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How Can I Stay Healthy?

For Patients

For anyone with COPD it is important to keep as healthy and active as possible. You can do many things to keep yourself healthy. Quitting smoking and rigorous activity are the most important.

Do I really need to stop smoking?

Smoking is the single greatest reason people develop COPD, but smoking itself is also a condition that requires special treatment. It is well known that smoking can cause lung cancer, heart and lung disease. About 90% of people with COPD get COPD from damage caused by smoking. Nevertheless, stopping smoking can help patients, even in severe cases. For example, everyone loses lung tissue as they get older. People with COPD who smoke, however, lose lung tissue at a much faster rate. Stopping smoking can slow the rate of loss to a normal rate. In addition, smoking causes swelling and irritability in the breathing passages. Some of these changes will no longer happen or will be less severe when smoking is no longer irritating the breathing passages.

Is it too late to stop?
No, it is never too late to stop for the reasons mentioned above. While stopping smoking will not make the lungs normal again, stopping smoking slows the damaging process from getting even worse.

What are some tips that can help me to stop smoking?

Tip 1: for those who are having trouble stopping smoking on their own, medication can help.

Tip 2: no single treatment is right for everyone. If the first approaches you take fail, try to figure out why. Speak with your healthcare provider about other options.

Tip 3: don’t be discouraged if your first attempts to quit fail. It may be that you need a different form of treatment, or that you weren’t quite ready to give up smoking.

Tip 4: avoid being in situations where people are smoking until you feel strong enough to resist the temptation.

Tip 5: never give up trying to stop. Most smokers try several times before successfully quitting for good!

Tell me more about the process of stopping smoking?
Stopping smoking is a two-part process. One part is the nicotine dependence developed from smoking, the other is the habit of smoking. Nicotine leaves the body 24-48 hours after the last cigarette, but withdrawal symptoms may continue after the nicotine has left the body. Usually, cravings are less frequent and less strong after 2 weeks. The other part that smokers need to deal with is the connections their brains have made with multiple doses of nicotine throughout the day. Someone once said "anything you do 500 times a day, 365 days a year has got to be addictive, regardless of what it is!". While most people who smoke stop smoking by their own method, some do better with the help and support of family and healthcare providers, and medication.

What treatments are available to help me stop smoking?
Smoking cessation support groups are available through many hospitals, clinics or other sites. Studies show that smokers benefit most from the combination of a support group and medication. It is well known that the more support you receive when quitting smoking, the better success you will have. While therapies such as biofeedback and hypnosis have also been used to treat smoking, their usefulness is less clear. Ask in your community if a "Quit Line" is available. Having telephone access to support is very helpful.

What medications might help me stop smoking?
Medications to help people stop smoking vary and the cost can be a factor for some people. When considering the cost of a treatment or medication, however, the smoker should consider the ultimate cost they will pay by continuing to worsen their chronic lung condition.

Nicotine replacement therapy includes gum, lozenges, patches, nasal spray and inhalers. Nicotine gum and patches are often available over the counter, while the nasal spray and inhalers are available by prescription, depending on where you live. Nicotine replacement therapy provides low levels of nicotine in order to decrease the withdrawal symptoms from nicotine addiction. Heavy smokers may require higher doses. This low dose of nicotine gives the smoker time to adjust to stopping smoking.

Because nicotine replacement can affect your heart and blood pressure, these medications should not be taken if you have had a heart attack in the past month or have significant heart irregularities. Discuss the use of these products with your provider if you have recently experienced a heart attack, have chest pains, heart irregularities or you are having difficulty controlling your blood pressure.

You should stop smoking when using these substances, since the combination of smoking and these medications reduce your chances of stopping successfully. You and your provider may find that using two types of nicotine replacement products (for example using the gum along with patches) helps control your desire to smoke. This combination therapy should be done under the supervision of your provider.

What is nicotine gum?
Nicotine gum (Nicorette, Nicotinelle) is a way of providing the body with nicotine without the harmful effects of smoke. Nicotine gum releases nicotine slowly when chewed. Gum must be chewed until a tingling sensation in the mouth occurs, the gum should then be "parked" between the cheek and gums until the tingling or taste goes away. Repeat the chewing until the tingling reappears. Repeat this process for 30 minutes, then discard the gum in a safe place, away from children and animals. Continual chewing may cause the jaw to be sore, upset the stomach, cause hiccups or a sore throat.

What is a nicotine inhaler?
Nicotine inhaler (Nicotrol inhaler, Nicorette inhaler) is another way of providing the body with nicotine without the harmful effects of smoke. This inhaler is different from bronchodilator inhalers. It is a small tube containing a cartridge of nicotine. The individual slowly inhales on the tube/holder and the nicotine is absorbed in the mouth. It is not inhaled into the lungs. This delivers a low level of nicotine similar to nicotine gum. Some people find that holding something in their hand and putting a tube in their mouth is helpful during withdrawal. This can be used at regular times throughout the day or when one anticipates a craving.

What is a nicotine patch?
Nicotine patches (Habitrol, Nicoderm CQ, Nicotrol, Nicorette, Nicotinell, Niquitin CQ and ProStep) are a way of providing the body with nicotine without the harmful effects of smoke. How often you use them will vary. Most patches are worn for 24 hours, except for Nicotrol, which is worn for 16 hours. The patch provides a low level of nicotine over time and "takes the edge off" withdrawal symptoms. Since the nicotine dose delivered at night may interfere with sleep, patches are sometimes removed at bedtime. However, nicotine craving on awakening is then worsened. While patches are well tolerated, skin irritation is a common problem. This problem can be reduced by placing the patch at a different place on the skin every day.

What is a nicotine spray?
Nicotine nasal spray (Nicotrol NS, Nicorette) is a way of providing the body with nicotine without the harmful effects of smoke. The spray delivers nicotine through a spray and is absorbed in the nose. It is not inhaled like other nasal sprays. One to two doses are used per hour as needed. Most need nine to 12 sprays per day. The spray should be used for at least 3 months but for no longer than 6 months.

What are nicotine lozenges?
Nicotine lozenges (Niquitin CQ, only available in some European countries, Commit is available in the US) deliver nicotine through a tablet. The tablet is placed under the tongue when the desire to smoke arises and is allowed to dissolve. One to two lozenges can be taken every hour, with a maximum of 20 lozenges a day. Lozenges should be taken for 3 months, when the number of lozenges used daily should be reduced. Lozenges should be stopped when only one to two lozenges per day are being used.

Are there other medications besides nicotine replacement that can help me to stop smoking?

Yes, two other medications have been used to help individuals stop smoking.

Bupropion (Zyban) was originally used as a medication to treat depression. It was later found to be particularly helpful for people trying to stop smoking. This medication does not contain nicotine. It is a tablet taken once or twice a day. You and your healthcare provider will decide the best amount for you. Generally, 2-3 months of treatment are needed. Those who should not take this medication include those who are at risk for seizures, eating disorders or use MAO inhibitors (a special class of medications to treat depression). If you are taking any medication to treat depression, including Bupropion, tell your physician before you begin taking Zyban.

Clonidine (Catapres) and nortriptyline (Aventyl, Pamelor) have also been used to assist smokers stop smoking, but these drugs have not had as wide a use and study as bupropion.

These medications can be used alone but may be more effective if used with some form of nicotine replacement.

Where do I get help to stop smoking?
Many organizations want to help. In addition to the clinic or hospital where you are being seen, call your local Lung Association, or refer to the following sites:

Should I get the flu and/or pneumonia vaccination?

Unless told otherwise by your healthcare provider, and you are not allergic to eggs, you should receive both the flu and pneumonia vaccination. The flu shot is available each Fall and you should get one every year. There are no live viruses in the shot, so you will not get the flu from the shot. As with any shot, it may make your arm tender.

You should get the pneumonia shot at least once a lifetime. If you have had the pneumonia shot 6-8 years ago or have had pneumonia since you first got the shot, ask your healthcare provider if you should get another one. Like the flu shot, there are no live viruses in the shot, but it may make your arm tender.

Is it normal to get depressed?

Having COPD and being unable to do what you want to do because of shortness of breath can be a reason for depression. Depression is a treatable condition and should not be ignored. Some patients find that being enrolled in a pulmonary rehabilitation program and having contact with others can lessen depression. Others require medications to treat their depression. Discuss your feelings with your healthcare provider. Depression is not a condition that is always obvious to those caring for you.

What should I know about osteoporosis?

You should know that both men and women get osteoporosis (weakening of the bones). This occurs in many people as they grow older or because of medication. A common medication taken by patients with COPD, steroids, can increase your chances of getting osteoporosis. Your healthcare provider can monitor the strength of your bones (bone density) with a bone density scan. There are medications that can slow the progress of bone loss and in some cases actually strengthen the bones.

Is there a special diet for patients with COPD?

There is no special diet for people with COPD. At one time, it was felt that people with COPD should avoid carbohydrates found in sugars and starches. This theory has never been shown to be true for patients not hospitalized. In addition, people with COPD can experience two very different problems with weight. Some people with COPD gain weight and others have difficulty maintaining their weight.

While COPD does not cause weight gain, some medications used to treat COPD, such as steroids, may cause some people to gain weight. Being overweight will make the symptoms of COPD worse. Carrying the added weight requires more work for the body and keeps the lungs from expanding fully. The result can be greater breathlessness and increased tiredness because the person is less active. People who are overweight often lose their motivation to exercise. The challenge for these patients is to lose weight and exercise. Those needing to lose weight should be actively involved in a weight loss program that is no different than a person without lung disease.

Some people with COPD may have serious problems maintaining their normal weight. Weight loss comes from not having enough calories to simply keep up with the daily demands of the body. Additional calories are needed to make up for those they burn with the act of breathing. They, therefore, do not have any "extra" calories to use in order to maintain their normal weight. The challenge for these patients is to eat enough calories to maintain their weight. Those who are underweight need to consume as many calories as possible. Therefore, foods that are high in calories, but easily swallowed and digested, are best. In some instances, medications to stimulate the appetite may be needed.

Whether a person with COPD is overweight, underweight or their ideal body weight, they all can lose muscle function from nutritional imbalance and lack of exercise. The way to reverse this process is to exercise and eat a balanced diet.

Are there activities that I should not do?

After stopping smoking, keeping active is the second most important thing you can do to help your breathing problem. The kind and amount of activity is almost limitless, for example play golf, shop, take hikes or garden. In order to do these exercises without causing severe breathlessness, you need to learn to pace your breathing with the activity. Paced breathing helps you breathe in coordination with your activity. One of the biggest adjustments patients with COPD must make is to pace their breathing, economize their motion and slow their pace. These techniques are taught in pulmonary rehabilitation programs and at COPD support groups.

It is very unusual for people with breathing problems to "over exert" themselves. Usually, people who feel that they are over exerting are experiencing the normal symptom of breathlessness. With the exception of activities that may expose you to environmental irritants or a cold or flu, you should be involved in physical activities every day.

Can I travel?

People with COPD should not avoid traveling because they have a breathing problem. In some cases, those with COPD are advised to avoid traveling to higher altitudes (elevation) because of decreased oxygen levels at altitude. They may be prescribed oxygen when traveling at altitude. If you choose to travel to a higher altitude, discuss your oxygen needs with your healthcare provider.

Flying does not "hurt" the lungs. The major concern is the pressure in the airplane and your need for oxygen in flight. If you are receiving oxygen for any reason, discuss the possible need for oxygen with your provider before flying (see Oxygen section).

Why do I sometimes have trouble sleeping?

COPD sometimes affects a person’s sleep. People with COPD may experience sleep problems for a variety of reasons, including sleep apnea, low levels of oxygen at night, medications and cough. Low oxygen levels may disrupt sleep. Those with disrupted sleep because of low oxygen levels may or may not be aware of a low oxygen level. Your healthcare provider may refer you for a sleep evaluation. There are a number of medications that are used to treat COPD that may interfere with sleep. Most bronchodilators including beta-agonists and theophylline are stimulants. Taking these medications near bedtime may make it difficult to fall asleep. Cough may awaken patients resulting in disrupted sleep. Coughing that awakens you should be discussed with your healthcare provider so that they can evaluate and treat it. Patients with severe difficulty breathing may develop fears of falling asleep. This should also be discussed with your healthcare provider since it is easy to develop poor sleep habits.

Signs of sleep problems that should be discussed with your healthcare provider include difficulty getting to sleep or staying asleep, awaking with headaches, awaking with shortness of breath and complaints by your sleep partner that you stop breathing during sleep. When evaluating your sleep problem, your provider will want to know all medications you take before going to sleep.

What about sex?

Your lung disease does not directly affect your sexual ability. However, the symptoms of your lung disease, such as shortness of breath, fatigue and the emotional reactions of having a chronic disease, may interfere with your ability to perform and enjoy sexual activity. Many people with COPD have concerns about the effect of sexual activity on their lungs. Sex, like other physical activities, is not harmful to your lungs.

The medications you are taking for your lung disease, such as bronchodilators and steroids, have not been documented to cause difficulties with sexual functioning. Other medications you are taking for another health problems could possibly cause difficulty with sexual activity. Pulmonary rehabilitation programs usually have a class that discusses issues related to sexual functioning or you can discuss your concerns with your healthcare provider.

How often should I see my healthcare provider?

Your healthcare provider will schedule regular visits with you, either every year or every 2-3 years, depending on how well your COPD is under control. Between these regularly scheduled visits, you should see your healthcare provider when you have an increase in your symptoms that you are unable to control with your "action plan".

What is an "action plan"?

An "action plan" is a strategy that you and your healthcare provider develop to handle increased symptoms, such as increased shortness of breath, increased cough or greenish sputum. This plan should outline how often you can use your bronchodilators, when and how much steroids to take, and specifically when you should call your healthcare provider.