Your COPD Guide. Contents

Transcription

1 Your COPD

2 Your COPD Guide Contents Introduction Page 3 Why is Self-Management Important? Page 4 Self-Management and Your Goals Page 5 How to use this guide Page 8 Section 1: What is COPD? Page 9 Section 2: Flare-ups Page 15 Section 3: Self-Management Page 21 Section 4: Medicines, Oxygen and Travel Page 25 Section 5: Exercise and Self-Help Page 32 Section 6: End of Life Page 37 2

3 Your COPD Guide Introduction This guide has been given to you to help you understand and manage your chronic obstructive pulmonary disease (COPD). The guide is designed to give you information and advice that will help you to manage the symptoms of your COPD. The information in your COPD guide is divided into sections. Each section has been chosen because it contains information that is relevant to you. Other sections may be added to your guide in future if you need more advice or information about managing your COPD. The first few pages of the guide will ask you to think about the goals or changes that you want to make in your day-to-day life. Then, over the coming weeks and months you will be helped to make these changes by your nurse, doctor or physiotherapist. 3

4 Your COPD Guide Why is Self-Management important? Being able to control the symptoms of your COPD will help you to reduce the effect the condition has on your day-to-day life. Managing your COPD will mean that you may have to make some changes to your lifestyle. These changes are important if you want your symptoms to be better controlled. However, be patient with yourself and remember that you do not have to make all the changes at once. Self-management works best if you think about the things you want to be able to do in your day-to-day life. This will help us to make sure you have the best information and advice in your COPD guide. 4

5 Self-Management and Your Goals What is important to you? To help you make the most of your COPD guide please list five things that you would like to be able to manage more easily To help you be able to self-manage you symptoms it will help if you see these five things as goals that you would like to achieve. You should therefore make sure that they are realistic for you. 5

6 Self-Management and Your Goals Now think about the reasons why you are unable to manage the five things you listed on the previous page. What would you need to happen to feel that you could manage them more easily? For example, do you have to stop doing a certain thing because you become too short of breath to continue? If you feel able to, try and think about when you feel you would like to be able to achieve your goals. Remember to be realistic and accept that changes cannot happen overnight. Use this information to fill out the table on the following page. This will help us to understand what you need to do to help you to achieve your goals. 6

7 Self-Management and Your Goals Goal Number and Description (Use the information from page four) What stops you from doing this easily at the moment? What would you need to happen to be able to manage this more easily? When would you like to achieve this by? 7

8 How to use this Guide Once you have decided what your goals are your nurse or doctor will be able to decide which sections of the guide will help you achieve them. The sections that will help you with each of your goals are listed below: Goal Number Sections of the guide that will help you

9 Section One Contents Your lungs Page 10 What is COPD? Page 12 Causes of COPD Page 12 Diagnosis Page 13 Symptoms Page 13 9

10 Section 1: Your lungs Your lungs lie in your chest within your rib cage. You have two lungs, one on either side of your heart. The right lung is a bit bigger than the left, because the heart takes up some of the room on the left-hand side. Air travels into your lungs through your windpipe (also called your trachea). The windpipe divides into two large air tubes, or bronchi, one supplying air to the right lung and one to the left. These air tubes divide again many times within each lung so that air can flow to all parts of the lungs. At the end of the smallest air tubes (called bronchioles) there are tiny air sacs called alveoli. This is where the oxygen from the air is transferred into your bloodstream. There are about 300 million alveoli in the lungs, and if you were to iron them all out flat they would cover an area roughly the size of a tennis court. Bronchus Trachea Alveoli Bronchioles Diaphragm 10

11 Section 1: Your lungs Small blood vessels called capillaries run around the outside of each of the alveoli. The walls of the alveoli and the capillaries are very thin, which allows oxygen from the air to transfer into the blood. This blood is then pumped all around the body by the heart. All the tissues and cells in your body need oxygen to make energy. As this energy is used, the body produces the waste product carbon dioxide. This is collected in the blood stream and taken back to the lungs, where it is transferred back into the air that you breathe out. Microscopic air tube Microscopic blood vessels Capillaries Alveoli 11

12 Section 1: COPD What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease. It is a disease that damages the airways of the lungs, causing them to become inflamed and narrow. This makes it harder for the air to flow in and out of the lungs, which is why breathing becomes more difficult. COPD is a long-term condition, which means that it cannot be cured. However the symptoms of COPD can be controlled through ongoing management. What causes COPD? Most people get COPD as a result of smoking tobacco / cigarettes. This is because the chemicals in cigarette smoke irritate and damage the airways. Continuing to smoke when you have COPD will cause even more airway damage, which will speed up the rate at which the disease progresses. Other factors such as coal dust can cause COPD and there are some people who have a genetic cause, although this is quite rare. There is currently no evidence that air pollution can cause COPD, although it can make the symptoms worse if you already have the disease. 12

13 Section 1: COPD How have I been diagnosed with COPD? In most cases you will have been sent for a breathing test to confirm your diagnosis of COPD. This test will have shown if there are any problems with the way the air flows in and out of your lungs. What are the symptoms of COPD? People with COPD can have any of the following symptoms: l Wheeze l Cough l Shortness of breath l Repeated chest infections l Phlegm What is the treatment for COPD? There is no cure for COPD but you can do a lot to ease your symptoms. Stopping smoking is the most important thing that you can do to stop your symptoms from getting worse. You will probably have been given some medications - usually inhalers - that will help to reduce the inflammation and make the airways wider. You may also be given other medicines depending on your symptoms and how well you respond to treatment. 13

14 Section 1: Breathlessness What is Breathlessness? Breathlessness is a sensation felt that can be described as chest tightness, feeling unable to breathe deeply or difficulty in breathing normally. Breathlessness is often quite frightening and because you feel anxious, your breathlessness can feel worse. Learning to control breathlessness is an important part of reducing these symptoms. When you have COPD, the airways become inflamed and narrowed. This means that it is more difficult for the air to flow in and out of your lungs. Because you have to work harder to get the air in and out of your lungs, it can make breathing feel more difficult. What if I can t get enough air? It is important to remember that, even though you may be feeling short of breath, you will almost always get enough air into your lungs. In fact, to supply the body with oxygen when you are resting, the lungs only need to take in about mls of air in each breath to be able to supply the body with all the oxygen it needs - that is about the volume of a fizzy drink can. 14

15 Section Two Contents Flare ups Page 16 How do I know if I am having a flare up? Page 17 What if I don t feel any better? Page 19 What happens if I have to go into hospital? Page 20 15

16 Section 2: Flare-Ups What is a Flare-Up? A flare-up happens when you have a worsening of any of your symptoms (for example, you may become more short of breath than normal). You may have heard your doctor refer to this as an exacerbation of your COPD. There are many reasons why you may be having a flare-up and it does not necessarily mean that you have a chest infection. Sometimes the airways can just become more inflamed than normal, even though there is no infection present. Flare-ups can be quite common in COPD. However, taking your regular medications, keeping fit and stopping smoking can all help to reduce how often they happen. Flare-ups can cause more damage to your lungs, so it is important that you are able to tell when your breathing feels worse than normal. However, you need to remember that it is normal to have good days and bad days with COPD and having one bad day may not necessarily mean you are having a flare-up. 16

17 Section 2: Flare-Ups How do I know if I am having a Flare-Up? Most people tend to feel unwell for a couple of days before they have a flare up of their COPD. Look out for warning signs that might mean that you are about to have a flare-up: l Wheeze l Generally feeling unwell and / or more tired than normal l Feeling more short of breath than normal l Feeling feverish or as if you have a temperature l Nasal congestion or difficulty breathing through your nose l Coughing more than normal l Coughing up more phlegm than normal l Coughing up phlegm that is a darker colour or is thicker than normal l Swelling of your ankles and feet that is not normal for you l Cold or flu symptoms, such as runny nose, sore throat, watery eyes, feeling achy, chills or fever l Wheezing or whistling sound in the chest or tightness of the chest when you breathe l Not being able to walk as far as normal l Difficulty sleeping l Poor appetite The earlier you spot the signs of a flare-up, the better, as it may prevent further damage being done to your lungs. 17

18 Section 2: Flare-Ups What should I do when I feel unwell? Your doctor or nurse should have provided you with a personalised care plan or self management plan, this will tell you what to do based on your symptoms. If you have any of the warning signs, act immediately, do not delay. If you are unsure what to do, ring your GP or the COPD nurses ( ) or your out of hours service. Most people can be treated at home if they have a flare-up. To help you feel better you should: l Increase the amount of times that you take your reliever medication (normally your blue inhaler). This will help to open up your airways so that the air can flow more easily in and out of the lungs l Keep taking all your normal medication even if you are feeling unwell - don t skip doses l Keep warm and have plenty of rest l Drink enough fluid especially water. Aim to drink 8 glasses of water per day (unless you have been told not to). This will help to keep you hydrated and will keep the phlegm on your chest looser l Eat small, regular meals l Take paracetamol every 6 hours if you have a temperature. (up to a maximum of 8 tablets in 24 hours) 18

19 Section 2: Flare-Ups What if I don t feel any better? Sometimes, it might be necessary for you to have additional treatment to try and help ease your symptoms. You might need to take antibiotics if there is an infection in your lungs, or steroids if your lungs are very inflamed. It is important that you don t take either antibiotics or steroids if you don t need them, so if in doubt, ask your GP or Practice Nurse or ring the COPD Team. Make sure that you follow the advice in your personalised plan, as this will tell you when you might need antibiotics or steroids. If you have had a lot of flare-ups, or if you have felt unwell for a while, you may be offered a clinic appointment with the specialist COPD nurse or respiratory consultant. 19

20 Section 2: Flare-Ups What if I have to go into hospital? Sometimes, it is not always possible for you to be treated at home and you may have to go into hospital for more treatment. Please take your current medications with you if you have to go to hospital. When in hospital, it is really important that you get up and move about regularly as this will help your circulation and breathing. Try not to lie in bed all day even if you feel short of breath. You might need to have additional assessments if you feel that you might struggle to manage when you get home. If you have any concerns about this, make sure that you tell the doctor or nurse who is looking after you. Because there is a risk of you getting another infection while you are in hospital, the doctor might want to make sure that you can return home as soon as possible. This might mean that your treatment will continue at home. If this happens, one of the respiratory nurses may visit you at home to check your progress. 20

21 Section Three Contents How can I reduce the risk of getting a chest infection? Page 22 How can I help myself? Page 23 Keeping well in winter Page 24 21

22 Section 3: Keeping Well How can I reduce the risk of getting a chest infection? l Make sure that you have had your flu and pneumonia vaccinations. l Try and reduce the amount of time that you spend in crowded places. l Wash your hands regularly. Keep your inhalers and spacer clean. If you use a nebuliser, make sure that you keep it clean and replace the mask/mouthpiece and tubing after each flare-up. l If friends or family members have colds or flu, ask them not to visit if possible. l Take your medications as advised by your doctor. 22

23 Section 3: Keeping Well How can I help myself? l If you smoke, consider stopping now. This is something that you should think about seriously, as smoking can stop some of your medicines from working properly and will also keep damaging your lungs. For further advice or information contact your practice nurse or the Smoking Cessation Team on l Take all of your medications as prescribed and make sure that you have a good supply in your house. Never let yourself run out of medications. l Look after yourself, avoid infections where possible and avoid getting too hot or too cold. l Eat healthily and seek advice about your diet if you need it. l Exercise is important and it will keep you fitter for longer. Walk to the shops or do some gardening or other gentle exercise on a daily basis. Try not to sit around, even if you feel breathless. l Consider joining you local Breathe Easy group for support from people living with similar lung conditions - you are not on your own. l Some days you will feel better than others. Be flexible. Do more on your good days. 23

24 Section 3: Keeping Well in Winter Cold weather may make your breathing worse there are a few things that you can do to help you stay well in winter. Keep your home warm. We recommend you use a room thermometer and try to keep your rooms downstairs at 21 degrees centigrade and upstairs at 18 degrees centigrade. Keep yourself warm and as active as possible. Wear layers of clothing as this helps to trap heat. Keep a blanket to hand to cover you when you are resting. Check the weather forecast before you go out avoid going out on days that are very damp or foggy. Ideally wear a hat and cover your nose and mouth with a scarf. Carry your reliever inhaler with you at all times when you go out and use it a few minutes before you leave the house as cold air will make your chest feel tight. Make sure you have your flu jab every autumn. This does not protect from the common cold though so avoid contact with friends and relatives who have colds wherever possible. For more information speak to your nurse or call the British Lung Foundation on

25 Section Four Contents Medication Page 26 Nebulisers Page 27 Other medicines to help your breathing Page 28 Oxygen Page 29 Travel Page 30 25

26 Section 4: Medication Inhalers Most of the medication that you need to treat your lungs will come from inhalers. Inhalers allow you to breathe the medication directly into your lungs, where it can start working straight away. Unlike taking a tablet, medicines in inhalers do not have to go through the rest of the body first, meaning that they work more quickly and effectively, and you are less likely to suffer side effects. It is very important that you: l Take all of your inhalers as prescribed every day. l Carry your reliever inhaler (usually a blue colour) at all times, particularly when you go out. l Make sure someone shows you how to use any new inhalers you get if you have never used that type before. l If you are provided with a spacer that means your inhaler technique is not quite right and this will help get more of the medication into the lungs. You must use it to get the full dose. l NEVER run out of your inhalers. l Always take your inhalers to appointments with the doctor or nurse as they may need to check that you are using them correctly. 26

27 Section 4: Medication Nebulisers Nebulisers are used to deliver high doses of medicine into the lungs. The compressor machine turns the liquid medicine into a gas which you breathe in. Nebulisers are useful for people who are unable to take their inhalers but it is important to realise that not everyone who has COPD will benefit from a nebuliser. Before you are given a nebuliser it may be necessary to carry out a series of breathing tests (usually at the hospital) to see if the nebuliser opens the airways any better than your usual inhalers. Sometimes it may not make any difference in which case you will not be given a machine and should carry on using your inhalers as before. If you are given a machine it is important that you keep the mask or mouthpiece and pot clean and dry after use as bacteria can develop in a warm moist pot which you will then inhale next time you use the nebuliser. Avoid placing the machine on the floor or on the bed. Ideally it should be placed on a hard surface whilst in use. Machines need to be serviced annually. If you have a hospital machine they will contact you when it is due. If you buy your own machine it will need to be returned to the manufacturer for servicing. 27

28 Section 4: Medication Aminopyhline/Uniphyllin/Phyllcontin These are tablets to help your breathing that your doctor may give you in addition to your inhalers. The names you see above are all different names for the same treatments, and you should only be taking one type at a time. Certain things affect the level of this drug in the body, if you stop smoking for instance, you should tell your doctor or nurse as we may need to adjust the dose. Your doctor may also change the dose while you are taking certain antibiotics or other medicines. You may need to have a blood test from time to time to check that the drug is working. The blood will need to be taken within four hours of taking the tablet. As with most medications there are side effects - most commonly stomach upset or palpitations. You will usually notice this within the first week of taking this medication. Please contact your nurse or doctor for advice if you notice any of these side effects. 28

29 Section 4: Oxygen Oxygen is only used in COPD when the oxygen levels in the blood are too low. We can tell this from the oxygen saturation test we do which is when we put a small clamp onto your finger. If this is below 92% we may send you for a special blood test at the hospital called a blood gas test. A small amount of blood will be taken from your wrist and analysed to accurately check the levels of oxygen and carbon dioxide in your blood. If oxygen is prescribed it may be given in various ways. The oxygen assessment team will decide what is best for your needs. It may be necessary for you to have oxygen only when you are active or out and about; we call this ambulatory oxygen. You may need to have oxygen for longer through the day and night usually for a minimum of 15 hours in every 24 hours. Oxygen will usually be delivered in the following ways: l From a machine called an oxygen concentrator l From a cylinder small enough to carry on your shoulder when you are active There are other forms of oxygen which can be provided but this is determined by the oxygen assessment team depending upon your needs. 29

30 Section 4: Travel We hope you will still be able to carry on with as normal a life as possible with COPD. This includes enjoying holidays. You will need to plan your holiday in advance and you may need to consider your destination more carefully in terms of access and terrain for instance. Always make sure you have enough medication to last while you are away and take a copy of your medications list with you. It may be advisable to take a rescue pack with you in case you become unwell whilst you are away. Discuss this with your doctor or nurse before you go. If you use a nebuliser it may be possible for you to borrow a battery operated nebuliser from the hospital to allow you to go out more while you are away. These are in limited supply though so contact Clinical Measurement Unit at the hospital well in advance to book a machine. If you use oxygen it may be possible to arrange for a concentrator or cylinders to be delivered to your destination. You will need to contact Air Products to arrange this. 30

31 Section 4: Travel Holidays abroad If you plan to go abroad it is important that you seek advice about whether it is safe for you to fly. You may need a letter from your doctor stating you are fit to travel or you may need to arrange for a flight assessment at the hospital as the oxygen concentration on an aeroplane is often less than air at sea level. If you already use oxygen it is important to check with your airline whether you can take your cylinder on board. Some airlines provide oxygen cylinders for passengers with specific needs but may charge you for this service. If you need oxygen at your destination contact Air Products who will advise you. There will be a charge for oxygen provision abroad and it may not be available at all in some areas. Check before you book. 31

32 Section Five Contents Why is it important for me to Exercise? Page 33 Healthy Eating Page 35 Breathe Easy Club Page 36 32

33 Section 5: Exercise Why is it important for me to exercise? People with breathing problems often don t like feeling short of breath, so avoid doing the things that make them feel breathless. This means that you may do less and as a result, your muscles become weaker because you are not using them as much. Weak muscles need more oxygen from the air you breathe to make energy. This means that you have to breathe harder and faster to get more oxygen into your body. This is why you feel more breathless when you exercise. Exercising regularly improves your muscle strength; the stronger your muscles are, the more efficient they become so they need less oxygen to work. This means you don t have to breathe as hard or as fast to get the right amount of oxygen to your muscles and organs, so you don t feel as breathless. This means you may be able to walk further or do a hobby or activity that you haven t been able to do for a while. Exercise will also: l Make your bones stronger and can help prevent osteoporosis. l Release endorphins (chemicals in your brain) which help relieve depression, anxiety and stress, improve your mood and reduce pain. l Help control weight. l Reduce the risk of heart disease, high blood pressure, high cholesterol and stroke. l Reduce the risk of developing diabetes. 33

34 Section 5: Exercise What s the difference between activity and exercise? Activity is defined as any bodily movement. It is what you do everyday to go about your normal daily routine. This includes shopping, walking to the shops, getting washed and dressed, cleaning, cooking, looking after children/grandchildren. Exercise is different! Exercise should push you a little bit further that your normal daily activity. In other words, you should feel your heart beating faster and you should become moderately short of breath. This means that you are working the muscles hard enough to make them stronger, and will improve your stamina over time. Being active is really important. However, It is not enough just to be active, you need to exercise as well and it s important that you can tell the difference between the two. You may be able to attend a special exercise programme called pulmonary rehabilitation designed specifically for people with COPD. Ask your doctor or nurse for more information. 34

35 Section 5: Healthy Eating Living with COPD means you use a lot of energy when you are breathless as your muscles work harder to help you breathe. This is often why people with COPD lose weight. However eating a big meal may make you more breathless as your full stomach restricts your diaphragm movement. You may need to adjust your eating habits to eat smaller meals more often to help with this. You need to eat a well balanced diet but it may be beneficial to eat a diet that is high in protein and calories, quality is more important than quantity. Try preparing more food than you need when you are well and freezing meals for the days you feel less able to cope with this task. Make sure you drink plenty of water unless you have been told not to as this keeps your sputum thin and makes it easier to cough up. Tea and coffee contain caffeine which actually makes you lose more water in your urine so whilst it is still ok to drink these, make sure you balance the intake of these with water in between. Eating a healthy diet reduces the risk of infection or helps you fight them better. Ask your doctor or nurse for more information about healthy eating or go to for more information. 35

36 Section 5: Breathe Easy Club Breathe Easy groups are part of the British Lung Foundation and offer support and information for anyone affected by a lung condition. There are over 200 groups throughout the UK, one of which is in Walsall and meets every third Wednesday in the month at Pelsall Community Centre, Station Road, Pelsall, WS3 4BQ. Meetings start at 1pm. For more information regarding the local group please contact John on The members of the group meet and support each other. As the members have a respiratory condition or have a partner who has a respiratory condition, they know a lot about the daily problems faced by fellow sufferers. Respiratory nurses do support the meeting but the group is run by members of the group who have a respiratory condition. The Walsall group has a planned programme which includes visits to local attractions and guest speakers, the talks are not always about medical problems but anything that interests the group. All are welcome. Because of the nature of respiratory diseases the members of the group realise that it is not always possible to attend every month but are happy for anyone to come when they can. The British Lung Foundation is a national charity who supports people affected by lung disease. They produce a wide range of information aimed at helping people understand lung conditions. A wide range of leaflets are available to give information about lung disease, these are available in clinics and surgeries, there is also a very comprehensive web site available at 36

37 Section Six Contents Hospital Care Page 38 Medication Page 39 Long-Term Oxygen Therapy Page 40 Death and Dying Page 43 37

38 Section 6: Hospital Care From time you may need to come to hospital because you are having a flare-up of your COPD. The doctors and respiratory nurses will assess you and it may be that you will be provided with some treatment and sent home or sometimes you may need to stay in hospital. You may be sent home after a few hours under the care of the Early Supported Discharge Team who will visit you at home for a few days to make sure that you are recovering from the flare-up. If you are too unwell to go home straight away the respiratory nurses will follow your progress on a daily basis and decide with the doctors when you are fit to go home. Whilst at home the nurses will monitor things like your oxygen levels and symptoms and have direct contact with the medical team if there are any problems. They may also need to change medicines or wean you off a nebulizer during this time making sure you can use you inhalers correctly before you are discharged back to the care of your GP. The nurses will also provide some information about COPD and any treatments or referrals that may be necessary either whilst you are still in hospital or when you go home such as oxygen therapy or pulmonary rehabilitation. 38

39 Section 6: Medication Whilst you are in hospital you may be given some drugs directly into your veins for a short time. These are usually antibiotics and will be changed to a tablet after two or three days. Most of the time a flare-up can be treated with antibiotics and steroid tablets which is why it is often possible to let you go home quickly. Sometimes you will need to have oxygen or a nebuliser in the first few hours of a hospital stay but you will be taken off this treatment if you do not normally use it at home before you are discharged. If the nurses or doctors think you may need to have these treatments on a more long term basis they will arrange for you to have an assessment after you have gone home and have fully recovered from the flare-up. 39

40 Section 6: Long-Term Oxygen Therapy For some people with COPD the disease makes it difficult for enough oxygen to get into the blood stream from the lungs. We can tell this from the oxygen saturation test we do which is when we put a small monitor onto your finger. If this is below 92% we may send you for a special blood test at the hospital called a blood gas test. A small amount of blood will be taken from your wrist and analysed to accurately check the levels of oxygen and carbon dioxide in your blood. If your oxygen levels are too low you may need to use oxygen at home for at least 15 hours every day. This is the minimum number of hours needed to protect your heart and other organs from damage due to a lack of oxygen. You will still need to continue with your inhalers and other treatments as oxygen will not treat your breathlessness. It may however help you to get your breath back quicker if you have exerted yourself. The oxygen is usually delivered from a machine fitted into your home called a concentrator. This is about the size of a small fridge and runs off mains electricity. It draws in room air and concentrates the oxygen ready for delivery through oxygen tubing into your nose. This is a prescribed treatment and it is vital that you do not use too much or too little. Once the machine is set by the engineer the level should not be adjusted without repeating the blood test. We would suggest you try to sleep with the oxygen on to use up at least half of the fifteen hours, then use the remaining hours to suit your plans through the day. You do not need to use all fifteen hours continuously but must make sure you fit 15 hours into a 24 hour period. 40

41 Section 6: Advanced Stages of COPD There does come a time when you feel that your breathlessness is getting worse and that the medication is not having the same effect that it used to. This is a very difficult time because you will probably be increasingly aware that your breathlessness is impacting on what you want to do more and more. It is also difficult for people around you as it may be affecting them and they may or may not understand why the medication isn t having the same effect that it used to and it why you are unable to participate in the things you used to. Your COPD specialist nurse will be able to talk this through with you and explain what is happening. He/she will also check that you are on the right medication and that you are still able to take it effectively. It may mean taking a different approach to your COPD but you will be given an individualised care plan to help you through this stage and give you back some control over what is happening to you. The term palliative care may be used. This is nothing to worry about, it just describes the time when controlling your symptoms is the most important, that you are on the maximum treatment but as above a different approach will include looking at other ways of managing your breathlessness. 41

42 Section 6: Hospital or Hospice Care As your disease advances there may be times when it is necessary for you to go into hospital. This may only be for a short time while certain tests are carried out or treatments started, then it may be possible to arrange for you to go home with some support from the Respiratory Nurses. Non-invasive ventilation For some people with COPD there can be times when carbon dioxide rises to dangerous levels in the blood. If this happens it is a potentially life threatening situation and needs to be treated. You may need to be put on to a type of ventilator with a tight mask fitted over your face. This helps to reduce the carbon dioxide levels in the blood and helps you to breathe more easily. As soon as levels are safe again you will be weaned off the machine. Hospice Care With advancing disease and as your needs for care increase it may be possible for you to spend a week or two in our local hospice for a period of respite. 42

43 Section 6: Death and Dying As your disease advances you may start to think about what this will be like when the time comes. No two people are the same so it may be best to discuss this with your doctor or specialist nurse if you have particular worries. If you have particular requests or views on resuscitation or ventilation it is important to let your doctor or nurse know so that it can be properly recorded. We want to ensure that your needs and wishes are met, particularly in terms of your preferred place when the time comes. Morphine is sometimes prescribed for people with very severe COPD, this may not be for pain but to reduce the sensation of breathlessness and make you more comfortable. We will do all we can to support you and your family during this time and may involve many other services to provide the care that you need. 43

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