Laura J. Martin, MD
Chronic obstructive pulmonary disease, or COPD, affects more than 12 million American adults.
The term COPD includes two types of lung conditions: emphysema and bronchitis.
Many people diagnosed with COPD have both emphysema and bronchitis. Together, the two reduce the amount of oxygen exchange in the lungs and thicken the lining of the airways. COPD is progressive and causes shortness of breath, wheezing, and chronic cough -- a persistent, phlegm-producing cough.
People with COPD can have varying abilities when it comes to breathing. Some may experience shortness of breath during moderate exercise. Others need oxygen just to walk across the room.
There are things people with COPD can do to improve their breathing. And for the most part, things like exercise, pulmonary rehabilitation, and smoking cessation can be very helpful, even for those with little lung capacity.
Long-term exposure to environmental pollutants can cause COPD but the main culprit, particularly in the U.S., is smoking. By the time someone gets COPD, their lungs are already damaged, but if they stop smoking, they can reduce future harm.
Neil MacIntyre, MD, a pulmonologist and professor of medicine at Duke University Medical Center in Durham, N.C., tells his patients it is critical that they stop smoking when they become short-winded.
“The first thing you have to do to get out of a hole is stop digging,” he says.
It is important to take medication, and if there are problems, patients should talk with their doctors, MacIntyre says.
Maintenance medications such as salmeterol and fluticasone don’t always start working immediately. It can take a week or two before a patient feels their breathing improve. This can be discouraging for some, but MacIntyre says not to give up.
If there is no improvement after a couple of weeks, people should talk with their doctor to make sure they are using medications correctly. Many of the drugs used for COPD can be challenging to use properly because they come in specialized inhalers.
People who are very sick with COPD use so much energy to breathe that they can have problems gaining weight, says Raed Dweik, MD, director of the pulmonary vascular program at Cleveland Clinic. They often need to eat enough to gain weight.
But if people are overweight, shedding excess pounds can improve their breathing. “It is two ends of the spectrum,” Dweik says. “For people who are overweight, it is like carrying something around that contributes to their shortness of breath.”
Like people with asthma and other lung conditions, COPD patients can be affected by things in the environment -- fumes, strong perfumes, pollen, dust, secondhand smoke, and construction sites. Dweik says these can exacerbate the disease, causing flare-ups and breathing problems.
Avoid bad air as much as possible. Using air filters in the house or air conditioning when allergens are prevalent can be helpful.
People with COPD have compromised lungs and can have a difficult time “shaking off” an infection, Dweik says. Common colds or the flu can sometimes progress to pneumonia more easily than for people without COPD.
Dweik recommends avoiding big crowds and people who are sick, calling a physician in the early stages of a cold or flu, and getting flu shots annually and pneumonia vaccinations about every five years.
MacIntyre says a lot of people with COPD also have sleep disorders such as sleep apnea or hypoventilation (breathing that is too slow or shallow). People who have this may be helped by using masks for continuous positive airway pressure (CPAP) therapy.
Signs of sleep problems to watch out for include feeling unusually tired all day, falling asleep during the day, morning headaches, and excessive snoring.
Everyone with COPD -- and, in particular, people who use oxygen or have shortness of breath when doing daily activities -- can benefit from pulmonary rehabilitation.
“People will learn some specific things they can do to help breathing,” Dweik says. “It won’t change their lung function, but it is designed to help them cope and make the best of it.”
Emil Olson,a 62-year-old from Sweet Ridge, Colo., went through pulmonary rehab to build up strength for a lung replacement surgery. With only about 10% of his lung functioning, he went through rehab for three months in order to walk six minutes on a treadmill (a requirement for the transplant).
Aside from walking on the treadmill, Olson exercised on a stationary bike. He used light weights to build his upper back muscles, which helps with breathing. Therapists taught him how to eat right and offered tips like not bending over when lifting objects to keep from compressing the lungs.
“I don’t think anyone expected me to stay alive long enough to get a transplant, but I did,” he says. “It’s amazing how much good you get out of 30 to 45 minutes of really limited exercise.”
There are two main exercises that are practiced in rehab to help people with COPD improve their breathing.
The first is pursed-lip breathing. Some people with COPD have particular difficulty breathing out. When this occurs, air gets built up in the lungs and the lungs can’t expand as well, Dweik says.
Pursed-lip breathing helps regulate this problem. To perform this, sit comfortably and inhale deeply through the nose. Purse lips (as though whistling) and breathe out three times longer than the in breath, but don’t force the air out. This technique can be used when shortness of breath occurs to regulate breathing patterns.
A second exercise is diaphragm breathing. This technique helps strengthen the diaphragm muscle so people use less energy when breathing. To perform the exercise, lie on the back with knees bent, one hand on the upper chest and another resting on the abdomen. When inhaling and exhaling, keep the chest as still as possible and use the stomach to breathe. This should be practiced for five to 10 minutes three times daily.
Though someone who can’t breathe well may not feel like exercising, it is one of the most important things people with COPD can do to improve their breathing and overall health.
Exercise doesn’t directly change a person’s lung function, but it improves muscle tone and cardiac function, MacIntyre says. This allows oxygen in the blood to be delivered more efficiently to the muscles and increases stamina.
“Patients with COPD have different degrees of ability,” Dweik says. “Even if they are progressed, they can still remain active -- the more the better -- but their activity has to be moderated by their capability.”
Dweik tells patients to be mindful of their limits and not push through when they can’t breathe. For people with “symptom-limited exercise” he recommends walking a couple of blocks until they get winded, stopping to rest, and walking more when they can. Eventually, a person may be able to walk farther with less shortness of breath.
The one daily treatment that is proven to prolong life for people with severe COPD is oxygen, Dweik says. Studies have borne this out. Two large clinical trials found that people with severe COPD may live twice as long as patients with severe COPD who don’t use oxygen.
Benefits aren’t proven for people with mild COPD.
Many patients don’t like it because it is inconvenient or looks unattractive, but when oxygen goes down, it strains and can damage the heart, Dweik says.
Four years ago, Olson had a right lung transplant. His odds of survival weren’t great -- he was extremely weak and just barely weighed enough to be viable for the operation -- but he chose to have the surgery anyway.
Three days after the transplant he was no longer using oxygen. By the time he left the hospital, he was walking a mile. He has no more symptoms of COPD and was around for the birth of his granddaughter. He has walked a 5k race and has plans to take part in three more this summer.
There are two main types of surgery performed on people with COPD. First is a lung transplant like Olson received. Second is lung volume reduction surgery where the damaged lung tissue is removed to make the lungs work more efficiently.
For Olson, the lung transplant was life-saving. But it is not for everyone. Dweik says it is a relatively rare surgery and only an option for certain people with COPD. There is a “transplant window - you can’t be too sick, but you have to be sick enough,” he says. A doctor can help determine if someone is eligible for surgery.
There are also risks involved in lung transplants. According to the National Heart, Lung, and Blood Institute, patient survival rates are about 78% the first year after surgery, 63% after three years, and 51% five years out. Also, medications taken to reduce the risk of infection and rejection of the lung after surgery can suppress the immune system for the rest of the person’s life.
“I was given a one-in-10 or 1-in-20 odds of not being here after,” Olson says. “Compared to my quality of life at the time, there was no decision. It was a gimme.”
SOURCES:Raed Dweik, MD, director, pulmonary vascular program, Cleveland Clinic.Neil MacIntyre, MD, pulmonologist and professor of medicine, Duke University Medical Center, Durham, N.C.Emil Olson,Sweet Ridge, Colo.National Heart, Lung, and Blood Institute: "What is COPD?" "Long-term Oxygen Treatment in Chronic Obstructive Pulmonary Disease: Recommendations for Future Research," "What are the Risks of a Lung Transplant?"Cleveland Clinic: "Diaphragmatic Breathing."
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