What help is available? including benefits September 27, 2005 2:46 PM
Inhalers and nebulisers
In the early stages of COPD you may have just one or two inhalers. As it worsens, additional therapy may be added. This may be inhaled or taken via a nebuliser. It may also be that a spacer, used with an inhaler, can also bring benefits. A nebuliser is a device that produces a fine mist from a liquid form of a drug. It allows a much larger dose of the medication to be delivered. Proper diagnosis and assessment is required from your doctor before it can be recommended and a formal 'nebuliser trial' is required to identify any benefits it may bring. Using a nebuliser does not restrict travelling; portable battery operated devices can be used. It is important that you take medication correctly. If you have any concerns about this, check with your practice nurse or doctor.
Home oxygen can be prescribed on the NHS in one of two ways. You may be prescribed an oxygen cylinder to relieve your breathlessness. Alternatively, if the level of oxygen in your blood is reduced, you may be prescribed an oxygen concentrator (a machine that increases the oxygen level in the air) to use at home for at least 15 hours a day. It is important that you use it for as long as your doctor says. The best way to 'clock up' the hours is to sleep with the oxygen on.
Pulmonary rehabilitation has two primary aims: to reduce the symptoms of COPD and to improve your level of activity/function. This is achieved through an individually tailored exercise plan with information and advice on how best to manage the disease.
As COPD progresses you may find it difficult to perform some domestic tasks. Life can be made easier with devices developed for just that purpose. Popular items for people with COPD include equipment to help put socks and tights on. If COPD affects you more severely, you may be considered for a stair lift and equipment for the bathroom. Your local occupational therapy team, contactable through Social Services, your GP or the local hospital, should be able to help you.
There are a number of benefits you may be eligible for. For example, if you need help with personal care or getting about you may be entitled to Disability Living Allowance or Attendance Allowance. For more details the Benefits Agency runs a free and confidential telephone advice line for people with disabilities, their carers and representatives. The freephone number is 0800 88 22 00. If you are deaf or hard of hearing and have a text phone you can call free on 0800 24 33 55.
If you have a great deal of difficulty getting around you may be eligible for a 'blue badge' for your car. This would allow you to park nearer to your destination in specially-allocated parking spaces. Contact your local council for an application form.
Breathe Easy Club
The British Lung Foundation's Breathe Easy Club is specifically for people with respiratory disease and their partners/carers. The Club is growing and now has about 20,000 supporters and over 100 local support groups throughout the UK. Each group supports its members through newsletters, regular meetings and social activities. Groups also have a dedicated health professional, who provides medical information on a more informal basis. Breathe Easy supporters also get a quarterly magazine and access to all British Lung Foundation educational material.
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Pulmonary Rehabilitation September 28, 2005 11:43 AM
What is pulmonary rehabilitation?
Pulmonary rehabilitation combines exercise training and behavioral and educational programs designed to help patients with COPD control symptoms and improve day-to-day activities. It is a team approach—patients work closely with their doctors; nurses; respiratory, physical, and occupational therapists; psychologists, exercise specialists; and dietitians.
The main goals of pulmonary rehabilitation are to help patients improve their day-to-day lives and restore their ability to function independently. If your illness has affected your daily living, pulmonary rehabilitation can help you:
Reduce and control breathing difficulties and other symptoms.
Learn more about your disease, treatment options, and coping strategies.
Learn to manage your disease and reduce your dependence on health professionals and costly medical resources.
Maintain healthy behaviors such as smoking cessation, good nutrition, and exercise.
In addition, pulmonary rehabilitation can help reduce the number and length of hospital stays and increase your chances of living longer.
Who benefits from pulmonary rehabilitation?
In the past, pulmonary rehabilitation was used primarily for patients with COPD. However, it can also be helpful to people with other chronic lung conditions such as:
Thoracic cage abnormalities.
Pulmonary rehabilitation can also be helpful to those who need lung transplants or other lung surgeries. Whether you have a chronic respiratory system disease or are experiencing disabling symptoms, such as shortness of breath, cough, and/or mucus production, pulmonary rehabilitation can help. Even patients with severe disease can benefit.
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September 28, 2005 11:43 AM
What is involved in pulmonary rehabilitation?
Pulmonary rehabilitation involves these components:
Exercise training: lower body, upper body, ventilatory muscle training (for some patients).
Lower body training
Lower body exercises like walking or riding a stationary bicycle will help strengthen your leg muscles and increase muscle tone and flexibility. These exercises will help you move about more easily, often for longer periods of time. They can also make certain tasks, like walking up stairs, easier to do.
Many patients find that as their technique improves, their motivation to continue with the exercise program increases as well. As a result, many patients report feeling better about themselves and their ability to control symptoms such as breathing difficulties.
Upper body training
Upper body training increases the strength and endurance of arm and shoulder muscles. Strengthening these muscles is important because they provide support to the ribcage and can improve breathing. These exercises can also help in tasks that require arm work such as carrying groceries, cooking dinner, lifting items, making the bed and vacuuming, taking a bath or shower, and combing hair. They can also decrease the amount of oxygen needed for these activities. This may be due to less worry about breathing difficulties and better coordination of the muscles involved in raising the arms.
Many patients with lung diseases are not in very good physical condition or have never exercised on a regular basis. Don't worry. Your pulmonary rehabilitation team will meet with you to assess your needs and will work with you to develop an exercise program designed specifically for you. They will advise you about which exercises will give you the best results, how often you should do them, for how long, and at what level. They will give you information on how to maintain your exercise abilities on a regular basis.
Ventilatory muscle training
Weakness of the respiratory muscles can contri-bute to breathing problems and make exercising difficult. For some patients, ventilatory muscle training (VMT) may improve respiratory muscle function, help reduce the severity of breathlessness, and improve the ability to exercise.
Research at this time does not support the use of VMT for everyone. However, it may be helpful for some patients with COPD who have respiratory muscle weakness and breathlessness. Your pulmonary rehabilitation team will let you know if you are a candidate for VMT.
Psychosocial support and education
In addition to exercise training, many pulmonary rehabilitation programs provide help with the em-otional stresses common to COPD. Some patients never experience any significant emotional distress as a result of their disease. But for many, COPD can cause depression, anxiety, or other emotional problems. These might include concerns about:
Relationships with family and friends.
Lack of social support.
Negative self-concept and low self-esteem.
Support may be provided through patient education programs, or as part of support or stress management groups. Patients are counseled about depression and anxiety, taught relaxation skills, encouraged to talk about their feelings, and learn the importance of giving and receiving emotional support from others.
It is important to remember that support for psychological or emotional difficulties is most beneficial over a longer period of time—there is no such thing as a "quick fix." If you are experiencing any of the above feelings, make sure you discuss them with your pulmonary rehabilitation team.
Since smoking is well known to be the primary risk factor for the onset and working of COPD, many pulmonary rehabilitation programs provide educational sessions and counseling to help patients stop smoking. Most patients with COPD have quit smoking by the time they begin a pulmonary rehabilitation program. Others may continue to smoke as a way to cope with depression, anxiety, and loneliness.
Other patient education classes often cover a wide variety of topics. These might include:
How the lungs work.
Information about COPD and other chronic lung diseases.
Information about medications, including drug action, side effects, using an inhaler, and self-care techniques.
Understanding and using oxygen therapy.
Diet, nutrition, and weight management.
Importance of exercise.
Strategies for managing breathing problems.
Symptom assessment and knowledge about when to seek medical treatment.
Information may be provided through lectures, printed hand-outs, demonstrations, or one-on-one instruction.
In summary, much has been learned about the effectiveness and benefits of pulmonary rehabilitation. Patients with COPD greatly benefit from the combination of physical training and behavioral and emotional support. Pulmonary rehabilitation helps patients with COPD improve their quality of life and their ability to function independently. Talk to your physician about pulmonary rehabilitation and how it can help you.
For a list of programs in your area, you may contact the American Association of Cardiovascular and Pulmonary Rehabilitation (608-831-6989) or your local chapter of the American Lung Association.
The American College of Chest Physicians is the leading resource for the improvement of cardiopulmonary health and critical care worldwide. Its mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.
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