Factors Affecting Breathlessness

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

Scouts Motto : Be Prepared

I have such wonderful conversations with my patients that often have lessons for both patient and therapist. The best patient centred relationship is one where we learn off each other.

We were discussing relievers and spacers and how research has proven the improved dispersal of the reliever when a spacer is used. My patient then went on to say that she has taken to travelling with her reliever and the hand held fan as a kind of mini pulmonary toolkit that gives her the confidence of knowing she is prepared for every circumstance.

It reminded me of a situation I was in last week whilst travelling in Tasmania.

Cradle Mountain, world heritage area of majestic beauty but also a place of extreme weather and unpredictability. I was climbing to the Mt Marion Lookout and found that half way up in the cold and floating rain I had trouble catching my breath.

Exercise induced asthma has little warning I find. As every good explorer should do I had a snack in my pocket and my bottle of water and was rugged up in beanie and coat against the cold.

However just shy of the top things got a little uncomfortable. That need to fill the lungs but not getting as much as I’d like coupled with the knowledge that I was literally in the middle of nowhere and my nearest reliever was , you guessed it, in the car park an hour and a half away.

There was no way I was going to turn around and miss getting to the top so I used what I had to get relief. I stopped and leaned forward, blowing out through pursed lips and took a rest break to get my breathing under control. After a few minutes rest and hydrating with my drinking water I started up again pacing myself this time, keeping up the pursed lips as I went.

I made it and with a little sprint to compete with my 13 yr old daughter I got there ahead of the family and promptly claimed the seat to lean forward and recover my breathing once more.

To say the least, my patient was wise in her preparation and a puffer in my pocket next time will be part of my good explorer ensemble.

Factors Affecting Breathlessness: Relaxed Posture

Factors affecting breathlessness of course has to include posture.

Tension in the upper body is one thing that you can start with.

So stand in front of a mirror and take a look after you’ve just done something that has left you puffy. As you catch your breath what can you see – how are you standing, supporting your arms/shoulders, sitting down, chest heaving, shoulders going up and down???

Now that you know what you are doing normally, try this as an alternative;

Lean forward, support your upper body by leaning on the bench/ back chair or sit and lean on your thighs with your forearms, drop your shoulders and relax as you gradually slow the pace of your breathing.

This will do two things:

it will relieve the tension between your shoulder girdle and chest to allow for chest expansion
it will release the accessory muscles in your upper body for the action you have been engaged in so they are not being overused.

Factors Affecting Breathlessness: Keep it close

A third way to reduce breathlessness in activity is to keep it close. So bring the work space up in front to waist level so there is no reaching and bending. This lessens the load on your heart and lungs thereby reducing the energy need and your level of breathlessness.

This can be done by putting the task on the table in front and sitting or by doing it on a table in standing or at a bench. The other way we have talked about previously is to have important daily used items on shelves between hip and shoulder height thereby bringing the activity closer to waist level.

This is the same for if you are lifting or moving items. Keeping it close reduces the strain on your arms and reduces your level of breathlessness. Remember never to hold your breath whilst you are lifting but continue to blow out through pursed lips in a gentle manner, always looking for ways to slide the load , break it up or use a trolley.

A Simple Fan to Reduce your Sense of Breathlessness

Breathlessness can be anxiety provoking when trying to get a job done and exert yourself. There is a lot of research that suggests that movement of air across the face and nose can reduce a persons sense of breathlessness and hence their level of anxiety . https://www.ncbi.nlm.nih.gov/pubmed/20471544

The main benefit is that it reduces your recovery time and is a self management tool you can take anywhere you need it. If you don’t have a hand held fan in the moment then sit by an open window or on the verandah so the breeze crosses your face, especially the nose and mouth, and it may also help.

A hand held fan held 15- 20cm from the face works through cooling the nose and mouth with receptor messages sent to the brain altering the person’s sense of breathlessness, if your nose is blocked or mouth dry then it will be less effective.

The Lung Foundation has fans for sale in its online shop, alternatively they can be found with other retailers such as those specialising in electricals.

Hand-held fan

Factors Affecting Breathlessness – Take a Load Off

A fourth way to make activity easier is to lighten the load by sitting to do the task or by reducing lift and carry. Sitting uses less energy by taking the load off your body just in the same way that using trolleys can take the load off when you are moving.

Examples of this sitting to do the ironing, sitting to pot plants, leaning on the trolley in the supermarket, using a wheel barrow in the garden, a tray mobile in your living area, or a laundry trolley in the yard.

If you are struggling in getting about then try a wheelie walker that includes a seat and basket and this will assist you in staying mobile and connected with your community.

Factors Affecting Breathlessness: Big Tasks

We have been talking about how activity can make you breathless and ways to cope with this.

The second idea is to break up the task. This means to spread it out over several days, do a bit in the morning and then finish after lunch, or do one bit and delegate another bit to a family member or service provider.

For example, cleaning the house can be overwhelming but if you delegate the once a fortnight floor clean to a service and potter each day for 15 min to declutter or dust then the task becomes doable.

Another example is to wash your smalls in a bucket whilst you are seated in the shower. Give them a swish round with your feet, gentle squeeze and hang on the laundry stand in the sun. Larger items can go in the machine when family drop by to help.

Factors Affecting Breathlessness: Store Smart

Everyone knows that activity increases our sense of breathlessness especially if there is bending and reaching involved. So how do we make this simpler? How to we make things easier so we can still do the things we want to do?

One idea is storage. The things we use for an activity whether its making a cup of tea or doing the laundry can often be placed in awkward positions so the effort in using the materials is what makes the job hard, not necessarily the job itself.

Store heavy items low and light items high and well used items at waist height. This is a recipe for ease and simplification around the home. this reduces lifting, bending and reaching loads within each activity that you do. For example, keep mugs on a cup rack on the bench and the tea caddy next to the kettle. In the laundry keep heavy laundry containers on a waist high bench and put your basket of wet washing on a chair when hanging on the line. This way you can get to that all important cup of tea a lot more easily.

Factors Affecting Breathlessness: Doing Less Not Always Best

Breathlessness itself is fatiguing and its easier to sit and rest and let someone else do the job at hand. This is great in the short term and having friends and family assist gives us a lovely feeling of connectedness. But its a sliding scale when we begin to delegate more and more for others to do and we are engaging in less activity than ever before.

We can lose independence sooner than what could have been as arms and legs decondition and instability and weakness prevents access to things that use to bring enjoyment and engagement outside of the home.

The solution? Delegate the hardest things that involve heavy lifting or bending and manage your breathlessness as would an athlete in training to keep the moderate tasks to maintain fitness and mobility. Work out a plan with your practitioner and family to ensure you are maintaining your ability for good quality of life.