Lungnet

Your doctor has diagnosed chronic obstructive pulmonary disease (COPD).  This brochure is designed as a guide to help you to improve your quality of life by following some simple recommendations.

COPD stands for 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 airways or 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 slowly 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 any 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?

The most important thing you can do to help yourself if you have COPD is to stop smoking.  It is true there's no cure for COPD, but quitting smoking should stop the rapid decline in your lung function over time.  Smoking damages different people at different rates.  This explains why some smokers have severe COPD and others very little after an equivalent amount of smoking.  Because the lungs are not good at repairing damage from smoking, years of abstinence from smoking will not return your lungs to normal but the rate of ongoing damage will be dramatically reduced compared to those who continue to smoke.

If you can't stop smoking or don't see why you should, ask for help.  Stopping smoking is often not easy. Your doctor along with medications, programs and information can help you.  If you try to stop smoking and fail, don't give up.  Most people try and fail many times before they finally stop smoking altogether. 

Quitting will also reduce your risk of developing lung cancer, vascular disease such as strokes and heart attacks, pneumonia and other infections.  Stopping smoking should involve your whole family.  It is much easier to stop smoking if no one else in the family smokes.

What therapies are likely to help me?

Having stopped smoking, there are many therapies available to improve your symptoms and quality of life.  These can be organised through your doctor.

Infections

An important principle in COPD is to treat infections when they develop (these are usually caused by bacteria and require antibiotics).  You often know if you have infection by the colour and quantity of your sputum or phlegm, and increasing breathlessness.  If your sputum is dirty, this usually means an infection and you need to see your doctor.  Infections can cause a rapid decline in lung function and can be very serious.  The influenza vaccine is of proven benefit in reducing the risk of getting ‘the flu' and because the influenza virus changes every year, you should have a repeat vaccination every autumn.  The pneumonia vaccine (Pneumarex 23) gives about 5 years of protection from one of the commonest causes of pneumonia in COPD.

Medication

Not all people with COPD require medication designed to ‘open the airways' but with increasingly severe disease these therapies may be able to help substantially.  The medication is often delivered by inhalers and can be used regularly or when needed.  Know what your medications do and how they should be used. Have your inhaler technique checked (how you use your puffer or inhaler device) to ensure best usage.  Your doctor will be able to guide you.

Oxygen Therapy

Breathlessness does not always mean you lack oxygen, but low blood oxygen levels may develop if your lung disease worsens.  Your oxygen level can be monitored by a machine (oximeter) or by a blood test.  Your doctor can arrange these tests, if required.  Oxygen therapy is important if your oxygen level is low and if this situation persists, home oxygen therapy can be arranged through a referral to a specialist respiratory physician (via your doctor) who will assess whether oxygen would be appropriate and helpful.

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.

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.  

Don't let panic overwhelm you. Turn these feelings 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 a comfortable position, with your arms 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.

How important is exercise?

You may have noticed that your ability to carry out normal daily activities and tasks has deteriorated. It's easy to give into the feeling of breathlessness. After all, you may well feel quite well when you are resting.  People with COPD say that they start to avoid physical activity when it is associated with breathlessness, muscle fatigue or tiredness. This sets up a vicious cycle of inactivity, breathlessness, muscle weakness and this makes physical activity all the harder as time goes by.

So what can you do to become more active?  Start with a regular walking program - everyone needs to walk and it is a simple activity. Start by walking for 10-15 minutes and gradually build up to walking for 20-30 minutes. You should walk on at least 4 or 5 days each week. Walk at a pace (intensity) that causes some (moderate) breathlessness. Take regular rests if you are very breathless or tired, recover and then start walking again.

To get started with a walking program, set yourself a target (a time to walk for or a place to reach) and record what you achieve. Many people with COPD say they have a time of the day when they feel ‘better' so this should be the time that you choose to exercise. Wear good shoes and walk on firm, flat ground. Local pathways, shopping centres (especially when it is very hot, windy or humid), parks, by the river or the beach are good places to walk. To make the task more enjoyable think about varying the venue or walking with your wife or husband, a friend, your children or grandchildren, or your dog. Whatever you do, make sure you enjoy it. However, it is important not to talk and walk because too much effort will go into talking and not enough on walking! You may be able to progress your walking program by including some inclines or steps along the way. Getting started on a regular walking program can provide the confidence, fitness and strength to get out and about again.

There are some other types of exercise that are helpful for people with COPD. The muscles around the shoulders and upper arms help with breathing so simple strengthening exercises for the upper body are good. Sports (bowls, golf), swimming and Tai Chi are good exercise BUT are not a substitute for regular walking. Some people hire or buy a treadmill or bike so that they can exercise at home.

Physiotherapists can provide you with guidance on a suitable exercise program. It is best to check with your doctor prior to commencing an exercise program.

Is nutrition important?

If you are overweight it is hard to move around. Shifting extra weight takes so much more energy and therefore you experience more severe breathlessness. Excess weight also squashes your lungs from below, 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.

On the other hand, if you start to drop below your ideal weight your muscles lose strength which also increases breathlessness. 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 contain 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?

Pulmonary rehabilitation programs consists of exercise training and information sessions to improve your understanding of your lung condition and it's treatment (including medications and diet), the benefits of exercise and ways to deal with the stress of having a lung disease. Most programs consist of a supervised exercise program provided in small group classes and a team of available health professionals to deliver the information sessions. Participants are encouraged to become more knowledgeable about their lung disease and to manage the ups and downs associated with having such a condition.

These programs aim to make physical activity easier and reduce fatigue, give you a feeling of control and ease both anxiety and depression and improve your overall quality of life.

There are many pulmonary rehabilitation programs in 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. If you have portable oxygen, take it with you to the shopping mall, picture theatre etc. Keep up your 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 COPD.  They often meet regularly and have a guest speaker, organise a trip or just have a chat. 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.

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.

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

Content updated November 2005