Living well with lung disease
For people with chronic obstructive pulmonary disease (COPD), quality of life hinges on how actively they participate in their treatment. This means not just taking your medicine or other treatment as directed, but also incorporating practices into your daily routine to prevent infections, control your symptoms, and make daily activities like dressing and bathing easier. COPD is not necessarily a progressive disease; there are many steps you can take to continue enjoying the activities you do. There’s often a positive snowball effect when you take an active role in managing your disease — you feel more in control, so you feel better psychologically and physically. Feeling better boosts your spirits, which then helps you maintain a sense of control and well-being. The following sections describe some of the steps you can take to remain in control of your lung disease and live an active and rewarding life.
Prevent respiratory infections
Any respiratory infection — even the common cold — can cause an acute exacerbation of COPD, so it is to your advantage to do whatever you can to avoid catching what’s going around. Washing your hands frequently with soap and water can reduce your risk. Alcohol-based instant hand sanitizers can also help. As much as possible, avoid getting too close to people who have colds or other respiratory infections that can be spread by sneezing or coughing.
All patients with COPD should have an annual flu shot. It is also recommended that individuals with lung disease get vaccinated against pneumonia. This vaccine does not need to be given every year, but you may need a repeat injection five years after your first vaccine depending on your age and overall health. Speak to your physician about your individual vaccination schedule, which may also include a shot to prevent pertussis, otherwise known as whooping cough. If you think that you may have been exposed to the flu or are developing symptoms that may be related to the flu, speak to your physician immediately. You may benefit from antiviral medications for preventing and treating influenza, such as zanamivir (Relenza), amantadine (Symmetrel), and rimantadine (Flumadine). These drugs are not substitutes for a flu shot, but they can offer added prevention. Most importantly, if you get the flu, research has shown that taking antiviral medications early in the course may help reduce the severity and duration of your illness.
If you are attending a pulmonary rehab program, you will also need to exercise at home on the days you don’t attend sessions. It’s especially important to find an exercise that you enjoy well enough to do almost every day. Aerobic exercises, which increase the heart rate and breathing rate, are most beneficial. If you don’t like the treadmill, try tai chi, yoga, swimming, or walking around your neighborhood with a friend. Aim for at least 20 minutes a day on most days. Even if you aren’t in a pulmonary rehabilitation program, regular exercise helps maintain strength in your arms and legs and prevent you from becoming easily tired during physical activities.
Do breathing exercises
Another lesson from pulmonary rehabilitation that can easily become a part of your daily routine is pursed-lip breathing. This technique is valuable for helping you improve your breathing before and during physical activities. Before you start, moving, inhale through your nose deeply so that your abdomen expands. Then, as you begin to move, exhale through your mouth with your lips pursed to slow down the airflow. Your exhalation should last twice as long as your inhalation. You will feel pressure in your windpipe and chest as you slowly breathe out. When you finish exhaling, rest for a moment, then inhale and start the process again.
Breathing exercises can help keep you from feeling out of breath while going up and down stairs, walking in the mall, or otherwise exerting yourself. Use breathing exercises to pace yourself through physical activities. When climbing stairs, for example, you might inhale, then climb three steps as you exhale, rest, then inhale, climb three more steps as you exhale, and so on until you have reached the top of the stairs.
Eat and drink regularly
Small meals are easier to digest and use less energy than large meals. If you have been avoiding eating because it makes you tired or out of breath, try having smaller, more frequent meals throughout the day instead of three large meals. In addition, drink plenty of water or other non-caffeinated, nonalcoholic beverages. Staying hydrated can help relieve congestion by thinning mucus, enabling you to cough it up more easily. There’s no magic number of glasses you should drink daily; simply get into the habit of drinking regularly throughout the day. If you have other medical problems that may impact your fluid status, such as congestive heart failure or kidney disease, speak to your physician about the appropriate intake for you.
Many patients with lung disease are malnourished. If you are unable to maintain a healthy weight ask your doctor about nutritional supplements. There are also medications which are sometimes used to increase appetite.
Avoid lung irritants
An important way to control your symptoms and prevent acute exacerbations is to keep your airways from becoming irritated. Many things can irritate the airways, especially exhaust fumes from your stove, smoke from your fireplace, dry air, and molds and mildew from water damage in your home. If you have allergies, try to avoid exposure to whatever causes them — pollen, pet dander, house dust, mold, and so on.
Here are some specific tips for avoiding irritants:
- Use a humidifier when the air is very dry. Moisture in the air can reduce irritation by keeping your airways moist. A humidifier is especially helpful during the winter, when the air in your home may be dry. Change the water and clean the filter of your humidifier regularly to prevent buildup of dangerous mold and bacteria.
- Ventilate your home. Good ventilation can reduce the amount of irritating dust and cooking exhaust in the air. Use an exhaust fan vented outdoors when cooking. Avoid using a fireplace or wood stove; wood smoke is a lung irritant. Unless you are allergic to pollen and other outdoor allergens, keep windows open when the weather is warm enough. Fresh air not only helps ventilate your home but can also raise the humidity level. Although it would seem that air purifiers may help, there is no clear evidence that they are beneficial for people with COPD.
- Have furnaces and chimneys inspected. Making sure that furnaces are operating normally can reduce the amount of smoke and fumes they emit. Having chimneys cleaned can ensure that they vent smoke and exhaust effectively.
- Avoid aerosol products. Just about any aerosol (other than medicine or oxygen therapy) can irritate your airways. That includes hairspray, perfume, deodorant, paint sprayers, and insecticides. Instead of aerosol products, use gel or liquid preparations; for deodorants, use roll-on or stick forms.
|A patient’s experience: Pulmonary rehabilitationAfter smoking for 35 years, Kurt reached a point when his concern for his health outweighed his craving for a cigarette. So he quit cold turkey, with the support of his wife and children. A decade later, his doctor diagnosed emphysema and asthma. “I used to be able to handle heavy loads with no trouble, but then I found myself huffing and puffing,” recalls Kurt, 67, whose job in computer training sometimes required that he carry heavy computers. “I also started getting tired and out of breath on my endurance walks.”For several years, Kurt was able to control his symptoms with bronchodilators, but then the symptoms got worse. “If I climbed stairs while carrying a briefcase, I became exhausted,” he says. His doctor recommended pulmonary rehabilitation.
He went to an outpatient rehab center for 12 weeks, starting out twice a week and then going once a week. Under the guidance of a physical therapist, he exercised on a treadmill. The therapist recommended that he use a portable oxygen canister while exercising to help reduce his shortness of breath.
The therapist also taught him breathing retraining, techniques to make it easier to breathe even without oxygen therapy. First, she showed him a technique for inhaling deeply and exhaling slowly to prevent running out of breath during activities. Then she taught him to pace his breathing so that he inhaled deeply before doing something physical, then exhaled slowly during the activity. She also told him that he could improve his breathing even more by improving his posture — relaxing his shoulders instead of hunching them as was his habit. “It all worked,” he says.
Kurt credits pulmonary rehabilitation with restoring his vitality and vastly improving his well-being. “When I started rehab, I was able to walk for only 20 minutes on a treadmill. Then I worked up to 40 minutes,” he says. Not only that, but his lung capacity improved by 22% by the end of his rehab and another 1% six months later, as he continued to exercise on a treadmill at home.
A year later, Kurt works part time, although he has someone else do the heavy lifting. “You can’t reverse emphysema,” he says, “but you can stabilize it.”
For many people, the toughest challenge is not controlling symptoms such as coughing and shortness of breath, but rather coping with the relentless march of the disease as it slowly encroaches on daily activities. Knowledgeable as your doctor and other health professionals are, they can’t advise you on the many small but significant ways that COPD can impair your ability to function. This is the sort of advice you can get only from resourceful patients who have faced the same problems you have and found ways around them. The following are tips gleaned from COPD patients.
If you find a shower or bathtub difficult, try using a bath stool. For bathing, use a hand sprayer, which may be attached to the tub faucet or shower head. When excess humidity bothers you while bathing, leave the bathroom door open and use your bathroom exhaust fan. If you feel weak, don’t take a bath or shower when you are alone. People who use oxygen may find that bathing is easier if they wear the apparatus during their bath or shower. The tubing can be draped over your shower curtain rod.
Shaving and putting on makeup is much easier if you have a low mirror so that you can sit down. Women should avoid elaborate hairdos that require tiresome setting and extended use of dryers. Try to avoid toiletries that are heavily perfumed; many patients find them irritating.
It’s a bad idea to restrict chest and abdominal expansion; avoid belts, bras, and girdles that are tight. Men may find that suspenders are more comfortable than belts. Most women find that slacks and socks are much easier to put on than pantyhose. You can place your underwear inside your pants and put them on together. Wear slip-on shoes. Putting on any kind of shoe is much easier if you use a long shoehorn (12–28 inches). You may find that cotton underclothing is more comfortable than synthetic in both warm and cold climates.
One of the handiest gadgets is a pair of pickup tongs (these look like giant scissors) for retrieving things from hard-to-reach places. Most medical supply houses stock these. Another pickup device is a magnet on a short string. It’s great for getting thumbtacks, hairpins, etc., that have fallen on the floor. If you must vacuum, use a machine with a disposable bag or a filtering method to keep dust from escaping. A small hand vacuum is easy to use for spot cleaning.
A matter of concern to those who live alone is how to get help quickly when needed. Make arrangements to have a relative or friend call at the same time every day to make sure you are okay. Consider buying a cordless phone and carrying it around with you. This way, if you run into trouble, you can call for help. Many companies offer monitoring services. They provide a panic button, worn on a chain around the neck that can summon emergency help if you are unable to make it to your phone.
Traveling with COPD
Traveling is generally safe for patients with lung disease, but proper planning is required. Discuss any travel plans with your physician. It is important to realize that increases in altitude may have a major impact on the levels of oxygen in your blood. Even if you don’t normally use oxygen, having COPD places you at risk for developing low oxygen levels. This means that you may require oxygen while you fly in an airplane. There are special breathing tests which simulate air travel and allow your physician to determine if oxygen is needed while flying.
People who use oxygen can travel to most places, but it requires some advance planning.
- Make sure you know how much oxygen you need during the flight and layovers. Keep this information with you at all times.
- Bring several copies of a letter from your physician which documents the need for oxygen and approval to travel. This letter should include your name, your physician’s contact information, your lung disease, the appropriate flow rate of oxygen that you need and the duration of use.
- Regular oxygen tanks are not permitted on flights. Call your local oxygen supplier at least one to two weeks in advance to arrange for your oxygen supply while you are traveling. Your needs will vary according to your mode of transportation and length of stay at your destination.
- If traveling by air, book far in advance because airlines allow only a limited number of people traveling with oxygen per flight. Airlines may charge a fee for oxygen use during a flight.
- Take antiseptic hand-washing packets or gel to help avoid picking up bacterial or viral infections. Also wash hands with soap and water frequently.
- If you are traveling to an area of high altitude, plan ahead for an oxygen supply at your location.