Chronic obstructive pulmonary disease is a serious, progressive illness that hits the homeless and underinsured the hardest. It’s something Lindsay Bishop is seeing more and more of in her role as COPD educator for Open Airways. COPD is a chronic lung condition characterised by swollen, inflamed airways and excessive mucus which makes it difficult to breathe, especially when exhaling.

In severe cases, it can lead to oxygen dependence or leave people bedridden. It primarily affects smokers, but can also be hereditary or caused by workplace exposure to chemicals or dust.

Of real concern to Ms Bishop is that the charity has taken on an unsustainable role: caring not only for people’s health needs, but also their entire wellbeing.

“Unfortunately, what I'm seeing more and more in the community, after 35 years of nursing, is more homeless people, more people living in cars, people living in squats, living wherever they can find shelter in town,” she said.

Open Airways has typically paid for inhalers, oxygen and doctor's appointments for people that are not employed and not insured. A donor-funded programme gives added help, but only to people in desperate circumstances.

“We're finding more and more people fall into that category, and it almost becomes pointless paying for [medication] when they're sleeping rough and catching lots of colds; they're in dirtier environments, which is affecting the breathing, and they're getting pneumonia from being in contact with viruses and not being able to eat properly, sleep properly and be warm,” Ms Bishop said.

“And for [COPD] patients, they're not going to get better and so our role is to educate them, so that they know how not to get worse, how to slow that deterioration down.”

Three weeks ago the nurse was contacted by a COPD patient with a chest infection.

The man had been unable to call a doctor for help because he did not have a phone and he was too unwell to make his way to a pharmacy and fill a prescription.

“It was very simple for me to call the doctor and go pick up his meds, but it was going to take a week for that to improve how he was feeling,” said Ms Bishop, who is raising the issue to draw attention to COPD Awareness Month observances.

“He'd been quite weak for a very long time and quite tired for a very long time and was on home oxygen.

“Because he lives alone and has no family, his house, you can imagine, was in a terrible state. It was quite dirty through no fault of his own.

“He was unable to push a mop around, unable to scrub the tub, unable to do dishes. He was pretty much bed-bound in the week before I saw him until a neighbour lent him a phone to call.”

Another patient of hers lives “in the rough and has been in a squat for a while”. Thanks to Open Airways his name is now on a housing list, but in the meantime he relies on others for food.

“We went to all the different helping services. He was a year too young for Ageing and Disability; Age Concern helped a little with a food card,” Ms Bishop said.

“He was sleeping in a squat; the squat’s now boarded up and locked with his possessions inside. So he's been sleeping outside on a wet porch, and we've been paying for inhalers for him.”

The man was referred to Open Airways by the Emergency Department at King Edward VII Memorial Services after he had been admitted for treatment three times.

“We have managed to get him a card to help with some of his medications, not all, and he eats three times a week at a church. They would kindly give him more food, but he has nowhere to store it.”

An effort to get the man on financial assistance has “been a long process” because he didn't have the money to open a bank account or pay for the birth certificate he needed as proof of ID.

“So while I’d like to say that we were just helping with people’s health, I’m finding more and more that this job is social work as well because we have to take care of the whole patient, not just the inhalers.

“Telling them how to use their inhaler properly is of no benefit if they can’t eat or sleep,” Ms Bishop said.

Also alarming to her is the rising number of individuals who are homeless because illness prevents them from working. It’s a contrast with past decades, when most people were sleeping in the rough because of "alcohol, mental health, or drug issues”.

“Often with COPD, patients get breathless. So if they were in a job painting or mowing grass, or doing something that required a lot of exertion, they can no longer do that job,” Ms Bishop said.

Of the five patients she saw with COPD last week, three were new. It’s a definite increase over what she has seen in her 30-odd years of nursing.

“The World Health Organisation says that COPD is the third leading cause of death in the world. It’s a common umbrella term for diseases such as chronic bronchitis and emphysema. It’s treatable, but it's not curable,” she said.

Open Airways follows guidelines set by the Gold Initiative for Lung Disease and the medication that is available here is of a good quality however it’s up to the patient to ensure a successful outcome.

“Best practice is that people need physio. Best practice is that people need to exercise, take the medicines properly and take care of themselves.

“Generally, it's hard to get people to increase their exercise. When they're short of breath they’re very frightened [about doing that] so it's important to do that with an expert helping them, so they know how far to push themselves,” Ms Bishop said.

Early diagnosis is key. Smokers and former smokers over the age of 40 should have a lung function test, which is free to anyone with insurance.

“We've got patients with COPD that are runners; we’ve got patients that are homebound and palliative, very end-stage and soon to die.

“So it runs the whole gamut, and not everybody reaches that oxygen homebound stage, but even for people that do, we can make sure they're very comfortable,” she said.

“But it's also a case of knowing how to use the inhalers properly. And that's one of the things that our free home visits and consults do, teach you how to use these things properly.”

• For more information on COPD, visitopenairways.com