If you’re one of the 16 million Americans living with chronic pulmonary obstructive disease (COPD), you know that trying to breathe normally and avoid breathlessness is always top of mind. Everyday tasks like shopping or having lunch with a friend can begin to feel out of reach or “not worth the hassle” because of the risk of breathlessness or a bout of coughing.
Although you may miss some of the confidence and autonomy you had before your COPD diagnosis, there are breathing “best practices” to help you regain control of your life. Breathing better can boost your health and your outlook.
Your doctor may recommend that you enroll in a pulmonary rehabilitation program to help you learn about COPD. Over the course of several weeks, respiratory therapists cover topics that include proper nutrition, exercises you can do to strengthen your muscles and boost your energy, and the correct way to take your COPD medication.
These programs teach exercises that not only make your muscles more conditioned but also help you use oxygen more efficiently, says Joseph Khabbaza, MD, a pulmonologist in the Cleveland Clinic Health Network who practices in Independence, Ohio. “You learn breathing techniques that can be used in response to certain situations, like when you feel short of breath, which can help improve symptoms,” says Dr. Khabbaza.
“Our goal is to train people with COPD to do these things on their own so that they can?improve their shortness of breath, stay out of the hospital, and just feel better,” says Scott Marlow, the director of the pulmonary rehabilitation program at Cleveland Clinic in Ohio.
“This knowledge can build confidence; the more you know, the more you are able to do,” says Marlow.
Here are several strategies to help you get on your way to better breathing with COPD.
1. Stop Smoking
According to the Centers for Disease Control and Prevention (CDC), almost 40 percent of people with COPD continue to smoke after their diagnosis. Quitting smoking is the most important thing you can do to improve your breathing.
Studies have shown that people with COPD who stop smoking can slow the rate of lung function loss by about half.
If you have COPD and still smoke, talk to your provider about a plan to help you reduce the number of cigarettes you smoke per day as well as possible paths to kicking the habit altogether.
2. Start Your Morning Slowly
“Turning to get out of bed to stand up and go to the restroom can cause some people to get short of breath,” says Marlow. If you’re having trouble with your breathing first thing in the morning, taking your medicine almost right away could help, says Marlow.
Try sitting at the edge of the bed to catch your breath and then taking your time getting to the bathroom, he says.
“Some people will have their nebulizer next to the bed, and they’ll take a breathing treatment as soon as they get up. That not only opens up and relaxes the airway, it also gives them a moment to catch their breath,” says Marlow.
3. Practice Different Styles of Breathing
There are many different types of breathing exercises that can help you manage bouts of breathlessness, says Marlow. “We teach these exercises to help people get through those times when they’re short of breath or anxious and they change their respiratory pattern,” he says.
Many of the recommended breathing exercises are similar to mindful breathing exercises. “There’s many different types of breathing, so you can pick the one that’s best for you,” says Marlow. For example, you can do visualization or a progressive tension relaxation exercise in which you identify those muscles that are tense and try to relax them, he explains.
4. Pursed-Lip Breathing
Practicing pursed-lip breathing can help make breathing easier for people with COPD, says Khabbaza.
“In COPD, the O stands for obstruction,” he says. “If you have COPD, your lungs have been damaged and they don’t have their same integrity and stiffness. They are a little bit softer, and when you breathe out they tend to close down a lot earlier than in normal healthy lungs.”
“Because the airways are closing earlier, a lot of air is trapped back behind the lungs. That area where the airway is closing is very high resistance; there’s a lot of air trying to get out and it’s kind of getting stuck down there,” says Khabbaza.
Pursed-lip breathing is performed by inhaling through the nose when the mouth is closed and breathing out slowly through a smaller hole in the mouth (pursed lips).
“By breathing this way you’re making the highest point of resistance at your lips instead of down lower at your lungs. By shifting that highest area of resistance to be outside of the airway, moving air takes less work,” he says.
5. Plan Activities and Troubleshoot Ahead of Time
Strategies for breathing and medication to help you in the moment are important, but part of breathing better is being proactive so that you reduce the chances of getting into a situation where your breathing is compromised, Marlow says.
“We like to walk people through situations to help them troubleshoot and reduce the chance that they will become breathless,” he says.
For example, you may want to go to church on Sunday, but there are stairs that are hard to get up even when you use your oxygen. “The first step is timing your inhaler use to get the optimal effect prior to getting there. Then I would suggest using your oxygen while you’re going up the stairs to get into the church,” says Marlow.
“We’ll practice breathing techniques ahead of time for climbing the stairs so that you’re exhaling as you step up,” he says. “Take your time, pay attention to your breathing, and pace yourself.”
6. Watch the Weather and Air Quality
If you’re going to leave the house for an activity, you need to pay attention to the conditions outside, says Marlow. “Is it going to be very cold or hot? If your schedule is flexible you’ll want to try to go out when the weather is milder,” says Marlow.
“On cold days, it’s a good idea to wear a loose scarf over your face to warm and moisten the air. Using a nebulizer before you go out to pretreat the airway can also help with breathing,” he says. If there are high air pollution conditions, then you should try to plan your outing for another day or wear a mask, he adds.
7. Conserve Your Energy
“We encourage people to exercise, but we also teach them energy conservation techniques,” says Marlow. For people with more severe COPD, shortness of breath can occur while doing everyday activities like fixing their hair or brushing their teeth, he says.
“Stop to rest as much as you need, and think about ways you can preserve your energy,” he says. Are there some tasks, such as taking a shower or putting on your makeup where you could sit down? If you’re fixing a meal, could you keep a chair nearby, so you can stop and rest? “When you do get short of breath, just move slowly,” says Marlow.
8. Make Sure You're Using Your Inhaler Correctly
There are many different types of inhalers, and it’s important to check in with your doctor periodically to make sure that you’re using it correctly.
“Occasionally, I’ll see someone who is using their inhaler 20 times a day. Every time they get short of breath, they use their inhaler,” says Marlow. A person might overuse their inhaler because it’s not really helping that much, he says.
“People often use their inhaler incorrectly so they’re not getting the medicine. We teach inhaler technique in pulmonary rehab to make sure they are using it in the optimal way.”
Sometimes people credit their inhaler for helping with breathlessness, but it’s actually the act of stopping and resting that’s helping, not the inhaler or the medicine, according to Marlow.