World COPD Day: a blog with Dr Nick Hopkinson

Dr Nick Hopkinson
By Dr Nicholas Hopkinson     18/11/2020

World COPD Day is a global campaign to raise awareness of chronic obstructive pulmonary disease (COPD) and recognise the importance of looking after your lungs and living well with the disease.

COPD is a group of lung conditions including chronic bronchitis and emphysema which cause airflow limitation making it harder to breathe.

In this blog, honorary respiratory consultant and clinical lead for chronic obstructive pulmonary disease (COPD) at Royal Brompton Hospital, Dr Nicholas Hopkinson, shares what he enjoys most about his job, his tips for better managing COPD, the most significant developments in COPD care, and more.

What does World COPD Day mean to you?

More than 1.3 million people in the UK have been diagnosed with COPD, historically it’s not had as much prominence as other conditions like heart disease and cancer. It is an area where awareness really is an issue because people often ignore the symptoms and signs of lung disease – cough, sputum, getting out of breath during ordinary activities, for many years before they get a diagnosis, by which time their condition is often quite advanced.

A lot of people don’t really understand what COPD is or what it means. Often, people feel that there is not much they can do to improve their quality of life. But this is not true, and World COPD Day is a good opportunity to remind people living with the condition and those looking after them of the “five fundamentals” of COPD care. These are:

  • treatment and support to stop smoking
  • getting vaccinated
  • rehabilitation
  • having a self-management plan
  • identifying and managing other health problems

Awareness and education can also help to ensure that patients get access to the correct medication and treatment, and crucially, information on how to take their medications correctly for example, the proper use of inhalers.

What three tips would you give to people who want to better manage their COPD?

1. Stop smoking – it’s really important to quit completely because smoking drives progression of the disease, drives the symptoms that cause chest infections and increases the risk of getting other medical problems like heart disease or cancer alongside COPD.

2. Get vaccinated – COPD can put a significant strain on the body and means people with the condition are more vulnerable to infections. Get the flu vaccination every year and a one-off pneumococcal vaccination.

3. Exercise regularly – keeping active is important for quality of life and managing COPD better. Because lung disease makes people breathless, and breathlessness is unpleasant it makes sense that people stop doing things. But this can lead to them becoming less physically active and less fit so they get breathless more easily – a vicious cycle. The key message is that it’s not harmful to make yourself breathless during physical activity. It’s important for maintaining fitness and gaining more control over your breathing. Whether it’s having a daily exercise regime or taking part in an organised programme of pulmonary rehabilitation (supervised exercise and education), staying active is very important.

What changes have you seen in COPD care over your career? What do you consider to be the most significant development in COPD care/research at the moment?

Over the course of my career, the biggest change in clinical practice has been the introduction of non-invasive ventilation for patients admitted to hospital where their lung disease has got so bad that they can’t move enough air in and out to stop carbon dioxide accumulating. When I first qualified, non-invasive ventilation wasn’t really an option and the chances of patients surviving invasive ventilation in ICU was very low. The development of non-invasive ventilation i.e. a face mask that takes over some of the work of breathing for patients while their lungs recover, has made a huge difference. 

Another significant development that’s just happened this month (Nov 2020) is the decision by NHS England to support specialist commissioning for lung volume reduction procedures (lung volume reduction is a treatment for emphysema and aims to reduce the amount of air trapped in the lungs). At Royal Brompton, we’ve been performing lung volume reduction surgery and putting endobronchial valves into people’s airways to improve lung functionality and breathlessness for around 20 years, but these have been specialist, niche procedures. 

Specialist commissioning means there’ll be a specific funding stream that will allow the NHS to provide lung volume reduction procedures for people with COPD. It’s a really important intervention. Although they are only appropriate for a relatively small proportion of people with COPD who have the right pattern of emphysema, these treatments can turn the clock back a few years for patients and really improve quality of life and breathlessness, as well as prolonging survival.

What inspired you to pursue a career in respiratory care?

It was a while ago now, but it was my interest in physiology (the branch of biology that aims to understand the mechanisms of living things) and breathing. I like the way breathing is quite tangible – you can see someone is breathing in and out and it’s happening right in front of you.

What do you enjoy most about your job?

I think the most enjoyable thing is finding someone who thinks nothing can be done to improve their COPD and in fact, it turns out that one of the specialist interventions we have available at the hospital can make a big difference, improve breathlessness and ultimately, improve quality of life.  

For more information on COPD, please see our Trust webpage. There is also helpful information on the British Lung Foundation website.