1. What COPD is
COPD — chronic obstructive pulmonary disease — is long-term narrowing and damage of the airways and air sacs in your lungs, usually from years of smoking or other exposures. It makes it harder to push air out, which is why breathlessness, cough, and phlegm are the main symptoms. The damage doesn't fully reverse, but the symptoms, flare-ups, and decline are very treatable.
The goals of your plan are simple: breathe more easily day to day, have fewer flare-ups, stay out of hospital, and keep doing the things you enjoy. Most of that comes from a handful of habits done consistently — taking your inhalers correctly every day, staying active, getting vaccinated, and (if you still smoke) stopping.
2. Your numbers: spirometry, CAT, mMRC, oxygen
Spirometry (a breathing test)
Spirometry measures how much and how fast you can blow air out. Two values matter:
- FEV₁/FVC ratio — below 0.70 confirms the airway obstruction that defines COPD.
- FEV₁ % predicted — how strong your breath is compared with someone your age/size. It grades severity (GOLD 1 mild → GOLD 4 very severe).
You don't need to memorize these — they're on your dashboard when available. If we don't have a recent spirometry, we grade your COPD from your symptoms instead (CAT and mMRC below), so your plan still works.
CAT and mMRC (your symptom scores)
You'll fill these out in the app every month or so. They take about a minute and tell us whether your treatment is keeping your symptoms in check.
Oxygen (SpO₂)
If you have a fingertip pulse oximeter, you can log your oxygen level. Your target range is 88–92% — for people with COPD, higher isn't always better. A reading below 88% is a warning sign (see §11).
3. Your COPD targets
These reflect the GOLD 2025 report, the international COPD standard.
| Area | Target |
|---|---|
| Smoking | Zero cigarettes — the most powerful thing you can do |
| Symptom score | CAT <10; breathlessness mMRC <2 |
| Oxygen (if you measure) | 88–92% |
| Flare-ups | As few as possible — ideally none per year |
| Maintenance inhalers | Taken every day, with correct technique |
| Vaccinations | Flu, pneumococcal, COVID-19, RSV (if 60+), Tdap up to date |
| Activity | Keep moving daily; pulmonary rehab if breathlessness limits you |
4. Your inhalers and how to use them
There are two kinds of inhalers, and the difference matters:
- Maintenance long-acting inhalers (e.g. tiotropium, umeclidinium/vilanterol, trelegy) — taken every day, even when you feel fine. These keep your airways open and prevent flare-ups.
- Rescue fast-acting inhaler (e.g. salbutamol/Ventolin) — taken only when you're breathless. Needing it a lot is a signal that something is changing (see §5).
Some people also take an inhaled steroid (ICS) as part of a combination inhaler. Whether that's right for you depends partly on a blood test (eosinophil count) and your flare-up history — that's a decision we make together.
5. Flare-ups (exacerbations) and your action plan
A flare-up is a sustained worsening of your breathing that needs a change in treatment. Catching it early keeps you out of hospital. Watch for these three warning signs:
If two or more of these happen together, it's likely a flare-up. The app will flag this for you when you log your symptoms.
6. Breathing techniques and pacing
Pursed-lip breathing
Breathe in gently through your nose for about 2 seconds. Breathe out slowly through pursed lips (as if cooling soup) for about 4 seconds — twice as long as you breathed in. This keeps airways open longer and eases breathlessness.
Pace yourself
Break tasks into smaller steps. Rest before you get breathless, not after. Sit to do tasks where you can. Exhale during the hard part of an effort (e.g. standing up).
Position of comfort
When short of breath, lean forward with your forearms resting on your knees or a table. This helps your breathing muscles work more efficiently.
Keep moving
Breathlessness with activity is uncomfortable but not dangerous in itself. Staying active protects your strength. The app's guided breathing and gentle activity tools can help you build up safely.
7. Stopping smoking — the single biggest win
If you still smoke, stopping is the only thing proven to slow COPD down — more than any inhaler. It's hard, and most people need several attempts and some help. That's normal, not failure.
- Nicotine replacement (patch + gum/lozenge together works best), or prescription medication (varenicline, bupropion) — ask us.
- Set a quit date, tell people, remove cigarettes and lighters from your home and car.
- Your coach in the app can support you through cravings and slips.
8. Vaccinations and pulmonary rehab
Vaccinations (they prevent flare-ups)
- Influenza — every year.
- Pneumococcal (pneumonia) — as recommended for your age/risk.
- COVID-19 — keep up to date.
- RSV — if you're 60 or older.
- Tdap (tetanus/diphtheria/whooping cough) — if due.
Pulmonary rehabilitation
This is a supervised program of exercise and education designed for lung conditions. It's one of the most effective treatments for breathlessness and quality of life. We strongly recommend it if your breathlessness limits you (mMRC ≥2) or after a flare-up.
9. Your heart and your lungs work together
Because you're cared for in a heart clinic, here are two things that matter for you specifically:
Breathlessness can come from the heart, the lungs, or both. If you also have heart failure or atrial fibrillation, your shortness of breath might be a COPD flare, fluid from your heart, or a fast heart rhythm — or a mix. Logging your symptoms (and weight/heart rate if asked) helps us tell them apart and treat the right cause.
10. The daily log and what we watch
A quick daily check-in in HeartAge+ keeps your care team in the loop between visits:
| What you log | Why |
|---|---|
| Breathlessness today (0–4) | Trend in symptoms; rising = early flare signal |
| Rescue inhaler puffs | Going up is one of the earliest flare-up signs |
| More phlegm than usual? Yellow/green? | Two of the three flare-up warning signs |
| Oxygen (SpO₂), if you have a pulse ox | Below 88% is a red flag |
| Activity limited by breathing? | Tracks how COPD affects your day |
You don't have to log everything every day — even breathlessness and rescue-puff counts are very useful.
11. Getting help and what to watch for
- Severe breathlessness at rest that isn't improving
- Blue or grey lips or fingertips
- Confusion, drowsiness, or trouble staying awake
- Chest pain, or an oxygen reading well below 88% with symptoms