Chronic Obstructive Pulmonary Disease COPD

By Bonnie Jenkins, Advanced Natural Medicine
My mother-in-law smoked for nearly 35 years before she finally gave it up more than 15 years ago. The problem is, however, that the damage to her lungs was already done – and now she’s living with a diagnosis of Chronic Obstructive Pulmonary Disease, more commonly known as COPD.

The dog days of summer, with its thick and stagnant weather, can leave her literally gasping for air. She’s not alone. More than 30 million Americans live with a chronic lung disease and, for them, breathing can be a chore every day of the year.

3 Ways to Boost Your Lung Power

By David Blyweiss, M.D., Advanced Natural Medicine

Take a deep breath.
For most people, it’s not a big deal. But if you suffer from chronic obstructive lung disease (COPD), breathing may be one of the most difficult things you do.

COPD is a group of conditions that includes emphysema, chronic bronchitis and asthma. Smoking is the most common cause of COPD. But pollution and chemical fumes can also set you up for respiratory problems later in life.

Gasping For Breath

By David Blyweiss, M.D.

The other day, my office got a frantic call from Jane. The night before she had suffered a frightening bout of breathlessness. You see, Jane had been a pack-a-day smoker for much of her life. And, although she quit more than 10 years ago, she was left with a devastating case of COPD. 

Long-time tobacco smokers like Jane have the highest risk of developing COPD, also called Chronic Obstructive Pulmonary Disease. It’s a major cause of disability, affecting at least 12 million people, and the fourth leading cause of death in the U.S.

Everyday Tips to Make Living With COPD Easier

Host: Carolynn Delany
Guest: Robert T. Schreiber, MD
February 27, 2012

Carolynn Delany:
Welcome to this Everyday Health podcast, “Everyday Tips to Make Living With COPD Easier.” I'm your host, Carolynn Delany. Chronic obstructive pulmonary disease, also known as COPD, affects your breathing and can make it harder to do everyday activities. That's why it's so important to learn habits that can help make your life easier.

Joining us today is Dr. Robert Schreiber, a pulmonary medicine specialist at Nassau Chest Physicians and director of the surgical ICU at St. Francis Hospital in Roslyn, New York. Dr. Schreiber and Nassau Chest Physicians are also actively involved with the American Lung Association in New York. Thank you for being with us, Dr. Schreiber.

Dr. Schreiber:
I'm very glad to be here with you today, Carolynn.

Carolynn Delany:
Dr. Schreiber, why do people with COPD need to be especially mindful of conserving their energy?

Dr. Schreiber:
Patients with COPD have damaged lungs. In general, you use more oxygen when you exert yourself, so it's important for them to pace themselves and to decide to use their muscles and oxygen for really important things and not for things that could be skipped and put off or done by someone else.

Carolynn Delany:
As COPD progresses, people will become more aware of what taps their energy levels. How can planning ahead help with the fatigue?

Dr. Schreiber:
You can plan rest periods and you can plan naps. You can plan time to take your medicines, including nebulizer treatments, so that you can work around your schedule and help keep things under control and do the things that you want to.

Carolynn Delany:
Well, I'm sure that you and your nurses have learned a few tricks from your patients about energy‑saving shortcuts. Can you share a few of those with us, please?

Dr. Schreiber:
Yes. My nurses were very eager to give me lots of tips for patients for today's recording when I told them I was doing this because they actually spend more time with the patients about some of these issues than I do.

So one thing, which I think is a great idea, is when you go to the grocery you can buy precut‑up fruit and healthy prepared food. And when you cook, make extra food, that is, make enough for two or three meals but then go ahead and freeze some. For about the same amount of energy expenditure cooking one meal, you can make a few, and then you don't have to go through the whole bother of cooking every day for several days.

A couple other tricks that I was taught was to eat small, frequent meals and eat them slowly and to pick foods that are easy to chew. All these things don't tax the respiratory system so much. The small meals won't distend your abdomen as much and push up on the diaphragm. And with easy‑to‑chew foods, you don't have to work so hard to get food chewed and ready to be swallowed.

I was told that a good idea is to avoid long lines. So you don't want to go to the Saturday night movie, when you could go to a Thursday afternoon matinee. So, you know, anything you can do like that, or not going to the grocery store at the most popular shopping times, so that you avoid long lines and just standing there. Where you're not doing anything but standing on a line can sometimes be very tiresome for our patients.

And another good trick I was told was to wear loose clothes that are not restrictive so the respiratory muscles can work easily. Loose‑fitting clothes are also easier to put on. You don't want things that have lots of little snaps and buttons and things like that. You want stuff that's easy to get on and off.

Another tip that someone told me was that you could try using an absorbent robe instead of drying yourself with a towel, so you don't have to bend over and reach all around your body, and you can just put on a simple robe. And that will also be a little bit easier and less energy expenditure for yourself.

Carolynn Delany:
Great tips. Well, how can organizing things in your own home make life a little bit easier?

Dr. Schreiber:
Again, finding simple ways to do our chores is probably the most important thing. All this is about doing things efficiently so you don't have to go back and forth and back and forth. Being organized, leaving things in the same place so that you don't have to waste time and energy using up your oxygen looking for things. If you leave your keys or your shoes or your clothes or whatever it is in the same place all the time it's a lot easier for you, and you don't have to waste the energy trying to track these things down.

Also keeping frequently used items within reach is a good tip that I was told. That way you don't have to go straining and stuff to try to find a pot or pan or a book or commonly used clothes or cosmetics. So keep them in a place that's easy to get to. If you have to move stuff from room to room or around a room, having a small table on wheels or a cart and putting it on that and then moving the item will save you energy rather than carrying it. I thought that was wonderful tip for people.

One other one I was told is don't hang your mirrors high. If they're lower then it's easier for you in terms of combing your hair or dressing because you can sit down and do it in front of a mirror rather than standing to do the same thing. For patients with more severe emphysema, you know, standing up and combing your hair can actually be very energy taxing.

Carolynn Delany:
There are mobility aids that can help conserve energy too, like shower chairs are very helpful, recliners that assist with helping you get out of a chair, and even electric scooters. Do you recommend these to your patients?

Dr. Schreiber:
I think shower chairs are great because again you can sit rather than stand, and it's less energy taxing for patients with advanced emphysema. In terms of recliners and walkers, these are good mobility aids to try to keep you independent and moving and doing the things you want to, which will all help you get the things done with less energy use and do it in a safe way.

In terms of wheelchairs and scooters, I try to discourage most of my patients from using them on a regular basis unless they have very advanced COPD and cannot get someplace or do things without them. What I'm always afraid of is once somebody has a wheelchair or scooter that they're going to start relying on it more and more and using their own muscles less and less.

Carolynn Delany:
Are there any special tricks that you'd like to share about reducing stress and anxiety for people living with COPD?

Dr. Schreiber:
Well, we all have stress, and I think we all have to learn how to deal with it and find healthy outlets for it. There are unhealthy outlets for stress, things like smoking, drinking, taking illicit drugs, yelling at your spouse or loved ones. These are all destructive things to do with stress.

On the other hand, there are healthier things you can do with stress. Exercise is a wonderful thing that can be a stress reliever for some people, and it's good for your heart and lungs and your muscles. So I think that's a wonderful choice. For other people, yoga, meditation, listening or playing music are also wonderful ways of reducing stress.

There are other things to help people with stress like support groups, which I think are wonderful because it gives a chance for people to talk about the issues that they share with other people who have the same disease. Ideas are passed around, little tips with each other. And I think it also helps people to know that they're not alone, that there are other people who face the same challenges.

Of course, being educated helps reduce stress. Listening to podcasts, reading, getting information from your healthcare provider I think are all wonderful things to help reduce stress because knowledge about what's happening to me and what should I expect, I think there's a fear of the unknown.

And of course as a last resort there are medications for people who feel stressed. I personally don't like to prescribe medications for stress, but there are some people who need them, and sometimes that's an option that you could talk to your doctor or other healthcare provider about, too.

Carolynn Delany:
Well, Dr. Schreiber, you've shared so many useful tips with us today. Thank you so much.

Dr. Schreiber:
Well, Carolynn, once again it's my pleasure to be with you and share these tips with patients with COPD. I also want to just take one moment to thank the nurses in my office, Lee, Joan, and Karen, who gave me some of these tips I shared with you today.

Carolynn Delany:
That's great. Thank you, nurses, you're always such a huge help. And also it's a great tip to get in touch with the American Lung Association because they're a great asset and resource, as you've said.

Dr. Schreiber:
I agree a thousand percent. Thank you, Carolynn.

Carolynn Delany:
You've been listening to an Everyday Health podcast, “Everyday Tips to Make Living With COPD Easier.” For more information on COPD, visit EverydayHealth.com. I'm Carolynn Delany for Everyday Health. Thanks for joining us.

http://www.everydayhealth.com/copd/podcasts/tips-to-make-copd-easier-transcript.aspx

COPD: 8 Ways to Avoid Infections

Patients with COPD must be extra careful to prevent infections that could affect their lungs.

By Krisha McCoy, MS

Medically reviewed by Cynthia Haines, MD

For people who have COPD (chronic obstructive pulmonary disease), avoiding infections such as colds and the flu is extremely important, because these illnesses can harm their lungs and possibly cause pneumonia.

COPD: Importance of Preventing Infections

Staying healthy is important for COPD patients because being infected with viruses, bacteria, and other infectious organisms can make you more susceptible to getting lung infections, which can lead to breathing difficulties. When you have a lung infection, your shortness of breath, coughing, fatigue, and other COPD symptoms can quickly get worse. And when you have any type of respiratory infection, there is a chance it could progress to pneumonia, which can be life-threatening.

COPD: Tips to Prevent Infections

Here are eight tips that can help you reduce your risk of developing an infection:

• Wash your hands. Regular hand-washing is one of the most important things you can do to reduce your risk of infection. Wash your hands thoroughly and often, especially when you are around a lot of people (for example, in a hospital or doctor's office, or at school or work).
• Avoid infections. "Stay away from people who you know have an infection," says Jane Whalen-Price, PT, director of rehabilitation services at National Jewish Health in Denver. Ask people who are sick not to visit until they are well again, and wear a face mask if you do have to come in contact with someone who has an infection.
• Clear your airways. "COPD patients should make sure they keep their airways open and clear of mucus," says Whalen-Price. Your doctor can provide you with devices and your respiratory therapist can teach you maneuvers that can make your coughing more productive, which helps to clear your airways.
• Stay hydrated. Whalen-Price says drinking plenty of fluids is part of practicing good bronchiole hygiene, which can reduce your risk of infection. Bronchioles are small airways deep in the lungs.
• Clean your equipment. All equipment that you use, including humidifiers, oxygen masks, and flutter valves, should be properly cleaned and maintained to ensure that they don't harbor infectious organisms.
• Get vaccinated. Talk with your doctor about which vaccines you should get. In general, people with COPD should get a pneumococcal vaccine (Prevnar) once, as well as a flu vaccine every year. Revaccination for pneumococcal disease is controversial, but it may be right for you. Talk to your doctor to find out.
• Stay away from crowds. When possible, avoid large crowds, especially during cold and flu season. For example, "go to the store when it is less busy," says Phyllis Dibbern, PT, physical therapist at National Jewish Health, who has more than 30 years of experience in pulmonary rehabilitation.
• Treat infections as early as possible. Call your doctor at the first sign of infection, so it can be treated before it progresses to a more serious infection of your lungs. "When COPD patients notice a change in color of their sputum from white or clear to yellow or dark, they should go to their doctor before a major infection develops," says Dibbern.

Avoiding infections doesn't mean that you have to live in a bubble. You can still lead a normal, productive life when you have COPD, but you just need to take some extra precautions to protect yourself from getting sick. There is no way to completely prevent an infection, but by following these simple guidelines, you can increase your chances of staying healthy.

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

The Best Diet for COPD Patients

A healthy diet can play an important role in the management and treatment of COPD.

By Krisha McCoy, MS

Medically reviewed by Lindsey Marcellin, MD, MPH

Finding the right diet can be tricky for people with chronic obstructive pulmonary disease(COPD), since they need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.

COPD: The Impact of Body Weight

For COPD patients, maintaining a healthy weight is important for controlling symptoms.

"If you're overweight, you have to carry more of your weight around," says Barry Make, MD, co-director of the COPD program at National Jewish Health in Denver and professor of medicine at the University of Colorado. Having more weight to carry around can increase shortness of breath, which is one of the primary symptoms of COPD.

With that said, it’s even more crucial for COPD patients not to be underweight. "Being overweight is bad, but being underweight is probably even worse in COPD patients," says Dr. Make. "A lot of COPD patients want to lose weight, but we tell them not to lose too much." According to Make, losing too much weight when you have COPD is associated with a poorer prognosis, or worse long-term outlook. In addition, not weighing enough can zap your energy, making it difficult to adhere to your COPD management plan.

COPD: Nutrition Tips

Talk with your COPD medical team about the nutrition plan that is best for you. They may recommend that you see a nutritionist, who can work with you to develop a meal plan to best meet your needs and monitor your progress along the way.

In general, people who have COPD should consider the following to maintain an optimal weight:

• Monitor calories: If you are overweight, you can lose weight by eating fewer calories. But don't eat so few calories that you feel fatigued and hungry all of the time. If you need to focus on maintaining your body weight, talk with your medical team or nutritionist about the foods you should be eating to keep the weight on.
• Avoid fad diets: "Fad diets are not appropriate for COPD patients," says Make. Make recommends that COPD patients eat a healthful, balanced diet instead of going on fad diets to control weight.
• Focus on protein: Work with your medical team and/or nutritionist to determine the amount of protein you need. "A lot of people do not get enough protein in their diet," says Make. Make says that protein is particularly important for COPD patients who are exercising as part of their pulmonary rehabilitation plan.
• Watch your portions: "We tell our COPD patients to eat small meals frequently, rather than large meals," says Make. Eating several small meals throughout the day instead of two or three large meals can help lessen shortness of breath.
• Get balanced: Focus on consuming fruits, vegetables, dairy products, whole grains, and lean proteins.
• Limit salt: Consuming excessive sodium can lead to fluid retention, which can worsen your shortness of breath.
• Remember your oxygen: If your medical team recommends it, use supplemental oxygen during and after meals to aid in digestion.

A healthy diet is an important part of a COPD patient's treatment plan. Eating the right foods can help manage your symptoms, make you feel better overall, increase your energy level, and give your body the fuel it needs to fight infection. It takes energy to breathe when you have COPD, so feed your body well.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/diet-for-copd-patients.aspx

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

11 Ways to Make Mealtime Easier With COPD

COPD may make it difficult to get needed nutrition. Being strategic with meal planning and food preparation can help you work around the fatigue and shortness of breath you feel.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

Struggling with COPD, specifically the fatigue and shortness of breath that come with it, can leave you struggling to prepare and eat even the simplest meals. Yet it's possible to bring joy and nutrition back to your daily menu, despite COPD symptoms.

"For people with COPD, it's challenging and exhausting to eat and take a breath at the same time," explains registered dietitian Carol Wolin-Riklin, MS, RD, an instructor in the department of surgery at the University of Texas Health Science Center at Houston Medical School.

As tiring as it can be to eat, people with COPD still want to enjoy mealtime. A survey of 81 people with COPD showed that the majority wanted more information on what to eat and how to manage their symptoms.

COPD and Diet: A Primer

"When you have a hard time eating, every bite should provide nutrition," advises Wolin-Riklin.

Here is a brief outline of a healthy COPD diet:

• Calories. Living with COPD symptoms takes so much energy that you may need to increase your diet's calorie count to 3,000 or more a day. Work with a dietitian to figure out exactly how many calories you need.
• Protein. People with COPD often experience muscle wasting because of the way their bodies use protein. As a result, higher-protein diets are advised, as long as you don't have other conditions that this would negatively impact, says Wolin-Riklin. Check with your doctor first, especially if you have any illnesses that affect the kidneys. Nut butters, smoothies or shakes with protein powders, chicken, and fish are all easy-to-prepare protein sources.
• Fruits and vegetables. Eat as many as possible and in a rainbow of colors to get various nutrients. If you don't want to chew raw veggies, steam them, puree them for soups, or try low-sodium vegetable juices.
• Healthy fats. Opt for foods with omega-3-fatty acids, such as cold-water fish, like salmon and sardines, and healthy fats such as olive oil. These are good sources of additional calories and may also help cut down on inflammation overall.
• Fiber. Aim for 25 grams of fiber daily. You might need to take fiber supplements to reach that amount.
• Limited carbohydrates. You need some carbs, but eating too many can increase the carbon dioxide in your blood. Stick with six to eight servings throughout the day.

11 Tips to Make Mealtimes Easier

Struggling to eat the same way you did before COPD symptoms took over simply won't work. Instead, try these strategies:

• Select prepared foods. If you don't have someone to cook for you, Wolin-Riklin suggests buying prepared foods as much as possible. Prepared foods do not have to be expensive — consider choices like hot, store-roasted chicken instead of roasting one yourself. Check whether your household qualifies for a Meals on Wheels program or another service that delivers prepared hot meals.
• Rethink dinnertime. "Find the time of day you feel best, and make that your biggest meal," advises Wolin-Riklin. For most people, that's early afternoon. It's fine to spend the rest of the day enjoying healthy snacks or eating liquid meals, such as smoothies or shakes with added protein or nutrient powders.
• Freeze extras. If you have leftovers or muster up extra energy to cook at certain times, freeze meal-sized portions you can easily reheat on a day you're feeling tired.
• Avoid carbonated beverages. Fizzy drinks will make you feel uncomfortable and bloated, putting pressure on your lungs and airways from below. Gas-producing foods, such as beans, may also make you uncomfortable unless you take an over-the-counter supplement such as Beano at the beginning of the meal.
• Choose low-salt foods. Look for low-salt labels, or make sure caregivers don't add salt to foods they prepare for you. Too much salt (you want only about 1,500 milligrams a day) can cause fluid retention, which adds to COPD symptoms.
• Eat small but frequent meals. Wolin-Riklin says this approach, which should result in five or six mini-meals, will help you feel less tired while eating and get consistent energy and nutrition through the day. Keep small high-calorie snacks, such as peanut butter and apple slices or cheese and crackers, on hand when you're out of the house.
• Ease your chewing. A number of people get in the habit of eating large mouthfuls quickly, but people with COPD do best with small bites of easy-to-chew foods. Instead of thinking of this as restrictive, consider that chewing small bites slowly helps you appreciate the flavor of your meal.
• Sip liquid throughout the day. It's important to get enough fluids — water, juices, smoothies, and soups. Try sipping 6 to 8 cups of water and possibly meal-replacement drinks like Boost or Ensure, over the course of the day instead of drinking a lot of fluid at one time.
• Wear your oxygen. If you have been prescribed oxygen, wear your nasal cannula while you eat. This allows you to breathe and eat at the same time more easily, says Wolin-Riklin.
• Eat sitting up. You'll breathe more easily while you eat and swallow more safely if you eat sitting up rather than reclining in bed or a chair.
• Be dairy-aware. Some people feel like dairy increases their mucus production. If this sounds familiar, try a milk alternative like soy or almond milk.

If you make these adjustments and still have difficulty eating and breathing at the same time, talk with your doctor or your pulmonary rehabilitation team to get some more ideas about how to cope.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-function/mealtime-easier-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