COPD Resolutions You Should Keep

The following was written by me and published at healthcentral.com/copd on January 4, 2016

COPD Resolutions You Should Keep

A New Year's Resolution can be a powerful aide to helping you live well with COPD. Here are some we think would be perfect for you to choose from.

 

1.  Learn about your disease.  Both COPD and Asthma are complex diseases that researchers are learning more and more about every day. It's a good idea purchase a book so you can become a pseudo expert on your disease. Or, at the very least, continue to hang out at sites like this, as we do our best to keep you updated with the latest wisdom. This is also important because there are a lot of new respiratory medicines in the pipeline, and you'll want to be aware of them when they come out. Who knows, the next discovery might lead to a cure for our disease.

 

2.  Walk more frequently.  I recently wrote a post about titled, "9 Ways Exercise Improves Asthma Control."  You should go ahead and read that article (and then come back here), because the same is true for COPD. The more you exercise, the stronger your heart and lungs become, and the more efficient they become at pumping oxygen and nutrients through your body. This leads to better breathing.  As a bonus, it also improves your mood and your overall sense of wellbeing. Look, there are even victims of COPD who walk marathons.

 

3.  Join a pulmonary rehabilitation program.  This kind of goes along with walking more frequently. Pulmonary rehabilitation programs can help you get the exercise you need while educating you about your disease, and helping you meet others just like you to give you the support you need.  Actually, Pulmonary Rehabilitation is now a top-line recommendation for anyone with a COPD diagnosis, especially if you get winded doing normal routines (like going to the bathroom or brushing your teeth). Again, exercise makes your cardiovascular system work better, making you more tolerent to exercise.

 

4.   Eating healthier.  Look, many of us have difficulty maintaining a healthy weight. But if you have a breathing disorder, it's almost essential that you eat healthier.  Most experts recommend eating five or six smaller meals, rather than three large ones. The reason is that a full stomach pushes up on your diaphragm, making less room for your lungs to expand. You could try to do this on your own, or, better yet, you could have your doctor refer you to a dietician who can give you tips to healthier eating.

 

5. Eliminate carbonated beverages from your diet.  A good idea for any person with a lung disease is to lay off the pop and beer. For one thing, they can cause gas and bloating, and this causes your stomach to push up on your diaphragm making less room for your lungs to move.  They may also increase the carbon dioxide in your blood, which is chronically elevated in some COPD patients anyway. A good idea is to avoid them altogether, or at least limit your intake to one or two a day.

 

6.  Go on vacations.  Even if you need supplemental oxygen 24/7, the equipment is now so modernized you should be able to go anywhere. You can travel across the state to visit relatives you haven't seen in a while, or simply go on a vacation for fun (like to Disney World).  The idea here is that you can still keep living, you can still have fun, even with a chronic lung disease like COPD.

 

7.  Participate in a COPD community like ours.  The best place to learn about your disease is to hang out at communities like ours.  Here you will get the expert advice from doctors, nurses, and respiratory therapists like me.  We will educate you about your disease, provide tips to help you live better with it, and sometimeseven share our own stories. Along with experts like me, you will also meet other people living with it just like you. So feel free to hang out with us, sign up for our newsletters if you want, and have a Happy Easy Breathing New Year!

 

You May Also Enjoy Reading:

• 10 Tips to Living An Active Life With COPD
• Have COPD? Here's 6 Things To Keep Handy
• Maining Control Of Your COPD

Christmas-time COPD triggers

The following was written by me and published at healthcentral.com/copd on December 18, 2015.

8 Christmas COPD Triggers

In order to get the most out of the Christmas season, those of us with lung disorders have to be wary of Christmas asthma triggers. Here are those seven triggers along with some tips to help you get around them.   

1. Real Christmas Trees.  Christmas trees are a common decoration in homes during the Christmas season.  But they may also be filled with unseen substances that can get into the air, such as dust mites, pollen and mold spores.  When you carry them into your home, and shake them, these allergens end up in the air of your home for you to inhale, possibly causing flare-ups. While some experts recommend avoiding them altogether, others suggest that rinsing them off with water, and letting them air dry, prior to bringing them into your home should remove most of these allergens. It may be best, however, to delegate this job to someone else.

2. Artificial Christmas Trees. So, if real trees are full of COPD triggers, fake trees should be better, right? Well, experience shows this not to be the case.  Artificial trees may be fine the first time you set them up.  But after storing them in boxes in closets and basements, they become breeding grounds for dust mites.  When you open the box and put the branches on the tree, you’re inadvertently  freeing these microscopic critters into the air and inhaling them. The best solutionhere, other than avoiding them, is to rinse the tree off with water and letting it dry before setting it up. But this job should be delegated to someone other than you.  Another solution is to store your tree in an airtight container.  

3. Decorations. Dust mites are the culprits here too.  Decorations are stored in boxes in closets, attics, and basements.  Like fake trees, they become infested with dust mites.  One way to avoid this is to store decorations in plastic storage bins to keep dust mites out.  Another solution is to let someone else set up the decorations.

4. Visitors. Okay, so the greatest joy of the holiday season is spending time with friends and family. Still, visitors carry germs that can get you sick, and even a common virus (common cold) can cause a flare-up.  The greatest culprits here are little children, who love to share their germs through their sniffles and sneezes, but also their hugs and kisses.  We certainly recommend spending time with those you love, just make sure they know that their germs might take your breath away. As best you can, try to stay away from sick people. And, no matter who you’re spending time with, just note that the single best method of avoiding the spread of germs is by frequent hand washing with antimicrobial soap or hand sanitizer.

5. House Cleaning.  Of course part of the holiday season is getting your home ready for guests. While this may seem like no big deal, chemicals inside some cleaning supplies can act as rather potent COPD triggers.  Just make sure you are careful not to use cleaning supplies that may cause problems for you. One solution here is to simply stick with the cleaning solutions you’ve already been using. Or, better yet, let someone else do the cleaning.  

6. Scented Candles. Candles and incense can make your home smell good for the holiday season.  But it’s also good to remember that strong smells may also act as COPD triggers.  Likewise, smoke from candles and incense may also act as triggers.  It’s probably best just to avoid them altogether.

7. Wood Fires.  A fire in the fireplace can make a home feel very cozy for the holiday season.  The problem is that wood smoke in and of itself may trigger flare ups. Also posing a problem is the stack of wood next to the fireplace, which may contain mold spores and pollen. So it’s best to just avoid lighting the fire and keep the logs outside.  However, newer fireplaces can be lit by electricity or gas, and these should be fine.

8. Stress. So you’re known for shopping long hours searching for that perfect gift.  You’re known for spending hours decorating your home just right, and preparing the perfect meal.  These are things that can cause ongoing pressure during the holiday season, causing a rise in hormones that may weaken your immune system and cause flare-ups.  The best solution here may be to delegate some of the responsibilities that come with the holiday season to others.  And, chances are, they will be more than willing to help you.

Enjoy the holiday season!  So long as you are aware of them, these eight potential COPD triggers should not stop you from having a joyous holiday season. Here’s our opportunity to wish you and your family a Merry Christmas and a Happy New Year!

Further Reading

• MNT: Wood Smoke Exposure Multiplies Damage From Smoking, Increases Risk of COPD
• 7 COPD Winter Triggers
• 10 Tips To Living An Active Life With COPD
• Living With COPD: 10 Tips To Enjoy The Holidays 

10 Links Between Poverty and COPD

Originally published at healthcentral.com/copd

Research published in January, 2014, suggests an inverse relationship with Gross National Income (GNI) and the incidence of COPD. Data from 170 countries showed the incidence of COPD was highest in areas where the GNI was below $15,000. The data seems to confirm a suspected link between COPD and poverty.

This information noted, we thought we'd list 10 possible reasons why those in poverty may be at an increased risk for developing COPD, or at an increased risk for having COPD flare-ups. 

1.  Tobacco smoke.  CNN reported in 2014 that as smoking rates have declined in more affluent areas, they have stayed relatively unchanged in poor and working class areas.  The report quotes a study showing cigarette companies advertise cheaper cigarettes in such areas. Being that studies overwhelmingly show that cigarette smoking is responsible for about 80 percent of COPD cases, it only makes sense the impoverished would have a greater incidence of COPD.

2.  Wood Smoke.  Studies seem to suggest this may be just as harmful to airways as tobacco smoke. It contains many of the same chemicals and irritants contained in tobacco smoke. Studies have linked it with both asthma and COPD. Wood as a source of heating and cooking seems to be more prevalent in impoverished neighborhoods and underdeveloped nations. It’s a significant source of both indoor and outdoor air pollution in such areas.

3.  Occupations.  Those in poverty are more likely to take on high risk jobs. This may expose them to harmful chemicals, irritants or fumes that may harm airways, cause COPD flare-ups, and even cause COPD.

4.  Crowding.  Too many people in small, enclosed rooms may increase the risk of spreading germs that cause infections. This is even more important during winter months when doors and windows are closed and homes are heated and poorly ventilated. Respiratory infections may trigger asthma attacks and COPD flare-ups.

5.  Education.  Lack of access to education, or lacking the time to educate one's self, may cause impoverished people to expose themselves to situations that the educated would otherwise avoid. This may explain why smoking rates are higher in impoverished areas.

6.  Stress. Of course, another reason explaining high smoking rates may be pressure caused by poverty. Lacking the ability to support yourself and your family may result in stress leading to risky behaviors such as smoking cigarettes. Stress may also trigger flare-ups, result in poor compliance with medicine, and result in poor COPD control.  

7.  Housing. Older homes, or homes in poor repair, may increase exposure to mold due to water leaks and humid basements. Mold spores can get into the air inhaled and trigger COPD flare-ups.  Dust mites thrive in warm and humid environments, and feed off flakes of skin that land on pillows, mattresses, and upholstered furniture. Lack of money may make it difficult, if not impossible, to remedy these problem areas.

8.  Crowding.  People with limited resourses are increasingly likely to shack up with other people in similar situations. Many people in closed in spaces can create a breeding ground for germs that may cause respiratory infections. Sneezing and coughing can help them spread from person to person. This is compounded when the heat is on and all the doors and windows are closed. Lung infections are a major source of COPD flare-ups.

9.  Poor nutrition.  A simple way of staying healthy is by eating a healthy diet. This may be difficult if you don’t have the funds to afford healthy foods.  Or, worse, if you cannot afford food altogether. Proper nutrition is essential to maintaining healthy lungs. Proper nutritian is also necessary so you have the strength to stay active and reduce loss of muscle mass caused by sedentary living. Those in poverty are also more likely to eat at affordable fast food restaurants like McDonald’s. This is not good, as high fat foods have been linked to asthma, and of course asthma is linked to COPD.

10. Healthcare.  Many governments have attempted to make healthcare more affordable. Sometimes, however, even affordable healthcare isn’t so affordable. Also posing a problem here is poor awareness of healthcare options, poor access to physicians, and poor access to funds needed to pay for COPD medicine, which tends to be rather expensive.

What does this mean?  It means that those in poverty are at an increased risk for developing lung diseases like COPD. This spotlights the ongoing need for governments to create economic environments that encourage economic growth and prosperity. It also spotlights the need for creating programs to help those in poverty gain access to healthier neighborhoods, healthier homes, health care education, health care coverage, physicians, and medicine.

You may also enjoy reading:

Links Between Asthma and COPD

High Fat Foods May Trigger Asthma

Is It A Cold Or Allergies Triggering Your Asthma

Links Between Mold And Asthma

Dusts Mites May Trigger Asthma and COPD

Why Are COPD Inhalers So Expensive, And What Can You Do About It?

Gold: COPD Guidelines, page 21

RT Magazine: Study Identifies Link Between Poverty And COPD Mortality

Wood Smoke Linked to COPD and Asthma

The following was originally published at healthcentral.com/asthma. 

Wood fires have been used for heating and cooking for most of history. Even today they continue to be used, sometimes for fun and entertainment, although often as a much needed source of heating and cooking. The problem, though, lies in the smoke created, which has now been linked to asthma and COPD.

What is wood smoke?  

Well, most poeple know what wood smoke is.  Still, the technical name for wood smoke is biomass smoke.  Biomass is fuel created from living or recently living organisms, such as trees, plants, animal dung, charcoal and coal. Biomass smoke comes from wood stoves, fireplaces, campfires, wildfires, and leaf burning.  It also comes from cigarettes and cigars.

Biomass contains carbon, hydrogen and oxygen. Biomass burning, called combustion, results in a series of chemical reactions that turn carbon, hydrogen and oxygen into carbon dioxide, water and heat. However, due to incomplete combustion, the reaction also releases pollutants into the smoke created.

These include:

• Harmful Chemicals.  These include carbon monoxide, formaldehyde, benzene, toluene, acrolein, methane, and methyl chloride.  These may irritate cells lining your respiratory tract to trigger asthma attacks and COPD flare-ups.
• Particulate Matter.  These are solid and liquid particles of incompletely burned wood, many of which are small enough to be inhaled deep into airways. Like chemicals, they may also irritate cells lining your respiratory track to trigger attacks and flare-ups. 

What do the studies show?  

A great deal of studies have pretty much confirmed the link between wood smoke and respiratory diseases like asthma and COPD. As a matter of fact, wood smoke may trigger asthma attacks and COPD flare-ups, and it may also cause asthma and COPD, just like cigarette smoke does.

Studies have also linked inhaling wood smoke with:

• Small birth weight, which has also been linked to asthma and to COPD
• Respiratory infections like pneumonia, which may trigger asthma and COPD
• Lower respiratory tract infections in children, including pneumonia and bronchiolitis, which are also linked with the development of lung disease later in life
• Increased incidence of strokes and heart problems
• Eye disease, as smoke also irritates cells lining your eyes
• Cancer, such as lung cancer
• Headaches

How does wood smoke cause respiratory complications?

Acute Exposure. Inhalation of certain chemicals and particulate matter may irritate airways, triggering an immune response.  This sets off a series of chemical reactions that cause cells lining airways to become inflamed.  This irritation results in asthma and COPD symptoms like wheezing, coughing, and shortness of breath.

Chronic Exposure.  Exposure to biomass smoke day after day after day may cause this inflammation to become chronic, such as what occurs in asthmatic airways. Chronically inflamed airways may also cause scarring that makes airways thicker.  It may also result in loss of lung tissue. These are patterns that result in airflow limitation, or COPD.

What circumstances increase your risk for developing health problems due to smoke inhalation?  

Cold Weather.  Molecules in hot air are farther apart, and so warm air tends to rise. This makes it so smoke created from a campfire on a warm summer day is likely to rise away from people, and therefore is less likely to cause problems. Molecules in cold air are bundled together, and so cold air tends to stick near the ground. So smoke on a cold day tends to linger near the ground and is more likely to be inhaled. So, if you have a lung disease, some alternative source of heat may be beneficial.

Enclosed Spaces. During winter months, when it’s cold outside, people tend to keep their windows and doors shut. This makes it so wood smoke lingers inside homes, increasing the likelihood of it being inhaled. One study actually showed that women who spent years cooking over wood fires had an elevated incidence of respiratory complications. So it’s best to avoid using wood stoves and fireplaces, although if you must use them, keep a window open to improve ventilation.

Neighborhoods.  Of course if you have a wood stove or fireplace in your home, you are at the greatest risk of inhaling wood smoke.  However, if you do not burn wood in your home and your neighbor does, smoke may enter your home even with closed windows and doors.  This may be especially true on cold days. Some neighborhoods may solve this problem with bans on wood stoves and fire pits.

Poverty.  Wood heat is convenient and it’s also relatively inexpensive. This is nice for people in poverty, and it’s also nice for people in underdeveloped countries. Unfortunately, this also leads to indoor air pollution and an increased incidence of the complications of inhaling it. About three billion people continue to heat and cook using biomass fuel.

What does this mean?  Surely this may be difficult for some people, although it basically shows the need to limit exposure to wood smoke, especially if you have a family history of respiratory diseases, and especially if you already have a diagnosis of asthma or COPD. Alternative sources of heat, include gas, electricity, and heating oil. 

References and further reading:

• 6 Tips to Help You Quit Smoking
• 7 Things That May Cause COPD
• PubMed: Wood smoke exposure and risk of chronic pulmonary disease
• PubMed: Exposure to biomass smoke as a cause for airway disease in women and children.
• NCBI: Indoor air pollution from biomass fuel smoke is a major health concern in the developing world
• CDC: Biomass smoke exposure: health outcomes measures and study design
• WHO: Biomass Pollution Basics
• WHO: Household Air Pollution and Health
• State of Washington: How Wood Smoke Harms Your Health

Fetal Origins Hypothesis: Mother’s Environment May Cause COPD

Originally published at healthcentral.com/copd

Researchers are working overtime to learn what causes COPD. The Fetal Origins Hypothesis suggests it all begins in the uterus as the fetus adjusts to its environment. Such adjustments may predispose the fetus to chronic diseases like asthma and COPD later in life.  

During the 1950s and 1960s, physicians thought the placenta was a natural barrier that protected unborn babies from the mother’s environment; that it protected the fetus from anything bad ingested or inhaled; that it only allowed good substances, such as essential nutrients, to get to the fetus.

It was based on this old theory that caused physicians, or at least many of them, to remain indifferent to a mother’s nutritional status.  If anything, it was prefered they didn’t gain too much weight. Physicians also remained unconcerned about mothers having a few drinks or inhaling cigarette smoke. In fact, during the 1960s, about half of expectant mothers reported smoking cigarettes.

However, by the 1990s an abounding amount of evidence started to show that this theory was probably poppycock, that the placenta was not a natural barrier, and that anything the mother inhaled or ingested could have a major impact on the growth and development of the fetus, especially during the first trimester.  

In 1992, Dr. David J. Barker became the first person to seriously consider this new evidence. He postulated that undernourished infants tended to have small birth weights and were likely to have trouble with obesity later in life. This became known as Barker’s Hypothesis. This hypothesis was later expanded upon to include other chronic diseases, and is now referred to as the Fetal Origins Hypothesis.  

Barker believed inadequate nutrition programmed the fetus’s to develop metabolic changes that would predispose the unborn baby to chronic diseases later in life. Others suspected gene mutations leading to physiologic and metabolic changes that prevent the child from reaching a healthy birth weight.  

A good example here is COPD. The hypothesis suggest that changes made in utero as fetus’s attempt to adapt to their mother’s environments cause airway changes that prevent these children from obtaining peak lung function by early adulthood.  It is these children who are most likely to develop COPD when chronically exposed to harmful substances in the air.

Subsequent studies have linked small birth weights with decreased lung function and increased risk for respiratory symptoms (wheezing, shortness of breath) in childhood.  Other studies have small birth weights with the development of asthma later in life. It should also be understood here that researchers suspect up to 15 links between asthma and COPD.

There exist other interesting facets of this hypothesis. For instance, it suggests that the nine months in utero are the most critical in a person’s life.  It suggests that the mother’s environment may have a significant impact not just on the development of chronic diseases later in life, but also on a child’s future life, maybe even determining the child’s level of intelligence and future abilities.  

While it’s just one hypothesis, it seems to be well accepted by the scientific and medical communities. It shows the importance of ingesting a healthy diet and inhaling healthy air on the future health and abilities of unborn babies. Perhaps future research in this regard will lead to an end to diseases like asthma and COPD.

Here are my references and some further reading you may enjoy:

15 Links Between Asthma and COPD

Impact of Genes on COPD

Links Between Asthma and Genetics

NCBI:  Killing Me Softly: The Fetal Origins Hypothesis

NCBI: Early Life Influences on the Development of COPD

NCBI: Early Origins Or Chronic Pulmonary Disease

NCBI: The Fetal Origins of Adult Disease: A Narrative Review of the Epidemiological Literature

NCBI: Effects of Low Birth Weight on Childhood Asthma

Here’s 10 Potential Causes of COPD

The following was originally published at healthcentral.com/copd. 

Studies suggest that about 95% of people who develop COPD are current or former cigarette smokers. Still, evidence suggests that smoking is not the only risk factor, and that people who have never smoked may still develop COPD. Here are ten risk factors for developing COPD.

1  Smoking Cigarettes.  It’s not so much the nicotine, but the 5,000 chemicals in cigarette smoke that cause all the harmful effects of smoking, including the destruction of lung tissue and the loss of lung function. In fact, studies show smoking is harmful to the smoker and anyone else who happens to inhale it -- including children, and even fetuses.

2   Genetics.  I previously discussed the impact of genetics on COPD.  The general idea is that repeated exposure to certain substances in the air, such as chemicals in cigarette smoke, may cause airway changes that result in COPD. Certain genes may also increase the risk of developing COPD, especially when exposed to environmental triggers like cigarette smoke.

3.  Aging.  Some people develop senile emphysema, which is the slow but natural breakdown of lung tissue as one gets older. Studies suggest this is probably caused by increased air spaces in the lungs due to natural causes, and not due to inflammation caused by chronic exposure to pollutants.

4.  Gender. Older studies showed that men were more susceptible to COPD than women, although this may have been due to the fact men were more likely to smoke.  Modern evidence may actually suggest that women are more likely to develop COPD than men. You can learn more by reading our post Why Women Are at Higher Risk for COPD Than Men.

5.  Lung Maturity.  Studies seem to suggest that anything that negatively impacts lung growth at or near birth may contribute to the development of asthma or COPD later in life. Premature birth, small birth weight, and severe lung infections have all been linked with the development of asthma and COPD. Generally, small birth weight is considered less than five pounds.

6.  Wood Smoke.  Smoke produced from wood stoves, fire places, wildfires, campfires, and cigarettes contains microscopic particles and toxic chemicals that can easily be inhaled deep into the lungs. These particles are believed to damage airways leading to loss of lung function over time. 

7.  Chemicals.  Chemicals from common household cleaners, or those produced at work, may easily be inhaled deep into airways.  Chronic exposure may result in airway changes that cause a gradual loss of lung funciton. Harmful chemicals are also in cigarette and wood smoke.  

8.  Poverty.  Some studies show an inverse relationship between income and COPD, with those in poverty more likely to develop it. No one knows the exact reason, although exposure to outdoor and indoor air pollution at home or work may be a contributing factor. Stress may result in risky behavors, such as smoking cigarettes and taking high risk jobs, both of which increase exposure to high risk chemicals that are linked to lung disease. To learn more, read our post “7 Links Between Poverty and COPD.”

9.  Asthma. Asthmatic airways are chronically inflamed and over-sensitive to asthma triggers, such as dust mites, mold spores, pollens, cockroach urine, and other microscopic substances that get into the air inhaled.  Studies suggest that repeated and uncontrolled asthma may lead to airway changes and the development of the Asthma COPD Overlap Syndrome, otherwise known as Severe Asthma.  Other studies suggests those diagnosed with asthma have a 10% greater chance of developing COPD than those without asthma.

10.  Chronic Bronchitis. This is defined as chronic cough and increased sputum production at least three months a year for two straight years. It may exist without loss of lung function, and without the presence of emphysema.   Still, evidence exists that the accumulation of mucus may obstruct airways leading to loss of lung function and shortness of breath. Evidence suggests that those who continue to smoke after a diagnosis of chronic bronchitis are at increased risk for developing COPD.  

10.  Infections.  Severe lung infections early in life may cause airway changes that  lead to loss of lung function and increased shortness of breath later in life. Actually, various studies have linked severe lung infections early in life with asthma and COPD.

Continuing Education.  As researchers learn more, there may be more added to this list of things that might potentially cause one to develop COPD. Such knowledge may be key to preventing chronic lung disease in the future.

You may also enjoy reading:

• GOLD: COPD Guidelines
• Impact of Genetics on COPD
• What is Asthma COPD OverLap Syndrome
• Why Women Are More Likely To Develop COPD Than Men
• 12 Things that May Cause Asthma Near Birth
• What is Third Hand Smoke

6 Things COPDers Should Keep Handy

The following post was written by me and published at healthcentral.com/copd on November 4, 2015

Have COPD? Here's 6 Things To Keep Handy

Having a chronic disease like COPD means being prepared for that inevitable flare-up. This requires having easy access to all the tools needed to help you breathe better. Here are six things to keep handy at all times.

1.  Controller Medicines.  These are all the medications meant to keep you breathing well.  They usually include a combination of inhalers and nebulizer medications. They should be kept in a location that is easy for you to access, such as your medicine cabinet, or even your bedside or kitchen table. You must make sure you take these every day exactly as prescribed.  Not only are these meant to prevent flare-ups, they may also make inevitable flare-ups less severe and easier to control.  

2.  Oxygen equipment.  If you have oxygen at home, and you wear it all the time, you probably don’t have to worry here.  However, many who have home oxygen only wear it at night, or in times of trouble. This equipment needs to be in a very convenient location so you can get to it even when you feel like you can’t catch your breath.  Depending on the cause of your flare-up, many times oxygen alone can help you feel better.

3  Rescue medications.  These are the medicines -- like Albuterol and Xopenex -- meant to help you catch your breath. Inhalers can easily fit in your purse or pocket, but they are also easy to lose. Make sure you have a spare nearby.  If you take breathing treatments, you’ll need easy access to both the nebulizer, the air compressor, and the medicine to go with it.

4  Emergency phone numbers. These include the numbers to anyone who can help you decide what to do, or who can drive you to your doctor or to the hospital.  Numbers to include are your doctor, hospital, and caregiver.  This list will also tell emergency professionals who to call in the case of an emergency.  

5.  Directions.  So your doctor wants to see you at the office. When you can’t breathe, sometimes it’s hard to remember how to get places. Don’t just assume your caregivers know where to go.  Have addresses, and directions, easily available. Directions to the nearest hospital should also be included.

6  COPD action plan.  This is a plan to help you decide what action to take in the event a flare-up does occur.  Should you use your oxygen? Should you use your rescue medicine? Should you call your caregiver, your doctor, or 911?  It should also include emergency phone numbers and directions. An ideal place for this plan is on your refrigerator or on top of a table nearby where you spend most of your time.  You should also keep a copy in your wallet or purse.  This way anyone who cares for you has easy access to it.

Be prepared.  It’s normal to have trouble moving around, or to have trouble deciding what to do, when you’re having trouble breathing. This is why it’s so important to plan ahead and have readily available all the tools you or anyone else needs to help you breathe better.

Related Links:

• 10 Tips to Living An Active Live With COPD
• What Controller Medicine Works Best For You?
• What Is A COPD Action Plan?
• Do You Need Oxygen Therapy?
• What Is A Nebulizer?
• RT Cave Facebook Page
• RT Cave on Twitter

Learning Basic Lungsounds

The following was written by me and published at healthcentral.com/copd on January 25, 2016

Lungs 101: Learning Basic Lung Sounds

I have been listening to lung sounds for 20 years now, and every so often someone wants to know what I heard and what it means. That said, here is a pithy lesson on the five basic lung sounds and what they mean. 

First, however, a few definitions. 

Auscultation: The process of listening to lung sounds.  It can be done ear to chest, although most health professionals prefer to use a stethoscope. 

Stethoscope: It's a medical device used to auscultate (hear) lung and heart sounds.

Listening to lung sounds is an important part of assessing a patient. Based on what is heard can help a caregiver both diagnose and treat patients, and determine the progression of lung diseases over time. 

There are basically only five lung sounds.  You'd think that would make listening to them easy, but that's not always the case considering every patient is different. Regardless, here are the basic five and what they might mean.

1.  Clear.

This is a normal lung sound. It means the airways are open and air is easily moving through airways.

2.  Diminished.

This means that air movement is difficult to hear. It's quite common for COPD patients to develop diminished lung sounds, perticularly in the bases, or in the lower lobes. This is most commonly found when emphysema is present, as there is less lung tissue to move air. Of course it may also be due to a COPD flare-up where airways are obstructed by bronchospasm and increased secretions. This may indicate a need for a bronchodilator (like albuterol).

3.  Rhonchi. 

This is the sound of air moving through secretions.  It is a low-pitched, continuous sound that is best heard on expiration. Some describe it as coarse lung sounds, as it sounds coarse. Some say it sounds like snoring. It's usually lower than a wheeze because it's occurring in the larger airways.  It is also sometimes audible, and sometimes occurs with gurgling. Quite often rhonchi clears up with a good cough. Since this is common among COPD patients, we often teach methods to make a cough more effective.

4.  Wheeze. 

This is a high-pitched continuous sound heard on inspiration, expiration, or both. It's most commonly heard on expiration, though.  It is the sound of air moving past an obstruction in the airway. This can occur in the large airways or smaller airways.  An obstruction in the larger airways may produce an audible wheeze.  However, obstructions in the smaller airways, as what occurs with asthma and COPD, will cause a wheeze that can only be heard by auscultation.  Wheezing is a symptoms of bronchospasm, and may clear up after using a bronchodilator.

5.  Crackles. 

This is often described as a discontinuous sound, like the sound of velcro being torn apart. It usually needs a further qualification.

• Fine Inspiratory Crackles.  This is when the crackle is heard on inspiration. A cause might be the popping open of an air sac (alveoli) that had been collapsed. This is a common sound in the lung bases of people with COPD, and it can become a normal sound for them.  When crackles are heard in one lobe, this can be a sign of lobar pneumonia.
• Coarse Crackles (Rhales):  This is when crackles are heard on inspiration and expiration, and is the sound of air moving through fluid.  The fluid can be excessive secretions the patient is unable to cough up, or it could be pulmonary edema caused by heart failure. It means that the lungs are wet (the patient has wet lungs). Usually, but not always, this lung sound is heard on both sides of the lungs equally, as fluid is not prejudiced to one side of the lung. 

People with asthma should have clear lungmsounds when their asthma is controlled, and between asthma attacks. You can have clear lungs ounds with COPD too.  After using a bronchodilator, diminished lung sounds may become clear.

Or, sometimes, as airways open up, wheezing may occur. This we consider good, as it means air is moving better, and so wheezing can now be heard. So, you see, wheezing can be good, too. So auscultating before and after rescue medicine usage is one tool we have to determine if it's working (a peak flow meter is another such tool). Of course another tool is you, because you can just tell us that you feel better.

Pneumonia is a common complication of chronic bronchitis.  Fine inspiratory crackles can often be heard before pneumonia shows up on an x-ray, allowing your physician to start treating you early. As the pneumonia improves the crackles may go away. So, in this way, you can see how auscultating lung sounds can show how your illness is progressing over time.

Keep in mind that lung sounds are subjective, so every person may describe them somewhat different. Still, the basic principles are the same. It takes some practice to be able to hear and describe the different lung sounds. Nonetheless, I hope this post gives you a little better idea of what lung sounds are and what they mean. 

To hear the lung sounds described above you can check out practicalclinicalskills.com, "Auscultation Lesson." You can also check out UCLA's "Auscultation Assistant."

See More Helpful Articles

• Best Coughing Techniques For COPD
• What Is A Nebulizer?
• What Is Rescue Medicine
• What is a Peak Flow Meter?
• How Does Chronic Bronchitis Affect the Lungs?

The Benefits of Pulmonary Rehabilitation

The following was written by me and published at healthcentral.com/copd on January 11, 2016

Would Pulmonary Rehabilitation Benefit You 

Pulmonary rehabilitation is a top-line recommendation for patients with chronic obstructive pulmonary disease (COPD), and this seems to be true whether you have mild, moderate, or severe COPD. So what is pulmonary rehabilitation, and how might it help you?

It generally involves three elements:

1.  Exercise training.  Health experts show you what exercises are best for people with COPD, and the safest ways of doing them. Most programs meet once or twice a week for about 8 weeks. You may also be able to make arrangements to continue participating even after programs end. 

2.  Education. You will learn about your disease and the medicines used to treat it. You will learn how to properly use inhalers and nebulizers.  You will learn coughing techniques to help you remove secretions. You will learn how to conserve energy and reduce fatigue to help you make it through a day.  You will learn how to reduce anxiety and depression.  You may also learn how to quit smoking, if you still smoke.

3.  Psychological support.  Along with the experts, you will also meet others just like you who can help to support you on your journey, motivate you to stay on track in your efforts to easy breathing and living a quality life. Dieticians and psychologists are also often available if needed.

Why should you participate?  Studies (such as Lacasse et al) show that these programs help reduce dyspnea (shortness of breath, the feeling of air hunger) that results from physical exertion, and this in turn improves the quality of life.  This makes sense, considering other studies confirm that regular exercise, even if it's simply walking, makes your heart and lungs stronger, increases your energy, and reduces fatigue. Plus, the more you exercise the more tolerant to exertion you become over time. 

I recently wrote a post for asthmatics explaining the benefits of exercising called,9 Ways Exercise Improves Asthma Control—you should read that post, as all the benefits described also apply to anyone with COPD.

Who should participate?  Traditionally, pulmonary rehabilitation was only recommended if you were diagnosed with moderate or severe COPD.  However, the latest research suggests that it helps anyone with COPD live better with it, including those with the mild form.

The April, 2014, issue of RT Magazine has a nice article on this subject by Cristina Ja'come and Alda Marques, Pulmonary Rehabilitation for Mild COPD: A Systematic Review. They said that even those with mild COPD (or FEV1 of 80 percent or less) already show evidence of decreased activity level, which results in muscle loss that makes it increasingly difficult to stay physically active.

They discuss a review of studies performed on the subject, and concluded that "most of the pulmonary rehabilitation programs implemented in the included studies had significant positive effects on the exercise capacity and health related quality of life of patients with mild COPD.

However, and as usual, they say that further evidence will be needed to verify this finding. Still, it clearly seems that pulmonary rehabilitation benefits anyone with a COPD diagnosis.

Begin a pulmonary rehab program today.  The evidence clearly shows the benefits of pulmonary rehabilitation programs for anyone with COPD. They also benefit individuals diagnosed with other lung diseases, such as those with cystic fibrosis or severe asthma. So, if you haven't done so already, talk to your doctor about pulmonary rehabilitation. Chances are pretty good there is one available in your area.

You may also enjoy reading

• 8 Ways to Improve Quality of Life With COPD
• The Latest in COPD Treatments: Doctor Q&A
• 10 Tips for Exercising With COPD

Living Longer with End Stage COPD

The following was written by me and published at healthcentral.com on October 6, 2015.

9 Ways to Live Longer with End Stage COPD

End Stage COPD, also known as Severe COPD or Stage IV COPD, severely limits your airflow, making it hard to perform any basic activities. At this stage you may have also developed Cor Pulmonale or Congestive Heart Failure. While your quality of life may be limited, this is not a death sentence—there are still ways to live in the "end stage." You may, however, have to alter your life to adjust, starting with...

Quit Smoking. Studies show that quitting smoking, even in the late stages of the disease, is the most effective way of prolonging life. This is why your doctor will encourage smoking cessation even in the later stages of disease -- if you haven’t quit already.  

COPD Action Plans. These are agreements you create with your doctor to help you decide what actions to take when you feel symptoms.  Read my post “What Is A COPD Action Plan?”  The key to these plans is that it is essential that you take action sooner rather than later.  The earlier you seek help for flare-ups, the easier it will be to fix you and to get you back home.

Drug Therapy. As the disease progresses, most people with COPD benefit from a combination of medicines.  Bronchodilators and anticholinergics open airways and keep them open long term. Corticosteroids reduce inflammation to keep airways open to prevent and treat flare ups. Anxiolytics are useful for treating and preventing anxiety, and to assure adequate sleep at night. Opiates are useful for relieving the feeling of air hunger (dyspnea). While poor lung function in COPD cannot be reversed, studies suggest a combination of these medicines can help you take a deeper breath and reduce the feeling of dyspnea.

Oxygen Therapy. If resting oxygen levels are low, supplemental oxygen should be worn to maintain safe oxygen levels.  

Oxygen is the only drug proven to prolong life.

Noninvasive Positive Pressure Ventilation (such as CPAP and BiPAP). This is a pressure supplied to your airway by a mask.  It’s usually only worn while you are sleeping, because that’s when your breathing is most relaxed. CPAP supplies a pressure on inspiration and expiration to keep your airways patent and to assure adequate oxygenation.  BiPAP supplies CPAP plus a pressure on inspiration to assure you take deep enough breaths to blow off carbon dioxide.

Pulmonary Rehabilitation. Other than quitting smoking and wearing your oxygen as prescribed, this might be the most important part of any treatment program.  Such programs keep you in touch with experts who specialize in training you how to obtain proper exercise, conditioning, nutrition, and coping skills. It also keeps you in touch with others like you who will motivate you to stay fit and active so you can keep up your strength.

Nutrition. You may need to see a dietician to learn how to eat properly with COPD.  Most experts recommend that you eat smaller meals with increased frequency, as opposed to three larger meals. There may also be other tips a dietician can give you to help you keep up your strength and live better with it.

Education.  Educators, which may include your doctor, nurse, respiratory therapist, physical therapist, or rehabilitation specialist, will teach you about your disease and the importance of sticking with your agreed to treatment regime.  They will assure you that the best way to live long and well is to be the gallant COPD patient who stays positive and does everything right.

Follow-up.  The end stages of this disease are when most hospital admissions occur.  Recent efforts by hospitals have focused on following-up with COPD patients after they are discharged to assure they are being compliant with their treatment programs, as compliance is the key to staying well.  Early studies suggest these programs are effective in preventing recurring flare-ups and readmissions.

Bottom Line.  The fact that people are living longer with End Stage COPD is just the beginning—the quest to find better options to help the nearly 13 million people living with it breathe better is ongoing.

See More on This Topic:

• Recommendations for End-of-life Care for Patients with COPD
• 10 Ways COPD Affects The Heart
• Common COPD Co-Morbidities
• When to Seek Help for COPD
• RT Cave Facebook Page
• RT Cave on Twitter

Learning about end stage COPD

The following post was written by me and published at healthcentral.com/copd on September 29, 2015.

What is End Stage COPD?

So you, or a loved one, have been diagnosed with End Stage COPD.  What is this, and what does it mean for you or your loved one?

First off, it must be understood that there is no generally accepted clinical definition to End Stage COPD. What it means for one physician may not mean the same thing for another.  In fact, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines "severe COPD," but it does not even mention the phrase “End Stage COPD.”

That said, here is what End Stage COPD might entail, if this term is used by your doctor.

Stage IV COPD or Severe COPD. What is it?

• Severe airflow limitation, meaning it’s very hard to blow out a candle
• FEV1 during pulmonary function testing (PFT) will be 30 percent or less. Unlike asthma, this does not improve with medicine. However, medicine can help you take a deeper breath and reduce the feeling of dyspnea (air hunger).
• You get winded (short of breath, dyspnea) with minimal exertion, meaning you may get winded going to the bathroom, or even brushing your teeth.
• You have trouble engaging in activities, meaning you might have to skip out on that birthday party or wedding.
• You have frequent flare-ups, that sometimes require hospitalizations.
• You take a variety of medicines to keep your airways open.
• You require supplemental oxygen, probably around the clock.
• You may require CPAP to keep your airways open while you are sleeping.
• You may require BiPAP to assure you take deep enough breaths, and to assure you are adequately oxygenating while you are sleeping..
• You may have other ailments with it, such as frequent pneumonia, heart failure, osteoporosis, depression, anxiety, and hypertension.

 Others will diagnose it when you develop Cor Pulmonale and Congestive Heart Failure.

Cor Pulmonale. This is when the right side of your heart becomes enlarged after years of working hard to pump blood through diseased lungs. This makes it a weaker pump.

Congestive Heart Failure (CHF). With COPD, this usually begins with cor pulmonale. When the left side of the heart becomes too weak to pump blood through the lungs, this leads to left heart failure or CHF. This is when the heart is too weak to pump blood through the body, so blood pools in the ankles causing pedal edema. This can also lead to pulmonary edema, or fluid backed up in the lungs, making it hard to breathe. To learn more, read my post on How COPD Affects the Heart.

CHF may cause COPD flare-ups, or exacerbate them. Thankfully, modern medicine can both prevent and treat flare-ups caused by heart failure.  Still, once a diagnosis of heart failure is made, this is often considered the end stages of COPD.

Some, however, suggest that providers and caregivers avoid using phrases such as "End Stage COPD" and "Advanced Stages of COPD" altogether.

Okay, so what does this mean for you or your loved one? As Jane Martin once wrote for us, “Being told you have ‘end-stage COPD’ is not a death sentence. There is a lot you can do, and you can live a long time.”

She is right: it is not a death sentence. However, it’s your doctor’s job to tell you when he thinks your disease has progressed to this point.  It’s a way of saying: “Hey, this is it. If you want to continue living, and if you want to have some quality in your life, you are really going to have to work at it." 

I will describe some things you can do to live longer with End Stage COPD in my next post.

See more articles like this one:

• GOLD: Pocket Guide to COPD Diagnosis
• ERJ: Series on comprehensive management of COPD
• NCBI: Exacerbation rate, health status and mortality in COPD -- a review of potential interviews
• 10 Ways COPD Affects The Heart
• End Stage COPD: What is it? What does it mean?
• Common COPD Co-Morbidities
• Breaking Down a PFT
• RT Cave Facebook Page
• RT Cave on Twitter