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Introduction to COPD Breathing - 2 of 14

Dynamic Hyperinflation

How to Train a COPD Patient

How to Train a COPD Patient

How to Train a COPD Patient

How to Train a COPD Patient

How to Train a COPD Patient

How to Train a COPD Patient

COPD Breathing Technique - 1 of 14

If you are willing to practice, these breathing techinques might help you.

Carolyn

Measuring COPD

How Do I Know How Much Lung Disease I Have?

If you have lung disease, there are a number of tests that will help you and your doctor determine the severity of your disease. Some of the most common tests that provide these measurements are chest x-rays, CT scans, pulmonary function tests, blood gas (oxygen and carbon dioxide) studies and exercise studies. We will review how some of these tests work, and what information can be gathered from them.

The Chest X-Ray

The chest x-ray can reveal clues about the presence of chronic lung disease (COPD), especially if the amount of disease in the lung is moderate or severe. But it does not provide an accurate measure of disease, and in fact, the x-ray can appear normal even in a significantly diseased lung. The signs of COPD that we look for in an x-ray are:

• Increased lung size.
• Decreased normal lung blood vessels and other markings (both of these findings are more common in emphysema).
• Flattening of the diaphragm (long muscle separating the chest and abdomen).
• Increased air between the front part of the chest and the heart.

In most cases, a diagnosis of COPD should not be made from a chest x-ray. If COPD is suspected on the basis of an x-ray, further studies should be done.

Pulmonary Or Lung Function Studies

Lung function studies are used to better clarify the state of disease in the lungs. The most common of these tests is spirometry.

Spirometry
Spirometry is designed to measure the amount of air you can move in and out of your lungs and how quickly you can move it. You do this test by breathing through a tube connected to a machine that measures volumes and flows. First you take several normal breaths (called tidal breaths) after which you take in as big a breath as you can and blow it out as fast as you can. Recording the volumes and flow rates of these breaths provides a measurement of the maximum volume, or amount, of air you can move in and out of your lungs (vital capacity, or FVC) and how rapidly you can breathe it out of your lungs (forced expiratory volume or FEV).

Normal people can blow most of the air out of their lungs in one second, so the standard measure of how well people move air out of the lungs is FEV1. This measurement is the number most often found to be abnormally low in people who have COPD, but it does not establish the exact nature of the disease - it could be emphysema, chronic bronchitis or some other cause of COPD. These measurements can never be interpreted properly in isolation. In order to make meaningful judgments about these measurements several things must be done.

• The FEV1 must be compared to the FVC and only if the ratio of these two (FEV1/FVC, or flow rate of exhaling to volume of breath exhaled) is less than normal can we say that airway obstruction, which is characteristic of COPD, is present.
• Second, to make a judgment about whether or not these measures are abnormal, they must be compared to measurements taken from people without lung disease who are the same age, sex and height since lung capacities vary depending on these factors. Normal values for different races may also vary by as much as 10-15 percent.
• Third, it is critical that the test be done properly and meets the standards of the American Thoracic Society Guidelines or it will be impossible to interpret accurately.

Lung Volumes

Spirometry measures volume in the lung, but only the volume you can voluntarily move in and out of the lung. You can never empty your lungs of air completely or they would collapse and it would be very hard to take another breath. The amount of air left in your lungs after you blow out as much air as you can is called the residual volume. This amount of air, like the spirometry values, varies from person to person depending on age, sex, height and, in some cases, race. The residual volume is harder to measure and is only measured under certain circumstances. While there are several ways to indirectly measure the residual volume, usually the most accurate way in people with COPD is with a body plethysmograph or body box. This is a small enclosed "box" in which a person must sit for a few minutes with the doors closed while measurements are made. The volume of air remaining in the lung is measured by pressure changes recorded when you breathe against a pressure-sensitive valve. Some people feel a little claustrophobic during the body-box measurement; however, it can be done relatively quickly and most modern "boxes" are almost entirely glass (usually plexiglass), so you can always see out of it.

If you have COPD, your doctor may want to measure your residual volume, which can be used to calculate the total volume of air that your lungs will hold. This is called total lung capacity and is often greater than normal in people with emphysema and some other forms of COPD. It is found by adding together the residual volume (measured in the body box) and the vital capacity (measured by spirometry) described above.

What Is The Diffusing Capacity?

The surface area of the lung where oxygen can 'get in' to the body is very limited in people with COPD. For example, in patients with emphysema, both the small air sacs (alveoli) and the small blood vessels (capillaries) that run past them are destroyed, leaving a smaller area for oxygen to come in contact with the oxygen-carrying proteins in the blood (hemoglobin).

"Diffusing capacity" refers to the capacity of the lung to release carbon dioxide and take in fresh oxygen. This lung function test measures the amount of area of the lung where oxygen can move into the blood vessels. It is performed much like the spirometry test, except that during this test, you breathe in a small amount of carbon monoxide gas. Carbon monoxide is used because it binds very quickly and well with hemoglobin and the amount is easily measured.

The test is usually performed during a single breath. To measure the diffusing capacity, you have to have certain minimal lung volumes and be able to hold your breath for a brief period of time. Also since diffusing capacity varies with the concentration of hemoglobin in the blood, the values obtained need to be revised if your hemoglobin level is not normal.

Are There Any Other Lung Function Tests I Might Have To Take?

We have only covered the most commonly used lung function tests that are performed to help in the diagnosis and management of COPD. A number of other tests exist and are done in special circumstances. There are tests, for example, that measure the elasticity of the lung tissue, the air-flow through just the smallest of the airways, and the strength of the muscles participating in breathing. If you require a specialized test like this, you should ask your doctor for a full explanation of the test goals and procedure.

Arterial Blood Gases
If your spirometry shows moderate or more severe disease, your doctor may want to measure the levels of oxygen and carbon dioxide in your blood. Normal oxygen levels are pressures of oxygen of more than 80 mmHg (sea level) and normal carbon dioxide pressures are in the low 40's mmHg. The oxygen pressure varies with altitude so that in areas of high altitude where the barometric pressure is lower, the normal values are also lower. In people with COPD, oxygen levels may fall below normal and carbon dioxide levels can rise above normal. Usually, oxygen levels fall before carbon dioxide levels rise. If the carbon dioxide levels rise and stay elevated, the patient is said to be in chronic respiratory failure; this is a sign of advanced lung disease.

The most accurate way to test the levels of these gases in the blood is to take blood from an artery, usually the radial artery at the wrist, and directly measure the pressures of oxygen and carbon dioxide in the drawn blood. It is important to take the blood from an artery, as arterial blood represents blood that has passed through the lungs where it has picked up oxygen and is being pumped to the body by the heart. Therefore, it more accurately represents the amount of oxygen that is being delivered to the tissues. It is also possible to get an estimate of blood oxygen levels without taking blood, by measuring hemoglobin saturations with a finger probe, a small device placed on the finger.

Computerized Tomography, or CT Scans
A CT scan is an imaging tool that provides radiographic images of the body. This scan is not necessary to diagnose COPD, but the images help doctors to distinguish between types of COPD. CT scans can also sometimes pick up unsuspected things like small lung cancers or areas of bronchiectasis (abnormally widened airways).

CT scans can be perfomed in several ways. Different from a chest x-ray, which provides a two-dimensional view of the chest, CT scans offer a more three-dimensional picture. CT scans really look at individual slices of the chest taken at varying intervals from your neck to your waist. New high resolution CT's look at slices of the body as thin as 2 millimeters or less, or slightly larger than a sixteenth of an inch, and this allows the structure of the lung tissue to be seen in fine detail. For example, high resolution CT scans can usually distinguish emphysema very clearly from other diseases, and can give doctors a good idea how the emphysema is distributed in the lung. These scans also offer very sensitive and clear images of bronchiectasis. New spiral CT technology makes it possible to complete a scan in less than a minute and with no more radiation than a chest x-ray. Another benefit of CT scans is their ability to pick up small lung nodules which are not visible on a chest x-ray and which sometimes represent early cancers.

Exercise Studies
There are two major categories of exercise studies: graded exercise studies and non-graded studies.

Graded exercise studies: In graded exercise studies, you usually walk on a treadmill or an exercise bicycle at a determined work-load. Your work-load is progressively increased and various breathing and heart measurements are recorded as you exercise. These tests are not done routinely in patients with COPD.

The test may be done if:

• the diagnosis is uncertain.
• you are participating in a clinical trial where specific improvements in exercise capacity are important outcomes.

This type of exercise test is similar to the ones done by internists and cardiologists to determine if you have coronary artery disease, but in those situations the doctors are primarily interested in the EKG changes during exercise.

Non-graded exercise: Non-graded exercise studies can be very useful in determining how much exercise capacity you have. In a non-graded study, you walk on level ground for a determined period of time (often six minutes). You should walk as fast as you can manage, with stops if necessary. During this test you will likely wear an oxygen saturation probe on your finger or ear to detect whether your blood oxygen value falls below acceptable values, an indication that your lungs do not supply adequate oxygen to your blood when you exercise. Successive six-minute walking tests may be done at intervals to assess the functional benefits of pulmonary rehabilitation programs, or sometimes to assess the functional impact of the progression of your disease. A second type of test is one in which you walk a set distance, usually at your own pace, again with a saturation probe in place to determine if you need supplemental oxygen. This would be done if the six minute walk test revealed falls in blood oxygen values (desaturation) to unacceptable levels.

Conclusion
COPD is a common disease which can be measured with a variety of tests. Chest x-rays may suggest the presence of COPD, but lung measurements are necessary to confirm airway obstruction. CT scans are helpful in distinguishing one type of COPD from another. Exercise tests and other studies may also be used to help make a difficult diagnosis or to get specific about a person's exercise capability. The simpler tests, like spirometry, are often repeated at intervals to get an idea of the progression of disease.

COPD - Introduction to Breath Training

Living with COPD- Part 4 - Stress

The COPD Cough Technique

THE HUFF COUGH TECHNIQUE

Coughing is one of the most important lung defense mechanisms, and unfortunately it is significantly impaired in COPD. While the nasal passages provide a mechanism to warm and humidify the incoming air, and trap dirt particles and germs, inevitably some undesirable foreign material penetrates down into the lungs. Coughing is needed to clear undesirable material from the bronchial tubes. This module will teach you a more efficient way to do a COPD cough, called "Huff Coughing." To understand Huff Coughing you first need to have some understanding of normal coughing.

The Normal Cough

With normal coughing you take in a deep breath, then close the vocal cords in your throat "Voice Box" (called the "Glottis") to shut off air flow from the lungs. Then, straining with your chest and abdominal muscles you build up a high expiration pressure on your. At this juncture the "Cough Center" in the brain initiates an abrupt opening of the Glottis, which then produces an explosive blast of air from the lungs that propels the mucus ("Phlegm") out as an expectoration.

The Impaired Cough of COPD and Emphysema

Unfortunately with COPD / Emphysema the cough is typically weak. Not only are the muscles building up pressure usually weakened, the airways are narrowed and distorted. Therefore the necessary explosive rush of air for effective mucus clearing cannot be generated. In addition, and very important, your airways are particularly prone to premature collapse. High pressure straining therefore causes rapid and excessive bronchial closure, further impairing the rapid blast of air flow necessary for an effective cough. The Huff Cough technique will teach you a new and more efficient method of coughing.

The Huff Cough for COPD and Emphysema

Huff Coughing is a low pressure cough, which uses a series of multiple "mini-coughs" instead of a typical single big cough. Here is how it is done.

First, it is crucial that you get an adequate volume of air deep into your lungs, past the mucus or phlegm. Without an adequate preparatory volume of air deep in the lungs and behind the phlegm, to force the phlegm out, your cough isn't going to move much phlegm. To get a good breath in, remember the basic rule, that every breath of air must begin by first getting the old stale air out of your lungs. Here there is a special need to get an adequate breath in, though it is not necessary to take in a maximal inspiration breath for coughing. A comfortably large breath should be adequate. If you are feeling the need to cough, it is commonly associated with the condition of lung overinflation. This is why it is particularly important for you to first have a good exhalation, and then take in that initial deep breath of air for the Huff Cough.

In addition, these deep inspirations and expirations have a massaging or "milking" effect on the bronchial tubes, to further loosen-up and dislodge the phlegm, and prepare it for the Huff Cough to finally remove it from the lungs.

The Huff Cough Technique

To deflate the excess air from your lungs, slow your breathing way down, and do a gentle and prolonged exhalation over three or four breaths. In doing this series of preparatory deflation breaths, don't breathe in a full breath, or you will re-inflate your lungs again. Breathe in only about 75 to 80% of a normal inspiration breath. "Breathing Belt" exercises and the "Respiratory Squeeze" technique, described elsewhere, may be used to advantage here.

Now, take in a slow, comfortably deep breath (but not a maximum deep breath).

At this juncture you must now concentrate on keeping your Glottis ("Voice Box") open, and with your mouth open and shaped like a loose "O." With the Glottis kept open, it is now impossible to build-up a high pressure cough.

Now, give a short, abrupt, relatively gentle "mini-cough" by a sudden contracting of your upper abdominal muscles. Try to imagine contracting centrally, from just below your ribs down to your umbilicus. If you do this correctly you should produce a soft exhalation sound like "huff," hence the name Huff Cough. You should not say the word Huff, but rather make the "huff" noise. Note how different this is from the typical sharp, barking, explosive sound of a normal cough.

Remember, the moment you produce the Huff Cough you will also initiate some excessive bronchial compression, which will immediately impair phlegm clearing. This is why the Huff Cough must be kept very short. But this bronchial compression is not as bad as with a traditional hard cough, particularly if it is a repetitive cough, as this "normal" cough will cause much more dynamic bronchial closure, and therefore wasted energy with little further mucus production.

Now, at the end of the Huff, take in a quick partial breath of air, and try to feel this being sucked into the bottom of your chest. This is to again put some air out past the offending mucus, and to open up the collapsed airways, in preparation for the next Huff Cough. Do not take in a deep breath as you did at the beginning of this exercise.

Now, repeat the Huff Cough a second time, this time with the smaller breath.

Again, abruptly take in a still smaller partial breath, and repeat the Huff Cough for a third time. (Some times you may feel difficulty in that third Huff Cough, and if so then do only two Huff Coughs.)

At this juncture, at the end of the Huff Cough sequence, with progressively smaller cough volumes, you should feel that most all of the air is out of your lungs. This is because you were not taking in the same sized deep breaths between the Huff Coughs. This decreasing changing lung volume you have produced will help to further "milk" and squeeze phlegm from your lungs.

Next, take in a forced, full (but not maximally full) breath of air deep into the bottom of your lungs.

Now, keeping the Glottis open, give a single, hard, FORCED Huff Cough. This forced breath should result in phlegm being produced to where it can be expectorated.

What has happened here is, the two or three (preferably three) Huff mini-coughs have loosened peripheral small bronchial mucus, and progressively brought it into the large bronchial tubes, and the larger forced HUFF cough results in final expectoration.

Failure to finally expectorate your phlegm

Sometimes the final forced Huff Cough brings sticky mucus only part way up, where it "hangs-up" in your large airways and causes a further coughing attack. This can be hard to control and very distressing. If you are in this situation, don't panic and try to force the phlegm out with a series of hard coughs.

Stay calm, and try to suppress your coughing spasms. Concentrate on doing slow, deep breaths with a long expiration time. You may also do Pursed Lip Breathing to help your dyspnea. Rest yourself, and regain your strength. A sip or two of water often helps with cough control.

Almost always this situation produces a temporary state of lung overinflation, so it is very important for your recovery that you concentrate on lung deflation as noted above. Then, repeat the Huff Cough sequence as needed.

As sticky phlegm is often the culprit causing this problem, increase your clear fluid intake for the next few days, until your urine becomes consistently less yellow. This is done to moisten the phlegm and encourage looser sputum.

Remember, always immediately examine your sputum at least twice a day, and particularly the first morning sputum. This should be done in a tissue to enable close inspection. If you suspect you are developing a "Chest Cold" bronchial infection you should examine all of your phlegm for signs of progressive infection. It is very important that you know what your "normal"phlegm looks like. This must be done to permit recognition of early bronchial infections. Examine all sputum if it is getting less in amount, or thicker or stickier, or if it becomes slightly opaque, or dirty yellowish or greenish appearing. This may be the warning signal of early bronchial infection, a "Bronchitic Exacerbation." This may require prompt medical attention. More on this important topic in another module.

Huff Cough technique Summary

In summary, the sequence of the Huff Coughing technique is:

• Lung Deflation (several breaths, or with Breathing Belt and/or Respiratory Squeeze assist).
• Deep breath in.
• Huff Cough #1, with lung deflation, followed by rapid partial inspiration.
• Huff Cough #2, with further lung deflation, followed by rapid partial inspiration.
• Huff Cough #3, with still further lung deflation, down to near the bottom of your lungs.
• Deep breath in.
• Single abrupt and forced HUFF COUGH for final expectoration.
• Repeat as necessary after a brief rest if clearance is not complete.
• Examine your sputum in a tissue, at least twice a day.

We will now go on to discuss your getting more active, and increasing your exercise tolerance.

Yoga for COPD

YOGA FOR COPD: Secrets Of Breathing From An Ancient Tradition

Yoga is unique program for self-management for people with COPD or other chronic illnesses because yoga is one of the most comprehensive body, breath and mind systems.

Surveys point out that COPD affects the whole body and causes a wide range of negative emotions such as the sense of personal loss, hopelessness, depression, anxiety and panic attacks and anger and frustration.

Yoga can be particularly beneficial for COPD. We must constantly work on improving our physical health, breath function and emotional strength.

My yoga teacher used to say that breath is the bridge between the body and the mind. Breath really is the "BRIDGE' between the body and the mind because all medical conditions and negative emotions automatically cause such negatives changes in our breathing as the over breathing, under breathing, breath holding, chest breathing or jerky breath. Such negative breathing changes happen automatically and we are often not very aware of them.

By the same token, when we are healthy, feeling well, doing well and feeling good about ourselves and others, we automatically breathe more deeply, more slowly, fully and freely. Such positive breathing changes also happen automatically and we are often not very aware of them.

Everybody is writing about "secrets" these days. "Secrets of wealth," "Secrets of Success," "Secrets of Happy and Satisfying Relationships" and the list goes on. Here are the "Secrets of Breathing" which are practical and can be easily utilized:

1. Everyone including people with COPD or any other medical or psychological disorder can to some extent positively change their breathing when they consciously choose to do so.

2. By changing your breathing, you can change how you emotionally feel at that moment, and it takes just a few minute.

3. By shifting to abdominal breathing and slower and longer exhalation, you can influence many physiological and emotional processes such as lowering the blood pressure, heart beat rate and stress hormones and improve on oxygen and carbon dioxide exchange, coherent heart frequency and brain waves, concentration, to name just a few.

So without further ado, let's put this to practice.

A Brief Body, Breath and Mind Exercise

1. Make yourself steady and comfortable. Lie down or sit. Keep your head, neck and spine in a straight line as much as possible. Make yourself comfortable and relaxed to the extent you can.

2. Mentally scan your body and relax. Bring your mind to one part of the body and let it relax by following this order: face, neck, right arm and hand, left arm and hand, throat, chest, abdomen, right leg and foot, left leg and foot, pelvis, abdomen, chest, throat and face.

3. Do soft abdominal breathing. Return to your abdomen and observe your breathing. Your abdomen should bulge a little as you inhale and pull inward as you exhale. If needed, put your hand or a small book on your solar plexus (between the navel and breastbone) to guide your breath to that area.

4. Crown-to-toes breathing. Imagine inhaling as if through the crown of your head to the toes and exhaling as if through the soles of your feet and toes. Take next few breaths with this imagination.

5. Inhaling the positive and exhaling the negative. This is the time to link your vision and feelings with your breath. Therefore, as you inhale see and feel pure white light enters as if through the crown of the head and travels down to the toes down to the toes. While exhaling, see and feel grayish, blackish light traveling from the toes and exiting through the nostrils. Pure white light in this context stands for such positives as the solar energy, health, peace and joy. The grayish, blackish light stands for such negatives as the toxins, fatigue, stress, fears and anger, etc. Take 5 to 10 breaths holding such thoughts and feelings.

After doing this body, breath and mind exercise, check how you feel and how is your breathing.

COPD & Anesthesia

ciao ciao

Carolyn

Living with COPD - 3 of 3

Living with COPD - 2 of 3

cop

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Living with COPD - 1 of 3

Ted Koppel's Wife Has COPD

Here is the link to see the video. Click Here

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Carolyn

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COPD & Oral Hygiene

New COPD Treatments

What is COPD ?

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- from the privacy and comfort of your own home.

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(This program is not for infants or very young children. It is for individuals ages 8 and up.)

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