COPD: FAQ

Question: Why is important to exercise for patients with COPD?

Answer: Exercise has many benefits. First, it decreases shortness of breath and improves your energy level. It also decreases the risk of heart disease, high blood pressure, depression, high blood sugar and side effects from medicine (steroids). Exercise increases bone strength, muscle strength, endurance, relaxation and restful sleep. Overall, exercise will improve your quality of life. Learn more about COPD and exercise.

Question: How can I exercise when I can't breathe?

Answer: By using coordinated breathing techniques and starting out slowly, you will be able to find an exercise program that works for you. When you have shortness of breath, it can cause you to become anxious. This can lead to inactivity. The more inactive you are, the more short of breath you become. The increased shortness of breath in turn increases your anxiety about activity. This is called the "Vicious Cycle of Dyspnea." If you exercise, you can beat this cycle. This will give you more energy, decrease your level of breathlessness (dyspnea) and decrease some of the anxiety that comes with being short of breath. Often, participating in a pulmonary rehabilitation program can help one resume regular physical activity.

Question: Will I have to exercise for the rest of my life?

Answer: Yes. Regular exercise will become part of your everyday life. Exercise should be considered one of the most effective medications you can take. You will need to exercise four to five times a week for 30 minutes to maintain or improve your current fitness level. Exercise five to six times a week for 45 to 60 minutes to promote weight loss.

Question: Why should I use pursed lip breathing while exercising with COPD?

Answer: Shortness of breath in COPD is caused by too much air remaining in the lungs, decreasing the amount of room left in the lungs to breathe. Pursed lip breathing will help you feel less short of breath by reducing the amount of trapped air in the lungs, giving you more room to breathe. It also helps increase your oxygen saturation. Pursed lip breathing causes a positive pressure in your airways, keeping them open longer while you are breathing out. This helps move air out of your lungs more easily, thus allowing fresh air to come into the lungs.

Question: Do I have to purse lip breathe all the time?

Answer: Pursed lip breathing can be helpful any time you are short of breath. It can help you focus on your breathing and relax. It is most important that you use pursed lip breathing during activities that involve exertion to decrease your shortness of breath and maintain your oxygen saturation levels. In other words, you should purse lip breathe anytime you are short of breath and anytime you are moving (walking, exercising, chores, etc.).

Question: Do I have to wear my oxygen while I exercise?

Answer: If your health care provider has prescribed oxygen for activity, it is very important that you wear it when you exercise. Oxygen is prescribed when the oxygen level in your blood drops below an acceptable level either at rest or with activity. Using your prescribed oxygen will allow you to feel less shortness of breath when you are active and allow you to do more. Wearing your oxygen will not make you become "addicted" to it. It only makes up for what your lungs are unable to do at that time.

Question: Should I wear my oxygen in the shower?

Answer: If your health care provider has prescribed oxygen for activity, it is also very important that you wear it in the shower. Showering is a very demanding activity. Therefore, as with any other activity, you should wear your oxygen.

Question: Why do I always get so short of breath after climbing stairs, but not while I am climbing them?

Answer: Generally, this may occur because of your breathing technique. Two possible explanations may be:

• If you did not apply the coordinated breathing technique while climbing the stairs, you may feel more short of breath after the task due to the energy expended. You asked your muscles to do more work while climbing the stairs. Your body needs an increased amount of oxygen as it is rapidly trying to pump it to all of your muscles. If the oxygen need is greater than the demand or your capacity, you may feel more short of breath.

• If you were so focused on coordinating your breathing with the rhythm of stair climbing that when you stopped, your coordinated breathing stopped as well, here’s what you should do. Breathe slowly, deeply and rhythmically, with a focus as you exhale, throughout the stair climbing activity. This should decrease your feeling of breathlessness.

Question: Once I start on supplemental oxygen, will I have to stay on it? Or, will I become addicted to supplemental oxygen?

Answer: This is a good question to ask your health care provider. Some people may need to continue oxygen therapy routinely to maintain the oxygen level in their blood. We all need oxygen to survive and for our bodies to operate more efficiently and effectively. It is important that you have the proper levels of oxygen in your body so that your heart and lungs are not working too hard and/or inefficiently. Depending on the progression of your disease, sometimes exercise will help your body systems work more effectively and may decrease the amount of supplemental oxygen needed.

Question: Can I just take a "hit" of oxygen when I need it?

Answer: No. You should use your supplemental oxygen as prescribed by your health care provider. Your oxygen is a prescription, just like your medication. Do not try to "wean" yourself off or use amounts other than as instructed by your doctor. We don't know what our body's oxygen needs are without a formal oxygen titration test. During this test, your oxygen level is measured with a pulse oximeter while you exercise. Your health care provider uses this test to determine the amount of oxygen you need when you rest and exercise.

Question: I do a lot of yard work and housework, and my job is physically demanding. Do I still need to exercise?

Answer: Yes. Even though it is good to work outdoors and to continue doing physical work, it is important to do the exercises given to you by your physical therapist. Usually, work around the house or on your job is of a start and stop nature, as is dog walking. It is important to progress to doing some form of endurance exercise for 30 minutes or more continuously to improve function of your heart muscle and lungs. Endurance exercise will help to make everyday tasks easier.

Question: Why am I short of breath if my oxygen saturation is good?

Answer: Depending on your disease, sometimes you may feel short of breath even though your body is getting the oxygen it needs. It is important to use good breathing techniques, use your medications properly and discuss your symptoms with your physician or health care provider so your specific needs can be met. Exercise can be used to improve functional endurance and strength so tasks become easier with less shortness of breath.

Question: Is COPD the same thing as emphysema?

Answer: COPD is short for chronic obstructive pulmonary disease. COPD includes lung conditions such as emphysema and chronic bronchitis. Most people with COPD have a combination of both.

Question: I have recently been diagnosed with COPD, and I still smoke. Is it too late to quit smoking now that my lungs are already damaged?

Answer: No. Even if you used tobacco for many years, you will benefit from quitting smoking. When you quit smoking, the lung damage will progress more slowly. In addition, your breathing and response to your medicines may noticeably improve.

Question: I feel short of breath a lot, but my doctor says my chest X-ray is clear. Does this mean that my lungs are OK and COPD free?

Answer: Not necessarily. Ask your doctor about a breathing test, known as spirometry. Spirometry is a better test for detecting early stages of lung damage. A chest X-ray is more likely to show COPD at a later stage, when there is more damage.

Question: Since I've had COPD, I'm worried about being around my grandchildren and catching their colds. Is there anything I can do other than avoid being around them?

Answer: Fortunately, there are other steps that you can take to lessen your risk of lung infections with COPD. Ask your health care provider about the yearly flu vaccine (every fall) and the pneumonia vaccines. The pneumonia vaccines prevent common types of bacterial pneumonia. Avoid touching your nose, mouth or eyes, and wash your hands thoroughly (with soap) and frequently. Good hand-washing is one of the easiest and best ways to avoid getting all sorts of infections. Keep in mind that it is still important to avoid close contact with people who are coughing and sneezing.

Question: Should I eat a special diet because I have COPD?

Answer: It is important for everyone to eat a healthy diet and maintain a healthy weight, but even more so when you have COPD. If you are underweight or overweight, talk to your doctor about your specific needs. Overall, it is important to eat foods that are nutritious and easily digested. If you get short of breath when eating, eat smaller meals more often. Also, eat slowly and drink your beverage after eating to avoid early fullness.

Question: If I have COPD, what sort of arrangements do I need to make before a flight?

Answer: People using daily supplemental oxygen will need oxygen on a plane and may need to turn it up one to two liters when flying. Some people with COPD who are not on daily oxygen may also need it during airplane flights. Check with your health care provider about your need for supplemental oxygen during air travel and with the airline to make arrangements.

While most major airlines do allow portable oxygen concentrators on board, it is important to plan ahead. Contact the airline and oxygen company ahead of time to get the appropriate forms your health care provider will need to sign.

Question: Is it safe to try alternative therapies to treat COPD?

Answer: Currently, there is little scientific evidence to support the use of alternative therapies, such as homeopathy, herbs and acupuncture, for COPD. While a number of therapies are probably harmless, others may pose considerable risk.

Homeopathy, yoga and acupuncture are probably safe. Trials of acupuncture have shown inconclusive evidence of positive effects in the treatment of respiratory disorders. Other alternative therapies, such as herbal medications, vitamin supplements and restrictive diets, pose greater risks to people. A few herbal medications, mostly from India and Southeast Asia, contain a variety of contaminants, ranging from aspirin, steroids and narcotics, to toxic substances such as lead, mercury and arsenic.

The most concern is for the herbal preparation ma huang, which contains ephedra, a natural bronchodilator. This has several side effects that can lead to heart attacks, strokes and blood pressure crises. Prescribed bronchodilators, such as albuterol, have considerably fewer side effects.

Licorice, a plant used not only in flavoring but also in herbal mixtures, inhibits steroid metabolism. Patients who use licorice to reduce their steroid medications are still exposing themselves to steroids and their potential systemic side effects. The amount of licorice used to flavor candy, however, poses little to no risk.

Question: I have severe COPD, and I use a nebulizer. What do I need to think of with the nebulizer?

Answer: If you are using a nebulizer, there may an increased risk of lung infections for COPD patients, as it is difficult to completely clean the nebulizer chamber. Taking inhaled medications without a nebulizer is preferred (metered dose, dry powder or soft mist inhalers). There are some steps to help prevent infections in your lungs if you must use a nebulizer. At National Jewish Health, we tell our patients to use a non-disposable nebulizer, rinse the nebulizer cup after each use, shake it out, and then re-attach the cup to the nebulizer. Turn on the compressor and leave it on until the nebulizer is totally dry and free of any droplets of water. Also, disinfect it by boiling the nebulizer or soaking in a vinegar and water solution regularly. See the nebulizer package insert for complete instructions. It is important to correctly clean any respiratory equipment that you use.

Question: Is having pain in the lungs typical of COPD?

Answer: Chronic lung pain is not commonly associated with COPD. However, pain can come from the wall of the chest and not directly from the lungs — this in fact can be seen in COPD. Pain in the chest can come from coughing very hard and straining the muscles of the chest. Pain in the chest can be due to a rib fracture from coughing hard. Pain in the back of the chest can come from osteoporosis, or thinning of the bones. Check with your health care provider to find out the cause of your pain. If you have new chest pain, or have pain that frightens you, call 911 or go to the emergency room.

Question: How can I help bring up mucus when I cough?

Answer: Simple devices such as Acapella^® or Aerobika^® airway clearance devices, combined with effective coughing techniques, can help break up mucus in the lungs, making it easier to cough up thick mucus. Medications or other devices may also be helpful. If you have difficulty bringing up mucus, you should speak to your health care provider about this. Learn tips for how to cough up mucus.

Question: Is it safe to smoke marijuana?

Answer: No. Smoking marijuana has been associated with more chronic bronchitis symptoms.