Conditions

• Asthma • Pulmonary Hypertension • Sleep Disorders • Chronic Obstructive Pulmonary Disorder (COPD) • Lung Cancer • Alpha-1 Antitrypsin Deficiency

COPD (Chronic Obstructive Pulmonary Disease)
Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe lung diseases in which there is a chronic (long-term) problem with air getting into and out of the lungs, because the bronchial tubes are narrowed.

Chronic bronchitis / emphysema
Chronic bronchitis occurs when there is long-term inflammation of the airways. This causes swelling of the airways and extra mucus is produced. The muscles of the small airways get spastic (tighten) and constrict (narrow) the airways. Emphysema occurs when the air sacs are destroyed. Air gets trapped in the sacs, making it difficult to get oxygen in and carbon dioxide out.

Common symptoms may include:

• Being out of breath
• Tightness in the chest
• Having a cough that produces a lot of mucus especially in the morning.
• Wheezing

How is COPD diagnosed?
Your doctor will:

• Take a medical history and give you a physical exam

In addition, your doctor may order one or more of the following tests:

• Chest x-ray and/or CAT scan
• Pulmonary (lung) function test — a pulmonary technician uses several tests to determine how well your lungs are working
• Pulse oximetry — a painless test that measures the level of oxygen in your blood
• Blood gas test — a blood test that measures the amount of oxygen and carbon dioxide in your blood

What causes COPD?
Smoking
Cigarette smoking is the main cause of COPD. It is also one that you can control. If you smoke, speak with your doctor. Your doctor can refer you to a "stop smoking" program or prescribe medications to help you stop smoking.

Click here to visit our smoking cessation programs.

Air pollution/ occupational exposure
Pollution can irritate the lungs and can cause lung damage. You should avoid contact with dust, dirt, fumes, cleaners and other things that may irritate your lungs as much as you can.

How can I manage COPD?
Your doctor will work with you to develop a plan to treat your COPD. It is important that you discuss your questions and concerns with your doctor.

Treatment may include:

• Medications such as:
  • Bronchodilators, which open up the airways
  • Anti-inflammatory medications including inhaled and oral steroids, which decrease swelling and inflammation
  NOTE: It is important to know the names of any medications you take, how often you are to take them and to know of any potential side effects. Medication should be taken as prescribed, and any concerns should be discussed with your doctor.
• Breathing techniques, which help you breathe better, control coughing and help clear the lungs of mucus.
• Healthy living measures, such as eating healthy food and avoiding irritating substances, such as cigarette smoke
• Using oxygen, in some cases
• Starting or continuing an exercise program. Your doctor may suggest that you participate in a pulmonary rehabilitation program. These programs have helped many people learn new ways of breathing and to conserve energy for special tasks.

Call (212) 523-5471 for more information.

What medications are used to treat COPD?
In recent years, the treatment of COPD has changed with the development of newer and better medications. This makes it is easier to control your symptoms, but it is important to work with your doctor closely to develop the best and easiest plan for you.

Anti-Inflammatory Medicine
One type of medicine is called anti-inflammatory medicine. It controls the inflammation in your airways and decreases swelling and mucus production. Talk to your doctor before you stop taking it, as you should not stop this medication suddenly. If your doctor wants you to stop this medicine, he/she will usually tell you to slowly decrease the dose over a few days.

Bronchodilators
Another type of medicine that is used to treat COPD is called a bronchodilator. A bronchodilator is used to relax and open the airways so that more air can flow through and you can breathe easier. Bronchodilators may be helpful before you exercise to prevent shortness of breath.

For your medication, be sure you understand:

• Why you take it
• How it should be taken
• How often it should be taken
• What are the side effects
• If there are any interactions with other medications or foods
• When you need to contact your doctor

Medication fact sheets that discuss important information about each of your medications are available. Ask your nurse for a copy of the sheets for your medications.

What is a metered dose inhaler?
Many medicines come in a small metal canister that sprays the medicine into your lungs. This is called a metered-dose inhaler (MDI). Some people call them "puffers." The MDI or "puffer" sprays the medicine out in the right amount for you to breathe in. You usually take one or two puffs.

Between puffs you usually have to wait 30 seconds to one minute. Breathing in or inhaling your medicines is a good way to take them because they get into your breathing tubes quickly. If you take a pill, it takes longer to start to work.

How do I use a metered-dose inhaler?
Here are the basic steps to use an MDI or "puffer":

• Shake the MDI well to mix up the medicine.
• Remove the cap from the mouthpiece and hold the mouthpiece in front of mouth.
• Blow out all the air from your lungs.
• Begin to breathe in slowly and at the same time press on the MDI to release one puff of medicine into your mouth.
• Continue to breathe in all the way after the press. Your breathing in is what carries the medication to your lungs.
• Close your mouth and hold your breath for five to 10 seconds before slowly breathing out through pursed lips. This helps make sure you get all the medicine.
• If your doctor told you to take two puffs, wait 30 seconds to one minute between puffs. This way the first puff can open your airways and the second puff can work better.

What is a spacer?
These tubes or bags are attached to the MDI. They act as a holding chamber from which the medicine can be breathed in more easily. You spray the medicine into the spacer before you breathe in and you don't have to coordinate pressing the puffer and breathing in so precisely. You just breathe in slowly. It makes it easier for medicine to go further down your airways and work better in your lungs. Spacers also reduce gagging and coughing that can occur from the spray hitting the back of your throat.

There are now dry powder inhalers that are activated by your breath. They are easier to use because you do not have to coordinate spraying and breathing in at the same time.

Contact Your Health Care Provider if:

• You don't get relief from your MDI (bronchodilator) or the relief lasts only a short time
• You are short of breath after using your bronchodilator medicine
• Your medicine supply is low
• Your have the following:
  • Fast, pounding heartbeat
  • Nausea, stomach ache, diarrhea or vomiting
  • Irritability and restlessness
  • Trouble sleeping
  • Headache
  • Muscle twitching

Using Oxygen
If your lungs are not able to get enough oxygen into your blood by breathing room air, your doctor may order oxygen for you. Using oxygen increases the amount of oxygen in your blood. This will help reduce feeling out of breath. If you need oxygen, you may need it all the time, or only at certain times such as when you exercise or sleep. If your doctor prescribes oxygen for use at home, arrangements will be made for a company to deliver oxygen to your home and show you how to use it.

Be sure to use the exact level of oxygen prescribed for each activity.

Exercise
One of the most important things that you can do is to take part in a regular exercise program. This can really help you feel better. Exercise tones your muscles so that they use less oxygen. This helps to decrease shortness of breath.

Check with your doctor before you start an exercise program. Your doctor may suggest that you join a pulmonary rehabilitation program. These programs are specially developed for people with lung problems. There is a pulmonary rehabilitation program at St. Luke's and Roosevelt Hospitals. Ask your doctor about it.

You may be afraid that exercise may make you more short of breath, but muscles that are out of shape will make you feel more out of breath.

Keep in mind these important tips:

• Choose an activity you enjoy. If you feel bored, try something else
• Make your exercise program part of your daily routine
• Remember to include time to warm up and cool down in your program
• Start slowly and gradually increase the amount of activity over time
• Don't get discouraged — it is important to exercise on a regular basis. If you have not exercised in a while, it will take time for you to feel comfortable.
• Use breathing techniques such as pursed lip breathing when you exercise. Your doctor may tell you to use your fast acting bronchodilator before you exercise.

Breathing Exercises

Diaphragmatic breathing
What is diaphragmatic breathing?
Your diaphragm is the large muscle located between your lungs and abdomen. It is the major muscle used in breathing. This exercise will make your diaphragm stronger and help you breathe better.

How to do diaphragmatic breathing:

• Sit or lie down on your back on a comfortable surface. Relax.
• Place your right hand on your upper chest area. This hand should remain very still during this exercise.
• Place your left hand over your abdomen (belly).
• Breathe in through your nose slowly for a count of two. Your left hand (on your abdomen) should rise.
• Tighten your abdominal muscles and breathe out slowly to a count of four. Your left hand should fall.
• Practice this exercise for five minutes two to four times a day.

Pursed-lip breathing
What is pursed-lip breathing?
Pursed lip breathing can help you relax and help decrease feeling out of breath. This technique helps you reduce the amount of stale air trapped in your lungs allowing you to breathe more effectively. Pursed lip breathing can be used when you are exercising, climbing steps or bending and lifting.

• Breathe in through your nose for a count of two.
• Breathe out though your mouth with your lips pursed or puckered. This means that your lips are gently and partially closed so that the air goes out more slowly. This allows the air to go out more fully. Breathe out slowly for a count of 10. Make sure you do not blow out the air or do it with force.
• Always breathe out for twice as long as you breathe in. This will decrease air trapped in your lungs and rid your body of excess carbon dioxide.

Other ways to control COPD
There are many things you can do to help control COPD. In addition to working with your doctor and taking your medications as prescribed, here are some helpful tips.

Eat Healthy

• Maintain an ideal or healthy body weight. Being overweight makes it harder to breathe—it puts extra pressure on your diaphragm. Being underweight decreases your energy.
• Drink plenty of fluids. This makes the mucus easier to cough up. Limit liquids with caffeine, such as coffee or soda with caffeine, as they can cause dehydration and make your mucus thicker.
• Eat a balanced diet. Eat enough protein especially if your appetite is poor. Good sources of protein include meats, eggs, fish, poultry, milk products and cheese.
• Eating several small meals instead of three large meals may be better. This puts less pressure on your diaphragm.
• Consider avoiding gas-producing foods such as broccoli, cabbage, cauliflower, beans etc. These foods can cause gas, which puts extra pressure on your diaphragm. This gives your lungs less room to expand.

Avoid irritating substances

• Stay inside when there is a lot of air pollution and heavy smog. Listen for local alerts and plan outdoor activities accordingly. Avoid going outside in the mid-day sun when the ozone level is highest.
• Avoid dusty work areas as much as possible.
• Stay away from strong chemicals and aerosol sprays.
• Use a scarf or your hand to warm the air that you breathe when the weather is very cold.
• Wear a mask to help filter the air when vacuuming, sweeping or doing yard work.
• Stay away from pets if they cause breathing problems.

Avoid smoke and stop smoking

• If you smoke, stopping is one of the most important steps you can take to improve your health. Speak with your doctor about programs and techniques that can help you. St. Luke’s and Roosevelt Hospitals have a smoking cessation program. There are also some medications that your doctor can prescribe to help you quit.
• Avoid second hand smoke — do not allow anyone to smoke around you.

Prevent infection

• Ask your doctor about flu and pneumonia vaccines. Remember to get a flu shot every year.
• Stay away from people with colds and flu.
• Wash your hands frequently. This can help stop germs from spreading.
• Speak with your doctor right away if your mucus changes color to yellow, green or rust.

Balance rest and activity

• Pace your activities during the day. Plan rest times between activities.
• Use your breathing techniques to help control breathing when you get out of breath.
• Sit when doing activities whenever possible. Gather items that you need before you start.
• Keep things that you need within easy reach so that you don’t need to bend or reach for things.

Manage stress

• Practice relaxation techniques when you feel tense. Find something that helps you to relax. Examples include: taking a mini-vacation by imagining you are in a place that is peaceful, meditating, doing yoga, or listening to relaxing music or relaxation tapes.
• Do your diaphragmatic and pursed-lip breathing techniques. They can help slow your breathing and help you breathe more effectively when stress causes you to breathe faster.
• Medications can also help in some situations.

General tips

• Wear loose fitting clothing. Avoid using belts or girdles that can hinder your breathing. Consider suspenders instead.

When to call your doctor
Call your doctor if you have any of the following:

• Increased symptoms, such as being more short of breath or coughing more than usual
• Mucus color changes to yellow, green or rust
• More mucus than usual
• Fever over 101º
• Inability to perform usual activities due to shortness of breath
• Dizziness or feeling lightheaded
• Swelling of feet or ankles
• Any other unusual symptoms

These may be symptoms of an infection or indicate a possible need for your medications to be adjusted. Letting your doctor know of these changes as soon as possible can help you start feeling better sooner and may prevent more serious problems.

Other disorders can also cause shortness of breath. Your doctor will help to determine the cause and the best treatment.

Resources
You may find it helpful to:

• Learn more about COPD
• Find education sessions or rehabilitation programs that are available
• Join a support group for people with COPD

The following organizations can be helpful:

St. Luke's Roosevelt Hospital Center Resources
The James P. Mara Lung Center
Services provided include: pulmonary rehabilitation, patient and family education, pulmonary wellness lecture series, smoking cessation, clinical research studies and patient support groups. For more information, call (212) 523-5471.

Margarita Camche Smoking Cessation Program
St. Luke's Division (212) 523-6056
Roosevelt Division (212) 523-4410

Other organizations include:
American Lung Association
1-800-LUNGUSA
http://www.lungusa.org

National Heart, Lung and Blood Institute, NIH
(301) 592-8573
http://www.nhlbi.nih.gov

National Jewish Medical and Research Center
(800) 222-LUNG
http://www.njc.org