Not reversible, but very much treatable — and stopping smoking is the only thing that changes its course.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
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Care led personally by Dr Khan
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COPD covers chronic bronchitis and emphysema — lung damage that narrows the airways and destroys the air sacs, making it progressively harder to breathe out. Unlike asthma, the obstruction is largely fixed rather than variable.
Around 1.2 million people in the UK have a diagnosis, and a similar number are thought to have it without knowing. It is one of the most under-diagnosed conditions in general practice, largely because breathlessness gets attributed to age or weight, and a persistent morning cough gets called a smoker's cough and accepted.
Two things drive everything on this page.
Stopping smoking is the only intervention that changes the course of the disease. Inhalers relieve symptoms; none of them slows the decline in lung function. Stopping does, at any stage and at any age — which makes it the single most valuable thing available.
Pulmonary rehabilitation is as effective as most drug treatment and is massively under-used. A structured exercise and education programme improves breathlessness, exercise capacity and quality of life more than adding another inhaler usually does. Most people with COPD have never been offered it, and many who are offered it decline because nobody explained what it does.
The MRC scale is used because it tracks function rather than feeling:
From grade 3 upwards, pulmonary rehabilitation is indicated — and that is precisely the point at which most people are simply given another inhaler.
Continued smoking; chest infections — each exacerbation causes a step down in lung function that does not fully recover, which is why preventing them matters more than treating them; cold weather and pollution; and untreated reflux, which is a common and reversible aggravator.
COPD cannot be diagnosed on symptoms alone, and it cannot be diagnosed remotely. It requires spirometry — breathing tests measuring how much air you can force out and how fast — showing obstruction that does not fully reverse after a bronchodilator.
We are direct about this: we will not label anyone with COPD without spirometry, because both over- and under-diagnosis are common and the label carries consequences for insurance, employment and treatment.
No inhaler slows the decline in lung function. Stopping does, at any age and any stage. Combining medication with behavioural support roughly triples the success rate compared with willpower alone, and NHS stop smoking services are free. This is not a moral point — it is the intervention with by far the largest effect available.
A six to eight week programme of supervised exercise and education. It improves breathlessness and exercise capacity more than most drug changes, reduces admissions, and improves mood. It is indicated from MRC grade 3, is available on the NHS, and is dramatically under-referred. If you have never been offered it, ask.
We cannot perform spirometry, measure your oxygen levels, or examine your chest. Anyone acutely unwell, with low oxygen, or needing oxygen assessment needs in-person care, and we will direct you there.
Call 999 for:
Seek same-day assessment for an exacerbation:
Act early. Exacerbations treated within the first day or two resolve faster and cause less lasting damage. If you have a rescue pack and your plan says to start it, start it — and tell someone you have.
Book a routine review if: you have never had spirometry but have been told you have COPD; you have never been offered pulmonary rehabilitation; you have had two or more exacerbations in a year; your inhaler technique has never been watched; you are on a steroid inhaler and have never had it reviewed; or you are still smoking and would like help — which is always available without any lecture attached.
Breathlessness makes people avoid exertion; inactivity deconditions the muscles; deconditioned muscles need more oxygen; breathlessness worsens. Breaking that spiral is the single most useful daily habit. Walking daily, within your limits, is genuinely treatment rather than advice.
Anxiety and depression affect a large proportion of people with COPD and are routinely untreated. Breathlessness causes anxiety, and anxiety worsens breathlessness — so treating it improves the breathing, not just the mood. It is worth raising.
NHS COPD care is free and comprehensive, and it contains the two interventions that genuinely change outcomes — both of which are free and both of which are under-used.
The first is stopping smoking. It is the only intervention that slows the decline in lung function, and NHS stop smoking services roughly triple success rates compared with willpower alone. No inhaler does what quitting does.
The second is pulmonary rehabilitation — and this is the most under-used effective treatment in respiratory medicine. A structured six to twelve week exercise and education programme, free on the NHS, improves breathlessness and quality of life more than any inhaler. Uptake is poor, partly because people assume exercise will make breathlessness worse. It does the opposite.
Free vaccinations matter too — annual flu, pneumococcal and COVID vaccines reduce exacerbations and admissions.
Where a private consultation adds something is a prompt review, checking inhaler technique, and reviewing whether a rescue pack is appropriate.
What we will not do is issue repeated rescue packs of steroids and antibiotics without review. Recurrent courses of oral steroids carry real cumulative harm, and repeated exacerbations mean the underlying treatment needs revisiting.
Increasing breathlessness with confusion, drowsiness, blue lips or chest pain needs emergency assessment.
NICE NG115, Chronic obstructive pulmonary disease in over 16s: diagnosis and management, is the governing guideline. It requires spirometry showing persistent airflow obstruction for diagnosis, and recommends smoking cessation support as the highest-value intervention.
NG115 recommends pulmonary rehabilitation for anyone with functional breathlessness — typically MRC grade 3 and above — and after hospitalisation for an exacerbation.
NG115 sets out inhaled therapy by phenotype, including the assessment of asthmatic features or steroid responsiveness in deciding on inhaled corticosteroids.
NG114, COPD exacerbations: antimicrobial prescribing, covers rescue medication and cautions against unnecessary antibiotic use.
NG115 recommends annual influenza and pneumococcal vaccination, and covers assessment for long-term oxygen therapy — which is specialist-led and is not something to arrange privately.
No — and this is the most important answer here. Stopping slows the decline in lung function at any age and any stage of COPD. It is the only intervention that changes the course of the disease; every inhaler treats symptoms. Even after decades of smoking, stopping now measurably changes what the next ten years look like.
A supervised six to eight week programme of exercise and education, designed specifically for people who are breathless. It improves breathlessness, exercise capacity and mood more than most medication changes, and reduces hospital admissions. It is free on the NHS and hugely under-offered — if nobody has mentioned it, ask.
Because inhaled steroids are not appropriate for everyone with COPD. They help where there are asthma features or a raised eosinophil count; in others they increase pneumonia risk without benefit. Stepping down is a deliberate, evidence-based decision rather than a cost-saving one.
No. Asthma is variable and largely reversible, often starts young, and varies day to day and at night. COPD is persistent and progressive, usually starts after 35, and is mostly caused by smoking or exposure. Some people have features of both, which changes the treatment — which is why spirometry rather than assumption is what settles it.
Most people with COPD never need it. Home oxygen is for a specific group with persistently low blood oxygen levels, and it is assessed formally rather than given for breathlessness. Breathlessness and low oxygen are not the same thing — many very breathless people have entirely normal levels.
No, and this is the trap. Avoiding exertion leads to deconditioning, which makes you more breathless at lower levels of activity, so you do less. Being breathless during exercise is not harming your lungs. Staying active within your limits is one of the most effective things you can do.
A course of antibiotics and steroid tablets kept at home so you can start treatment within hours of an exacerbation rather than waiting days. It works well with a clear written plan on exactly when to use it — and it is not for use at the first sniffle. We write the plan down.
Worth investigating properly. Alpha-1 antitrypsin deficiency is an inherited cause to consider in anyone diagnosed under 45 or in a non-smoker, and it is a simple blood test that is frequently never done. Occupational exposure and childhood biomass smoke are other explanations. The answer matters for you and for your relatives.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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