EMPHYSEMA~COPD VITAL INFO HERE

Most of us know what it feels like to struggle to catch our breath when we're running, biking, or trying to keep up with the latest aerobics video.

"People with emphysema experience shortness of breath when performing very simple daily activities such as brushing their teeth, taking a shower, and even eating," says Lisa Schulz, a respiratory therapist at the National Jewish Center for Immunology and Respiratory Medicine in Denver.
As the disease progresses, however, a stroll through a garden or just a walk from the house to the car may leave you gulping for air like a goldfish.

Emphysema involves irreversible damage to the air sacs inside the lungs where the vital exchange of oxygen and carbon dioxide takes place. The air sacs lose their elasticity, making it hard to exhale fully. So the lungs remain filled with stale, oxygen-poor air, and fresh air can't get in.

This lung damage doesn't happen overnight, says Sally Wenzel, MD, associate professor at the University of Colorado School of Medicine in Denver. "Most people with emphysema are long-term smokers or former smokers who develop this condition in their fifties and sixties," she says. "And these days, almost as many women as men get the disease, as more long-term female smokers hit middle age and beyond."

If you still haven't been able to kick the smoking habit, try imagining your life with emphysema.

Treatment
People with severe emphysema use pressurized oxygen to get around. A new surgical procedure called lung reduction surgery also helps people with emphysema to better use the remaining good parts of their lungs. These additional tactics can help damaged lungs work their best.

Pucker up and blow. An exercise called pursed-lip breathing helps people with emphysema move more stale air out of their lungs with each exhalation, says Dr. Wenzel.
To do this exercise, inhale fully through your nose, purse your lips as though you are going to blow out a candle, and then, after holding your breath for a second or two, exhale slowly and fully for a count of at least six. "I tell people to hold the back of their hand 3 to 5 inches away, facing their mouth," says Betty Booker, a respiratory therapist and pulmonary rehabilitation coordinator at University Hospital in Denver. "If they can feel their breath on the back of their hand, they are exhaling really well." Pursed lips provide a little resistance that maintains air pressure in airways. "That keeps the airways from collapsing before air has left the lungs, which can happen in people with emphysema," says Dr. Wenzel. "That's what traps stale air in the lungs and makes it even harder to breathe." Most people do pursed-lip breathing during exertion if they feel short of breath, Schulz says. "It can require a little practice initially, especially to exhale slowly and fully, but it is very relaxing. We also encourage people to do it whenever they feel short of breath or anxious."

Breathe from your belly. To take deep breaths that fill your lungs with air from the bottom up, you need to properly use your diaphragm, the sheet of powerful muscles that create the vacuum that makes your lungs fill.
"You can learn to do this while lying down, sitting up straight in a hard chair, or standing," says Schulz.
Place your hand on your belly, relax your belly, then inhale slowly through your nose, concentrating on relaxing your abdomen so that your diaphragm drops down and your belly expands. When exhaling, pull the abdomen in and the diaphragm up, to slowly push the air out of the lungs through pursed lips. "People can learn to focus their energy on certain muscles or on certain areas of their lungs to breathe more efficiently," Schulz says. "It takes concentration and practice, but it works."

Position yourself for better breathing. "Some people with emphysema can actually get in more air if they lean forward and place their forearms on a table or shopping cart," says Karen Conyers, a respiratory therapist at the University of Kansas Medical Center in Kansas City. Most other times you'll want to sit or stand up straight, keeping your belly relaxed. "This allows your diaphragm maximum movement," she says.

Shake a leg. It's a vicious circle. People with emphysema tend to become more and more sedentary. "The gradual reduction in activity is barely perceptible to most people, but the less they do, the less they are able to do," Conyers says.
Although exercise won't improve your lungs' function, it does improve endurance, Dr. Wenzel says. "It helps the heart and other muscles to use available oxygen more efficiently, so people can do more."

Most people with emphysema can walk on a treadmill or outdoors, or use a stationary bicycle. It's best to check with your doctor first if you haven't been active, says Dr. Wenzel.

You can be tested to see if you do better getting supplemental oxygen while you're exercising.
Some people begin with only 2 minutes of walking before they need to rest. "But once they get past 2 weeks or so, they see their endurance begin to pick up and they are willing to extend the time more," Booker says. "Some really get into it." Their goal isn't marathons, but to be able to do simple activities without hauling an oxygen tank.

Don't be passive about smoke. Chances are it's cigarette smoke that damaged your lungs in the first place. So you want to avoid even secondhand smoke. "This can be really hard for people whose friends still smoke," Schulz admits.
Get extra oxygen when flying. Cabin pressures on airplanes can lower blood oxygen levels enough to cause problems for people with lung disease, Dr. Wenzel says. You won't be allowed to bring your own oxygen tank onto the plane, but many airlines can arrange for supplemental oxygen during a flight if they have advance notice.

Drink enough water. Aim for at least eight glasses of water, juice, or the equivalent a day, says Dr. Wenzel. "Being well-hydrated thins out mucus in the lungs, making it easier to remove."

Dress loosely. Clothes that pinch you around the waist make it hard to breathe properly, Dr. Wenzel says.

Eat wisely. Don't eat so much that you become uncomfortably full, Dr. Wenzel says. "The size of meals is very important. If you eat too big a meal, your stomach pushes up on your diaphragm and you can't breath properly."

Guard against girth. Just as a full belly can cramp your diaphragm, so can weight around the middle, Dr. Wenzel says. "If you can keep your weight normal, you'll have fewer problems."

When to See a Doctor
If you have emphysema, you should be seeing your doctor regularly for checkups. That's because labored breathing can put a big strain on your heart. If your symptoms seem to be worsening, if you have congestion in your lungs, or if you have swelling in your legs, see your doctor as soon as possible, says Dr. Wenzel.

And be sure to line up early for flu shots. Add an acute infection to a chronic disease, and you have the potential for deadly trouble. "I tell my patients to get flu shots every year as soon as the shots are available, usually in October," says Dr. Wenzel.

If you feel like you're getting a cold or the flu, or if you have fever, chills, or severe coughing, you should get to a doctor quickly for antibiotics or other treatment. Don't wait, Dr. Wenzel says.