COPD at Home: Equipment, Routines and Flare-Ups

What COPD feels like

• Breathlessness, first on exertion, then on small tasks, and in advanced disease at rest.
• A chronic cough, often with sputum (phlegm), worse in the morning.
• Wheeze or chest tightness.
• Tiredness, reduced activity, weight loss and low mood.
• Frequent chest infections.

Many people put these symptoms down to age and wait years before seeing a doctor. The diagnosis needs a breathing test called spirometry. If your parent has not had one, ask the doctor. COPD can overlap with asthma; see asthma in older adults.

The basics of treatment

Treatment is set by the doctor, and may include:

• Inhaled relievers (short-acting bronchodilators) for breathlessness.
• Long-acting inhaled medicines used daily to keep airways open, sometimes combined with an inhaled steroid for selected people.
• Vaccines against influenza, pneumococcal infection and COVID-19, and others as advised; see vaccines that protect older lungs.
• Pulmonary rehabilitation: exercise and education; see pulmonary rehabilitation exercises at home.
• Stopping smoking, the single most effective step for those who smoke.
• Oxygen for those with low blood oxygen, under strict prescription.
• Treatment of flare-ups, with antibiotics or steroid tablets only when the doctor prescribes them.

Do not change, add or stop medicines yourself.

Equipment you may need

Inhalers and spacers. The backbone of treatment. Check technique at each visit; see inhaler technique and spacers for older adults. Keep a list of each inhaler: what it is for, how often, and which is the reliever.

Nebuliser. Used for those who cannot manage inhalers or as the doctor prescribes; see nebulisers: types, use and cleaning and nebuliser or inhaler: understanding the difference.

Pulse oximeter. Helpful if the doctor advises, particularly during a flare-up or on oxygen. Remember its limits; see pulse oximeters: how they work and how to use one and pulse oximeter accuracy. People with COPD may have a normal level lower than 94 per cent, and their doctor sets a target.

Home oxygen. For selected people with persistent low oxygen. The flow and hours are prescribed. Never change the flow; keep flames and smoking away. See oxygen flow rates and prescriptions: what families should know, oxygen concentrators: a buying and renting guide and using an oxygen concentrator safely at home.

Air purifier and air quality monitor. May help when outdoor pollution or indoor smoke is a problem; see air purifiers: choosing one for an older adult's room and air quality monitors for homes with older adults.

Other aids. A stable chair with arms, a shower stool, a cordless phone, a walking aid with a seat for rests, and a perching stool in the kitchen help energy conservation.

A daily routine

• Morning: take regular medicines as prescribed; clear the airways by gentle coughing; rinse the mouth after steroid inhalers; plan the day's activities with rests.
• Through the day: pace activities; sit for tasks like chopping or ironing; use breathing techniques; drink fluids unless restricted; eat small, frequent meals; keep windows closed during heavy pollution.
• Exercise: daily walking or exercises at the pace the doctor or physiotherapist advises.
• Evening: a light meal, avoid heavy food late; check inhalers and medicines; prepare for night.
• Night: sleep with the head raised; keep the reliever and phone within reach.

Breathing techniques

• Pursed-lip breathing: breathe in through the nose for two counts, then breathe out slowly through pursed lips for four counts, as if blowing a candle gently.
• Positions for relief: sit leaning forward with forearms on a table or knees, or stand leaning on a counter.
• Pacing: break tasks into steps and stop before you are very breathless.

See breathlessness: positions and breathing techniques that help.

Food and weight

Being underweight, which is common in advanced COPD, worsens outcomes. A big meal can crowd the diaphragm and increase breathlessness. Small, frequent, energy-rich meals work better. A dietician can help with affordable, protein-rich Indian meals. See malnutrition in older adults and weighing scales and unplanned weight loss in older adults.

Air in the home

• Smoking: nobody should smoke in the home. Support anyone who wants to stop, and ask the doctor about help.
• Cooking smoke: shift to cleaner fuels, such as LPG or electric, where possible, and ventilate the kitchen with a chimney or exhaust. Keep the person out of the kitchen when frying or using a wood or coal stove.
• Dust and damp: damp-mop, avoid dry sweeping, keep the bedroom clear of dust-collecting items, and fix leaks. See indoor air quality for older lungs: dust, smoke and damp.
• Incense, mosquito coils and strong fragrances can irritate airways.
• Pollution days: stay indoors with windows closed, and see a pollution season plan for older adults.
• Cold air and temperature extremes: a scarf over the mouth in cold air, and a cool, ventilated room in heat; see temperature and ventilation at home.

Flare-ups: early signs

A COPD flare-up (exacerbation) is a worsening beyond the usual day-to-day variation, often triggered by infection or pollution. Typical signs:

• More breathlessness than usual.
• More cough.
• More sputum, or a change in colour to yellow or green, or thicker.
• Needing the reliever more often.
• Fever, chills or feeling generally unwell.
• Swollen ankles, drowsiness or confusion, which need quick medical attention.

Act early: the sooner a flare-up is treated, the shorter and milder it tends to be.

What to do in a flare-up

• Follow the written action plan from the doctor; see building a COPD action plan with your doctor.
• Take the reliever as prescribed. Do not exceed the prescribed dose.
• Rest and sit upright; use pursed-lip breathing.
• Call the doctor the same day, or sooner, for these changes. The doctor may prescribe a steroid course or antibiotics. A "rescue pack" of tablets should be used only if the doctor has prescribed one and told you exactly when to start it.
• Check oxygen level and temperature if you have the devices.
• Do not turn up oxygen yourself.
• Keep fluids up unless restricted.

Call 112 if your parent is:

• Very breathless, unable to finish sentences or to walk a few steps.
• Blue or grey around the lips.
• Confused, very drowsy or hard to wake, or has morning headaches with drowsiness.
• Has chest pain.
• Not helped by the reliever as the plan expects.

See when breathlessness is an emergency.

Mood, sleep and support

Anxiety and depression are common in COPD and make breathlessness worse. Tell the doctor if your parent seems low, panics when breathless, or is not sleeping. Social support, company and gentle activities help; see depression in older adults and anxiety in older adults. Caregivers also tire; see caregiver burnout: signs and prevention.

Keeping records

Keep a one-page summary: diagnosis, medicines and inhalers, vaccines, oxygen prescription, usual oxygen level, doctor's numbers and the action plan. See keeping a health record at home and emergency contact card and medical summary. Bring it to every visit and to hospital.

When to ask a professional

Ask the chest doctor for a diagnosis by spirometry, a written action plan, a review of inhaler technique, vaccine advice and whether oxygen is needed. Ask a physiotherapist for breathing techniques and exercises. Ask a dietician for meal plans. Ask the pharmacist to review medicines. Call the doctor for increased breathlessness, sputum change, fever or swelling. Call 112 for severe breathlessness, blue lips, confusion or chest pain.