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Lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD) that includes emphysema and chronic bronchitis, impact the lives of millions of Americans. The New York City-based American Lung Association estimates adults with asthma miss a total of three million workdays annually. People with COPD find that it limits activities of daily living such as dressing, taking a shower, or housecleaning.
The problems don’t end with breathing, either. Often, these patients’ nutrition is poor because they become short of breath just trying to fix meals or eat, says Bari Franklin, CRT, senior support services coordinator for the Central Ohio Breathing Association in Columbus.
Yet education can provide patients with chronic lung disease the techniques they need to help manage shortness of breath and save energy as well as information that will help relieve their anxiety, which tends to exacerbate the problem. "Education is a major factor in managing shortness of breath. The more the patient understands about what is going on, the better they can control it," says Mahasti Rittinger, RRT, coordinator of the pulmonary rehabilitation program at The Ohio State University Medical Center in Columbus.
For example, if patients learn that inhalation uses energy while exhalation is passive, they can learn to expend energy when they are exhaling rather than inhaling. The technique is called pace breathing, and patients would, for example, pace themselves while climbing stairs by taking a step when exhaling and resting when inhaling. So they would take one step, then pause to breathe in, and then take another step as they exhale, explains Rittinger.
A thorough assessment is key to a good education plan for patients with chronic lung ailments. Each senior who Franklin assists undergoes a two-hour assessment to uncover his or her knowledge about their disease, the medications he or she is taking, history of hospitalizations, support systems, and environmental conditions.
There may be many simple things that can be done to improve a senior’s quality of life when
he or she has COPD, such as moving from an upstairs bedroom to one on the first floor of the house or obtaining a handicapped parking sticker so he or she can park closer to the store entrance. If he or she can’t fix his or her own meals, organizations that provide meals for seniors such as "Meals on Wheels" might be contacted. "I always ask what they want to get out of the program, what their goal is. Some want to go to church on Sundays, others want to do their own laundry or cook a meal," says Franklin.
Learning a whole new lifestyle
Learning to live with chronic lung problems that cause shortness of breath often means learning a whole new lifestyle. "I tell my clients to slow down. They are used to going at a certain pace all their life, but once they develop the problem of shortness of breath, they must learn to slow down," says Franklin. They may need to sit on a stool while cutting vegetables for a meal or washing dishes. Rearranging items in the house can save breath too, such as putting all the frequently used pots and pans on the stove so there is no bending down to pull them out of a cupboard.
"Many of the people who come to our program have had COPD for a long time, but never realized how to make their quality of life better in simple ways such as sitting down to prepare meals. They don’t understand the mechanics of oxygen consumption and how that really works. What we are trying to do is educate them and make their life better," says Robin Wesolek, RRT, director of program services for the Central Ohio Breathing Association.
This is the same goal the association has for its asthma clients; therefore, an outreach worker goes to their home to help them determine what might be triggering asthma attacks, such as pet dander or a cigarette smoker in the house.
The outreach worker also encourages clients to develop a written action plan with their physician so when they become symptomatic, they know what to do. The action plan includes recording daily peak flow meter readings to monitor their lung function so that they can take medications appropriate for their lung function to avoid a visit to the emergency department.
Diary helps build a plan
For COPD patients, a diary tracking the activities patients were engaged in and their location when they experienced shortness of breath is a good way to come up with a plan to address the problem. "The more the patient can describe it and tell us when and how it happens, the better we can help," says Rittinger.
Many factors of breathlessness are addressed at the rehabilitation program at Ohio State. Sometimes weight contributes to the problem, and patients need direction in weight loss and nutrition. They may have respiratory muscle weakness and need to work with the therapist to make their muscles stronger. There are also psychosocial factors, so a team works with patients on stress management, coping with chronic disease, and relaxation techniques.
Breathing techniques assist in the relief of shortness of breath by helping patients relax, control their anxiety, and avert panic attacks during times of breathlessness. One technique is pursed lip breathing where patients learn to breathe through their nose and exhale through pursed lips. "By pursing their lips, they create resistance to the air flow; that creates back pressure in their airways and keeps the airways open longer," explains Rittinger.
Another technique is diaphragmatic breathing, where patients learn to use their diaphragm to breathe so they are using one muscle rather than the chest muscles and shoulder muscles, and therefore use less energy. With COPD patients who have hyperinflated lungs, the diaphragm muscle usually becomes weak from lack of use; therefore, the exercise also strengthens it. "Like any other muscle, the more you work it, the more you get the strength back into it; and the diaphragm is an important breathing muscle," says Rittinger.
Keep meds in check
The proper use of medications under the care of a physician also is important for controlling shortness of breath, especially for asthma patients, says Wesolek. If asthma patients are working with a physician, have identified their triggers, and corrected environmental issues that trigger shortness of breath, they shouldn’t have too many problems, she says.
Proper use of medication also is important for COPD patients. Franklin advises the patients she works with to either document when they have taken their daily medications or use a pill sorter so they don’t miss doses.
For more information about teaching patients to manage shortness of breath, contact:
• Bari Franklin, CRT, Senior Support Services Coordinator, and Robin Wesolek, RRT, Director of Program Services, The Central Ohio Breathing Association, 1520 Old Henderson Road, Columbus, OH 43220. Telephone: (614) 457-4570. Web: www.breathingassociation.org.
• Mahasti Rittinger, RRT, Coordinator, Pulmonary Rehabilitation Program, The Ohio State University Medical Center, 2050 Kenny Road, Suite 1010, Columbus, OH 43221. Telephone: (614) 293-2820. E-mail: firstname.lastname@example.org.
• American Lung Association, 1740 Broadway, New York, NY 10019-4374. Telephone: (212) 315-8700 or (800) 586-4872. Web: www.lungusa.org . On the web site, find a list of nonmedical suggestions to help people live with COPD titled "Around the Clock with COPD."