DEAR DOCTOR K:
My doctor has recommended pulmonary rehabilitation for my COPD. What will this involve?
COPD stands for “chronic obstructive pulmonary disease.” This group of disorders damages the lungs and makes it increasingly difficult to breathe. Common symptoms include a mucus-producing cough, breathlessness, rapid breathing, wheezing, tightness in the chest and fatigue.
No treatment can fully reverse or stop COPD. But not smoking, taking medications, making environmental changes and using supplemental oxygen can help. These measures should ease symptoms, treat complications and minimize disability.
Pulmonary rehabilitation can take these improvements a step further. Pulmonary rehab combines exercise therapy, breathing retraining, patient education and psychological support. It helps to improve quality of life, and it allows you to carry out day-to-day activities with greater ease and independence.
Exercise, particularly aerobic exercise, is the primary focus. Exercise increases your endurance and strength. This improves symptoms, which allows you to perform more normal daily activities. Exercise therapy typically involves walking on a treadmill, climbing stairs or cycling on a stationary bicycle. Many rehab programs also offer strength and flexibility training.
Another important part of pulmonary rehab is breathing retraining. One of the biggest problems COPD patients have is running out of air during exertion. In rehab, you’ll learn to modulate your breathing, which will help improve your stamina and decrease breathlessness. You should be able to get through everyday activities more easily — and possibly even resume activities you’ve had to give up.
You will also learn to take a more active role in managing your illness. For example, most people with COPD take an inhaled medicine to open up their airways. Your doctor probably told you when and how to use an inhaler when he or she first prescribed it. During rehab, a nurse may watch as you use it to ensure that you’re doing it correctly. Or you may get some tips on how to use oxygen therapy most effectively.
The final piece is psychological support. Ongoing breathing difficulties can lead to depression and anxiety. Therapy can help you sort through your feelings and teach stress reduction techniques to help you cope.
A patient of mine was a brilliant and tireless journalist. As a young reporter, he worked up to 16 hours a day to cover breaking city news. He then became a bylined journalist, covering more complex stories that required lots of in-depth research. He outworked people 20 years his junior. He also drank a lot and smoked several packs a day. It was what journalists did.
By age 50, he was easily winded and exhausted by mid-afternoon. By age 60, he became breathless doing nothing more than walking across the room. He still wrote with great skill, but he could work only on occasional stories and had to work from home. Fortunately, the Internet made that possible.
A pulmonary rehabilitation program improved his level of function to the point where he could return to the newsroom several times a week. It was a great gift — to him and to his colleagues.