COPD

Managing overview

COPD is an illness that challenges patients and their families across all aspects of life. Still, there are many things you can do to take charge of your breathing and feel better. This section has more on:

Avoiding infections

People with COPD should make a concerted effort to stay well. A cold, the flu, or a virus can make lung disease worse. Here are a few things you can do to stay healthy:

• Talk with your doctor about vaccines. Most COPD patients should get the flu shot each year in the fall. You also should get a pneumonia vaccine every five to seven years. Neither of these vaccines guarantees that you won’t get these illnesses, but they greatly reduce your risk.
• Wash your hands frequently, especially during flu season. When you use an ATM machine, for instance, or open doors or turn on faucets, germs can collect on your hands. If you then rub your eyes or nose or touch your mouth, the germs can enter your body, making you sick. When washing hands, use soap and warm water, work up a good lather, and wash for 30 seconds, about as long as it takes to say the alphabet.
• Avoid crowds, and don’t socialize with people who are sick. If your friend has a cold, don’t get too close, or consider rescheduling until he or she has recovered and is no longer infectious.

COPD and sleep

COPD brings with it many factors that can make it difficult to get a good night’s sleep. These include having to sleep sitting up or taking medications that “rev you up” or cause you to have to go to the bathroom in the middle of the night. Emotional changes such as depression and anxiety can also impair sleep. Medications can be prescribed to induce sleepiness, but there are steps you can take to get a better night’s sleep without relying on a drug.

• Try to do only two things in bed–sleep and make love. If you are having difficulty sleeping, do not watch television in bed, read, or just lie awake watching the clock. After 20 minutes, get up and do something relaxing like reading a magazine, watching old sitcoms (but not in the bedroom), or looking out the window. When the “edge” starts to come off, return to bed, and if you are not asleep in 20 minutes, get back up. This time, think of a low-energy chore you have wanted to do (such as putting photos in an album or cleaning out the “junk drawer), and do it. You may not have gotten a full night’s sleep, but you will have accomplished something. And the next night, your body should be more tired and ready for sleep.
• Avoid napping. If you don’t nap, you’re more likely to be tired enough at bedtime to fall asleep.
• Try to get approximately 30 minutes of exercise at least three times a week. This can be as simple as going for a walk.
• Don’t do anything too stimulating in the two hours before you go to bed. During this time, try to avoid exercising, arguing with someone, working, etc.
• Don’t go to bed hungry, but also don’t eat a big meal or a lot of carbohydrates just before going to bed. Instead, have a small, high-protein snack such as cheese and crackers, a glass of milk, or some nuts.
• Keep your sleep environment conducive to sleep–cool, dark, and quiet.
• Don’t drink caffeinated beverages after 5 p.m.
• Try to keep regular bedtime and wake-up times.

If you snore, you may have a condition called obstructive sleep apnea. With this condition, the quality of sleep is poor, and oxygen levels may fall to dangerous levels. This is especially risky for people with lung disease such as COPD. If you awaken tired after a full night’s sleep, tend to fall asleep during the day (especially while driving), or lack energy, you may have this condition. Check with your doctor, who may arrange for a sleep study in a nearby sleep laboratory.

Diet and exercise

Losing weight and exercising can help you manage your COPD, even if your lungs can’t get better. Improving the overall health of your body can help it deal more effectively with your illness.

Before starting a diet or exercise program, always talk with your doctor about your plan to be sure that it is safe. Then start with small steps rather than attempting a quick lifestyle overhaul. Changing lifelong patterns is a gradual process.

When it comes to losing weight, there is no magic formula. To take off pounds, you will need to consume fewer calories than you expend, but as many of us know, this is easier said than done. Some first steps may include:

• Continue eating all the same foods, but use a smaller plate and take smaller portions.
• Keep a bottle of water with you, and take a drink before eating something.
• Include one fresh vegetable or fruit with every meal.
• Consult with your healthcare provider if you are experiencing dyspnea while eating.

Don’t be deterred from exercising by shortness of breath. First, your doctor may suggest that you use your inhaler to open up your lungs before you exercise. Second, you can–and should–start with small, gradual changes; for instance, by resolving to move more about the house. A step counter will give you feedback on how much you’re moving. You can then try to beat your number every day, even if only by a step or two.

The “suffocation alarm”

Our brains are designed to protect us and keep us alive. Deep in our brain is a region that constantly samples our blood to be sure that we are getting enough oxygen and breathing clean, healthful air. If it detects anything wrong, it sends out an alarm that feels to us like a sudden rush of anxiety or panic. This feeling prods us into getting up and away from whatever is interfering with our breathing.

With COPD, you regularly have trouble breathing, and your suffocation alarm can become hyperactive. As a result, you may feel edgy or anxious a lot of the time or feel panicky at being hurried or when you smell strong odors.

It is important to understand that this is common in people with COPD and that you aren’t falling apart emotionally or mentally. With help from your doctor, there are a number of things you can do to “reset” your suffocation alarm. These include:

• Breathing training
• Counseling and relaxation training
• Anti-anxiety medications

Coping with worry

Fears and worrying are common problems for people with COPD. These may be caused by your “suffocation alarm” or result from all the changes brought on by your condition. Below is a list of some of the ways you may be experiencing worry:

• I have trouble getting to sleep because I’m worrying.
• I can be sitting quietly and suddenly become short of breath.
• I am almost always worrying about when I will have an episode of difficult breathing.
• I seem to be more and more frightened about leaving the house.
• I’m frightened of getting onto elevators, airplanes, or bridges and will go out of my way to avoid them.
• I walk around feeling as if something bad is going to happen.

It is also common for people who are feeling overwhelmed by their COPD to want to “take a break” from being sick. At these times, you may do some of the following:

• Overextend yourself and pay for it with worse symptoms over the next day or so
• Use as little medication and oxygen as possible, even when the doctor wants you to use more
• Keep your COPD from other people, even when it might be important to let them know
• Drink more alcohol than you should because it helps you forget about the COPD

It is unrealistic to hope that you’ll be able to rid yourself of worry altogether. But you can work toward an “ideal level of worry.” In this ideal state, you accept that you have a chronic and challenging illness and know that there are things you can do to help (and hurt) your experience with the illness.

Over the long term, you most likely will go through periods when you worry too much and other periods when you should give your illness more consideration. These fluctuations are entirely normal. Your goal should be to find the “just right” amount of worry that will help you keep your life and illness in balance.

Dealing with depression

COPD can make you feel tired all the time and still make it difficult to sleep. It can be exhausting to eat, and the medications can take all the taste out of your food. You may be self-conscious about your oxygen or chronic cough and become more reluctant to go out in public. You may have been active for all of your life and now can’t do the things you once enjoyed. All these challenges can put you at risk for developing depression.

If you are like many people, you may say, “Well, look at all I’ve lost. Shouldn’t I be depressed?” The answer is both yes and no. You certainly may have lost a great deal, and it is understandable that you may be feeling anger, sadness, and a sense of loss. But if the feelings are pervasive and keeping you from taking care of yourself, you need to speak with your doctor about depression. This condition is very common and is treatable with therapy and/or medication.

This section has more on the signs of depression.

Signs of depression

Read through the following list. If five or more items apply to you, consult with your doctor about depression.

• A sense of sadness more days than not for several weeks in a row
• Restless sleep or sleep that is disrupted by early waking or difficulty falling asleep
• Excessive sleep
• Decreased interest in favorite people or activities
• Decreased energy and motivation
• Difficulty concentrating and problem solving
• Altered appetite, either increased or decreased
• Low self-esteem
• A sense of hopeless, that you’ll never feel better no matter what happens
• Crying much more easily and more frequently than usual
• Feeling irritable with everyone and everything in your life
• Feeling excessively guilty
• Thinking about suicide or wishing your life would end
• Inability to laugh or enjoy yourself

Facing tough questions

At one time or another, most people with COPD find themselves thinking about various questions that may be hard to discuss with anyone, including their doctors and families.

Some of the questions doctors hear:

Will there come a time when I can’t take care of myself and need to be in a nursing home?

How long do I have to live?

What is it like to die of COPD? Will it hurt? Will it feel like I’m drowning?

If you find yourself wondering about any of these questions, discuss them with your doctors. Although they don’t have a crystal ball and so won’t be able to give you exact and detailed answers, they should be able to give you enough information to help put your mind at ease. They also can help you find other sources of help, information, and support.