Tips to Help COPD Patients Avoid Attacks How to Have More Energy and Breathe Better

Living with chronic obstructive pulmonary disease (COPD) isn't easy. Daily activities like dressing and eating can drain COPD patients of energy, and bronchial episodes are scary and stressful. Medical Detective talked to experts and a longtime patient for tips on coping with this chronic respiratory disease... When Knowles Hamrick was diagnosed with chronic obstructive pulmonary disorder (COPD) 16 years ago at 39, he wasn’t surprised. Severe shortness of breath, wheezing, coughing and an allergic reaction to aerosol sprays and perfumes had been his constant companions for years, as were his daily five packs of cigarettes. “I was very ill,” Hamrick says. “The doctor confirmed what I suspected.” Like his fellow 12 million Americans with COPD, Hamrick faces daily struggles coping with a disease that can make even cooking dinner a breath-robbing task. “By the time COPD is diagnosed, patients often have lost up to half of their lung capacity,” says respiratory therapist Jane Martin, associate director of education at the COPD Foundation. “The effects can be extremely severe.” COPD is a group of respiratory diseases that include chronic bronchitis and emphysema. More women than men have the disease, which is the fourth leading cause of death in the U.S. Researchers believe the incidence of COPD among women is higher because they smoke more now than before, and smoke may damage women’s lungs more than men’s, according to the Centers for Disease Control and Prevention. Chronic coughs, intense mucus production and disabling shortness of breath are common symptoms. As the disease progresses and lung function deteriorates, physical activity and social interactions become increasingly difficult for COPD patients. As devastating as the disease is, there are steps people with COPD can take to improve the quality of their lives. Lifescript’s Medical Detective unveils the top 10 doctor-recommended tips for enjoying easier, more productive days. 1. Quit smoking Lighting up accounts for as many as 90% of COPD-related deaths, according to the National Heart Lung and Blood Institute. Quitting smoking “is the most important thing patients can do” to improve their condition and prognosis, says David Au, M.D., associate professor of medicine in the Division of Pulmonary and Critical Care Medicine at the University of Washington. “When COPD patients quit smoking, lung function improves a little," he says. "If they continue to smoke, they double the rate of lung loss.” Quitting isn’t easy. “I tried 550 zillion times,” says Hamrick, but it took his COPD diagnosis to make him give it up for good. “I went home and threw away four cartons of cigarettes," he says. "I bought a case of peppermints and cinnamon toothpicks to help with nicotine urges. They worked.” Unfortunately, the cold turkey approach often isn't effective for others. Experts recommend using a nicotine patch, gum or lozenges or prescription medications for a short period. Also try support groups, as well as avoiding alcohol and the company of other smokers. To see how others did it, read How I Quit Smoking and consult your doctor for the best method for you. 2. Avoid lung irritants Everything from perfume to cigarette smoke to toxic industrial chemicals can irritate the lungs of COPD patients. “There isn’t a blanket recommendation about what to avoid,” Au says. “We tailor it to the individual.” However, COPD patients generally should: Avoid second-hand smoke, fumes and strong odors. Steer clear of common allergens like pollens and dust. Remain indoors when it’s smoggy outside. Make your house mold-free. Mop up damp spots in bathrooms and kitchens to prevent spores from growing. On cold days, cover your mouth and nose when outdoors because frigid air may trigger worse symptoms and cause more fatigue. Industrial workers with COPD should wear protective face masks. 3. Engage in exercise As hard as it is to imagine exercising, it’s strongly recommended by respiratory disease doctors. “Even in severe stages of COPD, it can be effective,” Martin says. That's because exercise makes the lungs and heart work harder to carry oxygen to the body, and the right workouts can strengthen chest muscles and improve breathing. But don't start training for a triathlon. The best way for COPD patients to ease into exercise is to start pulmonary rehabilitation, in which specialists design exercises to an individual’s ability, Au says. “It’s not about speed, but endurance,” Martin says. “Even those with extremely limited breathing can walk for 20 minutes at a slow pace.” Women, particularly, benefit from physical movement, because weight-bearing exercises like walking can help maintain bone density and prevent osteoporosis, Martin adds. Exercise is especially important after an acute bout of chronic bronchitis because long hospital stays and steroids – medication often used during and after acute attacks – weaken muscles, experts say. “I take patients to Wal-Mart, where they use grocery carts as support and walk around the store," Au says. "It’s great exercise!” 4. Watch your diet Maintaining proper weight is key to improving a COPD patient’s quality of life, pulmonologists say. “Half of COPD patients are overweight,” Au says. “Carrying an extra load with impaired lungs makes breathing more difficult.” That's because an oversized stomach presses on the diaphragm, a muscular partition that plays a major role in breathing. The stomach is located right under the lungs, and large meals may push against the diaphragm, impeding respiration. To aid breathing, respiratory disease experts recommend these tips: Eat small meals several times a day, rather than three large ones. Stay hydrated. Fluids help keep airway mucus thin, aiding in breathing. Avoid talking when eating. It helps conserve energy. Steer clear of gassy foods, such as Brussels sprouts, cabbage and sodas. They bloat your stomach, pressing on the diaphragm. But while it’s important to avoid being overweight, being too thin is also dangerous. “COPD patients use more calories just to breathe than others use for all their daily activities,” Martin explains. “They should always be 10 pounds over their ideal body weight.” That way, they have extra weight for expending energy after an acute episode or hospitalization. 5. Get vaccinations and avoid infections COPD patients are at greater risk of lung infections than the general population. That's one reason it's important to get a yearly flu vaccination and pneumonia vaccine every 5-7 years, doctors say. Also, try to avoid catching a cold, which exacerbates COPD conditions and, in some circumstances, turns life-threatening, Au says. To avoid infections: Skip that family dinner if your cousin has a cold or other respiratory infection. “As important as it is to socialize, you must think about yourself first,” Martin says. “That means staying away from grandkids who are sneezing and coughing.” Wash hands frequently. Use anti-bacterial wipes and lotions often. In a doctor’s office or bank, use your own pen, not the public ones. 6. Get lots of rest Dyspnea, or shortness of breath, contributes to fatigue, exacerbating breathing troubles, experts say. Fatigue also contributes to loss of muscle mass, decreased strength and more frequent respiratory infections. “It’s better to exert yourself during the day and sleep at night,” Martin says. “Too much daytime sleeping may be a sign of something wrong.” For example, patient’s lungs may not be properly discharging carbon dioxide, intensifying fatigue, Martin adds. What’s the solution? Rest! Here’s how: Avoid sleeping during the day. Sleep quality is better if you’re tired at night. Exercise three times a week, but not within two hours of bedtime. Avoid caffeine after 5 p.m. Eat a small protein snack before bed, but avoid large dinners. “A little nap is OK after morning exercise,” Martin says. “But sleeping all day is not," he adds. "If you are, see your doctor.” 7. Conserve energy Just breathing saps the energy of COPD patients, bringing on fatigue. Try these energy-conserving tips: Move slowly. Avoid activities that require lots of energy, like vacuuming or washing dishes. Use the dishwasher instead. Engage in strenuous activities earlier in the day and rest afterward. Use a cart with wheels to haul laundry and household items. Sit when drying your hair or applying make-up. Standing requires more energy. Wear clothes and shoes that are easy to put on. Rest after eating. Digesting food exerts energy. Ask friends or family to help with big chores. 8. Limit stress High stress levels worsen breathlessness, leading to panic. “That’s when you get into trouble,” Martin says. These relaxation tips may help you better handle anxious moments: Take up yoga or meditation, which help you control breathing and quiet your mind. They also improve sleep and blood pressure, which reduces stress. Listen to relaxing music. Try guided imagery – programs of directed thoughts that take your imagination to relaxing places – or create your own, on a beach or in the mountains. Practice breathing techniques approved by your doctor. Join COPD support groups – in person or online – for encouragement and companionship when you’re under stress. Cuddle a pet. Hamrick pets his dog, which is especially helpful, he says, when waiting for an ambulance during an acute attack 9. Oxygen therapy As COPD progresses, many patients require supplemental oxygen therapy. Symptoms of hypoxemia (oxygen deficiency) are extreme fatigue, headaches, increased breathlessness and fluid retention, doctors say. Some patients resist starting oxygen therapy, Martin says, because of the stigma attached. “Lots of people don’t want to be seen with an oxygen tank," Martin says "My advice is, just do it, if your doctor recommends it.” “Like getting new auto parts when the old ones break down, you need supplemental oxygen to help your other body systems stay in shape,” he says. Advances in oxygen equipment have made the tanks lighter and longer-lasting. They’re also better at controlling oxygen flow, experts say. 10. Seek help COPD patients often experience flare-ups. “There usually are warning signs,” Martin says. “A change in your cough, more shortness of breath than usual – anything that’s not normal for you. Here’s when you should seek help: If you have more mucus than usual and have difficulty coughing it up A severe cough or more frequent coughing Cold or flu symptoms: runny nose, achiness, chills, fever Increased shortness of breath Wheezing You cough up blood Call 911 if you can’t complete a sentence without taking a breath between words or develop blue lips or fingernails Finally, as hard as a COPD diagnosis is, coping strategies do help ease daily life, Hamrick says. “Slow down, and try not to get upset,” Hamrick advises. “Read a lot about the disease and seek the support of others. I’ve had COPD for 16 years. I take it one day at a time. You get through it.” For more information, visit our COPD Health Center. How Much Do You Know About COPD? Chronic obstructive pulmonary disease (COPD) is on the rise, according to the National Institutes of Health. More than 12 million people in the U.S. are currently diagnosed with it, and another 12 million may have it but don’t know.