Professional Documents
Culture Documents
Queensland Health The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 a
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide is a joint project of the
Statewide COPD Respiratory Network, Clinical Practice Improvement Centre, Queensland Health and
The Australian Lung Foundation, COPD National Program.
This work is copyright and copyright ownership is shared between the State of Queensland (Queensland Health)
and The Australian Lung Foundation 2012. It may be reproduced in whole or in part for study, education or
clinical purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced
for commercial use or sale. Reproduction for purposes other than those indicated above requires written
permission from both Queensland Health and The Australian Lung Foundation.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012.
For further information contact Statewide Respiratory Clinical Network, Patient Safety and Quality Improvement
Service, e-mail: PSQ@health.qld.gov.au or phone: (07) 36369505 and The Australian Lung Foundation,
e-mail: enquiries@lungfoundation.com.au or phone: 1800 654 301. For permissions beyond the scope of
this licence contact: Intellectual Property Officer, Queensland Health, email: ip_officer@health.qld.gov.au
or phone (07) 3234 1479.
To order resources or to provide feedback please email: enquiries@lungfoundation.com.au or
phone 1800 654 301.
Queensland Health Statewide Respiratory Clinical Network and The Australian Lung Foundation, COPD
National Program Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide, 2012.
ISBN 978-0-9872272-0-1
Foreword
Chronic Obstructive Pulmonary Disease (COPD) is second only to diabetes as a
leading cause of avoidable hospital admissions. COPD impacts significantly on
the day-to-day lives of people with the disease, their families and carers, and the
health system. While there is no cure for COPD, there are things people can do to
improve their symptoms and therefore the quality of their lives.
In 2007, the Queensland Health Statewide Chronic Obstructive Pulmonary Disease
Collaborative identified the need for standardised, evidence-based patient information
to be available to people with COPD who were participating in pulmonary rehabilitation
programs. In response to this need, a team of health care professionals experienced
in providing care to people with lung conditions compiled this booklet. This original
publication has now been reviewed and updated in line with current best practice.
This booklet has been developed for people with COPD and their families and carers
and also for health professionals involved in the care of people with COPD.
The aim of this booklet is to:
provide useful information about how to live well with chronic lung conditions.
offer practical hints about what people with COPD can do to improve their
well-being.
act as a resource tool for people with COPD and health care professionals,
particularly those living in regional and remote areas.
Queensland Health and The Australian Lung Foundation are committed to supporting
those with COPD to manage their condition and get the best they can out of life. This
Dr Michael Cleary, Deputy Director-General
Health Service and Clinical Innovation Division
booklet is an important step to better living with COPD.
Queensland Health
We acknowledge the significant work undertaken by Queensland Health staff and
in particular the Queensland Health Statewide Respiratory Clinical Network in the
development of this booklet. A collaborative partnership between Queensland Health and
The Australian Lung Foundation has made it possible to widen access to this resource
to people with COPD, regardless of where they live in Australia. Additionally, we
thank the consumers who provided feedback about this booklet during its development.
For access to this resource on-line, visit www.lungfoundation.com.au, or for
further information, call The Australian Lung Foundation on 1800 654 301.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 I
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Acknowledgements
Queensland Health and The Australian Lung Foundation wish to Statewide COPD Clinical Network,
acknowledge the efforts of all those involved in the development, Queensland, Steering Committee
review and update of Better Living with Chronic Obstructive
Reviewers
Pulmonary Disease A Patient Guide.
Judith Hart, Australian COPD Patient Taskforce.
Associate Professor Stephen Morrison, Chair Associate Professor Christine McDonald,
Associate Professor Ian Yang, Immediate Past Chair Respiratory Physician, Austin Hospital, Melbourne, VIC.
Statewide COPD Clinical Network, Queensland Vanessa McDonald, Clinical Nurse Consultant,
John Hunter Hospital, Newcastle, NSW.
Dr Bill Scowcroft, Co-Chair,
Project Officers
Australian COPD Patient Taskforce.
James Walsh (Coordinating Author), Physiotherapist,
The Prince Charles Hospital, Brisbane, QLD. Myrna Wakeling, Talk Lung Care Support Group.
Helen Seale, Assistant Director of Physiotherapy, Thoracic 2nd Edition August 2012 Project Officers
Program The Prince Charles Hospital, Brisbane, QLD.
Pauline Hughes, Respiratory Nurse Practitioner,
Heather Allan, Director, COPD National Program,
Metro North Health Service District, Brisbane, QLD.
The Australian Lung Foundation.
David McNamara, Respiratory Clinical Nurse Consultant,
Simon Halloran, Physiotherapist,
Nambour General Hospital, Nambour, QLD.
Bundaberg Base Hospital, QLD.
James Walsh, Physiotherapist,
Contributing authors The Prince Charles Hospital, Brisbane, QLD.
Helen Seale, Assistant Director of Physiotherapy Thoracic
Robyn Cobb, Physiotherapist,
Program, The Prince Charles Hospital, Brisbane, QLD.
The Prince Charles Hospital, Brisbane, QLD.
Heather Allan, Director, COPD National Program,
Annette Dent, Respiratory Scientist,
The Australian Lung Foundation.
The Prince Charles Hospital, Brisbane, QLD.
Judy Henry, Project Co-ordinator,
Mary Doneley, Social Worker,
The Australian Lung Foundation.
The Prince Charles Hospital, Brisbane, QLD.
Emily Gill, Dietician, Lead Reviewers
Royal Brisbane and Womens Hospital, Brisbane, QLD.
Dr Vanessa McDonald, Clinical Nurse Consultant,
Di Goodwin, Respiratory Clinical Nurse Consultant, John Hunter Hospital and The University of Newcastle,
Royal Brisbane and Womens Hospital, Brisbane, QLD. Newcastle, NSW.
Kathleen Hall, Physiotherapist, Associate Professor Ian Yang, Thoracic Physician,
The Prince Charles Hospital, Brisbane, QLD.
The Prince Charles Hospital, Brisbane, QLD.
Simon Halloran, Physiotherapist,
Bundaberg Base Hospital, Bundaberg, QLD. Additional Contributing Authors
Karen Herd, Dietician, Dr Helen Reddel, Research Leader, Clinical Management,
The Prince Charles Hospital, Brisbane, QLD. Woolcock Institute of Medical Research, Sydney, NSW.
Michele Kennedy, Respiratory Clinical Nurse Consultant, Moira Fraser, Clinical Nurse Specialist,
Logan Hospital, Meadowbrook, QLD. Concord Hospital Medical Centre, NSW.
Renae Knight, Occupational Therapist, Amanda Ballard, Senior Social Worker,
Brisbane South Respiratory Service, QLD. Metro North Health Service District, Brisbane, QLD.
Jennie Lettieri, Speech Pathologist, Toowoomba Hospital, QLD. Susan Marshall, Senior Psychologist,
Lisa McCarthy, Thoracic CNC, The Prince Charles Hospital, Metro North Health Service District, Brisbane, QLD.
Brisbane, QLD. Wendy Noyce, Advanced Occupational Therapist,
David McNamara, Respiratory Clinical Nurse Consultant, Metro North Health Service District, Brisbane, QLD.
Nambour General Hospital, Nambour, QLD. Judy Powell, Project Manager, Primary Care COPD
Judy Ross, Respiratory Clinical Nurse Consultant, National Program, The Australian Lung Foundation.
Princess Alexandra Hospital, Woolloongabba, QLD. Elizabeth Harper, Program Manager, Pulmonary
Helen Seale, Physiotherapist, Rehabilitation and Lungs in Action, COPD National
The Prince Charles Hospital, Brisbane, QLD. Program, The Australian Lung Foundation.
John Serginson, Respiratory Nurse Practitioner,
Caboolture Hospital, QLD. Statewide Respiratory Clinical Network, QLD
Stella Snape-Jenkinson, Advanced Occupational Therapist,
Heart Lung Team, The Prince Charles Hospital, Brisbane, QLD. Consumer Reviewers
Tracy Tse, Pharmacist, Judy Hart, QLD.
The Prince Charles Hospital, Brisbane, QLD. Caroline Polak Scowcroft, ACT.
Barb Williams, Respiratory Clinical Nurse, Ezy Breathers Support Group, Northlakes, QLD.
Logan Hospital, Meadowbrook, QLD.
James Walsh, Physiotherapist, Pulmonary Rehabilitation Booklets
The Prince Charles Hospital, Brisbane, QLD. The following COPD Pulmonary Rehabilitation Booklets were
Robert Walton, Clinical Psychologist, reviewed and used as models to produce this Patient Guide:
Nambour General Hospital, Nambour, QLD. Brisbane South Community Health Service District
Brett Windeatt, Respiratory Clinical Nurse, Bundaberg Health Service District
Logan Hospital, Meadowbrook, QLD. Cairns Health Service District
Michelle Wood, Physiotherapist, Nambour General Hospital
The Prince Charles Hospital, Brisbane, QLD. Gold Coast Health Service District
Associate Professor Ian Yang, Thoracic Physician, The Prince Charles Hospital
The Prince Charles Hospital, Brisbane, QLD. The Alfred Pulmonary Rehabilitation Program
II
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Contents
Chapter Page
1. Introduction .................................................................................................................. 1
2. The lungs ..................................................................................................................... 2
3. Lung conditions ............................................................................................................ 5
4. Lung function tests ........................................................................................................ 8
5. Your role in managing your COPD ................................................................................. 11
6. Stopping smoking and preventing a relapse .................................................................... 16
7. Knowing your medication ............................................................................................. 20
8. Using your inhalation devices ....................................................................................... 27
9. Preventing and managing a flare up ............................................................................... 36
10. Introduction to pulmonary rehabilitation ......................................................................... 40
11. Exercise and physical activity ....................................................................................... 42
12. Breathlessness, breathing control and energy conservation ............................................... 52
13. Airway clearance: keeping your lungs clear ..................................................................... 58
14. Home oxygen therapy .................................................................................................. 60
15. Healthy eating ............................................................................................................ 63
16. COPD and swallowing ................................................................................................. 68
17. COPD and other related conditions ................................................................................ 71
18. Managing stress, anxiety and depression ........................................................................ 76
19. Intimacy and COPD ..................................................................................................... 80
20. Travel and COPD ......................................................................................................... 82
21. Legal issues ................................................................................................................ 86
22. Community support services ......................................................................................... 89
23. Frequently asked questions .......................................................................................... 93
24. Resources and support available from The Australian Lung Foundation .............................. 95
25. References ................................................................................................................. 97
26. Feedback ................................................................................................................... 99
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 III
1
chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term for a group of disorders that cause
obstruction of airflow in the breathing tubes or airways of the lungs. When the condition occurs it is
chronic (long term) in nature, and therefore the airflow obstruction is usually permanent or irreversible.
1 Chapter 1: Introduction
2
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
chapter
The lungs
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 2
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Within the lungs is a transport system for oxygen moves from the bloodstream back into the air sacs
and carbon dioxide. Each time you breathe, air is and through the breathing tubes or airways, where
drawn via the mouth and nose into the windpipe it is breathed out.
(trachea).
The windpipe splits into two breathing tubes (bronchi): Lungs
one to the left lung and one to the right lung. The
breathing tubes continue to divide into smaller and
smaller tubes (bronchioles), which take air down
into each lung.
Breathing tubes
(bronchioles)
Branch of bronchial artery Air sacs (alveoli)
What is the role of the How does your respiratory (or breathing)
nose and nasal cavity? system protect against irritants or
The nose and nasal cavity perform a number of foreign particles?
functions, including: The breathing system provides protection against
Providing us with a sense of smell. irritants or foreign particles entering the lungs. The
breathing system has several protection mechanisms.
Warming and moistening the air that is breathed in.
Firstly, the nose filters the air when breathing in,
Filtering the air that is breathed in of irritants, preventing irritants, such as dust and foreign matter
such as dust and foreign matter. from entering the lungs.
Assisting in the production of sound.
Secondly, if an irritant enters the airways or
The nose is the preferred route to deliver oxygen to breathing tubes, sputum that lines the airways traps
the body as it is a better filter than the mouth. The unwanted particles. Tiny hair-like structures called
nose decreases the amount of irritants delivered to cilia line the breathing tubes or airways. They move
the lungs, while also heating and adding moisture in a sweeping motion to help move the sputum and
(humidity) into the air we breathe. unwanted particles up into the mouth where they
When large amounts of air are needed, the nose can be cleared. The function of the tiny hairs can be
is not the most efficient way of getting air into the affected by smoke, alcohol and dehydration.
lungs. In these situations, mouth breathing may The third protective mechanism for the breathing
be used. Mouth breathing is commonly needed system is the cough. A cough is the result of irritation
when exercising. to the breathing tubes (bronchi and bronchioles).
Infection or irritation of the nasal cavities can result A cough can clear sputum from the lungs.
in swelling of the upper airways, a runny nose or Lastly, the lungs also have a built-in immune system
blocked sinuses, which can interfere with breathing. that acts against germs.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 4
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Lung conditions
Extra mucous However, not all air sacs are involved to the same
degree, and only parts of the lungs may be affected.
Emphysema
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 6
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
COPD and Asthma breathing tubes, which can lead to further infections
Because asthma and COPD have similar symptoms, and damage to the breathing tubes or airways.
it may be difficult to distinguish between the two Sputum is often white. If it changes to a different
conditions. We know that many people with COPD colour such as yellow, brown or green, it usually
may have asthma as well, especially those who are means there is an infection. Sometimes people with
aged over 55 years. We also know that many older bronchiectasis will have discoloured sputum even
Australians being treated for asthma, in fact have COPD. when they are well.
Asthma and COPD have different causes, affect The main treatments for bronchiectasis include:
the body differently and some of the treatments are
1. Airway clearance techniques to loosen and
different. It is important, therefore, to determine if
clear sputum.
you have asthma, COPD or both. The best way to
do this is by having your doctor perform a lung 2. Prevention of further infections by vaccinating
function test (spirometry). See chapter 4 Lung against infectious diseases, removing irritants and
function tests, page 8, for further information. using aerosols and antibiotics when indicated.
3. Pulmonary rehabilitation is also recommended
What is bronchiectasis? for people with bronchiectasis.
Bronchiectasis is a lung condition involving the
destruction of the airways or breathing tubes inner What is interstitial lung disease?
lining and widening or dilatation of the breathing
Interstitial lung disease refers to a group of lung
tubes (bronchi and bronchioles).
conditions, including pulmonary fibrosis, in
Bronchiectasis is not caused by cigarette smoking which the lungs harden and stiffen (become
and is usually caused by a previous severe infection fibrosed or scarred).
of the lungs.
During interstitial lung disease, the walls of the air
Bronchiectasis is characterised by repeated episodes sacs (alveoli) thicken, which reduces the transfer
of acute bronchial or airway infection with increased of oxygen (or other gases) to and from the blood.
coughing and sputum production. This alternates
Interstitial lung disease may be caused by immune
with periods of chronic infection and mild coughing.
conditions, asbestosis, exposure to chemicals
In bronchiectasis, sputum becomes difficult to clear. or irritants, or have no known traceable cause
Sputum can be trapped in pockets within the (idiopathic).
Why are lung function tests important Spirometry will be used to monitor your COPD and
in the diagnosis and treatment of COPD? to check how well your treatment is working.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 8
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What should I know before taking the 4. FEV1 /FVC. This measures how much air is blown
spirometry test? out in the first second proportional to the total
amount blown out of the lung. So it shows how
You may be asked to not take your breathing
quickly the lungs can be emptied. People with
medications on the day of the test. However,
healthy lungs can usually blow out 70% to 90%
if you feel really breathless, take your breathing
of their air in the first second.
medications and let the person conducting your
test know when you used your breathing
medications.
As effort is required to do this test, you may get
tired. This is not unusual.
The person conducting the spirometry test will
give you instructions on how to do the test. If you
do not understand them, ask for the instructions
to be repeated or for a demonstration on how
the test should be undertaken.
You can sometimes become light-headed during
the test. If this happens, stop breathing into
the machine and let the person conducting
your test know.
To get the best results, you will be asked to do
the test several times.
Breathing test results vary according to a
persons age, height, whether they are male
or female, and their ethnic background.
The results of these breathing tests allow your lung
function to be compared with people who are like Spirometry measures how quickly you empty your lungs
you, but who do not have lung conditions.
Your breathing test results can be used to classify What is a gas transfer measurement?
the severity of your lung condition. Different The gas transfer measurement is a test that measures
measurements are taken to assess your lung function. how well oxygen in the air moves from your lungs
across the air sacs (alveoli) and into your blood stream,
The most common measures are:
and thus to your vital organs.
1. Forced Expiratory Volume in one second (FEV1).
This test is done by breathing into a mouthpiece
This is the maximum amount of air that can be
connected to a machine.
expelled from the lungs during the first second
of breathing out following a maximal breath in. You will be asked to breathe out as much as you can,
to take a large breath in, and to hold your breath for
2. Vital Capacity (VC). This is the maximum amount
10 seconds before breathing back into the machine.
of air that can be expelled from the lungs while
To get the best results, you will be asked to repeat
breathing out following a maximal breath in.
the test.
3. Forced Vital Capacity (FVC). This is the
This test will take about 15 minutes to complete.
maximum amount of air that can be expelled
from the lungs while breathing out forcefully. VC Typically, if you have severe COPD, your results
and FVC are equal in a normal lung but can differ will be low when compared with people who are
in patients who have a chronic lung condition. like you, but who do not have lung conditions.
What should I know before taking the gas transfer What should I know before taking the lung volume
measurement test? measurement test?
If you are on oxygen, you will be asked to take If you are on oxygen, usually you will be asked
the oxygen off for a few minutes before the test. to come off the oxygen during the test.
If you suffer from claustrophobia in small spaces,
What is a lung volume measurement?
let the operator know. They may ask you to
The lung volume measurement is a test that attempt the test as most people can do the test
measures the amount of air in your lungs. There even if they have claustrophobia.
are three measurements, which are taken:
At the end of a normal breath.
When you have taken in a deep breath.
When you have blown out all the air.
No matter how hard you try, when you have blown
out all the air, there is still some air left in your lungs.
It is this amount of air that is left in the lungs that
is measured.
Lung volumes are measured in a machine called a
body plethysmograph, which is like a box with glass
walls. This test is done in a box because very small
pressure changes need to be measured while you
are breathing.
During the test, you will sit in the box with the door
closed and breathe through a mouthpiece attached
to the machine.
You will be instructed to breathe normally through
the mouthpiece. However, every now and then, you
will be asked to breathe against a blockage and to
also breathe all the air out and then take a large
breath in. The test will take approximately 10 minutes
to complete.
Typically, if you have COPD, your lungs will be a lot
bigger than normal because of the amount of air Lung volume measurement measures how much air
trapped in your lungs (hyperinflation). is in your lungs
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 10
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
reduce the impact of these symptoms. A sample The following are some tips that others have used
symptom diary is discussed in more detail in to help them set goals and stick to them.
chapter 9.
Set realistic goals that are important to you.
Managing the impact that COPD has on your Write your goals down and let your health care
physical, emotional and social life. team, family and friends know what they are
Adopting lifestyle behaviours that promote so they can support you to achieve them.
health, such as eating a healthy diet, getting Reward yourself when you have done well.
regular exercise and quitting smoking if you
Simplify your life as much as you can.
are a smoker.
Be kind to yourself.
Using support services that are made available
Seek support from family, friends and others.
to you.
Locate your nearest support group by contacting
The Australian Lung Foundation (phone:
How do you develop and get the most 1800 654 301). Others have found the support
from your management plan? from others in a similar situation very helpful.
When you have a chronic lung condition, you may Enrol in pulmonary rehabilitation and once,
experience difficulty managing all your treatments completed, maintain a regular exercise routine.
day after day. Support from your health care team, Ask a family member or friend to participate in
family and support groups can help you to stay your exercise and walking program, or join a
motivated and look after yourself. local exercise group such as Lungs in Action.
The Australian Lung Foundation can give you
the contact details of a group close to you.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 12
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
D: DEVELOP SUPPORT
O: OPTIMISE FUNCTION
NETWORK AND
To improve your condition your doctor will prescribe
SELF-MANAGEMENT PLAN
treatments. These treatments may include inhaled
I regularly exercise
C: CONFIRM DIAGNOSIS
I have discussed my other medical problems with
By now your doctor will have informed you that
my doctor and other members of the COPD team
you have COPD.
To confirm your diagnosis and to assess the severity I have had regular health checks with my doctor
of your COPD it is important that you have a to monitor my signs and symptoms
I know how to start a quit plan My doctor and I have developed a written COPD
Action Plan
I am aware of the medications that can
help me stop smoking I am aware of the signs and symptoms
of a flare up
I have had my yearly flu vaccination
I know how to increase my treatment
I have had my pneumococcal vaccination during a flare up
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 14
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
How do you work with your The Australian Lung Foundation has developed a
health care team? helpful fact sheet called, Talking to your doctor about
COPD. It can be found at www.lungfoundation.com.au
Your doctor looks after your health together with a or call 1800 654 301.
range of other health care professionals, such as
your nurse, pharmacist or physiotherapist. Good In summary
communication with all the members of your health Learning to live well with a chronic condition is
care team will help you to look after your health. It possible. Coping with a chronic condition involves
is easy to get flustered or confused when talking to skills training, learning to manage a number of
a doctor, especially if he or she uses words or symptoms, and consciously assessing and making
terms that you are not familiar with. However, it lifestyle changes. Experience has shown that those
is important that you understand exactly what they who develop a management plan with their health
are saying. It is also important that your doctor care team and follow it can live better with COPD.
understands what is important to you.
The following chapters will provide all the details
Your COPD may also change over time. As different you need as you think through and develop a
symptoms occur, you will need to recognise these management plan, including:
changes and talk to your health care team about
adapting to these changes. Stopping smoking and preventing a relapse
(Chapter 6)
The following are some tips you might find useful
Knowing your medication (Chapter 7)
when you are visiting your doctor.
Using your inhalation devices (Chapter 8)
Make appointments with the same doctor,
Preventing and managing a flare up (Chapter 9)
except in an urgent situation or when your
normal doctor is not available. Introduction to pulmonary rehabilitation
(Chapter 10)
Make a list of questions and concerns before
your visit. List these in order of priority. Exercise and physical activity (Chapter 11)
If you have many questions, ask for a longer Breathlessness, breathing control and energy
appointment or schedule a second visit. conservation (Chapter 12)
Show your list to your doctor and decide Airway clearance: Keeping your lungs clear
together what you will discuss during this visit. (Chapter 13)
Do not avoid asking questions because you are Home oxygen therapy (Chapter 14)
embarrassed or uncomfortable. Your doctor is Healthy eating (Chapter 15)
there to help you. COPD and swallowing (Chapter 16)
Bring a friend or family member for support. COPD and other related conditions (Chapter 17)
If you feel you do not fully understand what Managing stress, anxiety and depression
your doctor is saying, ask for further explanation. (Chapter 18)
Ask your doctor to write answers down for you Intimacy and COPD (Chapter 19)
to refer to again.
Travel and COPD (Chapter 20)
Find out the best way to contact your doctor in
Legal Issues (Chapter 21)
case you have additional questions or if you are
concerned about symptoms or suspect a flare up. Community support services (Chapter 22)
Let your doctor know if you have concerns over Frequently asked questions (Chapter 23)
the costs of your treatment. They can help you Resources and support available from
find the best solution. The Australian Lung Foundation (Chapter 24)
Why is it important to stop smoking? in their brains that were once hooked on nicotine.
Many people with COPD have already been able These receptors lie dormant, waiting to be turned
to stop smoking. If that is you, congratulations! on again by just one cigarette. If these receptors are
turned on again, the addiction cycle can start again.
Stopping smoking is important because it is the
single most important step in slowing the progression As a result, people who relapse and make another
of chronic obstructive pulmonary disease (COPD). attempt to stop smoking can, once again, experience
the unpleasant symptoms of nicotine withdrawal.
Tobacco smoking is responsible for over 19,000 deaths
These symptoms include strong cravings or urges
in Australia each year and is widely regarded as the
to smoke, anxiety, agitation and depression.
most common preventable cause of chronic conditions.
Although many ex-smokers report being able to
Smoking is the major cause of COPD.
remember how much they enjoyed smoking, the
actual physical addiction to nicotine is no longer
Quitting smoking has the added benefit of active. Fortunately, just having these thoughts doesnt
protecting those around you from exposure to mean you will have cravings or urges to smoke.
second hand smoke. There is an established The important message for many ex-smokers is that
link between exposure to second hand smoke stopping smoking is a lifelong process, rather than
and the risk of developing lung disease such an isolated event. For the majority of smokers who
as COPD, asthma and lung cancer. were once heavily nicotine-dependent, the potential
for relapse continues to be a lifelong possibility.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 16
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Age (years)
Quitting smoking at any age is beneficial to your health
Adapted from Fletcher C. Peto R, Br Med J 1977; 1:1645-8.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 18
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
3. Medications that work on brain nicotine receptors programs are particularly helpful for people who
There are medications that work on brain receptors have established disease conditions, such as
that are available as prescription medicines. These COPD. These programs can help people make
have been specifically designed to help smokers the appropriate behavioural or environmental
stop smoking and have good success rates. You changes that are required to stop smoking. Studies
may wish to discuss with your GP your suitability have shown that clinics that offer professional
for these types of medications. behavioural support and advice on effective NRT
use can help people stop smoking. Quit rates are
The most widely known drug in this category is
highest in people who combine counselling
Varenicline or Champix which is available by
support and take smoking cessation medication.
prescription on the PBS. Champix is a tablet
prescribed for 12 weeks and if a smoker quits it There is no time like now to quit smoking!
is available for a further 12 weeks immediately Please ask for a referral to a clinic or a smoking
following the first course. This is in an attempt counsellor who can help you stop smoking and
to keep the brains nicotine receptors asleep. dont give up giving up!
Another medication in this category available Preventing a relapse
on the PBS is Bupropion or Zyban. It is also
Unfortunately there is no clear evidence that supports
a tablet which works on the brains receptors and
any method of staying smoke free once you have quit.
has been used as a smoking cessation medication
for many years. In the past there were some myths The best defence is the knowledge that smoking
in the media about Zyban being unsafe, however, cessation is a journey and not a single event. Nicotine
these are untrue. This treatment is an effective receptors in the brain can be switched off during
option for smokers wishing to quit. It is not suitable the quitting process, but as little as a few puffs of
for people who are taking anti-depressant a cigarette, months or years later will switch them
medication or who have a history of seizures. back on. When this occurs most people will find
themselves addicted smokers again.
Speak to your doctor about whether any of these
options are suitable for you.
4. Stop smoking clinic programs Participating For support to quit smoking, call the
in a clinic program can give you the advice and National Smoking Quitline on 13 78 48.
support required to help you stop smoking. These
19 The State
Chapter 6: Stopping smoking and preventing a relapse
of Queensland (Queensland Health) and The Australian Lung Foundation 2012 19
7
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
chapter
Why are medications used in the cause side effects, it is important to remember that
management and treatment of COPD? only a small number of people using that medication
will develop side effects.
To improve or manage your COPD symptoms, your
doctor may have prescribed various medications. As respiratory medications target the lungs, most
Although medications cannot cure COPD, when COPD medications are inhaled using special inhaler
used as prescribed, they can go a long way towards devices so that the medication is delivered directly
reducing your symptoms and preventing flare ups. to the lungs. Correct technique is important in
As each persons health is different, each person delivering your medication effectively. To ensure you
may be prescribed different medications at different are receiving the full benefits from your medication,
doses your medication program is tailored have your inhaler technique checked regularly by
especially for you. your doctor, pharmacist or respiratory nurse.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 20
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
For quick relief For regular, long For regular, long For short term
of breathlessness. term use to control term use, in more use during a flare
Also called rescue symptoms and severe COPD (If you up of COPD.
medication. to help prevent experience frequent
flare ups. flare ups).
What are the types of medication? your symptoms worsen or you experience more
frequent flare ups, your doctor may prescribe
There are four main categories or groups of medication
additional medications for maintenance and
you may be prescribed (see diagram above). You
prevention. Some patients find themselves on three
will notice that some of your medications may fit
different medications, each with its own inhaler.
into more than one of these categories depending on
This is normal, however, it is important that you
your situation:
understand the role of each of your medications
1. Reliever medication for quick relief of increasing and you take them properly.
symptoms of breathlessness.
The majority of medications for people who have
2. Maintenance medication for long term regular
COPD are listed on the Pharmaceutical Benefits
use to control your symptoms and to help prevent
Scheme (PBS) and require prescriptions from a
flare ups.
doctor. However, Ventolin and Bricanyl are
3. Preventer medication, including combination available over the counter without a prescription,
medications for long term regular use when but will cost more than through the PBS.
COPD becomes more severe and you experience
several flare ups.
4. Flare up medication for short term use during
All medications come with Consumer Medicine
an acute flare up of your COPD symptoms.
Information. Ask the dispensing pharmacist if
When you are initially diagnosed with COPD, your you have any concerns or dont understand
doctor may start you on a reliever medication and what is included in the information.
then, if the severity of your disease progresses and
What are the uses, effects and side effects of your medications?
Reliever medications should be used for symptom relief as a rescue medication for the relief of breathlessness.
They are called short-acting (because they work quickly) bronchodilators. They work by relaxing the muscles
around the breathing tubes or airways. This helps to open up the breathing tubes or airways which reduces
the obstruction and allows air to flow out of and into the lungs when you breathe easing your feelings of
breathlessness and increasing your ability to exercise. Relievers often work within minutes of inhalation and
their effects last for several hours.
There are two types of reliever or bronchodilator medications: short-acting beta2 agonists and short-acting
anticholinergics (or muscarinic antagonists).
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 22
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Maintenance medications
Maintenance inhalers are bronchodilators too, since they open up the breathing tubes or airways by relaxing
the muscles around the breathing tubes or airways in the same way that relievers do. Most maintenance
bronchodilators take a little longer than relievers to start working, but once you have taken them, their effects
last for much longer, for 12 hours to 24 hours depending on the medication.
Maintenance medications include short and long-acting anticholinergics (or muscarinic antagonists) and
long-acting beta2 agonists (or bronchodilators) will help to reduce your COPD symptoms in the long term and
can help to prevent flare ups.
All maintenance inhalers work in one of two different ways to relax the muscles around the breathing tubes
or airways. You can be prescribed one type alone, or may receive a combination of both types.
Indacaterol (Onbrez)
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 24
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Preventer medications
Preventer inhalers contain corticosteroids, sometimes referred to just as steroids. These steroids are effective
in COPD and are different from anabolic steroids. In more severe COPD, these medications help to reduce the
number of flare ups people may experience by reducing inflammation which causes swelling and sputum
production in the breathing tubes or airways. They are especially important to use if you also have asthma as
they specifically treat the type of inflammation or swelling that commonly occurs in asthma. Preventers must
be taken twice a day every day to be effective. It may take up to a few weeks for you to start noticing their
effect. So, it is important for you to keep taking them to have an impact on your symptoms.
1. Inhaled corticosteroids for people with moderate to severe COPD who have
had two or more flare ups over the previous year.
Combining medication like this can help to reduce
the number of flare ups which in turn improves lung
function and overall health. In addition, combined
medications are easier to use since they are available
in one inhaler for two different medications. They
are prescribed twice daily.
Combination inhalers
include:
i. Budesonide and
eformoterol (Symbicort)
QVAR Pulmicort ii. Fluticasone and
salmeterol (Seretide)
> Beclomethasone (QVAR) - it is recommended
delivered via Accuhaler
that this is used with a spacer.
or via a puffer and spacer.
> Budesonide (Pulmicort) - is given by a Turbuhaler.
> Fluticasone (Flixotide) - is often given as a Symbicort
puffer to use with a spacer or it may be given
by an Accuhaler.
Use
Inhaled twice a day.
Must be used regularly to be effective.
Effects
Reduces swelling and the amount of sputum
in the breathing tubes or airways.
May take up to a few weeks for you to notice
its effect.
Seretide
Side effects
A sore mouth and throat caused by a thrush Use
infection or hoarseness of the voice are the most Designed to improve patient adherence with
common side effects. To avoid these effects, use two medications in one inhaler.
a spacer when using a metered dose aerosol Improves quality of life, improves lung function,
(puffer), and rinse your mouth, gargle and spit and prevents flare ups.
after each dose. The use of long-acting bronchodilator
2. Inhaled combination medications maintenance therapy (Eformoterol, Salmeterol
or Indacaterol, see page 23) should be stopped
Sometimes inhaled steroids (preventers) are combined
once combination therapy is started.
with a long-acting bronchodilator (maintenance
inhalers) in one inhaler. This is often called Effects and side effects
combination therapy. These are usually prescribed Refer to individual medications.
Flare up medications
These medications are used when your symptoms start to worsen and you are experiencing a flare up.
These medications should be taken as detailed in your COPD Action Plan (see page 38) and will help
you to reduce the severity of your flare up.
Vaccinations
1. Influenza vaccine
A yearly influenza vaccine has been shown to reduce risk of death and hospital admissions.
2. Pneumococcal vaccine
Vaccination against pneumonia (PneumoVax 23) is recommended for people at high risk of serious
pneumococcal infection, such as COPD. This should be given no more than five yearly. After two vaccinations
(over 5 years apart), you should discuss with your doctor whether further vaccinations should be given.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 26
8
chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Why is using inhalation devices Typically you should be sitting upright or standing
an important skill? while taking your inhaled medication.
Using an inhalation device is a skill. After many The inhalation devices covered in this
years of using inhalation devices, you can develop chapter include:
habits that may not allow you to make the most of 1. Puffer (or metered dose inhaler)
your inhaled medications. You may also have extra 2. Puffer and spacer
medications prescribed over time that can complicate
3. Autohaler
your treatment schedule. The more device types you
are using, the greater the chance you have of using 4. Turbuhaler
them incorrectly. If you are using more than two 5. Accuhaler
device types, talk to your doctor about reducing the 6. HandiHaler
number of device types without changing the 7. Breezhaler
medications you are on.
8. Nebuliser
Having your inhalation device technique assessed
by an appropriate member of your health care or Puffer (or metered dose inhalers)
pulmonary rehabilitation team is essential. You can A puffer is also known as a metered dose inhaler,
also check with your managing doctor, nurse or a or an aerosol.
pharmacist.
How does the puffer work?
To make the most of using an inhalation device, it
In the puffer, the medication is stored under pressure
is important to position your body appropriately.
in the metal canister. When the puffer is fired, a fine
mist of the medication is produced that can be inhaled
It is important to store your inhalation into the lungs. These devices work best with spacers
device below 30oC and do not keep it in or holding chambers (see the following section on
the car on hot days. puffers and spacers).
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 28
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Puffer and spacer 4. Hold the puffer upright, remove the cap and
shake well.
Puffers (also known as a metered dose inhaler or
an aerosol) may be used with a spacer, which is 5. Place the puffer mouthpiece into the end of the
a small or large volume holding chamber. spacer opposite to the valve.
6. Place the mouthpiece between your teeth and
close your lips around it making sure your neck
is slightly tilted back.
7. Breathe out gently and slowly.
8. Activate the puffer into the spacer once only.
9. Either:
Breathe in slowly and deeply for five seconds
through your mouth, and hold your breath
for 10 seconds, if possible.
Or
Breathe in and out through your mouth
normally for four breaths.
10. Wait 30 seconds between doses and repeat
steps 2 to 9.
Using a spacer with your puffer can increase the amount
of medication that reaches your lungs
A B Mouthpiece
Indicator window
Air vents
A. Remove the cap and hold the Autohaler upright.
B. Push the lever up until it clicks and stays up.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 30
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
How to prime a new Turbuhaler On other Turbuhalers, a red line will appear at
Before you start to use a new Turbuhaler you the top of the indicator window on the side of the
need to prime it. device, which indicates that 20 doses are left (this
is a good time to organise a new device). When
1. Remove the cap. the red line appears at the bottom of the window,
2. Hold the device upright and twist the base left the Turbuhaler is empty.
and right as far as it will go. You will hear a click.
How to clean the Turbuhaler
3. Repeat step 2 one more time. Wipe the inhaler with a clean, dry tissue after use.
The Turbuhaler is now primed. To use the
Do not wash any part of the Turbuhaler or
Turbuhaler, follow the instructions below. get it wet.
Indicator
20 doses window
left
Empty
Accuhaler
Determining when the Turbuhaler is empty 2. To open, hold the base of the Accuhaler
horizontally in one hand; place the thumb
When is the Turbuhaler empty? of the other hand in the thumb grip and push
the thumb grip around as far as possible.
The Symbicort Turbuhaler (red base) has a counter
that counts down to zero (in twenties). When the 3. With the Accuhaler held horizontal, push the
counter is at 0, the device is empty. lever around until it clicks. The number indicator
reduces by one.
Mouthpiece
The Accuhaler is empty when the dose counter Centre
indicates zero. chamber
Green
piercing
When is the Accuhaler empty? button
The Accuhaler is empty when the dose counter Base
on the top indicates zero. The last five doses will 3. Open the mouthpiece by pulling upwards.
appear in red.
4. Peel the foil back carefully to expose only
How to clean the Accuhaler one capsule.
Wipe the inhaler with a clean, dry tissue 5. Remove the capsule from the foil and drop
after use. the capsule into the centre chamber.
Do not wash any part of the Accuhaler
6. Firmly close the mouthpiece, leaving the
or get it wet.
dust cap open.
How to care for the Accuhaler
Keep your Accuhaler dry.
Mouthpiece
Keep your Accuhaler closed at all times.
Green
piercing
button
Air intake
valve
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 32
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Breezhaler
How does the Breezhaler work?
The Breezhaler is activated by breathing in through
the mouthpiece. When loaded, a capsule (containing
the medication) that has been pierced inside the
Breezhaler allows the medication to be inhaled.
Rinse under warm water to remove 7. Breathe out gently away from the device.
dry powder. 8. Place the mouthpiece in your mouth and form a
Shake out excess water. seal with your lips around the mouthpiece. Hold
Leave to air dry for 24 hours with the the inhaler with the buttons to the left and right
HandiHaler open. (not up and down).
Dry the outside with a clean cloth, if needed. 9. Breathe in rapidly and steadily, as deeply as
Remember that as the HandiHaler takes 24
you can.
hours to dry, you should wash it immediately You should hear a whirring noise, which is
after a dose to ensure that it is completely dry the capsule spinning in the chamber. If you
before the next dose. dont hear the noise, the capsule may be
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 34
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Each week, soak the nebuliser bowl and the the bowl called a baffle (sometimes the baffle
mouthpiece or facemask in half vinegar and is missing, and if so, the bowl will need to
half water, rinse and allow to air dry. be returned).
Replace your nebuliser tubing, bowl and face The filter on the nebuliser pump may need to
mask or mouthpiece every three months. be replaced occasionally. See the manufacturers
manual for how often the pump may need
replacing.
Correct cleaning of your nebuliser will reduce
the risk of chest infections. Have the nebuliser pump checked annually for
correct airflow and pressure by the company
that sold you the nebuliser or by your local
How to care for the nebuliser pharmacy.
Inspect the nebuliser bowl and tubing for cracks, If nebulising Atrovent or Pulmicort, the use
and if cracks are found, replace. of a mouthpiece is preferable. If you do not
Nebuliser bowls have a limited life span. Check use a mouthpiece, the use of eye protection
the manufacturers manual for the expected life is advisable.
span of your nebuliser bowl. Ensure you rinse your mouth and face afterwards.
If you have acquired a nebuliser bowl through
a hospital, it will only last one to three months
and should be replaced (check manufacturers Nebuliser bowls have a limited life span.
recommendations). Check manufacturers manual for expected
If you have a new nebuliser bowl and it is not life span.
working, check for an extra piece of plastic in
What is an exacerbation or flare up? How can you monitor your symptoms
All people with chronic obstructive pulmonary disease and avoid having a flare up?
(COPD) are at risk of having an exacerbation or There are several possible triggers that can cause a
flare up. flare up. Some people are particularly susceptible to
A flare up is what happens when your COPD gets certain ones. These triggers include:
worse. Flare ups can become serious and you may Respiratory infections, such as a cold or the flu.
even need to go to hospital. It is important for you to Smoke.
understand how to avoid having a flare up, what the
Pollutants such as dust, wood smoke or smog.
signs and symptoms of a flare up are, and how you
can minimise their impact. Other unknown causes account for about one
third of all flare ups.
Some of the typical signs and symptoms of a flare
up are one or more of the following: There are things you can do to avoid getting a flare up:
More wheezy or breathless than usual. Develop a written COPD Action Plan with your
doctor and know how to use it (see page 38).
More coughing.
Learn what the triggers are that make your
More sputum than usual.
COPD worse and how to avoid them.
A change of colour in your sputum.
Stay inside on particularly cold or hot days
Loss of appetite or sleep. if possible.
Less energy for your usual activities. Avoid second hand smoke.
Taking more of your reliever medication Avoid strong cleaning products or
than normal. strong perfume.
Make sure you get the flu vaccination
every autumn.
COPD Action Plans aim to help you recognise
a flare up earlier and provide instructions on Make sure that you are vaccinated to protect
how to act to reduce the severity and duration you from pneumonia (see page 93 for details).
of your illness. Take your medications regularly and as
prescribed by your doctor.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 36
37
COPD Symptom Diary
The common symptoms of COPD are shortness of breath, persistent cough, coughing up sputum, and wheezing. Use this diary to track your symptoms on a daily basis.
Take this table when you go to visit your doctor. This will help to manage your COPD.
21/03/12 Shortness of breath 4 times a day Worse than normal All of the above I am not usually breathless.
Example
Maintain good hand hygiene. were both associated and not associated with an
Avoid people with colds and flu. infection), the treatment and outcomes. Check your
Symptom Diary for information.
Take good care of yourself by eating healthy
foods, exercising and getting enough sleep. Step 2
Keep track of your daily symptoms so that you You and your doctor will then agree on what actions
can recognise quickly when you are starting to you should take to manage your COPD whilst you
become unwell (a sample symptom diary is are stable but also during a moderate flare up and
provided on page 37). a severe flare up.
The sample symptom diary captures information Your stable section will include your usual daily
about your symptoms such as cough, sputum and medication and may include other information
shortness of breath. Some people find a diary like about your care, i.e. contact details for your doctor,
this one helps them to recognise when their oxygen use and lung function readings.
symptoms change.
Step 3
What can you do when you become sick? Mild to moderate flare up What to do when unwell/
having a moderate attack.
When you start to become sick it is important that
you act quickly. The quicker you act, the less likely You and your doctor agree on treatment directions
it is that you will end up in hospital. for management of a moderate flare up. This will
include details about increasing your reliever dose,
Follow the instructions on your written COPD
the frequency and the delivery method. You may also
Action Plan (see page 39).
get directions on starting a course of steroid tablets
Reduce your activity level. and / or an antibiotic if signs of an infection are present.
Clear sputum with the cough and huff
You and your doctor will then agree on the point that
technique (see page 59).
you will need to seek urgent medical treatment in
Practice controlled breathing and relaxation the case your flare up becomes severe. It will be
techniques (see page 54). extremely important to recognise when to seek urgent
Eat small amounts of nourishing food. treatment and what you can do whilst waiting for
Drink extra fluids. help to arrive. Your Action Plan will provide you with
Use additional medication as planned by these instructions.
your doctor.
Step 4
Contact your doctor if flare up becomes severe. Your doctor will need to provide or arrange for
prescriptions for extra medications to use with the
How can you develop and use a written COPD Action Plan (eg. steroid tablets or antibiotics
COPD Action Plan to keep at home with your COPD Action Plan).
To be successful it is essential that you plan it together
with your doctor. Nursing and allied health staff can Step 5
start the development of the plan, however decisions Dont forget to get your doctor to sign and date
about medication changes must be made by a doctor the plan to ensure it is up to date.
or an appropriately qualified nurse practitioner. Step 6
COPD Action Plans work best when they are checked, Ask your doctor, nurse or health care person to
updated and reinforced regularly. This should occur explain the COPD Action Plan to you and to your
each six months or after each flare up. carer regularly including all the signs to watch for
and actions to take.
Step 1
Talk to your doctor about developing a COPD Action Step 7
Plan. When developing the plan with your doctor, Keep your plan somewhere visible at home (on
you will discuss what happened with previous flare the fridge). Remember to always bring your COPD
ups. You will need to identify the lead up signs and Action Plan to your clinic, doctor appointments
symptoms you experienced (consider the events that and admissions to hospital.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 38
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
There are several types of Action Plans for COPD. A copy of The Australian Lung Foundation COPD Action
We provide two of these below. It doesnt really matter Plan can be downloaded from the following website:
which Action Plan you use. It is just important that www.lungfoundation.com.au and look under Professional
you use one! Resources or can be obtained by calling 1800 654 301.
A copy of the Queensland Health COPD Action Plan
can be downloaded from the following website:
www.health.qld.gov.au/psq/Networks/docs/
srcn-copd-actpln.pdf
The Australian Lung Foundation
COPD Action Plan
Queensland Health
COPD Action Plan
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 40
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Why is it important to maintain Increase the number of activities that you are
or improve your fitness? able to do each day or each week.
Improve your balance.
People who have chronic lung conditions are often
less active, can have reduced fitness and reduced Improve your mood and make you feel
muscle strength. By exercising regularly, a persons more in control.
fitness and muscle strength can be maintained Make you more independent.
or improved. Assist your weight control.
People who have chronic lung conditions and who Improve and maintain your bone density.
exercise regularly, such as by walking or cycling for
The benefits from pulmonary rehabilitation, such as
more than two hours per week, can improve their
improvements in exercise performance or quality of
health. As a result, they will feel better, keep well
life, have been shown to decline gradually over 12
and are more likely to stay out of hospital.
to 18 months after completing these programs.
Therefore, to maintain the health benefits of pulmonary
How can you benefit from rehabilitation, it is very important to keep exercising.
exercise and physical activity? If your exercise program stops, you lose fitness and
Exercise will help to: muscle strength very quickly.
Make your heart stronger and healthier. Talk to your doctor, physiotherapist or The Australian
Improve your arm, body and leg muscle Lung Foundation about local programs available to
strength. you to help maintain your exercise program, such as
the Lungs in Action classes.
Improve your breathing.
Clear sputum from your lungs.
People who exercise regularly can reduce their
Reduce your breathlessness during
need for hospital admission.
daily activities.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 42
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What if I am on oxygen?
If you have low oxygen levels in the blood and are
prescribed oxygen therapy, then when you exert
yourself, wearing oxygen can help you tolerate the
exercise more easily.
When exercising, be careful to avoid tripping and
falling on your oxygen tubing.
How often should you exercise? These scales can be used to guide training intensity
Exercise should be part of your weekly routine, and and to set personal goals for exercise. You should
you should plan enough time to fit this into your week. aim to exercise to a level where your breathlessness
is at a moderate to somewhat severe level as
You should exercise for a minimum of 4 to 5 days highlighted in the scale below.
per week. Anything less will not allow you to gain
health benefits or improve your fitness. Borg scale
There are many ways to prescribe a training 0.5 Very very slightly 10
intensity for your exercise program:
1 Very slightly 11 Light
1. Your level of breathlessness can be measured
2 Slightly 12
during an activity and rated against the Borg
Training zone
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 44
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Mode Distance Time Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
Example
The
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
State of Queensland (Queensland Health) and The Australian Lung Foundation 2012
46
47
Strength training sheet
To use your strength training sheet, write your prescribed exercise program in the columns as follows: the exercise to be performed (for example, squat) in the Mode column,
the load (for example, no added weight) in the Load column, the number of sets and repetitions of each exercise (for example, 2 sets of 10 repetitions) in the Number column.
Once you have completed the exercise, tick the box corresponding to the day that you completed the exercise. Samples of strength training exercises are shown on pages 49.
Mode Load Number Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
Example
2. Shoulder rotation
Place hands on your shoulders as shown 5. Triceps stretch
Slowly make forwards and backwards circles Gently pull on raised
with your elbows elbow until a stretch
Repeat five times each way is felt in the arm
Hold for 20 seconds
Repeat two to
three times
6. Side stretch
Reach one arm straight
over your head
Lean to that side as
3. Thoracic stretch far as is comfortable
Hold hands behind Hold for 20 seconds
your back as shown Repeat two to
Move your hands three times
away from your back
Hold for 20 seconds
Repeat two to
three times
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 48
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Balance retraining
As you get older, your balance may be affected.
As a result, you may find it useful to do some
balance retraining exercises.
Please discuss balance retraining with your
physiotherapist as they can give you exercises
that are appropriate to strengthen your balance.
3. Wall push up
6. Seated row
From the start position, lean into the wall then
From the start position and while keeping your
push up away from wall
back upright, pull your arms to your chest
Do 6 to 10 repetitions
Do 6 to 10 repetitions
Do one to three sets
Do one to three sets
To progress, move feet away from the wall
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 50
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What are the causes of breathlessness? who have COPD can become frustrated, anxious
and depressed. These emotions can make breathing
Who becomes breathless? problems worse.
Breathlessness (or dyspnoea) is common in people
Importantly, for people who have lung conditions,
with lung or heart conditions, as well as in people
such as COPD, there are things they can do to make
who are overweight or unfit.
life easier. It is important not to stop doing things
People who are overweight or unfit will have to work altogether but to try to stay as active as possible.
harder during everyday activities and, as a result,
will fatigue more quickly. When do you notice your breathing change?
We are not usually aware of our breathing, but there
As people get older, their lung function declines
are times when we do become aware.
owing to changes in their lungs, their chest wall
and the strength of their breathing muscles. These The breathing centre in the brain is constantly
changes contribute to older people becoming more receiving signals from your body about the amount
breathless when performing activities. of oxygen that is needed.
Those with lung diseases like COPD will experience The oxygen requirements of your body will depend
breathlessness as the disease affects the breathing on many factors, such as:
tubes or airways and the lungs. The feelings of 1. The severity of your lung condition and the ability
breathlessness may increase as the disease progresses. of oxygen to pass through your lungs into your
How do people feel about their blood stream for use by the body.
breathlessness? 2. The level of activity you are currently doing will
In mild forms of lung disease, breathlessness may affect the amount of oxygen your body will need.
occur when walking up hills or stairs. As the disease For instance, when you are resting quietly,
becomes more severe, breathlessness can occur on the oxygen demand is less than when performing
minimal exertion such as when walking slowly strenuous activities, such as walking up stairs
along flat ground or even at rest. or hills.
Daily activities become more difficult as the lung 3. Your fitness or conditioning will also affect your
condition gets worse. It is not surprising that people oxygen requirements during an activity. A person
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 52
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
with a better fitness level will generally be more COPD and breathlessness
efficient in moving oxygen around their body, and COPD affects both the lungs and the body. As
their muscles will require less oxygen to do the a result, breathlessness can be caused by a
same activity than a person who is unfit. combination of reasons:
1. In COPD, the lungs lose their natural elasticity
Healthy COPD as they become damaged and over-expanded.
Resting
Person Person This can make it harder for someone who has
COPD to breathe air out fully.
2. As a result of being unable to breathe air out
4% 15%
fully, the trapped air leads to an over-expansion
of the lungs. This is often called a barrel chest
(hyperinflation). Hyperinflation changes the way
Exercising your muscles and chest wall work. The breathing
muscles of a person who is hyperinflated will
have to work harder and as a result, will fatigue
more quickly. Other muscle groups can be used
10% - 15% 35% - 40% to help people breathe; these muscles are known
as accessory muscles. The neck muscles are an
example of these accessory muscles.
3. The muscles used for breathing, like all muscles
in the body, require oxygen to be able to work. A
4. Stress or anxiety, or a low mood, can affect person who has COPD may have a higher oxygen
your breathing rate. These mood states can make requirement just to continue breathing.
you focus on your breathlessness and make you
4. The narrowing or swelling of the breathing tubes
more aware of your breathing.
or airways, in combination with producing larger
5. If you are unwell more effort is required to breathe. amounts of sputum, can restrict the flow of air in
and out of the lungs. Airway clearance techniques Aim to breathe out slowly and without force. As you
can help to keep the breathing tubes or airways breathe out, let your shoulders and neck muscles
clearer and assist in making breathing easier (see relax. Most of your breathing should occur by the
chapter 13). lower ribcage expanding and relaxing, rather than
in the upper chest.
5. When you are living with COPD, you may be
unable to continue your normal level of activity, By breathing out fully, you
which can result in a cycle of inactivity (see the will be able to breathe
previous diagram). Frequently, this will lead you in better. You may find it
to reduce your physical activities, causing you to useful to practice relaxed
become unfit or poorly conditioned. Being unfit breathing when you are at
or poorly conditioned makes your movements rest so that you are familiar
less efficient and requires greater effort to complete with the technique.
everyday activities. To practice relaxed breathing,
6. People who have COPD often experience increased place one hand on your
anxiety about becoming breathless or short of chest and one hand on your
breath. This anxiety can lead to a fear of undertaking stomach at the level of your
activities. navel while sitting. When
you take a deep breath in,
In summary, people with COPD need to work harder
the hand on your stomach,
than others to breathe. Relaxed breathing technique
rather than the hand on
your chest, should move first. Practice breathing so
How do you better control or that the hand on your stomach moves first.
reduce your breathlessness? 3. Prolonged expiration breathing
There are many treatment options and management The purpose of prolonged expiration breathing is to
strategies that can help you control or reduce your try to reduce the amount of air trapped in the lungs
breathlessness. and reduce airway collapse by prolonged breathing
1. Medication out (unforced expiration). Breathing out should take
Using your reliever, maintenance and preventer longer than breathing in.
medication can assist in controlling breathlessness. Breathing out through pursed lips is an example
It is important that medications are used correctly of this technique. Pursed lips (lips that are closer
to ensure their effectiveness. together than usual, as if you were whistling or
For more details on medications and inhalation kissing somebody) create a smaller opening for the
devices, refer to chapter 7 Knowing your medication air to flow through.
and chapter 8 Using your inhalation devices. 4. Recovery positions
Good posture is very important. The more you slump,
2. Relaxed breathing
the more you squash your lungs and stomach, and
People who have COPD have more difficulty
the harder it is to breathe.
breathing out fully. The bodys normal reaction
when breathlessness occurs is to breathe faster Try taking a deep breath while slumped. Now try
and shallower. However, faster and shallow again while standing or sitting fully upright with a
breathing is not an effective way to regain control tall spine. Can you notice a difference?
of your breathing.
A comfortable recovery position is important.
You could practice relaxed breathing any time Typically, recovery positions are upright with your
you are trying to catch your breath. For example, arms supported. Common examples of recovery
relaxed breathing may be useful after coughing positions are shown in the images on the
or exercising. following page.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 54
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
1. Control and coordinate your breathing with Bring your feet to you (for example, rest your foot
daily activities on your knee to towel dry, put on socks, and tie up
People with lung disease use more energy simply to your laces).
breathe. Therefore, it is important to coordinate your
Avoid heavy lifting:
breathing with all activities. Even the simplest tasks
use energy. Use trolleys; push rather than pull; slide rather
than lift.
Standing Up: Breathe in before you move. Breathe
out as you rise up from your seat. Let your bigger muscles do the work squat
with your legs, avoid bending your back.
Lifting an object above your head: Breathe in
before you lift. Breathe out as you lift your arms Ask for help.
above you. Divide the load eg. groceries, half fill the kettle.
Putting on shoes: Breathe in before you move. 3. Sit when possible to perform activities
Breathe out as you bend down to put on your shoe. Standing uses more energy than sitting.
When possible, consider sitting while ironing,
washing dishes, showering, chopping vegetables,
gardening, making a phone call or working in
the shed.
Breathe IN Breathe OUT as you
before you start complete the activity Keep a high stool or chair for you to use in
your kitchen or at your work bench.
4. Take frequent rest breaks
Continuing to work until you are out of breath may
If you go slowly and pace yourself, you will go then take you longer to recover. So take regular
a lot further before needing a rest. If you rush breaks to rest and recover while working. Dont
and try to beat the shortness of breath, you will wait until you need a break.
spend longer trying to catch your breath.
5. Plan and prepare before you perform tasks
When you are feeling short of breath, use High expectations can lead to frustration, so be
recovery positions to help regain control of patient with yourself and set achievable goals.
your breathing.
Challenge old habits. Ask yourself Is it essential
2. Reduce strenuous movements that this task be performed in the usual way?
Keep your arms and body close to the activity Plan for rest breaks and interruptions.
you are performing:
Break jobs into smaller steps. For example,
Carry objects close to your body. rather than cut the entire lawn in one go,
Organise equipment or food to be within do it in two or three goes.
easy reach. Prepare and prioritise.
Keep most activities between waist and Use a diary or calendar to plan daily,
shoulder level: weekly and monthly tasks.
Store commonly used items on middle shelves Put items where they can be found easily
between your waist and shoulders. and quickly.
Work at benches that are at waist height. Keep most frequently used items between
Use long handled equipment (for example, waist and shoulder level.
long handled reachers, long handled pruning Use equipment that makes the job easier,
shears, a broom, a dressing stick, a sock aid eg. light weight crockery, long handled reachers,
and a bathing brush). long-handled garden equipment, stools, trolleys,
velcro shoes, buttonless shirts and clothes that
dont need ironing.
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Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
PREPARE all the items you will need to complete the task.
What is the role and function of In some lung conditions, the ability to clear these
sputum in lung conditions? secretions can be more difficult, resulting in:
The lungs provide protection against foreign particles More coughing, which increases your fatigue
entering the body by trapping unwanted particles in and can make you more breathless.
the mucous lining of the breathing tubes or airways. Narrowing of the breathing tubes or airways,
Your secretions can be cleared from the lungs by and tightness of the chest which can make
coughing, breathing out and the movement of tiny breathing harder.
hairs called cilia. These tiny hairs line the breathing
tubes (bronchi and bronchioles) and move like a When should you use airway
wave to help move the mucous and unwanted
clearance techniques?
particles up to the mouth where they can be cleared.
When to use airway clearance techniques will depend
The function of the tiny hairs (cilia) can be affected greatly on your individual needs. For example:
by smoke, oxygen therapy, alcohol and dehydration.
Many people who have chronic lung conditions
If you have a lung condition or a chest infection, the produce very little or no sputum. These people
breathing tubes can become more swollen or inflamed. generally do not need to do any regular airway
As a result, the breathing tubes or airways can produce clearance techniques.
thicker and stickier mucous secretions called sputum
or phlegm. Some people who have chronic lung conditions
develop a moist cough when they have an
infection. These people may need to do a few
Why is it important to simple airway clearance techniques when
keep your lungs clear? this occurs.
Repeated chest infections have been shown to A small number of people who have chronic
contribute to worsening in lung function. If sputum lung conditions and who cough up sputum
is not cleared from the lungs, it can cause ongoing every day may need to use an airway clearance
inflammation, which can lead to further lung damage. technique regularly.
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Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Huffing
In most instances a huff uses a medium volume
breath in, followed by a forceful expiration (breath
out) that helps to move sputum towards the mouth
so it can be cleared. This is particularly useful if
the airway tends to collapse with coughing. If a
wheeze is heard on the breath out then the
expiration is too forced and you may need to
breathe out slower. The wheeze represents airway
closure and may cause sputum not to be cleared
as effectively.
Coughing
Coughing is an effective way to remove secretions.
However coughing should be done with minimum
of effort.
Breathlessness
You have probably learned by now that long term
lung conditions, such as chronic obstructive
pulmonary disease (COPD), bronchiectasis and
pulmonary fibrosis, cause breathlessness. People
often think that when they feel breathless, it is
because they are not getting enough oxygen into
their body.
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Healthy eating
Why is healthy eating important for If you are overweight, you are likely to become
people who have lung conditions? more short of breath during activities, such as
walking up stairs or carrying the groceries.
Lung conditions increase the risk of poor nutrition, Carrying additional body weight increases the
weight loss and reduced muscle strength because of: risk of high blood pressure, high cholesterol
Increased energy needs. Studies have shown and diabetes.
that people who have chronic lung conditions
use 25% to 50% more energy than healthy What is healthy eating?
people due to the increased work of breathing
and fighting chest infections. A selection of servings from each of the five food
groups each day will provide the energy, vitamins,
Poor appetite, or for some people on steroids,
minerals and antioxidants your body needs to
a bigger appetite.
maintain good health.
Increased need for certain vitamins, minerals
and antioxidants. The five food groups are captured in the table on
page 64 with recommended daily servings.
A lack of energy to shop, cook and eat meals.
Malnutrition adversely affects lung structure,
respiratory muscle strength and endurance.
1 to 2
fish and or 3/4 cup legumes
legumes or 2 small eggs
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 64
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Morning tea
Two plain biscuits
What if you are overweight?
Lunch Carrying too much weight can make it hard for
Two slices of bread, a bread roll or lavash you to do normal activities and make breathing
bread with 65 grams of lean ham or turkey, even more difficult.
mustard or cranberry sauce, and salad
Additional weight can interfere with breathing and
(lettuce, tomato, beetroot and cucumber)
increase your oxygen requirement, causing your
or
A tin of tuna or salmon stirred through lungs to work even harder.
one cup cooked pasta Weight gain can be related to an increased appetite
A side salad and/or fluid retention as a side effect of the
or medication, prednisone or prednisolone.
A small tin of baked beans on two slices
of toast Being overweight also increases your risk of high
and blood pressure, diabetes and high cholesterol.
A piece of fruit, such as a banana, apple,
What can you do about being overweight?
orange, or two apricots or plums
If you need to lose weight try the following hints:
Afternoon tea
A tub of low-fat yoghurt (200 grams) Eat a balanced diet that is low in fat, salt,
sugar and alcohol, and high in fibre.
Dinner Use small amounts of added fat (for example,
100 grams of lean meat, such as chicken, butter, margarine or oil) in your cooking. Use
fish, lamb or pork, that has been stir fried, marinades, herbs and spices for added flavour
steamed or grilled, or cooked in a curry, stew without added fat.
or bolognaise or other pasta sauce with a
Trim visible fat from meat and remove the skin
variety of vegetables, such as:
from chicken before you cook.
Pasta sauce: tinned tomatoes, mushrooms, Use low-fat cooking methods, such as grilling,
capsicum, zucchini barbecuing, steaming, microwaving, boiling,
Curry: potato or sweet potato, eggplant, oven baking and stir frying.
carrots, chickpeas
Choose low-fat dairy products.
Stir fry: capsicum, ginger, garlic, bean
sprouts, snow peas, carrots Reduce or eliminate the use of spreads, such
Grilled: mashed potato, peas, carrots as butter, margarine and mayonnaise. For extra
and moisture and flavour, try mustards, chutneys
One cup of pasta, rice or potato and extra salad ingredients.
Watch your portion sizes.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 66
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Drink plenty of water (approximately eight cups) To maintain your bone strength and protect against
every day unless you have been advised by your osteoporosis:
doctor to limit your fluid intake.
Ensure that your calcium intake is high (three
Change your recipes to use low-fat ingredients. to four serves of low-fat calcium rich foods
Increasing your physical activity is an important each day).
way to help you lose excess weight. Increase your intake of foods that are sources of
Always combine a weight loss program with an vitamin D, which helps absorb dietary calcium.
exercise program to minimise the loss of muscle. Limit your intake of salt, caffeine and alcohol as
these substances increase calcium excretion.
What if you are too tired to shop, What about other supplements?
cook or eat? Omega-3 polyunsaturated fatty acids are known to
When you are tired or unwell, it can be difficult be beneficial in helping reduce lung inflammation in
to make sure you are eating enough. However, people who have COPD.
this is usually the time when good nutrition is The best sources of omega-3 polyunsaturated fatty
most important. acids are:
To help, try some of these tips: Oily fish (for example, mackerel, sardines,
Consider using a home delivered meal service, herring, salmon, trout, tuna and mullet):
such as Meals on Wheels. Consume at least two fish meals per week.
Remember to have a rest before meals. Canola oil, soybean oil, flaxseed oil and
Eat slowly and chew foods well. mustard seed oil.
Breathe evenly while chewing and sit quietly
for 30 minutes after eating.
Try having five or six smaller meals or snacks
rather than three large meals per day.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 68
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Swallowing problems (called dysphagia) can occur Swallowing problems are often under-diagnosed in
because the need for oxygen will always overrule people who have COPD because silent aspiration
the need to protect the lungs from food or fluids. can be difficult to detect.
List 2
Food or drink going into your nose.
Food or drink remaining in the mouth
after swallowing.
Reflux or regurgitation.
Taking much longer to finish meals.
Getting more fatigued after eating and drinking.
Unexplained weight loss.
Unexplained temperatures or changes in
sputum colour.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 70
17
chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
71 Chapter 17: Chronic obstructive pulmonary disease and other related conditions
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What can you do to strengthen your pelvic floor? be performed occasionally, as this action may
A weak pelvic floor cannot do its job properly. Research interfere with your normal bladder emptying.
has shown that the pelvic floor responds to regular How to do your pelvic floor routine
exercise. In fact, the sooner you start pelvic floor
For men: tighten and draw in strongly the
exercises, the better your chance of preventing or
muscles around your rectum (back passage)
overcoming many of the problems associated with
and urethra (urine tube) all at once, trying to
a weak pelvic floor.
hold them up inside. Hold this contraction as
If you experience stress incontinence, contracting you count to five and then relax. You should
the pelvic floor before any activity (for example, have a feeling of letting go as you relax. Rest
coughing, sneezing, lifting or jumping) that will for at least 10 seconds and repeat. Aim to do
increase pressure to the pelvic floor can help to 10 contractions.
protect you against leakage. Practise this technique For women: tighten and draw in gently the
regularly to ensure that it becomes a lifelong habit. muscles around your rectum (back passage),
What are good bladder and bowel habits? vagina and urethra all at once, trying to hold
them up inside. Hold this contraction as you
Going to the toilet between four and six times a day
count to five and then relax. You should have
and no more than twice at night is normal.
a feeling of letting go as you relax. Rest for
Some simple steps to keep your bladder and bowel at least 10 seconds and repeat. Aim to do
healthy are: 10 contractions.
Try to drink at least six to eight cups (one and When doing these exercises:
a half litres) of fluid a day (unless advised Do not hold your breath.
otherwise by your doctor).
Do not push down; squeeze and lift up.
Limit the amount of caffeine (for example,
Do not tighten your buttocks or thighs.
coffee, cola and tea) and alcohol you drink
as these drinks irritate the bladder. What else do you need to know?
Try to go to the toilet only when your bladder is Strengthening the pelvic floor muscles takes
full and you need to go (emptying your bladder time. If you have very weak muscles initially,
before going to bed is fine). they will fatigue easily. Dont give up. These
Take your time when urinating so that your exercises do work if done regularly.
bladder can empty completely. These exercises should be done regularly and
Keep your bowels regular and avoid constipation. you can add them into your daily routine, such
as after going to the toilet, when having a drink
Do not strain when using your bowels.
or when lying in bed.
Keep your pelvic floor muscles in good condition.
A position that enhances pelvic floor function
How to do pelvic floor exercises should be chosen if you regularly perform airway
clearance techniques. When sitting, this is
How to tighten your pelvic floor muscles achieved with feet flat on the floor, your hips at
Sit or lie comfortably with the muscles of your 90 degrees and your lumbar spine in neutral or
thighs, buttocks and abdomen relaxed. straight (not slumped). Ensure you contract the
Tighten (and then relax) the ring of muscles pelvic floor muscles before huffing and coughing.
around your back passage (anus) as if you are For more information, please contact your
trying to control diarrhoea or wind. Practise doctor, physiotherapist or continence advisor,
this movement until you are able to exercise or contact the National Continence Helpline
the correct muscles. (phone: 1800 330 066). There are specialist
When you are passing urine, try to stop the flow health care professionals that deal with the
midstream and then re-start it. This should only problem of incontinence.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 72
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What is obstructive sleep apnoea? What other problems can develop from OSA?
Untreated, OSA can be a contributing risk factor for
Why do you need to know about
high blood pressure, heart attack, heart failure, and
obstructive sleep apnoea?
stroke. All these conditions occur more frequently in
Obstructive sleep apnoea (OSA) and other breathing people with OSA.
conditions are common for many people who have
COPD and other chronic lung conditions. OSA-associated poor concentration and daytime
sleepiness have been associated with an increased
What is Obstructive Sleep Apnoea? risk of accidents in the workplace and on the road.
People who suffer from OSA reduce or stop their
How is OSA assessed?
breathing for short periods while sleeping. This can
happen many times during the night. These breathing In a person suspected of having OSA, their doctor
stoppages or apnoeas interrupt sleep which results will need to ask questions about waking and sleeping
in poor sleep quality with excessive sleepiness during habits. Reports from the sleeping partner or other
the day. Because these events occur during sleep, a household members about any apnoeas are
person suffering from OSA is usually unaware of them extremely helpful.
and is often the last one to know what is happening. Referral to a sleep disorders specialist and an overnight
In OSA, the apnoeas can last for ten or more seconds sleep study will assist with the diagnosis of OSA and
and the cycle of apnoeas and broken sleep is repeated measurement of its severity.
hundreds of times per night in severe cases. Most
How is OSA treated?
sufferers are unaware of their disrupted sleep but
awaken unrefreshed, feeling tired and needing The chosen form of treatment depends on the severity
more sleep. of OSA and patient factors.
73 Chapter 17: Chronic obstructive pulmonary disease and other related conditions
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What is osteoporosis?
Osteoporosis is a condition of low bone density,
where your bones become thin and break more
easily. Referred to as a silent disease where often
no symptoms are present and for many, a fracture
(broken bones) is the first sign of osteoporosis.
Other non-surgical treatments Common sites for osteoporotic fractures are the
Individually designed oral appliances or mouth spine, hip, wrist, and ribs. Hip fractures are
splints made by dentists may help people with common in people over 75 years.
snoring or apnoea.
How common is Osteoporosis?
Tongue retainer devices may be useful in those
Over 2 million Australians have osteoporosis.
who no longer have their own teeth.
Fractures due to osteoporosis can occur at any
Specially designed mouth plates may help
age and the risk increases as we get older.
people who have a narrow maxilla.
Surgery What are the risk factors for developing
Surgery to the upper airway may ease some of
osteoporosis?
the structural problems that contribute to airway There are a number of risk factors that contribute
blockage during sleep. These operations include: to osteoporosis seen in people with COPD. These
risk factors include:
1. Removal of tonsils and adenoids: this is far
more common in children than adults and Smoking.
can have excellent results. Vitamin D deficiency.
2. Nasal surgery to improve nasal airflow. Such Low body mass index (BMI).
operations improve nasal airflow and enable Hypogonadism (deficiency in the secretory
nasal CPAP to work more efficiently. activity of the ovaries and testis).
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 74
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
75 Chapter 17: Chronic obstructive pulmonary disease and other related conditions
18
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
chapter
Stressors, such as illness, financial concerns or There are effective treatments for anxiety that you can
relationship difficulties, could cause: ask your GP or health care team about. Talking to a
mental health professional can increase understanding
Your heart to beat faster. of anxiety and support a person to learn new skills
The muscles of your arms and legs to that reduce symptoms.
tremble or shake.
Medication such as anti anxiety and anti depressant
Your breathing to change. medication to reduce physical symptoms and stop
You to start sweating. racing thoughts can also be very helpful.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 76
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
6. Maintain your social network. People with 12. Practice relaxed breathing. When stressed,
chronic conditions who have few friends and or experiencing strong emotions most people
dont get out much may have worse health tend to breathe faster and shallower; this type
outcomes. Getting out and catching up with of breathing can lead to a feeling of breathlessness
friends is important and you should plan to and sometimes panic breathing. People who
do this regularly. have COPD can minimise the risk of becoming
breathless during times of stress or high emotion,
7. Join a local patient support group. Contact
by using the relaxed breathing techniques
The Australian Lung Foundation to find out
(see chapter 12).
about patient support groups near you
(phone: 1800 654 301 or website:
www.lungfoundation.com.au). If a patient
support group has not been established
in your area, The Australian Lung Foundation
can help you to start one.
8. Maintain interests and hobbies. Often people
who have chronic conditions let go of interests
and hobbies because they believe the effort
outweighs the benefits. Participating in enjoyable
activities can give life meaning and can help you
maintain and enhance your skills and abilities.
9. Be aware of automatic or unhelpful thinking.
When life is busy or stressful, you may respond
to events without stopping to consider your
response. Before responding, stop and take
some deep breaths, count to 10, or go for a
short walk and consider whether you need to
respond and how you will respond.
Why is relaxation practice important?
10. Planning and time management. People who
Scheduling time to relax in your daily or weekly
plan how they will apply the skills they have
routine is important. Relaxation can be formal,
learnt in pulmonary rehabilitation to their home
such as guided relaxation practice, or informal,
or work life are more likely to use these skills in
such as watching football or listening to music.
their daily lives. Effective time management is
Formal relaxation practice helps to:
essential for maintaining your health, work,
social and home life. Spread tasks, or parts of Increase your metabolism.
tasks, across several days, and build time into Slow your heart beat.
your schedule for unexpected events. Relax your muscles.
11. Communicate effectively. Effective communication Slow your breathing.
includes both speaking and listening. Often
Lower your blood pressure.
when you feel under pressure, you can spend
all your time speaking or thinking about what If you are interested in finding out more about formal
you want to say rather than listening. Take relaxation practice, ask your pulmonary rehabilitation
the time to listen to what is being said before co-ordinator for a tip sheet on relaxation. You can
responding. Assertive communication requires also find CDs in bookstores or in your local library or
honest and direct discussion that describes the audio downloads on the internet that will guide you
problem, the effect and the solution. through different types of formal relaxation exercises.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 78
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
How can you reduce the number of of the event. The following strategies may help you
crisis events and manage them? manage crisis events:
Reducing the number of crisis events Become aware of your expectations. In the past,
if a similar crisis event went from bad to worse,
The chance of crisis events occurring due to
it doesnt mean that the current event will also
ill health should be reduced if you use your
go from bad to worse.
medication and inhalers appropriately, and
remember to eat well and exercise regularly. Become aware of the language you are using and
replace unhelpful thoughts with more helpful
The number of crisis events occurring due to
thoughts. For example, rather than thinking
injury, muscle strain or physical exhaustion
your weekend was a disaster, recognise that it
should be reduced if you increase your
rained on the weekend and, as a result, you
exercise tolerance and practise your energy
were unable to do what you wanted to do.
conservation skills.
Protect yourself against becoming too stressed
The number of crisis events occurring due to
by developing a plan to deal with a difficult
stress should be reduced if you practise your
situation. You can mentally rehearse what you
relaxation techniques and improve your
might do or say before a potentially challenging
communication and problem solving skills.
event occurs. You can also review how you
Managing crisis events managed after the event and create options for
When a crisis event does occur, and you find yourself how you might handle a similar situation if it
getting emotionally upset, you will need to decide what happens again.
you can do to avoid the situation from becoming Dont forget to practice relaxation techniques
worse or how you can reduce the emotional impact and use relaxed breathing (see chapter 12).
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 80
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What do you need to know prescribed long term oxygen you should clarify
about driving safely? with your doctor about using oxygen while driving.
Make sure the oxygen is secured in the car so
Many people with COPD continue to drive safely.
that it doesnt pose an additional safety risk in
The following are some considerations to ensure
case of a crash.
your safety and that of others.
Daytime sleepiness, sleep apnoea and other
COPD may affect your ability to drive safely, and
sleep disorders have the potential to impair
could result in a crash.
driving performance and safety and pose a risk
Drivers who develop a permanent or long term of crashing. Consult your doctor and seek
medical condition that may negatively affect advice about precautions when driving.
their ability to drive safely must report their
condition to the Department of Transport as
soon as it develops. How can you plan your travel to
Talk to your doctor about your medical condition prevent health problems?
and any potential impact this may have on your Travel related health problems arise from a variety of
ability to drive safely. They may provide a medical factors related to your travel environment eg. holiday
certificate stating your fitness to drive, or any destination, types of activities, food and water quality.
conditions under which you can drive.
Travel related health problems can also arise when a
Low oxygen levels or increased carbon dioxide
pre-existing medical condition worsens during travel.
levels may lead to poor judgement, drowsiness
and reduced concentration. Fortunately most travel related problems can be
Driving ability may be affected by severe coughing prevented with careful advance planning. Consult
fits which may lead to loss of consciousness. your doctor or travel medicine clinic so that a travel
plan can be discussed in detail.
Oxygen therapy can enhance cognitive
performance, longevity and wellbeing in those Consider the destination and how the following
with chronic lung disease. If you have been might affect your underlying health condition.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 82
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Check in early
Check for any epidemics Flexible tickets
Arrive before darkness
Stress of navigating busy airports, Learn what your oxygen needs will be while
unknown roads. flying, and while in terminals. Airlines do not
provide oxygen on the ground. Speak with your
doctor and other health care team members
Although air travel is safe for the majority of about arrangements to supply oxygen for each
people, people with COPD may be at risk due
to the decrease in the concentration of oxygen
in humidified air.
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Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Legal Issues
The information in this chapter has been provided by Turner Freeman Lawyers
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 86
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Legal advice can help to ensure that the information Anti-discrimination laws across Australia recognise
you receive is correct and assists you with accessing that people with illnesses are at a disadvantage and
all your entitlements. should be treated fairly. An employer must make
reasonable adjustment in the workplace to assist
The terms and conditions applying to these you to conduct your work duties to the best of your
insurance components are sometimes straight ability having regard to the impacts of your illness.
forward but often more complex than they look.
What steps can you take to protect
You do not need to show fault on the part of anyone your assets for the benefit of your family?
or that the cause of your illness was beyond your
Wills
control. Generally the mere fact of having the illness
and that it stops you from working is enough. It is essential that your intentions regarding distribution
of property as well as your wishes in relation to the
Benefits are generally available for people of working continuation of treatment are known and documented.
age. Different funds have different rules and you
should carefully check your own circumstances and A will is a document which identifies your intentions
seek advice. and provides instructions as to the distribution of
your assets when you die.
The information in this chapter has been provided by Turner Freeman Lawyers
87 Chapter 21: Legal Issues
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
The information in this chapter has been provided by Turner Freeman Lawyers
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 88
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What is a patient support group? focusing our energy on helping others is the best
therapy for overcoming our own troubled feelings.
A patient support group is a group of people who
have common interests and needs. The Australian There are people who need your support and
Lung Foundation supports a network of support friendship.
groups for people who have lung conditions, and
their carers and family.
Who will attend the patient support group?
You will meet ordinary people, from all different
What do patient support groups do? working and ethnic backgrounds. They will share
When you join a patient support group, you can with you a common personal interest in managing
expect to benefit from a range of possible activities their lung condition, whether they are a patient or
from social support to special seminars to online a carer.
support chat rooms. Group members will also have a wide variety of
How you can benefit from a social and lifestyle interests.
patient support group Where and when do patient
Joining a patient support group allows you to: support groups meet?
Discuss the information you have learnt from your Most groups have regular meetings that are held at
doctor and other health care professionals, as a community or neighbourhood centre, or a meeting
sometimes the information is difficult to remember or room at a local hospital. Venues with reasonable
confusing. transport access are normally chosen.
Access new information on your lung condition. How much does participating in a patient
Share your experiences in a caring environment. support group cost?
Participate in pleasurable social activities. Membership of a patient support group normally
Change the way you think about your condition. involves a small annual fee and perhaps a gold
coin at meetings to cover the costs of membership
Help your carer to understand your condition.
services, such as postage, photocopying and meetings.
Have you ever experienced the satisfaction of These fees are always kept to an absolute minimum.
helping someone else in distress? Sometimes,
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 90
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Disability parking permits (for more information, Gold Card. Veterans who have served for
see your GP or occupational therapist). their country and who are deemed suitable
for this benefit are eligible for a full range
A taxi subsidy scheme with reduced taxi fares
of health care services.
(for more information, see your GP).
White Card. Veterans who have served their
An ambulance service at reduced cost for
country are eligible for compensation related
transport to and from medical appointments
to their service in the forces. Australian
(for more information, talk with your local
veterans are eligible for Veterans Home Care;
ambulance service).
however, British or other overseas veterans
A Home and Community Care Program are not eligible for Veterans Home Care.
(for more information, talk with your local
Orange Card. Eligible veterans can access
community health centre).
the range of pharmaceutical items available
A Patient Transit Scheme that provides financial under the Repatriation Pharmaceutical
help for travel and accommodation expenses for Benefits Scheme.
people from rural, regional and remote areas in
some parts of Australia when travelling to the For more information contact Veterans Home Care
closest specialist treatment centre. Patients should (phone: 1300 550 450).
make arrangements with a means test clerk, social 2. The Home and Community Care Program
worker or welfare officer at their local hospital provides government funding for the frail aged
before travelling. and young disabled people, and includes the
following services:
What other community support Medical Aids Subsidy Scheme.
services may be helpful? Meals on Wheels.
1. The Department of Veterans Affairs can provide Community Agencies (for example, Queensland
financial, medical, transport and homecare Health Primary and Community Health
assistance for those people who have served in Services, Blue Care, Spiritus and Ozcare).
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 92
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
What other tests may be useful? a walking test or on an exercise bike. These
tests can be done in an exercise laboratory, a
A computed tomography (CT) scan can take
gymnasium or on a walking track. In the
many small specialised pictures of the lungs.
laboratory, you will usually be asked to breathe
Although a CT scan is not routinely performed,
through a mouthpiece connected to a machine.
it can provide more detail than a chest x-ray.
This machine measures how much effort it takes
An arterial blood gases (ABG) test is a blood you to exercise. You may also be connected to
test that measures how efficient your lungs are heart and oxygen monitors.
at bringing oxygen into the blood and removing
carbon dioxide from the blood. As an ABG test
requires withdrawing blood from an artery, What is Lungs in Action?
this test can be more painful than a standard Lungs in Action is a community-based exercise
blood test. class designed specifically for those with COPD
An oximetry test is a way of indirectly measuring or other chronic respiratory conditions. The program
oxygen levels in your blood. This test is not is appropriate for people who have completed
painful and is commonly used to measure oxygen pulmonary rehabilitation and will help you maintain
saturation, which indicates how much of the the gains you achieved in your rehab program. Each
oxygen in your body is in red blood cells. However, Lungs in Action class is developed in conjunction
as this test can be less reliable than ABG, ABGs with the pulmonary rehabilitation coordinator.
will be used when a more accurate measure of Many people find that Lungs in Action helps them
oxygen levels is required, such as when deciding continue on their exercise program in a supportive
whether home oxygen is required. and familiar environment.
A sputum test is used to find out what type of Ask your pulmonary rehabilitation coordinator if
infection is in your sputum and which antibiotics there is a Lungs in Action class associated with their
would be most effective against that infection. program. Or call The Australian Lung Foundation at
Exercise tests are done to stress your heart and 1800 654 301.
lungs. Exercise testing will usually be performed as
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 94
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
The Australian Lung Foundation is here to help. We are a national charity providing information
and support to those affected by lung disease. The following are some of the resources developed
for those with Chronic Obstructive Pulmonary Disease (COPD). All these resources can be found
on our website www.lungfoundation.com.au or can be ordered by calling 1800 654 301.
95 Chapter 24: Resources and support available from The Australian Lung Foundation
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Patient Support
In addition to the wide range of educational material
available to those with lung disease, The Australian
Lung Foundation provides a range of support services.
For further information on how to access this support,
please call our Information and Support Centre on
1800 654 301.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 96
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chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
References
National Asthma Council Australia Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery
Website: www.nationalasthma.org.au CF, Mahler DA, et al. Pulmonary Rehabilitation:
Nutrition Education Materials Online. Texture Joint ACCP/AACVPR Evidence Based Clinical
modification soft diet. Available from: www.health. Practice Guidelines. Chest. 2007;131: 4S42S.
qld.gov.au/nutrition/resources/txt_mod_a.pdf Romieu I, Trenga C. Diet and obstructive lung
Nici L, Donner C, Wouters E, Zuwallack R, diseases. Epidemiol Rev. 2001;23:26887.
Ambrosino N, Bourbeau J, et al. American Thoracic Ruffin R and Adams R. How to treat. Asthma in the
Society/European Respiratory Society statement on elderly. Australian Doctor. 1 April 2005. Available
pulmonary rehabilitation. Am J RespirCrit Care Med. from: www.australiandoctor.comau/htt/pdf/AD_
2006;173:1390413. HTT_025_032_APR01_05.pdf
No fuss feeding and swallowing centre. Shand, D. The assessment of fitness to travel.
Adults: Dry Mouth. Available from: Occupational Medicine 2000; 50 (8):566-571.
www.nofussfeeding.com.au/adults
Smit HA. Chronic obstructive pulmonary disease,
Osteoporosis Australia asthma and protective effects of food intake: from
Website: www.osteoporosis.org.au hypothesis to evidence? Respir Res. 2001;2:2614.
Rashbaum, I, Whyte, N. Occupational Therapy in Velloso, M, Jardim, J. Functionality of patients
Pulmonary Rehabilitation: Energy Conservation and with chronic obstructive pulmonary disease:
Work Simplification Techniques. Physical Medicine energy conservation techniques. Journal Brasilian
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7(2):325-340.
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Disclaimer
The materials presented in this resource are distributed by Queensland Health and The Australian Lung
Foundation for and on behalf of the Queensland Government and are presented as an information source
only. The information is provided solely on the basis that readers will be responsible for making their own
assessment of the matters presented herein and are advised to verify all relevant representations, statements
and information. The information does not constitute professional advice and should not be relied upon as
such. Formal advice from appropriate advisers should be sought in particular matters.
Clinical material published in these pages does not replace clinical judgement. Treatment must be altered
if not clinically appropriate.
Queensland Health and The Australian Lung Foundation do not accept liability to any person for the
information or advice provided in this resource, or incorporated into it by reference or for loss or damages
incurred as a result of reliance upon the material contained in this resource.
In no event shall Queensland Health and The Australian Lung Foundation be liable (including liability for
negligence) for any damages (including without limitation, direct, indirect, punitive, special or consequential)
whatsoever arising out of a persons use of, access to or inability to use or access this resource or any other
resource linked to this resource.
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide is a funded project of the Statewide
COPD Respiratory Network, Clinical Practice Improvement Centre, Queensland Health and The Australian
Lung Foundation, COPD National Program.
Queensland Health