Better Living With COPD PDF

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Better Living with

Chronic Obstructive Pulmonary Disease
A Patient Guide
Second Edition
November 2012
Queensland Health The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 a
Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide is a joint project of the
Statewide COPD Respiratory Network, Clinical Practice Improvement Centre, Queensland Health and
The Australian Lung Foundation, COPD National Program.
This work is copyright and copyright ownership is shared between the State of Queensland (Queensland Health)
and The Australian Lung Foundation 2012. It may be reproduced in whole or in part for study, education or
clinical purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced
for commercial use or sale. Reproduction for purposes other than those indicated above requires written
permission from both Queensland Health and The Australian Lung Foundation.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012.
For further information contact Statewide Respiratory Clinical Network, Patient Safety and Quality Improvement
Service, e-mail: PSQ@health.qld.gov.au or phone: (07) 36369505 and The Australian Lung Foundation,
e-mail: enquiries@lungfoundation.com.au or phone: 1800 654 301. For permissions beyond the scope of
this licence contact: Intellectual Property Officer, Queensland Health, email: ip_officer@health.qld.gov.au
or phone (07) 3234 1479.
To order resources or to provide feedback please email: enquiries@lungfoundation.com.au or
phone 1800 654 301.
Queensland Health Statewide Respiratory Clinical Network and The Australian Lung Foundation, COPD
National Program Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide, 2012.
ISBN 978-0-9872272-0-1
b Chapter 5: Your role in managing your chronic obstructive pulmonary disease

Foreword
Chronic Obstructive Pulmonary Disease (COPD) is second only to diabetes as a
leading cause of avoidable hospital admissions. COPD impacts significantly on
the day-to-day lives of people with the disease, their families and carers, and the
health system. While there is no cure for COPD, there are things people can do to
improve their symptoms and therefore the quality of their lives.
In 2007, the Queensland Health Statewide Chronic Obstructive Pulmonary Disease
Collaborative identified the need for standardised, evidence-based patient information
to be available to people with COPD who were participating in pulmonary rehabilitation
programs. In response to this need, a team of health care professionals experienced
in providing care to people with lung conditions compiled this booklet. This original
publication has now been reviewed and updated in line with current best practice.
This booklet has been developed for people with COPD and their families and carers
and also for health professionals involved in the care of people with COPD.
The aim of this booklet is to:
provide useful information about how to live well with chronic lung conditions.
offer practical hints about what people with COPD can do to improve their
well-being.
act as a resource tool for people with COPD and health care professionals,
particularly those living in regional and remote areas.
Queensland Health and The Australian Lung Foundation are committed to supporting
those with COPD to manage their condition and get the best they can out of life. This
Dr Michael Cleary, Deputy Director-General
Health Service and Clinical Innovation Division
booklet is an important step to better living with COPD.
Queensland Health
We acknowledge the significant work undertaken by Queensland Health staff and
in particular the Queensland Health Statewide Respiratory Clinical Network in the
development of this booklet. A collaborative partnership between Queensland Health and
The Australian Lung Foundation has made it possible to widen access to this resource
to people with COPD, regardless of where they live in Australia. Additionally, we
thank the consumers who provided feedback about this booklet during its development.
For access to this resource on-line, visit www.lungfoundation.com.au, or for
further information, call The Australian Lung Foundation on 1800 654 301.
Dr David Serisier, Chairman

We encourage people with COPD and their families and carers and health
The Australian Lung Foundation professionals to make use of this valuable resource.
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 I
Acknowledgements
Queensland Health and The Australian Lung Foundation wish to Statewide COPD Clinical Network,
acknowledge the efforts of all those involved in the development, Queensland, Steering Committee
review and update of Better Living with Chronic Obstructive
Reviewers
Pulmonary Disease A Patient Guide.
Judith Hart, Australian COPD Patient Taskforce.
Associate Professor Stephen Morrison, Chair Associate Professor Christine McDonald,
Associate Professor Ian Yang, Immediate Past Chair Respiratory Physician, Austin Hospital, Melbourne, VIC.
Statewide COPD Clinical Network, Queensland Vanessa McDonald, Clinical Nurse Consultant,
John Hunter Hospital, Newcastle, NSW.
Dr Bill Scowcroft, Co-Chair,
Project Officers
Australian COPD Patient Taskforce.
James Walsh (Coordinating Author), Physiotherapist,
The Prince Charles Hospital, Brisbane, QLD. Myrna Wakeling, Talk Lung Care Support Group.
Helen Seale, Assistant Director of Physiotherapy, Thoracic 2nd Edition August 2012 Project Officers
Program The Prince Charles Hospital, Brisbane, QLD.
Pauline Hughes, Respiratory Nurse Practitioner,
Heather Allan, Director, COPD National Program,
Metro North Health Service District, Brisbane, QLD.
The Australian Lung Foundation.
David McNamara, Respiratory Clinical Nurse Consultant,
Simon Halloran, Physiotherapist,
Nambour General Hospital, Nambour, QLD.
Bundaberg Base Hospital, QLD.
James Walsh, Physiotherapist,
Contributing authors The Prince Charles Hospital, Brisbane, QLD.
Helen Seale, Assistant Director of Physiotherapy Thoracic
Robyn Cobb, Physiotherapist,
Program, The Prince Charles Hospital, Brisbane, QLD.
The Prince Charles Hospital, Brisbane, QLD.
Heather Allan, Director, COPD National Program,
Annette Dent, Respiratory Scientist,
Judy Henry, Project Co-ordinator,
Mary Doneley, Social Worker,
Emily Gill, Dietician, Lead Reviewers
Royal Brisbane and Womens Hospital, Brisbane, QLD.
Dr Vanessa McDonald, Clinical Nurse Consultant,
Di Goodwin, Respiratory Clinical Nurse Consultant, John Hunter Hospital and The University of Newcastle,
Royal Brisbane and Womens Hospital, Brisbane, QLD. Newcastle, NSW.
Kathleen Hall, Physiotherapist, Associate Professor Ian Yang, Thoracic Physician,
Simon Halloran, Physiotherapist,
Bundaberg Base Hospital, Bundaberg, QLD. Additional Contributing Authors
Karen Herd, Dietician, Dr Helen Reddel, Research Leader, Clinical Management,
The Prince Charles Hospital, Brisbane, QLD. Woolcock Institute of Medical Research, Sydney, NSW.
Michele Kennedy, Respiratory Clinical Nurse Consultant, Moira Fraser, Clinical Nurse Specialist,
Logan Hospital, Meadowbrook, QLD. Concord Hospital Medical Centre, NSW.
Renae Knight, Occupational Therapist, Amanda Ballard, Senior Social Worker,
Brisbane South Respiratory Service, QLD. Metro North Health Service District, Brisbane, QLD.
Jennie Lettieri, Speech Pathologist, Toowoomba Hospital, QLD. Susan Marshall, Senior Psychologist,
Lisa McCarthy, Thoracic CNC, The Prince Charles Hospital, Metro North Health Service District, Brisbane, QLD.
Brisbane, QLD. Wendy Noyce, Advanced Occupational Therapist,
David McNamara, Respiratory Clinical Nurse Consultant, Metro North Health Service District, Brisbane, QLD.
Nambour General Hospital, Nambour, QLD. Judy Powell, Project Manager, Primary Care COPD
Judy Ross, Respiratory Clinical Nurse Consultant, National Program, The Australian Lung Foundation.
Princess Alexandra Hospital, Woolloongabba, QLD. Elizabeth Harper, Program Manager, Pulmonary
Helen Seale, Physiotherapist, Rehabilitation and Lungs in Action, COPD National
The Prince Charles Hospital, Brisbane, QLD. Program, The Australian Lung Foundation.
John Serginson, Respiratory Nurse Practitioner,
Caboolture Hospital, QLD. Statewide Respiratory Clinical Network, QLD
Stella Snape-Jenkinson, Advanced Occupational Therapist,
Heart Lung Team, The Prince Charles Hospital, Brisbane, QLD. Consumer Reviewers
Tracy Tse, Pharmacist, Judy Hart, QLD.
The Prince Charles Hospital, Brisbane, QLD. Caroline Polak Scowcroft, ACT.
Barb Williams, Respiratory Clinical Nurse, Ezy Breathers Support Group, Northlakes, QLD.
Logan Hospital, Meadowbrook, QLD.
James Walsh, Physiotherapist, Pulmonary Rehabilitation Booklets
The Prince Charles Hospital, Brisbane, QLD. The following COPD Pulmonary Rehabilitation Booklets were
Robert Walton, Clinical Psychologist, reviewed and used as models to produce this Patient Guide:
Nambour General Hospital, Nambour, QLD. Brisbane South Community Health Service District
Brett Windeatt, Respiratory Clinical Nurse, Bundaberg Health Service District
Logan Hospital, Meadowbrook, QLD. Cairns Health Service District
Michelle Wood, Physiotherapist, Nambour General Hospital
The Prince Charles Hospital, Brisbane, QLD. Gold Coast Health Service District
Associate Professor Ian Yang, Thoracic Physician, The Prince Charles Hospital
The Prince Charles Hospital, Brisbane, QLD. The Alfred Pulmonary Rehabilitation Program
II
Better Living with

Chronic Obstructive Pulmonary Disease
A Patient Guide
Second Edition
Contents
Chapter Page
1. Introduction .................................................................................................................. 1
2. The lungs ..................................................................................................................... 2
3. Lung conditions ............................................................................................................ 5
4. Lung function tests ........................................................................................................ 8
5. Your role in managing your COPD ................................................................................. 11
6. Stopping smoking and preventing a relapse .................................................................... 16
7. Knowing your medication ............................................................................................. 20
8. Using your inhalation devices ....................................................................................... 27
9. Preventing and managing a flare up ............................................................................... 36
10. Introduction to pulmonary rehabilitation ......................................................................... 40
11. Exercise and physical activity ....................................................................................... 42
12. Breathlessness, breathing control and energy conservation ............................................... 52
13. Airway clearance: keeping your lungs clear ..................................................................... 58
14. Home oxygen therapy .................................................................................................. 60
15. Healthy eating ............................................................................................................ 63
16. COPD and swallowing ................................................................................................. 68
17. COPD and other related conditions ................................................................................ 71
18. Managing stress, anxiety and depression ........................................................................ 76
19. Intimacy and COPD ..................................................................................................... 80
20. Travel and COPD ......................................................................................................... 82
21. Legal issues ................................................................................................................ 86
22. Community support services ......................................................................................... 89
23. Frequently asked questions .......................................................................................... 93
24. Resources and support available from The Australian Lung Foundation .............................. 95
25. References ................................................................................................................. 97
26. Feedback ................................................................................................................... 99
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 III
1
chapter Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term for a group of disorders that cause
obstruction of airflow in the breathing tubes or airways of the lungs. When the condition occurs it is
chronic (long term) in nature, and therefore the airflow obstruction is usually permanent or irreversible.
not be able to run to catch the train or play with

C chronic long term young children. However, breathlessness can worsen
to a stage where everyday tasks, such as hanging
O obstructive partly blocked out the washing or walking to get the mail, become
P pulmonary the lungs more and more difficult.
If you have COPD, the good news is that there are
D disease or illness
steps you can take to control the symptoms of COPD
and slow down the ongoing damage to your lungs.
These conditions commonly include chronic bronchitis,
Better Living with Chronic Obstructive Pulmonary
emphysema and chronic asthma. The Australian Lung
Disease A Patient Guide outlines the important
Foundation estimates that one in seven Australians
steps that will make you feel better, such as:
over 40 years of age has COPD. Alarmingly at least
50% of those people do not know they have COPD, Quitting smoking.
and, therefore are not taking the important steps to Understanding your medications.
control their symptoms and slow down the progress
Enrolling in a pulmonary rehabilitation program.
of this disabling condition.
Maintaining a healthy diet.
Breathlessness, a key symptom of COPD, creeps up
Developing an Action Plan.
on people slowly. As symptoms begin people may
Joining a support group.
Discussing immunisation with your doctor.
Better Living with Chronic Obstructive Pulmonary
Disease A Patient Guide has been written specifically
for people with COPD. However, there are many
chronic lung conditions for which the principles and
advice written in these pages will apply.
For more information about this Patient Guide
and how to use it, contact The Australian Lung
Foundation (phone: 1800 654 301 or website:
www.lungfoundation.com.au) or speak to your
doctor, nurse or pulmonary rehabilitation coordinator.
1 Chapter 1: Introduction
2
chapter
The lungs
This chapter will help you to understand:

What the respiratory (or breathing) system is.
What the structure of the lungs is.
What the lungs do.
How you breathe.
What the role of the nose and nasal cavity is.
How the breathing system protects against irritants or foreign particles.
What is the respiratory What is the structure of the lungs?

(or breathing) system? Both lungs and the heart are located within the
The respiratory system includes the upper and lower chest. There are two lungs inside the chest: the left
respiratory tract. The upper respiratory tract consists of: lung and the right lung. Each lung is divided into
segments called lobes. The lungs are soft and
The nose and nasal cavity.
protected by the ribcage.
The throat (pharynx).
The voice box (larynx).
The lower respiratory tract consists of:
Right Lung Left Lung
The windpipe (trachea).
Breathing tubes (bronchi and bronchioles).
Air sacs (alveoli).
Nose and
nasal cavity
Throat
(pharynx) Voice
(larynx)
Windpipe
(trachea) Breathing tubes
(bronchi and
bronchioles)
Heart
Lung The Lungs
The Breathing System
The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012 2
Within the lungs is a transport system for oxygen moves from the bloodstream back into the air sacs
and carbon dioxide. Each time you breathe, air is and through the breathing tubes or airways, where
drawn via the mouth and nose into the windpipe it is breathed out.
(trachea).
The windpipe splits into two breathing tubes (bronchi): Lungs
one to the left lung and one to the right lung. The
breathing tubes continue to divide into smaller and
smaller tubes (bronchioles), which take air down
into each lung.
Breathing tubes
(bronchioles)
Branch of bronchial artery Air sacs (alveoli)
Capillary network Capillaries crisscrossing the air sacs (alveoli)

around alveoli
How do you breathe?
The lungs do not move on their own. The diaphragm
(the main breathing muscle) helps the lungs to work.
Branch of When you breathe in, the diaphragm contracts and
pulmonary artery moves down. The muscles between the ribs also
contract. The lungs expand, and air is drawn into
the lungs.
When you breathe out, the diaphragm relaxes and
moves back up. The muscles between the ribs relax.
The lungs reduce to normal size and air is pushed
out of the lungs.
Air sacs (alveoli)
The Bronchi
What do the lungs do?

To survive, your body needs oxygen (O2) which you
Chest Chest
get from the air you breathe. The lungs help take
expands contracts
the oxygen from the air, through the air sacs
(alveoli), into the body. Sternum
The air sacs are surrounded by tiny blood vessels Ribs
(capillaries), which crisscross the walls of the air
Lungs
sacs. The air sacs are where oxygen, which is a
gas, is absorbed into the bloodstream. Diaphragm
Diaphragm Diaphragm
Oxygen is then carried along the bloodstream, contracts relaxes
through the heart, to where it is needed in the body.
Breathing in Breathing out
Carbon dioxide (CO2) is a waste product that is
produced by the body. As a gas, carbon dioxide The diaphragm is the main breathing muscle
3 Chapter 2: The lungs

What is the role of the How does your respiratory (or breathing)
nose and nasal cavity? system protect against irritants or
The nose and nasal cavity perform a number of foreign particles?
functions, including: The breathing system provides protection against
Providing us with a sense of smell. irritants or foreign particles entering the lungs. The
breathing system has several protection mechanisms.
Warming and moistening the air that is breathed in.
Firstly, the nose filters the air when breathing in,
Filtering the air that is breathed in of irritants, preventing irritants, such as dust and foreign matter
such as dust and foreign matter. from entering the lungs.
Assisting in the production of sound.
Secondly, if an irritant enters the airways or
The nose is the preferred route to deliver oxygen to breathing tubes, sputum that lines the airways traps
the body as it is a better filter than the mouth. The unwanted particles. Tiny hair-like structures called
nose decreases the amount of irritants delivered to cilia line the breathing tubes or airways. They move
the lungs, while also heating and adding moisture in a sweeping motion to help move the sputum and
(humidity) into the air we breathe. unwanted particles up into the mouth where they
When large amounts of air are needed, the nose can be cleared. The function of the tiny hairs can be
is not the most efficient way of getting air into the affected by smoke, alcohol and dehydration.
lungs. In these situations, mouth breathing may The third protective mechanism for the breathing
be used. Mouth breathing is commonly needed system is the cough. A cough is the result of irritation
when exercising. to the breathing tubes (bronchi and bronchioles).
Infection or irritation of the nasal cavities can result A cough can clear sputum from the lungs.
in swelling of the upper airways, a runny nose or Lastly, the lungs also have a built-in immune system
blocked sinuses, which can interfere with breathing. that acts against germs.
The nose decreases the amount of irritants

delivered to the lungs.
3
Lung conditions

What chronic obstructive pulmonary disease What asthma is.
(COPD) is. What bronchiectasis is.
What chronic bronchitis is. What interstitial lung disease is.
What emphysema is.
What Alpha-1 antitrypsin deficiency is.
Your lung condition emphysema usually occur in people who have

smoked or continue to smoke cigarettes, but they
Lung or respiratory conditions can be caused by:
can be caused by environmental or genetic factors.
Acute or long term breathing in of toxic Asthma commonly occurs in non-smokers as well
agents (for example, cigarette smoke or as smokers. It is caused by a number of different
chemical fumes). factors including but not limited to the environment,
Infections. allergy and genes.
Genetic causes (for example, cystic fibrosis). A small number of people can get emphysema
Another disease, such as a muscular disorder, from an inherited protein deficiency called
that impairs the function of the lungs. Alpha-1 antitrypsin deficiency.
Sometimes lung disease can be caused by
unknown reasons.
COPD is a term used to describe a condition
that includes chronic bronchitis, emphysema,
What is chronic obstructive pulmonary chronic asthma or any combination of these
disease (COPD)? conditions.
The term chronic obstructive pulmonary disease
(COPD) is commonly used to describe a person who
has chronic bronchitis, emphysema, chronic asthma What is chronic bronchitis?
or a combination of these conditions. Chronic
Chronic bronchitis is a constant swelling and irritation
obstructive airways disease (COAD), is also a term
of the breathing tubes (bronchi and bronchioles)
that has been used to describe these conditions.
and results in increased sputum production. This
Chronic bronchitis, emphysema and chronic asthma condition usually occurs as a result of infection and
are common long term lung conditions that cause is often related to smoking. Chronic bronchitis is
shortness of breath. Each condition can occur recognised or identified when sputum is produced
separately, but many people have a mixture of these on most days for at least three months, for two
conditions. In Australia, chronic bronchitis and consecutive years.
5 Chapter 3: Lung conditions

The trapped air leads to an over-expansion of the

lungs; this is often called a barrel chest.
The combination of constantly having extra air in the
lungs, and the extra effort needed to breathe, results
in the feeling of shortness of breath.
Extra mucous However, not all air sacs are involved to the same
degree, and only parts of the lungs may be affected.
What is Alpha-1 antitrypsin deficiency?

Alpha-1 antitrypsin deficiency is a genetic disorder.
People with Alpha-1 antitrypsin deficiency are at
greater risk of developing COPD. Alpha-1 antitrypsin
(AAT) is a substance normally present in the blood;
Inflamed, swollen airway
its role is to protect the lungs from damage. Over the
Excessive sputum obstructs airways course of a lifetime, the delicate tissues of the lungs
are exposed daily to a variety of inhaled materials,
Airway obstruction occurs in chronic bronchitis such as pollutants, germs, dust and cigarette smoke.
because the inflammation and excessive sputum AAT helps the body fight against the damage caused
production causes the inside of the breathing tubes by these pollutants. The estimated 1 in 2,500
to be narrower than usual. Frequent infections occur Australians with a deficiency of AAT have too low a
due to the increased sputum. As the breathing tubes level to protect the lungs from the damaging enzymes
or airways become narrower, it is harder for air to move produced by the body in reaction to the pollutants.
in and out of the lungs and breathlessness results. This puts them at greater risk of developing COPD.
Other conditions:
What is emphysema? Other lung conditions that commonly co-exist with
Emphysema is a condition where the air sacs (alveoli) COPD are asthma, bronchiectasis and interstitial
become distended and the walls between them break lung disease. These are briefly explained below.
down causing larger air spaces.
With emphysema, the breathing tubes (bronchi and What is asthma?
bronchioles) become narrower and the lung tissue
Asthma is a chronic condition manifested by
loses elasticity or springiness, which makes it harder
variable constriction and swelling of the breathing
to breathe the air out. As a result, air trapping (or
tubes and airways and triggered by various factors,
hyperinflation) can occur.
such as cold air or pollens.
Swelling of the airway wall and tightening of the
muscles around the airway results in the narrowing
of the breathing tubes (bronchi and bronchioles).
Wheeze, chest tightness, breathlessness and cough
are classic symptoms of asthma.
Damaged, enlarged
air sac (alveoli) The swelling may produce an obstruction of the
breathing tubes or airways, similar to COPD. Some
people have both COPD and asthma.
Asthma is often believed to be a disease that affects
children and young adults. However, asthma can
occur in all age groups.
Emphysema
During an asthma attack, the breathing tubes or Pocketed and

airways become inflamed, swollen and blocked with widened breathing
sticky sputum (as shown in the diagram below). This tubes
makes breathing more difficult.
Muscle contraction Mucous hides

Mucous and stagnates
(sputum)
produced by
Muscles
airways
relaxed
Wall normal
Normal mucous Thickened

production swollen walls
Excessive sputum narrows the airways Bronchiectasis
COPD and Asthma breathing tubes, which can lead to further infections
Because asthma and COPD have similar symptoms, and damage to the breathing tubes or airways.
it may be difficult to distinguish between the two Sputum is often white. If it changes to a different
conditions. We know that many people with COPD colour such as yellow, brown or green, it usually
may have asthma as well, especially those who are means there is an infection. Sometimes people with
aged over 55 years. We also know that many older bronchiectasis will have discoloured sputum even
Australians being treated for asthma, in fact have COPD. when they are well.
Asthma and COPD have different causes, affect The main treatments for bronchiectasis include:
the body differently and some of the treatments are
1. Airway clearance techniques to loosen and
different. It is important, therefore, to determine if
clear sputum.
you have asthma, COPD or both. The best way to
do this is by having your doctor perform a lung 2. Prevention of further infections by vaccinating
function test (spirometry). See chapter 4 Lung against infectious diseases, removing irritants and
function tests, page 8, for further information. using aerosols and antibiotics when indicated.
3. Pulmonary rehabilitation is also recommended
What is bronchiectasis? for people with bronchiectasis.
Bronchiectasis is a lung condition involving the
destruction of the airways or breathing tubes inner What is interstitial lung disease?
lining and widening or dilatation of the breathing
Interstitial lung disease refers to a group of lung
tubes (bronchi and bronchioles).
conditions, including pulmonary fibrosis, in
Bronchiectasis is not caused by cigarette smoking which the lungs harden and stiffen (become
and is usually caused by a previous severe infection fibrosed or scarred).
of the lungs.
During interstitial lung disease, the walls of the air
Bronchiectasis is characterised by repeated episodes sacs (alveoli) thicken, which reduces the transfer
of acute bronchial or airway infection with increased of oxygen (or other gases) to and from the blood.
coughing and sputum production. This alternates
Interstitial lung disease may be caused by immune
with periods of chronic infection and mild coughing.
conditions, asbestosis, exposure to chemicals
In bronchiectasis, sputum becomes difficult to clear. or irritants, or have no known traceable cause
Sputum can be trapped in pockets within the (idiopathic).
7 Chapter 3: Lung conditions

4
chapter
Lung function tests

Why lung function tests are important in the diagnosis and treatment of chronic obstructive
pulmonary disease (COPD).
What the lung function tests are.
Why are lung function tests important Spirometry will be used to monitor your COPD and
in the diagnosis and treatment of COPD? to check how well your treatment is working.
Lung function tests assist in the diagnosis and

management of COPD. The tests measure how well,
and how much air, you breathe in and out of your
lungs. Lung function tests can also show how well
oxygen enters your body, and how much air you
have in your lungs. The tests used are spirometry,
gas transfer measurements and lung volume
measurements.
What are the lung function tests?

What is spirometry?
Spirometry is the most commonly used test. It is
vital to confirm the diagnosis of COPD by spirometry.
This test measures the amount of air you are able to
breathe in and out, and how quickly you are able to
breathe air out. Typically, if you have COPD, you will
take longer to breathe all of your air out.
Spirometry is done by breathing into a machine
called a spirometer. You will be asked to take your
biggest breath in and to breathe all the air out as
fast as you can into the machine. This needs to be
done several times and your best result is recorded.
It can take up to 20 minutes to complete the tests.
Spirometry is often repeated after you have taken
some breathing medications (for example, Ventolin
or Bricanyl). This is done to find out if your lung
function improves with these medications. Spirometry is vital to confirm a diagnosis of COPD
What should I know before taking the 4. FEV1 /FVC. This measures how much air is blown
spirometry test? out in the first second proportional to the total
amount blown out of the lung. So it shows how
You may be asked to not take your breathing
quickly the lungs can be emptied. People with
medications on the day of the test. However,
healthy lungs can usually blow out 70% to 90%
if you feel really breathless, take your breathing
of their air in the first second.
medications and let the person conducting your
test know when you used your breathing
medications.
As effort is required to do this test, you may get
tired. This is not unusual.
The person conducting the spirometry test will
give you instructions on how to do the test. If you
do not understand them, ask for the instructions
to be repeated or for a demonstration on how
the test should be undertaken.
You can sometimes become light-headed during
the test. If this happens, stop breathing into
the machine and let the person conducting
your test know.
To get the best results, you will be asked to do
the test several times.
Breathing test results vary according to a
persons age, height, whether they are male
or female, and their ethnic background.
The results of these breathing tests allow your lung
function to be compared with people who are like Spirometry measures how quickly you empty your lungs
you, but who do not have lung conditions.
Your breathing test results can be used to classify What is a gas transfer measurement?
the severity of your lung condition. Different The gas transfer measurement is a test that measures
measurements are taken to assess your lung function. how well oxygen in the air moves from your lungs
across the air sacs (alveoli) and into your blood stream,
The most common measures are:
and thus to your vital organs.
1. Forced Expiratory Volume in one second (FEV1).
This test is done by breathing into a mouthpiece
This is the maximum amount of air that can be
connected to a machine.
expelled from the lungs during the first second
of breathing out following a maximal breath in. You will be asked to breathe out as much as you can,
to take a large breath in, and to hold your breath for
2. Vital Capacity (VC). This is the maximum amount
10 seconds before breathing back into the machine.
of air that can be expelled from the lungs while
To get the best results, you will be asked to repeat
breathing out following a maximal breath in.
the test.
3. Forced Vital Capacity (FVC). This is the
This test will take about 15 minutes to complete.
maximum amount of air that can be expelled
from the lungs while breathing out forcefully. VC Typically, if you have severe COPD, your results
and FVC are equal in a normal lung but can differ will be low when compared with people who are
in patients who have a chronic lung condition. like you, but who do not have lung conditions.
9 Chapter 4: Lung function tests

What should I know before taking the gas transfer What should I know before taking the lung volume
measurement test? measurement test?
If you are on oxygen, you will be asked to take If you are on oxygen, usually you will be asked
the oxygen off for a few minutes before the test. to come off the oxygen during the test.
If you suffer from claustrophobia in small spaces,
What is a lung volume measurement?
let the operator know. They may ask you to
The lung volume measurement is a test that attempt the test as most people can do the test
measures the amount of air in your lungs. There even if they have claustrophobia.
are three measurements, which are taken:
At the end of a normal breath.
When you have taken in a deep breath.
When you have blown out all the air.
No matter how hard you try, when you have blown
out all the air, there is still some air left in your lungs.
It is this amount of air that is left in the lungs that
is measured.
Lung volumes are measured in a machine called a
body plethysmograph, which is like a box with glass
walls. This test is done in a box because very small
pressure changes need to be measured while you
are breathing.
During the test, you will sit in the box with the door
closed and breathe through a mouthpiece attached
to the machine.
You will be instructed to breathe normally through
the mouthpiece. However, every now and then, you
will be asked to breathe against a blockage and to
also breathe all the air out and then take a large
breath in. The test will take approximately 10 minutes
to complete.
Typically, if you have COPD, your lungs will be a lot
bigger than normal because of the amount of air Lung volume measurement measures how much air
trapped in your lungs (hyperinflation). is in your lungs
5
Your role in managing your

chronic obstructive pulmonary disease

The important role you have in managing your chronic obstructive pulmonary disease (COPD).
How to develop and get the most from your management plan.
How to work with your health care team.
What is the important role you

Studies show that people involved in
have in managing your COPD?
managing their COPD feel less breathless
Chronic conditions are becoming one of the greatest and more in control.
health challenges worldwide. For people living with
a chronic condition, life can be a daily struggle.
Many people who are first diagnosed with COPD Effective management of COPD is based on a
report feeling confused and worried. Others say partnership between you, your carer and family,
that they are relieved to have an explanation for and your health care team. The following list is
their breathlessness and other symptoms. based on the Flinders Program, Flinders Human
We do know that COPD can seriously affect every Behaviour and Research Unit, Flinders University,
part of your life, particularly as the disease progresses. Adelaide, SA. You can take an active role in this
Simple activities you once took for granted, such partnership by:
as taking a walk or getting dressed can become Knowing as much as you can about COPD,
increasingly difficult. Exacerbations or flare ups including your diagnosis and problems associated
(when you have an acute worsening of your with your diagnosis.
symptoms) can further affect your quality of life.
Being actively involved in decision making and
The good news, however, is that there is a lot you the development of a management plan with
can do to slow down the worsening of your symptoms, your health care professional. This includes a
improve your fitness and prevent flare ups. written COPD Action Plan to help recognise
when you are getting sick and what you can do
Better Living with COPD is written to help guide you
about it. Developing a written COPD Action
through the steps you can take to help yourself.
Plan is discussed in more detail in chapter 9.
Recent studies show that positive results can be
achieved by people with chronic lung conditions, Developing and following a management plan
such as COPD, who are involved in managing their agreed between you and your health care team
own condition. People have reported feeling less that includes your medications as well as other
breathless, feeling more in control of things and important activities such as diet and exercise.
requiring fewer visits to the doctor or hospital. Monitoring your symptoms and taking action to
11 Chapter 5: Your role in managing your chronic obstructive pulmonary disease

reduce the impact of these symptoms. A sample The following are some tips that others have used
symptom diary is discussed in more detail in to help them set goals and stick to them.
chapter 9.
Set realistic goals that are important to you.
Managing the impact that COPD has on your Write your goals down and let your health care
physical, emotional and social life. team, family and friends know what they are
Adopting lifestyle behaviours that promote so they can support you to achieve them.
health, such as eating a healthy diet, getting Reward yourself when you have done well.
regular exercise and quitting smoking if you
Simplify your life as much as you can.
are a smoker.
Be kind to yourself.
Using support services that are made available
Seek support from family, friends and others.
to you.
Locate your nearest support group by contacting
The Australian Lung Foundation (phone:
How do you develop and get the most 1800 654 301). Others have found the support
from your management plan? from others in a similar situation very helpful.
When you have a chronic lung condition, you may Enrol in pulmonary rehabilitation and once,
experience difficulty managing all your treatments completed, maintain a regular exercise routine.
day after day. Support from your health care team, Ask a family member or friend to participate in
family and support groups can help you to stay your exercise and walking program, or join a
motivated and look after yourself. local exercise group such as Lungs in Action.
The Australian Lung Foundation can give you
the contact details of a group close to you.
COPD-X SELF-MANAGEMENT CHECKLIST

The following checklist is a useful tool to use when you develop a management plan with your health care
team. Later chapters of this patient guide provide more detail about all of the important steps that might be
included in your management plan.
breathing test performed (called spirometry). You

C: CONFIRM DIAGNOSIS should also have your spirometry checked regularly
to monitor the progress of your COPD. You may do
O: OPTIMISE FUNCTION this at the GPs surgery, at a specialist appointment
or in a lung function laboratory.
P: PREVENT
DETERIORATION I have had a Spirometry breathing test
D: DEVELOP SUPPORT
O: OPTIMISE FUNCTION
NETWORK AND
To improve your condition your doctor will prescribe
SELF-MANAGEMENT PLAN
treatments. These treatments may include inhaled
X: MANAGE E XACERBATIONS medications (puffers), exercises or Pulmonary

Rehabilitation (see pages 27 and 40) and treatments
for other common medical conditions that frequently
complicate COPD eg. osteoporosis. It is very important
that you use your medications correctly and as
The guidelines that are used by health professionals
prescribed and actively participate in physical activity.
in Australia to manage COPD are called the COPD-X
Plan. COPD-X is a good memory tool to remember
I understand my medications and what each is
the things that need to be done to manage your
doing for me
COPD well. In this booklet we have provided you
with a checklist using this same memory tool. It I have had my inhaler technique assessed
is different from the one your doctor uses, but (regularly) and learnt how and when to use
essentially the important steps are the same. Using my medications properly
the same checklist or tool as your health care team
can help you and your team communicate with I have been referred to a Pulmonary
each other better. Rehabilitation group
I regularly exercise
C: CONFIRM DIAGNOSIS
I have discussed my other medical problems with
By now your doctor will have informed you that
my doctor and other members of the COPD team
you have COPD.
To confirm your diagnosis and to assess the severity I have had regular health checks with my doctor
of your COPD it is important that you have a to monitor my signs and symptoms

P: PREVENT DETERIORATION I have discussed establishing an advanced

COPD is a progressive disease. However, there are a health care directive with my doctor (for
number of things you can do to prevent your COPD further information see chapter 21)
from getting worse. The most important of these is
to stop smoking if you have not already done so. In
addition to this you should ensure you get yearly X: MANAGE EXACERBATIONS (FLARE UPS)
vaccinations against the influenza flu virus. All people with COPD are at risk of exacerbations or
flare ups of their condition. A very important goal of
I have successfully stopped smoking your COPD management is to prevent flare ups or if
they do occur treat them early to prevent them from
If you are a current smoker: getting worse. A written COPD Action Plan can help
you identify flare ups and provides you with instructions
I have discussed stopping with a member about how to manage them at an early stage of
of my COPD team worsening illness.
I know how to start a quit plan My doctor and I have developed a written COPD
Action Plan
I am aware of the medications that can
help me stop smoking I am aware of the signs and symptoms
of a flare up
I have had my yearly flu vaccination
I know how to increase my treatment
I have had my pneumococcal vaccination during a flare up
I have medication or prescriptions at home

D: DEVELOP SUPPORT NETWORK AND to start my Action Plan
SELF-MANAGEMENT PLAN
I know how long to increase my treatment
Self-management support involves education by during a flare up
health care staff to assist you in increasing your
skills and confidence in managing your COPD. I know when to call for assistance
Members of the health care team including your (ambulance or hospital)
specialist, GP, nurse, physiotherapist or pharmacist
are there to help you become a good self-manager.
Using this checklist can help you and your
I have developed supportive partnerships health care team communicate about how
with my health care team you can achieve your goals.
My health care team and I have developed

a written management plan to assist me in
managing my health better
How do you work with your The Australian Lung Foundation has developed a
health care team? helpful fact sheet called, Talking to your doctor about
COPD. It can be found at www.lungfoundation.com.au
Your doctor looks after your health together with a or call 1800 654 301.
range of other health care professionals, such as
your nurse, pharmacist or physiotherapist. Good In summary
communication with all the members of your health Learning to live well with a chronic condition is
care team will help you to look after your health. It possible. Coping with a chronic condition involves
is easy to get flustered or confused when talking to skills training, learning to manage a number of
a doctor, especially if he or she uses words or symptoms, and consciously assessing and making
terms that you are not familiar with. However, it lifestyle changes. Experience has shown that those
is important that you understand exactly what they who develop a management plan with their health
are saying. It is also important that your doctor care team and follow it can live better with COPD.
understands what is important to you.
The following chapters will provide all the details
Your COPD may also change over time. As different you need as you think through and develop a
symptoms occur, you will need to recognise these management plan, including:
changes and talk to your health care team about
adapting to these changes. Stopping smoking and preventing a relapse
(Chapter 6)
The following are some tips you might find useful
Knowing your medication (Chapter 7)
when you are visiting your doctor.
Using your inhalation devices (Chapter 8)
Make appointments with the same doctor,
Preventing and managing a flare up (Chapter 9)
except in an urgent situation or when your
normal doctor is not available. Introduction to pulmonary rehabilitation
(Chapter 10)
Make a list of questions and concerns before
your visit. List these in order of priority. Exercise and physical activity (Chapter 11)
If you have many questions, ask for a longer Breathlessness, breathing control and energy
appointment or schedule a second visit. conservation (Chapter 12)
Show your list to your doctor and decide Airway clearance: Keeping your lungs clear
together what you will discuss during this visit. (Chapter 13)
Do not avoid asking questions because you are Home oxygen therapy (Chapter 14)
embarrassed or uncomfortable. Your doctor is Healthy eating (Chapter 15)
there to help you. COPD and swallowing (Chapter 16)
Bring a friend or family member for support. COPD and other related conditions (Chapter 17)
If you feel you do not fully understand what Managing stress, anxiety and depression
your doctor is saying, ask for further explanation. (Chapter 18)
Ask your doctor to write answers down for you Intimacy and COPD (Chapter 19)
to refer to again.
Travel and COPD (Chapter 20)
Find out the best way to contact your doctor in
Legal Issues (Chapter 21)
case you have additional questions or if you are
concerned about symptoms or suspect a flare up. Community support services (Chapter 22)
Let your doctor know if you have concerns over Frequently asked questions (Chapter 23)
the costs of your treatment. They can help you Resources and support available from
find the best solution. The Australian Lung Foundation (Chapter 24)

6
chapter
Stopping smoking and preventing a relapse

Why it is important to stop smoking.
What nicotine addiction is.
Why you shouldnt use nicotine to cope with stress.
The options available to help you stop smoking.
Why is it important to stop smoking? in their brains that were once hooked on nicotine.
Many people with COPD have already been able These receptors lie dormant, waiting to be turned
to stop smoking. If that is you, congratulations! on again by just one cigarette. If these receptors are
turned on again, the addiction cycle can start again.
Stopping smoking is important because it is the
single most important step in slowing the progression As a result, people who relapse and make another
of chronic obstructive pulmonary disease (COPD). attempt to stop smoking can, once again, experience
the unpleasant symptoms of nicotine withdrawal.
Tobacco smoking is responsible for over 19,000 deaths
These symptoms include strong cravings or urges
in Australia each year and is widely regarded as the
to smoke, anxiety, agitation and depression.
most common preventable cause of chronic conditions.
Although many ex-smokers report being able to
Smoking is the major cause of COPD.
remember how much they enjoyed smoking, the
actual physical addiction to nicotine is no longer
Quitting smoking has the added benefit of active. Fortunately, just having these thoughts doesnt
protecting those around you from exposure to mean you will have cravings or urges to smoke.
second hand smoke. There is an established The important message for many ex-smokers is that
link between exposure to second hand smoke stopping smoking is a lifelong process, rather than
and the risk of developing lung disease such an isolated event. For the majority of smokers who
as COPD, asthma and lung cancer. were once heavily nicotine-dependent, the potential
for relapse continues to be a lifelong possibility.
What is nicotine addiction? Unfortunately, no scientifically proven method to

prevent relapse currently exists. A significant number
Nicotine addiction is now recognised as a medical
of ex-smokers relapse even after they have not
condition, rather than a bad habit.
smoked for more than one year.
As such, people who were once heavily addicted
Dont be tempted to try just one cigarette to see if
to nicotine have the potential to relapse to this
you still like smoking. Most ex-smokers will still like
disease-like state and become a smoker again.
smoking if they try it. There is a high risk that just
People who stop smoking still have the receptors one cigarette could cause you to start smoking again.
Why shouldnt you use nicotine

to cope with stress? Stopping smoking is the best action you can
take that can slow down the progression of
Stressful events can cause ex-smokers to start
COPD. Stopping smoking is a lifelong process.
smoking again. We are all different and some of us
will require assistance, counselling or support to
help cope with lifes difficulties. These difficulties
can include the loss of a loved one, anxiety
What options are available to
regarding family members, financial stress or
sometimes stress for no particular reason. help you stop smoking?
As mentioned previously, stopping smoking is the
The nicotine delivered in tobacco smoke can act
single most important treatment for people who
like an anti-depressant and anti-anxiety drug. When
have COPD. There is no better time than now to
people return to smoking after a stressful event, they
seek help with your nicotine addiction.
are either deliberately or inadvertently using nicotine
as a medicine. However, the carbon monoxide, tar Smokers who have COPD have even more reason
and cocktail of chemicals that are also contained in to quit. Although lung function declines gradually
the tobacco smoke continue to damage the persons with age, this process is accelerated by smoking.
lungs and entire body. A 45-year-old smoker who stops smoking now will
experience a less rapid decline in their lung function
If you are having difficulty coping with a stressful
and ability to do activities than if they continued to
event, seek professional assistance from your GP,
smoke until 65 years of age. This example is
who can make referrals to counsellors or psychologists.
illustrated in the following diagram.
The option of prescribed anti-depressant or
anti-anxiety medications can also be discussed.
Smoking causes lung function to worsen at a faster rate

FEV1(% value at age 25 years)
Age (years)
Quitting smoking at any age is beneficial to your health
Adapted from Fletcher C. Peto R, Br Med J 1977; 1:1645-8.
17 Chapter 6: Stopping smoking and preventing a relapse

There is plenty of information available that describes

the damaging health effects of cigarette smoking.
However, this information is not always enough to
prompt cigarette smokers to stop smoking. For people
who have COPD, smoking is no longer just a risk
factor for chronic conditions; the chronic condition is
already a reality.
Smokers who have COPD and who are motivated
to stop smoking have a number of options available
to help them stop smoking. These options include
the following:
1. Cold turkey Going cold turkey (stopping
immediately without any support) is difficult.
Evidence shows that the best results are achieved
when medicines are used in combination with
counselling and support. The best quitting results are achieved when
medicines are used in combination with
2. Nicotine Replacement Therapy (NRT) NRT is counselling and support.
a medicine that can help smokers stop smoking.
It provides the body with a small amount of
nicotine without the toxic chemicals received by
NRT is safe to use in combination, for example
smoking a cigarette. If you are thinking about
with a patch or oral product such as nicotine
using NRT, you may wish to consider the
gum, lozengers or inhalers. An NRT patch is
following points:
used as base therapy and any form of oral NRT
People often report being worried about some is used to treat craving/urges through the day.
of the precautions and warnings associated Smokers need to have the confidence to use
with the use of NRT that are contained in the enough NRT to treat their cravings. Remember,
product information. from very early on, smokers have learnt to be
You should know that the nicotine in NRT is experts at satisfying their cravings by getting
provided in a very small dose and is delivered enough nicotine by the way they smoke.
very slowly to the body. Nicotine is the least Make sure you are getting enough NRT!
harmful part of a cigarette. NRT is safe to use while still smoking. In fact
All the warnings about heart, lung, vascular it has been shown that a smoker receives
disease and cancer contained on cigarette fewer poisons from a cigarette if NRT is being
packets are related to the detrimental effects used and at the same time can make a
of carbon monoxide, tar and the lethal cigarette less enjoyable/less rewarding to the
chemicals contained within cigarettes. brain. Therefore, there is no need to quit on
Nicotine is a drug of addiction and not a the same day that you start using NRT.
major cause of physical disease. Using NRT is the safest way to reduce smoking
You should be aware that any potential side before quitting and has been shown to help
effects from the use of NRT are outweighed people who at first were not ready to quit.
by the very real dangers of continued Speak to your pharmacist or health care
cigarette smoking. professional about how to use NRT.
The precautions and warnings contained in Since February 2011, NRT patches have
the product information of NRT packages been available on prescription subsidised on
have recently been amended to reinforce that the PBS for 3 months per calendar year. It
it is always more dangerous to keep smoking also continues to be available for purchase
than it is to use NRT. over the counter without a prescription.
3. Medications that work on brain nicotine receptors programs are particularly helpful for people who
There are medications that work on brain receptors have established disease conditions, such as
that are available as prescription medicines. These COPD. These programs can help people make
have been specifically designed to help smokers the appropriate behavioural or environmental
stop smoking and have good success rates. You changes that are required to stop smoking. Studies
may wish to discuss with your GP your suitability have shown that clinics that offer professional
for these types of medications. behavioural support and advice on effective NRT
use can help people stop smoking. Quit rates are
The most widely known drug in this category is
highest in people who combine counselling
Varenicline or Champix which is available by
support and take smoking cessation medication.
prescription on the PBS. Champix is a tablet
prescribed for 12 weeks and if a smoker quits it There is no time like now to quit smoking!
is available for a further 12 weeks immediately Please ask for a referral to a clinic or a smoking
following the first course. This is in an attempt counsellor who can help you stop smoking and
to keep the brains nicotine receptors asleep. dont give up giving up!
Another medication in this category available Preventing a relapse
on the PBS is Bupropion or Zyban. It is also
Unfortunately there is no clear evidence that supports
a tablet which works on the brains receptors and
any method of staying smoke free once you have quit.
has been used as a smoking cessation medication
for many years. In the past there were some myths The best defence is the knowledge that smoking
in the media about Zyban being unsafe, however, cessation is a journey and not a single event. Nicotine
these are untrue. This treatment is an effective receptors in the brain can be switched off during
option for smokers wishing to quit. It is not suitable the quitting process, but as little as a few puffs of
for people who are taking anti-depressant a cigarette, months or years later will switch them
medication or who have a history of seizures. back on. When this occurs most people will find
themselves addicted smokers again.
Speak to your doctor about whether any of these
options are suitable for you.
4. Stop smoking clinic programs Participating For support to quit smoking, call the
in a clinic program can give you the advice and National Smoking Quitline on 13 78 48.
support required to help you stop smoking. These
Stay away from that

one cigarette!
19 The State
Chapter 6: Stopping smoking and preventing a relapse
of Queensland (Queensland Health) and The Australian Lung Foundation 2012 19
7
chapter
Knowing your medication

Why medications are used in the management and treatment of chronic obstructive
pulmonary disease (COPD).
What the categories of medication are.
What the uses, effects and side effects of your medications are.
Why are medications used in the cause side effects, it is important to remember that
management and treatment of COPD? only a small number of people using that medication
will develop side effects.
To improve or manage your COPD symptoms, your
doctor may have prescribed various medications. As respiratory medications target the lungs, most
Although medications cannot cure COPD, when COPD medications are inhaled using special inhaler
used as prescribed, they can go a long way towards devices so that the medication is delivered directly
reducing your symptoms and preventing flare ups. to the lungs. Correct technique is important in
As each persons health is different, each person delivering your medication effectively. To ensure you
may be prescribed different medications at different are receiving the full benefits from your medication,
doses your medication program is tailored have your inhaler technique checked regularly by
especially for you. your doctor, pharmacist or respiratory nurse.
For each different medication that you are prescribed,

make sure you understand:
What the medication is for.
How the medication works.
How to take the medication.
How long the effects of the medication last.
What the possible side effects of the medication
are and how you can avoid them.
If the medication will cause problems with
your other medications.
If you are confused or unsure about any of the
information provided in relation to these points,
you should ask your doctor, respiratory nurse or
pharmacist to explain. You should be confident and
informed about your own condition, including the
medication you use. Although each medication may
Categories of COPD Medication

As the severity and symptoms of your COPD increase, your doctor may prescribe additional
medication. Increasing symptoms include more breathlessness, cough and sputum. As severity
increases the frequency of flare ups or infections increase.
Reliever Maintenance Preventer Flare up

medication medication medication medication
For quick relief For regular, long For regular, long For short term
of breathlessness. term use to control term use, in more use during a flare
Also called rescue symptoms and severe COPD (If you up of COPD.
medication. to help prevent experience frequent
flare ups. flare ups).
Vaccinations: Annual influenza vaccine and pneumococcal vaccine according

to Immunization Handbook.
What are the types of medication? your symptoms worsen or you experience more
frequent flare ups, your doctor may prescribe
There are four main categories or groups of medication
additional medications for maintenance and
you may be prescribed (see diagram above). You
prevention. Some patients find themselves on three
will notice that some of your medications may fit
different medications, each with its own inhaler.
into more than one of these categories depending on
This is normal, however, it is important that you
your situation:
understand the role of each of your medications
1. Reliever medication for quick relief of increasing and you take them properly.
symptoms of breathlessness.
The majority of medications for people who have
2. Maintenance medication for long term regular
COPD are listed on the Pharmaceutical Benefits
use to control your symptoms and to help prevent
Scheme (PBS) and require prescriptions from a
flare ups.
doctor. However, Ventolin and Bricanyl are
3. Preventer medication, including combination available over the counter without a prescription,
medications for long term regular use when but will cost more than through the PBS.
COPD becomes more severe and you experience
several flare ups.
4. Flare up medication for short term use during
All medications come with Consumer Medicine
an acute flare up of your COPD symptoms.
Information. Ask the dispensing pharmacist if
When you are initially diagnosed with COPD, your you have any concerns or dont understand
doctor may start you on a reliever medication and what is included in the information.
then, if the severity of your disease progresses and
21 Chapter 7: Knowing your medication

What are the uses, effects and side effects of your medications?
Reliever or bronchodilator medications
Reliever medications should be used for symptom relief as a rescue medication for the relief of breathlessness.
They are called short-acting (because they work quickly) bronchodilators. They work by relaxing the muscles
around the breathing tubes or airways. This helps to open up the breathing tubes or airways which reduces
the obstruction and allows air to flow out of and into the lungs when you breathe easing your feelings of
breathlessness and increasing your ability to exercise. Relievers often work within minutes of inhalation and
their effects last for several hours.
There are two types of reliever or bronchodilator medications: short-acting beta2 agonists and short-acting
anticholinergics (or muscarinic antagonists).
1. Beta2 agonists (short-acting) 2. Anticholinergic (short-acting)
Bricanyl Ventolin Atrovent
> Terbutaline (Bricanyl) given by a Turbuhaler > Ipratropium bromide (Atrovent)

and sometimes by a nebuliser.
Use
> Salbutamol (Asmol, Airomir, Ventolin) Has a slower onset than short-acting
given by a spacer and puffer and sometimes beta2 agonists, but it lasts longer.
a nebuliser.
Effects
Use Relaxes smooth muscles in your lungs and
Always carry a short-acting reliever with opens up breathing tubes or airways in a
you for unexpected situations or when doing different way compared with beta2 agonists.
exercise such as attending a pulmonary
It helps improve quality of life and
rehabilitation program.
breathlessness.
If you are using more than your prescribed
Lasts for up to six hours.
dose and your condition is getting worse,
you should see your GP as you may require Side effects
a longer lasting inhaler. Minor adverse effects such as dry mouth,
urinary retention and blurred vision are common.
Effects
Has been shown to increase risk of
Lasts for up to four hours.
heart problems.
Works within minutes to relieve symptoms.
Should NOT be used in conjunction with Spiriva.
Can be taken prior to exercise if needed.
Maintenance medications
Maintenance inhalers are bronchodilators too, since they open up the breathing tubes or airways by relaxing
the muscles around the breathing tubes or airways in the same way that relievers do. Most maintenance
bronchodilators take a little longer than relievers to start working, but once you have taken them, their effects
last for much longer, for 12 hours to 24 hours depending on the medication.
Maintenance medications include short and long-acting anticholinergics (or muscarinic antagonists) and
long-acting beta2 agonists (or bronchodilators) will help to reduce your COPD symptoms in the long term and
can help to prevent flare ups.
All maintenance inhalers work in one of two different ways to relax the muscles around the breathing tubes
or airways. You can be prescribed one type alone, or may receive a combination of both types.
1. Anticholinergic (long-acting) 2. Beta2 agonists (long-acting)
Indacaterol (Onbrez)
> Eformoterol (Oxis, Foradile)

> Salmeterol (Serevent)
Spiriva
> Indacaterol (Onbrez)
> Tiotropium (Spiriva)
Use
Use Do not use to treat an acute situation (use a
Inhale once daily only. short-acting reliever instead).
Use with the HandiHaler; the capsule Should be taken twice a day (morning and
should not be swallowed. night) except for Onbrez which is taken
Should not be used in conjunction with Atrovent. once a day.
Effects Effects
Relaxes smooth muscles in your lungs and Relaxes smooth muscles in your lungs.
opens the breathing tubes or airways. Improves your lung function which can improve
Lasts for up to 24 hours. your quality of life.
Improves your lung function which can improve Onbrez lasts up to 24 hours and is fast acting.
your quality of life. Serevent takes 10 to 20 minutes to take effect
Helps to prevent flare ups. and lasts up to 12 hours.
Side effects Oxis is fast acting and long lasting, that is up
Dry mouth, urinary retention and blurred vision. to 12 hours.
Use with caution if you have a prostate problem. Side effects
Narrow angle glaucoma. Tremor, headache and a rapid heartbeat.

3. Theophylline (Nuelin, Theo-Dur)

Use
Use twice (daily).
For use in severe COPD with frequent flare ups.
Is less often used because of the potential for
more significant side effects.
Regular blood tests may be required.
Take with food.
Available in controlled release tablet and syrup.
Effects
Theophylline relaxes the muscles that tighten or
constrict in the airways and reduces inflammation
in the breathing tubes or airways.
There are both short-acting (works for 6 hours)
and long-acting (works for 12-24 hours) forms
of theophylline.
Side effects
Theophylline can cause more frequent side effects
and therefore is prescribed less often than other
bronchodilators. If you have been prescribed
theophylline, your doctor may wish to monitor
you more closely.
Tremor, nervousness, light-headedness,
nausea and vomiting.
4. Anticholinergic (short-acting) This medication is
also discussed in the reliever section as it may be used
as both reliever and maintenance.
> Ipratropium bromide (Atrovent)
Use
In addition to being prescribed as a short-acting
reliever medication, some people are prescribed
Side effects
ipratropium bromide as a regular maintenance
Minor adverse effects such as dry mouth,
medication.
urinary retention and blurred vision are common.
Effects Has been shown to increase risk of adverse
Relaxes smooth muscles in your lungs and cardiovascular events.
opens up breathing tubes or airways in a Should NOT be used in conjunction
different way compared with beta2 agonists. with Spiriva.
It helps improve quality of life and breathlessness.
Lasts for up to six hours so should be taken
3 to 4 times a day if being used as maintenance
medication.
Preventer medications
Preventer inhalers contain corticosteroids, sometimes referred to just as steroids. These steroids are effective
in COPD and are different from anabolic steroids. In more severe COPD, these medications help to reduce the
number of flare ups people may experience by reducing inflammation which causes swelling and sputum
production in the breathing tubes or airways. They are especially important to use if you also have asthma as
they specifically treat the type of inflammation or swelling that commonly occurs in asthma. Preventers must
be taken twice a day every day to be effective. It may take up to a few weeks for you to start noticing their
effect. So, it is important for you to keep taking them to have an impact on your symptoms.
1. Inhaled corticosteroids for people with moderate to severe COPD who have
had two or more flare ups over the previous year.
Combining medication like this can help to reduce
the number of flare ups which in turn improves lung
function and overall health. In addition, combined
medications are easier to use since they are available
in one inhaler for two different medications. They
are prescribed twice daily.
Combination inhalers
include:
i. Budesonide and
eformoterol (Symbicort)
QVAR Pulmicort ii. Fluticasone and
salmeterol (Seretide)
> Beclomethasone (QVAR) - it is recommended
delivered via Accuhaler
that this is used with a spacer.
or via a puffer and spacer.
> Budesonide (Pulmicort) - is given by a Turbuhaler.
> Fluticasone (Flixotide) - is often given as a Symbicort
puffer to use with a spacer or it may be given
by an Accuhaler.
Use
Inhaled twice a day.
Must be used regularly to be effective.
Effects
Reduces swelling and the amount of sputum
in the breathing tubes or airways.
May take up to a few weeks for you to notice
its effect.
Seretide
Side effects
A sore mouth and throat caused by a thrush Use
infection or hoarseness of the voice are the most Designed to improve patient adherence with
common side effects. To avoid these effects, use two medications in one inhaler.
a spacer when using a metered dose aerosol Improves quality of life, improves lung function,
(puffer), and rinse your mouth, gargle and spit and prevents flare ups.
after each dose. The use of long-acting bronchodilator
2. Inhaled combination medications maintenance therapy (Eformoterol, Salmeterol
or Indacaterol, see page 23) should be stopped
Sometimes inhaled steroids (preventers) are combined
once combination therapy is started.
with a long-acting bronchodilator (maintenance
inhalers) in one inhaler. This is often called Effects and side effects
combination therapy. These are usually prescribed Refer to individual medications.

Flare up medications
These medications are used when your symptoms start to worsen and you are experiencing a flare up.
These medications should be taken as detailed in your COPD Action Plan (see page 38) and will help
you to reduce the severity of your flare up.
1. Antibiotics unless advised by your doctor as patients on

Antibiotics are used to treat flare ups when longer courses of oral steroid tablets may need
sputum colour, volume and texture change. to be weaned slowly. If you have been taking the
The antibiotics chosen will depend on your oral steroid for two weeks or less, you do not
allergy status or cause of infection. need to taper the medication.
Follow the instructions when taking antibiotics.
You may need to take the antibiotic on an empty Caution should be exercised in relation to
stomach or with food. long term use of oral steroids.
You must complete the full course of your
prescribed antibiotics. Long term
2. Oral steroids Are sometimes used when inhaled steroids on
their own is not enough to prevent a flare up.
> Prednisone (Sone, Panafcort)
> Prednisolone (Solone, Panafcortelone) Effects
Reduces the inflammation in the breathing
tubes or airways.
If oral steroids are part of your COPD Action Side effects
Plan, do not delay starting prednisone or Difficulty in sleeping, weight gain, bruising
prednisolone at the onset of a flare up because easily, osteoporosis, muscle wasting, diabetes,
you are concerned about the side effects of this hypertension (high blood pressure), mood
medication. Short term use of the oral steroids disturbance and glaucoma. The risk of side
should only have minimal side effects, unless effects increase with long term use.
very frequent courses are required. Ensure that
3. Mucolytics
you have a prescription at home for use when
symptoms of a flare up appear. > Bromhexine (Bisolvon)
Use
Drinking enough water is essential before
Use
starting treatment.
Short term use of oral steroids
Available in tablet or liquid form.
To manage flare ups of COPD.
Use doses as prescribed. Effects
If it is prescribed as a daily dose take it in the Reduces the stickiness of sputum.
morning with food. Side effects
If you have been taking this treatment for more Nausea, diarrhoea and bronchospasm
than two weeks, do not stop treatment suddenly (tightening of breathing tubes or airways).
Vaccinations
1. Influenza vaccine
A yearly influenza vaccine has been shown to reduce risk of death and hospital admissions.
2. Pneumococcal vaccine
Vaccination against pneumonia (PneumoVax 23) is recommended for people at high risk of serious
pneumococcal infection, such as COPD. This should be given no more than five yearly. After two vaccinations
(over 5 years apart), you should discuss with your doctor whether further vaccinations should be given.
8
Using your inhalation devices

Why using inhalation devices is an important skill.
How the inhalation devices work.
How to correctly use the inhalation devices.
When the inhalation devices are empty.
How to clean and care for the inhalation devices.
Why is using inhalation devices Typically you should be sitting upright or standing
an important skill? while taking your inhaled medication.
Using an inhalation device is a skill. After many The inhalation devices covered in this
years of using inhalation devices, you can develop chapter include:
habits that may not allow you to make the most of 1. Puffer (or metered dose inhaler)
your inhaled medications. You may also have extra 2. Puffer and spacer
medications prescribed over time that can complicate
3. Autohaler
your treatment schedule. The more device types you
are using, the greater the chance you have of using 4. Turbuhaler
them incorrectly. If you are using more than two 5. Accuhaler
device types, talk to your doctor about reducing the 6. HandiHaler
number of device types without changing the 7. Breezhaler
medications you are on.
8. Nebuliser
Having your inhalation device technique assessed
by an appropriate member of your health care or Puffer (or metered dose inhalers)
pulmonary rehabilitation team is essential. You can A puffer is also known as a metered dose inhaler,
also check with your managing doctor, nurse or a or an aerosol.
pharmacist.
How does the puffer work?
To make the most of using an inhalation device, it
In the puffer, the medication is stored under pressure
is important to position your body appropriately.
in the metal canister. When the puffer is fired, a fine
mist of the medication is produced that can be inhaled
It is important to store your inhalation into the lungs. These devices work best with spacers
device below 30oC and do not keep it in or holding chambers (see the following section on
the car on hot days. puffers and spacers).
27 Chapter 8: Using your inhalation devices

Note: Puffers used to deliver inhaled

corticosteroids eg. QVAR, Seretide, Flixotide
(see page 25) should be dry wiped weekly.
They should NOT be washed or made wet.
Puffers for short-acting reliever medication

(Atrovent, Airomir, Asmol, Ventolin) should
be washed weekly.
Remove the metal canister (do not wash the
metal canister).
Using the metered dose inhaler
Wash the plastic casing and cap with running
How to use the puffer warm water through the top and bottom for at
1. Remove the cap. least 30 seconds.
2. Hold the puffer upright and shake vigorously. Shake off excess water and allow to completely
air dry.
3. Raise your chin and look straight ahead.
4. Breathe out gently and fully.
5. Place the puffer mouthpiece between your
teeth and form a seal with your lips.
6. As you slowly start to breathe in, fire the
canister by pressing firmly and continue to
breathe in deeply.
7. Remove the canister from your mouth and
hold your breath for 10 seconds, if possible.
8. Breathe out gently.
9. If you need to deliver an additional dose of
your medication, repeat steps 2 to 8.
10. Replace cap. Cleaning the metered dose inhaler
When is the puffer empty?

How to care for the puffer
A purple puffer is empty when the dose indicator on
When reassembling the puffer, ensure that
the back reaches zero. For other puffers, it is more
the metal canister fits securely into the
difficult to know when they are empty. If the puffer
plastic casing.
is becoming empty, the amount of and speed at
which the spray comes out is reduced, or the puffer Always keep the cap on the puffer when not
may feel empty when shaken. in use to prevent foreign objects lodging in
the mouthpiece.
If using a puffer for regular medication, you can
calculate when your puffer is likely to be empty. To Haleraid
do this, work out how many puffs per day you use
The Haleraid can assist
and divide the number of puffs in the canister
people who have difficulties
(written on the canister box) by the number of puffs
pressing the canister.
per day you use. This will tell you how many days
you can use your puffer before it needs replacing. A Haleraid can be obtained
from independent living
How to clean the puffer centres or pharmacies, and
Wiping the mouthpiece with a clean cloth is often is available in two sizes.
all that is required unless the puffer becomes soiled
or blocked. Haleraid
Puffer and spacer 4. Hold the puffer upright, remove the cap and
shake well.
Puffers (also known as a metered dose inhaler or
an aerosol) may be used with a spacer, which is 5. Place the puffer mouthpiece into the end of the
a small or large volume holding chamber. spacer opposite to the valve.
6. Place the mouthpiece between your teeth and
close your lips around it making sure your neck
is slightly tilted back.
7. Breathe out gently and slowly.
8. Activate the puffer into the spacer once only.
9. Either:
Breathe in slowly and deeply for five seconds
through your mouth, and hold your breath
for 10 seconds, if possible.
Or
Breathe in and out through your mouth
normally for four breaths.
10. Wait 30 seconds between doses and repeat
steps 2 to 9.
Using a spacer with your puffer can increase the amount
of medication that reaches your lungs
How does the puffer and spacer work?

A spacer holds the metered dose briefly before the
spray is breathed in. Using a spacer with a puffer
allows more medication to get to where it is needed
in the breathing tubes or airways. A puffer and
spacer, when used correctly, can significantly increase
the amount of medication that reaches your lungs.
A spacer can prevent throat irritation by reducing
Small volume spacer with puffer
the amount of medication sitting in your mouth or
throat. Spacers have a one way valve that stops air When is the puffer empty?
being breathed into the spacer while the spacer is
To determine when the puffer is empty, refer to the
in your mouth.
section on puffers (page 28).
If used correctly, a puffer used with a spacer is
at least as effective as a nebuliser in delivering a How to clean your spacer
similar dose of medication, that is, 4 to 10 puffs To clean the spacer:
equals one nebuliser dose. Once per month, dismantle the pieces of the
If you change the size of the spacer you are using, spacer and wash in detergent water.
particularly for preventer or combination medications, Do not rinse as the detergent helps to reduce
it is best to have the dose reviewed by your doctor. the static charge in the spacer (static causes
the medication to stick to the sides of the
How to use the puffer and spacer spacer reducing the amount of medication
1. IMPORTANT - wash the spacer before first use. delivered to the breathing tubes or airways).
2. Sit upright or stand. Allow to air dry thoroughly after washing.
3. Assemble the spacer and shake device to ensure DO NOT dry with a tea towel and DO NOT wash
that the one way valve is not stuck. in dishwasher as these increase the static charge.

Autohaler How to clean the Autohaler

How does the Autohaler work? Airomir, delivered via Autohaler, should
be washed weekly. After removing the canister,
Medications delivered via an Autohaler are
and placing it aside to keep dry, wash the
Airomir (reliever) and QVAR (preventer).
mouthpiece and cap under warm running
The Autohaler is activated by breathing in through water for 30 seconds. Allow to air dry.
the mouthpiece, which triggers the device to expel
QVAR delivered via Autohaler should NOT
the medication. The Autohaler is primed before
be washed. Dry wipe at least weekly; do NOT
use by lifting the pressure lever (the grey lever),
wash the inhaler or get it wet.
which expels the medicine into a staging chamber.
How to use the Autohaler Turbuhaler

1. Unclip the mouthpiece cover from the back How does the Turbuhaler work?
and shake (Below A).
A Turbuhaler is a device that is activated by breathing
2. Hold the Autohaler upright and click the grey in. When you load the Turbuhaler, a precise dose
lever upwards so that it stays up (Below B). of powdered medication is measured and deposited
3. Breathe out gently. into a reservoir by gravity. Therefore, it is important
that you hold the Turbuhaler upright when you
4. Place the Autohaler between your lips to form a load it.
seal (do not block the air vents with your hands).
When the Turbuhaler is placed in your mouth and
5. Tilt head back and breathe in with a slow, you breathe in, air is drawn through vents on the
deep steady breath dont stop when you side of the Turbuhaler. This causes the air in the
hear the click. Turbuhaler to become turbulent. This turbulence
6. Hold breath for 10 seconds, if possible. breaks up the powdered medication into very fine
particles. As you breathe in, these very fine particles
7. Breathe out gently. are able to go further down the breathing tubes
8. Push the grey lever down. or airways.
9. Wait 30 to 60 seconds between doses.
Fine particles
10. If another dose is required repeat steps 2 to 8. of powdered
11. Replace mouthpiece cap. medication that
can be breathed in
A B Mouthpiece
Indicator window
Air vents
A. Remove the cap and hold the Autohaler upright.
B. Push the lever up until it clicks and stays up.
When is the Autohaler empty?

The Autohaler is empty when you do not hear
any medication being delivered. To test if the
Turning grip
Autohaler is empty, lift the lever, slide the lever
on the bottom of the Autohaler across; if the
Autohaler does not fire, it is empty. The Turbuhaler
How to prime a new Turbuhaler On other Turbuhalers, a red line will appear at
Before you start to use a new Turbuhaler you the top of the indicator window on the side of the
need to prime it. device, which indicates that 20 doses are left (this
is a good time to organise a new device). When
1. Remove the cap. the red line appears at the bottom of the window,
2. Hold the device upright and twist the base left the Turbuhaler is empty.
and right as far as it will go. You will hear a click.
How to clean the Turbuhaler
3. Repeat step 2 one more time. Wipe the inhaler with a clean, dry tissue after use.
The Turbuhaler is now primed. To use the

Do not wash any part of the Turbuhaler or
Turbuhaler, follow the instructions below. get it wet.
How to use the Turbuhaler How to care for the Turbuhaler

1. Remove the cap. Do not breathe into the device as the medication
2. Hold the device upright and twist the base left is a dry powder.
and right as far as it will go. You will hear a click. Do not expose to water (keep the cap on tightly
to prevent moisture entering the device).
3. Breathe out gently away from the Turbuhaler.
The powder you hear when you shake the
4. Place the mouthpiece between your lips and form device is NOT medication, it is a drying agent.
a seal (do not put your lips over the air vents on
The medication is inhaled directly into the lungs;
the side of the Turbulaher).
therefore, you may not feel or taste anything.
5. Hold the coloured part of the Turbulaher
(to make sure the air vents are not covered).
Accuhaler
6. Breathe in forcefully and deeply through
your mouth. How does the Accuhaler work?
The Accuhaler is a breath activated device that
7. Remove the Turbuhaler from your mouth
contains a hidden foil strip that has 60 regularly
and hold your breath for up to 10 seconds,
spaced doses of medication.
if possible, before breathing out.
8. If another dose is required, repeat steps 2 to 7.
9. Replace the cap.
Indicator
20 doses window
left
Empty
Accuhaler
How to use the Accuhaler

1. Check the window that indicates the number
of doses left.
Determining when the Turbuhaler is empty 2. To open, hold the base of the Accuhaler
horizontally in one hand; place the thumb
When is the Turbuhaler empty? of the other hand in the thumb grip and push
the thumb grip around as far as possible.
The Symbicort Turbuhaler (red base) has a counter
that counts down to zero (in twenties). When the 3. With the Accuhaler held horizontal, push the
counter is at 0, the device is empty. lever around until it clicks. The number indicator
reduces by one.

4. Breathe out gently away from the Accuhaler. HandiHaler

5. Put the mouthpiece between your teeth and How does the HandiHaler work?
lips to form a seal.
The HandiHaler is activated by breathing in
6. Breathe in steadily and deeply through your mouth. through the mouthpiece. When loaded, a capsule
(containing the medication) inside the HandiHaler
7. Hold your breath for about 10 seconds, if possible.
is pierced, allowing the medication to be inhaled.
8. Remove the Accuhaler from your mouth.
How to use the HandiHaler
9. Breathe out away from the Accuhaler.
1. Have the HandiHaler and capsules ready for use.
10. If another dose is required, repeat steps 3 to 9.
2. Open the dust cap by pressing the green
11. To close the Accuhaler, put your thumb in piercing button.
the thumb grip and slide it until the cover
clicks in place. Dust cover
Mouthpiece
The Accuhaler is empty when the dose counter Centre
indicates zero. chamber
Green
piercing
When is the Accuhaler empty? button
The Accuhaler is empty when the dose counter Base
on the top indicates zero. The last five doses will 3. Open the mouthpiece by pulling upwards.
appear in red.
4. Peel the foil back carefully to expose only
How to clean the Accuhaler one capsule.
Wipe the inhaler with a clean, dry tissue 5. Remove the capsule from the foil and drop
after use. the capsule into the centre chamber.
Do not wash any part of the Accuhaler
6. Firmly close the mouthpiece, leaving the
or get it wet.
dust cap open.
How to care for the Accuhaler
Keep your Accuhaler dry.
Mouthpiece
Keep your Accuhaler closed at all times.
Green
piercing
button
Air intake
valve
7. Press the green button once to pierce the

capsule, and then release the green button.
8. Breathe out gently away from the HandiHaler.
9. Put the mouthpiece between your lips to form
a seal, making sure not to block airway vents
with your fingers.
10. Breathe in slowly and deeply (enough to hear or
feel the capsule vibrate) and fully through your
mouth, keeping your head in an upright position.
Breezhaler
How does the Breezhaler work?
The Breezhaler is activated by breathing in through
the mouthpiece. When loaded, a capsule (containing
the medication) that has been pierced inside the
Breezhaler allows the medication to be inhaled.
How to use the Breezhaler

1. Have the Breezhaler and capsule ready for use.
11. Hold your breath for about 10 seconds,
2. Pull off the cover/cap.
if possible.
3. Open the inhaler by holding the base firmly and
12. Remove the HandiHaler from your mouth.
tilt the mouthpiece.
13. Breathe out away from the HandiHaler.
4. Remove one capsule from blister pack with dry
14. Repeat steps 8 to 11 to completely empty the hands (always keep capsules in blister pack
capsule. Do not pierce capsule a second time. until use), and insert into base of the inhaler.
When is the HandiHaler empty?

When you have run out of capsules, you will have
no more medication. The HandiHaler should be
replaced yearly.
How to clean the HandiHaler

Once a month, you should:
Open the dust cap.
Open the mouthpiece.
Open the bottom part by pressing
the green lever in and up.
5. Close the inhaler fully. You should hear a click

as it closes fully.
6. Hold the inhaler upright. There are two blue
buttons at the base of the inhaler. Press both
of these buttons fully, one time. You should hear
a click as the capsule is being pierced. Then
release the buttons. DO NOT PRESS THE
PIERCING BUTTONS MORE THAN ONCE.
Rinse under warm water to remove 7. Breathe out gently away from the device.
dry powder. 8. Place the mouthpiece in your mouth and form a
Shake out excess water. seal with your lips around the mouthpiece. Hold
Leave to air dry for 24 hours with the the inhaler with the buttons to the left and right
HandiHaler open. (not up and down).
Dry the outside with a clean cloth, if needed. 9. Breathe in rapidly and steadily, as deeply as
Remember that as the HandiHaler takes 24
you can.
hours to dry, you should wash it immediately You should hear a whirring noise, which is
after a dose to ensure that it is completely dry the capsule spinning in the chamber. If you
before the next dose. dont hear the noise, the capsule may be

stuck in the cavity. If this occurs, open the

inhaler and carefully loosen the capsule by
tapping the base of the device. Do not press
the piercing buttons to loosen the capsule.
10. Continue to hold your breath as long as is
comfortable up to 10 seconds. Then breathe out.
11. Most people are able to empty the capsule with
1 or 2 inhalations. You can check this by
opening the inhaler to see if any powder is left
in the capsule. Repeat steps 7 to 10 if needed.
12. Remove capsule and discard, close the inhaler
and replace the cap.
You may experience a sweet taste as the medication Nebuliser Machine
goes into your lungs.
Some people occasionally cough soon after inhaling How to use the nebuliser
the medicine. If you do, dont worry, as long as the 1. Assemble clean dry equipment (face mask
capsule is empty you will have received the full dose. or mouthpiece, nebuliser bowl, tubing and
Do not store capsules in the Breezhaler. nebuliser pump).
2. Place pump on a firm flat surface.
How to clean the Breezhaler
Clean your inhaler once a week. 3. Ensure the two halves of the nebuliser bowl
are connected.
Wipe the mouthpiece inside and outside
to remove any powder with a clean, 4. Fill the nebuliser bowl with the required amount
dry, lint-free cloth. of medication.
Do not wash your inhaler with water. 5. Connect the tubing and the mouthpiece or face
Keep it dry. mask to the nebuliser bowl.
Do not take the inhaler apart.
6. Put the facemask on or the mouthpiece in your
mouth, and turn the machine on.
Nebuliser
7. Sit upright and breathe normally until the nebuliser
How does the nebuliser work? starts to splutter and the amount of vapour
Medications delivered by inhalers are an effective, coming out is minimal (usually 10 minutes).
easy and convenient way to deliver the correct
8. Switch the machine off when finished.
amount of medication into your breathing tubes or
airways. Most people with COPD can effectively How to clean the nebuliser
use their inhalers to manage their conditions. After each use, rinse the nebuliser bowl and
This is preferred as inhalers are more practical, the facemask or mouthpiece.
convenient and are less likely to cause infection.
Ensure that the nebuliser parts are completely
However, if you cannot use your inhalers correctly dry before storage (liquid left in the bottom of
a nebuliser might be prescribed. the nebuliser bowl is an ideal site for germs
In a nebuliser, pressurised air is pumped through to grow).
liquid to form a fine mist that is inhaled through Do not wash the tubing. You may remove the
a face mask or mouthpiece. The pump is usually mask and bowl from the tubing and turn the
driven by electricity; some pumps may be driven nebuliser on to blow air through the tubing.
by a battery or 12 volt car batteries. This can reduce any condensation in the tubing.
A mouthpiece stops the medication going into the eyes Replace the tubing if it is discoloured or there
and on the skin which sometimes causes irritations. is any sign of mould.
Each week, soak the nebuliser bowl and the the bowl called a baffle (sometimes the baffle
mouthpiece or facemask in half vinegar and is missing, and if so, the bowl will need to
half water, rinse and allow to air dry. be returned).
Replace your nebuliser tubing, bowl and face The filter on the nebuliser pump may need to
mask or mouthpiece every three months. be replaced occasionally. See the manufacturers
manual for how often the pump may need
replacing.
Correct cleaning of your nebuliser will reduce
the risk of chest infections. Have the nebuliser pump checked annually for
correct airflow and pressure by the company
that sold you the nebuliser or by your local
How to care for the nebuliser pharmacy.
Inspect the nebuliser bowl and tubing for cracks, If nebulising Atrovent or Pulmicort, the use
and if cracks are found, replace. of a mouthpiece is preferable. If you do not
Nebuliser bowls have a limited life span. Check use a mouthpiece, the use of eye protection
the manufacturers manual for the expected life is advisable.
span of your nebuliser bowl. Ensure you rinse your mouth and face afterwards.
If you have acquired a nebuliser bowl through
a hospital, it will only last one to three months
and should be replaced (check manufacturers Nebuliser bowls have a limited life span.
recommendations). Check manufacturers manual for expected
If you have a new nebuliser bowl and it is not life span.
working, check for an extra piece of plastic in

9
chapter
Preventing and managing a flare up

What an exacerbation or flare up is.
How to monitor your symptoms and avoid having a flare up.
What to do when you become sick.
How to develop and use a written COPD Action Plan to manage a flare up.
What is an exacerbation or flare up? How can you monitor your symptoms
All people with chronic obstructive pulmonary disease and avoid having a flare up?
(COPD) are at risk of having an exacerbation or There are several possible triggers that can cause a
flare up. flare up. Some people are particularly susceptible to
A flare up is what happens when your COPD gets certain ones. These triggers include:
worse. Flare ups can become serious and you may Respiratory infections, such as a cold or the flu.
even need to go to hospital. It is important for you to Smoke.
understand how to avoid having a flare up, what the
Pollutants such as dust, wood smoke or smog.
signs and symptoms of a flare up are, and how you
can minimise their impact. Other unknown causes account for about one
third of all flare ups.
Some of the typical signs and symptoms of a flare
up are one or more of the following: There are things you can do to avoid getting a flare up:
More wheezy or breathless than usual. Develop a written COPD Action Plan with your
doctor and know how to use it (see page 38).
More coughing.
Learn what the triggers are that make your
More sputum than usual.
COPD worse and how to avoid them.
A change of colour in your sputum.
Stay inside on particularly cold or hot days
Loss of appetite or sleep. if possible.
Less energy for your usual activities. Avoid second hand smoke.
Taking more of your reliever medication Avoid strong cleaning products or
than normal. strong perfume.
Make sure you get the flu vaccination
every autumn.
COPD Action Plans aim to help you recognise
a flare up earlier and provide instructions on Make sure that you are vaccinated to protect
how to act to reduce the severity and duration you from pneumonia (see page 93 for details).
of your illness. Take your medications regularly and as
prescribed by your doctor.
37
COPD Symptom Diary
The common symptoms of COPD are shortness of breath, persistent cough, coughing up sputum, and wheezing. Use this diary to track your symptoms on a daily basis.
Take this table when you go to visit your doctor. This will help to manage your COPD.
Symptoms Better / worse / more

How often? When?
Date (shortness of breath, persistent cough, Comments
(3 times a day) frequent then normal? (day, night, at rest?)
coughing up sputum, wheezing)
21/03/12 Shortness of breath 4 times a day Worse than normal All of the above I am not usually breathless.
Example
Chapter 9: Preventing and managing a flare up

Maintain good hand hygiene. were both associated and not associated with an
Avoid people with colds and flu. infection), the treatment and outcomes. Check your
Symptom Diary for information.
Take good care of yourself by eating healthy
foods, exercising and getting enough sleep. Step 2
Keep track of your daily symptoms so that you You and your doctor will then agree on what actions
can recognise quickly when you are starting to you should take to manage your COPD whilst you
become unwell (a sample symptom diary is are stable but also during a moderate flare up and
provided on page 37). a severe flare up.
The sample symptom diary captures information Your stable section will include your usual daily
about your symptoms such as cough, sputum and medication and may include other information
shortness of breath. Some people find a diary like about your care, i.e. contact details for your doctor,
this one helps them to recognise when their oxygen use and lung function readings.
symptoms change.
Step 3
What can you do when you become sick? Mild to moderate flare up What to do when unwell/
having a moderate attack.
When you start to become sick it is important that
you act quickly. The quicker you act, the less likely You and your doctor agree on treatment directions
it is that you will end up in hospital. for management of a moderate flare up. This will
include details about increasing your reliever dose,
Follow the instructions on your written COPD
the frequency and the delivery method. You may also
Action Plan (see page 39).
get directions on starting a course of steroid tablets
Reduce your activity level. and / or an antibiotic if signs of an infection are present.
Clear sputum with the cough and huff
You and your doctor will then agree on the point that
technique (see page 59).
you will need to seek urgent medical treatment in
Practice controlled breathing and relaxation the case your flare up becomes severe. It will be
techniques (see page 54). extremely important to recognise when to seek urgent
Eat small amounts of nourishing food. treatment and what you can do whilst waiting for
Drink extra fluids. help to arrive. Your Action Plan will provide you with
Use additional medication as planned by these instructions.
your doctor.
Step 4
Contact your doctor if flare up becomes severe. Your doctor will need to provide or arrange for
prescriptions for extra medications to use with the
How can you develop and use a written COPD Action Plan (eg. steroid tablets or antibiotics
COPD Action Plan to keep at home with your COPD Action Plan).
To be successful it is essential that you plan it together
with your doctor. Nursing and allied health staff can Step 5
start the development of the plan, however decisions Dont forget to get your doctor to sign and date
about medication changes must be made by a doctor the plan to ensure it is up to date.
or an appropriately qualified nurse practitioner. Step 6
COPD Action Plans work best when they are checked, Ask your doctor, nurse or health care person to
updated and reinforced regularly. This should occur explain the COPD Action Plan to you and to your
each six months or after each flare up. carer regularly including all the signs to watch for
and actions to take.
Step 1
Talk to your doctor about developing a COPD Action Step 7
Plan. When developing the plan with your doctor, Keep your plan somewhere visible at home (on
you will discuss what happened with previous flare the fridge). Remember to always bring your COPD
ups. You will need to identify the lead up signs and Action Plan to your clinic, doctor appointments
symptoms you experienced (consider the events that and admissions to hospital.
There are several types of Action Plans for COPD. A copy of The Australian Lung Foundation COPD Action
We provide two of these below. It doesnt really matter Plan can be downloaded from the following website:
which Action Plan you use. It is just important that www.lungfoundation.com.au and look under Professional
you use one! Resources or can be obtained by calling 1800 654 301.
A copy of the Queensland Health COPD Action Plan
can be downloaded from the following website:
www.health.qld.gov.au/psq/Networks/docs/
srcn-copd-actpln.pdf

The Australian Lung Foundation
COPD Action Plan
Queensland Health
COPD Action Plan
39 Chapter 9: Preventing and managing a flare up

10
chapter
Introduction to pulmonary rehabilitation

What pulmonary rehabilitation is.
How pulmonary rehabilitation will help you.
What pulmonary rehabilitation involves.
How to enrol in a pulmonary rehabilitation program.
What happens after you finish a pulmonary rehabilitation program.
What is pulmonary rehabilitation?

Pulmonary rehabilitation programs have been
Pulmonary rehabilitation is a program of group
shown to help people breathe easier, improve
education and exercise classes. These education and
their quality of life and stay out of hospital.
exercise classes will teach you about your lungs, how
After completing pulmonary rehabilitation,
to exercise, how to do activities with less shortness of
many patients find they can resume activities
breath and how to live better with your lung condition.
that they had previously given up.
Pulmonary rehabilitation programs involve patient
assessment, exercise training, education, nutritional
intervention and psychosocial support. How will pulmonary
Pulmonary rehabilitation involves a team approach rehabilitation help you?
with the participants working closely with their The education classes in pulmonary rehabilitation
doctors, respiratory nurses, physiotherapists and programs cover many topics including:
other allied health team members.
Information about your lungs.
How your medications work.
When to call your health care professional.
How to keep yourself from being hospitalised.
During a pulmonary rehabilitation program, you
will meet other people who have COPD or other
breathing problems. The program gives you the
opportunity to learn how others live with COPD
and to share your experiences.
At pulmonary rehabilitation you will be given an
individualised exercise program
You should discuss the benefits of enrolling in

a pulmonary rehabilitation program with your
specialist lung doctor, GP, physiotherapist or
respiratory nurse.
To find out more information about pulmonary
rehabilitation, or where your nearest pulmonary
rehabilitation program is located, contact The
Australian Lung Foundation (phone: 1800 654 301,
or www.lungfoundation.com.au).
What happens after you finish a

pulmonary rehabilitation program?
What you learn and practice during a pulmonary
The exercise classes in pulmonary rehabilitation rehabilitation program should carry over into your
programs involve exercises using both your arms daily life after the program finishes. To maintain the
and your legs and will help you to be more active benefits you have achieved, it is very important that
and improve your fitness. Many people report you continue with your exercise program. Many
experiencing fewer symptoms after participating pulmonary rehabilitation programs offer a maintenance
in pulmonary rehabilitation which helps them in program so that you can continue to exercise with
their daily activities. others. Participants who have completed pulmonary
rehabilitation can also access ongoing exercise in
What does pulmonary the community through The Australian Lung
rehabilitation involve? Foundations Lungs in Action programs (contact The
Australian Lung Foundation phone: 1800 654 301,
A pulmonary rehabilitation program typically runs or www.lungfoundation.com.au). Chapter 11 outlines
for eight weeks with two sessions per week. Each a sample exercise program you can do at home.
session will usually involve a group education
session (for example, lectures, demonstrations or
discussions) followed by supervised exercise.
At the start of the pulmonary rehabilitation program,
your medical history will be obtained and your
fitness level will be assessed, usually by doing a
walking test. From this assessment, an exercise
program will be set for you at your fitness level.
Another assessment will be completed at the end
of the program.
How do you enrol in a pulmonary

rehabilitation program?
The criteria to enrol in a pulmonary rehabilitation
program will vary among centres. Some pulmonary
rehabilitation programs will require a doctors
referral, whereas others will allow you to enrol
yourself. Some programs may have restrictions
on who can be referred.
41 Chapter 10: Introduction to pulmonary rehabilitation

11
chapter
Exercise and physical activity

Why it is important to maintain or improve your fitness.
How you can benefit from exercise and physical activity.
What the recommended guidelines for exercise are.
What to do if you are unwell.
How you can maintain your fitness level.
Why is it important to maintain Increase the number of activities that you are
or improve your fitness? able to do each day or each week.
Improve your balance.
People who have chronic lung conditions are often
less active, can have reduced fitness and reduced Improve your mood and make you feel
muscle strength. By exercising regularly, a persons more in control.
fitness and muscle strength can be maintained Make you more independent.
or improved. Assist your weight control.
People who have chronic lung conditions and who Improve and maintain your bone density.
exercise regularly, such as by walking or cycling for
The benefits from pulmonary rehabilitation, such as
more than two hours per week, can improve their
improvements in exercise performance or quality of
health. As a result, they will feel better, keep well
life, have been shown to decline gradually over 12
and are more likely to stay out of hospital.
to 18 months after completing these programs.
Therefore, to maintain the health benefits of pulmonary
How can you benefit from rehabilitation, it is very important to keep exercising.
exercise and physical activity? If your exercise program stops, you lose fitness and
Exercise will help to: muscle strength very quickly.
Make your heart stronger and healthier. Talk to your doctor, physiotherapist or The Australian
Improve your arm, body and leg muscle Lung Foundation about local programs available to
strength. you to help maintain your exercise program, such as
the Lungs in Action classes.
Improve your breathing.
Clear sputum from your lungs.
People who exercise regularly can reduce their
Reduce your breathlessness during
need for hospital admission.
daily activities.
What are the recommended

General precautions
guidelines for exercise?
Avoid strenuous exercise if you have a
What is involved in an exercise program?
fever, an infection or the common cold.
An exercise program should include:
Restart your program at a lower intensity
1. An aerobic program which involves a walking if your exercise routine is interrupted.
program as this is the most relevant exercise for Do not exercise immediately after a big meal.
daily living. Other types of aerobic exercise can
Do not exercise in extreme heat or cold.
include cycling, riding an exercise bike or even
Take your bronchodilators (inhaled reliever
using a rowing machine. You could use these
medications that open the breathing tubes
exercises to add variety to your program or when
or airways) before exercising.
you have difficulties with walking.
Use recovery positions to reduce
2. A strength training program, which will keep breathlessness (see page 54).
your muscles strong and prevent some of the
effects of having a chronic lung condition.
Strength training should include exercises for Getting started with your exercise program
your arms, torso and legs (see page 49). You may find it better to exercise using an interval
3. A stretching program, which can help you to program rather than trying to exercise continuously.
maintain your flexibility (see page 48). For example, an interval program might be: walk for
one to two minutes, rest for one minute and then
walk again. You may need to repeat this interval
Exercise guidelines
many times to achieve at least 20 minutes of total
Exercise regularly aim for 4 to 5 sessions walking time.
per week.
Interval exercise programs have many advantages.
Aim to exercise for at least 20 to 30 These include helping you to tolerate your exercise
minutes per session. routine better as well as enabling you to exercise at
Aim for moderate intensity. a higher intensity, which should give you a greater
Wear comfortable clothing and footwear. improvement in your fitness.
Ensure you drink enough fluids
while exercising.
What if I am on oxygen?
If you have low oxygen levels in the blood and are
prescribed oxygen therapy, then when you exert
yourself, wearing oxygen can help you tolerate the
exercise more easily.
When exercising, be careful to avoid tripping and
falling on your oxygen tubing.
Never turn your oxygen up higher than prescribed

for exercising unless you have discussed this
with your doctor or physiotherapist first.
An exercise program is an important part of your

management of your respiratory condition
43 Chapter 11: Exercise and physical activity

How often should you exercise? These scales can be used to guide training intensity
Exercise should be part of your weekly routine, and and to set personal goals for exercise. You should
you should plan enough time to fit this into your week. aim to exercise to a level where your breathlessness
is at a moderate to somewhat severe level as
You should exercise for a minimum of 4 to 5 days highlighted in the scale below.
per week. Anything less will not allow you to gain
health benefits or improve your fitness. Borg scale
How hard should you exercise? 6

When attending your pulmonary rehabilitation
7 Very very slightly
program, your physiotherapist will assess your
exercise tolerance at the start of the program. From Modified Borg scale
8
this assessment, you will be prescribed a program
at the right level for you. 0 Not short of breath 9 Very slightly
There are many ways to prescribe a training 0.5 Very very slightly 10
intensity for your exercise program:
1 Very slightly 11 Light
1. Your level of breathlessness can be measured
2 Slightly 12
during an activity and rated against the Borg
Training zone
or modified Borg scale (see the following 3 Moderately 13 Somewhat hard

diagram). The highlighted section is the target
training intensity. 4 Somewhat severe 14
2. Your physiotherapist can set you an exercise 5 Severe 15 Hard

program at 60% to 80% of an exercise test. The 6 16
exercise test, such as a six minute walking test or
shuttle walking test, may have been undertaken 7 Very severe 17 Very hard
at the start of your program.
8 18
3. Exercising at a percentage, such as 60% to
9 Very very severe 19 Very very hard
80%, of your maximum heart rate. This method
is generally not the best way to measure training 10 Maximal 20
intensity for people who have lung conditions as
usually they are limited by their breathlessness.
Adapted from: Borg G. Perceived exertion as an indicator
of somatic stress. Scand J Rehab Med. 1970;2:92-9;
Borg G. Psychophysical bases of perceived exertion. Med
Sci Sports Exer. 1982:14:377-81; Mahler D. The
Danger signs measurement of dyspnoea during exercise in patients
with lung disease. Chest. 1992;101:242-7
If you experience any of the following symptoms
when you are exercising, stop and rest immediately:
What are some other activities
Nausea. that you can choose?
Chest pain. If you are bored with walking or are looking for
Dizziness or feeling faint. variety, you can always consider other alternatives
that might interest you. You might like to consider
Extreme shortness of breath.
gardening, bush walking, dancing, Tai Chi, playing
Excessive wheezing. golf, lawn bowls and water-based exercise.
Coughing up blood.
NB. These symptoms are not normal and should Note: Those with heart failure should always
prompt you to seek medical attention. discuss exercise options with their health care team.
It is important for you to resume an exercise

program promptly following a flare up.
How can you maintain your fitness?

As discussed earlier, maintaining your physical
fitness has been shown to improve your health.
By completing a pulmonary rehabilitation program,
you should have established an exercise routine that
is suitable for you. Once you have completed your
What if you are unwell? pulmonary rehabilitation, it is important to continue
If you find it hard to do your usual exercise program, with your exercise routine.
this can be an early warning sign that you are There are a variety of options available that can
becoming ill. assist you in maintaining your fitness, including:
When you are unwell, your body is working harder 1. Enrolling in a maintenance exercise program
to fight off the infection, and your breathing may following the completion of your pulmonary
become more difficult. Therefore, you should not rehabilitation program. For information on
be exercising as hard as you would normally. a maintenance exercise program, such as
The Australian Lung Foundations Lungs in
Why do you lose your fitness when you
Action classes, contact: The Australian Lung
are unwell?
Foundation (phone: 1800 654 301, or
People who have COPD and who are unwell or have www.lungfoundation.com.au).
a flare up of their symptoms:
2. Joining a community-based walking group.
Are less active in their day and spend more time
sitting or lying down, and less time standing These walking groups are based at your local
and walking than they would normally do. parks or shopping centres. For further information
regarding the walking groups available in your
Lose muscle strength and conditioning as a
area, contact your local council, your local
result of this inactivity.
shopping centre or The Australian Lung
After an illness, you can take several months to Foundation (phone: 1800 654 301, or
regain your fitness level and muscle strength. This www.lungfoundation.com.au).
is true of all people who experience an illness and
3. Joining a local gym or community group.
subsequent loss of fitness. But it is particularly true
for those with COPD. This can provide you with some support while
you continue to exercise regularly.
What should you do to prevent losing your
fitness after a flare up? 4. Exercising regularly with someone else.
This is another simple way to commit to
The severity of a flare up will affect the exercise
maintaining your fitness. This option can
level you are able to do.
work quite well, providing the individuals
Generally, the aim is not to exercise as hard as have similar exercise goals.
usual. Instead, you could:
5. Participating in a home exercise program. Some
Walk at a slower speed (that you can tolerate) people may prefer to exercise on their own.
and use more rest breaks.
A home exercise program can be effective if you
Ride an exercise bike rather than going for a make this part of your daily routine. Using an
walk. You are moving less body weight while exercise recording sheet or an exercise diary can
riding an exercise bike; therefore, it should be help to make this a regular commitment (see the
easier to do. following aerobic exercise recording sheet and
Do a strength training program for your arm strength training sheet on pages 46 and 47,
and leg muscles. respectively).

Aerobic exercise recording sheet
To use your exercise recording sheet, write your prescribed exercise program in the columns as follows: the type of aerobic exercise (for example, walking or riding an exercise
bike) in the Mode column, the distance or speed of the exercise (for example, 500 metres) in the Distance column and the total exercise time or the intervals (for example,
two sets of 10 minutes) in the Time column. Once you have completed the exercise, tick the box corresponding to the day of the week that you completed the exercise.
Mode Distance Time Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
Walk 500 metres 2 x 10 mins
Example
The
State of Queensland (Queensland Health) and The Australian Lung Foundation 2012
46
47
Strength training sheet
To use your strength training sheet, write your prescribed exercise program in the columns as follows: the exercise to be performed (for example, squat) in the Mode column,
the load (for example, no added weight) in the Load column, the number of sets and repetitions of each exercise (for example, 2 sets of 10 repetitions) in the Number column.
Once you have completed the exercise, tick the box corresponding to the day that you completed the exercise. Samples of strength training exercises are shown on pages 49.
Mode Load Number Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
Squat no weight added 2 x 10 repetitions
Example
Chapter 11: Exercise and physical activity

Examples of a stretching program

4. Shoulder stretch
These stretches should be performed a few times
Gently pull on your elbow with your other
each week. A stretching program should be performed
hand until a stretch is felt in the shoulder
before and after the aerobic and strength program.
Hold for 20 seconds
Repeat two to three times
1. Side neck stretch
Slowly tilt head
towards one shoulder
Hold for 10 seconds
Repeat two to
three times
Repeat toward
other shoulder
2. Shoulder rotation
Place hands on your shoulders as shown 5. Triceps stretch
Slowly make forwards and backwards circles Gently pull on raised
with your elbows elbow until a stretch
Repeat five times each way is felt in the arm
Hold for 20 seconds
Repeat two to
three times
6. Side stretch
Reach one arm straight
over your head
Lean to that side as
3. Thoracic stretch far as is comfortable
Hold hands behind Hold for 20 seconds
your back as shown Repeat two to
Move your hands three times
away from your back
Hold for 20 seconds
Repeat two to
three times
Strength training program

7. Quadriceps stretch
There are many different types of strength training
Pull your foot
programs available. This is an example of a
towards your buttock
strengthening program. Please discuss with your
until a stretch is
physiotherapist or exercise physiologist about a
felt in the front of
suitable program for you to do.
your thigh
Hold for 20 seconds Aim to do three sessions per week of the
following strengthening exercises.
Repeat two to
three times Aim to achieve muscle fatigue between 6 and
10 repetitions. If you have not achieved muscle
fatigue after 10 repetitions, then you may need
to either add arm or leg weights to the exercise
or increase the weight of the arm or leg weights.
8. Hamstring stretch
If you find doing all the exercises at each session
Place your foot
is too much, you can split the exercises in half
on a block
and do them on alternate days. For example:
Slowly lean forwards
Day 1: You may choose to do the bicep curl,
until you feel a
wall push up or bench press, lateral pull
stretch in the back
down, leg press or squat, and step ups.
of your thigh
Day 2: You may choose to do the shoulder
Hold for 20 seconds
press, sit to stand, standing row or seated
Repeat two to row and lunge.
three times
Examples of strength training
Skeletal muscle weakness is present in people
9. Calf stretch with COPD and this weakness can affect lower
Place hands on a and upper limb strength. Strengthening these
wall or a bench muscles is important as these muscles are used
Slowly lean forwards on an everyday basis.
until you feel a
stretch in the back
1. Biceps curl
of your calf
Hold the arm weight at your side
Hold for 20 seconds
Curl arm towards your shoulder
Repeat two to
Do 6 to 10 repetitions for each arm
three times
Do one to three sets
If too difficult,alternate arms
Balance retraining
As you get older, your balance may be affected.
As a result, you may find it useful to do some
balance retraining exercises.
Please discuss balance retraining with your
physiotherapist as they can give you exercises
that are appropriate to strengthen your balance.

2. Shoulder press 5. Standing row

From the start position (sitting or standing), Lean forward onto a chair or bench
press the arm weight upwards to straight arms From the start position, lift the arm weight up to
Do 6 to 10 repetitions your chest
Do one to three sets Do 6 to 10 repetitions
Avoid this exercise if you have shoulder problems Do one to three sets
3. Wall push up
6. Seated row
From the start position, lean into the wall then
From the start position and while keeping your
push up away from wall
back upright, pull your arms to your chest
Do 6 to 10 repetitions
To progress, move feet away from the wall
7. Lateral pull down

4. Bench press Lean back slightly
From the start position, press the arm weight Pull bar down towards the front of your chest
upwards to straight arms
8. Sit to stand 11. Step ups

Sit on the edge of This activity can be either a strength or
your chair an aerobic exercise.
Stand upright For strength:
Do 6 to 10 repetitions Do 6 to 10 repetitions
Do one to three sets Do one to three sets
Progress to not using To progress hold hand weights and
your arms repeat exercise
For aerobic:
Do a 30 second set of step ups,
then rest for one minute
9. Squat
Repeat 5 to 10 times depending upon
Stand with your legs
your fitness
shoulder width apart
Lower your body as
if you are sitting on
a seat
Do not bend your
knees beyond 90
degrees
Do 6 to 10
repetitions
To progress, hold
hand weights and
repeat exercise
10. Leg press 12. Lunge

From the start position, press legs Stand with a wide
forward until knees are straight stride
Do 6 to 10 repetitions Bend both legs until
Do one to three sets forward thigh is
parallel with the
ground
Do 6 to 10
repetitions
To progress, hold
hand weights and
repeat exercise

12
chapter
Breathlessness, breathing control

and energy conservation

What the causes of breathlessness are.
How to better control or reduce your breathlessness.
Why energy conservation is important.
How you can conserve your energy.
What are the causes of breathlessness? who have COPD can become frustrated, anxious
and depressed. These emotions can make breathing
Who becomes breathless? problems worse.
Breathlessness (or dyspnoea) is common in people
Importantly, for people who have lung conditions,
with lung or heart conditions, as well as in people
such as COPD, there are things they can do to make
who are overweight or unfit.
life easier. It is important not to stop doing things
People who are overweight or unfit will have to work altogether but to try to stay as active as possible.
harder during everyday activities and, as a result,
will fatigue more quickly. When do you notice your breathing change?
We are not usually aware of our breathing, but there
As people get older, their lung function declines
are times when we do become aware.
owing to changes in their lungs, their chest wall
and the strength of their breathing muscles. These The breathing centre in the brain is constantly
changes contribute to older people becoming more receiving signals from your body about the amount
breathless when performing activities. of oxygen that is needed.
Those with lung diseases like COPD will experience The oxygen requirements of your body will depend
breathlessness as the disease affects the breathing on many factors, such as:
tubes or airways and the lungs. The feelings of 1. The severity of your lung condition and the ability
breathlessness may increase as the disease progresses. of oxygen to pass through your lungs into your
How do people feel about their blood stream for use by the body.
breathlessness? 2. The level of activity you are currently doing will
In mild forms of lung disease, breathlessness may affect the amount of oxygen your body will need.
occur when walking up hills or stairs. As the disease For instance, when you are resting quietly,
becomes more severe, breathlessness can occur on the oxygen demand is less than when performing
minimal exertion such as when walking slowly strenuous activities, such as walking up stairs
along flat ground or even at rest. or hills.
Daily activities become more difficult as the lung 3. Your fitness or conditioning will also affect your
condition gets worse. It is not surprising that people oxygen requirements during an activity. A person
with a better fitness level will generally be more COPD and breathlessness
efficient in moving oxygen around their body, and COPD affects both the lungs and the body. As
their muscles will require less oxygen to do the a result, breathlessness can be caused by a
same activity than a person who is unfit. combination of reasons:
1. In COPD, the lungs lose their natural elasticity
Healthy COPD as they become damaged and over-expanded.
Resting
Person Person This can make it harder for someone who has
COPD to breathe air out fully.
2. As a result of being unable to breathe air out
4% 15%
fully, the trapped air leads to an over-expansion
of the lungs. This is often called a barrel chest
(hyperinflation). Hyperinflation changes the way
Exercising your muscles and chest wall work. The breathing
muscles of a person who is hyperinflated will
have to work harder and as a result, will fatigue
more quickly. Other muscle groups can be used
10% - 15% 35% - 40% to help people breathe; these muscles are known
as accessory muscles. The neck muscles are an
example of these accessory muscles.
3. The muscles used for breathing, like all muscles
in the body, require oxygen to be able to work. A
4. Stress or anxiety, or a low mood, can affect person who has COPD may have a higher oxygen
your breathing rate. These mood states can make requirement just to continue breathing.
you focus on your breathlessness and make you
4. The narrowing or swelling of the breathing tubes
more aware of your breathing.
or airways, in combination with producing larger
5. If you are unwell more effort is required to breathe. amounts of sputum, can restrict the flow of air in
The cycle of inactivity
53 Chapter 12: Breathlessness, breathing control and energy conservation

and out of the lungs. Airway clearance techniques Aim to breathe out slowly and without force. As you
can help to keep the breathing tubes or airways breathe out, let your shoulders and neck muscles
clearer and assist in making breathing easier (see relax. Most of your breathing should occur by the
chapter 13). lower ribcage expanding and relaxing, rather than
in the upper chest.
5. When you are living with COPD, you may be
unable to continue your normal level of activity, By breathing out fully, you
which can result in a cycle of inactivity (see the will be able to breathe
previous diagram). Frequently, this will lead you in better. You may find it
to reduce your physical activities, causing you to useful to practice relaxed
become unfit or poorly conditioned. Being unfit breathing when you are at
or poorly conditioned makes your movements rest so that you are familiar
less efficient and requires greater effort to complete with the technique.
everyday activities. To practice relaxed breathing,
6. People who have COPD often experience increased place one hand on your
anxiety about becoming breathless or short of chest and one hand on your
breath. This anxiety can lead to a fear of undertaking stomach at the level of your
activities. navel while sitting. When
you take a deep breath in,
In summary, people with COPD need to work harder
the hand on your stomach,
than others to breathe. Relaxed breathing technique
rather than the hand on
your chest, should move first. Practice breathing so
How do you better control or that the hand on your stomach moves first.
reduce your breathlessness? 3. Prolonged expiration breathing
There are many treatment options and management The purpose of prolonged expiration breathing is to
strategies that can help you control or reduce your try to reduce the amount of air trapped in the lungs
breathlessness. and reduce airway collapse by prolonged breathing
1. Medication out (unforced expiration). Breathing out should take
Using your reliever, maintenance and preventer longer than breathing in.
medication can assist in controlling breathlessness. Breathing out through pursed lips is an example
It is important that medications are used correctly of this technique. Pursed lips (lips that are closer
to ensure their effectiveness. together than usual, as if you were whistling or
For more details on medications and inhalation kissing somebody) create a smaller opening for the
devices, refer to chapter 7 Knowing your medication air to flow through.
and chapter 8 Using your inhalation devices. 4. Recovery positions
Good posture is very important. The more you slump,
2. Relaxed breathing
the more you squash your lungs and stomach, and
People who have COPD have more difficulty
the harder it is to breathe.
breathing out fully. The bodys normal reaction
when breathlessness occurs is to breathe faster Try taking a deep breath while slumped. Now try
and shallower. However, faster and shallow again while standing or sitting fully upright with a
breathing is not an effective way to regain control tall spine. Can you notice a difference?
of your breathing.
A comfortable recovery position is important.
You could practice relaxed breathing any time Typically, recovery positions are upright with your
you are trying to catch your breath. For example, arms supported. Common examples of recovery
relaxed breathing may be useful after coughing positions are shown in the images on the
or exercising. following page.
Aim to find a rate of breathing that matches your

effort. If you find an activity too hard to do,
simply stop and recover before restarting the
activity at a slower pace.
6. Improve your fitness
Better fitness levels or improved tolerance to
exercise will enable a decrease in the effort required
to perform everyday activities.
7. Manage your anxiety
Learning how to manage or control your anxiety, or
situations that cause your anxiety, can assist your
Resting against a sign breathing control (see chapter 18 Managing stress,
anxiety and depression, page 76).
Resting against a tree
5. Pace yourself Why do you need energy conservation?

This is a very important skill and is often overlooked. With lung disease, the body is no longer as efficient
If you have breathing problems and are noticing that in meeting the bodys demand for oxygen.
you are more short of breath than previously, you
When the body receives less oxygen, energy supplies
will need to slow down to get your tasks done.
become limited. This can cause fatigue, shortness of
If you rush and try to beat the shortness of breath, breath and possible anxiety or panic with everyday
you will spend longer trying to catch your breath. If activities.
you go slowly and pace yourself, you will go a lot
By learning to conserve energy with everyday tasks,
further before needing a rest. For example:
you will be able to perform many activities with less
While walking, try to establish a pattern of effort and less shortness of breath.
breathing that matches your steps and that you
Along with exercise, keeping active in normal
can maintain easily. For example, you may
daily activities is an important part of maintaining
breathe with every step or over a number of
your fitness.
steps depending on your level of breathlessness
and fitness. Before stopping an activity, consider whether you
If you change your pace of walking, you will could make it easier by using the following energy
need to adjust your breathing pattern. saving techniques.
Before you begin climbing stairs or walking up
hills, it is important to gain breathing control. By learning to conserve energy with everyday
Do not hold your breath and rush through the tasks, you will be able to perform many activities
task to get it over with as this will only make with less effort and less shortness of breath.
you more short of breath.

1. Control and coordinate your breathing with Bring your feet to you (for example, rest your foot
daily activities on your knee to towel dry, put on socks, and tie up
People with lung disease use more energy simply to your laces).
breathe. Therefore, it is important to coordinate your
Avoid heavy lifting:
breathing with all activities. Even the simplest tasks
use energy. Use trolleys; push rather than pull; slide rather
than lift.
Standing Up: Breathe in before you move. Breathe
out as you rise up from your seat. Let your bigger muscles do the work squat
with your legs, avoid bending your back.
Lifting an object above your head: Breathe in
before you lift. Breathe out as you lift your arms Ask for help.
above you. Divide the load eg. groceries, half fill the kettle.
Putting on shoes: Breathe in before you move. 3. Sit when possible to perform activities
Breathe out as you bend down to put on your shoe. Standing uses more energy than sitting.
When possible, consider sitting while ironing,
washing dishes, showering, chopping vegetables,
gardening, making a phone call or working in
the shed.
Breathe IN Breathe OUT as you
before you start complete the activity Keep a high stool or chair for you to use in
your kitchen or at your work bench.
4. Take frequent rest breaks
Continuing to work until you are out of breath may
If you go slowly and pace yourself, you will go then take you longer to recover. So take regular
a lot further before needing a rest. If you rush breaks to rest and recover while working. Dont
and try to beat the shortness of breath, you will wait until you need a break.
spend longer trying to catch your breath.
5. Plan and prepare before you perform tasks
When you are feeling short of breath, use High expectations can lead to frustration, so be
recovery positions to help regain control of patient with yourself and set achievable goals.
your breathing.
Challenge old habits. Ask yourself Is it essential
2. Reduce strenuous movements that this task be performed in the usual way?
Keep your arms and body close to the activity Plan for rest breaks and interruptions.
you are performing:
Break jobs into smaller steps. For example,
Carry objects close to your body. rather than cut the entire lawn in one go,
Organise equipment or food to be within do it in two or three goes.
easy reach. Prepare and prioritise.
Keep most activities between waist and Use a diary or calendar to plan daily,
shoulder level: weekly and monthly tasks.
Store commonly used items on middle shelves Put items where they can be found easily
between your waist and shoulders. and quickly.
Work at benches that are at waist height. Keep most frequently used items between
Use long handled equipment (for example, waist and shoulder level.
long handled reachers, long handled pruning Use equipment that makes the job easier,
shears, a broom, a dressing stick, a sock aid eg. light weight crockery, long handled reachers,
and a bathing brush). long-handled garden equipment, stools, trolleys,
velcro shoes, buttonless shirts and clothes that
dont need ironing.
6. Pace yourself: Where possible, control the temperature

Use slow, rhythmic movements. in your environment.
Alternate light and heavy activities Use fans, air conditioners, heaters.
Spread heavier tasks throughout the day, Avoid extremes in temperature.
week and month. Reduce steam open doors, windows.
Learn to ask for help, or get someone else
8. Avoid activity after a meal
to do the task, such as family members,
Avoid strenuous activity after meals.
community services, neighbours, volunteers
or friends. Asking for help does not mean 9. Relax
you are dependent, it means you are using When you feel worried, anxious or uptight
your energy to its best advantage. your body uses a greater amount of energy.
7. Avoid extremes of temperature This can add to feelings of being tired
Hot or cold environments place greater demand or breathless.
on the body which may increase feelings of Relaxation can help restore energy.
breathlessness, fatigue, discomfort and anxiety. Concentrate on relaxing your muscles and
Avoid strenuous tasks, particularly in hot weather. slowing down your breathing.
When breathlessness or fatigue limits your ability to commence, continue or

complete an activity remember to PLAN, PREPARE, PACE & PAUSE
PLAN how you will carry out the task.
PREPARE all the items you will need to complete the task.
PACE yourself and slow down during the task.
PAUSE and rest whenever needed.

13
chapter
Airway clearance: keeping your lungs clear

What the role and function of sputum in lung conditions is.
Why it is important to keep your lungs clear.
When you should use airway clearance techniques.
What the airway clearance techniques are.
What is the role and function of In some lung conditions, the ability to clear these
sputum in lung conditions? secretions can be more difficult, resulting in:
The lungs provide protection against foreign particles More coughing, which increases your fatigue
entering the body by trapping unwanted particles in and can make you more breathless.
the mucous lining of the breathing tubes or airways. Narrowing of the breathing tubes or airways,
Your secretions can be cleared from the lungs by and tightness of the chest which can make
coughing, breathing out and the movement of tiny breathing harder.
hairs called cilia. These tiny hairs line the breathing
tubes (bronchi and bronchioles) and move like a When should you use airway
wave to help move the mucous and unwanted
clearance techniques?
particles up to the mouth where they can be cleared.
When to use airway clearance techniques will depend
The function of the tiny hairs (cilia) can be affected greatly on your individual needs. For example:
by smoke, oxygen therapy, alcohol and dehydration.
Many people who have chronic lung conditions
If you have a lung condition or a chest infection, the produce very little or no sputum. These people
breathing tubes can become more swollen or inflamed. generally do not need to do any regular airway
As a result, the breathing tubes or airways can produce clearance techniques.
thicker and stickier mucous secretions called sputum
or phlegm. Some people who have chronic lung conditions
develop a moist cough when they have an
infection. These people may need to do a few
Why is it important to simple airway clearance techniques when
keep your lungs clear? this occurs.
Repeated chest infections have been shown to A small number of people who have chronic
contribute to worsening in lung function. If sputum lung conditions and who cough up sputum
is not cleared from the lungs, it can cause ongoing every day may need to use an airway clearance
inflammation, which can lead to further lung damage. technique regularly.
What are the airway

If you regularly produce sputum, airway
clearance techniques?
clearance techniques will help you get rid
There are a variety of airway clearance techniques. of sputum build-up.
If you regularly produce sputum, then you should
discuss your airway clearance needs with your
respiratory physiotherapist. They will assist you to Your lung symptoms may change over time and this
find a technique that works best for you. Some of is important to remember. As a result of changes in
these may include: your lung symptoms, your airway clearance routine
may also need to be modified. For example:
Hands on techniques, such as percussion and
expiratory vibrations to the chest wall. Your breathing tubes or airways may become
Independent breathing techniques, such as tight and you may become more breathless as
Active Cycle of Breathing Techniques and a result. If this occurs, your airway clearance
Autogenic Drainage. technique may be changed to decrease the
work of your breathing.
Respiratory devices, such as positive expiratory
pressure devices (for example, PEP and Astra If you develop a chest infection in which you
PEP) and oscillating positive expiratory pressure begin to produce larger quantities of sputum,
devices (for example, FLUTTER and Acapella). you may be referred to a physiotherapist who
may commence an airway clearance technique
All airway clearance treatment regimes should
with you.
include effective huffing and coughing to
clear secretions.
Huffing
In most instances a huff uses a medium volume
breath in, followed by a forceful expiration (breath
out) that helps to move sputum towards the mouth
so it can be cleared. This is particularly useful if
the airway tends to collapse with coughing. If a
wheeze is heard on the breath out then the
expiration is too forced and you may need to
breathe out slower. The wheeze represents airway
closure and may cause sputum not to be cleared
as effectively.
Coughing
Coughing is an effective way to remove secretions.
However coughing should be done with minimum
of effort.
How to cough effectively

1. Take a slow relaxed deep breath in.
2. Hold the breath for a second to allow
pressure to increase in the lungs.
3. Then force the air out. You will feel the abdominal
muscles tighten to provide the force to expel the
air. Try to avoid a coughing fit by allowing one
or two coughs on the breath out.
59 Chapter 13: Airway clearance: keeping your lungs clear

14
chapter
Home oxygen therapy

When you need home oxygen.
What the benefits of using home oxygen are.
What equipment you will need to use home oxygen.
Who can help cover the cost of home oxygen.
Oxygen therapy When do you need home oxygen?

Oxygen therapy is prescribed for many people with Most people with lung conditions feel breathless at
chronic lung disease who have low blood oxygen times. Feeling short of breath is caused mainly by
levels. The body can tolerate low levels of oxygen the extra work of breathing.
for short periods of time, but low levels of oxygen
for long periods of time can cause problems in your Important considerations
vital organs. Home oxygen therapy helps return your You can feel breathless even with normal oxygen
blood oxygen levels to normal, thus reducing the levels in the blood.
damage to your vital organs. Not everyone with a chronic lung condition
Oxygen therapy is usually prescribed to prolong life needs oxygen at home.
and it may also improve the quality of life of the Tests are needed so your doctor can tell if you
user. While the use of oxygen MAY relieve shortness need home oxygen.
of breath, in many cases it does not. Home oxygen is prescribed at a flow rate and
for a minimum number of hours per day.
You only get the full benefit if you use home
oxygen as prescribed. Using your oxygen as
prescribed, and not just when you feel you
need it, is very important.
Using oxygen when it isnt prescribed can
be harmful.
Breathlessness
You have probably learned by now that long term
lung conditions, such as chronic obstructive
pulmonary disease (COPD), bronchiectasis and
pulmonary fibrosis, cause breathlessness. People
often think that when they feel breathless, it is
because they are not getting enough oxygen into
their body.
For most people who have chronic lung conditions,

breathlessness mainly occurs because it is harder Oxygen therapy is prescribed for patients who
to breathe the air in and out. have low levels of oxygen in their blood. It
is not prescribed to relieve breathlessness. While
This is called the work of breathing. Breathing air
oxygen therapy MAY relieve breathlessness, in
in and out requires more work if the lungs are too
many cases it does not.
full (hyperinflated) or are stiff, or if the breathing
tubes or airways are narrow. This is why it is
important to learn different breathing techniques
What are the benefits of
to help control your breathlessness.
using home oxygen?
You may have already found that these techniques
A common home oxygen prescription is to use
help when you get out of breath.
oxygen, set at a flow rate of two litres per minute,
Low oxygen levels in the blood for at least 16 hours each day.
Some people with severe lung conditions have lower Most people notice some improvement when
levels of oxygen in their blood, either all the time or they start using oxygen at home. You may notice
only when they are sleeping or exercising. that you:
Home oxygen is only prescribed when the blood Feel more refreshed on waking.
oxygen level is low. If your blood oxygen level is Feel less breathless performing activities,
very low, this means not enough oxygen is being such as showering and walking.
delivered to your vital organs via the blood. In this
Are able to think more clearly.
case, there are benefits of using oxygen at home in
the long term. Have more energy.
People who have severe COPD and very low oxygen
How do you (and your doctor) know you need
levels have been found to live longer if they use
home oxygen?
oxygen for at least 16 hours every day.
To determine if you need home oxygen, your doctor
can order a blood sample to be taken from an artery When to use home oxygen
(usually at your wrist) while you are resting. Youll Once you know your prescription, it is useful to
probably remember if youve had one of these blood work out when you will use your oxygen to make
samples taken as it hurts more than a normal blood sure that you get at least the minimum hours each
sample. They may also arrange to test your oxygen day. Wearing oxygen from late afternoon (5 pm),
level by placing a probe on your finger while you are through the evening and overnight while sleeping
sleeping or walking. until the morning (7 am) takes care of 14 hours.
In this example, you would need to wear the oxygen
for at least an additional two hours during the day
to reach at least 16 hours.
Keeping active, even though you may be on oxygen,
is important.
Fitting the oxygen in around your weekly routine is
important to ensure that wearing oxygen disrupts
your life as little as possible. Some people only need
oxygen while sleeping, because their oxygen level
is okay during the day. Others need to wear oxygen
all the time and need to plan their activities to
include oxygen.
61 Chapter 14: Home oxygen therapy

What equipment do you Who can help cover the

need to use home oxygen? cost of home oxygen?
An oxygen concentrator is the most common method Currently, each state has different arrangements
of giving oxygen. The concentrator is an electronic for funding oxygen equipment for use in the home.
pump that filters out nitrogen from the air (which is Discuss with your doctor about the financial support
a mixture of oxygen and nitrogen) that we breathe. that may be available for your home oxygen.
The concentrator supplies oxygen through long
The Australian Lung Foundation has an information
tubing connected to nasal prongs.
booklet called Getting Started on Home Oxygen. It
Another method of delivering oxygen is via small covers many aspects of living with home oxygen
cylinders. Small oxygen cylinders weigh about five therapy, such as:
kilograms, come with trolleys or carry bags and can
How home oxygen therapy works.
be used when away from home. The cylinders are
best used with oxygen conservers that make the The equipment that is used.
cylinders last longer. Check with your local oxygen Practical tips others have found helpful.
provider to confirm which oxygen conservers are The answers to some commonly asked questions.
available in your area. Portable oxygen concentrators
are also available.
To get a copy of Getting Started on Home Oxygen,

If you are prescribed home oxygen therapy, visit www.lungfoundation.com.au or call
register with your electricity supplier to ensure 1800 654 301.
you are identified with them as a priority in the
event electricity supply is interrupted.
15
Healthy eating

Why healthy eating is important for people who have lung conditions.
What healthy eating is.
How to identify potential nutritional issues common in lung conditions and
how to manage these.
What you can do if you are too tired to shop, cook or eat.
What are the types of food that have been associated with lung conditions.
Why is healthy eating important for If you are overweight, you are likely to become
people who have lung conditions? more short of breath during activities, such as
walking up stairs or carrying the groceries.
Lung conditions increase the risk of poor nutrition, Carrying additional body weight increases the
weight loss and reduced muscle strength because of: risk of high blood pressure, high cholesterol
Increased energy needs. Studies have shown and diabetes.
that people who have chronic lung conditions
use 25% to 50% more energy than healthy What is healthy eating?
people due to the increased work of breathing
and fighting chest infections. A selection of servings from each of the five food
groups each day will provide the energy, vitamins,
Poor appetite, or for some people on steroids,
minerals and antioxidants your body needs to
a bigger appetite.
maintain good health.
Increased need for certain vitamins, minerals
and antioxidants. The five food groups are captured in the table on
page 64 with recommended daily servings.
A lack of energy to shop, cook and eat meals.
Malnutrition adversely affects lung structure,
respiratory muscle strength and endurance.
63 Chapter 15: Healthy eating

you are underweight, overweight or within your

As well as eating a varied and balanced diet, healthy weight range. To work out your BMI,
it is important to drink adequate amounts of find your weight (in kilograms) along the side of
water and/or other fluids (eight or more cups the graph and your height (in centimetres) along
per day), unless you have been advised the bottom, then find where the two lines join in
previously to limit your fluid intake. the graph.
A waist measurement which is higher than 94cm
for men and higher than 80cm for women can
Recom. increase the risk of chronic diseases.
Food no. of
One serve equals
group serves/ What if you are underweight?
day
If you are underweight, your body has less energy
2 slices of bread and nutrient stores to help it do its work.
or 1 cup of cereal
Breads Being underweight can cause your muscles to
or 1/2 cup muesli
and
4 to 9* or 1 cup of cooked rice become weak. The respiratory muscles that help
cereals
or pasta you to breathe can also be affected.
or 4 to 6 large crackers
or 8 to 12 small crackers Being underweight can have a negative impact on
your lung function, impair your exercise tolerance
Vegetables and increase your risk of infection.
1/2 cup cooked vegetables
and 5 or more
or 1 cup salad
legumes
Body Mass Index (BMI) for Adults
1 medium piece of fruit
Fruit 2 to 3 or 1/2 cup of tinned fruit
or 3 to 4 pieces dried fruit
1 cup full cream, reduced

fat and low fat milk
Milk and
2 to 3 or 40 grams cheese
dairy foods
or 200 grams yoghurt
or 1 cup of custard
Meat, 85 grams meat

poultry, or 100 grams fish
Weights (kg)
1 to 2
fish and or 3/4 cup legumes
legumes or 2 small eggs
*Number of serves is dependent on age, sex and activity level.
For weight loss, eat 2 to 4 serves per day.
What are the common potential

nutritional issues in lung conditions
and how can you manage them?
What is a healthy body weight for me?
You can use the following graph to work out your
Body Mass Index (BMI), which will indicate whether Height in centimetres
What can you do about being underweight?

Eating foods that are high in protein and energy Sample meal plan if you are underweight
will help you to improve your nutrition and regain
Breakfast
lost weight and muscle.
A bowl of cereal with one and a half cups
Eat a healthy, balanced diet. Ensure you have a of full cream milk and one or two teaspoons
good intake of protein-rich foods, such as eggs, of sugar
dairy products, beans, meat, fish and poultry. or
Two scrambled or poached eggs on toast
Enrich your meals and snacks where possible
with margarine
with dairy products and eggs (use powdered
eggs if the food is not going to be cooked, for
Morning tea
example, eggflips).
A tub of full cream yoghurt (200 grams)
Fortify milk by adding one-half to one cup or
of skim or full cream milk powder to one litre A nutritious drink, such as a fruit smoothie,
of full cream milk. Use the fortified milk on Nestl MILO or Sustagen
breakfast cereals and in milkshakes, porridge,
soups, casseroles, milk desserts and mashed Lunch
potato. You can even add one to two tablespoons A soft sandwich, two slices of bread, ham,
of milk powder into batters, cake mixes, turkey or egg, cheese and salad (lettuce,
puddings, scrambled egg and gravies. tomato, beetroot and cucumber)
If you are feeling short of breath, it may be or
easier to drink more nutritious milk-based A tin of tuna or salmon stirred through one
drinks. Your dietician can talk to you about cup of cooked pasta and grated cheese
specific supplements, such as Sustagen and Side salad with an oil based dressing
Resource Plus, available in pharmacies. or
A small tin of baked beans on two slices
Nourishing snacks between meals can be a
of toast with margarine
good way of increasing your intake. Try milk
and
desserts and drinks, yoghurt, dried fruit and
A dessert, such as canned fruit and custard
nuts, raisin toast, muffins, crumpets, biscuits
and cheese, sandwiches or even breakfast
Afternoon tea
cereal with milk.
Cheese and biscuits
Soups can be easy to eat and can be made or
more nourishing by adding cereal (for example, A nutritious drink, such as a fruit smoothie
rice, barley or pasta) plus some meat, chicken Nestl MILO or Sustagen
or legumes (for example, lentils, canned bean
mix or canned chickpeas). Dinner
Add some extra calories by adding extra fat, A soft hot meal, such as quiche, casserole,
preferably poly or monounsaturated sources stew or fish with white sauce
of fat, to your meals: Well cooked vegetables, such as mashed
Fry meat, fish, chicken and vegetables potato or pumpkin, and cauliflower or
in vegetable oils (for example, olive oil or broccoli with cheese sauce
canola oil). and
A dessert, such as jelly and ice cream
Spread margarine, avocado, peanut butter or
hummus on breads, crackers or baked foods.
Supper
Add margarine or oils to cooked rice, pasta, A nutritious drink, such as hot chocolate
potatoes, vegetables and salads.

Sample meal plan if you are overweight

Breakfast
Two slices of toast, thin scrape of
margarine and vegemite, jam or honey
A tub of low-fat yoghurt (200 grams)
or
A bowl of cereal with one cup of low fat milk
and
A small glass of orange juice/ piece of fruit
Morning tea
Two plain biscuits
What if you are overweight?
Lunch Carrying too much weight can make it hard for
Two slices of bread, a bread roll or lavash you to do normal activities and make breathing
bread with 65 grams of lean ham or turkey, even more difficult.
mustard or cranberry sauce, and salad
Additional weight can interfere with breathing and
(lettuce, tomato, beetroot and cucumber)
increase your oxygen requirement, causing your
or
A tin of tuna or salmon stirred through lungs to work even harder.
one cup cooked pasta Weight gain can be related to an increased appetite
A side salad and/or fluid retention as a side effect of the
or medication, prednisone or prednisolone.
A small tin of baked beans on two slices
of toast Being overweight also increases your risk of high
and blood pressure, diabetes and high cholesterol.
A piece of fruit, such as a banana, apple,
What can you do about being overweight?
orange, or two apricots or plums
If you need to lose weight try the following hints:
Afternoon tea
A tub of low-fat yoghurt (200 grams) Eat a balanced diet that is low in fat, salt,
sugar and alcohol, and high in fibre.
Dinner Use small amounts of added fat (for example,
100 grams of lean meat, such as chicken, butter, margarine or oil) in your cooking. Use
fish, lamb or pork, that has been stir fried, marinades, herbs and spices for added flavour
steamed or grilled, or cooked in a curry, stew without added fat.
or bolognaise or other pasta sauce with a
Trim visible fat from meat and remove the skin
variety of vegetables, such as:
from chicken before you cook.
Pasta sauce: tinned tomatoes, mushrooms, Use low-fat cooking methods, such as grilling,
capsicum, zucchini barbecuing, steaming, microwaving, boiling,
Curry: potato or sweet potato, eggplant, oven baking and stir frying.
carrots, chickpeas
Choose low-fat dairy products.
Stir fry: capsicum, ginger, garlic, bean
sprouts, snow peas, carrots Reduce or eliminate the use of spreads, such
Grilled: mashed potato, peas, carrots as butter, margarine and mayonnaise. For extra
and moisture and flavour, try mustards, chutneys
One cup of pasta, rice or potato and extra salad ingredients.
Watch your portion sizes.
Drink plenty of water (approximately eight cups) To maintain your bone strength and protect against
every day unless you have been advised by your osteoporosis:
doctor to limit your fluid intake.
Ensure that your calcium intake is high (three
Change your recipes to use low-fat ingredients. to four serves of low-fat calcium rich foods
Increasing your physical activity is an important each day).
way to help you lose excess weight. Increase your intake of foods that are sources of
Always combine a weight loss program with an vitamin D, which helps absorb dietary calcium.
exercise program to minimise the loss of muscle. Limit your intake of salt, caffeine and alcohol as
these substances increase calcium excretion.
What if you are too tired to shop, What about other supplements?
cook or eat? Omega-3 polyunsaturated fatty acids are known to
When you are tired or unwell, it can be difficult be beneficial in helping reduce lung inflammation in
to make sure you are eating enough. However, people who have COPD.
this is usually the time when good nutrition is The best sources of omega-3 polyunsaturated fatty
most important. acids are:
To help, try some of these tips: Oily fish (for example, mackerel, sardines,
Consider using a home delivered meal service, herring, salmon, trout, tuna and mullet):
such as Meals on Wheels. Consume at least two fish meals per week.
Remember to have a rest before meals. Canola oil, soybean oil, flaxseed oil and
Eat slowly and chew foods well. mustard seed oil.
Breathe evenly while chewing and sit quietly
for 30 minutes after eating.
Try having five or six smaller meals or snacks
rather than three large meals per day.
What types of food have been

associated with lung conditions?
What about dairy products?
Some people with lung conditions believe that milk
increases sputum production. Scientific studies have
not backed up this claim.
Milk can coat the back of the throat and make
mucous secretions feel thicker. Rinsing the mouth
with water or soda water after milky drinks can help
prevent this.
Dairy foods are encouraged as they provide a rich
source of calcium. Many people with lung conditions
may require long term steroid medication this can
increase the loss of calcium from the bones. The
loss of calcium from the bones increases the risk of
osteoporosis and bone fractures.

16
chapter
Chronic obstructive pulmonary

disease and swallowing

How swallowing and breathing are related.
How breathing and swallowing are affected by chronic obstructive pulmonary disease (COPD).
What the consequences of swallowing problems are.
How you can tell if you are experiencing swallowing problems.
How a speech pathologist can help you with swallowing problems.
What strategies you can use to help manage swallowing problems.
How are swallowing and How are breathing and swallowing

breathing related? affected by COPD?
Swallowing is a highly complex process involving How does COPD affect your breathing?
the coordination of more than 26 muscles and six
Details of how COPD can affect your breathing are
nerves. For this process to occur smoothly, the body
provided in other sections of this Patient Guide (see
must also co-ordinate the breathing cycle during the
chapter 12 Breathlessness, breathing control and
swallow. Swallowing interrupts breathing. At the
energy conservation on pages 52 to 57). Basically,
exact moment you swallow, you must momentarily
COPD can cause you to breathe faster, which means
hold your breath to close the airway. Closing the
that your breathing muscles can become tired and
airway prevents any food or fluid from entering the
weak. Your coughing reflex can also become weak.
lungs. The normal swallowbreathing cycle (shown
As breathing and swallowing are related, a weak
in steps 1 to 4 in the following diagram) should only
cough reflex can cause problems with swallowing.
take a few seconds to complete.
How does COPD affect your swallowing?
1. Before the swallow, Swallowing and breathing are related. Many people
breathe in and hold breath with breathing problems also experience difficulty
co-ordinating breathing and swallowing while eating
4. Return to 2. During the swallow, the and drinking.
normal airways remains closed During mealtimes, you may use the swallow
breathing for about one second breathing cycle more than 100 times. People who
(to prevent food or fluid have COPD often become short of breath during
getting into the lungs) mealtimes because of the breath-holding that occurs
during the swallowingbreathing cycle. The more
short of breath you become, the more likely you
3. After the swallow, breathe out to clear will find it difficult to co-ordinate your breathing
any remaining food or fluid from the throat and swallowing.
Swallowing problems (called dysphagia) can occur Swallowing problems are often under-diagnosed in
because the need for oxygen will always overrule people who have COPD because silent aspiration
the need to protect the lungs from food or fluids. can be difficult to detect.
Swallowing problems and nutrition

What are the consequences As you are using more energy to maintain your
of a swallowing problem? breathing during chewing and swallowing, eating
Swallowing problems and aspiration and drinking can become more tiring. As a result,
you may take longer to complete your meals and
If breathing timing is even slightly changed during
you may eat and drink less. Eating and drinking
swallowing, the airway may not be fully closed and
less could cause you to miss out on important
food or fluid may be breathed into the lungs. This
nutrients and lose weight.
is called aspiration and may lead to chest infections
or pneumonia.
Normally, when food or fluid goes down the wrong How can you tell if you are
way (aspirated), you automatically cough up the experiencing swallowing problems?
food or drink. As people who have COPD often have Read the following two lists of the common signs of
a weakened cough reflex, they may not be able to swallowing problems. Tick the box next to any sign
clear all the food or fluid out of their breathing tubes that you experience when eating and drinking:
or airways.
List 1
Aspiration is a symptom of swallowing problems. The
Coughing or choking after swallowing
extent of the swallowing problems can change over
food or drinks.
time, and may depend on how bad your breathing
problems are at the time (and other medical factors). Increased shortness of breath during meals.
As many as 20% to 40% of people who have COPD Wet or gurgly voice after swallowing.
experience aspiration (particularly during a flare up). Feeling like food is getting stuck in the throat.
Difficulty chewing foods.
Taking longer to start a swallow.
List 2
Food or drink going into your nose.
Food or drink remaining in the mouth
after swallowing.
Reflux or regurgitation.
Taking much longer to finish meals.
Getting more fatigued after eating and drinking.
Unexplained weight loss.
Unexplained temperatures or changes in
sputum colour.
If you ticked two to three items (particularly those in

List 1), or are concerned about your swallowing, ask
your GP (or respiratory specialist) to refer you to a
speech pathologist who can assess your swallowing.
69 Chapter 16: Chronic obstructive pulmonary disease and swallowing

Try to minimise talking during mealtimes to

How can speech pathologists help
reduce the exertion on your breathing.
you with swallowing problems?
Remain upright for 30 minutes after your meal.
Speech pathologists are trained to assess, diagnose
If you experience reflux or heartburn, discuss
and treat swallowing and communication problems.
anti-reflux medication with your GP.
They can:
Assess your current swallowing function and Managing swallowing problems due
determine the cause of your swallowing to dry mouth
problem. People who have COPD often experience dry mouth.
Recommend appropriate foods and fluids, as Dry mouth can be related to oxygen use (via a mask
well as strategies to improve swallowing safety. or nasal prongs), mouth breathing or medications.
Having a dry mouth is uncomfortable, can increase
Start you on swallowing therapy, if appropriate.
the risk of dental problems and can cause swallowing
Identify the need for further investigations. problems. To reduce dry mouth symptoms:
Liaise with other health care professionals.
Sip fluids frequently throughout the day.
Always rinse and gargle after taking your
If you are experiencing swallowing problems, medication or inhalers.
a speech pathologist can give you specific advice Use artificial saliva products (for example,
to help you eat and drink safely. Biotene or Oralube), available at your
local pharmacy, or other oral lubricants
(for example, grape seed oil flavoured with
What strategies can you use to help peppermint essence).
manage swallowing problems? Suck sugar free lollies or chew gum.
Even if you are not experiencing swallowing problems, Avoid medicated lozenges or alcohol-based
you should be aware that there are a number of mouthwashes.
strategies that can be used to protect the lungs. Reduce your intake of caffeine, alcohol and
This knowledge could help you if you do encounter spicy foods, and avoid smoking.
swallowing problems (for example, if you have a
Regularly brush your teeth and gums
flare up). These strategies include:
(or clean your dentures) to reduce bacteria
Try not to eat or drink when you are breathless. build up in your mouth.
Always sit upright in a supported chair when Have regular dental check-ups.
you are eating and drinking. Talk to your GP about reviewing the
Eat slowly and take small mouthfuls. medications you are taking.
Select foods that are soft and easy to chew,
or add sauce or gravy to moisten foods.
To overcome difficulties with swallowing
If worn at home, oxygen prongs should not
medications, try cutting or crushing your
be removed during meals.
medications and mixing them with yoghurt,
Have smaller, more frequent meals, and take custard or jam before swallowing them.
a break during your meal if you become too However, as not all medications can be cut
short of breath. or crushed, you should always check with
Try to breathe out immediately after you swallow your GP or pharmacist first.
to help clear any food or fluid left in your throat.
Alternate between sips of fluids and solids.
Try swallowing twice per mouthful.
17
Chronic obstructive pulmonary disease

and other related conditions

What incontinence is.
What obstructive sleep apnoea is.
What osteoporosis is.
What is incontinence? Pregnancy and childbirth.

Continual straining to empty bowels (constipation).
Why do you need to know about incontinence?
Heavy lifting.
Incontinence and other complaints of a weak pelvic
floor are common for many people who have chronic Growing older
obstructive pulmonary disease (COPD) and other Being overweight.
chronic lung conditions. Being unfit.
What is the pelvic floor? Changes in hormone levels at menopause.
The pelvic floor is made up of layers of muscle and What are the symptoms of a weak pelvic floor?
other tissues. If you suffer from any of the following complaints,
The pelvic floor holds up and supports the organs you may have a weak pelvic floor:
in the pelvis including the bladder, the bowel, the Urgency: a sudden and urgent need to go to
uterus (or womb) in women and the prostate in men. the toilet and an inability to hold on.
The pelvic floor helps to control bladder and bowel Incontinence: a leakage of urine or faeces from
function. When the pelvic floor muscles contract, they the bladder or bowel.
contribute to the functional control of the bladder, Stress incontinence: a small leakage of the
the bowel and the uterus during daily activities. urine from the bladder when the pelvic floor is
Coughing and sneezing cause increased pressure stressed by activity, such as coughing, laughing,
on the pelvic floor muscles. sneezing, straining or lifting, jumping, running
Contraction of the pelvic floor muscles is important or doing exercise.
in preventing urgency (the urgent need to go to the Constipation or straining: the inability to empty
toilet), constipation and incontinence (the leakage without great effort.
of urine or faeces). The pelvic floor muscles also Frequency: a need to go to the toilet frequently,
contribute to good posture. The pelvic floor muscles which indicates an inability to hold on.
can be weak from: Other symptoms: such as vaginal flatus (wind)
Chronic coughing. or inability to keep tampons in.
71 Chapter 17: Chronic obstructive pulmonary disease and other related conditions
What can you do to strengthen your pelvic floor? be performed occasionally, as this action may
A weak pelvic floor cannot do its job properly. Research interfere with your normal bladder emptying.
has shown that the pelvic floor responds to regular How to do your pelvic floor routine
exercise. In fact, the sooner you start pelvic floor
For men: tighten and draw in strongly the
exercises, the better your chance of preventing or
muscles around your rectum (back passage)
overcoming many of the problems associated with
and urethra (urine tube) all at once, trying to
a weak pelvic floor.
hold them up inside. Hold this contraction as
If you experience stress incontinence, contracting you count to five and then relax. You should
the pelvic floor before any activity (for example, have a feeling of letting go as you relax. Rest
coughing, sneezing, lifting or jumping) that will for at least 10 seconds and repeat. Aim to do
increase pressure to the pelvic floor can help to 10 contractions.
protect you against leakage. Practise this technique For women: tighten and draw in gently the
regularly to ensure that it becomes a lifelong habit. muscles around your rectum (back passage),
What are good bladder and bowel habits? vagina and urethra all at once, trying to hold
them up inside. Hold this contraction as you
Going to the toilet between four and six times a day
count to five and then relax. You should have
and no more than twice at night is normal.
a feeling of letting go as you relax. Rest for
Some simple steps to keep your bladder and bowel at least 10 seconds and repeat. Aim to do
healthy are: 10 contractions.
Try to drink at least six to eight cups (one and When doing these exercises:
a half litres) of fluid a day (unless advised Do not hold your breath.
otherwise by your doctor).
Do not push down; squeeze and lift up.
Limit the amount of caffeine (for example,
Do not tighten your buttocks or thighs.
coffee, cola and tea) and alcohol you drink
as these drinks irritate the bladder. What else do you need to know?
Try to go to the toilet only when your bladder is Strengthening the pelvic floor muscles takes
full and you need to go (emptying your bladder time. If you have very weak muscles initially,
before going to bed is fine). they will fatigue easily. Dont give up. These
Take your time when urinating so that your exercises do work if done regularly.
bladder can empty completely. These exercises should be done regularly and
Keep your bowels regular and avoid constipation. you can add them into your daily routine, such
as after going to the toilet, when having a drink
Do not strain when using your bowels.
or when lying in bed.
Keep your pelvic floor muscles in good condition.
A position that enhances pelvic floor function
How to do pelvic floor exercises should be chosen if you regularly perform airway
clearance techniques. When sitting, this is
How to tighten your pelvic floor muscles achieved with feet flat on the floor, your hips at
Sit or lie comfortably with the muscles of your 90 degrees and your lumbar spine in neutral or
thighs, buttocks and abdomen relaxed. straight (not slumped). Ensure you contract the
Tighten (and then relax) the ring of muscles pelvic floor muscles before huffing and coughing.
around your back passage (anus) as if you are For more information, please contact your
trying to control diarrhoea or wind. Practise doctor, physiotherapist or continence advisor,
this movement until you are able to exercise or contact the National Continence Helpline
the correct muscles. (phone: 1800 330 066). There are specialist
When you are passing urine, try to stop the flow health care professionals that deal with the
midstream and then re-start it. This should only problem of incontinence.
What is obstructive sleep apnoea? What other problems can develop from OSA?
Untreated, OSA can be a contributing risk factor for
Why do you need to know about
high blood pressure, heart attack, heart failure, and
obstructive sleep apnoea?
stroke. All these conditions occur more frequently in
Obstructive sleep apnoea (OSA) and other breathing people with OSA.
conditions are common for many people who have
COPD and other chronic lung conditions. OSA-associated poor concentration and daytime
sleepiness have been associated with an increased
What is Obstructive Sleep Apnoea? risk of accidents in the workplace and on the road.
People who suffer from OSA reduce or stop their
How is OSA assessed?
breathing for short periods while sleeping. This can
happen many times during the night. These breathing In a person suspected of having OSA, their doctor
stoppages or apnoeas interrupt sleep which results will need to ask questions about waking and sleeping
in poor sleep quality with excessive sleepiness during habits. Reports from the sleeping partner or other
the day. Because these events occur during sleep, a household members about any apnoeas are
person suffering from OSA is usually unaware of them extremely helpful.
and is often the last one to know what is happening. Referral to a sleep disorders specialist and an overnight
In OSA, the apnoeas can last for ten or more seconds sleep study will assist with the diagnosis of OSA and
and the cycle of apnoeas and broken sleep is repeated measurement of its severity.
hundreds of times per night in severe cases. Most
How is OSA treated?
sufferers are unaware of their disrupted sleep but
awaken unrefreshed, feeling tired and needing The chosen form of treatment depends on the severity
more sleep. of OSA and patient factors.
What are the symptoms of OSA? General guidelines

A person with OSA may not be aware of the many In an overweight person, weight loss is an
arousals from deep sleep caused by their condition. important part of treatment. Even a small loss
Symptoms of OSA include: of weight can lead to improvement in symptoms
of OSA.
A perception of poor quality sleep despite long
Avoiding alcohol up to two hours before going
periods of time spent in bed.
to sleep and not using any sleeping tablets or
Difficulty maintaining concentration tranquillisers can also help.
during the day.
Nasal obstruction may respond to nasal
Poor memory. decongestant sprays and smoking cessation.
Excessive daytime sleepiness. For people whose sleep apnoea is worsened by
Other symptoms of OSA include: lying on their back, positioning devices such as
special pillows, rubber wedges and tennis balls
Morning headache.
attached to pyjama backs encourage sleep in
Depression. other positions but are of limited value in very
Short temper. severe OSA.
Grumpiness.
Personality change. Obstructive sleep apnoea (OSA) and other
Loss of interest in sex. breathing conditions are common for many
Impotence in males. people who have COPD and other chronic
lung conditions.
Specific treatments 3. Uvulopalatopharyngoplasty (UPPP): this involves

Continuous positive airway pressure (CPAP) removal of excess tissue at the back of the throat
which may contribute to upper airway obstruction
A CPAP pump is the most common treatment for
during sleep.
OSA and is very effective in many cases. A CPAP
pump delivers air to the upper breathing tubes or 4. Corrective surgery for jaw or hard palate deformity:
airways via a plastic tube attached to a close-fitting in a very few people with OSA, major surgery to
nose mask. re-align the bony structures of the lower and
mid-face may be helpful.
Further reading
Snoring, Sleep Apnoea and Other Sleep Problems,
3rd edition (Prof. Rob Pierce and Dr Matthew
Naughton) published by The Australian Lung
Foundation, phone 1800 654 301 for details.
Untreated obstructive sleep apnoea can be a

contributing risk factor for a number of other
health problems.
What is osteoporosis?
Osteoporosis is a condition of low bone density,
where your bones become thin and break more
easily. Referred to as a silent disease where often
no symptoms are present and for many, a fracture
(broken bones) is the first sign of osteoporosis.
Other non-surgical treatments Common sites for osteoporotic fractures are the
Individually designed oral appliances or mouth spine, hip, wrist, and ribs. Hip fractures are
splints made by dentists may help people with common in people over 75 years.
snoring or apnoea.
How common is Osteoporosis?
Tongue retainer devices may be useful in those
Over 2 million Australians have osteoporosis.
who no longer have their own teeth.
Fractures due to osteoporosis can occur at any
Specially designed mouth plates may help
age and the risk increases as we get older.
people who have a narrow maxilla.
Surgery What are the risk factors for developing
Surgery to the upper airway may ease some of
osteoporosis?
the structural problems that contribute to airway There are a number of risk factors that contribute
blockage during sleep. These operations include: to osteoporosis seen in people with COPD. These
risk factors include:
1. Removal of tonsils and adenoids: this is far
more common in children than adults and Smoking.
can have excellent results. Vitamin D deficiency.
2. Nasal surgery to improve nasal airflow. Such Low body mass index (BMI).
operations improve nasal airflow and enable Hypogonadism (deficiency in the secretory
nasal CPAP to work more efficiently. activity of the ovaries and testis).
Decreased mobility as the disease progresses. Conclusion

Family history. Its important to be aware of any risk factors you
Menopause. may have or if you have had a minor bump resulting
in a fracture, you may have osteoporosis. You can
Thin and small body frames.
receive treatment and/or make changes to your
Caucasian or Asian. lifestyle that can improve your quality of life.
Advancing age.
Further reading and useful resources
In addition to these risk factors, steroid use in many www.fractureriskcalculator.com
people with COPD is thought to be a contributing Osteoporosis Australia: www.osteoporosis.org.au
factor in the development of osteoporosis. Calcium Counter: www.arthritisvic.org.au
How is osteoporosis diagnosed?
A bone density test is a quick test to:
Measure osteoporosis or osteopenia
(where bone density is lower than normal).
Evaluate response to therapy.
Predict fractures occurring in the future.
The common sites scanned are the lumbar spine,
hip and forearm.
Your doctor may order blood and urine tests along
with x-rays to have a closer look at your bone health.
How is osteoporosis treated?

There are a number of medications available
through the Pharmaceutical Benefits Scheme to
treat osteoporosis. The medications work by
maintaining or improving bone density and strength.
This can reduce the risk of fractures. Lifestyle
changes may also be required.
What lifestyle changes can I make?

Lifestyle factors can play a role in reducing
age-related bone loss that contributes to
osteoporosis risk. These include:
Adding calcium to your diet if you are deficient.
Sensible sun exposure.
Doing weight bearing exercises.
If you smoke, quit.
Minimise your alcohol intake (no more than
2 standard drinks per day for women, and no
more than 4 for men).
18
chapter
Managing stress, anxiety and depression

What the signs of stress are. How you can reduce stress.
What you can do if you have anxiety. Why relaxation practice is important.
Feelings of helplessness. How you can reduce the number of crisis
What you can do if you have depression. events and manage them.
In response to stress, some people begin to avoid

certain situations or activities. Avoidance can be a
problem. Continuing to avoid situations or activities
that make you feel anxious can reduce your activity
level and social contacts. It can also increase your
risk of developing anxiety and interfere with your
ability to manage your condition.
If you avoid certain situations or activities, speak
with your pulmonary rehabilitation facilitator or
doctor about how you can gradually re-expose
yourself to those situations or activities.
What can you do if you have anxiety?

In addition to the stressors related to having COPD,
What are the signs of stress? the worry people experience when they have shortness
Research tells us that people with chronic disease of breath can lead to anxiety problems. In a circular
who enjoy the best quality of life and fewest relationship, experiencing anxiety or panic attacks
complications are those who understand their can increase a persons breathlessness. It can also
condition and are actively involved in managing make it more difficult to function on a daily basis,
their condition. achieve goals and maintain relationships.
Stressors, such as illness, financial concerns or There are effective treatments for anxiety that you can
relationship difficulties, could cause: ask your GP or health care team about. Talking to a
mental health professional can increase understanding
Your heart to beat faster. of anxiety and support a person to learn new skills
The muscles of your arms and legs to that reduce symptoms.
tremble or shake.
Medication such as anti anxiety and anti depressant
Your breathing to change. medication to reduce physical symptoms and stop
You to start sweating. racing thoughts can also be very helpful.
What are feelings of helplessness?

The diagnosis of COPD has a significant impact.
Everyone with COPD feels helpless to some degree,
particularly if experiencing recurring flare ups.
However, it is important to remember that these
feelings of helplessness are normal and remember
that everything you can do to manage your condition
helps. The tips on the following page might help
you to keep on track.
What can you do if you have depression?

Not surprisingly, severe or ongoing stress can often
lead to depression.
When a person is depressed you might notice changes How can you reduce stress?
such as withdrawal or lack of enjoyment in activities
1. Establish a routine. Having a regular routine
or not getting things done. A person may experience
helps maintain balance and increases your
sadness, irritability, guilt or worthlessness and say
sense of control. In your routine, you should
things like its all my fault or life isnt worth living.
include activities you need to do as well as fun
They may experience physical symptoms including
activities that you can look forward to.
changes in appetite or sleeping more or less than usual.
2. Eat well and drink plenty of water. Your body
If these changes occur consistently for a period of two
will perform best when you eat well and drink
weeks or more the symptoms may be an indication
plenty of water. However, if you have been advised
of depression. If you feel that you or someone close to
to restrict fluids, you should follow this advice.
you may be depressed, speak with your medical team
about how to access helpful resources in your area. 3. Exercise regularly. Talk with your pulmonary
rehabilitation facilitator about the type, frequency
Treatment for depression can include psychological
and intensity of exercise that is right for you.
treatments or anti depressant medication, or both. It
Find out how to upgrade your exercise program
is important to know that anti depressant medications
as you improve, and plan regular exercise into
may take four to six weeks before symptoms improve.
your routine. If possible, exercise earlier in the
Also, some medications may have unwanted side
day so as not to disturb your sleep.
effects in the short term, such as increased anxiety,
nausea or dizziness. People may also experience 4. Get plenty of sleep. Establish a regular bedtime.
some difficulty sleeping or sexual difficulties. Most A warm bath, shower or milk drink before bed
of these symptoms are likely to be short lived but may improve your sleep. If you cant get to sleep
it is important to advise your doctor if they persist after twenty minutes of being in bed, get out of
or if you are worried about them. bed and do a quiet activity until you feel tired.
Medicare rebated services are available if a GP refers 5. Limit your use of alcohol and other drugs. Many
you to a mental health professional for treatment for people use drugs and alcohol to help manage
anxiety or depression. their stress. For example, some people use alcohol
and cigarettes to calm down and other people
may use coffee, cola or energy drinks to get
Some people with COPD experience depression. themselves going. However, drugs and alcohol
If you believe this is you, speak to your doctor can have harmful effects on people and can
about support available to help. result in dependence.
77 Chapter 18: Managing stress, anxiety and depression

6. Maintain your social network. People with 12. Practice relaxed breathing. When stressed,
chronic conditions who have few friends and or experiencing strong emotions most people
dont get out much may have worse health tend to breathe faster and shallower; this type
outcomes. Getting out and catching up with of breathing can lead to a feeling of breathlessness
friends is important and you should plan to and sometimes panic breathing. People who
do this regularly. have COPD can minimise the risk of becoming
breathless during times of stress or high emotion,
7. Join a local patient support group. Contact
by using the relaxed breathing techniques
The Australian Lung Foundation to find out
(see chapter 12).
about patient support groups near you
(phone: 1800 654 301 or website:
www.lungfoundation.com.au). If a patient
support group has not been established
in your area, The Australian Lung Foundation
can help you to start one.
8. Maintain interests and hobbies. Often people
who have chronic conditions let go of interests
and hobbies because they believe the effort
outweighs the benefits. Participating in enjoyable
activities can give life meaning and can help you
maintain and enhance your skills and abilities.
9. Be aware of automatic or unhelpful thinking.
When life is busy or stressful, you may respond
to events without stopping to consider your
response. Before responding, stop and take
some deep breaths, count to 10, or go for a
short walk and consider whether you need to
respond and how you will respond.
Why is relaxation practice important?
10. Planning and time management. People who
Scheduling time to relax in your daily or weekly
plan how they will apply the skills they have
routine is important. Relaxation can be formal,
learnt in pulmonary rehabilitation to their home
such as guided relaxation practice, or informal,
or work life are more likely to use these skills in
such as watching football or listening to music.
their daily lives. Effective time management is
Formal relaxation practice helps to:
essential for maintaining your health, work,
social and home life. Spread tasks, or parts of Increase your metabolism.
tasks, across several days, and build time into Slow your heart beat.
your schedule for unexpected events. Relax your muscles.
11. Communicate effectively. Effective communication Slow your breathing.
includes both speaking and listening. Often
Lower your blood pressure.
when you feel under pressure, you can spend
all your time speaking or thinking about what If you are interested in finding out more about formal
you want to say rather than listening. Take relaxation practice, ask your pulmonary rehabilitation
the time to listen to what is being said before co-ordinator for a tip sheet on relaxation. You can
responding. Assertive communication requires also find CDs in bookstores or in your local library or
honest and direct discussion that describes the audio downloads on the internet that will guide you
problem, the effect and the solution. through different types of formal relaxation exercises.
How can you reduce the number of of the event. The following strategies may help you
crisis events and manage them? manage crisis events:
Reducing the number of crisis events Become aware of your expectations. In the past,
if a similar crisis event went from bad to worse,
The chance of crisis events occurring due to
it doesnt mean that the current event will also
ill health should be reduced if you use your
go from bad to worse.
medication and inhalers appropriately, and
remember to eat well and exercise regularly. Become aware of the language you are using and
replace unhelpful thoughts with more helpful
The number of crisis events occurring due to
thoughts. For example, rather than thinking
injury, muscle strain or physical exhaustion
your weekend was a disaster, recognise that it
should be reduced if you increase your
rained on the weekend and, as a result, you
exercise tolerance and practise your energy
were unable to do what you wanted to do.
conservation skills.
Protect yourself against becoming too stressed
The number of crisis events occurring due to
by developing a plan to deal with a difficult
stress should be reduced if you practise your
situation. You can mentally rehearse what you
relaxation techniques and improve your
might do or say before a potentially challenging
communication and problem solving skills.
event occurs. You can also review how you
Managing crisis events managed after the event and create options for
When a crisis event does occur, and you find yourself how you might handle a similar situation if it
getting emotionally upset, you will need to decide what happens again.
you can do to avoid the situation from becoming Dont forget to practice relaxation techniques
worse or how you can reduce the emotional impact and use relaxed breathing (see chapter 12).
79 Chapter 18: Managing stress, anxiety and depression

19
chapter
Intimacy and COPD

How you can maintain and improve intimacy and sexual activity
Intimacy & Sexual Activity Planning for Sexual Activity:

Many people who have chronic lung conditions, and Incorporate controlled breathing techniques and
their partners, have concerns about the effect of sexual energy conservation strategies.
activity on their lungs. Sexual activity is not harmful Plan sexual activity when you feel at your best
to your lungs, and resuming intimacy and closeness in the day.
with your partner can help to decrease feelings of Cough and clear sputum prior to sexual activity.
loneliness and isolation.
Use your reliever puffer before or during
Your lung disease does not directly affect your sexual sexual activity.
ability. However, COPD can have an effect on your If you use home oxygen for activities, plan
physical health, such as becoming more short of to use the same amount of oxygen during
breath, and perhaps your emotional health, such as sexual activity.
feeling anxious, depressed, or lonely. Physical and
Be aware of your symptoms: breathlessness is
emotional factors can affect your sexual ability.
normal during any demanding activity. If anxiety
The fear of becoming short of breath may lead to
and fatigue develops, stop and rest briefly.
avoidance of sexual activity or an inability to maintain
sexual arousal.
Medications, such as bronchodilators and steroids
that you take for your lung conditions, have not
been documented to cause difficulties with sexual
functions. Medications for blood pressure, diuretics,
and anti depressants may affect sexual drive and
function. If you experience difficulties that interfere
with intimacy, talk with your GP or nurse about
medication effects or the need for increased oxygen
during sexual activity.
It is possible to maintain and improve intimate
relationships by reducing breathlessness, fatigue,
fear and anxiety. Simple considerations include:
Pace Yourself: about problems may lead to misunderstanding and

Take your time, be relaxed and ensure adequate increase strain in your relationship. It can help to:
rests before and during sexual relations. Put your fears on the table. Partners may be
Avoid factors that will increase your fatigue, less concerned about things that worry us
such as heavy meals, alcohol consumption, (such as appearance, shortness of breath or
uncomfortable room temperature and technique) than you think.
emotional stress. Ask about and take time to listen to your
Talk to your partner about positions that are partners thoughts and feelings. Its possible
more comfortable for you to avoid pressure on they feel more fear or guilt than you do.
the chest and stomach, causing breathlessness.
Use I statements when discussing intimacy
Use support from pillows and other furniture. issues to reduce resistance and create more
Change positions if you become uncomfortable. open communication.
Avoid perfumes, powders and hair sprays that Be patient and kind with yourself and your
may impact on breathlessness. partner as you communicate more and
Equally important and less fatiguing forms explore alternatives.
of intimacy include touch, affection, and
physical closeness. All intimacy should be for your enjoyment and fun.
Laugh and talk about any difficulties either person
is experiencing. Be prepared to try different ways
Planning for sexual activity, pacing yourself and to express affection. Tell each other what feels nice.
communicating with your partner. Exploring sensuality and intimacy can open
communication and strengthen your relationship.
Communicate with your Partner: Pulmonary rehabilitation programs usually provide
Communication is a very important part of creating opportunities to discuss issues related to sexual
and maintaining emotional intimacy and satisfying function, or you can discuss your concerns with
sexual relationships with partners. Avoiding talking your health care professional.
81 Chapter 19: Intimacy and COPD

20
chapter
Travel and COPD

What you need to know about driving safely.
How you can plan your travel to prevent health problems.
What you need to know about air travel.
What you need to know about travelling with oxygen.
What do you need to know prescribed long term oxygen you should clarify
about driving safely? with your doctor about using oxygen while driving.
Make sure the oxygen is secured in the car so
Many people with COPD continue to drive safely.
that it doesnt pose an additional safety risk in
The following are some considerations to ensure
case of a crash.
your safety and that of others.
Daytime sleepiness, sleep apnoea and other
COPD may affect your ability to drive safely, and
sleep disorders have the potential to impair
could result in a crash.
driving performance and safety and pose a risk
Drivers who develop a permanent or long term of crashing. Consult your doctor and seek
medical condition that may negatively affect advice about precautions when driving.
their ability to drive safely must report their
condition to the Department of Transport as
soon as it develops. How can you plan your travel to
Talk to your doctor about your medical condition prevent health problems?
and any potential impact this may have on your Travel related health problems arise from a variety of
ability to drive safely. They may provide a medical factors related to your travel environment eg. holiday
certificate stating your fitness to drive, or any destination, types of activities, food and water quality.
conditions under which you can drive.
Travel related health problems can also arise when a
Low oxygen levels or increased carbon dioxide
pre-existing medical condition worsens during travel.
levels may lead to poor judgement, drowsiness
and reduced concentration. Fortunately most travel related problems can be
Driving ability may be affected by severe coughing prevented with careful advance planning. Consult
fits which may lead to loss of consciousness. your doctor or travel medicine clinic so that a travel
plan can be discussed in detail.
Oxygen therapy can enhance cognitive
performance, longevity and wellbeing in those Consider the destination and how the following
with chronic lung disease. If you have been might affect your underlying health condition.
Planned activities are

Countries/Regions visited Air quality Water & food quality
consistent with usual levels
Accessing health care

Type of accommodation & Season of travel:
Altitude
facilities available Any differences in electrical hot/cold/humidity
outlets and voltage
Check in early
Check for any epidemics Flexible tickets
Arrive before darkness
Other suggestions: Accommodation considerations

Take medical documents with you/have your GP Try to avoid places that cannot provide smoke
liaise ahead with major health centres. Map out free restaurants and accommodation.
phone numbers of medical services. If you need portable oxygen, check that
Have travel insurance or access to health care. your accommodation provider will allow
Insurance can be difficult for people with chronic oxygen cylinders to be delivered and stored
disease. Some countries have reciprocal health on their premises.
care with Australia - refer to the following websites: Check access to the room. Do you need to climb
http://medicareaustralia.gov.au/public/ flights of stairs to get there, or is there a lift?
migrants/travelling/index.jsp
http://www.smartraveller.gov.au/index.html What do you need to know
Take plentiful supply of medicine and health about air travel?
equipment eg. relievers, puffers, oxygen tubing, Although air travel is safe for the majority of people,
masks, electrical adaptors, batteries. people with COPD may be at risk due to the decrease
When driving in Australia, the National Public in the concentration of oxygen in humidified air.
Toilet Map, provides information on where the Some people with COPD may require supplementary
nearest facility is (www.toiletmap.gov.au). oxygen when travelling by air, even though they do
General Problems Caused by Commercial Travel not usually need it at home. Your doctor can arrange
for a test (High Altitude Simulation Testing) to assess
Dryness of air.
your oxygen requirements when travelling by air.
Reduced mobility and potential DVT (blood
clots) those with chronic disease such as Preparing for airline travel
COPD would be advised to wear compression Visit your doctor several weeks or months before
sockwear for long flights. travel, to check if you will need oxygen during
Proximity to others and risk of infections. flight. If you do, check with your airline before
Long periods of travel disturb 24hr clock you book your flight, as not all airlines provide
sleeping, eating, taking medications. easy access to oxygen facilities.
Stress of navigating busy airports, Learn what your oxygen needs will be while
unknown roads. flying, and while in terminals. Airlines do not
provide oxygen on the ground. Speak with your
doctor and other health care team members
Although air travel is safe for the majority of about arrangements to supply oxygen for each
people, people with COPD may be at risk due
to the decrease in the concentration of oxygen
in humidified air.
83 Chapter 20: Travel and COPD

part of the trip. Remember to bring enough

batteries and power adaptors, masks, and tubes Oxygen policies and charges can vary depending
for use during your trip. on the airline. Make sure you check their
Most airlines require a Travel Clearance Form requirements and available help for travellers
(MEDIF form) or a letter from a doctor outlining with medical conditions.
your condition, approval for air travel, need for
oxygen in-flight, specific information of oxygen
flow rate. Bring enough copies for all flights. What do you need to know about
Make sure you have adequate supply of your travelling with oxygen?
usual medications for the trip. There are two important considerations:
Carry multiple copies of your prescriptions in
How do you safely transport your oxygen
case luggage is delayed, lost or stolen.
supply, whether you have a concentrator or
If prescribed, carry relievers and puffers in your portable cylinders?
hand luggage.
Can you use portable oxygen whilst in transit?
Oxygen policies and charges can vary depending
on the airline. Make sure you check with the Transporting home concentrators
airlines about their requirements and available A home oxygen concentrator is transportable
help for travellers with medical conditions. (although heavy) and can normally be taken away
Travellers requiring CPAP may need a letter with you. It is important to talk to your supplier
from their doctor for equipment to travel in about how to transport it safely, but here are some
cabin as extra hand luggage. general guidelines:
Discuss risks and management of potential deep Concentrators must be carried upright. They
vein thrombosis. This may occur as a result of may be damaged if transported lying flat or on
reduced activity during prolonged travel. their side.
If travelling by car, put the concentrator in the
boot if possible, or on the back seat restrained
by a seatbelt.
Check with the airline or travel provider to make
sure they will allow your concentrator on board
as hand luggage and ask about the extra cost.
It may be cheaper and easier to hire one and
have it delivered to where you are staying.
Transporting portable cylinders

Ask your supplier for instructions on how to
safely transport your oxygen cylinders.
Check with the airline or travel provider to
ensure they will allow your cylinders on board
as hand luggage. Alternatively arrange to hire
cylinders at your destination.
Portable cylinders should not be taken overseas,
as other countries may not be able to fill them.
Using oxygen during your journey Portable concentrators

Portable oxygen cylinders Some portable concentrators are easy to use on
Many airlines do not allow you to take your own board planes and other modes of transport and
portable oxygen cylinders on board. Instead you can then be used during stop-overs as well. It is
may need to hire an aircraft approved oxygen wise, however, to check that the company you
cylinder or arrange in-flight oxygen through are travelling with will allow your concentrator
the airline. on board.
If you are using the airlines own in-flight oxygen You may need to book a seat near an appropriate
equipment, they may not allow you to take it off power source so the concentrator batteries can
the plane. So, if you have a stop-over on your continue to charge in transit. This is especially
journey, you will probably need to arrange a important for long journeys.
different oxygen supply for the time you spend
on the ground in between flights. Direct routes
The Australian Lung Foundation has a booklet
are easier for this reason.
Getting Started on Home Oxygen that provides
more useful information for those on home oxygen
therapy. Call 1800 654 301 to order a copy.
85 Chapter 20: Travel and COPD

21
chapter
Legal Issues

What your legal rights are to gain access to superannuation and insurance.
How to cope with changes in the workplace.
What steps you can take to protect your assets for the benefit of your family.
How to make sure your family and/or carers are aware of your wishes in relation to
ongoing treatment.
How to make sure you access all available financial support.
Introduction Superannuation benefits include:

When first diagnosed with any major illness, Contributions by your employer and you; and
particularly one which is chronic and life altering Insurance coverage for death and disablement
like COPD, legal issues are often the last things
All policies are different. Some funds will offer lump
you consider.
sum benefits in the event that you become totally and
Unfortunately, neglecting your legal rights and options permanently disabled or partially and permanently
to protect you and your family too often make those disabled. Some funds will provide temporary cover if
daunting legal issues more complicated. you are off work for only a short period of time by
There are some simple steps you can take now to paying all or a percentage of your income whilst you
ensure you have access to any financial support are unable to work.
you may need and also to ensure that in the future You can access:
your family are taken care of even if you are unable
to work or provide for them. Lump sum benefits
Income protection and/or
What are your legal rights to accessing Death benefits
superannuation and insurance? You should contact your superannuation fund to
All working Australians have a superannuation fund to find out what benefits are available. You should
which their employer must contribute amounts during critically analyse the information you are given
the course of their working life. Some people also elect by the superannuation fund manager or insurer.
to contribute further to their superannuation personally. Because of the complexities involved and the
different considerations that apply in your own
You can access your superannuation before retirement
different circumstances a one size fits all approach
age in the event of a serious illness like COPD. All
often means that some people will miss out on
superannuation funds also have a component of
their entitlements.
insurance which is there to help you in the event
you are unable to work because of serious illness.
The information in this chapter has been provided by Turner Freeman Lawyers
Legal advice can help to ensure that the information Anti-discrimination laws across Australia recognise
you receive is correct and assists you with accessing that people with illnesses are at a disadvantage and
all your entitlements. should be treated fairly. An employer must make
reasonable adjustment in the workplace to assist
The terms and conditions applying to these you to conduct your work duties to the best of your
insurance components are sometimes straight ability having regard to the impacts of your illness.
forward but often more complex than they look.
What steps can you take to protect
You do not need to show fault on the part of anyone your assets for the benefit of your family?
or that the cause of your illness was beyond your
Wills
control. Generally the mere fact of having the illness
and that it stops you from working is enough. It is essential that your intentions regarding distribution
of property as well as your wishes in relation to the
Benefits are generally available for people of working continuation of treatment are known and documented.
age. Different funds have different rules and you
should carefully check your own circumstances and A will is a document which identifies your intentions
seek advice. and provides instructions as to the distribution of
your assets when you die.
How can you cope with changes

in the workplace? Whenever your personal circumstances
change you should review and if necessary
Many people with more severe COPD find that the
update your will.
symptoms affect their ability to attend work or their
ability to undertake their work duties.
Depending on their relationship to you, family
All employees are entitled to some measure of sick
members will accrue rights under the will or in
or unpaid leave in the event of a serious illness.
accordance with the law and sometimes those rights
The sources of this entitlement are many and varied can conflict. Having a clear and up-to-date will is
and can range from legislation through to written essential to avoid any conflict.
contracts of employment.
The way in which assets are passed via a will
can impact on the beneficiary of those assets.
Whether you are an employee, an independent Development of appropriate testamentary trusts
contractor or in business, a serious illness should will assist the beneficiaries to access those assets
not be used by an employer or head contractor and assist with tax minimisation.
as an excuse to disadvantage you or treat
Testamentary discretionary trusts are particularly
you differently.
recommended if the beneficiary who will receive
the assets:
There are general protections available to you in
the workplace in the event that you suffer an illness Has a disability.
like COPD and need to access leave or have some Is poor at handling his/her finances.
reasonable adjustment undertaken to enable you to Practices in a profession which has a
continue to work. high risk of litigation.
An employer cannot treat you unfairly or take adverse Is in a high tax bracket.
action against you merely because you have a chronic Has a history of bankruptcy.
illness or are attempting to exercise a workplace
In the event of conflict between beneficiaries or
right like taking sick leave. If an employer does take
potential beneficiaries of an estate there are often
adverse action in these circumstances you are entitled
significant emotions at play.
to seek orders from a Court to restore the status quo
as well as requesting that the employer be subject Good planning and open communication in the
to a fine for breaching legislation. preparation of a will often avoids conflict or confusion.
87 Chapter 21: Legal Issues
In combination with an Enduring Power of

Attorney, an Advanced Health Directive will
ensure your wishes are met and maintained.
How can you make sure you access

all available financial support?
There are many community based and Government
organisations that will make financial and other
support available to you in your time of need.
You do not have to accept adverse decisions that
are made in relation to your entitlements to financial
assistance or services. Often there is a process of
How can you make sure your family review and appeal in relation to those decisions,
and/or carers are aware of your wishes particularly administrative decisions made by
in relation to ongoing treatment? Government. The courts have a general power of
review of those decisions to ensure that administrative
Enduring Powers of Attorney and
decision makers exercise their powers in a just and
Advanced Health Directives
fair manner.
For those living with COPD, it is important to
plan ahead and to ensure your family members As a member of a community organisation or
and/or carer are aware of your wishes in relation other support service your membership terms and
to ongoing treatment. conditions may also enable you to review or appeal
decisions made that are adverse to your interests.
You have the ability to document an Advanced Health
Directive or instructions for your loved ones as to You should seek legal advice about your rights in
your wishes in the event that you lose capacity to relation to any adverse decision.
make decisions because of your illness or while
undergoing treatment.
To access legal advice about these issues
An Advanced Health Directive can look at you can call:
issues including:
Turner Freeman Lawyers on 1800 683 928
What level and extent of treatment you
wish to undergo. or the Queensland Law Society on 1300 367 757
Who should have the power to make
decisions on your behalf.
Special medical conditions that your doctor
or other medical staff should know about.
Religious, spiritual or cultural beliefs that
may affect treatment.
Considerations in relation to resuscitation
or the withholding or withdrawing of life
sustaining measures.
Your wishes in relation to the donation of
organs in the event of your death.
An Enduring Power of Attorney appoints a responsible
and trusted person to make decisions on your behalf.
An Enduring Power of Attorney remains in force even
when you lose capacity to make decisions on your own.
22
Community support services

How you can use community support services.
Where you can seek or access community support services.
What a patient support group is.
What your transport options are.
What other community support services may be helpful.
How can you use community psychologist, occupational therapist or

support services? speech pathologist.
Be an active participant in your care. 2. From The Australian Lung Foundation

(phone: 1800 654 301 or website:
Learn about your lung condition and learn
www.lungfoundation.com.au), which
how to manage and adapt to it.
may include:
Benefit from the knowledge and experience
of other people who have lung conditions. Patient information resources.
Build your own support network to help Information on local pulmonary rehabilitation
manage your health. patient support groups and community
Plan ahead and use available services exercise programs (maintenance).
as you need them. 3. From your local Commonwealth Carelink Centre
(phone: 1800 052 222), which provides free
Where can you seek or access information about local community aged care,
disability and support services.
community support services?
4. From the Commonwealth Respite and Carelink
1. From your team of health care professionals,
Centre (phone: 1800 059 059), which provides
which may include:
information and options about respite care and
A local doctor or respiratory physician. other support services for carers, such as:
A community pharmacist. Respite care in emergency and short term
A community health centre. planned care situations.
Your local council. Assistance in locating and booking
A nurse, such as a community health or residential respite.
respiratory nurse. Access to an emergency respite service
Allied health care professionals, such as 24 hours a day.
a physiotherapist, dietician, social worker,
89 Chapter 22: Community support services

What is a patient support group? focusing our energy on helping others is the best
therapy for overcoming our own troubled feelings.
A patient support group is a group of people who
have common interests and needs. The Australian There are people who need your support and
Lung Foundation supports a network of support friendship.
groups for people who have lung conditions, and
their carers and family.
Who will attend the patient support group?
You will meet ordinary people, from all different
What do patient support groups do? working and ethnic backgrounds. They will share
When you join a patient support group, you can with you a common personal interest in managing
expect to benefit from a range of possible activities their lung condition, whether they are a patient or
from social support to special seminars to online a carer.
support chat rooms. Group members will also have a wide variety of
How you can benefit from a social and lifestyle interests.
patient support group Where and when do patient
Joining a patient support group allows you to: support groups meet?
Discuss the information you have learnt from your Most groups have regular meetings that are held at
doctor and other health care professionals, as a community or neighbourhood centre, or a meeting
sometimes the information is difficult to remember or room at a local hospital. Venues with reasonable
confusing. transport access are normally chosen.
Access new information on your lung condition. How much does participating in a patient
Share your experiences in a caring environment. support group cost?
Participate in pleasurable social activities. Membership of a patient support group normally
Change the way you think about your condition. involves a small annual fee and perhaps a gold
coin at meetings to cover the costs of membership
Help your carer to understand your condition.
services, such as postage, photocopying and meetings.
Have you ever experienced the satisfaction of These fees are always kept to an absolute minimum.
helping someone else in distress? Sometimes,
How do you join a patient support group?

The Australian Lung Foundation operates an
Australia-wide network of affiliated patient
support groups.
To find out about patient support groups in your
area, contact The Australian Lung Foundation
(phone: 1800 654 301, or website:
www.lungfoundation.com.au).
If there is no support group in your area The
Australian Lung Foundation will help you set
one up.
What are your transport options?

Options for transport will depend on what transport
is available in your local area. Your local council
and community health centre will be able to provide
details of the transportation services within your
community. the armed services. The assistance available
Options may include: includes the following options:
Disability parking permits (for more information, Gold Card. Veterans who have served for
see your GP or occupational therapist). their country and who are deemed suitable
for this benefit are eligible for a full range
A taxi subsidy scheme with reduced taxi fares
of health care services.
(for more information, see your GP).
White Card. Veterans who have served their
An ambulance service at reduced cost for
country are eligible for compensation related
transport to and from medical appointments
to their service in the forces. Australian
(for more information, talk with your local
veterans are eligible for Veterans Home Care;
ambulance service).
however, British or other overseas veterans
A Home and Community Care Program are not eligible for Veterans Home Care.
(for more information, talk with your local
Orange Card. Eligible veterans can access
community health centre).
the range of pharmaceutical items available
A Patient Transit Scheme that provides financial under the Repatriation Pharmaceutical
help for travel and accommodation expenses for Benefits Scheme.
people from rural, regional and remote areas in
some parts of Australia when travelling to the For more information contact Veterans Home Care
closest specialist treatment centre. Patients should (phone: 1300 550 450).
make arrangements with a means test clerk, social 2. The Home and Community Care Program
worker or welfare officer at their local hospital provides government funding for the frail aged
before travelling. and young disabled people, and includes the
following services:
What other community support Medical Aids Subsidy Scheme.
services may be helpful? Meals on Wheels.
1. The Department of Veterans Affairs can provide Community Agencies (for example, Queensland
financial, medical, transport and homecare Health Primary and Community Health
assistance for those people who have served in Services, Blue Care, Spiritus and Ozcare).
91 Chapter 22: Community support services

Palliative Care Services. Carers Australia (phone: 1800 242 636)

Home Assist Secure (Queensland Asthma Foundation Australia
Government Department of Housing). (phone: 1800 645 130).
Aged Care Assessment Service. 6. Financial support services such as Centrelink
Community Aged Care Packages. Financial Services 13 23 00; Financial
Day or Respite Care. Counselling Service 1800 007 007.
7. Legal and advocacy support services contact
3. The National Smoking Quitline
the Legal Aid Service and Public Trustee Office
(phone: 137 848) provides assistance
within your State or Territory.
if you wish to quit smoking.
8. Relationship support services Relationships
4. Will preparation do it yourself kits are Australia 1300 364 277 and Mensline
available for purchase if you wish to prepare 1300 789 978.
a will. Alternatively, speak to a solicitor or a
Public Trustee in your state (see chapter 21). 9. Accommodation support services contact
the Department of Housing within your State
5. Counselling and information services, such as: or Territory for information and referral to
Lifeline (phone: 131 114) appropriate agencies including Homelessness
Information Services. If your issues are related
Centacare (located in your capital city)
to a private rental property you may wish to
Suicide Call Back Service contact your local Tenant Advice and Advocacy
(phone: 1300 659 467) Service refer to your local phone directory for
Beyond Blue Info Line (phone 1300 224 636) your nearest service contact details.
The Shed OnLine (www.theshedonline.org.au)
23
Frequently asked questions
This chapter will help you to understand the

following frequently asked questions:
Should I be vaccinated for the flu and/or pneumonia?
What tests can be done to assess my lungs?
What is Lungs in Action?
Should I be vaccinated for the What tests can be done to

flu and/or pneumonia? assess my lungs?
Unless told otherwise by your doctor (for example, There are many tests that can be done to find out if
you are allergic to eggs), you should receive your health problem is related to your lungs. These
vaccinations for both the flu and pneumonia. tests, and what they are used for, are listed below:
The flu vaccine is available each autumn and you Respiratory function tests are breathing tests to
should be vaccinated every year. It has been shown find out how your lung function compares with
to reduce by 50% serious illness, hospitalisation people who are like you but who do not have
and death in patients with COPD. As there are no lung conditions. Spirometry, gas transfer tests
live viruses in the vaccine, you will not get the flu and lung volume measurements may all be
from injection of the vaccine. Like any injection, done as part of a complete test of pulmonary
injection of the flu vaccine may make your arm function or each measurement may be done
tender for a short period of time. Other side effects alone. These tests are discussed in detail in
are minor and include mild fever and joint pain. chapter 4 Lung function tests, pages 8 to 10.
Vaccination against pneumonia (PneumoVax 23) Lung function screening tests - these screening
is recommended for those at high risk of serious tests use a simple hand-held device that will
pneumococcal disease, such as those with COPD. quickly determine whether you are at risk of
This should be given no more than five yearly. After COPD and therefore would benefit from having a
two vaccinations (over 5 years apart), you should full spirometry test done. These devices (Piko-6
discuss with your doctor whether further vaccinations and COPD-6) are used by some general
should be given. Like the flu vaccine, there are no practitioners and pharmacists.
live viruses in the pneumonia vaccine; however, A chest X-ray takes a picture of your lungs and is
injection of the pneumonia vaccine may make your a routine test for evaluating COPD. A chest X-ray
arm tender for a short period of time. will show the lungs as well as the heart and
several major blood vessels. Chest X-rays are
useful if other conditions, such as pneumonia or
lung tumours, are suspected.
93 Chapter 23: Frequently asked questions

What other tests may be useful? a walking test or on an exercise bike. These
tests can be done in an exercise laboratory, a
A computed tomography (CT) scan can take
gymnasium or on a walking track. In the
many small specialised pictures of the lungs.
laboratory, you will usually be asked to breathe
Although a CT scan is not routinely performed,
through a mouthpiece connected to a machine.
it can provide more detail than a chest x-ray.
This machine measures how much effort it takes
An arterial blood gases (ABG) test is a blood you to exercise. You may also be connected to
test that measures how efficient your lungs are heart and oxygen monitors.
at bringing oxygen into the blood and removing
carbon dioxide from the blood. As an ABG test
requires withdrawing blood from an artery, What is Lungs in Action?
this test can be more painful than a standard Lungs in Action is a community-based exercise
blood test. class designed specifically for those with COPD
An oximetry test is a way of indirectly measuring or other chronic respiratory conditions. The program
oxygen levels in your blood. This test is not is appropriate for people who have completed
painful and is commonly used to measure oxygen pulmonary rehabilitation and will help you maintain
saturation, which indicates how much of the the gains you achieved in your rehab program. Each
oxygen in your body is in red blood cells. However, Lungs in Action class is developed in conjunction
as this test can be less reliable than ABG, ABGs with the pulmonary rehabilitation coordinator.
will be used when a more accurate measure of Many people find that Lungs in Action helps them
oxygen levels is required, such as when deciding continue on their exercise program in a supportive
whether home oxygen is required. and familiar environment.
A sputum test is used to find out what type of Ask your pulmonary rehabilitation coordinator if
infection is in your sputum and which antibiotics there is a Lungs in Action class associated with their
would be most effective against that infection. program. Or call The Australian Lung Foundation at
Exercise tests are done to stress your heart and 1800 654 301.
lungs. Exercise testing will usually be performed as
24
Resources and support available from

The Australian Lung Foundation is here to help. We are a national charity providing information
and support to those affected by lung disease. The following are some of the resources developed
for those with Chronic Obstructive Pulmonary Disease (COPD). All these resources can be found
on our website www.lungfoundation.com.au or can be ordered by calling 1800 654 301.
Resources Pulmonary Rehabilitation Factsheet This

fact sheet outlines the benefits of pulmonary
Breathe Easier Your Guide to COPD This fact
rehabilitation and answers frequently asked
sheet outlines in simple language the most important
questions.
facts you need to know about COPD.
LungNet News Published on a quarterly basis,
Save your Breath Information for People Recently
this is a free newsletter which provides useful
Diagnosed with COPD This resource has been
articles on lung health and a wide range of
developed for those people who have recently been
lung disease.
told by their doctor that they have COPD. It will help
you to understand more about COPD and what to Snoring, Sleep Apnoea and Other Sleep Problems
expect from living with this condition. This booklet has been developed for people with
sleep related breathing problems.
Getting Started on Home Oxygen This resource
has been developed for those people with a chronic Obstructive Sleep Apnoea This resource
lung condition, who have recently been prescribed has been developed for people who suffer
home oxygen therapy, or may be prescribed it in the from Obstructive Sleep Apnoea and answers
near future. frequently asked questions.
Talking with your Doctor about COPD This fact The Australian Lung Foundation also has a large
sheet gives some tips about how to get the most range of educational flyers related to the lungs, lung
out of your appointments with your doctor. health and respiratory disease. Visit the website and
look under patient educational material.
COPD Action Plan Take a copy of a COPD Action
Plan with you to your doctor and fill it out together.
Fitness to Fly Many patients living with lung All the resources developed by The Australian
disease have an increasing yearn to travel and Lung Foundation can be accessed on the website
this article will help you to understand the possible at www.lungfoundation.com.au or by calling
risks of air travel and whether you are fit to fly. 1800 654 301.
95 Chapter 24: Resources and support available from The Australian Lung Foundation
Patient Support
In addition to the wide range of educational material
available to those with lung disease, The Australian
Lung Foundation provides a range of support services.
For further information on how to access this support,
please call our Information and Support Centre on
1800 654 301.
Information and Support Centre Free-call

1800 654 301 3AVEYOURBREAT
)NFORMATIONFORPEO H
PLERECENTLY
The Information and Support Centre can help you to d
Getting Startegen
DIAGNOSEDWITH#
/0$
on Home Oxy
find out more about chronic lung disease and the help
that is available to you. A staff lung care nurse is
available to answer your clinical questions. The
Centre can be contacted during office hours on
weekdays on free-call 1800 654 301 or
enquiries@lungfoundation.com.au
Patient Support Groups -ARCH
Located in all states and territories, Patient

Support Groups meet regularly to provide a
welcoming, informal environment for those with
November 2010
a lung condition, their families and/or carers.

The Australian Lung Foundation maintains a list How you can support
of groups in each state and territory and can link
patients up with a group nearby, or, if there is no
existing group provide help to start one. The Australian Lung Foundation receives no
on-going Government funding to support our
Pulmonary Rehabilitation Programs core activities and therefore we rely on financial
The Australian Lung Foundation maintains a list of sponsorship and support from individuals,
contacts for programs in each state and territory, businesses and industry, donations and bequests,
including contact details, any required referral and as well as our own fundraising events and
dates and times of classes. initiatives. Here are some ways you can help
support The Australian Lung Foundation:
Education Days
Held annually in each State, LungNet Education Become a Financial Member
Days provide an opportunity for patients to hear Make a Donation A donation to The Australian
first hand from health professionals about the Lung Foundation will assist us to achieve our vision
latest developments in lung health. and goals. All donations over $2 are tax deductible.
Lungs in Action Make a Bequest A very positive and personal

commitment by you, which will help us to maintain
Lungs in Action is The Australian Lung Foundations
and expand our lung health programs.
community-based exercise program. Call us to find a
program nearest you. Hold a Fundraiser If you would like to hold a
fundraiser on behalf of The Australian Lung
Foundation, please let us know. We have lots of
tips and tricks to help you along the way.
25
References
Primary references British Thoracic Society Standards of Care Committee.

Managing passengers with respiratory disease planning
American College of Chest Physicians
air travel: British Thoracic Society recommendations.
Website: www.chestnet.org
Thorax 2002; 57: 289-304.
Continence Foundation of Australia
Website: www.lungfoundation.com.au
Website: www.continence.org.au
The Australian Lung Foundation and
Ferreira IM, Brooks D, Lacasse Y, Goldstein RS,
Australian Physiotherapy Association.
White J. Nutritional supplementation for stable
Pulmonary Rehabilitation Toolkit. 2006.
chronic obstructive pulmonary disease. Cochrane
Available from: www.pulmonaryrehab.com.au
Database Syst Rev. 2005; Apr 18 (2):CD000998.
COPD-X Plan: McKenzie DK, Abramson M,
Fletcher C, Peto R. The natural history of chronic
Crockett AJ, Glasgow N, Jenkins S, McDonald C,
airflow obstruction. Br Med J. 1977;1:16458.
Wood-Baker R, Frith PA. The COPD-X Plan:
Australian and New Zealand Guidelines for the Flinders Self-Management model. Available from:
management of Chronic Obstructive Pulmonary www.flinders.edu.au/medicine/sites/fhbhru/
Disease 2007. The Australian Lung Foundation. self-management.cfm
Available from: www.copdx.org.au/guidelines Garcia-Aymerich J, Lange P, Benet M, Schnohr P,
European Respiratory Society Ant J. Regular physical activity reduces hospital
Website: www.ersnet.org admission and mortality in chronic obstructive
pulmonary disease: a population based cohort
study. Thorax. 2006;61:7728.
Other references Jones et al, Osteoporosis Int. 1994; 4: 227-282.
Austroads. Assessing fitness to drive for commercial Knig P. Spacer devices used with metered-dose
and private vehicle drivers: medical standards for inhalers. Breakthrough or gimmick? Chest.
licensing and clinical management guidelines. 2003. 1985;88(2):276-84.
Australian Medicines Handbook.
Matsuyama W, Mitsuyama H, Watanabe M,
Available from: www.amh.net.au
Oonakahara K, Higashimoto I, Osame M, et al.
Branick, L. Integrating the Principles of Energy Effects of omega-3 polyunsaturated fatty acids
Conservation During Everyday Activities. on inflammatory markers in COPD. Chest.
Caring Magazine. 2003; Jan:30-31. 2005;128:381727.
97 Chapter 25: References

National Asthma Council Australia Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery
Website: www.nationalasthma.org.au CF, Mahler DA, et al. Pulmonary Rehabilitation:
Nutrition Education Materials Online. Texture Joint ACCP/AACVPR Evidence Based Clinical
modification soft diet. Available from: www.health. Practice Guidelines. Chest. 2007;131: 4S42S.
qld.gov.au/nutrition/resources/txt_mod_a.pdf Romieu I, Trenga C. Diet and obstructive lung
Nici L, Donner C, Wouters E, Zuwallack R, diseases. Epidemiol Rev. 2001;23:26887.
Ambrosino N, Bourbeau J, et al. American Thoracic Ruffin R and Adams R. How to treat. Asthma in the
Society/European Respiratory Society statement on elderly. Australian Doctor. 1 April 2005. Available
pulmonary rehabilitation. Am J RespirCrit Care Med. from: www.australiandoctor.comau/htt/pdf/AD_
2006;173:1390413. HTT_025_032_APR01_05.pdf
No fuss feeding and swallowing centre. Shand, D. The assessment of fitness to travel.
Adults: Dry Mouth. Available from: Occupational Medicine 2000; 50 (8):566-571.
www.nofussfeeding.com.au/adults
Smit HA. Chronic obstructive pulmonary disease,
Osteoporosis Australia asthma and protective effects of food intake: from
Website: www.osteoporosis.org.au hypothesis to evidence? Respir Res. 2001;2:2614.
Rashbaum, I, Whyte, N. Occupational Therapy in Velloso, M, Jardim, J. Functionality of patients
Pulmonary Rehabilitation: Energy Conservation and with chronic obstructive pulmonary disease:
Work Simplification Techniques. Physical Medicine energy conservation techniques. Journal Brasilian
and Rehabilitation Clinics of North America.1996; Pneumol. 2006;32(6): 580-6.
7(2):325-340.
Feedback
Queensland Health and The Australian Lung Foundation
welcome feedback on Better Living with Chronic
Obstructive Pulmonary Disease A Patient Guide.
This Patient Guide will be reviewed on a regular basis and

appropriate changes will be made:
If scientific evidence supports a change to the advice
contained in the Patient Guide.
According to feedback from patients, carers and managing
clinicians who use the Patient Guide.
Written feedback can be provided to the following addresses:

PO Box 847
Lutwyche QLD 4030
enquiries@lungfoundation.com.au
Clinical Practice Improvement Centre

Royal Brisbane and Womens Hospital
PO Box 128
Herston QLD 4029
cpic@health.qld.au
99 Chapter 26: Feedback

101
Disclaimer
The materials presented in this resource are distributed by Queensland Health and The Australian Lung
Foundation for and on behalf of the Queensland Government and are presented as an information source
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Better Living with Chronic Obstructive Pulmonary Disease

A Patient Guide Second Edition
November 2012

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Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Better Living with

b Chapter 5: Your role in managing your chronic obstructive pulmonary disease

Dr David Serisier, Chairman

Better Living with

not be able to run to catch the train or play with

This chapter will help you to understand:

What is the respiratory What is the structure of the lungs?

The Breathing System

Capillary network Capillaries crisscrossing the air sacs (alveoli)

What do the lungs do?

3 Chapter 2: The lungs

The nose decreases the amount of irritants

This chapter will help you to understand:

Your lung condition emphysema usually occur in people who have

5 Chapter 3: Lung conditions

The trapped air leads to an over-expansion of the

What is Alpha-1 antitrypsin deficiency?

During an asthma attack, the breathing tubes or Pocketed and

Muscle contraction Mucous hides

Normal mucous Thickened

Excessive sputum narrows the airways Bronchiectasis

7 Chapter 3: Lung conditions

Lung function tests

This chapter will help you to understand:

Lung function tests assist in the diagnosis and

What are the lung function tests?

9 Chapter 4: Lung function tests

Your role in managing your

This chapter will help you to understand:

What is the important role you

11 Chapter 5: Your role in managing your chronic obstructive pulmonary disease

COPD-X SELF-MANAGEMENT CHECKLIST

breathing test performed (called spirometry). You

X: MANAGE E XACERBATIONS medications (puffers), exercises or Pulmonary

13 Chapter 5: Your role in managing your chronic obstructive pulmonary disease

P: PREVENT DETERIORATION I have discussed establishing an advanced

I have medication or prescriptions at home

My health care team and I have developed

15 Chapter 5: Your role in managing your chronic obstructive pulmonary disease

Stopping smoking and preventing a relapse

This chapter will help you to understand:

What is nicotine addiction? Unfortunately, no scientifically proven method to

Why shouldnt you use nicotine

Smoking causes lung function to worsen at a faster rate

17 Chapter 6: Stopping smoking and preventing a relapse

There is plenty of information available that describes

Stay away from that

Knowing your medication

This chapter will help you to understand:

For each different medication that you are prescribed,

Categories of COPD Medication

Reliever Maintenance Preventer Flare up

Vaccinations: Annual influenza vaccine and pneumococcal vaccine according

21 Chapter 7: Knowing your medication

Reliever or bronchodilator medications

1. Beta2 agonists (short-acting) 2. Anticholinergic (short-acting)

Bricanyl Ventolin Atrovent

> Terbutaline (Bricanyl) given by a Turbuhaler > Ipratropium bromide (Atrovent)

1. Anticholinergic (long-acting) 2. Beta2 agonists (long-acting)

> Eformoterol (Oxis, Foradile)

23 Chapter 7: Knowing your medication

3. Theophylline (Nuelin, Theo-Dur)