Living With Your Pulmonary Illness

Summary

This new home video will help your patients learn the basic information and self-care skills they need to take an active role in self-management. Over an hour long, the video is not meant to be watched in one sitting. It is divided into chapters so patients can watch them one at a time, at their own convenience, and absorb the information. The chapter numbers appear in the corner of the TV screen so viewers can locate information easily. Wrap-up questions after each chapter stimulate thinking about individual treatment plans. Actual patients with pulmonary illness, featured throughout the video, reinforce the credibility of the information and show your patients that they too can benefit from taking an active role in managing their illness.

Chapters Include:

• What is a Pulmonary Illness?
• Following Your Treatment Plan
• Breathing Training
• Medications
• Using Your Medications
• Physical Activity
• Bronchial Hygiene
• Stress and Relaxation Techniques
• Energy Conservation
• Handling Flare-ups
• Choices for Healthy Living

Details

• How the lungs normally work:
  • The lungs have two functions:
    • They remove carbon dioxide, a waste product, from the blood.
    • They deliver oxygen to the blood stream.
  • The pathway of air:
    1. When you breathe in, air travels through your nose and mouth, into your windpipe or trachea.
    2. Air moves down through the bronchial tubes into smaller and smaller branches.
    3. Eventually these branches end in microscopic air sacs, called alveoli.
    4. In these air sacs, oxygen and carbon dioxide is transferred.
• Several muscles assist the lungs as they breathe:
  • The diaphragm is the most important muscle in the breathing process:
    • The diaphragm is a sheet of muscle that lies below the lungs.
    • It contracts and expands each time you breathe in and out to help pull the oxygen in and push carbon dioxide out.
  • Other muscles that help you breathe are located in:
    • The front of the abdomen
    • In between your ribs
    • In the upper chest and neck
• There are two types of pulmonary disease:
  • Two types:
    1. Restrictive Pulmonary Disease:
       • Makes it difficult to get air into the lungs.
       • Patients with this illness must work harder to breathe in.
       • Examples include:
       • interstitial fibrosis
       • rheumatoid pulmonary disease
       • asbestosis
       • morbid obesity
    2. Obstructive Pulmonary Disease:
       • Makes it difficult to get air out of the lungs.
       • The air becomes trapped, over inflating the lungs, which can flatten the diaphragm, and keep it from working normally.
       • Examples include:
         • emphysema
         • asthma
         • chronic bronchitis
  • Both diseases interfere with the breathing process.
• The progression of a pulmonary disease:
  1. When you struggle to breathe, your body begins taking quick breaths and you aren't using the diaphragm effectively.
  2. A greater demand is placed on the upper chest muscles to help with breathing:
  • This can quickly tire them out
  • Breathing becomes even more difficult
  3. As the illness progresses, shortness of breath can occur more often and easily.
  4. Eventually, getting the air you need to do almost anything can seem impossible.
  5. Other symptoms:
     • Constant cough
     • Tightness in the chest
     • Excess Mucus Production
• Wrap-up Questions:
  1. What type of pulmonary illness do you have?
  2. What type of symptoms are you experiencing?
  3. Try keeping track of when symptoms occur. Do you notice them occurring during certain activities?

• Successfully managing a pulmonary illness begins with a treatment plan:
  • You need to understand that plan.
  • You need to commit to following it.
• Most treatment plans include:
  1. Breathing training skills
  2. Medications
  3. Bronchial Hygiene techniques
  4. Physical Activity
  5. Instructions for handling flare-ups
• Steps you can take to get the most out of your treatment plan:
  1. Involve yourself.
  2. Get regular check-ups.
  3. Enlist the support of others.
  4. Stay committed.
• Wrap-up Questions:
  1. Try listing the parts of your treatment plan. Do you understand how each part helps you?
  2. How often do you have a check-up?
  3. Before each visit, write down any questions you have for your healthcare team.

• Diaphragmatic Breathing:
  • Helps retrain the diaphragm to push stale air out of the lungs.
  • Step-by-step instructions are given.
• Pursed Lip Breathing
  • Helps keep your airways open longer, making it easier to get stale air out of the lungs.
  • Step-by-step instructions are given.
• Breathing Goals:
  • For patients with restrictive pulmonary disease:
    • The goal is to slow down the breathing in and breathing out cycle.
    • For every second you breathe in, try to breathe out two or more seconds.
  • For patients with an obstructive pulmonary disease:
    • The goal is to slow down the breathing out cycle to help keep the airways open longer.
    • For every second you breathe in, try to breathe out three or more seconds.
• Practice and use your breathing skills everyday:
  • They can help you do more, and maybe even avoid shortness of breath.
  • With practice, they will become second nature.
• Wrap-up Questions:
  1. Which breathing skills work best for you?
  2. Have you discussed the benefits of breathing training with your health care provider? Do you know what they are?
  3. Try making a list of your daily activities. Do you use your breathing training skills while you’re doing them?

• Oxygen Therapy:
  • It can increase the amount of oxygen in the blood of patients with low levels of oxygen in their blood.
  • Benefits:
    • Reduce shortness of breath.
    • Help your muscles work properly, keeping them from tiring out as quickly.
  • Types of Oxygen:
    • Liquid
    • Compressed Gas
    • Concentrated Form
  • Misconceptions:
    • Oxygen devices do not explode.
    • Most devices do not restrict activity.
  • Oxygen adjustments should never be made without first consulting your doctor.
• Bronchodilators:
  • Relax the muscles around the bronchial tubes, opening them up, allowing air to travel more freely into and out of the lungs.
  • Benefits:
    • Reduce breathlessness.
    • Make it easier to move mucus.
  • Two classes:
    • First class:
      • works within 15-20 minutes
      • lasts for about four hours
    • Second class:
      • works over 30-45 minutes
      • lasts for up to 12 hours or longer
  • Possible Side Effects:
    • Nervousness
    • Rapid heartbeat
    • Headaches
    • Dizziness
    • Nausea.
    • Shakiness
• Antibiotics:
  • Fight off bacteria that cause lung infections, which can cause your illness to flare-up.
  • If they are prescribed, take the whole prescription.
  • If you don’t feel better after 3-4 days, call your doctor.
• Anti-Inflammatories:
  • Reduce swelling and inflammation along the airways.
  • Benefits:
    • Help air move into and out of the airways.
    • Help other medications penetrate deeper.
  • Anti-Inflammatories are very powerful and must be taken exactly as prescribed.
  • Possible Side Effects:
    • Indigestion
    • Weight gain
    • Swelling
    • Nausea
    • Vomiting
    • Sore throat
    • Fatigue
    • Moodiness
• Wrap-up Questions:
  1. Make a list of your medications and what they do.
  2. Have you experienced any side effects from taking your medication? Have you talked to your healthcare team about them?
  3. If you don’t already use it, discuss oxygen therapy with your healthcare team and whether it could benefit you?

• Inhalers deliver medication directly to the lungs and airways:
  • Dry Powder Inhaler:
    • A type of automatic inhaler, which administers your medication automatically when you inhale.
    • Using a Dry Powder Inhaler (step-by-step).
    • There are many types of dry powder inhalers, and each works a little differently.
    • For most, you should never click more then once.
  • Metered dose Inhalers:
    • Can be automatic or manual
    • Closed Mouth with a Spacer (step-by-step)
    • Open Mouth (step-by-step)
    • Closed Mouth without a Spacer (step-by-step)
  • Work with your healthcare team to figure out which type of inhaler and technique is best for you.
  • A nebulizer can be an effective alternative to using an inhaler.
  • Inhaler guidelines:
    • Clean your mouthpiece and spacer daily.
    • Store your inhaler in a cool, dry place.
• Other medication guidelines:
  • Some medications have certain food and/or drinking restrictions.
  • Pills shouldn't be chewed.
  • Develop systems to help you remember when to take your meds:
    • Make a chart
    • Pill boxes
  • Wear a medic alert bracelet.
  • Keep a list of your medications with you at all times.
  • If you experience any side effects or have difficulty with your medications, call your doctor.
• Wrap-up Questions:
  1. Have you discussed various inhaler techniques with your healthcare team?
  2. Do you have a system for helping you remember to take your medications?
  3. Are the people closest to you familiar with your medications and medication schedule? Are they aware of the possible side effects?
  4. Put together a list of medications to carry with you. Review and update it after each healthcare visit.

• The Effect of a Pulmonary Illness on the body:
  • Interferes with your ability to breathe.
  • To breathe, the lungs and other respiratory muscles must work harder, using more energy.
  • Less energy is available for the body to perform other tasks, increasing fatigue and shortness of breath.
• The Benefits of Exercise:
  • Physical:
    • Improves muscle strength.
    • Improves oxygen utilization of muscles.
    • Improves heart’s pumping ability.
    • Helps with weight control.
    • Strengthens the immune system.
  • Emotional:
    • Can improve self confidence.
    • Can increase sense of independence.
• A Basic Exercise Routine:
  • Warm-up:
    • Loosens the muscles and gets the blood and oxygen flowing.
    • Includes stretching exercises like twisting, calf-stretching, and side bends.
    • Should be performed for 5-10 minutes.
    • Safety Guidelines.
  • Strengthening and Aerobic Exercises:
    • Both help reduce shortness of breath and increase energy levels.
    • Strengthening exercises include weight lifting and resistance training.
    • Strengthening exercises improve muscle tone, strength, and endurance.
    • Aerobic exercises include cycling, swimming, and walking.
    • Aerobic exercises help your heart, lungs, and blood move oxygen better.
    • Safety guidelines.
  • A cool down will help get your heart rate back down to pre-exercise levels.
• Exercise Tools:
  • An Oximeter is used to monitor your blood oxygen level.
  • The Borg Scale, or Perceived Level of Exertion Scale helps you determine how hard you are exercising.
  • A modified version of the Borg Scale can measure how short of breath you are at any one time.
  • Target Heart Rate can also help monitor the intensity of your exercise.
  • These tools help guide your exercise, but aren't always needed to exercise safely.
• Other concerns:
  • If you have diabetes, monitor your blood sugar level before and after exercise.
  • Other health issues that could affect exercise should be discussed with your healthcare team.
• Exercising At Home:
  • Develop a home exercise program with the help of your healthcare team.
  • Start slowly but be consistent.
  • Vary exercises.
  • Find ways to increase your daily, physical activity level.
  • Don’t get discouraged by setbacks.
• Wrap-up Questions:
  1. Do you take part in a pulmonary rehabilitation program?
  2. Do you exercise on your own? If so, have you discussed safety and intensity issues with your healthcare team?
  3. Are there ways you could increase the amount of physical activity in your daily life?
  4. What exercises and physical activities do you find most enjoyable?

• Benefits of Bronchial Hygiene:
  • Clear out excess mucus.
  • Help you breathe better.
  • Reduce the risk of a lung infection.
• Basic bronchial hygiene techniques:
  • Drinking plenty of water thins the mucus, making it easier to get out of your lungs.
  • Exercise forces you take deeper breaths, helping get the mucus moving.
• Controlled Coughing:
  • Helps improve the effectiveness of your cough.
  • Step-by-step instructions.
• Postural Drainage:
  • Uses gravity to move mucus from your lungs.
  • You can drain different lobes of your lungs by laying in different positions.
  • Should always be performed on an empty stomach and at least 30 minutes after using a bronchodilator.
• Other techniques:
  • Chest Physical Therapy
  • Mechanical percussors
  • Flutter valve
  • PEP therapy
• Check with your healthcare team:
  • See which techniques they recommend you perform on your own at home.
  • Some techniques should only be performed in the presence of a healthcare provider.
  • Have your therapy evaluated regularly because changes in your condition may require adjustments in your techniques.
• Wrap-up Questions:
  1. Have you discussed drinking more water with your healthcare team, to help loosen up the mucus?
  2. Have you discussed bronchial hygiene techniques, or using mechanical percussors with your healthcare team?
  3. If you perform bronchial hygiene on your own, when was the last time your routine was reviewed?

• Causes of Stress:
  • Positive feelings
  • Negative feelings
  • Living with a pulmonary illness
  • Shortness of breath
  • Coping with medication side effects
  • Coming to terms with lifestyle changes
  • Financial burdens
• The body’s physical stress cycle:
  • Starts with the release of adrenaline which causes muscle tension and makes your heart beat faster.
  • Breathing becomes harder and faster, leading to breathlessness.
  • Gasping for breath makes you even more anxious, causing the release of even more adrenaline.
  • A vicious cycle begins, which eventually leads to panic situations and complications.
• Interrupting the Stress Cycle:
  1. Try not panic.
  2. Take a break and rest.
• Stress can affect you emotionally.
  • Crying
  • Mood swings
  • Constant worry
  • Feelings of overwhelming pressure
  • Loss of humor
  • Inability to make a decision
  • Anger
• Relaxation Techniques:
  • Muscle Relaxation (step-by-step)
  • Deep, Concentrated Breathing (step-by-step)
  • Mental Imagery (step-by-step)
  • Take time to do things you enjoy.
• Wrap-up Questions:
  1. What do you find most frustrating about living with your pulmonary illness?
  2. Have you shared your frustrations with your healthcare team, or your family?
  3. Do you set aside time to relax each day? What do you do?
  4. Make a list of three hobbies or activities you find enjoyable. Try setting aside time each week to do one.

• Everyday, you use a lot of energy needlessly:
  • Individual activities do not require a lot of energy.
  • Over an entire day, it adds up and can wear you out.
• Ways to conserve energy in your daily life:
  1. Organize your daily activities:
     • Plan the most difficult for times when you will have the most energy.
     • Combine chores.
     • Schedule tasks that need to be done first.
  2. Pace yourself.
  3. Allow more time to do things.
• Work Simplification Techniques:
  • Break down the steps in your activities.
  • Eliminate steps that may not be necessary.
  • Examples.
  • Tools can make your tasks easier.
  • Ask for help.
• Consult with your healthcare team:
  • Have them review your daily activities.
  • They can suggest ways for you to conserve more energy.
• Wrap-up Questions:
  1. Have you talked to your healthcare team about energy conservation?
  2. Make a list of daily activities that tire you out quickly. Can they be broken down into smaller steps? Are there any tools that could make them easier?
  3. Have you asked for assistance or input from your family and friends?
  4. Have you, or an occupational therapist, assessed your daily routine, looking for ways to adjust it?

• Flare-ups:
  • Sometimes called exacerbations.
  • Increases in the severity of your symptoms.
  • Can cause your condition to get worse.
  • Are most often caused by a lung infection.
• Preventing lung infections can reduce the risk of flare-ups:
  • Check your mucus everyday for signs of an infection.
  • Other signs and symptoms:
    • Fever
    • Chills
    • Increased shortness of breath
    • Increased sputum production
    • Increased coughing
    • Chest pain
  • Wash your hands often.
  • Avoid contact with people who have colds, the flu, or other infections.
• Dealing with flare-ups when they occur:
  • Develop a written plan with your healthcare team for dealing with flare-ups:
    • List of things that could make your condition worse.
    • List of steps to take when certain symptoms appear.
  • Never be afraid to contact your healthcare team, go to the emergency room, or call 911 if you think it is necessary.
• Wrap-up Questions:
  1. Review your written plan to follow when a flare-up occurs.
  2. Check for mucus each morning.
  3. When was the last time you received the flu and pneumonia vaccinations?

• Quit smoking and avoid second hand smoke:
  • It is the best way to prevent doing further damage to your lungs.
  • Methods:
    • Set a quit date.
    • Gradually cut back.
    • Nicotine patches and gum.
    • Ask your healthcare team for additional recommendations.
  • Try and avoid second hand smoke whenever you can.
• Nutrition and Eating Habits:
  • Your pulmonary illness, food choices, and eating habits all affect each other a lot:
    • Your body needs energy to fight the illness and breathe.
    • If you don’t eat enough, your body begins using stored energy, leading to unhealthy weight loss.
    • Symptoms of your illness can make eating more difficult.
  • Eating a well balanced diet helps you get enough energy and avoid other health problems.
  • Changing eating habits can help you avoid symptoms of your illness.
    • Try several small meals, instead of three large meals.
    • Rest between preparing a meal and eating.
    • Find ways to conserve energy in the kitchen.
  • Consult a clinical nutritionist.
• Intimacy:
  • Do not be afraid to discuss fears and concerns regarding your illness with a loved one.
  • When ready, take steps to plan sexual activity.
  • Loved ones play a key role in managing your illness, keep that relationship strong and healthy.
• Advanced Directives:
  • Instructions regarding future medical care.
  • A Living Will is a record of your wished concerning medical treatment for a time when you can no longer voice your opinion.
  • Medical Power of Attorney grants someone you trust the power to make decisions for you.
  • Discuss Advance Directives with your family and healthcare team.
  • Always express your wishes in writing.
• Support:
  • The role family and friends play in managing your illness is very important.
  • The community can also offer support.
  • Join online pulmonary chat groups and mailing lists.
  • Finding ways to stay active and involved can make your illness much easier to deal with.
• Wrap-up Questions:
  1. If you still smoke, work with your healthcare team to develop a plan for quitting.
  2. Have you talked to your doctor or a dietitian about foods you should be eating or avoiding?
  3. Look at how you prepare your meals. Are there things you can do to conserve energy in the kitchen?
  4. Take the time to discuss your feelings, your relationship, and the future with your loved ones?