There are some conversations in a pharmacy that stay with you.
I remember patients who would come in regularly for their inhalers, sometimes looking perfectly well, chatting away at the counter as if nothing was wrong.
Then they would walk away.
And you would hear the breathing.
Short, shallow breaths. A little wheeze. Sometimes a cough that sounded as though it had been there for years.
I would often wonder how many people had simply got used to breathing that way.
That is one of the difficulties with COPD.
It can creep up so slowly that people don’t always realise how much their breathing has changed. NHS – COPD
They don’t suddenly wake up one morning unable to breathe.
Instead, they stop walking quite so far.
They avoid the stairs.
They take a little longer to get dressed.
They stop going for walks.
They sit down more often.
And eventually, what used to be considered normal life becomes “just getting old.”
It isn’t necessarily ageing.
Sometimes it is COPD.
So what exactly is COPD?
COPD stands for chronic obstructive pulmonary disease.
It is a long-term condition where the airways and lung tissue become damaged, making it harder to move air in and out of the lungs. COPD includes conditions such as emphysema and chronic bronchitis. WHO – COPD
The word “obstructive” is important.
The airways can become narrowed and inflamed, and in some people the tiny air sacs in the lungs become damaged as well. This can result in airflow limitation and air becoming trapped in the lungs. GOLD 2026 Report
Imagine trying to empty a balloon through a very narrow opening.
You can get some air out, but not easily.
Now imagine having to do that every time you breathe.
That gives you some idea of why everyday activities can eventually become exhausting.
The smoker’s cough that isn’t just a cough
Smoking is one of the biggest risk factors for COPD. However, COPD can also be associated with exposure to second-hand smoke, occupational dusts and fumes, household air pollution and outdoor air pollution. WHO – COPD
But one of the phrases I have heard countless times is:
“I’ve always had this cough. I’m a smoker.”
That shouldn’t simply be accepted as normal.
A persistent cough isn’t normal just because someone smokes.
Neither is bringing up phlegm every morning.
Neither is becoming increasingly breathless walking short distances.
These can be signs that the lungs are being damaged and should be assessed. NHS – COPD symptoms
Smoking doesn’t just irritate the lungs for a few minutes after a cigarette.
Years of exposure to cigarette smoke can cause long-term damage to the airways and lung tissue and is a major cause of COPD. WHO – COPD
And unfortunately, the lungs don’t always complain loudly while this is happening.
They just gradually become less efficient.
“I’m not that breathless”
This is where I think patients can sometimes underestimate the problem.
Someone might say:
“I’m fine. I can still walk.”
Then you ask:
“Can you walk up two flights of stairs?”
“No.”
“Can you walk around the supermarket without stopping?”
“Not really.”
“Can you keep up with your family?”
“Not anymore.”
That tells a different story.
Breathlessness can become so gradual that people adapt their lives around it.
They don’t realise they have become less active because of their lungs.
They simply think they are getting older.
But becoming progressively breathless isn’t something we should automatically accept as part of getting older. Breathlessness is one of the characteristic symptoms of COPD and warrants assessment, particularly when it is persistent or worsening. NHS – COPD symptoms
What do inhalers actually do?
This is where the pharmacist comes in.
COPD inhalers aren’t all the same.
Some medicines work by relaxing the muscles around the airways, helping to keep them open.
Others reduce airway inflammation.
Some inhalers combine different medicines to provide longer-lasting control.
Treatment is individualised according to symptoms, exacerbation history and other factors. NICE – COPD diagnosis and management
The important thing is understanding what your own inhaler is supposed to do.
I’ve seen patients who have been using an inhaler for years but have never had their technique properly checked.
And this matters enormously.
You can have the right medicine, the right strength and the right prescription — but if the medicine isn’t getting into your lungs properly, you aren’t getting the full benefit.
Different inhalers require different techniques.
Some need a slow, steady breath.
Others require a stronger, deeper inhalation.
Some need the patient to press the device while breathing in.
Some don’t.
It is surprisingly easy to get it wrong.
That is why I would encourage anyone with COPD to take their inhalers into their pharmacy and ask the pharmacist to watch them use them.
There is no embarrassment in this.
I’d much rather spend two minutes checking someone’s technique than see them struggle for months with a medicine that isn’t being delivered properly.
NICE specifically recommends that inhaler technique is demonstrated and checked regularly, because incorrect technique can reduce the amount of medicine reaching the lungs. NICE – COPD inhaler treatment
The danger of a COPD flare-up
Most people with COPD have good days and bad days.
But sometimes things change significantly.
The cough becomes worse.
Breathlessness increases.
There is more phlegm than usual.
The phlegm may change colour.
The person feels exhausted and generally unwell.
This can be a COPD exacerbation — what many people simply call a flare-up. An exacerbation is a sustained worsening of a person’s usual symptoms that may require additional treatment. GOLD 2026 Report
These episodes can sometimes be triggered by infections, although not every flare-up is caused by bacteria. Viral respiratory infections are also important triggers, and exacerbations can occur without an identifiable infectious cause. GOLD 2026 Report
This is important because people sometimes assume that every flare-up requires antibiotics.
It doesn’t.
Antibiotics are not routinely appropriate for every COPD exacerbation; NICE recommends considering them according to factors including sputum colour and change in symptoms, and the likelihood of bacterial infection. NICE – COPD exacerbation antimicrobial prescribing
Doctors may also prescribe a short course of steroid tablets during some flare-ups. NICE recommends oral corticosteroids for certain acute COPD exacerbations because they can shorten recovery and improve lung function and breathlessness. NICE – COPD exacerbation management
But the key is recognising a deterioration early.
If your normal breathing has suddenly changed, don’t simply wait and hope it settles.
Don’t assume every breathlessness is COPD.
Don’t assume every breathlessness is COPD
This is particularly important.
A person with COPD can still develop other illnesses.
Chest infections, heart problems, anaemia and blood clots can all cause breathlessness. NHS – Breathlessness
Someone with COPD may also have heart disease, and cardiovascular disease is a common accompanying condition in people with COPD. GOLD 2026 Report
So if a person says:
“It’s just my COPD.”
I would never want that assumption to delay proper assessment.
Sudden or severe breathlessness, chest pain, blue or grey lips, confusion, coughing up blood, or being unable to speak properly because of breathlessness can indicate a medical emergency. NHS – Shortness of breath
Don’t sit at home trying to work out which disease it is.
Get help.
And then there is smoking
If you smoke and have COPD, stopping is probably the single most important thing you can do to reduce further damage to your lungs and slow the progression of the disease. NHS – COPD treatment
I’ve heard people say:
“There’s no point stopping now. The damage is already done.”
There is a point.
Stopping smoking doesn’t magically repair lungs that have already been damaged.
But it can reduce further damage and is beneficial at any stage. NHS – COPD treatment
And quitting isn’t simply a question of having enough willpower.
Nicotine is addictive.
Some people need nicotine replacement therapy. Some benefit from medicines. Some need several attempts before they finally stop.
That’s not failure.
For many people, it is simply part of the process.
As pharmacists, we are in a good position to help because patients often feel more comfortable talking to us about smoking than they might expect.
Exercise sounds strange when you’re breathless
One of the things that worries people with COPD is exercise.
They think:
“If walking makes me breathless, surely I should rest.”
But avoiding activity can create another problem.
The less you do, the less fit your muscles become.
The less fit you become, the harder everyday activities feel.
Then you do even less.
It becomes a vicious circle.
This is why pulmonary rehabilitation can be so useful for people with COPD. It combines exercise, education and support to help people improve their physical capacity and manage their condition. NICE – Pulmonary rehabilitation
It isn’t about turning someone into an athlete.
It is about teaching them how to exercise safely, manage their breathing and gradually improve their ability to function.
Sometimes the goal is wonderfully ordinary:
Walking to the shops without stopping.
Getting dressed without becoming exhausted.
Climbing the stairs.
Playing with the grandchildren.
Going out without constantly worrying about whether there will be somewhere to sit down.
Those things can make a huge difference to someone’s quality of life.
Don’t forget the vaccinations
For someone with COPD, a respiratory infection can be much more than an inconvenience.
That is why keeping recommended vaccinations up to date is important.
Flu, COVID and pneumococcal infections can all cause significant problems in people who are at increased risk of complications from respiratory infections. NHS – COPD treatment and prevention
Your pharmacist or GP can advise you which vaccinations you should have based on your age and medical circumstances.
It is much better to prevent a serious infection where possible than to deal with the consequences afterwards.
COPD isn’t a hopeless diagnosis
This is probably the most important thing I would want someone newly diagnosed with COPD to hear.
Yes, COPD is a serious, long-term condition.
But being diagnosed does not mean that your life is over.
There is a great deal that can be done.
Stopping smoking.
Using your inhalers correctly.
Taking your regular medicines.
Keeping physically active.
Maintaining a healthy weight.
Having appropriate vaccinations.
Recognising flare-ups early.
Attending your reviews.
And asking for help when your breathing changes.
These things matter. NICE – COPD management
I’ve always believed that one of the most useful things a pharmacist can do isn’t simply to hand someone their prescription.
Sometimes it is to notice something.
A patient who is suddenly collecting their reliever inhaler much more frequently.
Someone who keeps asking for something for a cough.
A person whose breathing sounds considerably worse than it did a few months ago.
Those little changes can sometimes tell us that something isn’t right.
And that is why I would say this to anyone reading this who has a persistent cough or increasing breathlessness:
Don’t just accept it.
Don’t automatically blame age.
Don’t automatically blame being unfit.
And don’t automatically tell yourself that it is “just a smoker’s cough.”
Your lungs are working every second of every day.
You don’t notice them when they are doing their job properly.
But when breathing becomes difficult, suddenly every breath matters.
And sometimes the earlier you do something about it, the more breathing you may be able to preserve for the years ahead.
Health is often something we only appreciate when it starts to disappear. Look after your lungs while you still have the chance.
Until next time take care of yourself.
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