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LIVING WELL WITH COPD, EMPHYSEMA, LUNG DISEASE

Posted Oct 17 2008 9:01pm
Prevent respiratory infections
Any respiratory infection — even the common cold — can cause an acute exacerbation of COPD, so it is to your advantage to do whatever you can to avoid catching what's going around. Washing your hands frequently with soap and water can reduce your risk. Alcohol-based instant hand sanitizers can also help. As much as possible, stay several feet away from people who have colds or other respiratory infections that can be spread by sneezing or coughing.
In addition to having an annual flu shot and an immunization against pneumonia every five years (see "Immunizations"), you may also benefit from antiviral medications for preventing and treating influenza, such as zanamivir (Relenza), amantadine (Symmetrel), and rimantadine (Flumadine). These drugs are not substitutes for a flu shot, but they can offer added prevention. If you get the flu, they can help reduce the severity and duration of your illness.


Exercise regularly
If you are attending a pulmonary rehab program, you will also need to exercise at home on the days you don't attend sessions. It's especially important to find an exercise that you enjoy well enough to do almost every day. Aerobic exercises, which increase the heart rate and breathing rate, are most beneficial. If you don't like the treadmill, try tai chi, yoga, swimming, or walking around your neighborhood with a friend. Aim for at least 20 minutes a day on most days. Even if you aren't in a pulmonary rehabilitation program, regular exercise helps maintain strength in your arms and legs and prevent you from becoming easily tired during physical activities.


Do breathing exercises
Another lesson from pulmonary rehabilitation that can easily become a part of your daily routine is pursed-lip breathing. This technique is valuable for helping you improve your breathing before and during physical activities. Before you start moving, inhale through your nose so deeply that your abdomen expands. Then, as you begin to move, exhale through your mouth with your lips pursed to slow down the airflow. Your exhalation should last twice as long as your inhalation. You will feel pressure in your windpipe and chest as you slowly breathe out. When you finish exhaling, rest for a moment, then inhale and start the process again.
Breathing exercises can help keep you from feeling out of breath while going up and down stairs, walking in the mall, or otherwise exerting yourself. Use breathing exercises to pace yourself through physical activities. When climbing stairs, for example, you might inhale, then climb three steps as you exhale, rest, then inhale, climb three more steps as you exhale, and so on until you have reached the top of the stairs.


Eat and drink regularly
Small meals are easier to digest and use less energy than large meals. If you have been avoiding eating because it makes you tired or out of breath, try having smaller, more frequent meals throughout the day instead of three large meals. In addition, drink plenty of water or other noncaffeinated, nonalcoholic beverages. This can help relieve congestion by thinning mucus, enabling you to cough it up more easily. There's no magic number of glasses you should drink daily; simply get into the habit of drinking regularly throughout the day.


Avoid lung irritants
An important way to control your symptoms and prevent acute exacerbations is to keep your airways from becoming irritated. Many things can irritate the airways, especially exhaust fumes from your stove, smoke from your fireplace, dry air, and molds and mildew from water damage in your home. If you have allergies, try to avoid exposure to whatever causes them — pollen, pet dander, house dust, mold, and so on.


Here are some specific tips for avoiding irritants:
Use a humidifier when the air is very dry. Moisture in the air can reduce irritation by keeping your airways moist. A humidifier is especially helpful during the winter, when the air in your home may be dry. Change the water and clean the filter of your humidifier regularly to prevent buildup of mold and bacteria.


Ventilate your home. Good ventilation can reduce the amount of irritating dust and cooking exhaust in the air. Use an exhaust fan vented outdoors when cooking. Avoid using a fireplace or wood stove; wood smoke is a lung irritant. Unless you are allergic to pollen and other outdoor allergens, keep windows open when the weather is warm enough. Fresh air not only helps ventilate your home but can also raise the humidity level. Although it would seem that air purifiers may help, there is no clear evidence that they are beneficial for people with COPD.

Have furnaces and chimneys inspected. Making sure that furnaces are operating normally can reduce the amount of smoke and fumes they emit. Having chimneys cleaned can ensure that they vent smoke and exhaust effectively.
Avoid aerosol products. Just about any aerosol (other than medicine or oxygen therapy) can irritate your airways. That includes hairspray, perfume, deodorant, paint sprayers, and insecticides. Instead of aerosol products, use gel or liquid preparations; for deodorants, use roll-on or stick forms.


A patient's experience: Pulmonary rehabilitation
After smoking for 35 years, Kurt reached a point when his concern for his health outweighed his craving for a cigarette. So he quit cold turkey, with the support of his wife and children. A decade later, his doctor diagnosed emphysema and asthma. "I used to be able to handle heavy loads with no trouble, but then I found myself huffing and puffing," recalls Kurt, 67, whose job in computer training sometimes required that he carry heavy computers. "I also started getting tired and out of breath on my endurance walks."
For several years, Kurt was able to control his symptoms with bronchodilators, but then the symptoms got worse. "If I climbed stairs while carrying a briefcase, I became exhausted," he says. His doctor recommended pulmonary rehabilitation.

He went to an outpatient rehab center for 12 weeks, starting out twice a week and then going once a week. Under the guidance of a physical therapist, he exercised on a treadmill. The therapist recommended that he use a portable oxygen canister while exercising to help reduce his shortness of breath.

The therapist also taught him breathing retraining, techniques to make it easier to breathe even without oxygen therapy. First, she showed him diaphragmatic breathing, a technique for inhaling deeply and exhaling slowly to prevent running out of breath during activities. Then she taught him to pace his breathing so that he inhaled deeply before doing something physical, then exhaled slowly during the activity. She also told him that he could improve his breathing even more by improving his posture — relaxing his shoulders instead of hunching them as was his habit. "It all worked," he says.

Kurt credits pulmonary rehabilitation with restoring his vitality and vastly improving his well-being. "When I started rehab, I was able to walk for only 20 minutes on a treadmill. Then I worked up to 40 minutes," he says. Not only that, but his lung capacity improved by 22% by the end of his rehab and another 1% six months later, as he continued to exercise on a treadmill at home.

A year later, Kurt works part time, although he has someone else do the heavy lifting. "You can't reverse emphysema," he says, "but you can stabilize it."
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