COPD: Chronic Obstructive Pulmonary Disease

Avoiding crises with COPD

With periodic flare-ups and dashes to the ER, it’s easy to feel overwhelmed.

The good news is that there are warning signs of a COPD flare. Knowing these red flags will help you nip a crisis in the bud.

Here are some signs to watch for:

• Coughing more and bringing up more mucus
• Feeling more short of breath than usual
• Feeling more fatigued
• Inability to sleep
• Medicines/oxygen don’t seem to provide relief like they did
• More swelling in the feet or ankles
• Loss of appetite

Create an Action Plan
The American Lung Association Action Plan Tool is an excellent way to organize what to do. Fill it out with the doctor so you will be clear about what needs to be done if you notice your loved one developing these symptoms.

When to seek immediate help
Call the doctor or 911 if your loved one has any of these urgent symptoms:

• Coughing blood
• Chest pains
• Fever and chills
• Confusion and drowsiness (often a sign of fever in older adults)
• Severe shortness of breath, even when resting
• So much trouble breathing, cannot engage in any activity
• Unable to sleep because of breathing problems

Daily life precautions
Here’s what you can do on a daily basis to ease breathing and reduce the chance of a flare:

• Run a fan
  If your loved one enjoys it, you can even point the fan to blow air directly toward his or her face.
• Add moisture to the room
  Hot air and a dry throat can make it harder to breathe. A simple humidifier adds moisture and soothes the airways.
• Open a window
  Fresh air is refreshing! If weather permits and the air is clear (no smog or smoke, low pollen count), this can be a natural way to promote easy breathing.
• Raise the head of the bed with pillows
  Lying flat makes breathing more difficult. Lying more upright relieves pressure on the chest. It also reduces the tendency to cough.

Household changes

• No smoking
  If your loved one has breathing problems, he or she should not be smoking at all. Smoke from the cigarettes of others also clogs the air and makes it harder for your relative’s lungs to do their job.
• Reduce or remove strong smells
  Perfumes, bleach, household cleaners, and paint fumes all represent chemical particles in the air. These can “catch at the back of the throat” and make it harder to breathe.
• Dust thoroughly and replace air filters
  A thorough dusting will remove this common irritant. (Best to do this on a day when your relative can be out of the house!) Replacing furnace and air conditioning filters will also reduce particles in the air.

Breathing and anxiety: Proven relaxation techniques

Anxiety is no stranger when you are caring for someone who is seriously ill. Or, for that matter, when you ARE the person who is ill. Medical emergencies, financial worries, everyday care issues. They all cause stress.

And emotional distress sets off a physical reaction. When we feel scared or angry, our heart rate and blood pressure increase, and our breathing speeds up. When the stress is chronic, our “fight-or-flight” response may be engaged for days, weeks, or months. That’s hard on the body. And it’s a particular concern for families dealing with breathing problems.

Shortness of breath can generate anxiety, which causes one to feel short of breath, creating more anxiety…It’s a nasty downward spiral.

You and your relative can take the edge off by learning to relax. Relaxation stops the stress reaction and even makes breathing easier. It also clears the mind, enabling less anxious thinking about any issue at hand.

Following are three basic relaxation techniques that take about 10 minutes each.

• Deep breathing. Sit comfortably, feet on the floor. Put one hand on your chest, the other just under your ribs. Breathe slowly through your nose, counting to five. Only the hand at your belly should rise. Exhale slowly, counting to five. Repeat.
• Muscle relaxation. Lie down or sit comfortably. Starting with your toes, tense and relax your muscles, moving up your body to calves, thighs, etc. Count to five while tensing and to 30 while relaxing. Notice the difference between tense and relaxed.
• Visualization. In a quiet place, lie down or sit comfortably. Imagine yourself at your favorite place of tranquility (beach, mountains, etc.). Bring in as many elements of the place as you can: what you would be seeing, smelling, hearing, touching.

Share these techniques with your loved one. It takes dedication and practice, but everyone benefits from better stress management.

Fatigue: When your loved one gets tired easily

Does the person you care for seem to “run out of gas” quickly, even when doing simple things around the house? Help your family member learn to conserve energy (physical energy) so he or she has enough “fuel” to enjoy special activities and exercise according to doctor’s orders.

It’s a simple strategy: Consider that there’s a limited amount of energy each day. If you’re careful how you use it for the routine tasks in life, you will have enough left over for necessary exercise and life’s pleasures.

Plan for the entire day and pace activities. Encourage your relative to:

• Allow ample time for what needs to get done. Rushing wastes energy.
• Alternate activity with rest. Divide large chores into smaller tasks spread across the day or week.
• Work smarter. Minimize trips up/down stairs. Shop with a list and in as few stores as possible. Cook in quantity and freeze the extra; soak dishes first for less scrubbing later. After a bath, slip on a terrycloth bathrobe instead of drying with a towel.
• Get help when you can. Have medications and groceries delivered.

Throughout the day, consider opportunities to reduce standing, walking, lifting, and bending:

• Sit down whenever possible. When cooking, cleaning, bathing, dressing, or grooming face and hair, have a stool or seat handy.
• Create task stations. Lay out supplies at waist height so everything is within easy reach before you start cooking, cleaning, bathing, or dressing.
• Wheel or wear; don’t fetch. Use a cart on wheels, a walker with a basket, a pocketed apron, or a fisherman’s vest to keep supplies at hand.
• Use extensions. To avoid bending and reaching, use an elevated toilet seat, a grabber for objects, and elongated handles on shoehorns, brushes, and dustpans.

By learning to operate on “cruise control” whenever possible, your family member can get further on a day’s tank of energy.

Diet: How your food affects breathing

We’re all aware that diet affects health. But did you know that people with COPD (chronic obstructive pulmonary disease) can help themselves breathe better by making simple changes to their eating habits?

The way we eat

• Consider eating four to six small meals a day and minimizing fluid intake at mealtime. It’s harder to breathe when your stomach is full.
• Eat earlier in the day. If energy is generally low by dinnertime, focus on consuming more of the day’s calories in the morning and afternoon.

What we eat
The food we eat combines with the oxygen we breathe to create energy and carbon dioxide. Our body needs the energy to function. The carbon dioxide is a waste product we need to exhale out of our bodies. Too much of it is toxic. But having to exhale a lot can be tiring.

• Limit sugar and sugary foods such as candy, cake, and soft drinks. Carbohydrates (sugars and starch) produce more carbon dioxide than fats or proteins. They make more work for the lungs.
• Fats produce the least carbon dioxide. The best fats are polyunsaturated fats such as vegetable oils and soft margarine (look for those labeled “zero trans fat”).
• Protein is necessary to maintain the respiratory muscles. At least two servings a day is recommended: eggs, dried beans, dairy products, and meats.
• Limit foods that produce gas, such as carbonated beverages, dried beans, cauliflower, and broccoli. They cause the stomach to expand which puts pressure on the diaphragm.
• Limit salt. It can cause the body to retain fluid, making it harder to breathe. See our article under congestive heart failure on reducing salt.

As always, check with a doctor or dietitian to determine the diet that is right for your family member. You can search for a registered dietitian near you at www.eatright.org.

How to beat "cabin fever"

Feeling housebound is common among family caregivers, and is particularly so for partners caring for a loved one with an “unpredictable” disease. Some conditions, such as COPD make planning difficult because the patient’s stamina can fluctuate dramatically. The inability to make plans and get out of the house can be especially hard for spouses who are used to doing things together.

Isolation frequently leads to depression in both patients and their partners. It has also been linked with worsening physical health among family caregivers. Unfortunately, spouses tend to feel guilty if they go out with friends or engage in pleasurable activities. But staying cooped up only puts their own health, and ability to care for their loved one, at risk.

There are many solutions to “cabin fever.” Help your relative’s spouse:

• Reach out. Maintain relationships with friends and family, even if just by phone or email. Join an online support group to connect with others who understand.
• Create personal time. Set aside time each day for a pleasant activity, unrelated to caregiving.
• Stay active. Do something physical every day, even if it’s just a walk around the house or yard.
• Get out of the house. Take a real break. Do something carefree. There are 168 hours in a week. Taking one or two hours for personal time without responsibilities is not too much!
• Safeguard health. Encourage your loved one’s spouse to talk to a doctor if you think he or she may be depressed. Depressed caregivers have much greater health risks. If they hesitate, remind them they will not be able to help their partner if their own health goes south!

Planning for travel with oxygen

If your family member needs medical oxygen, the crucial ingredient for successful travel is planning ahead.

First, decide how you will be traveling. By air, train, or cruise ship? By bus or car? This information will help determine how much oxygen your relative must carry.

Advance planning

• Consult with the doctor for medical clearance to travel. Obtain a brief medical history to carry along. Include a list of current medications and an oxygen prescription.
• Create a list of contact information of health care providers.
• Check the health insurance plan for guidelines regarding out-of-area medical emergencies. The International Association for Medical Assistance to Travelers has a tipsheet for traveling with lung (pulmonary) conditions.

Oxygen supply

• Have a respiratory therapist calculate how much oxygen will be needed. Allow for an extra supply in case departure or arrival times are delayed.
• Contact the airline, train, cruise ship, or bus company to make arrangements for oxygen. The requirements are different for each mode of travel.
• When flying, prepare for getting through the security checkpoint with oxygen.
• When traveling by car with oxygen, secure the tank in an upright position. Ensure that no one smokes. Crack the window to prevent oxygen build up.

Vacation days, have your loved one

• Wear emergency medical identification. Keep medications on hand at all times. Pack them in carry-on luggage and day-trip gear. Include a current prescription list and contact information for all health providers.
• Stay hydrated. Airplane air is especially dry. Drink lots of water and skip the caffeine or alcohol.
• Avoid sitting for long stretches of time. Try to move around every hour or so.
• Keep up to date about air pollution and weather at their destinations. Be alert to conditions that may make breathing more difficult.

If you have to go to the Emergency Room

About one of every five seniors goes to the ER in a given year. Most ER visits are literally “by accident.” But some conditions, like COPD, often result in frequent trips to the ER. Taking a few simple steps to prepare ahead of time can reduce some of the stress.

Create an “ER kit” and keep it updated with

• Medical information: A list of your loved one’s conditions, medications, allergies, and past surgeries. Include contact information for current physicians.
• Insurance information: A copy of your family member’s insurance card(s). Include any supplemental policies.
• Advance directive: This helps ensure your loved one’s preferences for life-sustaining treatment are followed.
• A change of clothes in case your loved one’s garments become wet or soiled.
• Stress-relieving supplies: ER visits are often lengthy and tiring. Pack water and snacks and cash for purchases. A pen and paper, a light sweater, and reading material or CDs can also come in handy.

What to Do: Strive for balance.

• Support your loved one with your calm attention.
• Provide information to ER staff as requested. Your input is essential to help them understand what’s different from “normal.”
• Ask for periodic updates. It’s fine to ask every 40 to 60 minutes for an update. If your family member’s condition seems to worsen while you are waiting, alert ER staff immediately.
• Observe and take notes. Write down what procedures were done and what medications were given.
• Get instructions. Don’t leave without written instructions. Ask specifically about the diagnosis, follow-up care, and any new prescriptions. Be sure you understand when to call the doctor. If you are uncertain, ask questions until you know what to do.

Making treatment decisions

If your relative is seriously ill, he or she is probably needing to make decisions about which treatments to pursue. These are deeply personal choices. And they aren’t always easy.

Try to compare apples with apples by:

• Gathering information into one document. Note as much as you can about each treatment: What are the benefits/advantages? What are the risks/disadvantages? Are there any side effects? What will “success” look like? (“How good does it get?”) How likely is that outcome? Will your family member still be able to do the things that give him or her purpose? If a cure is questionable, and treatments are difficult, you might want to include the option of not seeking treatment. Your loved one might prefer to stay comfortable and pain free, and spend his or her remaining time and limited energy on those activities that provide pleasure and meaning in life. Palliative care may be the wisest choice.
• Applying personal values. For each option, rate how important each benefit is: five stars for extremely important versus one star if it doesn’t matter much. Use this system for rating the disadvantages. Looking at the number of stars for each option is very helpful in making a decision.
• Assessing the support system. Serious treatment decisions are often made in consultation with others: the doctor, a spouse, other family members. The decision tool helps highlight the role others play in the process.
• Identifying the next steps. As you work with the tool, it will become clear what’s missing. Maybe you need more information. Perhaps your relative wants to talk with others who have made the same choice.