To really understand COPD, you must first have a clear understanding of how the lungs work.

Breathing is often taken for granted until it becomes an effort to get air into and out of the lungs. It might be helpful if you understand how air travels through your respiratory system and where the trouble spots can be when you have COPD.

If you take a close look at where the air goes when you breathe in and out, you’ll see that the path resembles a tree turned upside down. This is why the airways of your respiratory system are often referred to as the bronchial tree.

Each time you take a breath, air enters through your nose or mouth and continues down the trachea, better known as the windpipe. From here it goes into two sponge-like organs located in your chest called the lungs. Air enters the lungs through two large branches off the trachea known as bronchi. The air then travels deeper into the lungs through smaller bronchi and about a million miniature passageways called bronchioles. The walls of the bronchioles are surrounded by bands of smooth muscle which provide support. At the end of this maze of little branches are tiny, stretchy air sacs which are called alveoli. Each individual air sac is called an alveolus and is surrounded by microscopic blood vessels. The oxygen in the air you breathe travels through the stretchy air sacs into your blood so that it can be used by cells throughout your body. At the same time, carbon dioxide—a waste product—passes from the blood back into the air sacs and leaves the body by traveling back up the same path. This exchange of oxygen and carbon dioxide is very important because every cell in the body needs oxygen to function. It takes a constant supply of oxygen for your cells to live.

The process of moving air into and out of your lungs is called respiration. A strong wall of muscle located below your lungs, the diaphragm, is the major muscle of respiration. As the diaphragm moves down, it creates suction in the chest and draws in fresh air which expands the lungs. Then, as this muscle relaxes, it returns to its original position and the air is pushed out of the lungs.

Conditions which obstruct the flow of air from traveling easily through the respiratory system are called “Chronic Obstructive Pulmonary Disease” or COPD. The three conditions most frequently referred to when discussing COPD are emphysema. chronic bronchitis, and complicated asthma. In each, when the flow of air is blocked— or obstructed— it makes it harder to get enough oxygen to meet the body’s needs.

Most individuals with COPD have a combination of emphysema, chronic bronchitis, and asthma and may have other chronic respiratory problems, too. In all cases where COPD is suspected, it is important to have proper medical attention to determine which of these diseases is the primary cause of the COPD so that prescribed treatment and self-help techniques can be used effectively.

WITH CHRONIC BRONCHITIS, repeated infections and irritants such as cigarette smoke cause the airways in the lungs to become swollen and inflamed, producing large amounts of heavy mucus. This can cause clogging in the tiny air passages, and the excess mucus becomes an excellent breeding ground for infections. The major symptoms associated with chronic bronchitis are persistent coughing and production of excess mucus for long periods of time. One positive note about chronic bronchitis is that the outlook for recovery is good if you stop smoking and try to prevent repeated infections before any permanent lung damage occurs.

WITH EMPHYSEMA, the walls of the tiny air sacs peak down due to smoking and other inhaled irritants. Sometimes, even heredity can be a factor. Instead of having clusters of little stretchy air sacs, people with emphysema have enlarged air sacs that have lost their natural stretchiness. When this happens, the used air cannot be exhaled completely, and the air sacs remain partially full. This limits the amount of fresh air that can be breathed in and shortness of breath becomes a problem. Trying to compensate by breathing faster only causes more used air to be trapped inside. Although there is no known cure for emphysema, following your doctor’s orders, quitting smoking if you haven’t already done so, and practicing basic self-help measures and breathing techniques can help make breathing easier.

WITH ASTHMA, recent findings have shown that the airways or breathing tubes respond to various triggers by becoming inflamed and swollen. The inflammation causes an increase in mucus production which clogs the already narrowed breathing passages. In turn, the muscles surrounding the airways go into spasm, narrowing and collapsing these small passageways. This narrowing of the airways is what causes coughing and, frequently, a wheezing or whistling sound as the individual breathes in and out. Asthma is one condition which is often misunderstood because its symptoms come and go and can have many triggers such as allergens (examples— mold, pollen, dust, and animal dander), weather, infections, and sometimes unknown causes that are different for each individual. Controlling asthma can be as simple as avoiding those triggers which are known to ping on an attack. Sometimes this is hard to do, but learning some simple breathing exercises and relaxation techniques and taking prescribed medications makes it easier to breathe.

Learning helpful ways to breathe means learning to use your lungs smarter rather than harder.

Shortness of breath is often a major symptom for those with COPD, especially when exerting energy, when under stress, or, occasionally, for no apparent reason. There are techniques in this handbook to control your breathing and clear your lungs of excess mucus which, with your doctor’s okay, may help keep your airways open so you can breathe easier.

Controlling Your Breathing

Pursed-Lip Breathing

One of the simplest ways to control your breathing is pursed-lip breathing — a technique which helps keep the airways and air sacs open and slows down your breathing. By using this technique, any used air trapped within the lungs can get out, allowing fresh air to replace it.

To do pursed-lip breathing:

1. Slowly breathe in through your nose, keeping your mouth closed. It’s not necessary to take a deep breath; a normal one will do.
2. Pucker your lips in a whistling position and breathe out slowly, gently tightening your stomach muscles to help push the air out through your lips.

Be sure to use enough pressure to make a sound, but do not force exhalation. Stay relaxed and exhale at least twice as long as you inhale. For example, when doing pursed-lip breathing, inhale through your nose for two counts . . . one-two. Then, purse your lips and exhale for four counts . . . one-two-three-four. That’s all there is to it! After practicing this technique regularly, you’ll see that it will become a natural way of breathing when you are doing any physical activity or when you are short of breath.

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Another breathing technique which works hand-in-hand with pursed-lip breathing is diaphragmatic breathing, more commonly known as belly breathing.

Diaphragmatic Breathing

Individuals with chronic respiratory disease often have a weakened and flattened diaphragm (the major muscle of breathing). It’s weakened because other less efficient muscles in the neck and chest are used to breathe. It’s flattened because the air trapped in the lungs pushes down on the diaphragm and, in time, flattens it.

Diaphragmatic breathing (or belly breathing) involves training and strengthening your diaphragm to ease the work required for each breath.

To do diaphragmatic breathing:

There are two important things to remember when doing belly breathing. Concentrate on exhaling at least twice as long as you inhale, just as you did with pursed-lip breathing. Also, keep your chest still so that it is your diaphragm and not your neck and chest muscles that do the work of breathing.
 

1. Start by placing one hand on your belly just below the ribs and the other hand on the upper part of your chest.
2. Breathe in through your nose so that your belly moves out against your hand as far as it will go. Keep the other hand on your chest which should be as still as possible.
3. As you breathe out slowly and fully through pursed lips, press your belly gently upward and inward with your hand.

An inhaler or MDI (metered dose inhaler) is a pressurized canister that administers prescribed medications in aerosol form. It has become more popular recently because of its price and its convenience.

Following these 10 simple steps can help you use your inhaler effectively:

1. Shake the inhaler for at least 10 seconds and remove the protective cap. The metal canister should be on top and the mouthpiece on the bottom.
2. Hold the inhaler properly by placing your index and middle fingers on the top of the metal canister and your thumb on the bottom of the plastic mouthpiece (see drawing). Breathe out normally.
3. With your head erect, place the inhaler about 1 to 1-1/2 inches in front of your open mouth.
4. As you begin to breathe in deeply through your mouth, press the metal canister down with your index and middle fingers. Try to breathe in very deeply to carry the particles of medicine as far down into your lungs as possible.
5. Hold your breath for at least 10 seconds or as long as it’s comfortable. This allows time for the medication to travel through the breathing passages and deposit further in the lungs.
6. Slowly exhale through pursed lips and continue to breathe normally.
7. If your doctor has prescribed more than one puff per treatment, wait a few minutes between doses. Some inhalers specify a longer waiting period, so follow your doctor’s instructions carefully. Never exceed the inhaler dosage prescribed by your doctor without consulting him first.
8. Replace the cap on the inhaler when you’re finished. Wash the mouthpiece and cap daily in warm water and dry thoroughly.
9. After each treatment, rinse your mouth with water or your favorite mouthwash. *(See “Timing is Everything.”)
10. Remember, don’t puncture or destroy your inhaler by fire because its contents are under pressure. Also, don’t store or use the inhaler near heat or an open flame.

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Inhaler Accessories

Over the past few years, prescribed inhalers have become a major method for delivering medication when you have COPD. However, not everyone is capable of using their inhaler efficiently and effectively using the technique previously described. There are now available on the market today a number of accessories that can help you get the most from your inhaled medication. Whether you are older, or have arthritis, or just cannot coordinate this activity, you may find that a spacer or other device can help. They are relatively affordable and allow you to maximize the medication in your inhaler.

Spacers……a spacer is a generic term used to describe a holding chamber for your medication after it has left your inhaler. Brands on the market today are Inspirease® and Aerochamber®. These devices allow you to take your inhaled medication at your own pace. They’re especially beneficial for those individuals who have difficulty coordinating their breathing with administering their medication. You attach your inhaler to the chamber following manufacturer’s directions. Check with your pharmacist for availability.

Other devices…..another unique accessory for individuals who have dexterity problems (weak hands/fingers) is the Ventease®. This little gadget attaches to certain inhaler mouthpieces and makes depression of the cannister easier. Check with your doctor or pharmacist.

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Timing is everything!!

Many of you use more than one inhaler at a time. How do you decide what to take first? How long should you wait between each puff? between each medicine? Good question. Bronchodilators work faster than inhaled steroids. As a general rule, use the fastest acting bronchodilator first (e.g. Proventil®, Ventolin®, Alupent®, Maxair®, Brethaire®). Follow this with the next fastest acting bronchodilator, if prescribed (e.g. Atrovent®). Finally, follow with your inhaled steroid (e.g. Vanceril®, Beclovent®, Azmacort®, Aerobid®).

Below is a chart that gives you an idea how to set up your inhaled medicines regarding proper timing and sequencing. Read this over carefully and substiture your inhalers in the proper spaces. This is for guidance only and you should always consult your physician to adjust and tailor this to your own needs:

First Inhaler	Fastest-Acting Bronchodilator (e.g., Proventil®, Ventolin®)	1 puff	Wait 5-10 minutes between puffs.  Repeat until dosage completed.  Follow with next inhaler.
Second Inhaler	Secondary Bronchodilator (e.g., Atrovent®)	1 puff	Wait at least one minute between puffs.  Repeat until dosage completed.  Follow with next inhaler.
Third Inhaler	Preventive (e.g., Intal®)	1 puff	Wait at least one minute between puffs.  Repeat until dosage completed.  Follow with next inhaler.
Fourth Inhaler	Inhaled Steroid (e.g., Vanceril®, Azmacort®)	1 puff	Wait at least one minute between puffs.  Repeat until dosage completed.  Rinse mouth thoroughly!

The old adage “If a little is good, more is better” does not apply to any medication—especially oxygen.

Unlike the air around you which is made up of 21 percent oxygen as well as some other gases, the supplemental oxygen your doctor prescribes is almost 100 percent medically pure. Because of this, it’s considered a drug and may only be prescribed by a physician.

Not all patients with COPD require supplemental oxygen. Only your doctor can determine if oxygen will help you. He can prescribe the amount of supplemental oxygen you need after studying the results of a blood test called an arterial blood gas and evaluating your overall pulmonary condition. He’ll order a specific flow (liters per minute) of pure oxygen in the air you’re breathing. This increase may be as little as one percent, but the effects on your body and your breathing may be dramatic. That’s why it’s important to follow your doctor’s directions concerning the amount of oxygen you receive (liters per minute) and the length of time you should be using it. If not taken exactly as prescribed, it could cause problems.

OXYGEN IS SAFE IF USED SAFELY!

Contrary to what you may have heard, oxygen is not explosive but does support combustion. This means that anything in the presence of an oxygen enriched atmosphere will burn faster. That’s why most precautions for oxygen mention flames, sparks, and a strict “NO SMOKING” policy.

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Oxygen Systems For Home Use

1. Oxygen Cylinders or Tanks

   Large tanks which contain oxygen gas under high pressure are traditionally used when home oxygen is required. The tanks, sometimes referred to as “G” and “H” cylinders, are usually stationary because they stand about five feet high and weigh over 150 pounds when full.

   “D” and “E” cylinders are also available and are smaller and more portable, weighing approximately 15-17 pounds when full. Some newer types are constructed of a lightweight aluminum reducing their full weight to 10-12 pounds.

   How Long Will A Full Tank Of Oxygen Last?

   Circle your prescribed liter flow of oxygen (prescribed liter flow per minute). The chart will show you about how many hours of oxygen are available in a full “H” cylinder or a full “E:” cylinder.

   Be sure to order replacement tanks when pressure gauge reads 500 psi or 1/4 full.

2. Oxygen Concentrators

   These systems separate oxygen from room air and concentrate it to be medically effective. They range in size from table top to floor models and some are equipped with casters for mobility. They can save you money if you use more than 8-10 oxygen tanks per month but you may expect an increase in your monthly electric bill. A flat fee is charged for monthly rental and you should have a back-up tank in case of power failure or for your individual traveling needs.

3. Liquid Oxygen Systems

   Liquid oxygen is simply oxygen gas subjected to extremely low temperatures (-295°F) until it becomes a liquid. In this state, it can be stored in thermos-like containers under little pressure. As the liquid warms. the oxygen returns to its gaseous form. For this reason, it needs to be kept in a well-ventilated area. Home units are stationary, weighing about 70 pounds when full. There are also portable canisters available that are lightweight and enable you to leave your home for longer periods of time. Now there are different devices available to assist you in carrying your portable unit— carts, backpacks, and tote bags. These portable systems can be refilled from your own home unit. An indicator or scale lets you know how much liquid oxygen remains in the system and when to call for a refill.

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Administering Your Oxygen

Oxygen from each of the three systems for home use can be administered through a number of devices

 

1. Nasal Cannulas

   are nasal prongs which fit comfortably into your nose. They offer the convenience of eating, drinking, and talking without restraint. There is a variety of different styles available. Ask your home care supplier.

2. Venturi-Masks

   are masks which fit over your nose and mouth and, because of design, deliver the exact concentration of oxygen that your doctor prescribes. They must be removed when eating or drinking, and replaced with a nasal cannula.

3. New Alternative Delivery Methods

   have been developed over the last few years. One method is TransTracheal Oxygen (TTO) which provides oxygen via a small catheter through a surgical opening into the trachea. This procedure necessitates daily maintenance to the equipment and the incision, and requires special instruction and adjustment. This procedure is more common in some parts of the country than others. If you feel you may be a candidate for this method of oxygen delivery consult your physician. Another new item is the OxyFrames¨ which basically hides a small nasal-type cannula in a pair of spectacles. If this interests you, once again contact your physician.

Remember:

• A humidifier may be used with either the nasal cannula or mask to add moisture to the dry oxygen before it reaches your lungs.
• Adjust the flow rate before putting on the cannula or mask. This eliminates receiving a blast of oxygen and provides a quick check to see if everything is working properly.

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Do You Use Your Oxygen Safely?

Check and see by answering yes (Y) or no (N) to the following safety precautions to learn your Oxygen Safety Quotient (O.S.Q.). DO YOU:

1. Enforce a strict no smoking policy within 10 feet of oxygen equipment and post “N0 SMOKING” signs? Y N
2. Store oxygen cylinders away from heat and direct sunlight? Y N
3. Keep oil, grease, and flammable material away from your oxygen system and avoid using aerosols (such as room deodorizers) near it? Y N
4. Dust the cylinder with a cotton cloth and avoid draping or covering the system with any material? Y N
5. Secure the oxygen cylinder with an oxygen carrier, cart, or cylinder stand? Y N
6. Keep open flames (such as gas stoves and lighted candles) at least 10 feet away from the oxygen source? Y N
7. Have electrical equipment properly grounded and avoid operating electrical appliances, such as razors and hairdryers, while using your oxygen? Y N
8. Keep any electrical equipment that may spark at least 10 feet from the oxygen system? Y N
9. Avoid using nylon clothing (such as night gowns) andwoolen blankets to prevent sparks and static electricity? Y N
10. Always change cylinders when the pressure gauge reads 500 pounds per square inch (psi) or 1/4 full to avoid inhaling irritating debris? Y N
11. Avoid skin, eye, and clothing contact with the liquid from a leaking liquid oxygen system? Y N
12. Keep liquid oxygen in a well-ventilated area, as some oxygen will escape due to evaporation when the unit is not in use? Y N
13. Have a back-up portable oxygen cylinder in case of a power or oxygen concentrator failure? Y N
14. Use oxygen only as directed? Y N

 

WHAT’S YOUR O.S.Q.?

Each yes answer counts as one point.
Good: 11-14 points
Fair: 8-10 points
Need More Caution: 7 or fewer points

Getting in shape today can mean breathing easier tomorrow.

It’s Not Enough To Get In Shape … YOU MUST STAY IN SHAPE

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Being in good physical condition is important when you have COPD because the more efficiently your muscles work. the less oxygen they require to accomplish a task. You can do your part by exercising to condition your body and keep it in the best shape possible.

If you’re worried that exercise will hurt your lungs, don’t be. Experiencing shortness of breath during exercise only indicates that your body needs more oxygen at that moment, not that the lungs have been further damaged. Just concentrate on exhaling through pursed lips to slow down your breathing and restore the oxygen your system needs.

Don’t Overdo It!

Check with your doctor before beginning any exercise routine. You should also be able to recognize the signs and symptoms that could mean you are overexerting and need to stop and rest. These are:

• weakness
• excessive sweating
• chest pain or pain of any kind
• dizziness
• increased shortness of breath that does not return to normal within a few minutes.

Walking…

is one of the best exercises you can do because as you walk you condition your entire body, including your heart. It’s also a year-round body conditioner since you can use shopping malls for walking when the weather is too hot or too cold.

When walking. be sure to set a reasonable goal for yourself. One rule of thumb is to walk only as far as you can go without becoming overly short of breath and then try to increase this distance a little every day.

Use slow, deliberate movements as you walk, taking relatively long steps and letting your arms swing freely at your sides. Don’t forget to use your pursed-lip breathing as you walk, exhaling twice as long as you inhale. If you need oxygen, use your prescribed flow rate during this or any other exercise.

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Pulmonary Rehabilitation

There is no doubt that taking the initiative to get in shape and stay in shape is important especially if you have a chronic respiratory disease. But what about the men and women who need some additional help in doing this?

If you’re one of these individuals, you may be able to get the extra help you need through a pulmonary rehabilitation program. Some hospitals and home health care agencies have started “pulmonary rehab” programs to help you maximize your physical strength and tolerance to exercise in an effort to improve your ability to carry out daily activities.

Not only do most pulmonary rehab programs use physical reconditioning techniques to help you function at your best, but they also try to enhance emotional well-being. Most programs try to provide you with enough information, education, and understanding to manage your condition effectively on a day-to-day basis and to handle symptoms as they occur. They also encourage active participation for you and your family.

How successful are these pulmonary rehabilitation programs? Well, studies show that COPD rehabilitation programs can reduce the frequency of re-hospitalization, reduce your overall cost of care, and improve the quality of your life.

If you are interested in finding out about a pulmonary rehabilitation program in your area, ask your doctor or contact your local hospitals, home health care agencies, or the American Respiratory Alliance.

© 2007 The American Respiratory Alliance of Western Pennsylvania Cranberry Professional Park · 201 Smith Drive, Suite E · Cranberry Township, PA 16066

Compromise is often the key to coping with COPD

Men and women with COPD know that any daily activity takes more effort and energy than it normally would. This doesn’t necessarily mean you have to completely change your lifestyle, although you can benefit from learning simplified ways of doing household tasks and gardening, or even traveling. The sections in this chapter are filled with tips to help you conserve energy.

PLAN AHEAD

Consider the best time and best way to accomplish tasks. Try using the same methods each time you do a certain activity to improve your skill and conserve energy. Avoid unnecessary steps by gathering everything you need before you start. Don’t do two tasks back-to-back which require a lot of energy.

PRIORITIES FIRST

Schedule your day so that the most important activities get done before you run low on energy. It might be wise to eliminate unnecessary tasks on some days.

PURSE YOUR LIPS

Pursed-lip breathing is probably the best way you can minimize shortness of breath. It slows down your breathing which allows more air to move in and out of your lungs. Use this breathing technique throughout an activity and also during rest periods. Be sure to exhale for at least twice as long as you inhale.

PACE YOURSELF

Maintaining a steady pace rather than rushing around conserves energy. Scheduling rest breaks throughout an activity and between tasks can help you complete your day with less strain.

POSITIONING COUNTS

Choosing the most comfortable position for each activity can be a real energy saver. Sit down whenever possible and avoid bending over as this interferes with breathing. Try to push and slide equipment rather than carrying or lifting it.

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Breath Savers For Conserving Energy

Morning

• Take a bath rather than a shower when possible as standing for any length of time consumes more energy. If showering, use a plastic stool or chair to sit on. Hot water and steam may make you short of breath and could cause drowsiness, so use lukewarm water instead. Keep the door open slightly to help eliminate steam. Bathing is a strenuous activity and using prescribed oxygen while in the bath can help.
• You can save energy while shaving, brushing your teeth, washing your face,. combing your hair, or applying make-up by sitting on a stool that’s high enough for you to see into the mirror. You may even try propping your elbows on the sink.
• Energy-saving shortcuts for dressing include gathering all the clothes and accessories you plan to wear before you begin. Sit down while dressing. It’s smarter to clothe your lower body first because it takes more energy. Bring your feet up to you rather than bending down to put on shoes, socks, and pants. Use a footstool for support if necessary.

Afternoon

• Organize your work areas, placing supplies near where they will be used. This includes storing objects at shoulder or waist level to avoid bending or reaching.
• To reduce fatigue, sit down while you work and, whenever possible, use electrical appliances and other energy-saving devices.
• When moving anything heavy or awkward in the garage or kitchen, use a utility cart or wagon to avoid making numerous trips.
• Learn to recognize your personal limits and schedule rest periods to prevent fatigue. In fact, anytime you change your body’s position, it’s a good idea to rest after each movement. This includes even simple chores like standing up and lying down. Be sure to pause at least a second or two between movements.

Evening

• Individuals with COPD who have to cope with its symptoms and effects often experience an emotional loss of normal sex interest. If this is the case, sharing any concerns you have with your partner may help. Also, remember to choose the best time of day for sex when you are relaxed and rested.
• As with any activity, you should avoid sexual intercourse after a heavy meal or within three hours of alcohol ingestion. Use your bronchodilator either before intercourse or as soon as sudden shortness of breath is experienced. If oxygen has been prescribed for you, inhaling low-flow oxygen during intercourse will help.
• Certain positions tend to reduce the stress on the heart and lungs during sexual activity. They are:
  • On your back with your partner kneeling so that you are not bearing your partner’s full weight.
  • Seated in an armless chair, feet supported, with your partner sitting on your lap, facing you.
  • You and your partner positioned on your sides.
• Remember, rushing things also uses more energy, so take your time, relax, and enjoy each other.

Good nutrition is as important for men and women with respiratory problems as it is to an athlete in training

 

If you’ve gotten away from good eating since being diagnosed with a breathing problem, there’s a good chance your appetite has failed, too. Get back to the foods you know are good for you and serve them attractively to tempt the appetite you thought you lost!

THE FOOD GUIDE PYRAMID

A Guide to Daily Food Choices

In 1990, the United States Department of Agriculture (USDA) expanded the food groups from four to six and introduced the concept of legumes, or beans, as meat alternatives. The new groups, with suggested daily servings, include:

• Grains (bread, cereals, pasta, rice, and potatoes) provide many of the vitamins you need to stay healthy. Try to eat 4-6 servings from this group daily; 1 serving =1/2 cup or 1 ounce. COPD patients should consult their physicians regarding carbohydrate intake.
• Fruits provide essential minerals and vitamins. Eat 2-4 servings per day; 1 serving = 1/2 cup or 1 medium-sized fruit.
• Vegetables are another great source of vitamins and minerals. Eat at least 3-5 servings per day; 1 serving = 1/2 cup.
• Meats/Alternatives (includes fish, poultry, dry beans, peas, eggs, and nuts) are high in protein and vital for the maintenance of your muscles. This is important to the COPD patient who needs well-toned muscles to aid in breathing. Try to eat 2-3 servings for a total of 5-7 ounces each day.
• Dairy Products (milk, cheese, and yogurt) supply calcium and high quality protein for bones and teeth. Have 2-3 servings per day; 1 serving = 1 cup.
• Fats, Oils, Sweets , and Alcohol (fats include butter, margarine, and shortenings; sweets include candy, cookies, cakes, and soft drinks) should be used sparingly and in moderation.

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The remaining sections of this chapter deal with a variety of food-related concerns. Do you recognize any of these problems?

 

Shortness Of Breath From The Too Full Stomach?

Try eating smaller meals throughout the day instead of three big meals. The too-full stomach will take up some of the room needed by your diaphragm for breathing. When planning frequent small meals be sure to schedule them far enough away from bedtime. Remember, you can use your prescribed oxygen if you experience extreme shortness of breath while you eat.

Limit the liquids you drink with your meals because this can stretch your stomach. Certain foods can also distend your stomach, making it harder to breathe. For this reason, watch out for gas-forming foods which may cause you discomfort. Some of these are:

Raw Apples	Cucumbers	Baked Beans
Cabbage	Melons	Grape Juice
Broccoli	Brussel Sprouts	Radishes
Sauerkraut	Cantaloupe	Onions
Cauliflower	Turnips
Asparagus	Carbonated Drinks

Shortness Of Breath From Preparing Food?

This is a serious problem because eventually it can bring you to the point where all you’re eating is cereal and milk, cookies out of the box, or something else that’s “easy.” Soon your body is starved for vitamins and minerals and you’re even more tired, unable to eat well, and susceptible to infection.

If this is your problem, consider some of the newer convenience foods that are low in salt and saturated fat. Don’t forget that fresh fruits and vegetables are simple and quick. Make a salad and add some non processed cheese or bits of beef, chicken, or tuna. Replace the cookies or crackers with unsalted nuts and seeds or dried fruits. They’re just as “easy” to eat and they will provide the nutrients you need to function at your best.

There are lots of other easy and healthful foods: cottage cheese, yogurt, eggs, ground meat, and peanut butter. Some soups, stews, and casseroles almost prepare themselves. Even an instant breakfast drink provides “easy” and acceptable nutrition.

Problem Foods?

Adverse reactions to some foods may cause excess mucus to form, so try to recognize this problem and avoid those foods. Many individuals with COPD stop drinking milk because they complain that it produces excess phlegm. You can solve this problem and still drink milk, which is an excellent source of protein and calcium, by following with a glass of water. Some COPD patients are also troubled by ulcers and other gastrointestinal ailments and may not be able to tolerate certain foods. If this seems to be your problem, ask your doctor to suggest a menu plan that’s right for you.

Congestion?

Drinking plenty of water to help keep mucus thin is probably the best advice to control congestion. Unless you have a problem with fluid retention, you should try to drink about 6 to 8 glasses of water each day. A warm drink in the morning may help eliminate morning congestion if this is a problem for you.

Low Potassium Level?

Potassium is a mineral needed by the body for heart, nerves, and muscles to function properly. Taking some prescribed diuretics (water pills) may deplete your system of its potassium supply. Low potassium levels can result in muscle weakness and cramping, as well as numbness and tingling of the fingers and toes. There are certain foods that help replenish this loss of potassium but several of them are also high in sodium. If your doctor has prescribed a salt-restricted diet for you, check with him before eating some of these foods:

Lima Beans	Fresh Pineapple
Split Peas	Orange Juice
Fresh Mushrooms	Bananas
Shredded Coconut	Oranges
Sweet Potatoes	Salmon
Raw Nuts	Bacon
Fresh Spinach	Halibut
Dates	Dry Skim Milk
Raisins	Beef
Dried Fruits	Sardines

Weight Problems?

Overweight: Extra pounds mean extra work for your lungs and heart and can limit the movement of your diaphragm when breathing. You may also tire more easily. If you’re overweight, talk to your doctor about a sensible weight reduction plan. Salt should be watched since excess salt can cause you to retain fluids. Avoid adding salt when cooking or at the table, and limit salty foods such as ham, sausage, or bacon. Below is a no-salt seasoning recipe you may wish to try.

NO SALT SEASONING

5 teaspoons onion powder
2-1/2 teaspoons garlic powder
2-1/2 teaspoons paprika
2-1/2 teaspoons powdered mustard
1-1/4 teaspoons thyme leaves, crushed
1/2 teaspoon ground white pepper
1/4 teaspoon celery seed

Mix ingredients well to make about 1/3 cup seasoning. Spoon into a shaker.

Underweight: More commonly, people with severe lung disease have lost weight, sometimes as much as 15 or 20 pounds in a year. This is usually due to eating less as the result of a decreased appetite. If loss of weight is a problem for you, ask your doctor about it. He may prescribe a high-protein, high-calorie diet or special liquid nutritional supplements if you are considerably underweight. A good appetite booster is company. Invite a friend or family member to dine with you. A little extra exercise like walking with a pet or going to visit a neighbor can also increase your appetite. For a change of pace, you may also try eating out occasionally.

Your body gives off signals constantly and, if you’re observant, you can learn to interpret them to breathe better.

Who’s A Better Judge Of How You Feel Than You?

Who knows best when you’re feeling tired, when you’ve overeaten, or when you’re experiencing shortness of breath? Why, you do, of course. And if you learn to pay closer attention, your body can tell you lots more.

It’s especially important for people with COPD to be aware of any changes in their bodies that may indicate the start of a respiratory problem. Here is a list of such signs and symptoms which you will want to discuss with your doctor should they appear:

• Any loss of appetite which is more than normal for you.
• Heart palpitations.
• Unusual dizziness, drowsiness, headaches, irritability, or confusion.
• Inability to exercise or be as active as usual.
• A fever or any unusual rise in body temperature above what is normal for you.
• Cold and flu symptoms such as a runny nose, achiness, chills, and sometimes fever
• Swelling in the ankles, legs, or around the eyelids.
• Any sudden weight gain of four pounds or more in 48 hours.
• A change in any pulmonary symptoms such as those mentioned below.

Look For Changes In These Pulmonary Symptoms

• SHORTNESS OF BREATH — The sensation that results when you feel you must work harder to breathe. (For example: waking during the night due to a feeling of breathlessness.)
• CHEST PAIN — May be lung-related or may indicate heart or stomach problems. ( For example: pleurisy.)
• WHEEZING — Caused by a narrowing of the air tubes in the lungs. (For example: high-pitched, noisy breathing.)
• SPUTUM — Also known as mucus or phlegm. Be alert to changes in amount, color, consistency, and odor. (For example: a change from white to yellow sputum.)
• COUGH — The most common pulmonary symptom. (For example: a chronic or persistent cough. This always needs a medical evaluation. )

Ask Yourself the following questions to accurately report a symptom to your doctor:

1. WHERE is the symptom located?
2. WHAT KIND of symptom do you have?
3. HOW OFTEN OR HOW LONG have you had the symptom?
4. HOW did you get the symptom?
5. WHEN did you get the symptom?
6. WHAT MAKES THE SYMPTOM better or worse?
7. WHAT ELSE happens to you when you have the symptom?

Your doctor can help you achieve the best health possible, but only if you help him help you.

Remember—with good medical care, and using self-help as your strategy for living with COPD, you may notice fewer episodes of serious shortness of breath and enjoy a greater sense of well-being!