Engelska COPD COPD. Chronic Obstructive Pulmonary Disease. Information for you who have been diagnosed with COPD

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1 Engelska COPD Chronic Obstructive Pulmonary Disease COPD Chronic Obstructive Pulmonary Disease Information for you who have been diagnosed with COPD

2 Contents Sid 5 A disease not outwardly visible Breathing is affected 6 Good lifestyle for a good life 7 about breathlessness 9 about phlegm 10 about coughing 11 about muscular weakness This brochure is intended for you who have recently been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and want to know more. Here you can see what symptoms can arise and what you can do to ease matters. To learn more you can go to COPD school. Contact your health centre or call 1177 ( for more details. 13 about stiffness and pain 14 Mobility training 16 about tiredness 18 about loss of appetite and weight Text Fact checking Graphic design and layout Illustrations printing Revised and re-worked 2011 Revised and re-worked 2013 The Physiotherapy and Occupational Therapy Department and the Unit for Clinical Nutrition, Sahlgrenska University Hospital, 2005 Senior lecturer Ann Ekberg Jansson, Pulmonary Medicine and Allegology, Sahlgrenska Academy Information department, Sahlgrenska University Hospital Maria Nordberg Regiontryckeriet Gothenburg 19 about overweight 20 about stomach and intestinal trouble 21 about brittle bones (osteoporosis) 22 about stress 23 Notes 3

3 A disease not outwardly visible Lung Windpipe COPD - Chronic Obstructive Pulmonary Disease - is a chronic, progressive lung disease caused in most cases by smoking. A harmful indoor environment, for example in certain workplaces, can also contribute to the onset of the disease. The disease typically attacks the smallest airways in the lung and to a varying degree also the air sacs where oxygen is absorbed. This last is called the emphysema. Although you cannot see that a person has COPD, the disease can cause severe everyday problems. Normal airway Breathing is affected windpipe Healthy air sacs alveolus Slight obstruction A common symptom of COPD is that it feels difficult to breathe out. You also become breathless more easily from light exertion. For a small group of people suffering from COPD, the disease can develop so that it is difficult to oxygenate the blood. That means you sometimes need extra oxygen. Many people with COPD also have an inflammation in the main airways. That causes more phlegm to be created and a cough develops, so-called chronic bronchitis. People with COPD run a greater risk of catching infections and can also become more seriously ill than healthy people. A yearly influenza vaccination and a vaccination giving protection from serious pneumonia are therefore recommended. Bronchial muscles emphysema Mucous membrane Phlegm Moderate obstruction Severe obstruction 4 5

4 Good lifestyle for a good life Medication can help but does not cure COPD. If you are affected by the disease you must learn to live with it, but you can prevent continued deterioration. In most cases that means giving up smoking. Lifestyle is of great overall importance to everyone with COPD. Food must be nutritious and sufficient. Physical activity is very important, but plan breaks in everyday life to achieve a balance between activity and rest. If you give up smoking, eat well, keep your weight and stay physically active in the daytime you can often live well despite having COPD. about breathlessness COPD makes you breathless People with COPD find their breathing is affected. It can be hard to breathe and they quickly become short of When you become breathless Remember when carrying out physically demanding activities to take a break now and then. Use pursed lip breathing and breath. Breathlessness can be caused both by airway obstruction and emphysema (see ill. pp. 4 and 5). slow down. It takes time to find a new breathing technique that works, so let it take time. How pursed lip breathing works Pursed lip breathing is a type of breathing technique which can help you keep control over your breathing in situations where you often become breathless. You can try using pursed lip breathing both during rest and activities, for example when you get up from sitting to standing, or when you bend down to tie your shoelaces. Begin by training pursed lip breathing when you are sitting calmly. Then try it when you are in motion. 1 Breathing deep and calmly with relaxed shoulders. It is good if you can breathe in through your nose. 2 Let the air seep out between slightly closed lips. Let the outward breaths take the time needed. 3 At a calm pace, continue breathing out then breathing in. 6 7

5 You can use pursed lip breathing to more easily walk up stairs or slopes. 1 Take a break before you start walking up stairs or slopes. 2 Begin pursed lip breathing to bring down your breathing before you start walking. 3 First take a breath when standing still, then during your outward breath walk up three or four steps. 4 Then stop, take a new breath and walk while breathing out. Once you are used to this you will find your own rhythm. Work energy smart To help breathing you should think about your working position. Avoid working with your arms too high, or leaning forward, to save energy. Use a shopping trolley when possible and let the wheels do the work. It is also good to distribute the weight evenly between two bags, for example groceries or laundry. Try to work at a calm rate, it saves energy. Also, take breaks during everyday activities so you do not get too tired. 8 Remember when walking upwards Your occupational therapist can give advice and try out technical aids when necessary. Remember to rest before meals so that you have the strength to eat. Choose the food that feels easiest to eat, eat slowly and always have some ready prepared food in reserve, especially on days when a lot is going on around you. Energy consumption = the amount of energy your body uses for everyday activities. Energy intake = the amount of energy added to the body via food & drink. Do not try to hold your breath. Remember to breathe. about phlegm Irritated airways People with COPD can have problems with phlegm. This is due to irritation/ inflammation How to loosen phlegm It is important to loosen the phlegm in the airways, above all if you have an infection. It is also good to try to loosen phlegm before going to bed to sleep better. There are several ways to loosen phlegm. Some of this advice may help just you. Drink. Drinking may help make the phlegm looser and easier to cough up. Try which feels best, a warm drink or a cold drink. Take your inhalation medicines. They expand the airways so that you can more easily cough up. in the airways and leads to increased activity in the phlegmproducing cells. Pursed lip breathing. It can help strengthen your exhaling, so keep pursing! Exercise. Exercise can get the phlegm in motion, which makes it easier to cough up. Try the mobility programme in the middle of the brochure. If you have severe difficulties from not being able to cough up, it is good to do the above, for example in the mornings and evenings. If you need more advice, contact your physiotherapist. 9

6 about coughing Coughing transports phlegm Coughing can be caused by inflammation of the airways. The inflammation often causes increased sensitivity to different irritants, for example How to reduce coughing Remember not to become surrounded by strong scents, for example perfume, aftershave, rinse and similar products since they can irritate your airways. Try using pursed lip breathing to prevent the coughing getting going. If the cough is hard to manage, contact your physiotherapist. If you often start coughing in the night, it is important to clear your airways before going to bed. It can help to raise the head end of the bed. In addition to pillows there is a bed backrest you can use. Contact your occupational therapist. strong scents. Coughing is also a mechanism the body uses to bring up phlegm from the airways. Urinary incontinence can be a problem when you cough a lot. This is because the pressure on the pelvic floor increases when coughing. Your physiotherapist can help you with pelvic floor training, and you can get incontinence aids from your district nurse. about muscular weakness It is not dangerous to be short of breath but remember to take breaks. Lack of energy causes weak muscles If you do not get sufficient exercise it can lead to weakening muscles. Sometimes the reason can also be that the body does not receive sufficient energy and protein. Physical activity is important. It is also important to You can exercise in many ways, for example walking, cycling on a stationary bike indoors, keep a well composed diet with enough energy and protein. You can get help from your dietician if you are uncertain whether your diet is good. Choose a physical activity that suits you Nordic walking, swimming or aquarobics. Bodybuilding is also a good activity, since you can adapt the weights to your energy. Walking and shopping also give everyday exercise. Buy a few groceries every day rather than shopping a lot once a week. Remember to increase your energy intake by eating and drinking before and after physical activity

7 Assistive technology for day-to-day help If it is too strenuous and tiring to do what you want to, there are technical aids to help. Contact your physiotherapist. Certain technical aids can be bought online, at the pharmacy and in rehab shops. About stiffness and pain Reduced physical activity can cause stiffness Breathing problems can lead to reduced physical activity and thereby reduced mobility. Brittle bones are in fact not unusual among people with a pronounced COPD condition. All this can cause stiffness and pain. To continue to be as active as possible, try the following strategies, which can be summed up in four Ps. P P P P Plan your day and your week so that most activities are spread out over time make a schedule. Avoid stressful situations by planning. Prioritise activities that are enjoyable, they can give you energy. As far as possible give low priority to whatever takes unnecessary energy. Pacing is a loan word meaning working at a low tempo to avoid breathlessness. It does not mean slow motion, but a tempo where you have control over your breathing. Take a break to gather strength, try many short breaks instead of one long one. Two good exercises for leg muscles 1. Standing up from a chair. Get up, then slowly sit down. How to reduce stiffness and pain To reduce your stiffness and increase blood circulation, it is good to follow a light mobility programme. Do the exercises in a calm and pleasant tempo and remember to breathe while doing them. Pursed lip breathing is a good idea during the programme. Do the exercises 5-10 times, Depending on how you feel. You can follow the programme daily if it feels right. Mobility programme see next page. 2. Heel raising. Hold the chair, rise onto your toes, then slowly back down

8 Mobility programme 1 Remember to breathe Raise both shoulders, hold for a couple of seconds, lower them. 2 Sit straight, looking ahead. Pull in your chin, hold for about 15 seconds. Return. 3 Sit straight, looking ahead. Tip your head sideways, hold for about 15 seconds. Return. 4 Sit straight, looking ahead. Turn your head sideways. Hold for about 15 seconds. Alternate right/left, without raising your shoulders. 5 Lift both arms forward while breathing in. Look straight ahead. Lower your arms, relax and breathe out. Do the exercise at an easy tempo. 6 Raise your right arm. Bend it over to the left and breathe in. Lower the arm, relax and breathe out. Alternate right/ left. 7 Fingertips on shoulders. Draw circles backwards with your elbows. Breathe in during each upward movement, breathe out during downward movements. Let your own breathing decide the tempo. 8 Sit straight with relaxed shoulders and bent arms. Move your elbows backwards and breathe in. Stretch your arms forward and breathe out. 9 Stretch your right arm towards the ceiling. Bend your elbows and try to reach your shoulder blades with your fingertips. Hold for a couple of seconds

9 About tiredness Tiredness is part of the condition With a pronounced COPD condition you often have an increased energy output, and can therefore become tired. Tiredness can also be a sign of insufficient oxygenation of the blood. Save energy! Nor is it unusual to feel depressed. In some cases you may need to take medicines, which usually have a good effect. Talk to your doctor. Relax! Try to relax your shoulders and upper body when you are moving and resting. Tense muscles become tired and need more oxygen than relaxed muscles. Remember to take a break during activities and do not pressure yourself. Try every day to find a moment to sit down and relax without thinking about other things than rest. If you want to know more about relaxation training, contact your physiotherapist. It can be a good idea to save your energy for whatever feels important to you. The less energy spent on a work task, the more tasks you can carry out in a day. Get help from relatives/friends for things you cannot manage. To save energy in day-to-day activities you can try sitting a little more often, for example when cooking or showering. There are technical aids such as orthopaedic cushions that give the right working height. You can get more tips and advice from your occupational therapist to make things easier in the home. Find balance in everyday life! 16 17

10 About loss of appetite and weight Weight loss drains energy You can easily lose weight if you have COPD. If you lose weight against your will, or weigh too little, it can means you feel less wellbeing and have less energy than if you are normal weight. Weight loss can be due to the body using more energy and/or you having less of an appetite, so that you eat less than you need. About overweight Overweight reduces mobility If you weigh too much you can feel less healthy and may not manage to do so much. Breathlessness and the risk of other illnesses due to severe overweight, increase. Severe overweight brings mobility difficulties because of the increased strain on knees, hips and the back. The less mobile you are, the harder it is to keep normal bodyweight. It can easily become a vicious circle. More energy use with COPD Energy consumption may be greater for people with COPD, among other things because of increased breathing effort. To compensate for increased energy consumption it is important to eat small and energy-rich meals often and well spread out through the day. It is advisable to eat a late evening meal before going to bed. Choose the right diet! Your diet must be well composed and the energy and nutritional content must be adapted. You can get help from your dietician. To complement dietary treatment, suitable physical activity is needed for your muscles to be kept and perhaps also increased. Contact your physiotherapist for personal advice. Choose the right diet! Avoid light products and do not drink too much with meals. Choose mealtimes drinks that give energy and nutrition in order to compensate for your increased energy consumption. Do not skip meals that can further reduce your appetite. Your diet needs to be well composed and have adapted energy and nutrition content. You can get help from your dietician to adapt your diet to your personal needs and to keep a suitable weight

11 About stomach and intestinal problems Fibre-rich to prevent constipation Different stomach and intestinal problems, for example constipation, can arise in connection with COPD. They can be due among other things to reduced physical activity caused by breathing problems. Constipation can be prevented by sufficiently fibre-rich food, by fluids, physical activity and regular toilet habits. If you have stomach and intestinal problems, you should discuss suitable measures with your doctor. About brittle bones (osteoporosis) Calcium and vitamin D strengthen bones Many people with COPD develop brittle bones (osteoporosis). Consult your doctor if you want calcium and vitamin D treatment. You can also get help from your dietician to find food that contains plenty of these substances. Physical activity, spending time outdoors in daylight and giving up smoking are other factors that can counteract osteoporosis. Occupied 20 21

12 about stress Plan for breaks It can be hard to change habits. Try to plan, prioritise and think about start in good time to avoid stress. Tell your relatives why you need to take breaks and sit down. In that way they become aware of your need to change former habits. Remember that knowledge prevents anxiety. You can try relaxation training, qigong or yoga to reduce your stress and learn to handle it better. To find out more, contact your physiotherapist, look at opportunities to join a COPD score or contact the Swedish Heart and Lung Association (Hjärt- och Lungsjukas Förening) which has a wide range of courses. Notes We hope that this publication has provided useful information about the disease COPD. Here you have space for your own notes about things worth remembering names and telephone numbers to contacts in healthcare, supplementary facts about the disease, medicines, etc. If you want to read more:

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