Pulmonary Health, Exercise and Care – Information on COPD

What is COPD? Coping With a Diagnosis of Pulmonary Disease
and Pulmonary Health Exercise and Care

Free Health Articles and Health Alerts – Pulmonary Rehab Tips from The National Emphysema Foundation

This timely health article from the National Emphyzema Foundation will be helpful for those suffering with
COPD, Chronic Bronchitis, Emphysema and other Pulmonary Diseases.

Examples of specific exercises that you can do on your own are described below.

This Information Courtesy of National Emphysema Foundation

Exercise, even in small amounts, is very beneficial to your general health and particularly to your pulmonary
health. Your quality of life will improve by just walking even at a very slow pace. Unused muscles and bones
go away, including your breathing muscles. Exercise will also improve your appetite, so that you have sufficient “fuel” and
building blocks for repair and maintenance.

There are formal exercise programs for lung patients that are frequently supported by Medicare. Your local
Lung Association or your doctor will be able to supply a list of qualified facilities in your locality.

One very important concept to keep at the front of your mind is that once you start the good health enhancing
habit of exercise, you never should stop. You gain the benefits rather quickly, but you can also lose these
positive effects very fast. Once you start, never stop.

Examples of specific exercises that you can do on your own are described below.

Note: If you elect to do a program on your own, secure advice from your physician regarding which types and
intensity of exercise that would be best for you.

Breathing Retraining

Normal Breathing – Breathing is a multi-step process. Inspiration starts with the contraction of the diaphragms.
The diaphragms are two dome-shaped muscular structures located at the bottom of each of your lungs. By contracting,
they pull the lungs down and create a vacuum which draws air into the lungs. When enough air is inhaled,
the diaphragms stop contracting, and the lungs deflate passively. There are additional muscles in the chest
that can be recruited under certain conditions.

Breathing with COPD – People with COPD are not able to use their breathing muscles effectively. The principle
reason for this ineffectiveness is the mechanical disadvantage of the diaphragms. As smoking takes its toll,
one of its effects is the overinflation of the lungs. This overinflation pushes the diaphragms down and thereby
prevents them from contracting effectively. The result is increased work of breathing and, therefore, higher
energy expenditure.

Building Better Breathing

The following questions may indicate that you have a breathing problem.

  • Are you troubled by shortness of breath when hurrying on level ground or walking up a slight hill?
  • Do you get short breath when walking with other people of your own age or level ground?
  • Do you have to stop for breath when walking at your own pace on level ground?
  • Are you short of breath when washing or dressing?

If you answered yes to any of these questions, you should see your physician.

Exercise 1: Purse-Lip Breathing – The airways of people with COPD often lose their “tone” and have
a tendency to narrow during exhalation, making complete lung emptying difficult. The purpose of pursed lip
breathing is to prevent this collapse of the airways with slow, controlled exhalation, thus preventing more “stale” air
from being trapped in the lungs.

  • Inhale through your nose if you can. Remember that the nose helps to warm, filter and moisten the air
    you inhale.
  • Exhale slowly through pursed lips. To purse your lips means to pucker them as if blowing out a candle
    or whistling. However, you are not forcing the air out, blowing it out gently and gradually.
  • Exhale at least twice as long as you inhale. For example, if you inhale for a count of 2, exhale for
    a count of 4 or more.
  • Practice doing this type of breathing several times a day. At first it will take effort and concentration.
    With practice it will become second nature.
  • Use purse lip breathing during times of stress or breathing difficulty.

Exercise 2: Expanding Your Lower Chest Lower rib expansion will help you use your diaphragm better and avoid
overuse of your upper chest and neck muscles. The following is an example of what your doctor may prescribe.

Lower Rib Expansion Exercise:

  • Sit down on a chair with your feet on the floor.
  • Place your hands on the sides on your lower ribs. (Almost at the level of your navel).
  • Breathe in slowly through your nose and try to push your hands out with your lower chest.
  • Exhale through pursed lips, letting your hands move back in. Practice for ten breaths and then relax.

You can also try this exercise while lying on your side with one arm above your head. This helps to expand
one side of your chest at one time.

You must Lie on your right side with your left hand on your head. Bend your right arm at the elbow, across
your stomach and place your right hand on your left lower chest Now breathe in and try to push your hand
out with the left side of your chest (the side that is facing up). Practice for ten breaths on one side and
then switch. Physical Reconditioning Many of us realize that exercise is good for us, but when it comes right
down to it, we don’t always take the time to do it. To benefit from this, you must find the time and do the
work. There are many forms of exercise. Exercise: Consult your doctor before you begin any exercise. Can
people with lung problems and shortness of breath exercise? Yes they can ! In fact, exercise is one of the
therapies that help decrease shortness of breath for people with lung problems. To benefit from this, you
need to know how to do it correctly, how to avoid injury and how to recognize signs of trouble. It is also
important to learn how long, intensely and frequently to exercise.

A Vicious Cycle Shortness of breath and weakness are two common problems of people with a chronic lung disease.
In order to avoid shortness of breath, many people stop doing some of the activities that make them short
of breath. This leads to muscles that are out of shape, or “deconditioned.” Deconditioned muscles
are inefficient and use more oxygen than muscles that are conditioned. Eventually, deconditioned muscles
become weaker and weaker, and the person becomes short of breath with even less activity. This results in
a vicious downward spiral that can result in progressively less activity and more shortness of breath. A
program of regular exercise can help break this vicious cycle. Exercise can help strengthen your muscles
and make them more efficient (requiring less oxygen to do the same amount of work). The goal of getting in
shape from exercise is to make you stronger, improve your endurance and make you better able to do things
with less shortness of breath. A conditioning program can involve many types of exercises. In pulmonary rehabilitation,
there are three major types of exercises used:

  • Flexibility exercises: They increase the mobility of your muscles and joints. Examples: range of motion
    and gentle stretching exercises.
  • Muscle toning: Strength building exercises: They make your muscles more efficient and stronger. Examples:
    arm curls with small weights.
  • Endurance Building Exercises: They increase your stamina. Examples: stationary biking, walking, and swimming.

Consult your doctor before you begin.

Managing Acute Attacks of Shortness of Breath

The goal of breathing retraining is to help you avoid sudden periods of shortness of breath. There still may
be times when your breathing control gets away from you. Imagine one of the following:

  • You are feeling pressured to hurry to keep up with someone while walking.
  • You have forgotten to pace yourself and tried to get up a flight of stairs in record time.
  • You just had a breathing treatment and can feel secretions (mucus, sputum or phlegm) clogging your breathing

All of these situations and some added ones of your own can lead to acute shortness of breath. What do you
do? The tendency of many people is to gasp for breath. You may notice that you are using your neck and shoulders
to help you breathe (using your accessory muscles) and you may be inhaling and exhaling for the same length
of time. For such times try the following steps: Position, Breathing, Relaxation.

Position: Get in a position that helps your breathing muscles work most efficiently
(and takes the load off your other muscles that are not involved in breathing). Sit, leaning slightly forward,
rest your arms on a table or your lap. If you are standing and have no place to sit down, lean against a

Breathing: Get your breathing under control. Start by breathing out through pursed
lips. Gradually breathe out for longer and longer. As this gets easier slow your breathing down even more.
Remember, breathe in the nose, not the mouth. Breathe out for twice as long as you breathe in.

Relaxation: As you are getting your breathing under control, consciously relax all
the muscles not involved in breathing. Pay special attention to your shoulders and arms. Drop your shoulders
down, let your arms go limp. Close your eyes if this helps you to relax. You may even try saying the word
relax in your mind. Once your breathing is under control, resume your activity, but at a slower pace. If
secretions are your problem, spend some time on the techniques to help you clear secretions. There may also
be times when you need to use inhaled medication to help you control some of your shortness of breath. Your
doctor or a member of the pulmonary rehabilitation team can help you determine when inhaled medications might
be helpful.

A Word of Caution: Prolonged shortness of breath more than your usual may be a sign
that something else is going on. If you cannot get your breathing under control, or shortness of breath seems
to be increasing for you, it may be time to contact your doctor.

Do’s and Don’ts of Keeping Your Lungs Healthy

The Do’s. There are common sense things that everyone should do to maintain their health:

Good nutrition Ideal weight: Being either overweight or underweight can adversely affect your health. Sensible
exercise programs: It may be as simple as walking for 20 minutes, 3 times a week. However, anything more
strenuous and especially if you are over the ages of 45, you should first see your doctor for advice. Regular
check ups: These can help look for initial signs of disease, which may be easier to treat if detected early.

For those who already have pulmonary disease, special attention should be paid to the following:

Take medications as prescribed most medications work best when used on a regular basis. Keep an accurate up-to-date
list of medications from all your doctors. Be sure to notify your doctors of any previous medication reaction.
Consider a pneumonia vaccine if not current.

Talk to your doctor if you experience:

  • Increasing cough, especially when accompanied by a changing quality and color of sputum or increasing
    shortness of breath. (Speak to your doctor when you are well as to how to respond to this problem.
  • Increasing fatigue which may be a symptom preceding a serious worsening of your condition.)
  • Blood in sputum which may be a relatively simple problem, such as bronchial infection, but may represent
    something more serious. Speak to your physician.
  • Swelling (edema) that is new for you. This may indicate a heart problem and/or too much salt in the diet.
    This condition can lead to a greater chance of developing clots in the legs.
  • Fever which may indicate infection which can put a strain on the lungs and heart.
  • Excess anxiety which may can mean a worsening of the condition, or the need for additional training or
  • Depression which is a very common condition that is important to your overall care and can be easily
    missed by the patient, family and friends.
  • Heartburn which may be associated with a condition that can aggravate the lung problem. Example: gastroesophageal
    reflux can result in acid entering the lungs or indirectly causing bronchospasm.

With medications such as antibiotics, it is especially important to finish the prescribed course. This is
to avoid development of antibiotic resistance. Do not give your medications to another person ever. You may
do yourself and a friend great harm.

Flu shots must be given each year to be effective. This can help prevent approximately 80% of occurrence of
flu and may diminish the symptoms, even if you contract the flu. Also, during the flu season your physician
may wish to give you a preventive medicine, especially if you have not been able to get the flu vaccine.

Special pulmonary exercises which include pursed-lip breathing and expanding your lower chest.

Prepare ahead when traveling to make sure you have enough medications and bring a list of your medications
and dosage. Ask your doctor for names of doctors in the area where you expect to travel. Also take along
written prescriptions in case you need to replace lost items.

The Don’ts

1. Don’t Smoke Stop Smoking Help.

  • Smoking is the single largest contributor of pulmonary disease.
  • Smoking is the single largest cause of lung cancer.
  • Smoking also contributes to the risk of cardiovascular disease.
  • Smoking also has been linked to various other cancers (head and neck, bladder, etc). The toxic agents
    of smoke are absorbed immediately into your blood and carried to every part of your body.

2. Don’t overexert yourself. Know your limits and learn to pace yourself, but be sure to always follow your
exercise program.

3. Don’t forget medications, including oxygen. While you may notice immediate benefit from some of your medications,
they have long-term benefits also. Many medications are designed to last slightly beyond the time of next
due dose. Thus, in these cases you would not expect a “kick” when you take the next dose. The medicine
level in your body should ideally remain at the maximum effective level until the next dose is taken.

4. Don’t delay seeing your doctor when ill. Early treatment of certain conditions, i.e., infections, may prevent
their progression and/or complications and/or hospitalizations.

Books to Assist with Pulmonary Health

Life and Breath:
Preventing, Treating and Reversing Chronic Obstructive Pulmonary Disease. The fourth leading cause of death
in the United States, COPD, or chronic obstructive pulmonary disease, affects an estimated 35 million Americans.
Yet only half are aware that they are seriously ill. Life and Breath, by Dr. Neil Schachter, is the first
book that alerts people to their risks for COPD and explains the steps they need to take to prevent the development
of this debilitating and often fatal lung disease. Life and Breath begins with a quick quiz to rate your
risk for COPD. It explains the steps of a complete pulmonary work-up and teaches you about the painless,
inexpensive six-second test that can save your life.

Asthma and COPD:
Basic Mechanisms and Clinical Management: Chronic obstructive pulmonary disease (COPD), which encompasses
both chronic bronchitis and emphysema, is one of the most common respiratory conditions of adults in
the developed world. Asthma and COPD: Basic Mechanisms and Clinical Management provides a unique, authoritative
comparison of asthma and COPD. Written and edited by the world’s leading experts, it is a comprehensive
review of the most recent understanding of the basic mechanisms of both conditions, specifically comparing
their etiology, pathogenesis, and treatments. Highlights distinguishing features between asthma and COPD.
Reviews benefits and limitations of current therapies. Summarizes key information in two-color artwork.
Extensively referenced to primary literature.

An Atlas Of Chronic
Obstructive Pulmonary Disease: COPD A resource for reference, teaching and lecturing : The aim of
this book is to provide an in-depth review of our current understanding of the pathogenesis of both asthma
and COPD.

This volume also discusses the promising new options for pharmacological intervention of these diseases. Each
chapter is extensively referenced, generously illustrated with clear diagrams and photographs, and represents
a state-of-the-art review of this important area of lung biology. 

Despite being the most common respiratory disorder in the developed world and the fourth leading cause of
death in the US, chronic obstructive pulmonary disease (COPD) has received little attention compared to other
lung diseases.

Often it is not diagnosed until in its advanced stage. An Atlas of Chronic Obstructive Pulmonary Disease provides
a visual reference for diagnosing and treating smoking-related and other lung diseases. This book contains
approximately 120 detailed schematic diagrams that detail disease progression, diagnosis, and treatment;
clinical photographic material that illustrates visual diagnostic cues; and figures and flow diagrams that
present a concise review of the epidemiology, diagnosis, and management of the disease.

The authors cover the drugs recommended for treatment, their mode of action, potential side effects, and recommended
uses. They discuss the management of both stable COPD and exacerbations of COPD, differential diagnoses and
asthma, management in general practice and in hospitals, and future trends in therapy, such as new bronchodilators
and anti-inflammatory treatments.

The wealth of pictorial, diagrammatic, and photographic information combined with the clear, concise text
and easy-to-use format make An Atlas of Chronic Obstructive Pulmonary Disease a primary resource for the
management of COPD.

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