Breathing – Inlife Blog.

COVID – the long haul virus

Research is coming internationally on the long term effects of COVID-19. There has been an appalling trend for thousands of COVID survivors to remain debilitated by severe fatigue, brain fog, and tachycardia with a resulting inability to return to work. The economic implications of this with huge numbers of the 20 to 40 year old’s unable to work is hard to ignore, this accounts for 10-30% of those affected by the virus.

Amazingly some headway is being made into how to rehabilitate these patients. Unfortunately it is not a quick fix with a pill or a vaccination. The team at Mount Sinai Centre for Post COVID Care have found these people have developed ‘Dysautonomia’ or a dysregulation of the autonomic nervous system. Meaning their body is out of balance and struggling to cope with the smallest everyday actions, a bit like chronic fatigue syndrome or an immune disease.

This lack of balance is impacting on heart rhythm, blood pressure, temperature, fight and flight responses and a myriad of other functions such as digestion, cognition and breathing.

So how have they been making a positive change in these people’s lives? Well apart from dietary changes, stress management and individual rehabilitation programs they introduced a new breath management system called ‘Stasis’ which helps to regulate the body with interval breathing practice morning and night. This works to coach the body back into a regular rhythm and start to restore balance needed for them to get mobilising again without shallow breathing and spiking heart rate leaving them bedridden.

Good news for those who are struggling after contracting COVID-19 to get back to work and their daily routines. At least they can put a name to it and know that they are not malingering and seek help from a breath management service.

A Focus to Slow the Rate of Breath

I have recently been working with a patient who describes herself as a person who likes to just get in and get the job done. We have had a bit of a journey to find a tool that helps her to slow her rate and gain control not just physically but mentally when she gets breathless following exertion.

I have been using patterns of breathing, with oxygen saturation and heart rate monitoring, to influence the recovery rate of the individual during and post activity. There is much in the literature about resonance breathing to help you relax faster when stressed using the natural respiratory pause at the end of the extended exhalation. Shooting and marksman sports use this natural pause to steady themselves.

Adding a visual cue to this patterning such as used in the breath in a box technique can give a focus mentally and a rhythm to follow that can help slow the rate and help the person relax more easily. Everyone’s condition is different so it is important to find the rhythm that is comfortable for you and improves your self management in the moment of breathlessness. Daily practice will help you to improve.

Using the respiratory pause to slow your rate

Inlifetherapy Telehealth Remote Treatment (now available)

As part of Inlifetherapy’s COVID-19 Response Plan in line with Department of Health and WHO guidelines, strategies for treatment provision will include the following: use of outdoor areas for treatment, social distancing , use of hand washing, cough etiquette, hand sanitiser and use of minimal contact treatment methods / assessment tools have been put in place for home visits. Phone calls will precipitate all home visits to check health status and that an area for treatment that allows social distancing is available. Every referral will be assessed on an individual basis as to what is the best form of contact to be observed.

Treatment at this stage of the escalation pathway will not be provided to confirmed cases in order to protect patients who are not symptomatic.

Privately funded patients who have access to internet connected devices such as a desktop, Ipad, tablet, or smart phone will be able to seek treatment remotely from home without visitation if this is what they prefer.

On the 28 March Medicare Chronic Disease Management (CDM) plans have been approved for bulk billed funding of video or phone telehealth services by Occupational Therapists.

From the 1st April DVA has approved video or phone telehealth services by Occupational Therapists for referred patients.

Instructions for video telehealth can be emailed to you prior to your online appointment. If needed, it might be handy to preempt any difficulties by having a tech savvy family member or friend sit with you when you download the app or attend your first appointment.

Therapy aids will be emailed or mailed for appointments as required.

I am looking forward to this next phase of technical adaptation as a way to further enhance the quality of your health care and continue to help you meet your goals.

Breathing Well Checklist for COVID-19 Part Two

As we discussed in the previous article it is important to consider a few factors so you are a good scout and prepared. We have already discussed trigger awareness, use of management plans, up to date scripts, correct inhaler technique, hand hygiene, and cough etiquette. As they say forewarned is forearmed! Take a look at these next ones:

Keep your distance – when you are aware of others with symptoms, putting some space between you can reduce the risk of infection. On the other hand if you are symptomatic then help stop the spread of infection by minimising your movements and take to time to recover at home.
Hands off – when friends and family are unwell then reducing the physical contact can help in reducing the risk of infection – save the hugs and kisses for when they are feeling better.
Breathing efficiently – can help when things get tight in the chest and that mucous starts to build up. Try some pursed lip breathing and forward leaning postures. Refer to earlier blogs on ‘Factors Affecting Breathlessness’.
Keep active – as exercise helps shift mucous build up and maintains conditioning. This can be as simple as doing a few household chores, going for a walk or going to the gym. Pace yourself and don’t overdo things if you are feeling unwell.
Sleep well – rest gives you balance to your daily activities by repairing and energising us.
Stay hydrated – our bodies are happier when we keep a balance to our intake of fluids.
Immune support to help your body fight infection is often overlooked but can be a useful tool in your arsenal – check with your GP or health professional for more information.

As you can see there is a lot of self management that you can be in control of to lower your risk of illness this winter season.

Breathing Well Checklist for COVID-19 Part One

There has been a lot of media in the last few weeks that would make even the strongest person feel worried. But to keep it simple here are a few tips I will be sharing with my regulars that I thought would be useful for pulmonary/respiratory/cardiac/anyone with breathing problems, breathlessness, or shortness of breath difficulties:

Know your triggers – awareness of what sets off your breathlessness is pivotal in forming a management plan. Knowing your own symptoms and having your COPD/Asthma management plan in place is a starting point. https://lungfoundation.com.au/wp-content/uploads/2018/12/Information-paper-COPD-Action-Plan-Kit-Feb2019.pdf or https://asthma.org.au/wp-content/uploads/2020/01/341-NAC-Written-Asthma-Action-Plan-2015_Colour.pdf
Make sure your scripts are up to date and you have a supply of medication with your spacer with you ready when needed.
Know your inhaler technique – if you need to check then go to the Lung Foundation website to view videos on how to be effective in using your devices or ask your allied health professional. https://lungfoundation.com.au/resources/?search=technique
Hand Hygiene – important in reducing the risk of infection. Check out this Department of Health publication on how to wash your hands. It should take you 15-20 seconds to complete the task of hand washing, try singing a song with your children to help them stay at the basin longer. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A1CCE88EB168930CCA257E35007F6927/$File/wash_dry_hands.pdf
Cough Etiquette is equally important – coughing into your hand and then spreading the infection through touch can simply be avoided by following precautions such as using a tissue or coughing into your sleeve. Check out this poster at https://www.nqphn.com.au/wp-content/uploads/2019/05/00883-Cough-etiquette-poster-A3.pdf

Spend the time making new healthy habits, lowering your risk and improving your self management. Remember to keep a look out for Part 2 of this article..

World COPD Day

On this day World COPD Day 2019, https://goldcopd.org/world-copd-day/ bringing awareness of COPD, it’s important to remember some key self management strategies that you need in the community to prevent unnecessary admissions and stay at home independently:

COPD plans must be filled in by your allied health professional or GP to better understand how and when your medications are to be used and left where family/housemates are aware of your needs when you are too breathless to talk yourself.
Correct inhaler device and spacer use means the medication is effectively going into your lungs and not lining your mouth and causing side effects such as thrush. Asthma relievers if used more than 2 in 7 days is not under control, please seek help from your GP or your breath management health professional.
Breathing techniques that take the work out of breathing and reduce recovery times post activity keep you moving through the day for longer.
Exercise is an important way of preventing deconditioning. Less exercise/ activity can lead to more breathlessness.
Meaningful activity engagement whether it be household chores, hobbies or social engagement are important motivators that keep us moving.
Use oxygen as prescribed – exertional oxygen during activity, nocturnal oxygen while sleeping or continuous long term oxygen for at least 18hrs.
Bush fire smoke reduction – close doors and windows, air conditioning on recycle, rest and hydrate, avoid strenuous exercise, P2 respirator masks, emergency evacuation plan to reduce exposure.

Occupational Therapy Assists with Breathlessness

Occupational Therapy Week 2019 is here! How can we help you improve your quality of life?

Occupational therapists help you deal with health issues that impact on your activities by:

looking at ways we can do the activities differently,
teaching you skills that will help you do the activity,
using adaptive equipment or
changing the environment you are doing the activity in.

For example I see patients with breathlessness. Someone who has trouble sweeping the floor may need to use a long handled broom and dustpan to eliminate bending which worsens their symptoms. They can also learn breathing techniques that take the effort out of breathing and reduce the time it takes to catch their breath during and following the task. When a person understands the nature of their condition and ways to alleviate symptoms they feel less anxious and their confidence to self manage improves.
Go to https://www.otaus.com.au/find-an-ot to get back on top of your activities today.
#THISISOT

Inhaler Myths vs Techniques

One thing I’ve found is that there are a lot of ideas floating around about how to use inhalers but they are not necessarily the right ideas. Things get foggy as time passes since you’ve been shown how to use your inhaler or it may be that you were shown a technique years ago that has since been updated and changed after more recent research findings. When techniques are used effectively more medication reaches your lungs.

The other reason for incorrect technique is simply that your illness has outgrown your methods. The constant tightness or inflexibility of your lungs means you can’t take a deep breath anymore and gentle tidal breathing with a spacer or nebuliser may be the way to go from now on.

There are lots of devices and medications out there so it’s important to check annually, when you do a GP review of your COPD plan, that the way you are using your inhaler is the most effective way for you to get the medication into your lungs, after all that’s the main point isn’t it?

If you’re not sure, get in touch with your Doctor, Community Nurse, or Pulmonary Allied Health professional and ask them for a demonstration. The Lung Foundation has a patient resource page with videos and fact sheets on techniques specific to your device at: https://lungfoundation.com.au/resources/?search=inhaler%20device

Don’t leave it to work itself out but be pro active and self manage your way to effective use of your medications with good inhaler technique.

Singing Improves Breathing Symptoms in COPD

I have just read an interesting article on a study conducted in Kent, UK, on a group of participants with Chronic Obstructive Pulmonary Disease (COPD) that had completed a 10 month community singing program learning breath control, relaxation and breathing exercises whilst singing weekly as a group – https://www.ncbi.nlm.nih.gov/pubmed/29160737 .

Any activity that you find meaningful can distract you from the odious task of purposefully exercising muscle groups for health management. We all find it difficult to motivate ourselves to continuously do the actions required to maintain muscular strength and mobility when we are unwell.

Here is an activity that brings relaxation , enjoyment, friendship, mental dexterity and challenge whilst improving respiratory symptoms. I can personally vouch for the mental dexterity part after being involved in a Sing From Scratch with Schubert’s Mass No.2 in G Major in Germanic Latin! The study reported that the majority found their symptoms improved over the 10 weeks as well as their mental and social well-being.

A timely reminder as many choirs around the world are presently involved in practicing and performing parts of Handel’s Messiah for Easter celebrations.

The Language of Breathing

The MacMillan Dictionary lists 10 different words to describe breathing or difficulty breathing (https://www.macmillandictionary.com/thesaurus-category/british/to-breathe-or-to-have-difficulty-breathing) . The simple function of taking air in through your nose or mouth and then letting it go again is often not an easy thing to describe or relate for a patient.

People often have difficulty identifying if they have the breathlessness described and seen by their GP or case nurse. Their wording and explanations may not align with my use of the word breathlessness and may be more meaningful to them if explained with the words gaspy, or puffy…

The language we use in terms of words is one thing but then to be able to describe such fleeting changes that we experience with breathlessness in our activities can also be equally challenging. The only way forward is to use standardised activity to assess and then repeat to capture the initial ability and then review for change post treatment.

The patient learns to notice and become more aware of their breathing state, how to express it and how to rate it. In order to seek effective and timely treatment this becomes an invaluable addition to their chronic disease management toolkit.