Lifestyle Changes:

Quitting Smoking and Avoiding Other Irritants

Quitting smoking is the first and most essential step in treating COPD and slowing its progress. In many people who quit early, lung function stabilizes and eventually declines to about the rate of nonsmokers in the same age group. In some people, lung function may even improve slightly after quitting. As COPD progresses, quitting smoking can slow the rate of decline; however, lost lung function is never fully recovered.

Most patients who smoke try to quit an average of seven times before they are successful. Using a combination of smoking cessation aids improves the likelihood of quitting. These include nicotine replacement products (patches, gum, nasal spray, lozenges), counseling, and prescription medications such as bupropion (Zyban) and varenicline (Chantix). [See In-DepthReport #41: Smoking.]

Preventing Upper Respiratory Infections

Good Hygiene. People should wash their hands with ordinary soap before eating and after going outside the home. Antibacterial soaps add little protection, particularly against viruses. One study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia.

Vaccines. Two important vaccinations are recommended to protect against respiratory infection.

• Influenza vaccination. People with COPD should be vaccinated against influenza each year at least 6 weeks before flu season begins. Severely ill patients may experience mild adverse side effects from the vaccine. In general, however, the vaccine is very safe and appears to help reduce exacerbations of COPD during flu season.
• Pneumococcal vaccine. The pneumococcal vaccine protects against 23 types of pneumococcus, the major bacterium that causes pneumonia. The vaccine remains effective for years. Flu and pneumococcal vaccines can be given at the same time without increasing side effects.

[See In-Depth Report #94:Colds and Flus.]

Breathing Exercises

Pursed-Lip Breathing. A technique called pursed-lip breathing can help improve a patient's lung function before starting activities or doing a strenuous task, such as heavy lifting. Pursed-lip breathing helps change pressure in the airways and prevents the small airways from collapsing. To use this technique:

• First, inhale through the nose, moving the abdominal muscles outward so that the diaphragm lowers and the lungs fill with air.
• Exhale through the mouth with the lips pursed, making a hissing sound.
• Take twice as long breathing out as you did breathing in, so that there is pressure in the windpipe and chest, and trapped air is forced out.

Holding Breath and Coughing. A simple technique is to inhale deeply and slowly, hold the breath for 5 -10 seconds, then cough while breathing out.

Controlling Secretions

Fluids and Humidity. Patients with congestion and heavy phlegm should drink plenty of fluids and keep their homes humidified.

Chest Therapy. Chest therapy involves breathing in rhythmically for three to four deep breaths, then coughing to produce phlegm. Tapping the chest may also help loosen and bring up phlegm in patients who produce a lot of it. Avoid chest therapy during an acute exacerbation of COPD.

When coughing to produce mucus, another method is to lean forward and "huff" repeatedly. Take relaxed breaths, and then huff again. Avoid forceful coughing, if possible.

Physical Exercise

Because COPD is not simply a lung condition, but a disease that causes wasting of the muscles and bones, certain physical exercises may be very helpful.

Strengthening Exercises for the Limbs. Exercising and strengthening the muscles in the arms and legs helps some patients improve their endurance and reduce breathlessness. Exercising only one leg at a time (for example, pedaling a stationary bicycle with one leg instead of two) might benefit patients who are usually too out-of-breath to exercise, and help them increase their exercise capacity.

Walking. Walking is the best exercise for patients with emphysema. In studies of lung rehabilitation, regular exercise increased walking distance and improved breathing. Patients should try to walk three or four times a day for 5 - 15 minutes each time. Devices that assist with breathing may reduce the breathlessness that occurs during exercise.

Yoga and Eastern Practices. Yoga and tai chi, two practices that use deep breathing and meditation techniques, may be particularly beneficial for COPD patients. Research is underway to determine whether yoga is helpful for COPD patients.

Breath Training

Inspiratory Muscle Training and Incentive Spirometer. Inspiratory muscle training involves exercises and devices that make inhaling more difficult in order to strengthen breathing muscles, walking capacity, and quality of life.

The use of an incentive spirometer for 15 minutes, twice a day may help loosen phlegm. An incentive spirometer is a small, hand-held device that contains a breathing gauge. The patient exhales and then inhales forcefully through the tube, using the pressure of the inhalation to raise the gauge to the highest level possible. A device called a peak inspiratory flow (PIF) meter measures the patient's ability to draw air into the lungs and assesses the fitness of the breathing muscles.

Guidelines released by the American College of Chest Physicians (ACCP) and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) do not recommend the routine use of inspiratory muscle training during pulmonary rehabilitation.

A computer-controlled breathing training program may help COPD patients improve their exercise tolerance. The technique uses computer feedback to help patients learn to slow down their breathing. This can help prevent the over-inflation of the lungs that can lead to reduced exercise tolerance.

Dietary Factors

Because many patients with chronic bronchitis are obese and many with emphysema are underweight, nutrition assessment is an important part of COPD treatment. Not getting enough of foods that are rich in vitamins A, C, and E, and having a lack of fruits and vegetables can contribute to the development of the disease.

Protein and Fats. Patients with body wasting (cachexia) lack enough protein. Although most healthy diets emphasize proteins from fish, poultry, and lean meat, these people may benefit from foods with a higher-than-average fat content. (People should still prefer healthy fats, however, such as those found in olive oil and oily fish.)

Fruits, Vegetables, and Whole Grains. Healthy foods are as important for lung function as they are for general health. Specific foods that may be important for healthy lungs are those that contain antioxidants (fresh, deep green and yellow-orange fruits and vegetables), selenium (fish, nuts, red meat, grains, eggs, chicken, liver, garlic), plant chemicals called flavonoids (apples, onions), and magnesium (green leafy vegetables, nuts, whole grains, milk, and meats). One study found that, compared to a Mediterranean diet, which is high in fruits, vegetables, and whole grains, a Western diet high in red meat and simple carbohydrates increased the risk of COPD fivefold.

Vitamin supplements are not helpful, and they may be very harmful for smokers.

Psychological Support

Patients with COPD are at high risk for depression and anxiety, which can impair their outlook on life. Depression often gets worse as people with COPD need to limit their activities and social interactions. Psychological counseling and social support are important for helping people improve their emotional state, cope with daily stresses, and maintain their independence and social relationships.

Minimizing Airborne Contaminants

As much as possible, patients should avoid exposure to airborne irritants, including:

• Aerosol products
• Hair sprays
• Insecticides
• Paint sprayers
• Smoke from wood fires

To minimize the amount of contaminants in the home:

• Avoid exposure to pollen, pet dander, house dust, and mold. [See In-Depth Report #4: Asthma in Adults.]
• Eliminate molds and mildew from household water damage.
• Have furnaces and chimneys inspected and cleaned periodically.
• Make sure wood-burning stoves or fireplaces are well ventilated and meet the Environmental Protection Agency's safety standards. Burn only pressed wood products labeled "exterior grade," because they contain the fewest pollutants.
• Ventilate by keeping windows open (weather permitting), using exhaust fans for stoves and vents for furnaces, and keeping fireplace flues open.