Lungnet

COPD, is an abbreviation of Chronic Obstructive Pulmonary Disease. It is chronic because it is a long term condition, it is obstructive because a major feature is narrowing or obstruction of air passages in the lungs (known as the Bronchi and bronchioles), it is pulmonary because this is another word for the lungs and it is a disease or condition which is not normal to have. 

COPD is almost always caused by cigarette smoking, it is a slow progressive disease which is often well advanced before the main symptoms of breathlessness on exertion and cough develop. Your lung function can be reduced to half of normal before you become aware of the problem.

So you start to simply slow down and avoid activities that trouble you and you lose fitness and strength.

How important is it to stop smoking?

It is true there's no cure for COPD. But if you stop smoking your cough will ease up, and your breathing function won't continue to worsen so quickly. Quitting will also reduce your risk of developing heart problems, lung cancer or blood supply blockages to your brain or legs. If you can't stop smoking or you don't see why you should, ask for help. There are treatments available to help you quit smoking which your doctor can discuss with you. The Quitline in your state can also help.

Can stress play a role?

Stress does not cause COPD, however stress can certainly make COPD harder to live with. Most people who have COPD worry about their future, panic when they lose their breath, or feel frustration, irritability and depression about their poor physical performance and changing body image. These emotions can cause a lot of distress. However, if you can learn more about your lungs and why you become short of breath, it is possible to get rid of fear of the unknown and to cope better.

You need to know that it's normal to get stressed from time to time. When your body is under stress you might feel your heart pumping harder and faster, you tremble inside, you flush and perspire, you might even feel nauseous. This is a normal body reaction. If you let it get on top of you, a stage of fatigue and even fear sets in. Or you become angry, stubborn or start to blame others.

Often this feeling seems to overwhelm you, but it can be turned to your advantage. If you know that feeling like this is normal you can learn how to relax and control your breathing, your mind can become a master of your body. Deliberately slow your breathing. Concentrate on using your diaphragm by expanding your stomach as you breathe in. When you breathe out, try pursing your lips to slow the rate of breathing. Put yourself in the most comfortable position you can, and make sure your arms are supported so your shoulder and chest muscles help your breathing. Close your eyes and imagine you are in your favourite place of relaxation. Each time you breathe out, imagine the tension also being breathed out. Practice positive thinking.

If you need further help with these stress-management techniques your doctor or health centre should be able to point you in the right direction for help.

Which medicines are likely to help me?

Your doctors will usually prescribe medicines, often in the form of inhalers or puffers. These puffers either open the breathing tubes in your lungs (bronchi), or stop them from closing down. Some medications used for treating asthma can also help in COPD.

If you don't feel much immediate benefit from these medicines, don't be discouraged, but you should discuss your concerns with your doctor. Don't just stop your medications as this might suddenly make your lung condition worse.

Some people with COPD are prescribed oxygen therapy. Oxygen therapy is designed to help people with long-standing low blood oxygen levels. It helps to improve quality of life and has been shown to prolong life. It should be prescribed only if your blood oxygen levels are lower than is safe. This therapy should not be viewed as 'life support' which keeps you housebound, but as an aid to better life.

How important is exercise?

You might have noticed that your ability to carry on normal daily activities and chores has deteriorated. It's easy to give in to the feeling of breathlessness. After all, you probably feel quite well when you are resting. But this can lead to a vicious cycle of inactivity, so you lose fitness and muscle strength, and this makes exercising all that much harder.

So what can you do about it? Start with a short walk, counting your steps and the number of breaths - perhaps two slow steps as you breath in and four as you breathe out through pursed lips. Don't go too far, and stop to rest if your breathing starts to feel uncomfortable. Wait to recover, then walk on. Try this for 15 minutes every day. Measure the distance and set a realistic goal to better that distance next week. Don't rush it, just do it. When you think back, isn't this a bit like training for sport? You would push yourself till you were a bit puffed, had a rest, then did some more. Start gently for a the first week or more and gradually you will find exercise is becoming easier. If the weather is bad, drive to a large shopping centre and walk there. As you improve you might even like to try a few steps on the stairs or escalators. Some people buy or hire a treadmill or an exercise bike. Whatever you do, make sure you enjoy it. Do it with your wife or husband, your children or grandchildren or your dog. Drive to the beach or a park and walk there. Getting back into exercise can give you the confidence, fitness and strength to go to your favourite sport, or the movies or a theatre show. Why not try a swing or two of the rusty golf clubs, or take out the dusty bowls.

Your breathing muscles also need a regular work-out. The lower ribs and upper abdomen help the diaphragm. The shoulder and upper chest muscles also add to breathing power. A simple set of exercises can be done to strengthen them.

Guidance can be given by some physiotherapists or exercise rehabilitation scientists.

Is nutrition important?

If you are overweight it is hard to move around. Shifting extra weight takes so much more energy you become more breathless. Excess weight also squashes your lungs, making the problem worse. Even though you might find it hard to exercise to burn off the excess weight, it is still possible to lose weight slowly if you watch what you eat. Eat smaller portions at each meal, reduce the amount of fat you eat, fill up on high fibre foods, don't snack between meals, and keep a good balance to your food.

If on the other hand you start to drop below your ideal weight your muscles lose strength. You need to keep up your nutrition, even if you don't feel hungry or you lose breath whenever you try to eat. It often helps to eat small snacks, and to eat more often. Maintain a good balance between food groups. Keep your fat intake low, but remember that proteins and carbohydrates are essential. Fresh vegetables and fruit maintain the carbohydrates as well as important vitamins. Fish contains plenty of protein and also important protective oils.

Your doctor, health centre or hospital will be able to point you towards good nutrition advice.

How could pulmonary rehabilitation help me?

All these treatments can be combined together in a team approach. Pulmonary rehabilitation programs aim to improve shortness of breath, give a feeling of control, ease both anxiety and depression, reduce fatigue, make exercise easier, and make overall quality of life better. As you improve you will feel less of a burden on your spouse or other carer, and their enjoyment of life will also pick up. A series of small group classes helps to improve your understanding about your lung condition and its treatment (including drugs and diet), about exercise and control of stress, and teaches new ways of doing normal chores with less stress or breathlessness. Working with others with similar problems helps you and them. You all try to solve the problems in your own ways. You might be able to help each other socially or with transport or shopping. Exercise classes are usually included to help with your own individual goals.

There are pulmonary rehabilitation programs in many metropolitan, regional and rural centres. Your doctor, hospital or health centre will be able to refer you. The length and contents of the program may be different, depending on what your local service provides. You can also find out where these programs are by calling The Australian Lung Foundation. The Lung Foundation also has a network of support groups which offer support, education and friendship. Call 1800 654 301 (toll free) for details.

The methods mentioned above should help to set up a new way of living with your COPD. With practice, your new habits will become second nature. But you need to keep up the practice or you will start to become worse again. You are sure to forget something you have learnt as time goes by. Don't be too proud or shy to ask your doctor, phone The Australian Lung Foundation for information, or read the information you might have received from your rehabilitation program. The physiotherapist, pharmacist, specialist nurse, counsellor, or a rehabilitation program could also help. It's a good idea to make sure you have regular appointments with your doctor so your health can be monitored, and so you won't forget what to do. Don't just wait for things to go wrong - it's better to treat your body like you would your car, by having it inspected regularly.

Above all, try not to hibernate. Go out and enjoy yourself. Keep up our exercise and maintain good eating habits. Support groups may be just the thing for you and your closest carer (wife, husband, etc.) as they encourage and assist people with emphysema, and often arrange regular meetings with experts, or trips to interesting places. If it's hard to get out, try to find some things you can do at home to occupy your time and add happiness to your life.

Remember - you can live well with your COPD if you take a positive approach to learning and understanding your illness, and what you can do to help yourself.

Other COPD information available from The Australian Lung Foundation:

COPD - Chronic Bronchitis and Emphysema

Home Oxygen Therapy

Corticosteroid Therapy in Respiratory Diseases

LungNet News - a quarterly magazine about living well with a lung condition.

Please Note: This information is intended by The Australian Lung Foundation to be used as a guide only and is not an authoritative statement. Please consult your family doctor or specialist respiratory physician if you have further questions relating to the information provided here.

For details of patient support groups in Australia please call 1800 654 301