COPD

A COPD Action Plan is a written or digital plan that will help you monitor how well you are and outlines what to do if your COPD gets worse. These plans are written with your health practitioner and can be downloaded here.

Research confirms that stopping smoking and avoiding tobacco smoke is the most important way to improve the prognosis in those with COPD. Quitting smoking is the single most important step you can take to improve the outcome of your COPD diagnosis. No matter how severe your COPD is, stopping smoking can slow further decline and damage to your lungs. It is never too late to stop.

People who have COPD have to work harder to breathe and tend to breathe using the muscles in their upper chest, rather than the lower chest muscles. This takes more energy and is tiring. A physiotherapist is the best person to help you learn good breathing control.

The benefits of good breathing control should not be underestimated. Breathing control is useful to manage shortness of breath and for times when you are unwell.

See below for tips on what to do when you are breathless and how to clear mucus (sputum/phlegm) from your lungs.

Diaphragmatic breathing

This is also known as ‘tummy’ breathing or breathing control.

• Place one hand on your tummy, over your navel. Your upper chest and shoulders should be relaxed.
• Breathe in through your nose; you should feel your tummy rise as you breathe in.
• Breathe out gently through your nose; your tummy will fall as you breathe out.

Practice tummy breathing first when you are lying down, when you are feeling relaxed. As you get more used to this breathing pattern, you could try it when sitting too.

Pursed lip breathing

• Breathe in through your nose slowly for about two seconds.
• Pucker your lips as if you're about to blow out a candle.
• Breathe out slowly through your mouth for four seconds.

What to do when you are breathless

Here are some things you can try to help reduce your breathlessness. Remember to get into a comfortable position when you try these techniques.

1. Stop what you are doing and relax your body, particularly your shoulder and neck muscles.
2. Try tummy breathing.
3. Use pursed lip breathing: breathe in through your nose but breathe out slowly through pursed lips, as if you are blowing out a candle.
4. Try not to hold your breath during exercise or activity – try to find a rhythm that suits the activity e.g. breathe in time with the steps you take while walking.
5. Find a comfortable sitting or standing position: the most comfortable position when breathless will vary from one person to the next. The following positions support your breathing muscles and can make it easier to recover from an episode of breathlessness:
   • Supported forward lean sitting: sit with your feet apart and flat on the floor. Lean forward and rest your elbows on your knees or a table.
   • Supported forward lean standing: stand leaning forward and prop your elbows on a support e.g. the kitchen bench, a fence post.
   • Supported standing: stand leaning backwards or sideways against a wall.
   • High side lying: lie on one side, with several pillows to raise your head and shoulders.

Clearing mucus from your lungs

Some people with COPD produce a lot of mucus in their lungs and may find it hard to clear it. This can make breathing even more difficult. If you have a lot of mucus, you can learn ways to clear it (a physiotherapist can teach you this). It may help to use your reliever inhaler to open your breathing tubes before trying to clear mucus. Changes in the colour of the mucus may be a sign you have a chest infection, and you should contact your healthcare practitioner.

Try the following breathing exercises in the morning and evening to remove mucus.

• Start with some relaxed tummy breathing (diaphragmatic breathing).
• Then take four or five deep breaths, breathing in through your nose and out through your mouth.
• Take a break with relaxed breathing.
• Then repeat the four to five deep breaths.
• Follow these with one or two “huffs” (cough mucus up if it reaches the throat).
• A HUFF is a slow breath IN and a forced breath OUT with your mouth shaped like an “O”. Huffing helps move the mucus from your breathing tubes to a place where it can be coughed out.

Exercise is important for managing COPD. Exercise that makes you ‘huff and puff’ is good for your lungs and heart. Ideally, you should exercise for about 20-30 minutes per day. You may need to start with 10 minutes of exercise and slowly build this up over time. As you become fitter, your body will adapt, and everyday activities will begin to feel easier. Exercise should include aerobic (five days per week), strengthening (two days per week) and flexibility (daily).

Pulmonary rehabilitation is a programme of education and exercise which usually runs for 6-12 weeks. Pulmonary rehabilitation reduces breathlessness, improves quality of life, and reduces depression in people with COPD. Everyone with COPD should attend at least one programme as it helps to understand all you need to know about COPD and how to manage it. Find a programme here.

Although you may lose your appetite if you are breathless, it is important to eat well. With COPD, more energy is required by the body for breathing, so you need to alter your diet to allow for this. If you are overweight, your breathlessness may become worse as your body works harder to carry extra weight.

There are lots of people who can support you to look after your COPD. It is important to build a partnership with your healthcare practitioner. Following their advice should help you manage your symptoms. See our list of regional Asthma Societies here.

Physiotherapy

In addition to pulmonary rehabilitation, a physiotherapist can teach you breathing exercises, ways to help manage breathlessness and techniques to help clear mucus.

Visit physiotherapy.org.nz to find a local physiotherapist.

COPD Support Groups

These are usually informal groups for people who are affected by COPD. They aim to provide a supportive and non-judgemental environment and to relieve the isolation that can be felt by people living with COPD.

See our list of our regional partners and contact your local branch for information on their COPD support services.

Health Social Worker

Social workers can provide support to people with COPD and their families by pointing them in the direction of counselling, referrals to community services and support groups. Speak to your healthcare practitioner for a referral to the Social Work department at your local Te Whatu Ora Health New Zealand hospital.

Occupational Therapist

An occupational therapist can teach people easy ways to do basic daily tasks that become more difficult for people who are unwell. Speak to your healthcare practitioner for a referral to an occupational therapist.

An important preventive action for people with respiratory conditions is appropriate vaccination, including against influenza (flu) viruses and pneumococcus (which causes bacterial pneumonia).

To improve access for people who need it most, the annual flu vaccine is free for people who have a diagnosis of COPD. Find out more here.

People with COPD are also more at risk of severe illness with COVID-19. It is important for everyone with COPD to get COVID vaccination and booster doses as recommended by the Ministry of Health New Zealand.

A damp and humid home encourages mould growth. Mould can trigger COPD symptoms and increase the likelihood of a flare-up. To avoid mould growth, keep your home warm, dry and well-ventilated. You can reduce humidity by using a dehumidifier. Placing a dehumidifier in the bedroom may be particularly useful if your COPD symptoms worsen during the night. You can find out more about how to improve the health of your home here.

If you are living in a damp/mouldy home, you may be able to get help through the Healthy Homes Initiative or through Warmer Kiwi Homes.

EECA (Energy Efficiency and Conservation Authority) also has a range of tips for a warmer, drier and more efficient home.

Stress can be a COPD trigger. It may cause your breathing rate to increase, which can make you feel out of breath. Living with a chronic medical condition can increase how often a person feels stressed.

What can you do about stress?

• Change your pace or do something different.
• Try to keep as active as possible. Exercise can reduce stress hormones and increase the production of endorphins.
• Share the load with a friend or counsellor.
• Be realistic about the number and types of activities you can do in a day. You may need to swap jobs in the house that demand too much energy (e.g., cooking instead of gardening).
• Conserve your energy so that you still have time to do the things you enjoy.
• Learn to accept responsibility for your own feelings. Even when things seem unfair with your health, it's up to you to regain control over your feelings and actions.

Acknowledgement for assistance with this information to Claire Dawson, Senior Clinical Psychologist, Canterbury Respiratory Services.

Some people may require medicine to help them manage their COPD symptoms. It is important that you understand how your medicines work and then take them as prescribed. COPD medication works by either opening up the airways (beta agonists) or by relaxing the muscles around the airways (muscarinic antagonists). Both of these medications work to relieve COPD symptoms and make breathing easier.