Dear COPD Coach

I have had COPD for several years. The possibility of getting COVID-19 really scares me but so does the vaccination. Is it dangerous for someone with COPD to get the vaccination? I have heard that even healthy people are having a hard time with the shots.

Scared

Dear Scared,

I understand your concern and many of us have shared those same concerns. There seems to be no way of determining who will or will not have any side effects from the vaccine or which, if any, side effects they will have. Currently, the most common side effects for many of those getting the vaccines are tiredness, soreness or slight swelling at the injection site, slight fever, headache, chills, muscle aches and nausea. What is important to mention is that all of these symptoms remain for just a very short period of time and are easily treated with rest and over-the-counter pain relievers such as Tylenol or ibuprofen.

We received a few reports of slightly increased breathing problems in people with more severe lung disease (including myself) lasting around 24 hours. In each of these reports the symptoms were relieved by slightly increasing their oxygen flow or if they were only a night time oxygen user, having oxygen handy during the day. As with the other side effects from the vaccines, it lasted only a short time.

It goes without saying that the side effects pale in comparison to what one would experience if they actually got COVID-19. In my particular case I am very glad that I got the vaccine. After the first shot I had minor chills and a slight fever the following day. Other than having slightly increased breathlessness the second day after the second shot (that required increasing my oxygen flow by 1 LPM for 24 hours), the only other side effects I experienced were slight fever, tiredness and chills which required rest and some Tylenol. In both cases, I felt better by the third day.

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Dear Coach,

My wife has had COPD now for several years. In the past few months, she seems to get ill after eating with a lot of gas causing her to belch a lot. She also seems to have problems breathing afterwards, too. What would you suggest we do?

Dear Concerned Caregiver,

The problem you describe could be from a health problem other than COPD so she should talk to her doctor know about these new problems to make sure she can get any testing or treatment she needs. In people living with COPD, it is always smart to think about diet and food.

Having COPD presents many challenges and eating can be one of them. Nutrition is very important for everyone but with COPD it is not only important but often critical that we not just consume food, but in the process get the needed protein, fiber, fats, and carbohydrates. Something to keep in mind is that the simple act of breathing requires calories. But people living with severe COPD use many more (often hundreds more) calories to breathe than someone without COPD. If these calories are not replaced it can result in weight loss, fatigue and even more shortness of breath.

Instead of eating large meals a couple times a day your wife should try eating several smaller meals throughout the day. These smaller meals should be high calorie and protein such as cheese, peanut butter, protein shakes and meats. In my case, I find it easy to eat peanut butter crackers and sandwiches, small meat and cheese slices, and a high calorie nutritional shake. When I eat the smaller meals, I feel far less bloated and breathless.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on February 4, 2020.

Dear COPD Coach,
I was recently diagnosed as having COPD. The doctor who diagnosed me said that my condition is still not very severe, but could get worse if I were to start having exacerbations. I understood him to mean that an exacerbation means time that I would end up in the hospital because of not being able to breathe. What exactly is an exacerbation and how do you avoid having one?

—Newly Diagnosed

Dear Newly Diagnosed,

An exacerbation is when there is an increase in the severity of the symptoms of a chronic disease.

The main symptoms of a COPD exacerbation are an increase in breathlessness which can also be accompanied by these additional symptoms: increased wheezing, a tightness in your chest or soreness when breathing, increased mucous production with a change in its color (usually a darker yellow or green) or thickness, and a fever. Oftentimes, severe exacerbations may result in pneumonia. Each time a person with COPD gets an exacerbation, lung damage can occur, and it is quite possible that some or all of the damage can be permanent. Repeated exacerbations can accelerate the progression of COPD. The two most common causes for a COPD exacerbation are viral or bacterial lung infections or exposure to pollutants.

Treatments for an exacerbation might include supplemental oxygen, antibiotics, corticosteroids, bronchodilators or in the case of a major exacerbation, ventilation either by a mask or a tube inserted into the windpipe. Exacerbations are the most common cause for a person with COPD to be admitted to a hospital.

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Dear COPD Coach,

Why do I feel so short of breath after eating? More than a few times after eating out, I was so short of breath I could barely walk to my car. I love good food, but I am beginning to feel that it isn’t worth the pain of not being able to breathe.

-Breathless

Dear Breathless,

Feeling bloated or out of breath after a large meal is not uncommon with people who have COPD. There are actually a couple reasons why this occurs. When we eat a large meal, we require more energy to digest what we eat and experience more pressure on our chest and diaphragm. The result is we experience shortness of breath.

For many, COPD causes our lungs to become hyper-inflated, which means they take up more room in our chest. This results when air gets trapped in damaged areas of the lungs. When our stomach is filled, it can actually push against the lungs causing us to feel out of breath.

So, what is the answer? It is really quite sensible. Eat several small meals throughout the day. If you are at or below ideal body weight, eat foods that are high in calories. Avoid salt as much as possible since salt can cause you to retain fluid, feel bloated, and increase the workload on your heart. Avoid simple carbohydrates as these cause CO2 build-up in your blood causing less available oxygen. If you do eat foods containing carbohydrates, keep to complex carbohydrates like those found in fruits, vegetables, and whole grain bread.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 30, 2020.

Dear COPD Coach,
I’m confused about what having an exacerbation of my COPD really means. Are there any signs or symptoms which my family and I can see that indicate I am having an exacerbation or is this just the same as an infection?

—COPD Exacerbations

Dear Exacerbations,
Knowing the early warning signs of an exacerbation is very important. As we have documented in previous letters, exacerbations are a problem with COPD, especially when you have not quite recovered from a previous exacerbation. And it’s easier to treat an exacerbation in the early stages versus when it is full blown.

First of all, exacerbations are often the result of either a bacterial or viral infection. If you are exposed to harmful pollutants, this can also cause a worsening of your symptoms. The signs to look out for are:

• Your breathing becomes harder than what is considered normal for you. During an exacerbation you may experience unusual breathing sounds like wheezing. This would indicate that your airways may be partially blocked.
• Coughing that is more severe than normal. Your cough may be dry (also referred to as non-productive) or you may be bringing up more mucus than normal. If you are bringing up mucus, it will be yellow, green or bloody if an infection is present. You may also experience increased difficulty when lying down.
• Changes in skin or nail color. A blue tint on your nails or around your lips indicate that you may not be getting enough oxygen. If this happens you should seek help right away! A change in your response to regular breathing medications. For example, if you take a fast-acting reliever medication by inhaler or nebulizer and it always helps you feel “opened up,” but one day it doesn’t seem to help, that is an early warning sign of possible exacerbation.
• Headaches are often a sign of poor oxygen processing. If you wake up in the morning with a headache, and this is a new symptom for you, it could be a sign that you may be experiencing an exacerbation.
• Swelling in your ankles and feeling of pressure on your diaphragm or ribs, are common COPD symptoms and are associated with heart complications or results of lung damage. If these symptoms are new to you or appear to be increasing suddenly, it may be a sign of an exacerbation. Note: Talk with your doctor about chest pain and ask when you should seek immediate medical attention, or when the discomfort is not urgent but may be caused by changes in your ribs or chest wall due to COPD.
• If you feel yourself breathing more from the chest, shoulders, or neck than your abdomen, this can also be a sign of an exacerbation.
• Increased difficulty sleeping or no desire to eat could also signal an exacerbation.

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Dear COPD Coach,
My husband has been diagnosed with COPD but has not yet had pulmonary function tests to determine the type/severity. We purchased a pulse oximeter to monitor his 02 levels (he was sent home from the hospital on 4 liters but is now reduced to 2). My question is, do you take the first reading that comes up when the pulse oximeter is put on or do you wait 15 seconds and use that reading? Also, I would like to say this is one of the most informative websites I have found on COPD and I certainly appreciate the support it provides.

—Curious about Pulmonary Function Testing

Dear Curious,
A pulse oximeter can be a very useful tool for a COPD patient, providing you use it correctly and realize it has limitations.

The pulse oximeter measures two distinct things: The first number that comes up is most often the pulse rate. Usually this number is marked by a small heart. The second number that comes up is the level of oxygen in the blood. Both numbers are needed to assess your present levels.

At this point, it is important to discuss the limitations of the device. The pulse oximeter only gives you a limited amount of information, and is in reality just a snapshot of your functioning at that particular time. For example, it does not tell you the concentration of CO2 (Carbon Dioxide, the waste product of your breathing and something that is not healthy in high levels) in your blood stream. This means that you could be retaining a large amount of CO2, which could be limiting the amount of usable oxygen in your blood.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 31, 2020.

Dear COPD Coach,

After having a spirometry test in September, I visited my doctor a week ago for the results. I am a smoker–but I have cut back from one pack a day to two cigarettes a day. The results of the test were that I have mild to moderate COPD. The doctor prescribed medication and gave me a peak flow meter with instructions to take a reading twice a day.

My doctor told me that there is no cure for COPD, but that I should have no further progression if I do not smoke. I went home and since, have not smoked another cigarette. What would be my prognosis for getting to Stage Three? Why would you label the disease as a stage if it can be managed?

Thank you,
—Wanting Answers

Dear Wanting,

First of all, congratulations on being able to quit smoking! That’s a huge first step and often the hardest! Not smoking will not only be better for your breathing but will also offer a lifetime of benefits to your overall health!

You doctor is right in saying that there is no cure for COPD, but that COPD can be managed. Your ability to slow the progression of your symptoms will depend on several factors. Managing COPD will involve working closely with a pulmonary professional–taking your medications as prescribed and very importantly, learning to recognize the signs of an exacerbation (times when your symptoms get worse) and getting prompt treatment before small symptoms escalate into a full-blown episode or illness (COPD exacerbation).

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 29, 2020.

Dear Coach,

I just finished a pulmonary rehabilitation class and noticed today that my incidence of shortness of breath had decreased. However, I am still having trouble inhaling my new dry powder long acting inhaler. Everyone teaches pursed lip breathing, but what exercises will help with taking deep breaths through my mouth? I feel like I do not get the dry powder into my lungs and it only stays in my mouth.

Powder Puff

Dear Powder Puff,

As COPD progresses it is often difficult to take deep breaths. While it may seem counter-intuitive, COPD is actually a disease that limits your output of air, not taking it in. Until you can successfully empty your lungs, you will not be able to take as much air in; kind of like you can only fill a glass so far. Pursed lip breathing does help empty your lungs and it also helps rid you of excessive CO2 buildup. I also do a modified version of pursed lip breathing where I take a large breath through my mouth and slowly try emptying my lungs as much as possible. At first, I find I can only exhale a small volume but with continued tries I find I am progressively taking deeper breaths. I do this several times a day. This may not work with everyone because it would be dependent on how severe your disease process is; also, because of hyper-inflation of the lungs the breathing muscles aren't nearly as effective as they could be.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 29, 2020.

Dear Coach

It might be necessary for me to travel from east coast to Hawaii. My question is: with COPD is there a limited number of hours it is healthy to fly?

Thank you,
Looking to fly

Dear Looking to fly

There is no one answer to your question and it really depends on the person. Technically, no number of hours flying are healthy for a COPD patient to fly; some tolerate it better than others. A lot of it depends on how much oxygen you require and what the altitude does to your breathing. Airline cabins are generally pressurized at either 6 or 8 K feet with the larger jets usually being 8K; Jets flying longer distances fly at much higher altitudes. To give you some perspective; Denver is at 5000 feet . In general 20% of patients with COPD require supplemental oxygen but in Denver because of the altitude it is closer to 50%.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 29, 2020.

Dear COPD Coach,

I have had idiopathic pulmonary fibrosis (IPF) since 2009. I was an athlete. I did not smoke. I have been told I am de-saturated at night and have a concentrator for night use.

Based on my latest 6 minute walk test, my clinician’s impressions are the following: With treadmill titration, patient required 3L to maintain an oxygen saturation (SpO2) of 91% at a metabolic (MET) level of 4.8. Decrease in walk distance compared to January by over 350 feet. However, still with excellent effort on 6 minute walk test, but severe desaturation to 75% on 3 liters per minute of oxygen. With significant oxygen needs for higher exertion levels. Discussed paced activity, monitoring SpO2 with activity.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 29, 2020.

Dear COPD Coach,
I know it is important to have a regular exercise program to improve breathing, and that pulmonary rehabilitation is a great way of exercising. Will my exercising also improve my oxygen saturation for daily activities I do without using O2, and will it keep my oxygen saturations higher while doing the 6 minute walk at my doctors?

Thank you,
Into Exercise

Dear Into Exercise,
It is known that muscles that are in better condition do a better job of utilizing oxygen. When you’re in better shape, you can do more, even if your lung condition itself does not change. However, if a person with COPD increases their fitness level through exercise, it cannot be assumed that they will require less oxygen, or no longer need their supplemental oxygen. Again, your lungs are damaged and that cannot be reversed.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 29, 2020.

Dear COPD Coach,
I have a rather embarrassing question to ask you. I was diagnosed with moderate COPD just a few years ago. While I am still able to get around fairly well and am just on oxygen at night, I have noticed that lately when I get out of breath during activity I get this huge urge to either urinate or have a bowel movement. Sometimes this urge is over-powering and I am embarrassed to say that it has on a couple occasions resulted in having an “accident.”

My first question is why this happens, and secondly, what can I do about it?

-Need To Go

Dear Need To Go,

This problem is fairly common with those with respiratory problems and often one we do not discuss outside our COPD circle of friends. What is actually occurring is that when you get out of breath, your brain goes into (for lack of a better term) survival mode. In this mode, the brain triggers blood to the most essential organs that must keep working for us to remain alive. Unfortunately, this does not include the bladder or sphincter muscles. The result is the sudden need to either urinate or have a bowel movement. Often times after experiencing this urge, when you are finally able to eliminate, you might be somewhat surprised how little is actually eliminated.

With that said, there are some things you can do. Personally, my COPD philosophy is that I have never met a restroom I didn’t like, and rarely pass up an opportunity to visit when I am out and about. In fact, I have gotten in the habit and become somewhat an expert in scouting out locations of convenient restroom facilities. While use of the facilities whenever possible does not reduce the urge to eliminate, it does significantly reduce the chances of a major accident!

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