User:DayWalsh/Recommendations - How to manage COPD

COPD Management

While there is no cure for COPD and the airway damage cannot be repaired, all the symptoms can be reduced by following certain management strategies . Including:

• Prevent disease progression i.e. stop smoking - only smoking cessation and oxygen therapy (in significant hypoxaemia) have shown improved mortality in COPD .

- Concern about post-cessation weight gain has been identified as a barrier to smoking cessation for women, perhaps contributing to their lower cessation rates

- Smoking Specific Weight Concern (SSWC) is a barrier to cessation for female smokers.

- SSWC refers to a belief that smoking plays an important role in maintaining weight and that quitting will result in weight gain .

SO - Use exercise as a means to encourage cessation of smoking especially if weight gain is a concern.

• Relieve symptoms

• Improve exercise tolerance

• Improve health status

• Prevent and treat complications

• Prevent and treat exacerbations - managing exacerbations involves a combination of short-acting bronchodilators, systemic corticosteroids, and when needed, antibiotics .

• Reduce mortality, and

• Prevent or minimize side effects from treatment

The Importance of Exercise for the COPD Patient

Weakness, shortness of breath, and even the fear of breathlessness can cause people with COPD to avoid physical activity . This cycle of weakness, shortness of breath, and inactivity contributes to a progressive decline in muscle strength and inefficient oxygen use, making it difficult for some patients to perform Activities of Daily Living (ADLs)such as showering and dressing . As such, exercise is now recognised as an integral part of managing COPD and while it won't change the underlying structural problems in the lungs, it noes have a number of important benefits .

Exercise Increases:

• Energy levels

• Muscle strength, endurance and efficiency

• Cardiopulmonary endurance

• Restful sleep, and

• Bone density

• Independence

• Quality of Life

• Assist in weight control

Exercise Decreases:

• Shortness of breath

• Risk factors of heart disease

• Blood pressure

• Anxiety and depression

• Blood sugar levels, and

• Desire to smoke

- Given that exercise has been found to have a positive influence on affect in humans it is reasonable to propose that probably due to its affective influences, it might provide effective competition against smoking urges in humans .

- Enhanced exercise-related affect may provide coping resources during smoking cessation .

- Exercise appears to be an effective non-pharmacological method of reducing cigarette cravings and desire to smoke during temporary abstinence from smoking .

How Often Should I Exercise?

Those with COPD should aim to exercise for a minimum of 3 sessions per week, for at least 20 to 30 minutes per session .

What Intensity of exercise should I be Doing?

The Australian Lung Foundation recommends that COPD sufferers should exercise between levels three and four on the Modified Borg Dyspnea Scale .

This exertion should be somewhere between 'Moderate' and 'Somewhat Severe' .

Exercise should be undertaken at 60% of your maximal heart rate - You DO need to push yourself into minor breathlessness in order to adapt and increase exercise tolerance.

- In order to make exercise appealing to smokers, it may be more appropriate to set lower, more realistic intensity targets, and for shorter durations .

- Moderate exercise was shown to have a delayed effect on reducing the withdrawal symptoms of restlessness, stress, tension and poor concentration, relative to light exercise of the passive control, at 5 min or 10 min post-exercise .

- One possibility is that exercising somehow mimics the effects of nicotine, since both smoking and physical activity have been shown to increase plasma catecholamines. Alternatively, the effect may be partly caused by increased common affects and enhanced energy, both central features of mood regulation theory .

- A program of supervised vigorous exercise is associated with long-term maintenance of smoking cessation in females .

- 5 minutes of moderate intensity exercise was effective at reducing the desire to smoke in the short term .

What Type of Exercise Should I be Doing?

Those with COPD should be looking to undertake aerobic activity to build endurance and resistance training to strengthen muscles.

Good aerobic activities include walking, cycling, stair climbing, and aquatic exercises.

Resistance exercise involves the use of free weights, special resistance bands, or resistance machines.

How long should I Exercise for?

People who have chronic lung conditions and who exercise regularly, such as walking or cycling for more than 2 hours per week can improve their health . Aerobic sessions should aim to be around 20 to 30 minutes.

Pulmonary Rehabilitation

Pulmonary Rehabilitation is a comprehensive program for those living with COPD who have symptoms of beathlessness and a decreased ability to perform Activities of Daily Life (ADLs) . Pulmonary rehabilitation is one of the most effective interventions in COPD and has been shown to reduce symptoms, disability and handicap, reduce hospitalisation and improve function .

Pulmonary rehabilitation is recognised as an essential component of the management of people with COPD and improves exercise capacity and health-related quality of life .

Pulmonary rehabilitation should be offered to patients with moderate to severe COPD, but can also be relevant for people with any long-term respiratory disorder characterised by dyspnoea .

The benefits of pulmonary rehabilitation however have been shown to decline gradually over 12 to 18 months after stopping, therefore, it is important to continue exercising post pulmonary rehabilitation .

What Does the Program Consist of?

Pulmonary Rehabilitation generally consists of an individual assessment followed by exercise training and education . Patients generally attend twice a week for around 6 - 8 weeks; however there is some evidence of dose response-effect with longer programs producing greater and more sustained benefits in exercise tolerance . At the end of the program, there is generally a re-assessment and an agreed plan is set in place detailing a future exercise plan .

Future exercise plans may include enrolling in a maintenance exercise program, joining a community-based walking group, joining a local gym or community group, exercising regularly with someone else, or participating in a home exercise program.