Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that affects millions of people each year. COPD is a general term used to describe specific diseases such as emphysema and chronic bronchitis.
Emphysema involves destruction of the walls of the air sacs (alveoli) in the lungs. This results in a smaller number of larger air sacs that have poor gas exchange capabilities.
Chronic bronchitis, without another known cause, is characterized by chronic cough and chronic mucus production.
A person with COPD may have either emphysema or chronic bronchitis, but most people with COPD have both. Some people with COPD may also have an “asthma-like” or reactive component to their pulmonary disease.
WHAT ARE THE GOALS OF TREATMENT?
People with COPD can lead active and full lives. By diagnosing the disease early, treating symptoms, reducing the risk of complications, and educating patients and families about COPD, doctors, nurses, and respiratory care practitioners hope to improve the patients’ quality of life. The goal is to help people with COPD take charge of their breathing and regain or maintain control of their lives.
HOW IS COPD MANAGED?
People with COPD must become actively involved in the management of their disease. Participating in the treatment plan will help people with COPD and their families achieve the best possible results.
EXERCISE AND HEALTHY LIFESTYLE
An exercise or conditioning program is one of the most important aspects of managing COPD. Regular exercise can enable you to improve your overall strength and endurance. By improving general fitness, respiratory muscles are strengthened. This improves your ability to perform activities despite shortness of breath. Many people with COPD enjoy walking, water aerobics, and riding a stationary bike. Because poor nutrition is common for people with COPD, it is very important to eat a well-balanced diet and maintain a healthy weight. Shortness of breath and fatigue can interfere with your ability to eat a balanced diet. If you have special dietary needs, discuss this with a heathcare professional.
SMOKING CESSATION
Another important step in managing COPD is to quit smoking. If you smoke, this action is the single most important thing you can do to help manage your disease and prevent further damage to your lungs. Smoking is the main cause of most chronic lung diseases like emphysema and chronic bronchitis. And once you have developed such a disease, smoking will make it worse.
Even if you are participating in a rehabilitation program and following all the guidelines, your condition will get worse if you continue to smoke. A nicotine addiction can be very difficult to overcome. It involves chemicals that affect your body as well as your emotions and behavior. Under those circumstances, it is natural to try to convince yourself that it is okay to keep smoking. You may tell yourself that switching to low-tar cigarettes, smoking less a day, or switching to a pipe or cigars will be less harmful. You may even tell yourself that because the damage is already done, you may as well continue.
But the truth is, if you have lung disease and smoke even as few as two cigarettes a day your condition will get worse. There is no way around it - it’s essential to give up smoking. You will also need to avoid secondhand smoke to help decrease irritation to your lungs.
Each year more people are giving up smoking, and more effective ways to quit have been developed. Find a way that works for you. Quitting smoking is a difficult task. If you have trouble quitting on your own, ask your healthcare provider about programs and services that will help you to quit smoking.
AVOID INFECTION
Because people with COPD have an increased risk of respiratory infection, vaccines are generally recommended. You can receive the influenza vaccine and pneumonia vaccine to help prevent infection. Good hand washing can also help prevent the spread of germs and infections.
MEDICATION THERAPY
Your doctor may prescribe medications to control the symptoms of COPD. Bronchodilators help open the airways in the lungs and decrease shortness of breath. Inhaled or oral steroids may help decrease inflammation in the airways in some people. Antibiotics are often used to treat infections. For some people, cough expectorants can help clear mucus from the airways.
BRONCHIAL HYGIENE
In addition to medications, practicing good bronchial hygiene can help you get rid of mucus in your airways. Some people may benefit from chest physiotherapy. Treating patients in certain positions and clapping on their chest and back can help some patients cough up thick mucus.
BREATHING RETRAINING
Learning new breathing techniques will help you move more air in and out with less effort. This helps decrease shortness of breath. Diaphragmatic breathing, pursed lip breathing, and pacing your activities can be easily learned.
OXYGEN THERAPY
Some people with COPD may benefit from supplemental oxygen. Supplemental oxygen is necessary when there is not enough oxygen in the blood. Some people with COPD need oxygen only with activity or while sleeping. Many people with COPD need oxygen continuously, 24 hours a day. To achieve the maximum benefit, use your supplemental oxygen exactly as prescribed.
PULMONARY REHABILITATION
A comprehensive pulmonary rehabilitation program includes medical management, education, physical conditioning, nutrition counseling and consideration of psychological and social needs. A successful pulmonary rehabilitation program addresses the needs of each person and tailors the treatment to meet those needs.
Note: This information is provided to you as an educational service. It is not meant to be a substitute for consulting with your own physician.
RECOGNIZING SIGNS AND SYMPTOMS OF COPD
Recognizing changes in signs and symptoms of COPD is an important part of managing your illness. Knowing when symptoms are changing is helpful so that treatment and other interventions can begin promptly. Early treatment is most effective. If severe symptoms are present, it is vital to begin the appropriate treatment immediately. Accurate and timely assessment of your symptoms can help you and your healthcare provider decide if treatment should begin in the home, at your healthcare provider’s office, or in the emergency room.
Early symptoms or warning signs are unique to each person. These warning signs may be the same, similar, or entirely different with each episode. Usually you will be the best person to know if you are having difficulty breathing. However, some changes are more likely to be noticed by other persons, so it is important to share this information sheet with your family and those close to you.
A change or increase in the symptoms you usually experience may be the only early warning sign. You may notice one or more of the following:
• An increase or decrease in the amount of sputum produced
• An increase in the thickness or stickiness of sputum
• A change in sputum color to yellow or green or the presence of blood in the sputum
• An increase in the severity of shortness of breath, cough, and/or wheezing
• A general feeling of ill health
• Ankle swelling
• Forgetfulness, confusion, slurring of speech, and sleepiness
• Difficulty sleeping
• Using more pillows or sleeping in a chair instead of a bed to avoid shortness of breath
• An unexplained increase or decrease in weight
• Increased feeling of fatigue and lack of energy that continues
Symptoms do not go away when they are ignored. Therefore, knowing when to call your healthcare provider is very important in managing your chronic lung disease. It is very important for you to work with your healthcare provider to determine the appropriate treatment for signs and symptoms of COPD.
WHEN TO CALL THE DOCTOR
• Call immediately if disorientation, confusion, slurring of speech, or sleepiness occurs during an acute respiratory infection.
• Call within six-to-eight hours if shortness of breath or wheezing does not stop or decrease with inhaled bronchodilator treatments.
• Call within 24 hours if you notice one or more of the following severe respiratory symptoms:
» Change in color, thickness, odor, or amount of sputum persists
» Ankle swelling lasts even after a night of sleeping with your feet up
» You awaken short of breath more than once a night
» Fatigue lasts more than one day
Severe respiratory symptoms are a life-threating emergency. Have an action plan for getting emergency care quickly in the event of severe symptoms. Inform family members and those who are close to you of this emergency action plan. It is very important to work with your healthcare provider to determine the appropriate treatment steps for signs and symptoms of respiratory difficulty. These are guidelines; your specific treatment plan should be determined by you and your healthcare provider.
While there are many effective measures you can do at home to treat signs and symptoms, there are also actions that should be avoided because they can make your condition worse:
• Do not smoke.
• Do not take any extra doses of medication.
• Do not take codeine or any other cough suppressant.
• Do not use over-the-counter nasal sprays for more than three days.
• Do not increase the liter flow of prescribed oxygen.
• Do not wait any longer than 24 hours to contact your doctor if symptoms continue.
EXERCISE PROGRAM
An exercise or conditioning program is one of the most important aspects of managing COPD. Regular exercise can enable you to improve your overall strength and endurance. By improving general fitness, respiratory muscles are strengthened. This improves your ability to perform activities despite shortness of breath. Many people with COPD enjoy walking or riding a stationary bike.
It is important to build your tolerance to exercise slowly and at a gradual pace, and to always complete the stretching and toning exercises described in this booklet before each exercise session. When you begin an exercise program, your endurance - or ability to exercise for increasing periods of time - should increase. The key to increasing your overall endurance is to maintain a regular exercise schedule even if you find that you can only exercise for a short period of time.
After you have attained your goal of tolerating exercise for 30 minutes per day three to four times per week, you should continue that schedule in order to maintain the increased level of endurance that you have gained. If you discontinue your exercise program, you may find that your ability to do the activities of daily living will decrease to previous levels as your endurance decreases.
In order to receive maximum benefits from an exercise program, you should try to keep your heart rate in the target zone during the workout. Your recommended target heart rate to maintain during exercise is _______.
Here’s a handy chart to help determine your target heart rate range according to your age:
Age Target Heart Rate
35-39 91-145
40-44 88-141
45-49 86-137
50-54 83-133
55-59 81-129
60-64 78-125
65-69 76-121
70-74 73-117
75-80 71-113
Another important thing to remember is that you should exercise at a reasonable pace and not overexert yourself. If you experience chest pain or extreme shortness of air as you exercise, you should immediately stop and sit or lie down to rest. If the chest pain is not relieved or you are unable to catch your breath within five to 10 minutes of resting, you should notify your physician. Your doctor may want to modify your exercise program or recommend that you discontinue exercise for a time.
If you use oxygen, even if only at night, you should use it when you exercise. This will increase your tolerance for exercise. A respiratory care practitioner will monitor your oxygen level when you begin your exercise program and notify your physician if your
prescription requires adjustment during periods of exercise. If you use inhaled medications to manage your respiratory illness, scheduling your normal dose about one half hour before exercising may increase your tolerance as well.
A respiratory care practitioner will teach you how to take your pulse before, during, and after exercise. If your pulse is greater than _______ during exercise, you should stop and rest until your next scheduled exercise day. A respiratory care practitioner will monitor your progress throughout the program and help you to adjust your exercise scheduled as needed. If you have questions or concerns regarding your exercise program, you should contact the therapist who is monitoring your progress, or contact your physician.
WHAT KIND OF EXERCISE CAN I DO?
A variety of exercise methods can be used as part of your program. The most common is simply walking, but other aerobic type exercises can be helpful as well. These include using a treadmill, a stationary bicycle, step exercises, rowing, water exercises, swimming, and aerobic dancing. Upper body exercises, such as arm cycling, can be beneficial as well. And finally, some studies have shown that mild resistance training with strong rubber type bands can help build strength.
You don’t need a lot of expensive equipment to start an exercise program. Walking in the mall or up and down stairs in your home can be accomplished with no investment in equipment at all. You can also buy a small “peddler” for about $20 that can be used to exercise both upper and lower extremities with cycling motion. Therabands™, used for resistance training, are also fairly inexpensive.
As with any exercise program, you should discuss plans with your physician to make sure they approve of the type, intensity, and frequency of the exercises. Your doctor and your respiratory therapist will help you form an exercise plan. Talk to the therapist who is guiding you through the program for help in finding what equipment you plan on using.
TRACKING YOUR PROGRESS
As your endurance increases, the shortness of air you experience during exercise should decrease. It is helpful to track and log your exercise in order to determine if you are meeting this goal and to help your doctor or respiratory therapist modify your exercise program, if necessary. A simple way to keep track of whether or not your shortness of air (SOA) is decreasing as your endurance increases is to use a 1-10 scale to describe your feelings of air hunger at the end of an exercise session. Use the log provided to keep a record of the type, frequency, and duration of your exercise, and use the scale below as a guide to describe your feelings or shortness of air when exercise is complete.
STRETCHING AND TONING EXERCISES
1. Deep Breaths
• Stand erect, feet positioned hip distance apart. Inhale as you lift your arms up.
• Exhale as you lower your arms.
• Repeat two times, slowly.
2. Upper Body Side Stretch
• Stand tall with feet apart 18 to 20 inches.
• Reach up with one arm and down with the other without bending forward or backward.
• Hold for five seconds then switch arms.
• Repeat two times with each arm.
MEETING YOUR GOALS
The maximum benefit of a pulmonary rehabilitation exercise program is usually reached after four-to-six weeks of exercise, 30 minutes per day, three-tofour times per week. You should see a noticeable improvement in overall strength, endurance, and the ability to manage tasks in your daily life if you continue this exercise routine over the long-term.
Note: This information is provided to you as an educational service. It is not meant to be a substitute for consulting with your own physician.
Shoulder Circles
• In a comfortable standing position, slowly shrug shoulders around in a circle five times.
• Repeat going the other direction.
MANAGING YOUR MEDICATIONS
Managing your medications is very important to managing your COPD. When you take medication as prescribed, your disease can be more easily controlled. Your healthcare provider or pharmacist can give you specific information about your medications.
Learning about your medications and following the guidelines listed below will help you more effectively manage your disease:
4. Inner Thigh Stretch
• Face forward with feet in a long stride (36 to 48 inches apart).
• Bend right knee over right foot, keeping leg straight. Hold for 10 to 20 seconds then do other side.
• Repeat two-to-four times.
1. Learn about the medications you are taking. You should know how the medication works, what dose you are to take, when to take it, and what side effects to watch out for. Also, ask about any potential drug or food interactions, and know both the brand name and generic name of your medications.
2. Talk with your healthcare provider about the use of generic (non-brand name) substitutions. Some generic medications are not recommended, while others may be fine for your needs.
3. If your prescription does not look right, ask your healthcare provider or pharmacist before you take any of the medication.
4. Keep your medications in the original bottle. The original bottle has the correct label and instructions. But for the times you cannot, ask your pharmacists for an extra labeled container.
5. Do not substitute over-the-counter (OTC) medications for the medications your healthcare provider has prescribed. These medications can be dangerous. For example, OTC bronchodilators (e.g., Primatine® Mist, Bronkaid®) may contain epinephrine and/or theophylline, which can interact with the medications your healthcare provider has prescribed.
6. Most people with respiratory or allergic diseases can use OTC decongestants and antihistamines safely. But, it is still very important to talk with your healthcare provider about these types of medications so that they can make specific recommendations.
7. When your medications change, be sure to keep your old medications separate.
8. If you have difficulty swallowing medications, ask your pharmacist or healthcare provider about different ways to take your medications.
REMEMBERING TO TAKE YOUR MEDICATIONS
1. Develop a daily routine for taking your medications. Pick something you do every day (e.g., waking, brushing your teeth, eating meals, bedtime) and plan your medication schedule around that activity.
2. Use a medication checklist or worksheet to record when you take medications. Place the checklist someplace visible to use as a reminder.
3. Pillboxes can help you remember to take your medications. By packing a day’s or week’s worth of medication, you will know exactly if you took your medication or not. However, once the medication leaves the original bottle, it loses its identification and instruction label. You may want to have someone double check your pillbox to make sure it is packed correctly.
REFILLING YOUR PRESCRIPTIONS
1. When you first receive your medication, make sure the number of refills on the label matches the number on the original prescription. Ask the pharmacist at the time if you notice a problem. Plan to get a new prescription when you are on your last refill or sooner.
2. Contact your pharmacy well in advance of the time you need your medication. The pharmacist may need time to telephone the physician, check the medication supply, order the medication, then package and label the medication.
3. Most prescriptions, including refills, are only good for 12 months. At that time, a new prescription is necessary and any unused refills cannot be filled.
4. Date the canister of your metered dose inhaler (MDI) so you know how long the medication lasts. Plan ahead to get the quantities you need. See the information sheet on how to tell how much medication is left in your MDI so that you can plan for refills before you run out.
CHECKING FOR EXPIRATION DATES
1. Make a careful note of the expiration date on all medication packages.
2. Make sure you check expiration date on the medications you may have stored in different locations (e.g., work desk, purse, backpack, kitchen cabinet).
3. Never use medications after they expire.
STORING YOUR MEDICATIONS
1. Temperature changes and humidity can cause medication to become ineffective or dangerous.
2. Humidity can cause a tablet to become moist and powdery. Do not store medications in places with high humidity, such as bathrooms and above the stove.
3. Do not store medications in the glove compartment of your car. The temperature can range from -20°F to 120°F. When too cold or too hot, your metered dose inhaler (MDI) will not deliver a good spray and may burst. Check your MDI label for the recommended temperature range.
TRAVELING WITH MEDICATIONS
1. When you travel, make sure you bring more medication than you think you will need.
2. Put your medications in your carry-on luggage; don’t store them in bags that will be checked and possibly lost in transport.
3. Be careful about taking foreign purchased medications.
Note: This information is provided to you as an educational service. It is not meant to be a substitute for consulting with your physician.
BRONCHODILATORS
HOW DO THEY WORK?
Bronchodilator medicines open airways by relaxing (dilating) the muscles in and around the airways (bronchi) that tighten during a COPD episode.
HOW ARE THEY PRESCRIBED?
Bronchodilators come in many forms. There are also many ways to take them, such as:
• Inhaled using a metered dose inhaler
• Inhaled using a nebulizer
• A powder-filled capsule that is inhaled by using a device called a dry powder inhaler
• Swallowed as a liquid or tablet
• Taken as shots
Inhaled bronchodilators stop symptoms of COPD episodes and prevent COPD symptoms in some individuals. They are sometimes used in small doses (no more than three to four times a day) to keep daily COPD symptoms under control.
WHAT ARE THE SIDE EFFECTS?
Side effects include rapid heartbeat, tremors, feeling anxious, and nausea. These side effects tend to leave as the body adjusts to the medicine. Serious side effects are rare but may include chest pain, fast or irregular heartbeat, severe headache or feeling dizzy, very bad nausea, or vomiting. Call your doctor right away if you have any of these symptoms.
NOTES
Inhaled medicines are usually the first choice because they begin to work within five minutes and have fewer side effects. The medicine goes right to the lungs and does not easily go into the rest of the body. Using a nebulizer to take the medicine works the same way as using an inhaler. A nebulizer is easier to use than an inhaler. It is good for a patient who has trouble using an inhaler or for a patient with severe COPD.
CORTICOSTEROIDS
HOW DO THEY WORK?
Corticosteroids are anti-inflammatory medicines that prevent and reduce the swelling inside the airways and decrease the amount of mucus in the lungs.
HOW ARE THEY PRESCRIBED?
Corticosteroids come in three forms:
1. Inhaled using a metered dose inhaler
2. Liquids or tablets to be swallowed (called oral corticosteroids)
3. Shots
Inhaled corticosteroids are taken with a metered dose inhaler. When taken at the proper doses they are safe medicines that work well for people with moderate or severe symptoms of COPD. They reduce the sensitivity of the airways, and they prevent swelling in the airways.
Liquid and tablet (oral) corticosteroids are used to reduce swelling of the airways and prevent the episodes from getting even more severe. For people with moderate COPD, oral corticosteroids are sometimes used for three to seven days and then stopped. People with very severe COPD may take oral corticosteroids every other morning or daily.
Shots of corticosteroids are used only in a doctor’s office or emergency room for serious episodes.
WHAT ARE THE SIDE EFFECTS?
Inhaled corticosteroids may cause a yeast infection in the mouth or bother the upper airways and cause coughing. There are two things to do to keep these things from taking place: use a spacer device (an attachment on the inhaler) and rinse out your mouth after you take the medicine.
Using oral corticosteroids for a short time may cause different side effects. You may have a better appetite, fluid retention, weight gain, rounding of the face, changes in mood, and high blood pressure. These will stop when you quit taking the medicine, but do not stop taking this medicine without first talking to your doctor.
Oral corticosteroids used for a long time may have bad side effects such as high blood pressure, thinning of the bones, cataracts, and muscle weakness. Because of these side effects, most doctors only prescribe oral corticosteroids for a long time if a patient’s chronic lung disease is serious.
NOTES
Corticosteroids are not the same as the steroids used by some athletes. Inhaled corticosteroids and oral corticosteroids taken for a short time do not cause long-lasting changes in the body.
When oral corticosteroids are used to treat serious episodes, they take about three hours to start working and are most effective in six to 12 hours. They do not work immediately like bronchodilators do, even when taken through an inhaler. Talk to your doctor about what to do when you forget to take your medicine on time.
EXPECTORANTS
HOW DO THEY WORK?
Expectorants are used to help clear mucus or phlegm (pronounced “flem”) from the chest. They workby thinning the mucus or phlegm in the lungs. Drinking plenty of water while taking expectorants may help loosen mucus or phlegm in the lungs.
HOW ARE THEY PRESCRIBED?
Some expectorant prescriptions are available only with your doctor’s prescription. Others are available without prescription; however, your doctor may have special instructions on the proper dose of expectorant for your medical condition. Expectorants are available in the following dosage forms:
• Oral
• Capsules
• Extended-release capsules
• Oral solution
• Syrup
• Tablets
• Extended-release tablets
For patients taking the extended-release capsule form of this medicine, swallow the capsule whole, or open the capsule and sprinkle the contents on soft food such as applesauce, jelly, or pudding and swallow without chewing.
For patients taking the extended-release tablet form of this medicine, if the tablet has a groove in it, you may carefully break it into two pieces along the groove. Then swallow the pieces whole without crushing or chewing them. If the tablet does not have a groove in it, it must be swallowed whole. Do not break, crush, or chew it before swallowing.
The dose of expectorant will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of expectorant. If your dose is different, do not change it unless your doctor tells you to do so.
If you must take this medicine regularly and you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double dose.
TO STORE THIS MEDICINE:
• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule or tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medication to break down.
• Do not refrigerate the syrup form of this medicine.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
SIDE EFFECTS
If your cough has not improved after seven days or if you have a fever, skin rash, continuing headache, or sore throat with the cough, check with your doctor. These signs may mean that you have other medical problems.
MUCOMYST
HOW DOES IT WORK?
Mucomyst, or “Acetylcysteine” (a-se-teel-SIS-teen), is a mucolytic (medicine that destroys or dissolves mucus). It is given by inhalation through an aerosol nebulizer.
Acetylcysteine is used for certain lung conditions when increased amounts of mucus make breathing difficult. Acetylcysteine liquefies (thins) or dissolves mucus so that it may be coughed up.
HOW IS IT PRESCRIBED?
The dose of acetylcysteine varies from patient to patient. Follow your doctor’s orders or the directions on the label. The amount of solution that you use depends on the strength of the medicine and the method of inhalation used. Also, the number of doses you use each day, the time allowed between doses, and the length of time you use the medicine depend on the medical problem for which you are using acetylcysteine.
If your dose is different, do not change it unless your doctor tells you to do so.
• Adults – three to five milliliters (mL) of a 20% solution or six to 10 mL of a 10% solution used in a nebulizer three or four times a day. The medicine is inhaled through a face mask or mouthpiece.
After using acetylcysteine, try to cough up the loosened or thinned mucus. If this does not work, it may have to be suctioned out to prevent too much mucus from building up in the lungs. If you have any questions, check with your doctor or ask the therapist working with you during the program.
If you miss a dose of this medicine, use it as soon as possible. Then use any remaining doses for the day at regularly spaced intervals.
TO STORE THIS MEDICINE:
• Keep out of the reach of children.
• Before the container is opened, store it away from heat and direct light.
• After the container is opened, store it in the refrigerator. However, keep the medicine from freezing. The opened container should be discarded after four days.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
SIDE EFFECTS
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
• Less common: wheezing, tightness in chest, or difficulty in breathing (especially in asthma patients)
• Rare: skin rash or other irritation
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
• Less common: clammy skin, fever, increase in amount of mucus in lungs, irritation or soreness of mouth, throat, or lungs, nausea or vomiting, runny nose
For patients using a face mask for inhalation of acetylcysteine, the mask may leave stickiness on your face. This can be removed with water.
When you use acetylcysteine, you may notice that the medicine has an unpleasant odor at first. However, this smell will go away soon after you use the medicine.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
DIURETICS
HOW DOES IT WORK?
Loop diuretics are given to help reduce the amount of water in the body. They work by acting on the kidneys to increase the flow of urine. This helps patients who retain too much water in their bodies.
Diuretics are also used to treat high blood pressure (hypertension) in those patients who are not helped by other medicines or in those patients who have kidney problems.
High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled. Loop diuretics may also be used for other conditions as determined by your doctor.
HOW IS IT PRESCRIBED?
The dose of diuretics will be different for different patients. Follow your doctor’s orders or the directions on the label. The number of tablets or teaspoonful of solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length
of time you take the medicine depend on the medical problem for which you are taking diuretics. This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you take the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep.
If you are to take a single dose a day, take it in the morning after breakfast. If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your healthcare professional to help you plan the best time to take this medicine.
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double dose.
TO STORE THIS MEDICINE:
• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the oral liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
SIDE EFFECTS
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.
This medicine may cause a loss of potassium from your body. To help prevent this, your doctor may want you to:
• Eat or drink foods that have a high potassium content (e.g., orange or other citrus fruit juices), or
• Take a potassium supplement, or
• Take another medicine to help prevent the loss of the potassium in the first place.
It is very important to follow these directions. Also, it is important not to change your diet on your own. This is more important if you are already on a special
diet (as for diabetes), or if you are taking a potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary and, in some cases, too much potassium could be harmful.
To prevent the loss of too much water and potassium, tell your doctor if you become sick, especially with severe or continuing nausea and vomiting or diarrhea. Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position. This is more likely to occur in the morning. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for one or two minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.
The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time.
HOW TO USE A METERED DOSE INHALER
(MDI)
Using a metered dose inhaler is a good way to take lung medications. There are a few side effects because the medicine goes right to the lungs and not to other parts of the body. It takes only five to 10 minutes for the medicine to have an effect compared to liquid or tablet medicines, which can take one to three hours. A spacer or holding chamber attached to the inhaler can help make taking the medicine easier. These devices are helpful to people having trouble using an inhaler.
The inhaler must be cleaned often to prevent buildup that will clog it and reduce how well it works. The guidelines that follow will help you use the inhaler the right way. You should also ask your doctor, nurse, or therapist to show you how to use the inhaler.
USING THE INHALER
1. Remove the cap and hold the inhaler upright.
2. Shake the inhaler.
3. Tilt your head back slightly and breathe out.
4. Use the inhaler in any one of these ways: (“b” is the best way, but “c” is okay if you are having trouble with “a” or “b”.)
a. Open mouth with inhaler one to two inches away.
b. Use spacer.
c. In the mouth.
5. Press down on the inhaler to release the medicine as you start to breathe in slowly.
6. Breathe in slowly for three to five seconds.
7. Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.
8. Repeat puffs as prescribed. Waiting one minute between puffs may permit the second puff to go deeper into the lungs.
Note: Dry powder capsules are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece and inhale very fast.
CLEANING THE INHALER
1. Once a day clean the inhaler and cap by rinsing them in warm running water. Let them dry before you use them again. It is helpful to have another inhaler to use while it is drying.
2. Twice a week wash the plastic mouthpiece with mild dish washing soap and warm water. Rinse and dry well before putting it back.
WHEN TO REPLACE YOUR INHALER
If the canister is new, it is full. The package container should tell you how many puffs are in a full inhaler. Divide that number by the number of puffs you take in one day. That number will tell you how many days your inhaler should last. Use a marker to note on the inhaler the date when the inhaler will need to refilled, or mark your calendar.
For example, if your full inhaler contains 220 puffs and your doctor has prescribed two puffs, four times per day you would use eight puffs per day, divided by 220. That means that your inhaler should last about 27 days. It’s a good idea to refill your prescription two to three days before you expect it to run out.
HOW TO USE A SPACER
Unless you use your inhaler the right way, much of the medicine may end up on your tongue, on the back of your throat, or in the air. Use of a spacer or holding chamber can help this problem.
A spacer or holding chamber is a device that attaches to a metered dose inhaler. It holds the medicine in its chamber long enough for you to inhale it in one or two slow deep breaths. The spacer makes it easy for you to use the medicines the right way (especially if you have a hard time using just an inhaler). It helps you not cough when using an inhaler. A spacer will also help prevent you from getting a yeast infection in your mouth (thrush) when taking inhaled steroid medicines.
USING THE SPACER
1. Attach the inhaler to the spacer or holding chamber as explained by your healthcare provider or by using the directions that come with the product.
2. Shake well.
3. Press the button on the inhaler. This will put one puff of the medicine in the holding chamber.
4. Place the mouthpiece of the spacer in your mouth and inhale slowly.
5. Hold your breath for up to 10 seconds and then exhale. Wait one minute then repeat steps four and five for as many puffs as has been prescribed by your healthcare provider.
ANTIBIOTICS
HOW DO THEY WORK?
Antibiotics are medications used to fight bacterial infections; they will not harm viruses or parasites. Antibiotics are usually taken orally in pill form but can be administered through intravenous injection (into a vein), intramuscular injection (into a muscle to treat skin infections), or as a skin ointment. There are many types of antibiotics, and some have proven to be more effective than others at treating specific types of infection. “Broad spectrum” antibiotics are medications that harm or kill a wide variety of infectious bacterial agents.
HOW ARE THEY PRESCRIBED?
Always take all of your prescribed antibiotics, even if your symptoms improve after only a few days. Otherwise, the bacteria are only weakened instead of totally killed. The weakened bacteria can change (mutate) and re-attack. Unless all of the bacteria are completely killed, the bacteria can change into another form and produce symptoms again. Finishing all antibiotic medications prescribed, even if symptoms stop, is very important. This includes not missing or skipping a dose. Blood levels of the antibiotic must stay within a high enough range to kill bacteria.
Avoid “antibacterial” soaps and cleansers in favor of products with bleach, alcohol, ammonia, or hydrogen peroxide, which kill bacteria without promoting resistance. Many bacterial infections are preventable through immunization. You should discuss the options with your physician.
SIDE EFFECTS
Antibiotics are generally safe but can produce reactions and even serious medical complications in some individuals. You should contact your physician if you experience any of the following:
• Allergic reaction, including skin rash or itching
• Tachycardia (abnormally fast heartbeat)
• Fever
• Nausea
• Skin rash with or without itching
• Hives
• Dark or discolored tongue
• Dizziness or lightheadedness
• Unusual tiredness or weakness
• Headache
• Ringing in ears
• Bloating
• Unusual thirst
• Abdominal pain or cramps
• Diarrhea
• Nausea and vomiting
• Loss of appetite
• Weight loss
OXYGEN THERAPY
Oxygen is in the air we breathe and is necessary to live. When we inhale, oxygen enters the lungs and goes into the blood. If the lungs are not working well enough to transfer enough oxygen into the blood, oxygen therapy may be necessary. The major reason why oxygen therapy is used is to assure that there is enough oxygen in the blood to provide for the body’s needs.
There are many diseases for which oxygen therapy may be useful. Many patients have benefited from the use of oxygen therapy for acute healthcare needs and chronic lung conditions. Oxygen therapy is used to normalize the oxygen level in blood during sleep, rest, and activity, and during acute illnesses in the hospital.
HOW WILL OXYGEN THERAPY HELP ME?
There are many benefits of oxygen therapy. In adults with chronic lung disease, studies have shown that long-term oxygen therapy has improved quality and length of life. Oxygen can decrease shortness of breath when you are active, allowing you to do more.
HOW WILL I KNOW IF I NEED OXYGEN?
It is sometimes difficult for you to know when oxygen therapy is required. If your oxygen level is low in your blood, you may experience symptoms such as shortness of breath, irritability, morning headaches, or ankle swelling. If you notice any of these symptoms, see your physician or healthcare provider. They can review your overall medical condition and decide what treatment you need.
WHAT TESTS DO I NEED?
There are two methods to test the oxygen level in your blood: oximetry and arterial blood gases. Your oxygen level may be measured as a percentage of oxygen in your blood – this is called oxygen saturation. Oxygen therapy may be necessary if your level is below 89 percent.
Oximetry is one way to measure oxygen saturation in your blood. A small clip is placed on the hand, toe, or earlobe. This is a simple, convenient, painless way to determine your need for oxygen. This test may be done at rest, during sleep, and while you are walking for a thorough evaluation.
The second method of testing is the arterial blood gas. While this blood test is more complex, the results can provide your physician or healthcare provider with more information about how your lungs are working. For this test, blood is drawn from an artery in your wrist and both oxygen and carbon dioxide levels are measured.
HOW DO I GET A PRESCRIPTION FOR OXYGEN?
When the test determines that oxygen is needed, your physician will write a prescription for oxygen. The prescription will tell you how much oxygen to use and when to use it. The amount of oxygen you need to use is called the flow rate. You need to understand when to use the oxygen and how much to use during sleep, rest, and activity. Remember, oxygen is a medication and should be used only as prescribed. Oxygen is a medical therapy and, therefore, will be paid for by Medicare and other insurance companies.
WHAT TYPE OF OXYGEN SYSTEMS ARE AVAILABLE?
There are many oxygen systems available, including concentrators, compressed gas cylinders, and liquid oxygen vessels. Each type of system has advantages depending on your lifestyle and situation. Your therapist and your doctor will work together, with you, to decide which system best meets your needs.
HOW DO I USE THE OXYGEN?
Oxygen is most commonly delivered by a small plastic tube called a cannula. The cannula is placed under the nostrils and delivers oxygen to the airways. Oxygen can also be delivered by a face mask, oxygen tent, or by a number of other devices.
If you need a lot of oxygen (high flow rate) or want to be very active, your healthcare provider may consider an oxygen saving device. These devices include a reservoir or demand delivery. Ask your healthcare provider for more information on these devices.
WHAT ARE SOME COMMON CONCERNS ABOUT OXYGEN?
You may be concerned about how oxygen therapy may change your lifestyle, how oxygen affects your body, and whether oxygen therapy is safe. You may worry that oxygen treatment will prevent you from leaving your home, but many convenient portable systems are available. In fact, oxygen therapy allows you to be more active by providing the oxygen that your body needs.
Today, many people use oxygen, so you should not feel self-conscious when out in public. Oxygen therapy does not cause any harm to your lungs or your body, if used as prescribed. You will not develop an addiction to oxygen. Oxygen therapy is very safe, and the main thing you need to remember about safety is to keep your face and your oxygen away from flames. Your home medical equipment provider will talk to you about more specific safety concerns and give you specific instructions on how to use the oxygen as prescribed by your physician.
NUTRITIONAL GUIDELINES FOR PEOPLE WITH (COPD)
As COPD progresses and breathing becomes more difficult, consuming an adequate and healthy diet also becomes more difficult. Proper nutrition is important to help fight infections and maintain a healthy weight. Underweight COPD patients typically experience more physical weakness and lung infections, whereas overweight patients have more strain on their heart and lungs due to excess body weight. Both circumstances cause patients to feel exhausted and can decrease their appetite leading to poor nutritional intake.
Because COPD patients have difficulty eating due to discomfort or lack of appetite, it is important that they avoid non-nutritional foods. Non-nutritional foods include regular soft drinks, candy, and foods high in sugar, which provide calories but no protein, fiber, vitamins, or minerals. Carbonated beverages should be limited because the carbonated air causes a feeling of fullness and gas. Also, avoid salt as it can contribute to high blood pressure and causes fluid retention in the feet, ankles. and legs. Fried, greasy food and spicy foods are usually not tolerated well and should be avoided.
Proper nutrition for COPD patients becomes a balancing act. Labored breathing increases daily calorie requirements and physical discomfort, making it difficult to eat. Side effects of medications and depression can also contribute to a lack of appetite. For optimal well-being, COPD patients should focus on small, frequent meals of foods with high nutritional values. Meal planning should include these recommendations:
• Lean protein helps build and heal cells in your body as well as create antibodies that are used to fight infection. Fish, chicken, eggs, lean beef, and lean pork are healthy sources of protein. Avoid sausages, bacon, salami, pepperoni, as these are high in fat and sodium but low in protein.
• Whole grains contain fiber, vitamins, and minerals. Look for the whole grain seal on labels, which indicates that the healthy grain has not been milled out of the product.
• Fruits and vegetables are naturally high in fiber, vitamins, and minerals, making them healthy choices to include in meals. COPD patients should avoid any that cause them gas and bloating. Canned vegetables are higher in sodium, so frozen or fresh vegetables are recommended.
• Low fat dairy products are good sources of protein as well as calcium and vitamin D. Choose low fat milk, Greek yogurts, ricotta cheese, and low sodium cheeses.
HELPFUL BREATHING TECHNIQUES
DIAPHRAGMATIC BREATHING
Lung disease interferes with the ability of the lungs to exchange oxygen and carbon dioxide. The sensation of feeling short of breath comes from either a reduced level of oxygen or an increased amount of carbon dioxide in the blood. Improper or inefficient methods of breathing can compound the problems associated with lung disease by further impairing the exchange of these critical gases.
Normally, the most efficient and effective method of breathing relies on the activity of the diaphragm muscle. However, for reasons not fully understood, many people develop a habit of breathing with accessory muscles (meaning muscles of the chest wall, shoulders, and neck). This is referred to as thoracic or chest breathing.
People who do not have lung disease can usually breathe this way without becoming excessively tired or feeling short of breath. Nevertheless, thoracic breathing is not an effective way of exchanging air in the lungs and requires considerably more effort and uses more oxygen than diaphragmatic breathing. Therefore, one of the most important strategies for breathing easier is to master the technique of diaphragmatic breathing.
To determine if you are breathing correctly, place one hand over your abdomen at about the level of your navel. Place your other hand over your chest at about the level of your heart. Now, take a deep
breath. If you’re breathing correctly, you should notice the hand over your abdomen pushing outward when you breathe in. The hand positioned over your chest should remain still. If the opposite has occurred and the hand over your chest moves, you are chest breathing and need to learn diaphragmatic breathing.
Learning diaphragmatic breathing is the key to easier breathing. Although it will take time and effort to master, once you learn and can apply the mechanics of this more efficient style of breathing, you’ll be able to breathe with your diaphragm effortlessly. Also, you likely will discover that you are less short of breath and have more energy.
Begin your practice by lying as flat as you comfortably can. Place either a book or tissue box over your stomach just below your rib cage. Push the object up with your stomach muscles as you draw air into your lungs. If you’re doing this correctly, you will see the object on your stomach rise each time you breathe in. Also, pace your breathing. It should be as slow, yet as rhythmic as you can make it. Mastering this technique will send you well on your way to breathing easier.
PURSED LIP BREATHING
Pursed lip breathing is a special breathing technique developed for people who have emphysema. If you suffer from emphysema, learning this technique will improve your ability to breathe.
In the lungs, the tree limb shaped bronchi are hollow and act as air passages or tunnels. The muscles and cartilage serve the purpose of holding the branches open so that air can pass easily in and out of the lungs. When the muscles and cartilage become diseased, as in emphysema, they have difficulty holding the air passages open. When the airways collapse, air can become trapped in the lungs, especially during exhalation. Pursed lip breathing was developed as a technique to keep the airways from collapsing and trapping air. It is an easy technique to learn and important skill to master if you have been diagnosed with emphysema.
The general idea is to attempt to create some back pressure in the airways when you exhale. A little back pressure will help keep the airways open longer and less air will become trapped. This is accomplished by exhaling slowly through pursed lips. It’s a bit like whistling. If your lips are closed and you attempt to exhale through your mouth, you will feel the pressure of the air against your lips and cheeks. Part your lips just enough to allow a small steady stream of air out. You will continue to feel the pressure of the air against your lips and cheeks. The back pressure that you have created in your mouth will extend into the airways of your lungs and will help keep them open and exchanging air. Breathing with pursed lips will help you feel less short of breath. Once the technique is mastered, it should be used whenever you’re feeling air hungry or fatigued.
KEEPING YOUR AIRWAYS CLEAR
CONTROLLED COUGHING
Once your mucus is thin, you may be able to bring it up more easily by practicing a special coughing technique called controlled coughing. By controlling the way you cough you can force mucus up and out of your lungs without causing increased fatigue or shortness of breath.
1. Sit upright in a chair and bend forward slightly. Place a box of tissues next to your chair.
2. Inhale slowly through your nose. Take in as much air as you can and hold your breath for two seconds.
3. Instead of exhaling, cough twice with your mouth slightly open. (Coughing the first time loosens mucus. Coughing the second time moves it upward.)
HOW TO DO POSTURAL DRAINAGE
1. Place three pillows, one on top of the other, on the floor or in the center of your bed along with a box of tissues.
2. Your doctor or respiratory therapist will tell you which positions to use and how long to stay in each position. You may be asked to alternate between positions, spending a few minutes in each position. The amount of time spent in each position is usually about five to 10 minutes.
4. Wait a couple of seconds. Then inhale through your nose by sniffing gently. Breathing in deeply after you have coughed may force mucus back into your lungs.
3. After being in one position for several minutes, sit up slowly so you don’t get lightheaded. Then do the controlled coughing exercise to help bring up the mucus. A sip of water may help to stimulate a cough and loosen mucus in your throat. If you do more than one position, sit up between positions and do controlled coughing.
If you develop a headache, severe shortness of breath, a nosebleed, or nausea while doing this, stop the treatment and let your healthcare provider know.
POSTURAL DRAINAGE
Some people need to drain their lungs before excess mucus can be forced out. Postural drainage is a way of draining mucus from your lungs. It involves positioning your body so that the force of gravity helps bring up the mucus.
Do not practice this on your own. If your doctor prescribes postural drainage, your nurse or respiratory therapist will show you how to do it.
If you are taking a medication that helps to open your bronchial tubes or thins mucus, take it one half hour before beginning postural drainage.
POSITIONS FOR POSTURAL DRAINAGE
Practice breathing with your diaphragm while you do postural drainage.
Lie on your stomach over the top of the pillows with your head and chest lower than the rest of your body. Stay in this position for a few minutes. Relax and exhale slowly through pursed lips.
COPING WITH TASKS OF DAILY LIVING
Chronic lung disease can be frustrating. Routine tasks suddenly become exhausting. Taking a shower or doing the grocery shopping may become dreaded activities. Being afraid of becoming short of breath may cramp your style so that you don’t do the same things you used to enjoy doing. Gradually, without work, without a sense of independence, one may start to feel sluggish, turned off, and depressed.
But there are alternatives; learning to adapt your lifestyle to your disability may open up new options for you.
Your doctor will tell you how many times to do postural drainage each day.
Lie on your back over the top of the pillows with your head and chest lower than the rest of your body. Stay in this position for a few minutes. Relax and exhale through pursed lips.
Some of the principles of business management may be useful to you. In many ways the management of your life, your work, and personal affairs is somewhat like that of a business. By recognizing the resources available to you and realizing your physical limitations, you may learn to invest your time and energy wisely. Principles of good organization, planning, delegating responsibilities, and scheduling skillfully may make an enormous difference in the quality of life that you will live. Listed below are some general principles you may find helpful.
ENERGY MANAGEMENT
1. Buy staples in sizes you can handle easily.
2. Alternatives to carrying grocery sacks or laundry in the arms:
• Satchel-type bag that has shoulder straps
Lie on your side over the top of the pillows with your head and chest lower than the rest of your body. You will have to change sides and then the other. Stay in each position for a few minutes. Relax and exhale slowly through pursed lips.
• Knapsack
• Travel bag on rollers
• “Sidewalk Cadillac” grocery cart: the handle can be built up with foam rubber
3. Ask that groceries to be packed lightly. Have perishable items that need to be taken in immediately sacked together. Non-perishables can be brought into the house at another time. Ask someone to do shopping for you for heavy items on a monthly basis.
CONVENIENCE PRODUCTS
Explore the grocery store and have on hand a supply of easily prepared food.
Examples:
• Instant soups, soup in a cup (nothing to wash)
• Instant breakfasts
• Frozen dinners
STORING GROCERIES
Place most used items within easy reach range. Pre-positioning: place and store objects at point of first use.
Examples:
• Have can opener near canned goods.
• Store vegetables near vegetable preparation area.
ORGANIZED WORK CENTERS
Have all necessary equipment and supplies for various activities concentrated in one specific work area: cook center, clean center, and mix center.
Examples:
• Baking: have dry ingredients, mixer, mixing bowls, measures, etc. within a small radius to eliminate unnecessary steps.
• Vegetable preparation: confine parers and knives in one area, preferably near the sink.
• Leave heavy appliances or a frying pan used daily out on the counter top or stove.
• Gather all equipment and materials together before beginning to save extra steps and for more efficient time management.
• When baking, have a sink full of soapy water into which dirty utensils can be put immediately to pre-soak and to avoid clutter.
• Utilize Lazy Susans in cupboards and refrigerator.
EASY FLOW OF WORK
Working on an assembly line basis accomplishes more in less time and with less effort.
Examples:
• During meal preparation, one can take all of the necessary items from the refrigerator by cart to the sink area, do all of the preparation there, move on to the stove, and when cooking is completed, proceed to the table.
• During dish washing, the dishes to be washed are placed on the right, the hot soapy water middle right, the hot rinsing water middle left, and the rack for draining on the far left. Eliminate drying.
USE WHEELS TO TRANSPORT
It is desirable to have a utility cart on wheels to use in most household activities.
Examples:
• It is possible to place all cleaning supplies on the cart and proceed from room to room, thus eliminating back-tracking.
• It is also possible to place on the cart and distribute laundry from room to room in one trip.
EASY WORK HEIGHTS
Eliminate excessive or unnecessary bending, stooping, and reaching from household activities because they are fatiguing.
Examples:
• A dustpan with a long handle eliminates bending.
• One should be able to rest both hands on the bottom of the dish pan or in the sink while standing in an erect position.
SIT TO WORK
For tasks taking a long time, use a stool or chair to minimize fatigue. Standing for longer periods of time is usually tiring.
Examples:
• If possible, the ironing board should be adjustable so that ironing can be done at proper sitting or standing heights. The adjustable ironing board can also be used for other tasks.
• Sit during food preparation that will take much time. Some things can be cut up at one sitting and frozen for future use.
USE PLANNED REST PERIODS
When you know a task will take a long time or is unusually fatiguing, plan and take breaks. If this is difficult for you to do, create a “break center” with a comfortable chair and some reading or handwork so you don’t feel you are wasting time.
Miscellaneous:
• Use modern labor saving devices. Examples: dryer, food processor, remote controls (for TV, lights, etc.).
• Use both hands when possible to carry things in order to distribute weight.
• Do not nest bowls. Store singly so both hands may be used to take them out and put them back.
• Keep often used mixing utensils in a container on the countertop to eliminate opening a drawer and hunting for what you want.
• Using paper plates when necessary/appropriate eliminates dish washing and lightens the weight involved.
• Explore lighter weight plastic ware.
• Twist-type ice cube trays are more easily manipulated.
• Attach frequently used recipes inside a cupboard door to eliminate hunting through a recipe box.
• Delegate to other family members as necessary/ appropriate, either when not feeling well or when the taskis too difficult for you.
With this information you can learn to manage your time and energy more efficiently by setting goals, assessing your resources, and planning a workable schedule for yourself. We hope this helps you to experience a more functional and enjoyable lifestyle.
FATIGUE AND WELLNESS
Many people with COPD say they feel weak, tired, or fatigued. Sometimes people say they do not feel like eating when they are tired. Here are some useful tips to help decrease the feeling of fatigue and help you feel more like eating.
Both exercise and food are necessary to help you maintain and rebuild your strength. Plan to rest or take a short nap before meals and exercise times. Exercise at least two hours after meals to help boost your appetite. (Ask your doctor before beginning an exercise program.)
During times when you have more energy you may want to prepare recipes in large quantities and freeze individual portions to be reheated later. A brand of TV dinner that is recommended are ones made by Healthy Choice. These are lower in sodium, fat, and cholesterol.
Community agencies, senior citizen centers, and Meals on Wheels are also sources for inexpensive and nutritious meals for times when you don’t have the energy to cook for yourself.
If you find yourself waking up in the middle of the night or wake up in the morning feeling tired, try eating a bedtime snack such as hot oatmeal or a glass of warm milk.
LIMITING YOUR EXPOSURE TO TRIGGERS
A trigger is anything that caused symptoms, such as shortness of breath, wheezing, and coughing flare-up. Limiting exposure to your triggers will make it easier to live with your condition.
THE ELEMENTS
• Cold: Inhaling cold air can cause bronchial tubes to narrow and make breathing difficult. When you are out in the cold, cover your mouth and nose with a scarf or mask to warm the air as it enters your body. Stay indoors on very cold days.
• Humidity: Some people feel better when the weather is humid. Others feel better in drier conditions. If a certain amount of humidity makes you feel better, you may want to use a humidifier to moisten the air in your home. (A humidifier can easily become a breeding ground for bacteria, so be sure to cleanit regularly.)
If you seem to do better in a drier environment, you may want to install a dehumidifier, which will remove excess humidity from the air. Kitchen and bathroom venting fans and air conditioners will also remove some of the humidity from the air. For many people, the best humidity level seems to be between 35 and 50 percent.
AIR POLLUTION
You cannot avoid air pollution altogether, but you can limit your exposure to it. Stay away from areas indoors or outdoors that have a strong odor insecticide. Avoid
spending time outdoors on smoggy days. In some parts of the country daily air pollution reports are given. If you live in one of these areas, stay indoors on the days when the air pollution is high.
SMOKE
Tobacco smoke can trigger breathing problems whether you are smoking or exposed to second hand smoke. If you smoke you should quit. Steer clear of smoky environments. If others are smoking around you, politely ask them to stop. Place a no smoking sign on your door or desk. Always sit in the non-smoking section of restaurants or other public places.
DUST
Limit your exposure to dust both inside and outside your home because dust can cause breathing problems. If possible, have someone else do the cleaning when you aren’t home. Dust often with a damp cloth, damp mop, and vacuum furniture, carpets, and draperies. If you clean, wear a mask. Replace dirty filters on your furnace and air conditioners often.
VAPORS
Stay away from cleaning solvents, paint, paint thinners, and liquid chlorine bleach. Avoid using spray products, such as furniture polish, spray cleaners, hair spray, perfumes, or spray deodorant. The vapors from these products can cause breathing problems. Instead, substitute spray products with liquids or solids that can be rubbed on.
ALLERGENS
Allergens are substances in the air around you (either inside or outside) that trigger allergic reactions. Dander from cats, dogs, or other animals, mold spores, pollen, and ragweed are examples of common allergens. If you are allergic to certain things, steer clear of them. Many people find that running an air conditioner helps filter out some of the allergens.
Note: This information is provided to you as an education service. It is not meant to be a substitute for consulting with your own physician.
COPING WITH LUNG DISEASE
CLEARING THE MIND
By allowing yourself to mentally focus on a single, peaceful word, thought, or image, you can create a feeling of deep relaxation. Reduce distractions: sit comfortably, loosen tight clothing, close your eyes, begin to breathe slowly and deeply - mentally focus on one peaceful word, thought, or image - stretch as you complete the exercise.
TIPS FOR RELAXING
• For maximum benefit, the technique should be performed twice a day for 15-20 minutes per session. Even five minutes twice a day would be beneficial.
• Wait until at least two hours after a meal before practicing your relaxation technique.
• It should be performed in a quiet place, free from interruptions or outside stimulation.
• Check the time with a watch or clock –do not use an alarm.
• When your time is up, sit quietly a little longer, first with eyes closed, then with eyes open.
• If your mind wanders, turn your attention back to your breathing and keep repeating the chosen word or phrase, or focus on the guide’s voice.
• Don’t worry if you’re relaxing deeply enough or getting the right response. If you’re doing it, the response will occur and the physiological changes will take place.
• Afterwards you should feel relaxed and calm. This effect should continue for several hours.
• There are many techniques for relaxation, and no one method is better than another. In fact, it may be more effective for you to combine pieces of several different methods. The most basic is deep breathing.
DEEP BREATHING
Inhale: Sit or stand and place your hands firmly and comfortably on your stomach. Inhale slowly and deeply through your nose, letting your stomach expand as much as possible.
Exhale: Exhale slowly through pursed lips as if you were going to whistle. By pursing your lips, you can control how fast you exhale and keep your air ways open as long as possible.
AUTOGENICS
Concentrate on a mental suggestion such as “my left arm feels heavy and warm.” As you concentrate try to actually feel your arm getting heavier and warmer. Then repeat the same exercise focusing on your right arm, left leg, right leg, and so on.
PROGRESSIVE MUSCLE RELAXATION
First tense a muscle and notice how it feels; then, release the tension and pay attention to that feeling; and finally concentrate on the difference between the two sensations.
VISUALIZATION
A “mental vacation” allows your imagination to run free. Picture a tranquil setting that has a particular appeal to you and try to imagine all of the details. Are you lying on a warm beach? How does the sun feel on your back? Do you hear waves lapping on the sand? Is there a fragrance in the air? Do you see sailboats on the water?
UNDERSTANDING YOUR EMOTIONS
Like any permanent illness, lung disease can cause major changes in lifestyle, life goals, and relationships. Dealing with these changes can be very stressful for you and your family.
Fortunately, you can learn to cope with the emotional impact of lung disease, just as you can learn to manage the physical symptoms of your disease.
DENIAL
Finding out that you have a lung disease is bound to stir up some difficult emotions. It’s normal to feel anxious and afraid. The future may seem uncertain. Under the circumstances, you might want to deny that anything is wrong. Even if you’ve had difficulty breathing or frequent coughing spells, at first you may not believe that you have a serious problem.
ANGER
You are likely to feel angry. Your anger may be directed at your partner, other family members, friends, or your doctor. You may even resent healthy people who don’t seem to understand what you’re going through.
GUILT
Guilty feelings may surface, too. You may believe that you could have done something to prevent your condition.
DEPRESSION
It’s also normal to feel depressed. Depression usually lasts longer than other emotions and it may return frequently. You might think you are over your blue phase, only to find it returns without warning.
GRIEVING
All these emotions are a normal part of grieving, a process that helps us come to terms with our losses. We usually think of people grieving after someone has died, but any kind of loss, including the loss that occurs with a serious health problem, can cause people to grieve. Patients and family members alike often go through a period of grieving once lung disease has been diagnosed.
The stages of grief are often listed in a specific order, such as shock, denial, withdrawal, anger, depression, and acceptance. But few people pass through these stages in an orderly fashion. Instead, people who are grieving often swing back and forth between emotions or feel many strong emotions all at once. While the order in which you experience these emotions varies, one thing is clear – in order to move forward, you need to give yourself a chance to pass through all the states of grief.
Grieving is healthy if it helps you accept what has happened and gives you the determination you need to manage your symptoms. But sometimes a person can get “stuck” part way through the grieving process. A person who cannot get beyond the denial stage may refuse to take medication or insist that the treatment won’t do any good. Getting stuck makes it impossible to take an active role in treatment. You’ll be far better off if you work through, rather than fight or deny, all your emotions as they rise.
There are several ways of working through your emotions.
SHARE YOUR FEELINGS
Talking to your friends and loved ones can be a great source of comfort and relief. Other people can help you work through your grief, but only if you tell them how you are feeling.
It takes courage to express your feelings, especially if you’re not used to it. Sharing your feelings with close friends or family members does not mean that you have to find a solution for them. Just being able to talk about how you feel will help you through a difficult time.
STOP BLAMING YOURSELF
Dwelling on “what you should have done” will only make you feel more angry and depressed. If you are feeling guilty, it may help to remember that no one has a perfect lifestyle. Nearly everyone could improve their health by making better choices. Remind yourself that it’s not too late to begin living more healthy. This may help turn your feelings of guilt into motivation for making positive choices.
DEVELOP AN OPTIMISTIC ATTITUDE
Your situation, no matter how difficult, is not as important as your attitude toward it. Positive thoughts will give you a sense of confidence in your ability to cope.
Begin by saying to yourself, “I’m going to do whatever it takes to adjust to my condition. I may have lung disease, but I can still do many of the things I enjoy.” If your thoughts are more optimistic, your emotional reactions will improve as well.
EDUCATE YOURSELF
Get as much information as you can from the healthcare professionals who work with you. Read and practice what you learn. Once you know exactly what to do if symptoms flare, you’ll feel confident about managing your condition.
BE AS ACTIVE AS POSSIBLE
It’s normal to be less motivated when you’re blue. Practically everything seems overwhelming; it gets easier and easier to isolate yourself and do nothing.
Unfortunately, cutting yourself off from normal activities makes depression worse, and it may contribute to weakness and fatigue.
Getting back into a routine will improve your outlook, give more energy, and bring some order to your life. If your doctor wants you to exercise, begin planning regular fitness activities.
DON’T BE AFRAID TO ASK FOR HELP
Your self-image can suffer when you experience physical limitations. Being willing to admit how you feel is the first step toward improving your self-image. Your honesty will help your family reassure you. But sometimes more help is needed.
Joining a support group is one way to get the help you need. Talking and listening to people who have similar problems will provide insight and help you feel less alone. Your rehabilitation therapist can give you the number of local support groups in your area.
You might also want to consider talking with a counselor. Discussing your feelings with a professional can help you look beyond the limited view you may have of yourself and find the understanding and acceptance you need.
RESOURCES
Administration on Aging (www.aoa.gov): Home and community-based care for older persons and their caregivers. Supportive services provide handyman, chore, and personal care services.
American Lung Association (ALA) (www.lung.org): The ALA is the oldest voluntary health organization in the United States. Provides the latest in lung news and research in addition to online resources.
COPD Foundation (www.copdfoundation.org): Educational and medical materials for patients and healthcare providers.
COPD-Support, Inc. (www.copd-support.com): A nonprofit corporation that provides support, education, and information on COPD.
COPD Together (www.copdtogether.com): Discusses treatment options and additional resources for patients.
National Emphysema Foundation (www.emphysemafoundation.org): Works to improve the quality of life of those who have emphysema, asthma, and related diseases.
National Heart Lung, and Blood Institute (www.nhlbi.nih.gov): Part of the US National Institutes of Health, America’s premiere health research organization.
National Jewish Health (www.nationaljewish.org): Site for LUNG LINE: 1-800-222-LUNG (5864). Specializes in the treatment of patients with respiratory, immune, and other related diseases, and for groundbreaking medical research. Founded in 1899 as a non-sectarian, non-profit hospital, National Jewish remains the only facility in the world dedicated exclusively to these orders.
Your Lung Health (www.yourlunghealth.org): Information from a variety of sources, including respiratory therapist experts.
