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					  A Patient’s Guide to Understanding
Chronic Obstructive Pulmonary Disease




        “ACCESSING LIFE”
Contents:

 About this booklet                                      3

 What is Chronic Obstructive Pulmonary Disease (COPD)?   4

 What are the Signs and Symptoms of COPD?                8

 What can be done for COPD?                              11

 When to Get Medical Help                                18

 Tips for Talking to Your Doctor                         19

 Getting the Most out of Life                            22

 Glossary                                                32

 Acknowledgements & Resources                            33




                                                               2
                             About this Booklet
The information in this booklet is meant to be a resource for people with Chronic
Obstructive Pulmonary Disease (COPD) and their family and friends. The
following sections were designed to provide you with specific information about
COPD including the causes, symptoms, and treatments available.

This booklet will also offer people with COPD information about skills in
maintaining and improving their own well-being. It is intended to help those with
COPD gain greater independence and confidence in dealing with the physical
and emotional challenges of a long-term illness.

This information is not a substitute for the advice a doctor or pulmonologist (lung
doctor) may provide based on his or her knowledge of your specific condition.




                                                                                      3
         What is Chronic Obstructive Pulmonary Disease?
Chronic obstructive pulmonary disease (COPD) is a lung disease in which the
lungs are damaged, making it hard to breathe.

Emphysema is one of the most common forms of COPD. When someone has
emphysema, the lung's tiny air sacs become damaged, and then destroyed.
Shortness of breath is the major symptom of emphysema. At first, this difficulty
in breathing may occur only with heavy exercise. Later it happens with light
exercise and, still later, even when walking or engaging in other everyday
activities.

Chronic bronchitis is another common form of COPD. Chronic bronchitis causes
the lung's airways to become swollen and inflamed. The mucus produced by
these inflamed airways makes breathing even more difficult. A constant, mild
cough is one of the most common symptoms of chronic bronchitis.

COPD often develops slowly, and it may be many years before you notice
symptoms like feeling short of breath. Most of the time, COPD is diagnosed in
middle-aged or older people.

Currently, there is no cure for COPD. The damage to your airways and lungs
cannot be reversed, but there are things you can do to feel better and slow the
damage, maximizing your quality of life.

COPD Basics
In this section you'll find information about COPD, its symptoms, how it is
diagnosed, and treatment options.

How the Lungs Work
The lungs provide a very large surface area (the size of a football field) for the
exchange of oxygen and carbon dioxide between the body and the environment.
A slice of normal lung looks like a pink sponge filled with tiny bubbles or holes.
These bubbles, surrounded by a fine network of tiny blood vessels, give the
lungs a large surface to exchange oxygen (into the blood where it is carried
throughout the body) and carbon dioxide (out of the blood). This process is called
gas exchange. Healthy lungs do this very well.




                                                                                     4
How Normal Breathing Occurs
You breathe in air through your nose and mouth. The air travels down through
your windpipe (trachea) then through large and small tubes in your lungs called
bronchial tubes. The larger tubes are bronchi, and the smaller tubes are
bronchioles. Sometimes the word "airways" is used to refer to the various tubes
or passages that air must travel through from the nose and mouth into the lungs.
The airways in your lungs look something like an upside-down tree with many
branches.

At the ends of the small bronchial tubes, there are groups of tiny air sacs called
alveoli. The air sacs have very thin walls, and small blood vessels called
capillaries run in the walls. Oxygen passes from the air sacs into the blood in
these small blood vessels. At the same time, carbon dioxide passes from the
blood into the air sacs. Carbon dioxide, a normal byproduct of the body's
metabolism, must be removed.



The following illustration shows in more detail how normal breathing occurs.




                                                                                     5
Breathing with COPD
In COPD, the airways and air sacs lose their shape and become floppy. While air
can go in the lungs, it has difficulty going out and therefore more air stays in the
lungs causing your lungs to expand. These things occur because:

    The airways and air sacs lose their elasticity (like an old rubber band).
    The walls between many of the air sacs are destroyed.
    The walls of the airways become thick and inflamed (swollen).
    Cells in the airways make more mucus (sputum) than usual, which tends to
     clog the airways.

In the emphysema type of COPD, the walls between many of the air sacs are
destroyed, leading to a few large air sacs instead of many tiny ones. As a result,
the lung looks like a sponge with many large bubbles or holes in it, instead of a
sponge with very tiny holes. The large air sacs have less surface area for the
exchange of oxygen and carbon dioxide than healthy air sacs. Poor exchange of
oxygen and carbon dioxide causes shortness of breath.

In chronic bronchitis, the airways have become inflamed and thickened, and
there is an increase in the number and size of mucus-producing cells. This
results in excessive mucus production, which in turn contributes to cough and
difficulty getting air in and out of the lungs.

Most people with COPD have both chronic bronchitis and emphysema.




                                                                                       6
What Causes COPD?
COPD develops due to one or more of these factors:

   Cigarette smoking (80% to 90% of COPD is due to smoking).
   Inhaling large amounts of irritating fumes or dust at work or at home.
   In some cases, air pollution or second-hand smoke.

The lungs and airways are highly sensitive to irritants in the environment. This is
especially true for persons with COPD. Irritants can cause the airways to
become inflamed and narrowed, and destroy the elastic fibers that allow the lung
to stretch and then return to its resting shape. This makes breathing air in and
out of the lungs more difficult.

Other conditions that can make COPD worse are frequent colds or infections in
the nose, sinus, throat, or chest.

Emphysema can also be hereditary. In some families this might be due to a lack
of normal lung "defenses" that fight damage within the lung. It may also be
because certain habits are passed along to other family members. For example,
if parents smoke, there is a good chance that their children will smoke. Since
smoking is the main cause of COPD, persons with family members who smoke
are at greater risk of getting these diseases.




                                                                                      7
             What are the Signs and Symptoms of COPD?
The signs and symptoms of chronic obstructive pulmonary disease (COPD)
include:

    Cough
    Excess mucus production
    Shortness of breath (dyspnea), especially with exercise
    Wheezing (a whistling or squeaky sound when you breathe)
    Chest tightness

A cough that doesn't go away and coughing up lots of mucus are common signs
of COPD. These often occur years before the flow of air is reduced. However,
not everyone with a cough and excess mucus production goes on to develop
COPD, and not everyone with COPD has a cough.

Many people with COPD also experience fatigue – a loss of energy, and
tiredness either while at rest or following only a small amount of activity. The
tiredness can be quite overwhelming, making it difficult or impossible for you to
carry on as normal. The tiredness is due, at least in part, to reduced oxygen flow
to the exercising muscles and may be a symptom of COPD. Other symptoms of
COPD include frequent respiratory infections, weight loss, and loss of appetite.

The severity of the symptoms depends on how much of the lung has been
destroyed. If you continue to smoke, the lung destruction is faster than if you stop
smoking.




                                                                                       8
How is COPD Diagnosed?
A medical history, physical exam, and breathing tests are the most important
tests to determine if you have COPD. Your doctor will examine you and listen to
your lungs. Your doctor will also ask you questions about your family and medical
history and what lung irritants you may have been around for long periods of
time. You will probably need to have some further tests done. Your primary care
doctor may recommend that you see a lung specialist called a pulmonologist.

Breathing Tests
Your doctor will use a breathing test called spirometry to confirm a diagnosis of
COPD. Spirometry is the most sensitive and commonly used test of lung
functions. It can detect COPD long before you have significant symptoms. Based
on this test, your doctor can determine if you have COPD and its severity.

The test is easy and painless and shows how well your lungs work. You breathe
hard into a large hose connected to a machine called a spirometer. When you
breathe out, the spirometer measures how much air your lungs can hold and how
fast you can blow air out of your lungs after taking a deep breath.
Doctors classify the severity of COPD as:

                           Breathing test shows mild
                                                               At this stage, you may not be
                           airflow limitation. Signs may
      Mild COPD            include a chronic cough and
                                                               aware that airflow in your
                                                               lungs is reduced.
                           sputum production.
                           Breathing test shows a
                           worsening airflow limitation.
                           Usually the signs have              At this stage, a person usually
   Moderate COPD           increased. Shortness of             seeks medical attention.
                           breath usually develops when
                           working hard, walking fast, or
                           doing other brisk activities.
                           Breathing test shows severe
                           airflow limitation. A person is     At this stage, the quality of life
                           short of breath after just a        is greatly impaired and the
    Severe COPD            little activity. In very severe     worsening symptoms may be
                           COPD, complications like            life threatening.
                           respiratory failure or signs of
                           heart failure may develop.
                           In very severe COPD,                At this stage, the quality of life
                           complications like respiratory      is greatly impaired and the
 Very Severe COPD          failure or signs of heart failure   worsening symptoms may be
                           may develop.                        life threatening.

                                                                                                    9
Your doctor may also recommend tests to rule out other causes of your signs
and symptoms. These tests include:

Chest x-ray - A chest x-ray is a picture of your lungs. A chest x-ray may be done
to see if another disease, like heart failure or lung cancer, may be causing your
symptoms.

CT scan - A computed tomography (CT) scan enables your doctor to see organs
in the chest in two-dimensional "slices" of x-ray pictures. Doctors can spot
emphysema much sooner on a CT scan than on a standard x-ray. This test is
not routinely done unless your doctor sees something suspicious on your chest
x-ray.

Sputum Test - If you have a respiratory infection your doctor may ask you to
undergo a sputum (or mucus) test. You will be asked to provide a sample of
sputum, which they will send to a laboratory. The sputum will be examined for
signs suggesting inflammation or infection, which can mimic and/or complicate
your COPD.

Arterial blood gas - This is a blood test that determines the oxygen level in your
blood. It is measured in people with severe COPD to see if oxygen treatment is
recommended.

Exercise Study – This is a test where your oxygen level is measured while
exercising (during a six minute walk). The distance you walk will also be
assessed.




                                                                                     10
                      What can be done for COPD?
Quitting smoking is the single most important thing you can do to reduce your
risk of developing chronic obstructive pulmonary disease (COPD) and slow the
progression of the disease.

Your doctor will also recommend treatments that help relieve your symptoms and
help you breathe easier. Although there is no ―cure‖ for COPD, there are
treatments available to address symptoms.

The goals of COPD treatment are to:

   Relieve your symptoms with minimal or no side effects of treatment.

   Slow the progress of the disease.

   Improve exercise tolerance (your ability to stay active).

   Prevent and treat complications and sudden onset of problems.

   Improve your overall health.

The treatment for COPD is different for each person. Treatment is based on
whether your symptoms are mild, moderate, severe or very severe.

Advances in treatment mean that the outlook for many people with COPD has
improved substantially in recent years. Medicines and pulmonary rehabilitation
(rehab) are often used to help relieve your symptoms and to help you breathe
more easily and stay active. Oxygen therapy can help patients with COPD who
have a hard time getting enough oxygen. Some surgeries (such as lung volume
reduction or transplantation may be helpful for specific persons with COPD (see
page 15).




                                                                                  11
Medicines to Treat COPD
Your doctor may prescribe medications to control the symptoms of COPD. Most
people with COPD take medications on a regular basis to decrease breathing
difficulty. In addition, some medications are used only on an as needed basis to
decrease shortness of breath. For many, a combination of medications is
prescribed.

The important thing to remember is that there is no "standard" drug regimen.
Your medications must be individualized based on your symptoms and needs.
Monitoring your COPD and working with your healthcare provider on an on-going
basis is the best way to ensure that your medications are right for you.

The following is a discussion of the medications generally prescribed for people
with COPD. Most of the medications fall into one of these groups:

 Bronchodilators - Short or long acting medications, often taken by an inhaler,
  that help open airways in the lungs.

 Anti-inflammatories - Medications taken by inhaler or in pill form to offset
  inflammation in the air passages and lungs.

 Antibiotics - Can be helpful for fighting bacterial infections that make
  symptoms of COPD worse.

 Flu shot and Pneumonia vaccine - Can also be helpful for preventing
  viruses that make symptoms of COPD worse.

Bronchodilators

Bronchodilators help open the airways in the lungs by relaxing the muscles
around your airways. Most bronchodilator medicines are inhaled, so they go
directly into your lungs where they are needed. There are many kinds of inhalers,
and it is important to know how to use your inhaler correctly. You may ask your
doctor or nurse to demonstrate how to use your inhalers, and/or you may request
educational materials to take home with you.




                                                                                    12
Bronchodilators can be either short acting or long acting.

    Short-acting bronchodilators work quickly (within 5-10 minutes) to relieve
     shortness of breath, and last about 4 to 6 hours. They are sometimes
     described as "rescue" or "quick-reliever" medications. Your doctor may
     prescribe a short-acting brochodilator to use regularly or as-needed to
     relieve shortness of breath. You should always carry your ―rescue‖
     medicine in your pocket.

    Long-acting bronchodilators effects last for a long time (about 12 hours).
     Therefore, these medicines should not be used for acute attacks of
     breathlessness or in an emergency. Long-acting bronchodilators are used
     regularly, usually twice a day, to open the airways and keep them open.

      Some people may need to use a long-acting bronchodilator and a short-
      acting bronchodilator.
Anti-inflammatories

Anti-inflammatories help reduce airway inflammation and decrease mucus
production. Inhaled corticosteroids and corticosteroid pills are two types of anti-
inflammatories frequently used to treat COPD.

Inhaled corticosteroids

Some people with COPD benefit from the use of inhaled corticosteroids. Inhaled
corticosteroids are usually taken regularly. Long-term use at high doses can be
associated with some side effects, such as loss of bone mineral density, so you
should discuss the risks and benefits of these medications with your physician.
Corticosteroid pills

Most people with COPD show little or no improvement when corticosteroid pills
are given over a long period of time. They are, however, used in special
circumstances, such as when your symptoms are getting worse or you need to
be hospitalized. Long-term use of corticosteroid pills can result in serious side
effects.

Antibiotics

Antibiotics are medicines that can be helpful for fighting bacterial infections. An
infection can cause symptoms of COPD to worsen. This is called an
exacerbation. Your doctor will select the best antibiotic for your infection.
Antibiotics are not used to treat viral infections.
                                                                                      13
Flu shot and Pneumonia vaccine

You need to get your flu shot every year. Even if you do get the flu, you will have
a much milder case if you have the vaccination. The pneumonia vaccine,
Pneumovax, is recommended every 7-10 years. You should also get other
routine vaccinations. Check with your doctor on the recommendations for these
vaccines.




      Remember:

It is important to keep a list of your medications with you. If you go to any
additional doctors, dentists, or specialists, make sure they are aware of all of
your medications, including over-the-counter medications, vitamins, herbal
medications, and dietary supplements. Even if your physician does not
request this information, bring it up!




Helpful Hints for Managing Your Medications
    Use a daily routine for taking your medications. Pick something you do
     everyday (i.e. waking up, brushing your teeth, eating meals, going to bed)
     and plan to take your medications around that activity.

    Use a medication checklist or worksheet to record when you take
     medications. Place the checklist someplace visible to use as a reminder.

    Pack your medications in pill boxes to help you remember to take them.




                                                                                      14
Other Treatments for COPD
Pulmonary Rehabilitation
Pulmonary rehabilitation (rehab) is a coordinated program of exercise, disease
management training, and counseling that can help you stay more active and
carry out your day-to-day activities. These programs are included in most
hospitals but may be restricted to patients with severe forms of COPD or who
have exacerbations that require short-term hospitalization. Most rehabilitation
programs are offered on an outpatient basis.
What is included in a pulmonary rehab program will depend on what you and
your doctor think you need. It may include exercise training, nutrition advice,
education about your disease and how to manage it, and counseling. The
different parts of the rehab program are managed by different types of health
care professionals (doctors, nurses, physical therapists, respiratory therapists,
exercise specialists, dietitians) who work together to develop a program just for
you.

Even if you cannot get into a formal rehabilitation program, your doctor may be
able to help you find a qualified person to develop a suitable set of exercises and
activities that will help you improve your quality of life.

Oxygen Treatment
Oxygen treatment can help patients with COPD who have a hard time getting
enough oxygen and have shortness of breath. Oxygen is often stored in a
portable tank that you may take with you as you carry out your daily activities.
Oxygen therapy helps people with severe breathlessness from COPD do tasks or
activities with less shortness of breath, protects the heart and other organs from
damage, helps people with COPD sleep more during the night and improves
alertness during the day. Not everyone with COPD requires oxygen. Your
doctor will probably want to run some blood tests to determine the amount of
oxygen in your blood before recommending this treatment.

Surgery

For some people with severe emphysema, surgery may be recommended. Lung
volume reduction surgery (LVRS) is a procedure during which surgeons remove
sections of damaged tissue from the lungs of patients with emphysema. A
transplant involves removing the lung of a person with COPD and replacing it
with a healthy lung from a donor.


                                                                                      15
Surgery is usually done for people who have:

   Severe symptoms.

   Not had improvement from taking medicines.

   A very hard time breathing most of the time.




                                                   16
Managing and Preventing Exacerbations
People with chronic obstructive pulmonary disease (COPD) often have
exacerbations – times when their symptoms suddenly get worse. When this
happens, you have a much harder time catching your breath. You may also have
chest tightness, more coughing, change in mucus and its color, and a fever. It is
important to call your doctor if you have any of these signs or symptoms.

Your doctor will look at things that might be causing these signs and symptoms
to suddenly worsen. Sometimes the signs and symptoms are caused by a lung
infection. Your doctor may want you to take an antibiotic medicine that helps fight
off the infection (see medication page).


Your doctor may recommend that you spend time in the hospital if:

   You have a lot of difficulty catching your breath.
   You have a hard time talking.
   Your lips or fingernails turn blue or gray.
   You are not mentally alert.
   Your heartbeat is very fast.
   Home treatment of worsening symptoms doesn't help.

Staying away from other lung irritants such as pollution, dust, and certain cooking
or heating fumes is also important. For example, you should stay in your house
when the outside air quality is poor.

It is important to keep the air in your home clean. Below are some suggestions
that may help you in your home:

   Keep smoke, fumes, and strong smells out of your home.
   If your home is painted or sprayed for insects, have it done when you can
    stay away.
   Cook near an open door or window.
   If you heat with wood or kerosene, keep a door or window open.
   Keep your windows closed and stay at home when there is a lot of pollution
    or dust outside.



                                                                                      17
                         When to get Medical Help
When you are having symptoms, it is important to know whether treatment
should begin at home, the physician's office, or the emergency room.

If you have any of the following symptoms, you need to call your doctor
right away.

    If you are finding that it is becoming more difficult to catch your breath.

    Your coughing has gotten worse.

    You are coughing up more mucus or the mucus has changed in texture or
     color.

    You have signs of infection (such as a fever and feeling poorly).
Do not wait until your next appointment to make the call, and do not change or
stop taking your medications without first talking to your doctor. If your symptoms
are discovered early, your doctor may be able to relieve them by changing your
medications.

Get emergency help if you see any of these danger signs:
    You have a lot of difficulty catching your breath.

    You have a hard time talking.

    You are confused or feel like you are going to faint.

    Your lips or fingernails turn blue or gray.

    You are having difficulty staying mentally alert.

    Home treatment of worsening symptoms doesn't help.
Be prepared and have information on hand that you or others would need in a
medical emergency, such as information on medicines you are taking, directions
to the hospital or your doctor’s office, and people to contact if you are unable to
speak or call them.




                                                                                      18
                      Tips for Talking to Your Doctor
Taking an active role in your health care can help you get the best care possible
from your doctor. One way to do this is to improve your relationship with your
doctor. The following are some tips to help you and your doctor improve your
health care together.

Talk to your doctor                               Tips for Talking to Your Doctor
Be sure to tell your doctor about any
current and past health care issues or            Make a list of major items you want to
concerns. It's important to share any              talk about
information you can, even if you're               Ask questions
embarrassed. Making lists is extremely
valuable to both you and your doctor. If          Take information home with you
you want to get advanced, you can create
                                                  Follow up with your doctor
a ―health journal‖ for yourself on paper or
in a notebook, and bring it to your
appointments.
Give the following information to your
doctor during the exam:

   Any symptoms you are having.
   Your health history.
   Personal information, including whether you are stressed or if your life is
    changing.
   Any medicines you are currently taking. Bring them with you or create a list
    of all your medicines. Include information about when and how often you
    take the medicine. You should also write down the strength of the
    medicine (for example, do you take 150 mg or 200 mg?).
   Any side effects you have from your medicine(s), especially if it makes you
    feel sick or if you think you may be allergic to it.
   Any vitamins or supplements you take.
   Any x-rays, tests results, or medical records you have can be brought with
    you to the appointment.




                                                                                            19
Ask questions
Bring a list of things you want to talk about (including questions) – this list can
include questions about medications, symptoms, or other concerns that you
have.

Don't be afraid to speak up. It's important for you to let your doctor know if you
don’t understand something. If you don’t ask questions, your doctor will think you
understand everything he or she has told you.
The following are some tips on asking your doctor questions during the exam:

    Ask every time you don't understand something.
    If you have questions before the appointment, just write them down and
     ask them during the exam. Be sure to write down the most important
     questions first to make sure they are answered.
    Tell your doctor when you need more time to talk about something. If the
     doctor isn’t available to help, you should be able to talk to a physician
     assistant or a nurse. If no one else is available, see if you can schedule
     another appointment to continue your talk.

Take information home with you
Taking written or recorded information home with you can help you remember
information and instructions any time you need. Your doctor is a good source of
accurate information you can trust.
The following are types of information you can take home with you:

    Notes that you have taken during the appointment. It's ok for you to write
     down the information your doctor gives you. Sometimes it helps to bring a
     friend or family member with you, especially if you have difficulty writing.
     They can help write down the answers to your questions.
    Written instructions from your doctor.
    A tape recording. Ask your doctor if it's ok to bring a tape recorder to the
     appointment.
    Brochures or other educational materials. If there aren't any available, ask
     where you can find some.



                                                                                      20
Follow up with your doctor
Make sure to follow any instructions your doctor gave you during the
appointment, like taking medicine, scheduling a test, or scheduling an
appointment with a specialist. If you’re confused or if you've forgotten some
information, it’s ok to contact your doctor. The following are some common
reasons you may need to call your doctor:

   If you have any questions after the appointment. Ask to leave a message
    with the doctor or speak with a nurse.
   If you start to feel worse or have problems with your medicine.
   If you had tests and haven’t gotten the results.

Once you’ve decided to take an active role in managing your illness, you and
your doctor can work together to set goals that will lead to better health. There
may be different treatment options available to you. Talk to your doctor and help
him or her create a plan that’s right for you. After all, nobody knows more than
you do about your feelings, your actions, and how your health problems affect
you.




                                                                                    21
                        Getting the Most out of Life

Having a diagnosis of COPD means you will be living with a chronic illness.
COPD is a long-term health condition, which involves managing more than just
medical symptoms. It involves a wide range of emotions. For example, many
people experience strong feelings like anger, fear, anxiety, guilt, sadness, and
loneliness. This is completely normal and represents the first stages of coping
and learning to accept the illness.

Chronic illness can have a major impact on a person’s roles and responsibilities
in life, and their plans for the future. Sometimes, resulting dependence on others
can strain relationships and negatively affect self-esteem. In short, when you live
with chronic illness, almost every aspect of life can take on a new dimension.
But understand that you have the ability to live well with chronic illness.

Living well requires an approach that is realistic, but also positive. You can't
eliminate your condition, but you can understand the illness and your options,
and then take steps to adapt along the way. You will probably feel overwhelmed
and out of control now and then, but remember that no matter what happens, you
always have a choice about how you respond.

You can get the most out of life by a combination of sticking to your medical
treatment, making changes to your lifestyle, adopting a positive outlook, and
communicating effectively with your healthcare team.

The following sections are meant to help you develop skills in maintaining and
improving your own well-being. Taking control over your own well-being will help
you gain greater independence and confidence in dealing with the physical and
emotional challenges of a long-term illness.




                                                                                      22
Making Healthy Lifestyle Choices
When dealing with the challenges of a chronic illness is part of your daily life,
your choices and decisions can have a powerful impact on how you feel.

In some cases, lifestyle changes can help slow lung disease and contribute to a
better quality of life.



The following information lists               Making Healthy Lifestyle Choices
lifestyle changes that your doctor
may suggest, along with reasons for
each change and suggestions for              If you smoke, stop smoking or at least cut
                                              down.
how to accomplish them. These
changes can help relieve some of             Eat healthy foods (high protein diet,
the symptoms associated with                  vegetables and fruits)
COPD and reduce strain on your
lungs and body.                              Stay as active as possible and be sure to
                                              get adequate sleep.
If you smoke, stop smoking or at       Monitor your health by watching your weight
least cut down. Stopping smoking is      and your cholesterol and blood pressure
the single most important thing a        levels, and scheduling regular medical
smoker can do to live longer. If you     check-ups.
have tried to quit and have gone
                                       Actively manage your medications
back to smoking again, there are
things that can help. These include
products to help you stop smoking,
joining a stop smoking group
(sometimes called smoking
cessation treatment), or alternative
therapies such as hypnotherapy or acupuncture.

Eat healthy foods. Right now, your body needs the best nutrition. Ask your
family to help you buy and fix healthy foods. Eat lots of fruits and vegetables. Eat
foods that are high in protein like meat, fish, eggs, milk, and soy. Your doctor
may need to refer you to a dietician to help you determine what diet would fit your
needs.

Stay as physically active as possible. (Always check with your doctor before
starting an exercise program. Find out how often you should exercise, and ask
for a list of exercises and activities that would be appropriate for you.)

                                                                                           23
Often people make the mistake of believing that if they try to avoid becoming
short of breath, they will protect their lungs. THIS IS NOT TRUE! Remaining
physically active can reduce stress and improve energy, circulation, blood
pressure and ability to breathe. Walking, swimming and biking are popular
activities for people with chronic medical conditions.

It’s important not to let the fact that you have a long-term health condition change
your normal attitudes about exercise. You should walk every day, trying to do a
little more than you did the day before. Start by walking in your house, then try
walking out of doors (except when there is poor air quality) — walking longer
distances each time.

Monitor your health. One way to do this is to listen to your body and track its
changes. Look for patterns in your life that lead to positive and/or negative effects
on your physical health (e.g. climate changes, certain foods, exercise, doing
pleasant activities, etc.). This kind of monitoring at home lets you spot potentially
harmful changes before they turn into real trouble.

Maintain a healthy body weight. Drop extra pounds or gain weight (if
recommended by your doctor). If you need to lose weight, keep off the extra
pounds by limiting your total daily caloric intake, following a low-fat diet, and
exercising on most days. Don’t try to lose the extra weight too quickly. Losing
weight slowly and steadily (about a pound a week) is healthier, and you’re more
likely to keep the weight off for good.

If you need to gain weight to maintain positive health, look for foods with high
levels of protein (e.g. fish, chicken, lowfat meats) and eat frequent healthy
snacks such as fruits and vegetables.

Get the flu shot and pneumonia vaccine. You need to get your flu shot every
year. Even if you do get the flu, you will have a much milder case if you have the
vaccination. The pneumonia vaccine, Pneumovax, is recommended every 7-10
years. You should also get other routine vaccinations. Check with your doctor on
the recommendations for these vaccines.

Actively manage your medications. Remembering to take one pill a day is
tough; managing 10 or more is even more difficult. Knowing about the drugs you
take (why you take them, how best to take them, and what problems to watch out
for) is as important as learning about your condition. In addition, talking with your
doctor, nurse, or a pharmacist can put drug information into perspective.

Schedule regular medical checkups. See your doctor at least two times a year,
even if you are feeling fine. Make sure you bring a list of medicines you are
                                                                                        24
taking to your doctor visit. If you are taking medicines, make sure you ask your
doctor for refills so you do not run out.

Know when to get medical help. Sometimes it’s hard to know whether you
should schedule an appointment to talk to your doctor about your symptoms or
problems with medications, or whether you should seek emergency care.




                                                                                   25
Tips on Getting the Most out of Life

When you live with a chronic illness you may not
always have a choice of what difficulties you are
presented with, but you always have a choice
about how you respond. Remember that your
choices and decisions have a powerful impact on how you feel, both physically
and emotionally. The following are some suggestions to strengthen the ways in
which you cope with your illness.

 Learn as much as possible about your illness and what you can do to help
  yourself feel better. Educate family and friends to help them understand.

 Be creative. If your illness impairs your ability to do things you enjoy, be
  creative about possible ways to get around obstacles. You can try learning
  new or different ways of doing things and trying new activities. For example, if
  gardening is not possible, try growing houseplants. If you do not have the
  energy to go to the movies, try renting a movie and creating a ―theatre‖
  atmosphere at home (e.g. snacks, lighting, etc). A chronic medical condition
  does not affect your creativity and there are usually many ways to maintain
  the quality of your life.

 Try to focus on what you want and can to do, rather than the things you want
  but cannot do. Say to yourself, "Given the limits of my physical ability I will do
  whatever it is I want to do, for as long as I can."

 Make an effort to focus on the good things in your life, such as supportive
  relationships and activities that bring joy, pleasure, or usefulness. Learn to
  live in the moment and enjoy life’s simple pleasures. You may want to use a
  notebook to keep track of things that make you feel happy or peaceful.
  Research has shown that having a positive outlook can improve your quality
  of life and give your physical health a boost.

 Redefine what quality of life means to you, recognizing that there are many
  ways to lead a meaningful life. Remind yourself that your identity (who you
  are) goes much deeper than your physical abilities.

 Find an outlet for expressing your thoughts and feelings, perhaps talking with
  a friend, keeping a journal or participating in a support group.


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 Accept that how you feel and what you can do may vary from day to day, and
  be flexible about plans and expectations. Take things one day at a time.

 Recall past life challenges and how you overcame them to remind yourself of
  your strength and courage, and to generate hope.

 Stay connected to people who care. It is important to continue looking after
  your relationships, because they play a large part in helping you feel good,
  and maintaining your self-worth. If your social network is limited, develop new
  connections through volunteering, taking an adult education course or joining
  a club or group.

 If you are a spiritual person, set aside quiet time each day to give attention to
  your spirituality and help keep you grounded. Turn to your faith for comfort.

 Be on guard for depression and stress. It is not unusual to have emotional
  ups and downs when dealing with a chronic illness. Some days you may feel
  tired and depressed, or angry about your limitations, and worried about the
  future. These emotions are not bad in themselves, but they do wear you out.

   For some people these feelings fade as they begin to take charge of their
   health and make positive lifestyle changes. Others find that their mood is
   unbalanced, and may feel more worried and depressed than is usual for them.
   Talk to your doctor if you have feelings that interfere with your ability to enjoy
   life, or if you find yourself making unhealthy lifestyle choices.

   You may not be used to talking to your doctor about your feelings or problems
   in your personal life. But remember, he or she can’t always tell that you’re
   feeling stressed, anxious or upset just by looking at you. First, he or she will
   need to make sure that other health problems aren’t causing your physical
   symptoms. If your symptoms aren’t caused by other health problems, you and
   your doctor can begin to address the emotional causes of your symptoms.
   Your doctor may suggest ways to treat your physical symptoms while you
   work together to improve your emotional health.

 Accept offers of help from relatives and friends, and ask for assistance if
  necessary. Be specific about the kind of help you need. Also, find out about
  services in your community that may be able to help you now or in the future.

   If you have a hard time asking for help, consider what you would do if you
   were fully healthy and a friend of yours had your medical condition. What
                                                                                        27
  would you do? Would you be upset if your friend asked for the specific help
  that was required? Chances are you would feel fine about helping out if you
  could. In fact, it would likely make you feel good to be able to help someone
  you care about. Try to be as kind to yourself as you would be to another when
  it comes to asking for help.

 Ask friends and family to understand. Let people around you know when you
  are short of breath. You need not feel embarrassed because you cannot join
  others in some activities. As before, think about what you might do if a friend
  or loved one was in a similar position to yours. How would you react?




                                                                                    28
Practical Tips for Daily Living
 Take an active role in your treatment. Follow the
  management plan prescribed by your doctor,
  which might include medication, diet changes,
  exercise, rest, adaptive aids, lifestyle changes
  and stress management techniques.

 Talk to your doctor. Once you’ve decided to take an active role in managing
  your illness, you and your doctor can work together to set goals that will lead
  to better health. There may be different treatment options available to you.
  Talk to your doctor and help him or her create a plan that’s right for you. After
  all, nobody knows more than you do about your feelings, your actions and
  how your health problems affect you.

 Do as much for yourself as possible, to maintain your abilities and
  independence.
 Seek ways to streamline your life. Set priorities and don't waste time or energy
  on unimportant things. Pace yourself to avoid exhaustion.

 Develop daily routines, but don’t be inflexible. Simplify necessary tasks to
  carry out daily activities more easily and safely. You can simplify daily
  activities at home by:

          Asking your friends and family for help.

          Doing things slowly.

          Doing things sitting down.

          Putting things you need in one place that is easy to reach.

          Finding very simple ways to cook, clean, and do other chores.

          Wearing clothes and shoes that are easy to put on and take off.

          Asking for help moving your things around in your house so that you
           will not need to climb stairs as often.

          Picking a place to sit so that you can enjoy and visit with others.




                                                                                      29
 Keep busy so your difficulties don’t preoccupy you. Stay in touch with friends,
  and plan daily activities to get out of the house. Try to keep up with your
  hobbies, and perhaps try new ones. Still, don’t overdo it. keep your activities
  within the limits set by your doctor. Listen to your body so you know when it is
  time to rest and rebuild your energy.

 Find something relaxing to do each day, such as reading, listening to music or
  talking to a friend.




                                                                                     30
                           Some Final Thoughts
Adjusting to life with a chronic illness or feeling good about the future may seem hard
at first, but it can be done. It requires an approach that is realistic and positive.

Think of yourself as living with your illness, rather than suffering from it. Attitude
really does make a big difference

Understand that your choices and decisions can have a powerful impact on how you
feel both physically and emotionally.

However unwelcome it may be, illness, like other difficulties in life, presents
opportunities for growth. You have the opportunity to be courageous in living your
life to the best of your ability.




                                                                                          31
Glossary

Alveoli           Small air sacks in the lungs where oxygen is exchanged for carbon dioxide
Antibiotics       Medicines that can be helpful for fighting bacterial infections that make symptoms
                  of COPD worse.
Asthma            Asthma is a disease that features a narrowing of the airways, making breathing
                  difficult. This narrowing can be reversed by treatment with bronchodilators
Beta-2 agonist    Drugs that make breathing easier by relaxing and widening the airways.
Bronchi           The two big airways that take air from the trachea, or windpipe, to the lungs. One
                  bronchi goes to the left lung, and one to the right lung
Bronchioles       The smaller airways that take air from the bronchi to the lungs. About 24
                  bronchioles branch off each bronchi and go deep into the lungs, delivering air to the
                  alveoli
Bronchodilator    Medications, often taken by an inhaler, that help open air passageways in the lungs
Cilia             Hair-like cells that sweep away dust and mucus from the lungs. They beat in one
                  direction (upwards) so particles are driven up to the throat where they are
                  swallowed or coughed out
Corticosteroids   Medications taken by inhaler to reduce inflammation in the air passages and lungs.
Dyspnea           (Pronounced disp–NEE–uh) is a medical term for difficult or labored breathing, or
                  shortness of breath.


Emphysema         Damage to the air sacks (alveoli) so that the walls break down, making the air sacks
                  bigger. This makes the lungs less able to transfer oxygen to the blood to supply the
                  rest of the body
Exacerbation      The sudden worsening of a disease or its symptoms
Mucus             Mucus is produced in the airways to warm and moisturize the air before it reaches
                  the lungs. It also traps foreign bodies or infectious agents before they reach the
                  lungs. It is also called sputum or phlegm
Nebulizer         A device that delivers a drug by pumping a jet of air or oxygen through a solution of
                  the drug, to produce a fine mist. This is then breathed in through a mask
Phlegm            See mucus
Spirometer        A machine that measures how much you can breath out of your lungs, and how
                  quickly
Sputum            See mucus
Wheeze            The gasping or whistling sound made when breathing becomes difficult
(wheezing)


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Acknowledgements:

   American Thoracic Society

   U.S. Department of Health & Human Services, National Institutes of Health,
    National Heart, Lung, and Blood Institute

   The Jewish National Hospital COPD Program



Resources:



     Name                  Address           Phone Number            Website
 National Heart,    NHLBI Health
                    Information Center        301-592- 8573
 Lung and Blood     P.O. Box 30105                              www.nhlbi.nih.gov
                    Bethesda, MD 20824-
    Institute       0105
 American Lung                                 800-586-4872      www.lungusa.org
   Association
   American
  Academy of                                                      www.family.org
Family Physicians




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