COPD and Chronic Lung Disease: A Home Care Overview

What COPD feels like

• Breathlessness, first on exertion, such as climbing stairs, later with simple tasks such as dressing, finally at rest.
• Chronic cough, often worse in the morning, with phlegm.
• Wheeze and chest tightness.
• Frequent chest infections, and a long recovery after colds.
• Tiredness, weight loss and reduced appetite in later stages.
• Swollen ankles in advanced disease (heart strain).
• Low mood and anxiety, which are common and can worsen breathlessness; see anxiety in older adults and depression in older adults.

Other conditions, such as heart failure, anaemia, tuberculosis, lung cancer and asthma, can look similar, so diagnosis matters. See respiratory diseases and asthma in older adults. New or worsening breathlessness needs a doctor.

Treatment: the basic picture

Doctors use inhalers to open the airways and reduce inflammation, sometimes tablets, pulmonary rehabilitation, oxygen for those with low blood oxygen and vaccinations. The most important steps are stopping smoking and avoiding smoke and pollution. This guide names no medicines or doses.

Inhalers and medicines: safe habits

• Take preventer and reliever inhalers exactly as prescribed. Know which is which: the "reliever" works quickly for sudden breathlessness; the "preventer" is taken daily, even when well, to prevent flare-ups. Never stop a preventer because you feel well; never stop or change any medicine without the doctor.
• Technique matters, because many older people do not get the full dose. Ask the doctor, nurse or pharmacist to watch your parent use each inhaler and correct errors. If coordination or grip is poor, a spacer (a plastic chamber) or a different device may help; ask. See inhaler technique for older adults.
• Rinse the mouth after using certain inhalers, as advised, and spit out.
• Check how many doses are left and refill in time; keep the reliever always within reach.
• A nebuliser is used by some people; use only if prescribed; see nebuliser buying guide, how to use a nebuliser and nebuliser vs inhaler.
• Keep a medicine list; carry it to appointments; see emergency contact card and medical summary.
• Do not use leftover antibiotics or steroids from earlier flare-ups on your own; the doctor decides.
• Avoid sedatives and sleeping tablets unless the doctor knows about the lung disease, since some suppress breathing.
• Beware of herbal and home remedies, and steam inhalation burns; see steam inhalation safety and 24 home remedies for cough for general information, but ask the doctor first.
• Use a pill organiser and a chart if confusion is possible; see pill organiser guide.

Triggers and the home environment

• Tobacco smoke: the biggest cause and trigger. Support quitting, in any form of tobacco, and ask the doctor about help; avoid second-hand smoke.
• Cooking smoke: use a chimney or exhaust fan, a clean-burning stove or LPG rather than wood or dung, and good ventilation.
• Air pollution and dust: check the air quality; on bad days stay indoors with windows closed, avoid exercise outside; masks suited to particulate pollution (properly fitted) may help but can feel hard to breathe in; ask the doctor; see pollution season plan for seniors, air purifier buying guide, air quality monitor for homes and indoor air quality for older lungs.
• Incense, mosquito coils, sprays and strong fragrances: reduce or avoid; ventilate.
• Damp and mould: keep the home dry; see pest, damp and mould at home.
• Dust and pet hair: damp-wipe, avoid dry sweeping.
• Cold air and temperature extremes: keep warm in winter; cool and ventilated in summer; see cold weather health risks for seniors and temperature and ventilation at home.
• Infections: wash hands, avoid sick contacts, keep vaccines up to date.
• Strong emotions and stress can trigger breathlessness; practise calm breathing.

Breathing techniques that help

These simple methods can reduce the feeling of breathlessness and are taught by physiotherapists. See breathlessness techniques at home, breathing exercises for seniors and respiratory physiotherapy for elderly lung health.

• Pursed-lip breathing: breathe in slowly through the nose for two counts, then breathe out gently through lips pursed as if blowing a candle, for four counts. Helps keep airways open.
• Positions of ease: sit leaning forward with forearms on knees or a table; or stand leaning against a wall; relax the shoulders.
• Diaphragmatic (belly) breathing: place a hand on the belly; breathe in so that the belly rises, out so that it falls.
• Pacing: break tasks into steps; rest before you are very breathless; breathe out on effort (for example when standing up).
• Fan on the face: a small fan blowing gently on the face can ease the sensation of breathlessness for some.
• Airway clearance: your physiotherapist can teach techniques to bring up phlegm, such as huffing and controlled coughing.
• Stay calm: panic increases breathlessness.

Activity and pulmonary rehabilitation

Staying active is important. Pulmonary rehabilitation, a supervised programme of exercise, education and support, is among the most effective treatments for COPD; ask the doctor about a referral, or a home-based programme. Walking, chair exercises and arm exercises, paced to breathlessness, improve stamina and mood; see exercise at home for seniors: a safe starter guide and chair exercises for seniors. Rest when needed; use the talk test; avoid extremes of heat and pollution. A walker with seat may help; see rollator buying guide.

Food and weight

Both underweight and overweight can worsen breathlessness. Eating can be tiring: offer small, frequent, energy-rich meals; rest before eating; sit upright; choose soft foods; avoid gas-forming foods if they cause bloating; keep fluids up to keep phlegm thin unless restricted. See malnutrition in older adults and how much protein do seniors need. Ask a dietician for advice.

Oxygen at home

Some people with low blood oxygen are prescribed long-term oxygen from a concentrator or cylinder. Oxygen is a medicine: use only as prescribed, for the hours advised, at the flow rate set by the doctor; never adjust it on your own. Fire safety is critical: no smoking, flames, incense lamps, candles, gas stoves or heaters near oxygen; keep at least two metres away; do not use oil-based products on the face; secure cylinders upright; plan for power cuts. See oxygen concentrator buying guide, oxygen concentrator safe use at home, oxygen cylinder safety, oxygen and power cuts and safe use of oxygen and electrical equipment. A pulse oximeter has limits and can mislead; see pulse oximeter guide and pulse oximeter accuracy limits.

Vaccines and infection prevention

Chest infections trigger flare-ups. Ask the doctor about flu, pneumonia and COVID vaccines; see vaccines for older adults in India and vaccines for lung health after 60. Wash hands, avoid crowds in the flu and pollution seasons and treat dental infections. See pneumonia in older adults.

Spotting and handling a flare-up (exacerbation)

A flare-up is a sudden worsening for a day or more, usually from infection or pollution.

Signs: more breathlessness than usual, more cough, more phlegm, or a change in phlegm colour or thickness, fever, wheeze, tiredness, needing the reliever more often, swollen ankles, confusion, poor sleep.

What to do: - Call the doctor the same day, or follow the written action plan agreed with the doctor. The doctor may advise changes to medicines or tests; do not start leftover antibiotics or steroid tablets yourself. - Use the reliever as prescribed, sit upright, stay calm and use breathing techniques. - Drink fluids, rest and keep warm. - Avoid triggers.

A written COPD action plan helps; see copd action plan.

Emergency signs: call 112

• Severe breathlessness at rest, unable to speak a full sentence, or breathless despite the reliever.
• Blue or grey lips or face.
• Confusion, drowsiness or difficulty staying awake.
• Chest pain that is severe or persistent.
• Coughing up blood in more than streaks.
• A very fast or irregular heartbeat with breathlessness.
• Fainting or collapse.

Sit the person upright, loosen clothing, open windows, use the reliever as prescribed and stay with them. See when breathlessness is an emergency and ambulance and emergency numbers in India.

Travel, sleep and daily life

Plan travel with the doctor: carry medicines, oxygen plans, a summary and insurance; see travelling with oxygen and travel with an elderly parent checklist. Sleep with the head raised; see pillows for sleep apnoea and snoring and sleep apnoea in older adults. Pace the day, sit to wash and dress, use a shower seat; see shower chair buying guide.

Advanced disease and palliative care

In advanced COPD, breathlessness may limit most activity, and hospital stays may be frequent. Palliative care can ease breathlessness and anxiety, alongside lung treatment; see palliative care at home guide and advance care planning in India.

Family and carers

Learn inhaler technique; support smoke-free homes; keep the action plan and emergency numbers visible; keep calm during flares; look after your own health; see caregiver burnout signs and prevention.

When to ask a professional

A doctor or chest physician diagnoses and treats. A respiratory nurse or physiotherapist teaches inhalers, breathing and rehabilitation. A dietician helps with nutrition. A pharmacist checks technique and medicines. For senior services, call Elderline 14567. In an emergency, call 112.