COPD. Chronic Obstructive Pulmonary Disease

Transcription

1 COPD Chronic Obstructive Pulmonary Disease

2 Table of Contents Understanding COPD... 3 What Is COPD?... 3 How the Lungs Work...6 Symptom Guidelines... 9 Quitting Smoking The Quitting Process Quit-Smoking Aids Quit-Smoking Resources Taking Medicines for COPD Getting Started Guidelines for Taking Medicines Correctly Types of COPD Medicines Using Inhalers and Other Devices Breathing Better Breathing Techniques Keeping Your Lungs Clear Protecting against Infection Avoiding Irritants and Allergens Using Oxygen COPD and Your Heart Why Oxygen Therapy Is So Important Common Questions about Oxygen Therapy Qualifying for Home Oxygen Oxygen Equipment Oxygen Safety Living with COPD Conserving Energy and Simplifying Work Exercise and Pulmonary Rehabilitation Eating Well When You Have COPD Managing Stress and Anxiety Do Mini-Relaxation Breathing Exercises COPD and Depression Coping with Chronic Illness Tips for a Better Life Other Resources Notes

3 So You Have COPD Now What? A diagnosis of COPD does not have to change your life for the worse. There are things you can do to control COPD so it doesn t control you. This book gives you the information you need to know in order to take the best possible care of your breathing. Know your condition. The information about your lungs and COPD (pages 6-8) will help take the mystery out of COPD. By understanding what has happened in your lungs and why it happened, you will be better able to understand your treatment plan and discuss issues with your doctor. Quit the smoking habit (pages 11-12). This is the first and most important step in controlling your COPD. Take your medicine (pages 13-16). Most of the time, the best treatment for COPD includes taking several medicines. Understanding the medicines you have been prescribed and taking them correctly are vital if you are to have the best control of your COPD. Pay attention to changing symptoms (pages 9-10). Flare-ups of COPD will happen and are hard to completely prevent. These flare-ups do not have to result in lengthy hospital stays or increasing disability. Information about flu shots, pneumonia vaccines, avoiding infection, and keeping your lungs clear (pages 23-24) will also help you prevent flare-ups. Manage stress (pages 43-45). Having difficulty with breathing can be stressful. Managing stress can lead to a healthier, happier life. It is also important to know that depression is common with COPD. Depression is a medical illness that can be treated (page 46-47). Stay active. Giving up exercise and activities you enjoy is the worst thing you can do for your COPD. Staying active and exercising regularly are vital for your well-being. Pulmonary rehabilitation programs (pages 35-38) offer the best way to exercise. Exercising at home (page 37) or other places is also possible. Use your energy wisely and simplify the work you do (page 34). This will help you meet the challenges of life with COPD. Using simple techniques such as pursed-lip or diaphragm breathing (pages 21-22) will also help you improve your breathing during activities. 2

4 Understanding COPD What Is COPD? COPD is a term that means: Chronic: never goes away Obstructive: partly blocks the airflow Pulmonary: in the lungs Disease: sickness COPD refers to the obstruction of airflow into and out of the lungs caused by a group of lung diseases: chronic bronchitis emphysema chronic asthma COPD is a progressive illness. This means that symptoms may be mild at first but may worsen over time. Symptoms include shortness of breath, increased coughing, increased wheezing, and an increased amount and thickening of mucus. Facts about COPD COPD can be treated and controlled, but it cannot be cured. About 30 million people in the United States have COPD. COPD is a major cause of illness and disability throughout the world. 3

5 Risk Factors for COPD Between 80 and 90% of COPD is caused by cigarette smoking. Other risk factors for COPD include: secondhand smoke air pollution work-related exposure to harmful dust or chemicals severe respiratory infections during childhood family members who had COPD a rare genetic problem leading to a lack of the enzyme alpha 1-antitrypsin Diagnosing COPD Your doctor will ask you about: your level of shortness of breath chronic cough or wheezing how much mucus you have your smoking history exposure to toxins in the air any family history of lung disease During the physical exam, your doctor will listen to your lungs and look for any signs of breathing problems. 4

6 Pulmonary Function Test PFT The PFT is the most important test used to determine whether you have COPD. It measures your lung function, flow, and volume. Your doctor will review the test results to see if you have an obstruction or other types of lung disease and will determine how severe these are. The PFT is often repeated after inhaled medicine is given to see if there is any improvement in the airflow. Other tests that may be done include: EKG (electrocardiogram) chest x-ray CT (computerized tomography) scan pulse oximetry, which tests your oxygen level exercise treadmill test 5

7 How the Lungs Work The main purpose of the lungs is to get oxygen to your blood and to remove carbon dioxide from your blood. Diaphragm 6

8 Normal Lungs When you breathe in through your nose and mouth: Air travels down your windpipe (trachea), which divides as it enters the lungs. The air then travels through the large tubes (bronchi) in the lungs. These tubes divide and get smaller and smaller until they end in tiny grapelike clusters of air sacs (alveoli). There are hundreds of millions of these air sacs in the lungs. Oxygen transfers from the lungs to the blood in these air sacs. Carbon dioxide, the waste product of breathing, is transferred into the air sacs and then exhaled. In the larger airways, the tubes of the lungs are held open by cartilage. As the tubes divide and get smaller, the cartilage is replaced by rubber-band-like smooth muscle. Muscles hold the tubes open and make them larger when you need more air. The larger the tube, the more air can get through it. A dome-shaped muscle, the diaphragm, separates the lung cavity from the abdominal cavity. This muscle moves up and down to fill and empty the lungs during breathing. The diaphragm flattens when you inhale and rises when you exhale. Mucus is also an important part of normal lungs. The mucus in the lungs is very sticky. Its job is to catch the germs, dust, and debris that we breathe in every day and to move it out of the lungs before it has the chance to make us sick. Small hairlike structures (cilia) carry the mucus up and out of the lungs into the back of the throat. The mucus is then swallowed or coughed out. Normally, we are not even aware that this process is taking place. Lungs Affected by COPD In COPD, airflow is blocked or obstructed by inflammation (redness and swelling), muscle spasm, and excess mucus. COPD includes two diseases: chronic bronchitis and emphysema. Sometimes it is difficult to completely separate the diseases. Your doctor may tell you that you have emphysema, but you may also be bothered by problems from chronic bronchitis. Some people with COPD may also have asthma-like symptoms, such as wheezing. 7

9 Chronic Bronchitis Chronic bronchitis is diagnosed when you cough up mucus for 3 months or more each year for at least 2 years. This increased mucus may make you more short of breath and increase your risk of lung infection. The mucus results from years of exposure to cigarette smoke, pollution, or other irritants. These irritants trigger swelling and excess mucus in the lungs. This blocks normal airflow in and out of the lungs. The cilia are damaged, which leads to further problems with clearing the mucus. Preventing infection, taking medications, and clearing the airways, as well as other strategies discussed in this booklet, are important ways to control chronic bronchitis. Emphysema Emphysema damages the alveoli by breaking down the walls between the air sacs. The alveoli become one big air sac instead of grapelike clusters. The walls of the air sacs are no longer able to snap back into their original shape and become floppy like a balloon that has been blown up one too many times. The smallest airways (bronchioles) also tend to collapse. Both of these things lead to air becoming trapped in the lungs. This enlarges the lungs and flattens the diaphragm, making it hard for normal breathing to take place. The damage makes it difficult for the lungs to transfer oxygen into the blood and to clear carbon dioxide out of the body. Breathing exercises and using oxygen are important strategies for controlling emphysema. 8

10 Symptom Guidelines Paying attention to changing symptoms in COPD is very important. Doing so will help you stay out of the hospital and slow the progression of your COPD. In case of a medical emergency, seek medical attention right away. Always call 911 if: You are very short of breath, have trouble talking in short sentences, or have trouble walking across a room. You have severe chest pains or chest pressure that may move to your jaw or down your arm. Call your doctor when: Your mucus turns from clear or white to green or yellow, becomes very thick, or increases in amount. Yellow or green mucus is usually a sign of infection. Infection won t go away by itself. It requires an antibiotic only your doctor can give you. Waiting a few days to see if it will go away only allows the infection to get a stronger hold and become harder to treat. This can result in an unwanted visit to the hospital for IV antibiotics. If mucus doesn t change color but becomes very thick or hard to cough out, it can put you at higher risk for infection. You have shortness of breath not helped by your breathing medicines. If you are not getting relief from your breathing medicines, or if the relief you re getting doesn t last very long, something is not right. In other words, the breathing medicines that usually work for you are not doing their job. This could be a sign of infection, swelling, or inflammation in your lungs. Waiting a few days to see if it gets better on its own will make it more difficult to treat. You have more trouble doing your normal daily activities. The key word here is normal. Everyone s daily routine is a little different. If you have to alter your normal daily routine because you are too short of breath, something is not right with your lungs. Calling the doctor to report these symptoms may help you avoid a hospital stay. 9

11 You are coughing or wheezing more. Again, these are signs that something is not right in your lungs. Always report these symptoms to your doctor. You awaken at night more often than usual due to shortness of breath. We all have trouble sleeping at times for one reason or another. If shortness of breath keeps you awake, it could be a sign of something going on in your lungs and should not be ignored. If you have to sit up on the side of the bed to catch your breath, prop yourself up on more pillows in order to breathe, or take a breathing treatment in order to get back to sleep, you should contact your doctor. You have increasing morning headaches, dizzy spells, irritability, or confusion. Morning symptoms that go away after you have been awake for a while could mean that you are not breathing well when you are sleeping. These symptoms should always be reported to your doctor. You may have one or more of these symptoms at a time. Do not wait to have them all before you call your doctor. When you call your doctor s office, be as specific about your symptoms as you can. This will give the doctor the information he/she needs to decide how to treat you. 10

12 Quitting Smoking Stopping smoking is one of the most important things you can do to control your chronic lung disease. Continuing to smoke after you have been told you have chronic lung disease will lead to a quicker progression of this disease. It will also lead to more frequent, serious flare-ups. The Quitting Process Quitting smoking is a major life challenge. Some former smokers may share the fact that they decided one day to put down the pack and have not wanted to smoke since. This is not the case for most people. When you stop smoking, you may feel withdrawal symptoms and be tempted to smoke to stop those symptoms. Having a plan to help you through the process can be a big part of your success. Set a quit date. Pick a date within 2 weeks of your decision to stop smoking. Mark this date on your calendar. Get ready. Use the time between your decision to quit and your quit date to find out as much as you can about your smoking habits and routines. By knowing when and where you are most likely to smoke, you can better prepare for how you will feel when you quit. You will also learn what to avoid. Consider keeping a smoking diary to aid you in this process. Ask your friends and family members for their support. After your quit date: Throw away all cigarettes and other smoking-related items such as lighters and ashtrays. Seeing them will only remind you of smoking. Change your routines. Your daily routines provide strong triggers for you to smoke. You may have gotten up every day for the last 20 years and had a cigarette with your morning coffee. Or you may have had a cigarette every day during your break at work. To help control your urge to smoke, it is best to change your routines at least for a while. For example, replace your morning coffee with tea and take a walk outside during your work break. Clean your house by washing the drapes, cleaning the upholstery, or washing the walls to remove the cigarette smell. 11

13 Quit-Smoking Aids Nicotine Replacement Therapy Nicotine replacement therapy prevents withdrawal symptoms. It gives you time to break the habit of your psychological dependence on cigarettes. The products allow your body to adjust at a much slower pace to the decrease in nicotine. Nicotine replacement improves your chances of successfully quitting smoking. Nicotine replacement therapy is available as patches, gum, lozenges, nasal inhalers, and oral inhalers. It is very important to use these products according to the manufacturers or your doctor s instructions. Some of these products are available over the counter, but others require a prescription. Talk with your doctor, pharmacist, or other healthcare professionals about which nicotine replacement therapy is best for you. Zyban and Wellbutrin SR Zyban and Wellbutrin are brand names for the prescription drug bupropion. This medication can help reduce your urge to smoke. It does not contain nicotine and is safe to use with nicotine replacement therapy. Using this medication along with a nicotine replacement product increases your chances of staying smoke-free. Quit-Smoking Resources Ohio Tobacco Quit Line Smoking cessation assistance, including nicotine replacement therapy, is provided free of charge to all Ohio residents through the Ohio Department of Health s Quit Line. Call QUIT-NOW ( ). Smokefree.gov The website offers the Step-by-Step Quit Guide, Tools to Help You Quit, and professionals to help you click on the link Talk to an Expert. 12

14 Taking Medicines for COPD Getting Started Breathing medicines open your breathing passages, making it easier to get air in and out. Understanding your medicines how they work, how often they should be taken, and what kinds of side effects they may have will help you control your breathing. Brand Names versus Generic Names Medicines have two names: the brand name and the generic name. The brand name is decided upon by the company that makes the medicine. The generic name describes the main ingredient in the medicine. The generic medicine may be sold under several different brand names. Pharmacies sometimes substitute generic medicines for brandname medicines to provide the one that is least costly. Maintenance Medicines versus Reliever Medicines Medicines can be used to either decrease or eliminate the symptoms of COPD. Some medicines must be taken daily, while others need to be taken only when symptoms occur. Medicines that are needed only at times are called reliever or as-needed medicines. Because COPD is a chronic condition, daily maintenance or controller medicines are usually needed. These last longer and provide a more steady, even delivery of medicine over a longer period of time. Maintenance medicines keep day-to-day symptoms under control. Inhalers versus Pills Most medicines for COPD are in the form of inhalers. When the medicine is inhaled, most of it goes directly to the lungs where it needs to work. This allows the medicine to be given in smaller doses. When medicines for COPD are taken in pill or liquid form, they affect not only the lungs but also other organs and the nervous system as well. 13

15 Guidelines for Taking Medicines Correctly Take your medicines as prescribed. Never change or stop a medicine without checking with your doctor first. Stopping some medicines quickly can be dangerous. Have a routine for taking your medicine. Set up a schedule for taking your medicine. Making it a part of your routine is often very helpful. Using a pillbox can be a helpful way to remind you to take your medicine on time. Pillboxes are sold at most pharmacies and grocery stores. Make a medicine list. Include each medicine s name, the dose (number of puffs or mg), the reason you take it, and the time you take it. Put a copy of the list in your wallet or purse. Review the list with your doctor at each visit. Write the date on the list and update the list when changes are made. Throw away old copies of the list. Ask your doctor or pharmacist before taking over-the-counter medicine, herbal remedies, or vitamins. Many of these may interfere with your prescription medicines. Always check with your doctor or pharmacist first. 14

16 Types of COPD Medicines The following information is a general guide to medicines used most often for COPD. Talk to your doctor or pharmacist if you have any questions about your medicines. Bronchodilators Bronchodilators treat the muscle spasms in the tubes of the lungs. Relaxing these muscles makes the airways larger, allowing air to move in and out more freely. Bronchodilators can be either short-acting or long-acting. An example of a shortacting bronchodilator is albuterol (Proventil or Ventolin ). Examples of a long-acting bronchodilator include formoterol (Foradil ) and salmeterol (Serevent ). Side effects may include tremors and increased heart rate. These side effects might mean that you are taking the medicine more often than you should. Taking the medicine more often provides little to no extra benefit. Short-acting bronchodilators should not be taken more than once every 4 hours, unless otherwise prescribed by your doctor. Long-acting bronchodilators are not to be used more than once every 12 hours. Anticholinergics Anticholinergics affect the muscles around the tubes of the lungs. Anticholinergics can be either short-acting or long-acting. An example of a short-acting anticholinergic is Atrovent (ipratropium bromide). An example of a long-acting anticholinergic is Spiriva (tiotropium). Dry mouth is the most common side effect of anticholinergics. To prevent this, rinse your mouth after using them. Vision problems occur if these medicines come in contact with the eyes. To help prevent this: Always wash your hands after coming in contact with the inhalers or nebulizer solution. Sit downwind from the nebulizer mist. Don t let the nebulizer mist blow back in your face. 15

17 Corticosteroids Corticosteroids are used to treat and control swelling in the lining of the airways (tubes) of the lungs. Examples of corticosteroids are Flovent and Azmacort. These medicines are not the same as anabolic steroids, which are often used by bodybuilders to build muscles. Take these medicines as scheduled, not as needed. To prevent mouth soreness, rinse your mouth after using the medicine. Combination Medicines Combination medicines contain two different types of medication in the same inhaler or nebulizer solution. Combination medicines can also be short-acting or long-acting. Examples of short-acting combination medicines include Combivent and DuoNeb. An example of a long-acting combination medicine is Advair. The side effects that can occur with these medicines depend on which medications are in the combinations. Check with your pharmacist to see if any of your medicines are combination medicines. Leukotriene Modifiers Leukotriene modifiers prevent the effects of leukotrienes, which are chemicals in the body that cause swelling and inflammation in the lungs. Examples of leukotriene modifiers are Singulair and Accolate. Mucolytic Agents Mucolytic agents work to help loosen and clear mucus from the airways. An example of a mucolytic agent is Mucinex (guaifenesin). 16

18 Using Inhalers and Other Devices Inhalers dispense either a fluid or a powdered mist. Each inhaler or device can be a little different, so it is important to learn how to use them properly. If not used correctly, most of the medicine may never reach your lungs. Metered-Dose Inhaler and Spacer The metered-dose inhaler (MDI) is an aerosol and a very common type of device. The medicine comes out of the inhaler in a spray, which may make it difficult to use the device properly. For this reason, you should also use a holding chamber called a spacer whenever you use an MDI. Using a spacer: decreases the side effects of the medicine allows more of the medicine to reach the lungs requires less coordination when you are puffing the inhaler and breathing When you use a spacer, the medicine is puffed into the chamber instead of directly into the mouth. One puff of medicine is sprayed into the chamber, where the particles separate. The large particles, which are too big to enter the lungs, stick to the sides of the chamber. The small particles stay suspended for a few seconds. You can take your time inhaling them, allowing more of the particles to settle in your lungs, where they do the most good. If you do not use a spacer, the large particles settle in your mouth and may cause soreness, a hoarse voice, or a fungal infection in the throat and mouth. Using a spacer is quite easy, but because each spacer is different, you must follow the instructions. 17

19 Using a Metered-Dose Inhaler You should always use a spacer to get the best results from your inhaler, but if you can t use one, follow these steps. 1. Remove the cap and shake the inhaler. 2. Breathe out gently. 3. Put the mouthpiece just outside your mouth, and at the start of a slow and deep breath in, press the canister down and continue to inhale deeply. 4. Hold your breath for 5 seconds or as long as you can and then breathe out slowly. 5. Wait a few seconds before repeating steps 2 through 5 for each puff of medicine you are prescribed. Cleaning the Spacer (once per week) 1. Take the spacer apart. 2. Wash all three parts well with clean, hot soapy water. 3. Rinse with clean, hot water. 4. Soak the parts in a solution of 1 part white vinegar and 2 parts sterile water for 30 minutes. Vinegar is a good disinfectant and will help kill the germs. 5. Rinse well with clean water. 6. Set the parts out on a clean paper towel or dish towel. 7. Allow the parts to dry completely before putting them back together. If you do not allow them to dry, mold and bacteria may grow in your spacer, leading to infections. 18

20 Nebulizer A nebulizer is a machine that breaks up liquid medicine into a fine mist so the medicine can be inhaled. A nebulizer, like an inhaler, can be very helpful for taking your breathing medicines. Use the equipment according to your supplier s instructions. Here are a few helpful hints for using a nebulizer. Sit upright when you are taking your breathing treatment in order to let the mist properly distribute in your lungs. Take a deep breath every fifth or sixth breath and hold it for 5 seconds or as long as you are able. This will also help the mist properly distribute in your lungs. Always keep the plastic nebulizer cup and mouthpiece clean. If they are not cleaned properly, they could cause a respiratory infection. Some plastic nebulizer kits are designed to be replaced every 60 days. Some are designed to last 6 months. Check with your supplier to find out which kind you have. When in doubt, replace any of the plastic parts with new pieces. Cleaning the Plastic Nebulizer Kit Rinse your nebulizer after each treatment. Place it on a clean paper towel or dish towel to dry. When the pieces are completely dry, store them in a clean, dry bag. Disinfect your nebulizer 2 times a week: 1. Take the nebulizer apart and wash it in clean, hot soapy water. 2. Soak the parts in a solution of 1 part white vinegar and 2 parts sterile water for 30 minutes. Do not soak the tubing. Vinegar is a good disinfectant and will help kill the germs. 3. Rinse the nebulizer kit well with clean water. 4. Let the pieces air dry on a clean towel. 5. When the pieces are completely dry, store them in a clean, dry bag. 19

21 Dry-Powder Inhaler A dry-powder inhaler (DPI) is a device that delivers medicine in a powder form so fine that it can be inhaled easily. DPIs come in many different designs. It is very important to use this device properly. Ask your pharmacist or other health care professional about the correct use of your DPI. Always follow the manufacturer s instructions for the best use of any of these devices. 20

22 Breathing Better Breathing Techniques Pursed-lip breathing and diaphragmatic breathing are two simple techniques that will help you get more oxygen into your lungs. These techniques will help you when you re short of breath by slowing your breathing down and decreasing the work of breathing. Pursed-Lip Breathing When you have COPD and other chronic lung diseases, your airways change. When you breathe in, the airways widen to allow for the inflow of air. When you exhale with force, the airways collapse, which traps stale air in the lungs. This air is low in oxygen and high in carbon dioxide. Pursed-lip breathing helps keep airways open longer. You can empty more trapped air from the lungs and allow fresh air to come into them. With pursed-lip breathing, you form a slight resistance at your mouth when you exhale. This causes a back-pressure to occur in your airways, which helps keep those areas of collapse open. This simple but effective technique will help you breathe better right away: 1. Start by relaxing the muscles in your neck and shoulders. 2. Slowly inhale through your nose. 3. Exhale slowly with your lips in a whistling position as if you are blowing on soup or hot coffee. 4. Do not blow too hard or force the air out. 5. Do not puff out your cheeks. Remember: You should always exhale 2 to 3 times longer than you inhale. By doing this, you will empty your lungs as much as possible. Exhale as you exert yourself, usually during the difficult part of any activity. Don t ever hold your breath while exerting. 21

23 Effective Diaphragm Breathing Learning how to do diaphragm breathing, and practicing it on a regular basis, will help prevent shortness of breath. Normally, most of the work of breathing is done by your diaphragm. Chronic lung disease sometimes causes the lungs to enlarge and the diaphragm to flatten. To do diaphragm breathing well, keep your abdominal muscles relaxed as you breathe in. This gives your diaphragm more space to move down, allowing more air into your lungs. When you exhale, tighten your abdominal muscles to force more air out. 1. Lie down or sit comfortably. 2. Loosen any tight clothing. 3. Place one hand over your belly button and the other one on your upper chest. 4. Sniff in. You should feel your abdominal muscles move in. 5. Exhale slowly through pursed lips. 6. Tighten your abdominal muscles and gently push your stomach in. 7. Slowly inhale and push your stomach out. You should feel the most movement in your abdomen. Diaphragm breathing takes practice and patience. Give yourself time to learn this important technique. When you master this, you will have more control over your breathing. 22

24 Keeping Your Lungs Clear COPD can cause your lungs to produce excess mucus. Too much mucus makes breathing more difficult and places you at risk for a lung infection. Excess mucus also makes you cough often, which can be tiring. There are several things you can do to help clear the excess mucus: Drink 6 to 8 glasses of fluid each day, unless your doctor has told you to limit your fluid intake. Fluid thins the mucus, and when mucus is thin, it is easier to cough up. It will take several days of drinking enough fluids before you notice a change in your mucus. Try to limit caffeinated drinks. Coffee, tea, and cola are just a few of the many drinks that contain caffeine. Caffeine can cause fluid loss, which can lead to thicker mucus. Do not take antihistamines or diuretics, unless your doctor has told you to do so. These medications will make mucus thicker and harder to cough up. Controlled Coughing Explosive or uncontrolled coughing causes the airways to collapse or spasm. This traps the mucus, making it hard to get it out of your lungs. This can lead to fatigue and shortness of breath. A controlled cough comes from deep within the lungs. It has just enough force to loosen and carry mucus through the airways without causing them to narrow or collapse. Controlled coughing will save your energy. Using the Huff Cough Technique: 1. Sit on a chair with both feet on the floor. Fold your arms across your abdomen. Start by taking 2 to 4 slow, deep breaths. 2. Take in a slow, deep breath. To exhale, open your mouth and make a huff sound in your throat as you would to fog your glasses before cleaning them. Huff 2 to 3 times as you exhale. 3. Breathe in again by sniffing slowly and gently through your nose. This gentle breath helps prevent mucus from moving back into your airways. Rest and repeat the steps as needed. The first huff loosens the mucus and moves it through the airways. The second and third huffs allow you to cough the mucus up and out. Use this controlled coughing technique after you use your bronchodilator medication. 23

25 Protecting against Infection People with COPD are at higher risk for getting infections. Because of this risk, you need to protect yourself. The best way to keep yourself from getting sick is to wash your hands as often as you can. You can t wash your hands often enough. This is especially important when you are out in public or around others who are sick. Hand sanitizers that do not need water are easy to use as well. You should also ask those around you to wash their hands often. Stay away from large crowds during the time of year when many people have colds or the flu. If you do go out, use your hand sanitizer or wash your hands often. Tell your friends and family to stay away from you if they are sick. Exercising regularly and eating a balanced diet will also help your body fight off infection. Flu Vaccine The flu is caused by a virus that infects the nose, throat, and lungs. Everyone is at risk for catching the flu. The flu and its complications can be harmful for people older than 65 and for those who suffer from chronic lung disease. The best protection from the flu is a yearly flu shot. Flu season usually begins in December and can last into the spring. Plan to get your flu shot about one month before the flu season begins. Because the flu virus changes slightly each year, a yearly shot is needed to fight each year s virus. 24

26 Pneumonia Vaccine The pneumonia vaccine protects you from the most serious kind of pneumonia: pneumococcal pneumonia. It will not protect you against pneumonia caused by other types of bacteria or viruses. Pneumococcal pneumonia is caused by bacteria. These bacteria can also cause other kinds of pneumococcal disease. They can get in the bloodstream, causing bacteremia, an infection of the blood. If bacteria reaches the brain, they can cause meningitis. These are very serious infections that can lead to death. The pneumonia vaccine can be given at any time of the year. You can get it at the same time you get the flu vaccine. You do not need to get the pneumonia vaccine every year, only every 5 years. 25

27 Avoiding Irritants and Allergens When you have COPD, you need to make a special attempt to avoid things that cause flare-ups in your breathing problems. Irritants are substances that can irritate the airways. They may be different for each person. It is important to determine which irritants are your triggers and to avoid these things as much as possible. Common Irritants Smoke Avoid people who smoke, and don t allow others to smoke cigarettes, cigars, or pipes in your home. Always sit in the nonsmoking section of restaurants. Don t burn fires in your fireplace at home. Smog Smog contains car exhaust and other air pollutants. Pay attention to smog alerts announced on the news. The alerts are given when air pollutants are particularly high on that day and may present a problem for those with breathing problems. Stay indoors as much as possible on smog alert days and run your air conditioner if you have one. Strong Odors Any items that produce a strong odor, such as perfume, hairspray, cleaning fluids, scented candles, and insect repellants, should be avoided as much as possible. Cold Weather For some people cold air can cause bronchospasm, making breathing more difficult. If you find that you have trouble breathing cold air, wear some sort of facial covering like a lightweight porous paper mask. This will help warm your inhaled breath. Don t wear anything too heavy over your mouth. Any item that makes it hard for you to speak may interfere with your breathing. Other Irritants Dust, aerosol sprays, and powder are also irritants. Wear a mask if you will be exposed to these irritants when you are dusting, vacuuming, sweeping, or doing yard work. 26

28 Using Oxygen COPD and Your Heart Cor Pulmonale Cor pulmonale is a heart condition that is directly linked to COPD. When you have COPD, the damage to your air sacs and airways can interfere with blood flow in the lungs. The result of this damage is that not as much oxygen goes into the blood and the rest of your body. An oxygen level that is too low can cause pulmonary hypertension, which means high blood pressure in the lungs. This is not the kind of blood pressure that can be measured with a blood pressure cuff. When this happens, a lot of strain is placed on the right side of the heart. The heart s right pumping chamber (ventricle) tries to keep up with the demand of the lungs. This causes the right side of the heart to enlarge and thicken. Cor pulmonale is a result of low oxygen levels. It is something that usually appears later in the COPD disease process when lower oxygen levels have been present for some time. Symptoms of cor pulmonale include: an increase in shortness of breath and coughing swelling of the legs and ankles a bluish or purplish color of the skin or fingernail beds sometimes, pain in the right side of the abdomen Cor pulmonale is diagnosed using an ECG (electrocardiogram), chest x-rays, ultrasound of the heart, and an ABG (arterial blood gas) test that shows the oxygen level of the blood. There are no medicines that can fix cor pulmonale. Treatment is aimed at easing the work of the heart. This is done by providing extra oxygen during times when oxygen levels are low. Extra oxygen can prevent cor pulmonale or keep it from worsening. 27

29 Why Oxygen Therapy Is So Important It would be easy if your doctor or other health care professional could tell you that if you are short of breath, you should wear your oxygen, and if you are not short of breath, it is fine to go without it. It is not always that simple. Low oxygen levels can cause shortness of breath, but a low oxygen level and shortness of breath don t always go together. You could be very short of breath and have a normal oxygen level. On the other hand, you could feel relaxed and comfortable and have a low oxygen level. The best thing to do is to wear your oxygen as instructed by your doctor. When you do this, you will improve the quality of your life. You will be able to increase your activity. You will lessen your shortness of breath. You may even find that you think more clearly because of the increased amount of oxygen to your brain. Working with your doctor or other health care professionals to decide your need for oxygen therapy is very important. Some people need oxygen therapy all or nearly all of the time. Others need it only with exercise or while sleeping. Your need for oxygen might change over time. It is important to ask your doctor to check your oxygen level in case your need for oxygen has changed. FACT: Patients with COPD who need oxygen and use it as instructed by their doctors live longer and have fewer complications from their COPD than those patients who need oxygen and do not use it. 28

30 Common Questions about Oxygen Therapy Is oxygen addictive? No. Either you need oxygen or you don t. Need is decided by measuring the oxygen level of the blood. Your doctor can help determine how much oxygen is right for you. Can you use oxygen for part of the day and store it up for later? No. You get the effects from oxygen while you have it on. When you take it off, you lose the effects right away. It is best if you wear your oxygen during any type of activity if you know your oxygen level drops with activity. Can you wean yourself off oxygen by slowly decreasing the amount of time you wear it each day? No. Slowly decreasing the amount of time you wear oxygen will not make your lungs stronger. Again, either you need oxygen or you don t. If you need oxygen, wearing it will give you more energy and allow you to live longer with fewer complications from your COPD. Qualifying for Home Oxygen In order to qualify for insurance to pay for home oxygen, the oxygen level in your blood must be below a certain level. The guidelines require either a special blood test known as an arterial blood gas (ABG) test or a pulse oximeter test. A pulse oximeter is a device that is placed on the finger to determine the oxygen level. Sometimes, a pulse oximeter test is done at night to determine whether someone needs oxygen only while sleeping. To qualify for payment for oxygen, your oxygen level can be no higher than 55 in the ABG test or 88% on the pulse oximeter test. If your results do not meet these guidelines, oxygen therapy would not be helpful for you. These numbers are not decided by insurance companies. Medical studies have shown that only people with results below these levels benefit from oxygen therapy. 29

31 Oxygen Equipment There are some things you should know about your equipment if you have oxygen at home. Work closely with your doctor and your oxygen provider to determine which oxygen system is right for you. Oxygen Concentrator A machine called an oxygen concentrator is the one used most often to provide oxygen in the home. The concentrator runs by electricity. It separates the oxygen in room air and delivers it at 90% to 95% purity. Since the concentrator basically makes its own oxygen, no refills are needed. Concentrators also come in portable units providing continuous flow and pulse dose options. Many of these portable units have been approved by the Federal Aviation Association (FAA) for travel on most major airlines, cruise ships, trains, and buses. Liquid Oxygen in Tanks Oxygen is also available in liquid form. It is stored in large tanks in your home, and the oxygen supplier must regularly refill the tank. Because liquid oxygen is more expensive than other forms of oxygen, not all oxygen suppliers carry it. If your supplier does carry liquid oxygen, you may have to meet special guidelines in order to receive it. Liquid oxygen can provide small portable units that are filled off a larger holding unit or reservoir. Nasal Cannula Oxygen is often delivered through a nasal cannula. A nasal cannula is a two-pronged device placed in the nose and connected to tubing that in turn is connected to the concentrator or liquid tank. 30

32 Portable Oxygen Portable oxygen systems provide oxygen while you are away from home. These systems consist of an oxygen tank, a regulator (gauge), and a carrying device. Larger portable tanks need to be rolled around in a carrier. Smaller tanks can be carried in a shoulder bag or backpack. Smaller portable oxygen systems require the use of an oxygen-conserving device. The conserving device is a special regulator that delivers oxygen only when you take in a breath. This allows the tank or portable unit to last longer. Your doctor must write a prescription for an oxygenconserving device. A humidifier bottles helps with dryness of the nose. It should be filled with distilled water and cleaned well at least twice a week by washing it in hot soapy water and soaking it in a solution of 1 part white vinegar and 2 parts sterile water for 30 minutes. Caring for Oxygen Equipment Your equipment provider should provide you with written instructions on the care of your oxygen equipment. If you do not have these written instructions, contact your equipment supplier for a copy. Instructions should include information on: cleaning the outside of concentrators cleaning and/or replacement of filters replacing tubing and other disposable items 31

33 Oxygen Safety Accidents in the home are rare if a few common-sense safety rules are followed when using oxygen. Oxygen is actually a very safe gas. It is not flammable on its own, and it is not explosive. However, oxygen supports burning. This means in the presence of something that is already burning, oxygen will make it burn hotter and faster. Concentrators need to be: placed in a space that allows 6 to 12 inches around the unit for proper ventilation and heat exchange. plugged directly into the power outlet. (Do not use an extension cord.) Repairs Never lubricate your oxygen equipment with oil or any other petroleum-based products. Do not try to repair your own equipment. Most providers will teach you a few simple troubleshooting techniques. If these do not work, call your equipment provider for repairs. Backup Tank You will be provided with a backup tank to use in case of a power outage or equipment breakdown. Make sure that your backup tank is always ready to use in an emergency. Once you use it, have another tank delivered to replace it. 32

34 Other Safety Rules Never smoke with oxygen on. Post No Smoking signs and do not allow anyone to smoke near oxygen. Make sure smoke detectors are present and working. Have a fire extinguisher nearby and know how to use it. Remove your oxygen when you are using an electric razor or a hair dryer. At the beauty shop, take off your oxygen when you are sitting under the dryer or when the stylist is blow-drying your hair. Do not use a heating pad or electric blanket while you are wearing oxygen. Do not use Vaseline or other petroleum/oil-based products in the presence of oxygen. Use a water-based product like KY Jelly instead. Make sure your oxygen tubing does not come into contact with heat-producing appliances such as stove burners or a heater. Keep flammable materials and open flames at least 6 feet away from your oxygen equipment. Use caution while cooking: Remove your oxygen if you are using a gas stove. You can wear your oxygen while cooking at an electric stove if you keep the tubing over your shoulder. Use a clip clothespin or a chip clip to fasten the tubing to your clothes to make sure it doesn t accidentally fall forward. While wearing your oxygen, always use caution when operating a stove. Never turn your oxygen up past the prescribed flow rate without consulting your doctor. 33

35 Living with COPD The less you do, the less you ll be able to do. This does not mean your lung disease is getting worse. Conserving Energy and Simplifying Work Being active is good for your health. People with chronic lung disease and other pulmonary diseases can be active. This will help you function at your best. Doing More with Less Shortness of Breath Use your energy wisely. Use it for the tasks most needed and important to you. Always control your breathing while walking or doing other physical activities. Use pursed-lip and diaphragm breathing. Never hold your breath during any activity. Always exhale with the strenuous part of an activity or with the part of the activity requiring motion toward the body. Pre-plan your activities to avoid rushing. Try setting a daily or weekly schedule. Consider the best time for each activity. Do the most strenuous activities at the time of day when your energy level is highest. If morning is the hardest time for you, do as much as you can in the evening. Organize your activities. Gather together all the items needed to complete a task. Avoid making extra trips. Don t do something while standing up if it can be done while sitting down. Use a terry-cloth robe for drying yourself after bathing. Put the robe on right after getting out of the shower. After use, hang it up on a hook to use for the next time. 34

36 Exercise and Pulmonary Rehabilitation Has shortness of breath caused you to cut back on activity? You may have started this years ago without even realizing it by doing things such as parking closer to the door of the grocery store. When you cut back on your activities, your muscles get out of shape. When your muscles get out of shape, they use twice as much oxygen to do the same amount of work. This in turn makes you more short of breath. This is the vicious cycle of shortness of breath that occurs in chronic lung disease. It leads you to be inactive and unable to do enjoyable activities and to feel anxious and dissatisfied with your life. Exercise can stop this cycle. Exercise gets your muscles back into shape and allows them to make better use of the energy and oxygen that are available to them. Exercise improves your strength and stamina while reducing your shortness of breath, fatigue, and anxiety. Exercise can give you a new outlook on life. A regular, gradual increase in exercise slows the progression of chronic lung disease. Keeping active can help you feel better, increase your energy, and relieve stress. Some of the benefits include: Decrease in shortness of breath by increasing tolerance for exercise and activity Increase in muscle strength Increase in strength of heart and blood vessels Increase in lung efficiency for delivering oxygen to the body Slowing the progress of chronic lung disease and the aging process Improved quality of life Always check with your doctor before starting any exercise program. 35

37 Pulmonary Rehabilitation The best way to exercise and get your muscles back into shape is to participate in a pulmonary rehabilitation program. Pulmonary rehab is a standard of care for chronic lung disease patients around the world. Taking part in pulmonary rehab will allow you to: Increase your understanding of COPD Improve your exercise tolerance Improve your ability to do everyday activities Increase your sense of well-being Decrease your shortness of breath Reduce unnecessary hospitalizations Pulmonary rehab is a structured program of exercise and education for people with chronic lung disease. By combining exercise with education, breathing retraining, nutritional counseling, and psychosocial support, an outpatient pulmonary rehab program can help you begin to live a healthier life. Because a chronic illness can affect every aspect of your life, pulmonary rehab can teach you what you need to know in order to cope successfully with all the challenges that arise. Since your muscles didn t get out of shape overnight, it will take some time to get them back into shape. Most pulmonary rehab programs include 3 sessions a week for 8 weeks. When you finish with pulmonary rehab, you will be able to do more and have less shortness of breath. The commitment is worth it. Medicare and most other insurance plans often pay for these sessions. In order to choose the pulmonary rehab program that is right for you, you should ask questions such as: Is the program operated by licensed or certified health care professionals such as respiratory therapists and exercise physiologists? Is the program accredited by a national professional health care organization? How many sessions are included in the program? Will my insurance cover the program? Participating in pulmonary rehab can be one of the smartest decisions of your life. Pulmonary rehab will give you the tools to control your disease so it doesn t control you. 36

38 Exercising at Home If for some reason you are not able to take part in pulmonary rehab, you can start your own exercise program at home. It may take longer and the results may not be as dramatic, but you will still see benefits. If you are going to start an exercise program on your own, talk to your doctor before you start. Walking, cycling, and swimming are good activities you can do on your own to improve your health. Many people choose to walk, because you do not need any special equipment for walking. Walking outside is often not a reliable form of exercise. Many things can interrupt your outside exercise routine. It can be too hot, too cold, raining, snowing, or icy. Explore your options for walking indoors such as mall walking or walking up and down the aisles of your local supermarket. Other options for exercise include using an exercise bike or treadmill. These can be purchased new or at secondhand sports stores at a reduced price. Sometimes someone you know might have exercise equipment that he/she is not using. Senior centers often have exercise classes that can be easily adapted for people with COPD. It is important to check out all the options. Whatever form of exercise you choose, doing it on a regular basis is the key. You need to exercise nearly every day in order to see results. It is okay to start out slowly and build up over several weeks. If you exercise for 2 or 3 minutes one or more times a day, you will soon be able to exercise for 5 or 6 minutes every day. You will soon be able to do more with less shortness of breath. 37