11/13/24, 8\:17 PM Guide | Explaining COPD

Explaining COPD

Table of contents

Introduction

This guide provides a step-by-step approach to explaining a diagnosis of chronic obstructive pulmonary disease (COPD).
You should also read our overview of how to e

Structure

Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information
being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
Explanation structure

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before
explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to
establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better
understanding of their problem. After introducing yourself, it is important to take a brief history (this is the
structure)\:
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What has brought the patient in to see you today?
What are their symptoms?
Are there any risk factors that can be identi
For example, a patient with COPD may describe episodes of shortness of breath, wheezing and cough.
Tip\: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all
your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction
and brief history between 1-2 minutes maximum.

What does the patient understand?

Following a brief history, it is important to gauge the patient’s knowledge of their condition. COPD is one of the most common
1
respiratory diseases and ranks the third leading cause of death worldwide . Patients may know someone with the condition, or
this may be their
COPD – you may be the
Due to these reasons, it is important to start with open questioning. Good examples include\:
“ W h a t d o y o u t h i n k i s c a u s i n g y o u r s y m p t o m s ?”
“ H a v e y o u h e a r d o f C O P D b e f o r e ?”
“ W h a t d o y o u k n o w a b o u t C O P D ?”
“ W h a t h a s b e e n e x p l a i n e d t o y o u a b o u t C O P D s o f a r ?”
Open questioning should help you determine what the patient currently understands, allowing you to tailor your explanation
to an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks
(i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal
communication such as nodding).
Checking the patient’s understanding should not be solely con
throughout by repeatedly ‘chunking and checking’
.
Tip\: Try using phrases such as\:
“ J u s t t o c h e c k t h a t I a m e x p l a i n i n g C O P D c l e a r l y , c a n y o u r e p e a t b a c k t o m e w h a t y o u
u n d e r s t a n d s o f a r ?”
. This is far better than only saying,
“ W h a t d o y o u u n d e r s t a n d s o f a r ?” as the onus is placed upon the quality
of your explanation rather than an issue with the patient’s ability to understand.

What are the patient's concerns?

The patient’s concerns should never be overlooked. A diagnosis of COPD can be a signi
worries. Asking the patient if they have any concerns before beginning your explanation allows you to speci
most relevant to the patient, placing them at the centre of the explanation. The ICE (ideas, concerns and expectations) format,
can provide a useful structure for exploring this area further.

ICE

Ideas\:
What does the patient think is causing their symptoms?
What is their understanding of the COPD?
Concerns\:
What are the patient’s concerns regarding their symptoms and diagnosis?
Expectations\:
What is the patient hoping to get out of the consultation today?
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Explanation

After determining the patient’s current level of understanding and concerns, you should be able to explain their condition
clearly. COPD can be confusing to medical students and doctors, let alone patients. Avoid medical jargon so as not to confuse
your patient.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
“ I’ m g o i n g t o b e g i n b y t a l k i n g a b o u t h o w t h e l u n g s w o r k a n d t h e n m o v e o n t o d i s c u s s w h a t C O P D i s , w h a t c a u s e s i t a n d h o w w e
c a n m a n a g e i t t o g e t h e r .
”
In preparation for your OSCE, practice your explanation in patient-friendly terms. Consider using visual aids such as diagrams
or drawings to help understanding.
Tip\: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.
Normal anatomy and physiology1,2
“ Y o u r l u n g s a r e r e s p o n s i b l e f o r b r e a t h i n g , s u p p l y i n g y o u r b o d y w i t h o x y ge n a n d r e m o v i n g w a s t e c a r b o n d i o x i d e .
”
“ W h e n y o u b r e a t h e i n , a i r e n t e r s t h r o u g h y o u r m o u t h o r n o s e a n d go e s d o w n t h e w i n d p i p e ( t r a c h e a ) . T h e t r a c h e a d i v i d e s i n t o
s m a l l e r t u b e s c a l l e d b r o n c h i , w h i c h f u r t h e r b r a n c h e s i n t o e v e n s m a l l e r t u b e s c a l l e d b r o n c h i o l e s .
”
“ A t t h e e n d o f t h e b r o n c h i o l e s , t h e r e a r e t i n y s t r e t c h y a i r s a c s c a l l e d a l v e o l i . T h e s e a i r s a c s r e s e m b l e b u n c h e s o f gr a p e s o r a
b u n d l e o f b a l l o o n s . O x y g e n e n t e r s y o u r b l o o d t h r o u g h t h e w a l l s o f t h e a l v e o l i , w h i l e c a r b o n d i o x i d e , a w a s t e ga s , i s r e m o v e d .
”

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a group of long-term conditions that a
understand that COPD is not curable, but by avoiding smoking and receiving treatment, their symptoms can improve.
1
COPD includes conditions such as emphysema and chronic bronchitis.
Explain to the patient that emphysema is where the air sacs (alveoli) are damaged. The once elastic walls weaken, resulting in
larger sacs instead of numerous small air spaces. This impairs e
Additionally, explain that chronic bronchitis involves in
from the lungs. The airway walls become scarred and narrowed. This in
the ‘stale’ air to leave, leading to an increased risk of lung infections. This can also mean that patients bring up more phlegm or
3, 4, 5
mucus.
“ C h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e o r C O P D i s a c o m m o n c o n d i t i o n a
”
m a k i n g i t h a r d e r f o r y o u t o
“ I n C O P D , t h e r e i s i n
m a k e s i t m o r e d i
u p a s p h l e g m .
"
“ A l s o , i n C O P D , t h e a i r s a c s i n t h e l u n g s c a l l e d a l v e o l i a r e d e s t r o y e d ( e m p h y s e m a ) . T h i s m a k e s i t h a r d e r f o r y o u r b o d y t o a b s o r b
o x y g e n f r o m t h e a i r i n t h e l u n g s .
”

What are the causes of COPD?

Explain to the patient that COPD is usually caused by long-term exposure to harmful substances\:
6
Smoking\: the main risk factor for developing COPD is smoking or second-hand smoke. This risk increases the more the
patient smokes and the duration of their smoking.
Environmental pollutants\: prolonged exposure to chemical fumes, dust and occupational smoke.
Alpha-1-antitrypsin de
normally helps protect lung tissue from damage caused by enzymes.
1,4,7
“ C O P D i s c a u s e d b y l o n g-t e r m e x p o s u r e t o h a r m f u l i r r i t a n t s t h a t d a m a ge t h e l u n gs o v e r t i m e .
”
“ T h e m o s t c o m m o n c a u s e o f C O P D i s s m o k i n g. T h i s r i s k i n c r e a s e s t h e m o r e y o u s m o k e a n d t h e l o n g e r y o u’ v e b e e n s m o k i n g .
”
“ S o m e o t h e r t h i n g s t h a t c a u s e C O P D i n c l u d e b r e a t h i n g i n c h e m i c a l f u m e s , a i r p o l l u t i o n o r r a r e l y a n i n h e r i t e d ge n e t i c c o n d i t i o n .
”
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Problems/complications of COPD

Progressive symptoms
Explain to patients that COPD develops over several years and their symptoms may not be noticeable until recently. These
symptoms worsen over time and make their activities of daily living more di
progression of COPD.
Common symptoms of COPD include\:
Breathlessness and wheeze\: chronic bronchitis causes progressive narrowing of the airways, leading to increased
resistance to air
Chronic cough\: due to irritation and in
Chest infections\: damaged lung tissue and impaired clearance of mucus and bacteria making patients for susceptible to
infections.
“ T h e s y m p t o m s o f C O P D d e v e l o p s l o w l y u s u a l l y o v e r y e a r s ; y o u m a y h a v e n o t n o t i c e d y o u r s y m p t o m s u n t i l r e c e n t l y .
U n f o r t u n a t e l y , s y m p t o m s l i k e b r e a t h l e s s n e s s a n d c o u g h t e n d t o w o r s e n o v e r t i m e , m a k i n g d a i l y a c t i v i t i e s m o r e c h a l l e n gi n g .
W h i l e t r e a t m e n t c a n h e l p s l o w t h e p r o g r e s s i o n o f s y m p t o m s , t h e r e i s n o c u r e f o r C O P D .
”
“ D u e t o n a r r o w i n g o f t h e a i r w a y s , i t b e c o m e s h a r d e r f o r a i r t o
”
r e s u l t i n g i n a s e n s a t i o n o f
“ D a m a g e , ”
g o a w a y .
i r r i t a t i o n , a n d i n
“ S o u n d i n g w h e e z y o c c u r s w h e n t h e a i r w a y s b e c o m e n a r r o w e d , c a u s i n g r e s i s t a n c e t o t h e a i r
”
Infections and exacerbations
Patients should be aware that they could experience a sudden worsening of their symptoms, known as an exacerbation. They
may experience increased breathlessness, wheezing, coughing, and a change in the colour or amount of sputum (phlegm).
Exacerbations can occur spontaneously or be triggered by viral or bacterial infections.
3,9,10
“ P e o p l e w i t h C O P D a r e m o r e p r o n e t o d e v e l o p i n g c h e s t i n f e c t i o n s , e s p e c i a l l y d u r i n g t h e w i n t e r t i m e , t h e l u n g s t o e
”
a s i t b e c o m e s h a r d e r f o r
“ Y o u m a y s o m e t i m e s g e t a
e x a c e r b a t i o n s . Y o u m a y e x p e r i e n c e w o r s e n i n g b r e a t h l e s s n e s s , c o u g h i n g, w h e e z i n g, a n d m o r e m u c u s p r o d u c t i o n . T h e s e c a n
b e t r i g g e r e d b y i n f e c t i o n s , e x p o s u r e t o i r r i t a n t s o r c h a n g e s i n w e a t h e r .
”

Management

Stopping smoking
Emphasise to the patient that stopping smoking is the most important thing to do. While any damage done to the airways
cannot be reversed, quitting smoking is the most e
function.
11,12
“ T h e m o s t i m p o r t a n t t h i n g y o u c a n d o f o r y o u r C O P D a n d y o u r o v e r a l l h e a l t h i s t o s t o p s m o k i n g. T h i s i s t h e m o s t e
t o p r e v e n t y o u r C O P D g e t t i n g w o r s e , e v e n t h o u gh t h e e x i s t i n g d a m a ge t o y o u r l u n gs c a n n o t b e r e v e r s e d . B y q u i t t i n g s m o k i n g ,
c a n h e l p p r e v e n t f u r t h e r d a m a g e a n d i m p r o v e y o u r b r e a t h i n g.”
If the patient is a smoker osmoking
cessation counselling.
Vaccines
Patients with COPD should ensure they stay up to date with their vaccines. They are encouraged to have the annual in
vaccination and a one-o
symptoms and leading to complications.
12
“ A s a p a t i e n t w i t h C O P D , y o u a r e e n t i t l e d t o f r e e v a c c i n a t i o n s . Y o u s h o u l d h a v e a o n e-o
u p t o d a t e w i t h y o u r a n n u a l
”
Pulmonary rehabilitation
Pulmonary rehabilitation is a programme of exercise and education to help patients with chronic lung conditions such as
COPD. These programmes last six to eight weeks, with two sessions of two hours each week. They encompass physical
exercise, dietary advice, education on COPD and emotional support.
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The goals of pulmonary rehabilitation are to help patients understand and manage COPD, improve overall well-being, increase
exercise tolerance, improve lung function, reduce the chance of hospital admission and improve patients’ quality of life.
11,15
“ P u l m o n a r y r e h a b i l i t a t i o n i s a t r e a t m e n t p r o gr a m m e m a d e u p o f e x e r c i s e c l a s s e s , i n f o r m a t i o n a b o u t l o o k i n g a f t e r y o u r l u n gs ,
h o w t o e a t w e l l , a d v i c e o n m a n a g i n g C O P D a n d t e c h n i q u e s t o i m p r o v e y o u r b r e a t h l e s s n e s s .
”
“ T h i s w i l l h e l p y o u u n d e r s t a n d C O P D , r e d u c e b r e a t h l e s s n e s s a n d i m p r o v e b o t h y o u r p h y s i c a l a n d m e n t a l h e a l t h .
”
Inhalers
For most patients, short-acting bronchodilators are the
they feel breathless. The inhaler delivers a small dose of medicine directly to the lungs, relaxing the smooth muscles in the
airways, causing bronchodilation, and making breathing easier. These work quickly and e
11,13,14
“ W h e n y o u u s e t h i s i n h a l e r , i t d e l i v e r s a s m a l l a m o u n t o f m e d i c i n e d i r e c t l y t o y o u r l u n gs . T h i s m e d i c a t i o n w o r k s b y r e l a x i n g t h e
m u s c l e s i n y o u r a i r w a y s , w h i c h h e l p s t h e m t o o p e n u p . B r e a t h i n g w i l l b e c o m e e a s i e r , a n d y o u w i l l ge t r e l i e f f r o m
b r e a t h l e s s n e s s .
”
Other inhalers (e.g. long-acting bronchodilators and corticosteroids) may also be used to manage COPD.
12,14
“ L o n g-a c t i n g b r o n c h o d i l a t o r i n h a l e r s a r e u s e d t o p r o v i d e s u s t a i n e d r e l i e d o f b r e a t h l e s s n e s s a n d o t h e r C O P D s y m p t o m s
t h r o u g h o u t t h e d a y . Y o u t y p i c a l l y u s e t h e s e i n h a l e r s t w i c e a d a y a s t h e y h a v e l o n ge r l a s t i n g e
”
“ Y o u m i g h t a l s o b e p r e s c r i b e d a s t e r o i d i n h a l e r . T h e s e w o r k t o r e d u c e s w e l l i n g a n d i n
s y m p t o m s . T h e s e s h o u l d b e u s e d c o n s i s t e n t l y , e v e n w h e n y o u a r e f e e l i n g w e l l t o h e l p m a i n t a i n y o u r a i r w a y s a n d p r e v e n t
u p s o f y o u r C O P D .
”
For more information on inhaler counselling, see the Geeky Medics guide to inhaler technique.
Other medications
If a patient develops an exacerbation of COPD, they may be prescribed a short course of steroid tablets. The course typically
lasts
develops a bacterial chest infection or exacerbation.
These medications are best taken as the
aware of the signs and symptoms of an exacerbation.
11,12,14
“ D u r i n g a
a i r w a y s a n d b r i n g t h e
”
“ I f y o u e x p e r i e n c e s y m p t o m s s u g g e s t i n g a b a c t e r i a l c h e s t i n f e c t i o n l i k e w o r s e n i n g b r e a t h l e s s n e s s , c o u gh o r a c h a n ge i n c o l o u r
l i k e i t b e c o m i n g b r o w n , g r e e n o r y e l l o w o r a c h a n g e i n c o n s i s t e n c y l i k e i t ge t t i n g t h i c k e r y o u r d o c t o r m a y p r e s c r i b e y o u a s h o r t
c o u r s e o f a n t i b i o t i c s .
”
“ I t’ s i m p o r t a n t t o s t a r t t a k i n g t h e s e m e d i c a t i o n s a s s o o n a s y o u n o t i c e a
t h e s e t a b l e t s t o k e e p a t h o m e a s i t i s b e s t t o t r e a t t h e
”
Patients who experience a lot of phlegm production, persistent coughing and frequent exacerbations may be prescribed a
mucolytic (e.g. Carbocisteine). Mucolytics work by loosening the mucus in the airways, making it easier for patients to cough
up. This improves breathing and reduces coughing.
12,15
“ Y o u m a y b e p r e s c r i b e d a t y p e o f m e d i c i n e c a l l e d a m u c o l y t i c , t h i s h e l p s y o u c o u g h u p m u c u s o r s p u t u m b y m a k i n g y o u r
p h l e g m l e s s t h i c k a n d s t i c k y . T h i s w i l l m a k e i t e a s i e r t o c o u gh u p a n d c l e a r m u c u s f r o m y o u r l u n gs k e e p i n g y o u r a i r w a y s c l e a r .
”
Other treatments
Long-term oxygen therapy (LTOT) is used in speci
must have stopped smoking to be eligible for this treatment.
12,13,16
“I f o x y g e n l e v e l s i n y o u r b l o o d a r e l o w a n d y o u m e e t s p e c i
i n v o l v e s r e c e i v i n g a i r w i t h a h i g h e r o x y g e n l e v e l t h r o u g h a n a s a l t u b e o r m a s k f o r a t l e a s t 1 5 h o u r s p e r d a y . T h i s w i l l i m p r o v e
y o u r b r e a t h i n g , a n d t h e a i m i s t o e x t e n d y o u r l i f e .
”
Surgical treatments include lung reduction surgery and lung transplantation. These are only used in speci
and most patients with COPD will not undergo these procedures.

Closing the consultation

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Summarise the key points back to the patient.
“ W e h a v e d i s c u s s e d q u i t e a l o t t o d a y , i n c l u d i n g w h a t C O P D i s , t h e s y m p t o m s y o u m i gh t e x p e r i e n c e a n d h o w t h e c o n d i t i o n i s
m a n a g e d . I r e a l i s e t h i s i s a l o t o f i n f o r m a t i o n t o t a k e i n a n d t h e r e f o r e I h a v e a l e a
d i s c u s s e d . I t i s a l s o i m p o r t a n t t h a t y o u s e e k a r e v i e w i f y o u n o t i c e y o u r s y m p t o m s w o r s e n i n g. I f y o u b e gi n t o f e e l v e r y s h o r t o f
b r e a t h , d e s p i t e u s i n g y o u r t r e a t m e n t s , y o u s h o u l d c a l l a n a m b u l a n c e .
”
Ask the patient if they have any questions or concerns that have not been addressed.
“ I s t h e r e a n y t h i n g I h a v e e x p l a i n e d t h a t y o u’ d l i k e m e t o go o v e r a g a i n ?”
“ D o y o u h a v e a n y o t h e r q u e s t i o n s b e f o r e w e
Direct the patient to further information about the condition using websites and lea
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Sundari Ampikaipakan
Consultant Respiratory Physician

References

1. WHO. C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e ( C O P D ) . March 2023. Available from\: [LINK]
2. OpenStax. O r g a n s a n d s t r u c t u r e s o f t h e r e s p i r a t o r y s y s t e m . October 2020. Available from\: [LINK]
3. Asthma and the lung UK. W h a t i s C O P D ? . May 2022. Available from\: [LINK]
4. Patient info. C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e . November 2018. Available from\: [LINK]
5. Patient info. E m p h y s e m a . May 2018. Available from\: [LINK]
6. NHS.uk. C a u s e s c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e ( C O P D ) . April 2016. Available from\: [LINK]
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8. BMJ Best Practice. P a t i e n t l e a LINK]
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10. NHS.uk. C O P D - S y m p t o m s . April 2023. Available from\: [LINK]
11. NHS inform. T r e a t i n g C O P D . January 2023. Available from\: [LINK]
12. NHS.uk. C O P D - T r e a t m e n t . April 2023. Available from\: [LINK]
13. Asthma and lung UK. W h a t a r e t h e t r e a t m e n t s f o r C O P D ? May 2022. Available from\: [LINK]
14. Asthma and lung UK. M e d i c a t i o n s f o r C O P D . May 2022. Available from\: [LINK]
15. NHS.uk. A b o u t C a r b o c i s t i n e . March 2023. Available from\: [LINK]
16. NHS.uk. H o m e o x y g e n t h e r a p y . August 2023. Available from\: [LINK]
17. Asthma and lung UK. L u n g V o l u m e r e d u c t i o n p r o c e d u r e s . November 2022. Available from\: [LINK]
Source\: geekymedics.com
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