As a personal trainer in London I come across a wide range of health conditions in my clients. It’s hardly surprising that in a big capital city with high levels of air pollution, COPD is a common condition among Londoners with existing lung problems.
What is COPD?
COPD is an umbrella term for a range of chronic lung conditions. These include emphysema (damage to the alveoli, the millions of tiny air-sacs in the lungs) and chronic bronchitis (where the airways in the lungs, known as the bronchial tubes, become constricted with mucus and inflamed).
People with COPD experience restricted airflow and breathing difficulties. Symptoms include shortness of breath after even the most mild physical exertion, wheezing, a persistent cough with plegm (mucus in the lungs), fatigue when exercising and inability to take part in strenuous exercise.
There are 4 stages of COPD severity: mild, moderate, severe, very severe. Someone with very severe COPD has an increased risk of heart-failure and also lung cancer. It takes years of living with COPD to reach the very severe stage, and a flare-up can be fatal. Elderly lifelong heavy smokers are the most likely to suffer from very severe COPD.
Diagnosis of COPD
A chest X-Ray or CAT scan can diagnose COPD and assess the severity of the condition.
Pulmonary function tests are also used. A spirometry test is used to assess lung function, essentially how much air you can inhale/exhale and how fast you can exhale. A doctor can also listen to your lungs through a stethoscope as you breathe in and out, to assess the degree of wheezing.
A special machine is used to measure oxygen transfer ability, which gives an indication of alveoli function.
This is where the gas exchange between our lungs and bloodstream occurs. Oxygen from the air we breathe in goes down the trachea, then down the bronchial tubes, into the alveoli (tiny air sacs) and finally into the bloodstream. Carbon dioxide passes from the bloodstream and into the alveoli to be expelled when we breathe out. We have approximately 480 million alveoli in our lungs on average.
Causes of COPD
The number one cause of COPD is smoking cigarettes (and also smoking cannabis). There are around 6.4 million smokers in the UK (2022 figures), which is around 13% of the UK population, down from 20% in 2011. The London Borough of Barking & Dagenham has the highest percentage: 22.4% of its population are smokers.
As a personal trainer I always encourage my London clients to quit smoking, particularly if they have COPD. Make it your mission to give up smoking, using any means possible: nicotine patches, hypnotherapy, moral support from friends and family.
Other causes of COPD include living in areas of high air pollution, living in accommodation infested with mould (sadly a common occurrence in thousands of rented properties in the most deprived parts of London), and having worked in industries such as coal-mining.
This is the medical term for an acute episode of severe worsening of COPD, which if untreated can lead to a chronic worsening. The most common triggers are being in an enclosed space thick with cigarette smoke, being exposed to large amounts of dust in the air, being near vehicle exhaust from a high-polluting vehicle, contracting colds/flu, and stepping out into freezing cold air in the winter.
One form of treatment for an exacerbation is oxygen therapy in a medical clinic or hospital. More frequent use of your inhaler, under your GP’s direction, is also recommended. Always contact your GP as soon as you experience an exacerbation.
Treatment for COPD
There are a range of inhalers with medication to relieve the inflammation. A deep inhalation is needed to enable the medication to penetrate deep into the lungs. Bronchodilators are often the first type of inhalers used, which relax and widen the bronchial tubes. For more severe COPD, long-acting bronchodilators are used. Steroid inhalers are a third option for very severe COPD.
Medication is also available in pill form, and there are also specialist medicines to reduce excessive phlegm in the lungs.
Pulmonary rehabilitation is also used to help strengthen the lungs and to get patients on the path to recovery, through exercise and lifestyle changes. The most important thing is to quit smoking and to keep away from secondary cigarette smoke.
Exercise for people with COPD
The temptation is to avoid exercise because it is hard to breathe, and there is a fear of triggering a coughing-fit. However, it is important to exercise in order to strengthen the heart and lungs, to keep the muscles strong, and to promote your agility and mobility. The older you get, the more important this is for your independence.
If you’re not accustomed to exercise, start slowly and build up gradually. Always consult your GP before commencing an exercise programme if you have COPD.
For more about COPD I recommend the YouTube channel @lungfit2599. I also recommend the YouTube lecture Take a Deep Breath, a COPD Lecture with Dr David H. Bushell.
(Dominic Londesborough is a personal trainer in London and an online nutrition coach)