we breathe

(Animation – 5 Steps)

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  1. Breathing in and out (inhaling and exhaling) involves the breathing muscles , breathing tubes (airways) and air sacs (alveoli).
  2. Breathing in requires effort. The main breathing muscle lies just below the lungs, it is called the diaphragm. It is a very important muscle. Other breathing muscles (the intercostal muscles) are attached between each rib. When you breathe in, your diaphragm flattens and pulls the lungs down while the intercostal muscles pull the lungs up and out. This increases the size of the lungs and air gets sucked into the lungs.
  3. Air goes through the breathing tubes which are shaped like an upside down tree. They keep branching and getting smaller until they reach the air sacs. The breathing tubes are lined with a layer of smooth muscle, mucus glands and tiny hair-like structures (called cilia). Smooth muscle inside the walls of the breathing tubes control the width of the breathing tubes and the amount of air which can get in and out of the lungs. To work well your lungs need to be moist. The mucus glands secrete sputum (sometimes called phlegm) which warms and moistens the inhaled air. The cilia work like a brush, clearing the breathing tubes.
  4. When the air reaches the air sacs, oxygen is moved into the blood stream for circulation around the body. At the same time, carbon dioxide is moved into the air sacs and is breathed out. There is no smooth muscle in the air sacs. The walls of the alveoli are very thin.
  5. When you breathe out, the breathing muscles relax and the lungs shrink back into shape. This decreases the size of the lungs and air is squeezed out. Breathing out requires no effort.

How the lungs work?

Breathing (inhaling and exhaling) involves the breathing muscles, breathing tubes (airways) and air sacs (alveoli). To see how COPD affects the lungs we need to know how the lungs work normally.

Please note there is no audio for this animation.

You have two lungs which sit in your chest. The delicate lungs are surrounded and protected by the bones and muscles of the rib cage and spine. A large muscle called the diaphragm below the lungs moves up and down to push or pull air in and out when breathing  The lungs are attached to the rib cage by a membrane called the pleura. This helps to keep the lungs moistened and a suction action helps to inflate the lungs as you breathe in.

The function of your lungs is to breathe in oxygen and breathe out carbon dioxide. You are made up of millions of tiny cells all over your body that need oxygen to work properly. By breathing air in (inhalation) oxygen is sent via your breathing tubes (airways) into your blood stream and to the cells. The cells produce waste in the form of carbon dioxide. This is sent back via your blood stream to your lungs where it is breathed out (exhaled).

What happens when you are diagnosed – Tests

Weighing scales and tape measurePulse oximiterTest tubes containing blood samplesChest X-rayStethoscopeFeet

  • The doctor or nurse will check your weight, height and the level of oxygen in your blood. (This is called oxygen saturation which is measured using a device attached to your finger).
  • You may need some blood tests and a chest x-ray to rule out other medical conditions.
  • They will listen to your chest for signs of wheeze, infection or any other unusual or abnormal sounds that may be present.
  • By examining your ankles the doctor or nurse can check if they are swollen which can indicate other causes for your breathlessness.
  • A test called Spirometry may be arranged for you. See the Spirometry section on this website.

What happens when you are diagnosed – questions you may be asked?

preview Description: A mature woman patient consulting a GP in the surgery consulting room.

© Crown Copyright 2009

The doctor or nurse will assess you to decide if you have COPD and to identify any risk factors you have for developing the condition. They will ask you questions about your past medical history, your home circumstances and your general health and lifestyle. These questions may include:-

  • Your symptoms and how they are affecting your life.
  • You will be asked about your history of chest infections. If you have had more than two chest infections in a year this could be a sign that you may have developed COPD.
  • If you smoke, how long you have smoked and how many cigarettes you smoke per day. This is called your pack years. One pack-year of smoking would mean that someone had smoked one pack of cigarettes (20 cigarettes) daily for one year. Over 20 pack years puts you at higher risk of developing COPD. This is why COPD often starts to show symptoms from the age of 35 to 40 years if you start smoking as a teenager.
  • They will ask about your work history. If you have worked in heavy industry, building construction, farming or coal mining you may be at increased risk of developing COPD.
  • Your family history. If a close family member has COPD from a young age you may more likely to develop COPD. This would also involve having a blood test.
  • You will be asked about your current medication. You should take your prescription and inhalers with you to your appointment.

 

Signs and symptoms of COPD

Sputum chart

Sputum chart

Symptoms of COPD normally develop over many years

  • Usually in patients who are over 35 years of age.
  • A chronic cough is present on most days.
  • Along with a cough there can be increase in the amount of spit or phlegm.
  • The colour of your spit or phlegm may change from frothy and white to slightly yellow or green if you have a chest infection.
  • Breathlessness occurs on most days which can be worse on exercise and during chest infections.

Sputum
Sputum may be clear or white and frothy (mucoid).

Sputum which is slightly thicker and cloudy or opaque (mucopurulent).

If you have an infection you may see the colour of your sputum getting darker with either a yellow of green tinge. (purulent) This can be a sign to get early advice and medication from your GP or practice nurse.

If the sputum is darker green it may also start to become thicker and more difficult to cough up in order to clear your airways. This can be caused by a virus or bacteria. (severe purulent).

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

About COPD

Prevalance of COPD in Scotland by Health Board

Prevalance of COPD in Scotland by Health Board

Chronic Obstructive Pulmonary Disease known as COPD, affects over 100,000 people in Scotland. Although 3.8% of adults in Scotland have been diagnosed with COPD, we know many others are living with symptoms which have not yet been diagnosed. Although there is no cure, there is a lot that you can do to manage your condition with the support of Health professionals, carers and family.

To get the most from this website you might want to visit the self-management section first.

Source:  Scottish Government Health care experience survey (2021/2022)

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Prevalance of COPD in Scotland by Health board, 2008-2011
Health board Prevalance
Ayrshire & Arran 3.4%
Borders 2.6%
Fife 4.0%
Forth Valley 4.1%
Grampian 2.6%
Greater Glasgow & Clyde 4.4%
Highland 3.1.%
Lanarkshire 4.1.%
Lothian 3.8%
Orkney 3.3%
Shetland 2.3%
Tayside 4.2%
Western Isles 2.2%
Scotland 3.8%

What causes COPD?

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Select the pictures to see what causes COPD. It is likely that a combination of factors cause COPD.

  • Smoking (Icon: cigarette)
    • Smoking is the major risk factor of COPD and is thought to cause 85-90% of COPD cases.
    • Smoking cannabis is also thought to cause COPD by irritation of the lining in the lung. It is often mixed with tobacco when smoked.
    • People who have never smoked and who have been regularly exposed to passive or second hand smoke may develop COPD. If you live with someone who smokes you are also exposed to passive or second hand smoke even if you do not smoke yourself.  Children who’s parents smoke are particularly vulnerable to exposure at home and in cars.
    • If a child has asthma exposure to smoke can trigger an attack.Children who have severe and persistent asthma are more likely to develop COPD in later life.
    • If a parent who has smoked develops COPD then their children are likely to develop COPD in later life especially if they also start smoking. A parent who smokes can become a “smoking role model” as children of smokers copy what they see their parents do and are more likely to become smokers when they are older.
    • Smoking while pregnant may cause the child to develop COPD in adult life.
  • Environmental (Icon: power station)
    • Damp housing may contribute to COPD in adult life or trigger lung problems in children particularly if a child has an existing respiratory disease.
    • It is thought that there may be some environmental causes of COPD. It is known that weather changes can cause flare-ups of existing lung disease.
    • Air pollution from industrial chimneys or car exhaust fumes in built up areas make COPD much worse.
  • Genetics (Icon: DNA helix)
    • COPD can run in families with a genetic link. Alpha 1-antitrypsin deficiency (α1-antitrypsin deficiency) is a genetic disorder that affects less than 1% of patients with COPD. It is a gene deficiency which leads to the development of emphysema. See the support group link for more information.
    • Genetic research shows some people are more prone to nicotine addiction than others. This may explain why some people find quitting smoking much more difficult than others.
  • Occupational (Icon: coal mining)
    • Coal mining is a cause of COPD. In the UK, mining is the only occupation where compensation may be paid.
    • Farming, welding, the building trades and other dusty occupations are thought to cause COPD.
  • Children (Icon: child)
      Children may have a higher risk of developing COPD in adult life

    • if exposed to passive or second hand smoke when they are young
    • if diagnosed with respiratory problems
    • a low weight at birth.

What is COPD?

Conditions causing COPD

Chronic Obstructive Pulmonary Disease is a term that is used to describe a mixture of lung conditions. These conditions include:

  • Chronic bronchitis which is a narrowing of the airway.
  • Emphysema which is due to damage to the delicate alveoli (air sacs).
  • A mix of chronic bronchitis and emphysema.

However, people will have different symptoms and experiences of living with the condition because:

  • People with COPD can have mild to very severe disease.
  • Some people may experience mild symptoms which has little impact on their daily life.
  • Other people may have severe symptoms which affect or limit aspects of daily life.
  • It is possible to have severe disease but experience very few symptoms.
  • Though most people will have a mix of both conditions others may have only one condition. For example, some people may have emphysema only or chronic bronchitis only.

Common symptoms of COPD include:

  • Breathlessness.
  • Cough.
  • Wheeze.
  • Mucous production.

Self management

Family looking at a laptop computer
Self management is about growing in confidence and gaining new skills, to help you manage your condition. This will be done with support from your health care professionals, carers and family. This does not mean that you have to cope alone or that the health care professionals are abandoning you.

Self management is about you finding what works best for you in terms of coping and managing everyday living activities when living with a long term condition. The support you need will always be in place but you will be the person managing it. It is about you being in control of your condition and not it taking control of you!

Here are some tips for successful self management;

  • Understand as much as you can about COPD.
  • Understand how COPD affects you.
  • Improve the way you cope and your well being.
  • Know when and where to get the help you need.
  • Know how to communicate with the healthcare experts about your COPD symptoms.
  • Know which actions you can take which are personally meaningful and important to manage your COPD.
  • Know what to do if your COPD gets worse.
Self management is about making small changes or adjustments. You are already doing this by visiting this website.
You will see this icon on some pages when there is a self management tip.