Complex COPD Service

The Complex chronic obstructive pulmonary disease (COPD) service is based at City Hospital, Nottingham.  

People with COPD can present in a number of different ways. The condition can affect the breathing tubes (bronchi) and / or the airsacs (alveoli) that allow oxygen into the blood stream, in varying amounts. Some people with COPD are breathless, others cough up lots of sputum, some have an overexpanded chest (hyperinflated) and some need frequent courses of rescue medication for flare-ups (exacerbations). Of course, these often do not occur alone, making it complex.  

The vast majority of COPD in the UK is due to smoking tobacco but there are many other causes including genetic, air pollution and exposure to dusts at work.

There are several treatments for COPD.  These include inhalers and some tablets, but other treatments are also very important, particularly exercise, and support with stopping smoking. You can find out more about COPD at the Asthma and Lung UK https://www.blf.org.uk/support-for-you/copd , which also includes some diagrams.

At Nottingham, we have a team of healthcare professionals who provide care for people with COPD both as an in-patient and out-patient. This includes specialist nurses, physiotherapists, doctors and dietitians. In addition, we work closely with colleagues in Primary Care, including GPs, community nurses and many other colleagues.

Managing COPD

In managing and treating COPD, we need to consider:

  • The cause of the COPD
  • The effect on the person and the amount of breathlessness
  • The extent of narrowing of the airways
  • The amount of inflammation in the airways
  • The thickness of the phlegm / sputum
  • The frequency of exacerbations
  • The extent of damage to the airsacs
  • The extent of the overinflation of the lungs
  • The level of oxygen in the blood
  • Whether people are still being exposed to the cause – such as still smoking
  • Other medical conditions that a person has including heart disease, bone disease or other lung disease.

 

To help us in our decisions, a number of investigations are sometimes considered. They are not all needed for everyone but might include:

  • Breathing Tests: Blowing tests called spirometry or full lung function tests that also measure the size of the lungs and how well oxygen gets into the bloodstream.
  • Inhaler check
  • Height and weight
  • Sputum tests for infection
  • Oxygen assessment: either at rest, during walking or overnight
  • Walking test: how far you can walk in a certain time frame or at a certain pace
  • A CT scan of the lungs
  • Other imaging of the lungs: A VQ scan (Ventilation Perfusion scan)
  • A heart scan:  echocardiogram
  • Bone density scan (a DEXA scan) to look for thinning of the bone - also called osteoporosis
  • Series of bloods including inflammatory markers, blood count, antibodies and occasionally a genetic test for COPD
  • Bronchoscopy
  • Questionnaires on the severity of breathlessness and the impact on the person.

 

We offer, personalised treatments. Where appropriate, this might be:

  • Physiotherapy and advice on activity levels
  • Nutritional advice
  • Stop smoking support
  • Helping to reduce exacerbations with treatment
  • Giving advice on vaccinations and taking medications including a review of inhalers
  • Advice on a person’s health, including their mental health, support around the home and offering palliative care
  • Home oxygen
  • Consideration of lung volume reduction (LVR), either by surgery, or using special, small valves into the airways
  • Other procedures or referral to specialist centres for consideration of lung transplant
  • Non-invasive ventilation

The Team

Consultant Doctors who run COPD clinics include:

  • Prof Charlotte Bolton
  • Dr Amy Binnion
  • Dr Patience Ehilawa
  • Dr Samuel Kemp 

The COPD Specialist Nurses include:

  • Stephanie Holliday
  • Carolyne Baker
  • Alexis Dodsworth
  • Jennifer Maltby

Our COPD administrator is Michelle Crossley

The COPD dietitian is Eleanor Rudge

We also work with a number of other colleagues, including thoracic surgeons and doctors in training

 

The wider team:

Research into COPD

The NIHR Nottingham Biomedical Research Centre (BRC) conducts research into COPD:

  • Observational studies including BE COPD
  • Mechanistic studies including the REFLEX COPD Study
  • Clinical Trials including the Better-B study and of endobronchial therapies and medications
  • Registry studies including the EARCO study and the LVR registry
  • Imaging studies including the FAST COPD Study

 

We also conduct international Studies including working with colleagues in Nepal and conducting epidemiology research (using large anonymised databases).

We recently collaborated on an important exercise with patients with COPD to determine the top 10 priorities for research into COPD exacerbations. We hope to have the opportunity to take up some of these areas soon.

If you would like to know more about research, please contact respiratory-research@nottingham.ac.uk or phone 0115 8404844 and leave a message including your name and number.