This article was written by Dr. Byron Thomashow and Dr. Caroline Carter.

Do you have cough that won't go away? Or feel like you're breathing through a straw? Do you stop halfway up the stairs because you need to catch your breath? If so, it's time to pay attention. These are all signs of a potentially serious condition - chronic obstructive pulmonary disease (COPD).

COPD is a chronic, progressive lung disease that affects more than 30 million people in the United States, and shockingly, over 15 million of them remain undiagnosed. It comprises several conditions, including chronic bronchitis and emphysema, and can be caused by genetics and irritants like smoke or pollution. In the United States cigarette smoking remains the most common cause but data suggests that 25-40% of COPD occurs in never smokers.

While COPD is widely recognized, there are concerning gender differences in its diagnosis and management. Research has brought to light a significant increase in the number of women being diagnosed with COPD. While mortality rates for COPD have been decreasing, mortality rates are falling slower in women. Women now account for a higher proportion of COPD hospitalizations and in-hospital COPD related deaths. Despite this, women often experience delayed diagnoses compared to men, and it's often challenging for women to receive timely and accurate diagnoses.

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This article was written by Crystal Rothhaar, BS.

Are you at risk for chronic lung disease?

Chronic obstructive pulmonary disease (COPD) is a progressive and potentially debilitating lung condition that affects millions of people worldwide. It comprises several conditions, including chronic bronchitis and emphysema, and can be caused by genetics and irritants such as smoke or pollution.

In the United States cigarette smoking remains the most common cause but data suggests that 25-40% of COPD occurs in never smokers. Other risk factors include genetics, air pollution, occupational exposures, asthma, impaired lung growth during childhood, and infectious diseases.

The role of primary care in diagnosing, managing, and treating this condition can't be overstated.

"It's vitally important to have an established connection with a primary care provider to manage COPD," says Dr. Louis Gilbert, a primary care physician at Village Medical - a provider of quality primary care. "Your primary care provider will coordinate care with specialists, such as a pulmonologist, when necessary, and make sure you are getting all of your health screenings and vaccines."

Early detection, open communication with a primary care provider, and adherence to treatment plans are critical. In this article, we'll help you take charge of your respiratory health.

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This post was written by: Amanda Atkinson, MSN, RN.

We live in a changing world where it seems like the pressures around us grow every day. Mental wellness has never been more important. Mental well-being is not just trendy or a buzzword, it is an important part of our overall health and happiness. Just as we make the health of our body a priority, we must also make our mental wellness a priority. Some people think that these two parts of us are separate. In reality, they are tightly connected.

Dr. Kiran Palande and I discuss some common questions about how your mental health and physical health are connected.

Dr. Palande is a passionate Cardiopulmonary Physiotherapist from Mumbai, India. She received a Master of Physiotherapy in Cardiorespiratory Sciences from NMIMS University. In her current role, she especially enjoys connecting with her patients through pulmonary rehab (an exercise program for those with lung conditions) and is a member of the COPD Foundation's State Captain program. Dr. Palande believes that pulmonary rehab is an essential aspect of care for people with lung conditions.

Dr. Palande, can you talk to us about how a person's mental health can affect their physical health?

Physical and emotional health are connected.

Maintaining good physical health improves lung function while supporting good mental health reduces stress and worry. Both of these can worsen a lung condition. Mental and physical health have an unbreakable connection.

Regular exercise, a good diet, and pulmonary rehab can help to improve lung function. Meanwhile, controlling stress and anxiety with relaxation techniques helps both mental and lung health. For an all-inclusive approach, both mental and physical health must be a focus.

What are some ways that a person can overcome limits and shame surrounding talking about mental wellness?

When a patient is first diagnosed with a lung condition, it is common for them to be worried. Accepting a diagnosis can be difficult. It is important to get educated about common thoughts and feelings related to having a lung condition. This can make it easier for someone to open up about how they are feeling.

It is important to remember that not all days are the same. We all have good days and bad days that we deal with. Every day is different for everyone. Your experiences and feelings are valid, and it is okay to talk about them. In fact, it is an important step to healing.

I have noticed that many people are still hesitant to talk about their emotions. Joining a support group for people with similar lung conditions can bring a sense of connection and understanding. This can often help lessen concerns about talking about your mental wellness.

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This post was authored by Kristen Szymonik, BS, RRT, AE-C

Many of us take supplements and vitamins to help us stay healthy. But do you know what's really in your supplements? Many people think that supplements are safe because they are natural. But those of us with seasonal allergies know that things found in nature can cause severe allergic reactions.

Think about the supplements that you take. What are the names of the ingredients? Have you looked up those scientific-sounding names to find out what they mean? You might be surprised to know that you could be taking a supplement that contains things you are allergic to.

For example, did you know that if you're allergic to ragweed, you should avoid supplements and teas that contain chamomile, echinacea, dandelion, and daisy flowers? These plants are all from the same family and can have "cross reactivity." That means that they can cause allergy symptoms for people who are allergic to other plants in that family, such as ragweed, which is a very common fall allergen.^{1, 2}

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This post was written by Michael W. Hess, MPH, RRT, RPFT with guest authors Jean Rommes, PhD and David Reynolds, RRT, EMT.

Inside the hospital, oxygen therapy can seem pretty easy. There is an endless stream that comes out of the wall, or as many tanks as you need to move around. Outside the hospital, it gets more complicated. This is especially true when it comes to trying to figure out what portable oxygen system fits your needs best. To help cut through some of the confusion, we asked a couple of experts to share their thoughts on how to choose the best portable oxygen system for your lifestyle. Jean Rommes is an oxygen therapy user and longtime patient advocate. Dave Reynolds is a respiratory therapist and emergency medical technician with over 25 years of experience as a durable medical equipment (DME) supplier. Together, we hope to help answer some of the most common questions about oxygen therapy.

GETTING OXYGEN THERAPY

The first thing to figure out is if oxygen therapy can help you. Dave points out that to qualify, either your pulmonologist or primary care provider (PCP) must order a test that measures the oxygen level in your blood. This is sometimes done with a special lab test called an arterial blood gas sample, or ABG. Most commonly this is done by using a device called a pulse oximeter on your finger or ear. If your oxygen level is below a certain level (usually 88%), oxygen therapy might help. Jean points out that it is important that you do things like what you do in your daily routine when you are being tested. You will be tested while you are at rest, but your oxygen level should also be checked with low activity (as Jean describes it, “strolling through the mall”), harder exercise (“walking at a good steady clip”), and then your maximum level, like climbing stairs. You may need to change your oxygen settings depending on how hard you are working.

OXYGEN ON THE GO

Those settings may also affect the kind of portable oxygen system you need. The two main kinds of portable oxygen equipment are compressed gas cylinders (often called tanks) and portable oxygen concentrators (POCs). Both types have pros and cons. For example, many POCs use what is called “pulse dose” delivery. Instead of a constant flow of oxygen, a puff of oxygen is delivered as you start to inhale. That may not be enough for you, especially if you are exercising hard. Jean has used both but prefers using a tank while exercising for exactly that reason. “If the POC won't meet your O2 needs, then anything that will is better,” she says. Dave reminds us that POCs are also electronic devices that can fail unexpectedly. Oxygen tanks can be quite heavy, so you may need a backpack or a small cart to move them around. It is important to work with your care team and your oxygen equipment supplier to review the options. You may be able to do a “test drive” with different equipment to see what works best for your lifestyle.

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This article was written by Michael W. Hess, MPH, RRT, RPFT

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a strong voice in the COPD world. They create a yearly report with all the latest COPD research and treatment recommendations. Many members of the GOLD Science Committee are also part of the COPD Foundation’s Medical and Scientific Advisory Committee. Today, we will take a closer look at GOLD and the impact they have on everyone affected by COPD.

THE EARLY DAYS

Believe it or not, expert panels have been meeting to discuss COPD since the late 1950s. At the time, words like “emphysema,” “chronic bronchitis,” and even “asthma” were used by health care professionals (HCPs) with little consistency or even formal definitions. In 1959, a group of respiratory experts got together to create formal definitions for these problems and suggest future research directions.¹

Unfortunately, not much came of the symposium, and the real burden of COPD was still not very well understood. Because of that, there was little urgency to try and lower that burden. Worse, medical science did not fully grasp all the changes inside the body that lead to COPD. Much of the technology we rely upon today for diagnosis, like spirometers, was not yet common. Some of the diagnostic tools, like CT scanners, had not even been invented yet.

The COPD epidemic continued to grow under the radar for the next four decades. By the late 1990s, COPD was still not top of mind for many in health care, but a new generation of lung health experts knew it was time to act. They encouraged the United States National Institutes of Health (NIH) and the World Health Organization (WHO) to work together and create a new global initiative dedicated to preventing and treating COPD.² That initiative was GOLD.

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This post was written by: Amanda Atkinson, MSN, RN.

When you hear the word COPD, what do you think of first? There are several common beliefs surrounding COPD. Some are true but many are not. Today, we are going to uncover what is myth and what is fact.

Myth #1 COPD is only a smoker's disease

Fact: Some people think that if they never smoked, they are not at risk for COPD. While smoking of any kind and vaping are primary risk factors for developing COPD, approximately 25% of individuals diagnosed with COPD have never smoked.¹ Did you know that many things can influence the development of COPD? These can include certain genetic mutations, childhood asthma, premature birth, secondhand smoke exposure, and environmental or occupational factors.² Anyone can get COPD!

Myth #2 COPD cannot be passed down in families

Fact: Genetic forms of COPD, such as alpha-1 antitrypsin deficiency, can be passed down in families. Unfortunately, only about 10% of those with Genetic COPD are diagnosed. Screening ALL patients with COPD and their family members is vitally important to properly diagnose or rule out Genetic COPD.³

Myth #3 COPD only impacts older adults or those over 65

Fact: Symptoms of COPD can develop at virtually any age. This is especially true for genetic forms such as alpha-1 antitrypsin deficiency. Adults as young as 20 can experience early symptoms of COPD, ^2,4,5 Early identification of risk factors and early diagnosis and treatment may help reduce or reverse lung damage.^2,5

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This post was authored by Kristen Szymonik, BS, RRT, AE-C

Emergencies have the worst timing. They happen when we least expect it and often when we are not prepared. Being ready for an emergency or natural disaster is important for everyone, but especially for those with chronic obstructive pulmonary disease (COPD) and other chronic lung conditions.

You may be thinking that you don't need to worry about natural disasters because you don't live in an area that has wildfires, mudslides, and floods. But natural disasters and emergencies can occur anywhere. Emergencies don't have to be dramatic events like fires and floods. They can be as simple as losing electricity for a few hours—and not being able to run your oxygen concentrator or other medical equipment.

Consider where you live: Does your area have snowstorms, severe thunderstorms, or extreme temperatures that could cause you to lose electricity or phone service?

Consider your medical needs: Do you use oxygen, take refrigerated medications, or use a wheelchair or scooter? Losing electricity for a few days can be dangerous if you need it to power your medical equipment.

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This article was written by Michael W. Hess, MPH, RRT, RPFT

For many people with COPD, frequent coughing that produces sputum (the “junk” you cough out) is a fact of life. It can be uncomfortable, embarrassing, and very hard to control. However, there are things you can do to help manage your airway mucus. These are known as airway clearance techniques.

Coughing and Breathing Techniques

Many airway clearance techniques do not require any special equipment or tools. One of the most common techniques is called huff coughing, as seen in this video from the Cystic Fibrosis Foundation (CFF). With huff coughing, you simply sit down, take a breath deep enough to fill up your lungs, then "huff" the air back out in short bursts. Keep your mouth open so that it sounds like you are saying, "ha, ha, ha." Repeat these steps a couple of times, and you will probably find yourself coughing more strongly. Be sure to keep some tissues handy to cover your cough!

Another airway clearance method combines huff coughing with other breathing techniques. As you'll see in the following CFF video, this is called the active cycle of breathing technique, or ACB. With ACB, you start by taking five or six gentle breaths while placing one hand on your stomach. Purse your lips while you exhale to keep the airways open longer. After that set of breaths, take a very deep breath and hold it for three seconds. This helps get air deeper behind the sputum, helping to drive it out. After the breath hold, use huff coughing to bring the sputum up and out of your lungs.

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A diagnosis of COPD or other lung disease does not mean that you have to say goodbye to intimacy. While there may be challenges such as shortness of breath, coughing, or other symptoms that impact your activity level and how you feel each day, it is possible to maintain intimate relationships while living well with COPD.

Dr. Barbara Yawn and I discuss some common questions about intimacy and COPD.

What if I am nervous to speak to my partner about intimacy?

Remember, your partner is likely just as nervous about intimacy as you are. Most partners want to make sure they can continue sharing intimacy without causing harm. Many may have concerns about hurting you, or making you more short of breath. Talking is key. Remember, intimacy is much more than just sexual intercourse. Intimacy can be hugging, cuddling, kissing, rubbing, or massaging anything from your scalp to your feet. Let your partner know you want to continue being intimate. Talk about your needs, desires, and concerns and ask your partner about theirs.

It can help to ask your health care team about intimacy. You can talk about it in the office, pulmonary rehabilitation, or education programs. The discussion can help support ideas you have and reassure you and your partner about safety and satisfaction.

What are some tips for overcoming challenges with intimacy?

First, make sure you and your partner know how to tell when the other person wants intimacy. If it is uncomfortable to ask, come up with some clear hints like holding hands or guiding your partner to hugging, cuddling, or kissing. Find a private place where you can be comfortable sitting or reclining. Try positioning your body so that you feel comfortable and less short of breath, such as lying on your back or side with your head and chest elevated. If you are using supplemental oxygen, make sure you have a long enough tube to be comfortable. You may also want to use nasal prongs to help with kissing, rather than a mask. As a couple, think back on your history together before COPD. Talk about what intimacy looked like then, and how it can be adapted to your current opportunities and limitations.

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This month on COPD360Social, we discussed integrative medicine as an additional tool for the management of COPD. I had the opportunity to interview a former colleague of mine who has recently incorporated yoga into her work as a licensed counselor. While counseling and therapy by themselves can be very helpful to people living with chronic illness, there can be added benefit by including other types of complementary therapies, such as yoga.

I connected with April Hibdon, LCSW, and asked her several questions about yoga and integrative medicine. She said she was happy to share this information with health care professionals because she believes that this type of “breath work” could be helpful to those living with COPD and other lung conditions. She says the practice of yoga can be of particular help to people experiencing anxiety. April was generous with her time and answered the following questions:

Q: Can you tell me what kind of practice you are in? Individual counseling? Families?

A: I am a Licensed Clinical Social Worker. My practice is with individuals ages 16 and up. Currently, I see clients via telehealth as it is providing opportunities for those with busy schedules and in rural areas to seek care.

How did you learn about incorporating yoga into your work?

A: I have been interested in yoga for years because it is calming and relaxing. Actually, my chiropractor recommended it to me for my lower back pain. Yoga allows me to be more centered and connected. Several years ago, I became aware of therapists that were using it in their practice to help clients that have anxiety and histories of trauma.

Q: What did you have to do in order to provide that kind of treatment to your patients?

A: In order to provide yoga-informed care to clients, the provider has to complete the necessary training. There are many programs available; however, I chose to participate in the Yoga Fit program. I started with a level one training that teaches the basics, and I added different classes until I met all the requirements.

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Ask the experts and they will tell you that exercise is an important part of feeling your best when you have COPD, bronchiectasis, and other lung conditions. There are so many benefits to exercising. Exercise is known to help with anxiety and depression, which is common in people living with a lung condition. Exercise has also been linked to a better quality of life. Doing activities that increase your strength and fitness can help you do everyday tasks with less breathlessness.

This month we have taken some time to review pulmonary rehab (rehabilitation), which is a wellness program created specifically for people with lung conditions like COPD, bronchiectasis, and NTM lung disease. Pulmonary rehab programs combine what people living with these conditions need the most: exercise, support, and education. Pulmonary rehab can help improve your fitness level and allow you to enjoy your favorite activities. It can also be a wonderful tool to build confidence with exercising on your own.

Knowing all the wonderful things that pulmonary rehab and exercise can do for the body, it is a wonder why there are so many myths about exercise and pulmonary rehab. In this blog, I am going to review some common myths or untruths about exercising and pulmonary rehab. The best part is that I am going to give you “nothing but the truth.” So, let's get into it!

Myth: People with lung conditions like COPD should not exercise because it will make them short of breath.

The truth: There is no doubt that shortness of breath can be one of the biggest barriers to exercising. Frankly, it can be scary to feel breathless when you are exercising. However, when you choose to exercise, you build strength that will help you with your favorite activities and chores around the house like carrying a laundry basket, bathing, and vacuuming. Pulmonary rehab can help to build confidence in managing your shortness of breath while exercising. Pulmonary rehab can teach you skills like how to recover quickly and how to safely increase your activity. Avoiding exercise can weaken your body and therefore make you feel more breathless. The less you do now, the less you are able to do later.

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