Roundtable: The battle against COPD is psychological, not just physical

COPD is a debilitating progressive disease, characterised by breathlessness. It’s associated with exposure to a noxious substance – usually cigarettes but also cannabis.

While professionals may view it in terms of airflow reduction and inflammation, patients may experience it as the slow onset of symptoms that are often just put down to age.

But its impact on other parts of people’s lives is probably as profound as on their health. Panellists spoke of the “stigma” people with COPD felt and how they could be reluctant to use oxygen in public. Patients with COPD tend to be relatively old – 60s upwards – and from a deprived background.

Isolation – together with anxiety and depression – is an enormous issue for people with COPD. Many have to give up things they enjoy, such as gardening, and become more dependent on others.

Colin Gelder, respiratory consultant at the University Hospitals of Coventry and Warwickshire Trust, said many of his patients had been “alpha males” who had jobs and were seen as the head of their family. When they developed COPD, they were suddenly dependent on their wives.

Patients often felt their lives shrunk with limited contact outside the home. Physical exercise can help with some of the symptoms of COPD but it is difficult to get patients to take it up. Many COPD patients will have comorbidities and will be on multiple medications.

Using technology to monitor patients can help to spot a patient who is deteriorating while oxygen therapy can be delivered at home and reduce hospital admissions.

The struggle with smoking

Smoking is the major cause of COPD and stopping can help relieve symptoms – as Mike Roberts, lead for the national COPD audit programme at the Royal College of Physicians, put it, “it is never too late to give up smoking.”

But many patients struggle to do that, creating a series of dilemmas for the health service. Panellists were universally concerned that smokers may not be getting the support they need to quit at the right time and in the right place. A hospital admission, for example, may motivate patients to try to give up.

But, like other public health schemes, smoking cessation services are under financial pressure and being cut back in many areas – making it harder for clinicians to refer someone seamlessly into a scheme when they were ready to try to stop. Dr Roberts said: “You have to have a smoking cessation service ready to go.” Very often they had been decommissioned, he added, while other panellists said it showed how disjointed the system was.

“We may have taken our eye off the ball around cannabis”

Patients who continue to smoke at home and use home oxygen may be putting themselves and others at risk – as well as increasing their chance of more hospital admissions.

But without oxygen, their health may further deteriorate. Many of the clinicians round the table saw this as a difficult area – should they refuse to supply oxygen if patients were likely to smoke near it? Dr Gelder said this was considered on a case by case basis – someone living in a tower block could be a risk to those around them.

Sometimes the focus was on risk reduction – for example, using oxygen cartridges rather than cylinders with known smokers.

However, it was difficult because patients did not always tell the truth about smoking; home visits could reveal continued smoking when they claimed to have given up. Philips Healthcare’s Amie Day pointed out the considerable benefits oxygen therapy offered patients in terms of extra life.

But while fewer people may be smoking Mr Gelder warned: “We may have taken our eye off the ball around cannabis. We are seeing more younger people who are cannabis users with COPD.”