Enjoy Sexual Intimacy With COPD

Don't let fatigue and shortness of breath rob you of intimacy.

By Krisha McCoy, MS

Medically reviewed by Niya Jones, MD, MPH

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For people with chronic obstructive pulmonary disease (COPD), sexual intimacy can be difficult. COPD can lead to fatigue and limit your ability to exert yourself. COPD can also cause you to feel emotionally distant from your partner. With a little extra effort, though, you can still enjoy sexual intimacy despite COPD.

COPD: Effects on Sexual Activity

There are a number of reasons why COPD can impact your sex life, including:

• Shortness of breath: The most obvious way COPD impacts sexual relations is that it can cause shortness of breath when people with COPD overexert themselves. This makes it difficult for a person with COPD to enjoy intimacy.
• Fatigue: People who have COPD often have less energy, which can also make it tough to "get in the mood" for sex.
• Emotions: COPD can lead to depression and anxiety, which can be emotional barriers to sex.
• Nerves: The pressure of having to perform during sex and concern that your symptoms might flare up can cause you to feel nervous about having intercourse.

COPD: Tips to Stay Intimate

If you have COPD, here are some suggestions to help preserve your sex life:

• Think outside the box: "It is important to think about sex in a broader perspective," says Barry Make, MD, co-director of the COPD program at National Jewish Health and professor of medicine at the University of Colorado in Denver. Dr. Make recommends kissing and cuddling when you don't feel up to having actual sexual intercourse. Simply touching each other can be just as fulfilling as, and sometimes even more intimate than, intercourse for you and your partner.
• Use less energy: "Think about how to reduce the work that is being done by you if you are the COPD patient," says Make. He suggests you find a position that is the least physically demanding for you. Have your partner do a little more of the work so you are able to preserve your energy.
• Take medications: Taking prescribed medications and using supplemental oxygen prior to sex can be beneficial, says Make. Some people are able to manage their symptoms by using bronchodilators right before having sex.
• Get educated: Take your partner to one of your medical appointments and talk with your doctor, nurse, or respiratory therapist about whether sex is safe for you and what modifications will make having sex easier. Sometimes your medical team can help alleviate your or your partner's fear that sexual activity could harm you.
• Exercise: Regular exercise can build up your strength and endurance so that you will be able to tolerate the physical exertion of sexual activity with less shortness of breath.
• Rest when you need to: Get plenty of rest before you have sex, and take breaks during sex so that you don't overexert yourself.
• Clear your airways: Try to rid yourself of any excess bronchial secretions before sex.

You shouldn't have to give up sex because you have COPD. Talk openly with your partner and your medical team and make adjustments so that your sex life doesn't go by the wayside because you have COPD.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/sexual-intimacy-with-copd.aspx

COPD Blog: Inhaled Medications for COPD: Are the Steroids Dangerous?

Robert T. Schreiber, MD, an American Lung Association in New York expert

Many patients with COPD are prescribed inhaled medications to help treat symptoms of coughing, wheezing, and shortness of breath. However, some patients are reluctant to take them because they mistakenly think that all inhaled medications are steroids, and they’re afraid of the side effects. A patient might hear from family or friends that these medications have many adverse reactions — but they’re usually wrong.

Inhaled medications for COPD include short-acting and long-acting bronchodilators, and neither of them are corticosteroids. Patients with mild COPD and only intermittent symptoms are prescribed a short-acting bronchodilator, or short-acting beta agonist (SABA), to use when symptoms occur. Typically, these come in a metered dose inhaler and contain a quick onset medication (for example, albuterol). These medications are sympathomimetics (distant cousins of adrenalin), and work to open up the bronchial tubes quickly. A dose from a short-acting bronchodilator works rapidly and then leaves the body quickly, wearing off between four and six hours. The side effects are temporary, and may include nervousness, shakiness, increased heart rate or blood pressure, and insomnia. They do not have long-term consequences if used as directed.

Patients who have advanced COPD and persistent symptoms may be prescribed a long-acting bronchodilator as the next step in their treatment. Long-acting beta agonists (LABA) help to keep the bronchial tubes open for up to 12 hours. They are similar to SABAs in their action and side effects, and are also part of the sympathomimetics family. Salmeterol and formoterol are both LABA bronchodilators. Another type of long-acting bronchodilator is in the anticholinergic family. Tiotropium is the only long-acting inhaled anticholinergic currently available in the U.S. The most common side effects from this type of medication are dry mouth, constipation, and problems with urination, and they should be taken with caution by patients with glaucoma.

Recent medical research has shown that patients with moderate to severe COPD who took a combination of a LABA and an inhaled corticosteroid (ICS) had fewer exacerbations of their COPD in the course of one year. These combined medications (fluticasone plus salmeterol; budesonide plus formoterol) contain an extremely tiny dose of the corticosteroid, which is measured in micrograms. For comparison, oral doses of corticosteroids given to patients with COPD exacerbations typically contain 100 to 1000 times the amount found in the inhaled doses, and they’re measured in milligrams. In addition, most of the corticosteroid that is inhaled doesn’t travel beyond the lungs — very little gets into the blood stream and travels to the rest of the body.

While COPD medications are generally considered safe, there are some short- and long-term side effects that you should be aware of. When taken for many years, an ICS may increase the chance of osteoporosis, cataract formation, and skin bruising. It has also been suggested that the LABA-ICS combination may increase the chance of getting pneumonia. However, in medical practice, we typically don’t see the side effects from an ICS that people taking corticosteroid pills or shots may experience, such as face swelling, fluid retention, elevated blood sugar and blood pressure, and bone thinning.

So, most inhaled medications prescribed for COPD do not contain steroids. But even combined medications that have an ICS contain only small amounts and are usually safe for most people. Of course, everyone is different, and you may react differently than someone else to a medication. Therefore, you should always discuss the potential benefits and risks of a new treatment with your doctor before you start to take it.

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/inhaled-medications-for-blog.aspx

COPD Blog: COPD During the Dog Days of Summer

Robert T. Schreiber, MD, an American Lung Association in New York expert

It’s hot, hazy, and humid here in the United States. The “dog days of summer” produce poor air quality with high humidity and air pollution that makes it hard to breathe, particularly for people with COPD. Air pollution can irritate the bronchial tubes and alveoli (air sacks in the lungs) in people with and without lung diseases. For people with COPD, the resulting bronchospasm can lead to a “breathing attack” requiring further treatment, such as increased bronchodilator therapy and corticosteroids. If not managed properly, emergency room treatment and hospitalization can result. So what can you do to get through these hot and humid days?

1: Be aware. You can follow the air quality index on your iPhone with the Everyday Health COPD Tracker, or by watching your local weather forecast, reading the newspaper, or going to a Web site such as www.stateoftheair.org by the American Lung Association. Based on the air quality where you live, you can take actions to protect yourself.

2. Stay indoors. If the air pollution levels are high, try to stay indoors and avoid breathing the noxious gases out there. You can limit the time you spend outside by only doing things that “have to be done” on bad air quality days. Put off errands and visits that can wait. Shop for food and go to doctor’s appointments early in the day (best choice) or late in the day (second choice) when it’s not as hot. Air pollution levels usually are lowest in the mornings, so if you have to go out, get up early.

3. Run your air conditioner. Some people don’t like to use air conditioners since it makes them feel cold, or they might be trying to keep down the electric bill. But air conditioners aren’t just for lowering the temperature; they remove humidity and filter the air, keeping the air clean. They can be kept on a low setting (preferably with an energy saving model), and the living area doesn’t have to be cold — the air conditioner should be used to keep the home free of hot, humid, polluted air.

4. Change your exercise routine. Exercising increases your respiratory rate and depth of breath, increasing your minute ventilation, or the amount of air you breathe in a minute. This means your lungs are exposed to more air, and if it’s polluted, you’re more likely to have a difficult time breathing. Medical studies have shown that people who exercise in air pollution have a drop in lung function. So, keep your workouts indoors (at a gym or with home equipment) in air conditioning, and if you want to exercise outside, go early in the morning when the air quality is usually best.

5. Drink fluids. Many people don’t realize that your body loses a lot of fluid to stay cool in the heat, even when you don’t feel sweaty. This is especially true for older people, who may be even less aware of becoming dehydrated. You can also lose extra fluid while staying indoors in air conditioning. It’s a good idea to increase your liquid intake by at least an extra two glasses a day on very hot days, even if you’re inside.

It’s not easy getting through the hottest days of the year if you have COPD. Hopefully, these tips will make it easier for you to breathe well during the summertime, until the air quality improves and the temperature moderates.Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/summer-humidity-and-copd-blog.aspx

COPD Treatment Tips to Keep You on Track

Managing COPD means staying on track with a good treatment plan. Get tips for managing symptoms, exacerbations, and other COPD issues.

By Chris Iliades, MD

Medically reviewed by Lindsey Marcellin, MD, MPH

You can live well with chronic obstructive pulmonary disorder (COPD) if you get the right COPD treatment plan and stick to it. The goals of a good COPD treatment plan are to manage and avoid COPD symptoms, slow the progression of the disease, manage COPD exacerbations and emergencies, and improve your general health and well-being.

It's important to learn as much as you can about your condition and work closely with your treatment team. That means taking all your medications on time and keeping all of your treatment appointments.

Medications that your doctors prescribe — bronchodilators, steroids, and antibiotics — help keep your COPD symptoms under control, but there is also a lot you can do on your own to stay on the right track.

COPD Treatment Action Plan

The American Lung Association recommends that people with COPD work with their doctor to develop an action plan based on their specific COPD symptoms. Every plan is different, and your plan may change over time. But an action plan should outline specific steps depending on your symptoms. Here is an example:

• Green zone. You are in this zone when your symptoms are under control. Take all your daily medications, keep all your scheduled doctor appointments, and follow your exercise and diet regimens.
• Yellow zone. COPD symptoms like feeling breathless, increased cough, increased phlegm, decreased appetite, and trouble sleeping could be symptoms of a COPD exacerbation. Your action plan should outline how to take your rescue medications, when to use oxygen, and how to use breathing exercises such as pursed-lip breathing. It should also discuss when to call your doctor.
• Red zone. If you have COPD symptoms like severe shortness of breath, chills and fever, confusion, chest pain, or coughing up blood, your action plan goes into emergency mode. Have your emergency contacts ready, call 911 if you need to, increase your oxygen, and get help right away.

COPD Tips to Stay on Track

In addition to following your treatment plan, you can help keep your COPD under control by avoiding potential complications, watching out for anxiety and depression, and making sure you have a good support system. Here’s how:

• Preventing COPD flares. Quitting smoking and avoiding secondhand smoke are two of the most important things you can do to help control COPD symptoms. Air pollutants, allergens like dust and mold, and chemical fumes can also cause a COPD exacerbation. Keep your windows closed and stay indoors as much as possible when pollen and pollution levels are high. Also, make sure to get flu and pneumonia vaccines to help avoid the complication of infection.
• Avoiding depression. Having COPD can make it hard to sleep, enjoy food, and do many of the activities you once enjoyed. Feeling down occasionally is normal, but clinical depression — when feelings of sadness and other symptoms last for more than two weeks — is dangerous. Depression may keep you from sticking to your treatment plan. Learn the symptoms of depression and ask for help if you need it. Treatment for depression may be an important part of managing your COPD.
• Understanding COPD anxiety. Your brain has a region that sets off an alarm signal when oxygen levels are low. For people with COPD, this region can become overly sensitive and send off alarm signals that feel like an anxiety attack. If you are worrying about your breathing all the time, especially if you are afraid to leave the house because of it, you may need help managing anxiety. Treatments such as breathing exercises, counseling, and medication can help keep anxiety under control.
• COPD support. Managing COPD can be tough, but you don't have to do it alone. Talk to your friends and family about your physical and emotional needs. Many find that joining a COPD support group offers an opportunity to share with others who understand. A support group can be a source of experience, strength, and hope, and can help you keep your COPD treatment on track.

Your COPD treatment plan is a lifelong process. Sticking with the plan is the best way to keep living well with COPD, and staying in close touch with your health care team will allow you to adjust your COPD treatment plan over time.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-treatment-tips.aspx

How to Prevent a COPD Flare-Up

Find out how to prevent a COPD exacerbation and what to do if you experience one.

By Madeline Vann, MPH

Medically reviewed by Cynthia Haines, MD

In most cases, patients who have chronic obstructive pulmonary disease (COPD) can keep symptoms such as cough, shortness of breath, or sputum under control. But there are times when COPD patients can experience exacerbations, a worsening of symptoms that is also called a flare-up.

"An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” explains Richard Castriotta, MD, professor at the University of Texas Medical School at Houston.

COPD exacerbations result in about 1.5 million emergency room visits every year in the United States. The risk of an exacerbation varies according to the severity of your COPD. People with severe COPD have about 3.43 exacerbations a year compared with 2.68 on average for people with moderate COPD.

COPD Exacerbations: Signs and Causes

The COPD symptoms that you will recognize as an exacerbation are:

• Worsening cough
• Worsening feeling of being short of breath (dyspnea)
• Changes in sputum, such as changing color (clear to yellow, green, brown, or red) or quantity (either more or less than usual)

Many COPD flare-ups occur without any known cause. However, the most commonly understood causes of COPD exacerbations are respiratory infections such as colds or the flu.

If you have increased COPD symptoms such as a fever, chills, and "purulent" sputum (yellow in color), you should call your doctor immediately. You may need a prescription for antibiotics to help fight the infection.

COPD Exacerbations: How to Handle an Occurrence

How you handle a COPD flare-up will depend on how well you have your symptoms under control under normal circumstances and how severe the exacerbation is. If your symptoms are usually under control and your exacerbation is not severe, you should talk to your doctor about how to treat an increase in symptoms at home. You may be able to use your bronchodilator or steroids to address some symptoms under a doctor's supervision.

If you have followed your doctor's instructions and your efforts to control symptoms at home have not worked, do not take more medication. Instead, call your doctor's office or go to the ER.

If you're having trouble breathing, you should go to the ER immediately. At the hospital you may receive ventilator treatments or medication to help you breathe. In some instances, you may be hospitalized until you get better.

COPD Exacerbations: Prevention Strategies

There are several ways that you can prevent exacerbations or reduce their severity:

• Stop smoking. The more years you smoke, the worse your exacerbations are likely to be. Chronic and heavy smokers are at increased risk for severe exacerbations.
• Take antibiotics as prescribed. If your doctor gives you antibiotics to treat an infection that might lead to an flare-up, make sure you take all the medication as your doctor instructs, even if you feel better before you have finished every dose.
• Get your flu shot. Get a flu vaccine every year when flu season begins and make sure that you are up-to-date with your pneumococcal vaccine.
• Find a primary care doctor you can stick with. Data from a study of 388 COPD patients showed that those who did not have a regular doctor were more likely to need to go to the ER. The researchers estimate that 10 percent of visits could be prevented if more people with COPD had regular doctors. You also can reduce the risk of having to go back to the ER with a relapse if you have a doctor you can visit about a week after you go to the hospital with an exacerbation.

If you understand which COPD symptoms to watch out for, you will be able to respond to COPD exacerbations quickly and learn how to prevent them in the future.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/prevent-copd-flare.aspx

COPD Blog: Is It COPD or Asthma?

Robert T. Schreiber, MD, an American Lung Association in New York Expert

A middle-aged woman sits across the desk from me looking somewhat nervous. She’s been sent to my office by her primary care physician for a pulmonary evaluation. As a lung specialist, I’m being asked to determine the cause of her chronic cough and episodes of wheezing. Is it asthma or COPD?

I evaluate and treat patients like this all the time. To give an accurate diagnosis and treatment plan, I take a full history, do a physician examination, and order a few tests.

First I ask about her symptoms and medical history:

• Are the symptoms chronic (meaning long-standing) or did they start recently?
• Was there a sudden change that could have triggered the symptoms, such as an exposure to an allergen or toxic substance, an acute respiratory infection, or a new pet in the home?
• Is there a prior history of childhood asthma or recurrent coughing and wheezing as an adult?
• Is there a history of allergies?
• Does she smoke or has she smoked in the past?
• Do any family members have asthma or COPD?
• What level of physical activity is she able to do? Has her exercise tolerance been declining?

The answers to these and other questions are the strongest clues I have to diagnose a patient’s condition.

Smoking is the most common cause of COPD. The risk of COPD from smoking is determined by pack years (number of packs per day multiplied by the numbers of years of smoking). COPD is more likely in people who have a history of 20 or more pack years. If the patient’s symptoms have been present for a long time and slowly worsening, it is more likely to be from COPD than asthma.

However, my patient’s symptoms could be a sign of asthma. In people with a history of allergies and childhood asthma, their asthma can reactivate as an adult. People who never had asthma can develop “non-allergic” asthma after an acute respiratory infection.

Both asthma and COPD can produce chronic coughing and wheezing, but the symptoms appear differently: People with COPD tend to have a chronic morning “smokers cough” as a sign of chronic bronchitis; most asthmatics have coughing and wheezing only during flare-ups.

The woman who came in today was a pack-a-day smoker for 25 years, and a casual smoker for five years before that. She quit smoking a few years ago, but has had a morning cough and recently started wheezing in cold weather and when she has a cold. She also gets short of breath easily walking up stairs, particularly if carrying packages.

In the examining room, I check her vital signs and do a head and neck exam, looking for evidence of chronic nasal or sinus swelling or nasal polyps (seen more commonly in asthma and allergies). I listen to her heart and breathing with my stethoscope; I hear mild wheezing in both lungs. Her heart sounds normal. I check the extremities for cyanosis (a blue color that might indicate a low oxygen level) and feet for swelling (which might indicate heart strain).

Next I order a chest x-ray. It looks for signs of cancer, “water on the lungs” and other problems that might cause her symptoms. Luckily, her test doesn’t show any of these.

Pulmonary function tests (PFT’s) are done next; these are breathing tests that measure lung capacity and flow rates. My patient’s PFT’s show that she can’t blow out as much air as she should in one second (her FEV1 is reduced). The next step is to give her a quick-acting bronchodilator and repeat the test. Most asthmatics have normal results after a bronchodilator, but when people have COPD, their tests do not normalize. My patient’s FEV1 is still low and for me, this clinches the diagnosis of COPD.

When I sit down with my patient to review the findings, I tell her she has COPD from years of smoking. Although she quit several years ago, most smoking damage is permanent. It’s common for patients to lose over half of their lung function before they realize it. Some of her loss of lung function is also a part of aging.

I outline a treatment regimen for her which includes taking an inhaled bronchodilator to control her symptoms. I also tell her to:

• Eat a healthy diet to strengthen her immune system.
• Get regular exercise to improve functional capacity.
• Avoid inhaled irritants and, of course, never smoke again.
• Take steps to prevent respiratory infections, such as getting immunizations for influenza and pneumonia, avoiding sick people, and frequent hand cleansing.

Her treatment also requires regular checkups with me to monitor her progress and adjust her medicines. As my new patient leaves, she isn’t happy that she has a chronic condition, but she seems satisfied that she has the right diagnosis and a plan of action.

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

gotquestions  http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-blog-copd-or-asthma.aspx

Caring for a Loved One With COPD

What's involved in home care for the COPD patient?

By Krisha McCoy, MS

Medically reviewed by Lindsey Marcellin, MD, MPH

When you care for someone with chronic obstructive pulmonary disease (COPD) at home, you may have numerous responsibilities.

One of the most important things to do when your loved one is diagnosed with COPD is to learn as much as you can about the disease, says Barry Make, MD, co-director of the COPD program at National Jewish Health and professor of medicine in the division of pulmonary sciences and critical care medicine at the University of Colorado in Denver. COPD caregivers "need to understand the disease as well as the patient does," he says.

Talk to your COPD patient's doctors about what tasks you will need to perform. It is also important to seek support from your loved one's medical team, and other friends and family members.

COPD Home Care: Specific Tasks

Some tasks you may need to perform as a COPD caregiver:

• Encourage pulmonary rehabilitation. Pulmonary rehabilitation consists of prescribed exercise, nutrition counseling, and disease education. Rehab can improve quality of life, increase strength, and reduce shortness of breath and other COPD symptoms. As a caregiver, you can encourage your loved one to go to rehab and even attend rehab sessions with your loved one. "Not only should the patient be in [pulmonary rehabilitation], but their spouse or significant other should attend as well," says Dr. Make.
• Help with medications. Depending on your loved one's symptoms and severity of disease, he may need to take multiple medications at a variety of times throughout the day. You can help keep track of these medications and make sure your loved one is taking them by creating a chart that tracks each medication, its dosage, and time of day it is to be taken. You can use the chart to check off when the medication is taken as directed.
• Attend doctor's appointments. "I think that the spouse or significant other of the COPD patient should go into the physician visits as well as the patient," says Make. You can help your loved one remember what the doctor said and make sure all questions are answered. "One of the best things a caregiver can do before they bring home their newly diagnosed COPD patient is ask a lot of questions," says Kitty Weary, of West Yellowstone, Mont., who provided COPD care for her father, husband, and mother.
  Weary suggests writing down all of the questions you and your loved one have in a notebook and leaving spaces to fill in answers from the medical team. "All of this new stuff is getting fired at you, and there is a good chance you won't remember anything," she says. At the visits, you can learn how to use any prescribed equipment, which may include supplemental oxygen, a handheld bronchodilator inhaler, or a nebulizer.
• Monitor your loved one's condition. Talk with the medical team about the warning signs of an exacerbation (an episode of worsened symptoms), and when you should seek medical help. In general, you should call the doctor when your loved one has:
• 
  
  • Excessive trouble breathing during everyday activities
  • Greater than usual coughing or coughing-related chest pain
  • Increased mucus production or change in appearance of mucus
  • Swelling in the hands or feet
  • Cramping of muscles
  • Tiredness or weakness
  • Trouble sleeping that is related to shortness of breath

Caring for a COPD patient at home can be challenging. But by following the medical team's instructions and encouraging your loved one to adhere to her COPD treatment regimen, you can play an important role in improving your loved one's quality of life.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/caring-for-loved-one-with-copd