Ask the Doctor: ‘How can my elderly father reduce his symptoms of chronic obstructive pulmonary disease?’

“My elderly father has just been diagnosed with chronic obstructive pulmonary disease (COPD). I have managed to get him to reduce his smoking from 40+ per day to 10 per day and am hoping to soon get him off them altogether. Is there anything we can do to help him repair any damage from smoking or anything we can do to keep the symptoms of COPD at bay to give him a better quality of life?”

Answer from Dr Abhilash Sahadevan, Consultant in Respiratory Medicine and General Internal Medicine, Beacon Hospital

The diagnosis of COPD will be a shock to your father. Congratulations to both of you for
taking the most critical step for his future by tackling the root cause: smoking. Reducing the number of cigarettes smoked shows that your father is keen to stop the progression of his COPD and mitigate its symptoms. The benefits of reducing cigarettes compared to completely stopping smoking are unclear and likely only of minimal benefit.

Family support is crucial, as your father could feel isolated while dealing with his nicotine dependence. Ingrained over a lifetime, reducing smoking will incur withdrawal symptoms (irritability, anxiety and intense cravings).

He must also be encouraged to form new routines and ways to cope with stress. Quitting will immediately benefit his symptoms. Breathing, coughing and wheezing will improve as the lungs start healing immediately. The risk of hospital admissions or COPD exacerbations is significantly reduced with time.

Taking nicotine replacement in combination (e.g. patch and gum/inhaler) has a higher chance of success than in isolation. Hypnotherapy alone or combined with nicotine replacement should be considered to help quit.

Regardless of age, every COPD patient can be empowered to self-manage their symptoms. Get guidance from his medical team on a personalised treatment plan and managing breakthrough symptoms at home and outside. Watch for difficulties with inhaler technique at home. Using the inhaler name, you can easily find simple YouTube videos to reinforce the technique.

Meanwhile, you can invest in medical devices like an accurate pulse oximeter that can reassure and alert the need for further medical help. Air-driven nebulisers can help during exacerbations. Airflow directed at the face from a hand-held fan reduces the perception of breathlessness. The ideal fan has at least 3 blades and an easy-to-use switch.

Ensure he practises diaphragmatic breathing and pursed lip breathing daily. A daily minimum water intake can help mucus expectoration, and frequently check his weight so as to get a reasonable dry weight estimate.

Do not let symptoms lead to reduced physical activity. Help him enrol in community group exercises and pulmonary rehabilitation. Staying active, even with just regular walking, can allow the body to compensate for damaged lungs.

Discuss the need for portable oxygen and low-dose morphine to maintain his independence outside the house, if necessary, with his healthcare team. Most COPD patients can lead fruitful lives with good support and management.

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