Pulmonary Rehabilitation Information Leaflet - Cambridgeshire ...
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Pulmonary Rehabilitation Information Leaflet We hope you have enjoyed the pulmonary rehabilitation programme and have noticed the positive effects of regular exercise on your health. This booklet includes a lot of the information you have received during the rehab talks.
Handy Tips…..
How to keep myself well….
• Don't smoke
• Take daily exercise and pace myself
• Eat a good balanced diet
• Drink plenty of fluids
• Always have enough medications and never run out
• Take all medication as prescribed
• Make sure I have my annual flu vaccine
EXERCISE can help improve muscle strength and endurance. This will improve the ability of the
muscles to function more efficiently resulting in less breathlessness. This can result in an improved
exercise tolerance. Exercise should form a core part of the management of patients with chronic lung
disease.
Pulmonary Rehabilitation is highly effective The Respiratory System
in helping to introduce exercise to
people with lung disease in a
supportive environment, whilst also
providing education on how to
manage and live with lung disease.
Once someone has completed a
Pulmonary Rehabilitation course, they
are strongly encouraged to continue
with exercise at home or at a local
leisure facility.
What happens when we breathe?
• We breathe in oxygen (O2) from
the air and breathe out carbon
dioxide (CO2).
• As we breathe in, the air enters the lungs and the alveoli, where oxygen then moves from the
alveoli, into the blood.
• Chronic lung disease can affect the normal mechanism of breathing, resulting in breathlessness.
• This impacts on all aspects of life and can cause stress, anxiety and difficulty with daily activities.
Page 2
Understanding your condition
COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term to describe lung diseases
including emphysema, chronic bronchitis and chronic asthma.
Emphysema
Is a disease that affects the alveoli (the little air sacs) that causes shortness of breath. The walls
of the alveoli become weakened and rupture which causes larger air spaces instead of lots of little
ones. This reduces the surface area and in turn the amount of oxygen that gets into the blood.
Chronic Bronchitis
Chronic bronchitis describes chronic inflammation of the airways. It often causes an increase in
phlegm and swelling which causes narrowing of the airways. Some of the symptoms include cough,
wheeze, increased phlegm and breathlessness.
Chronic Asthma
Chronic asthma may occur due to long standing severe asthma. Over time the airways become
fixed and narrowed. This can cause cough and breathlessness and often more phlegm.
Interstitial Lung Disease
This is a restrictive lung disease which comes in over a hundred different forms. Over a period of
time the lung tissue becomes thickened and scarred which is called fibrosis. Because of this
scarring it is harder for the oxygen to get into the blood stream. Interstitial Lung disease can
Bronchiectasis
This is a condition where some of the tiny airways in your lungs become enlarged. This
enlargement causes a build up of excess mucus in the lung that can make the lungs more
vulnerable to infection. As well as excess phlegm it can cause a persistent cough and breathless.
Bronchiectasis is treated with pulmonary rehab, inhalers and good chest clearance techniques.
Although these chronic lung diseases cannot be cured they can be managed to prevent it from
worsening:
• Stop smoking
• Pulmonary Rehabilitation
• Medication
• Vaccinations
• Chest clearance techniques
• Early recognition of chest infections
• Good diet/hydration
Page 3
Breathlessness and Exercise Being short of breath goes hand-in-hand with having a chronic lung disease, however it is not just the condition of the lungs that determine how breathless someone will be. After noticing that physical exertion is causing someone to be breathless, they may try and limit the amount of exertion they do to avoid being short of breath. This can then cause them to be anxious or worried about being breathless, so often that results in even less exertion. Over time this can lead to a loss of physical fitness, which causes the muscles to be less efficient and this will lead to even greater levels of breathlessness on even less exertion. It is common to hear from patients with chronic lung disease that they are getting more and more breathless but according to their lung function tests (spirometry) their lung condition has not worsened, so the worsening breathlessness is more likely to be as a result of the factors described above. So how can we improve things? Page 4
Breathing Exercises
There are a number of different breathing techniques that are taught to patients with lung disease;
some are to manage breathlessness and some to help with sputum (phlegm) clearance.
Exercises to help manage breathlessness
Breathing Control - Breathing control means breathing gently, using the least effort. It will help to
use breathing control when short of breath or feeling fearful, anxious or in a panic. By using
breathing control the effort of breathing is reduced.
How to do breathing control
• Get into a comfortable, relaxed position. Make sure that arms are supported.
• Breathe in gently through your nose and breathe out through your nose, if you can. If you
cannot breathe out through your nose breathe out through your mouth instead.
• Try to let go of any tension in your body with each breath out
• Gradually try to make the breaths slower
• Closing your eyes may help you to focus on your breathing and help you to relax
• Do not force your breath
Positions of Ease
These are positions that you can use when you are breathless to help reduce the time it takes to
recover your breathing. When you are using any of the positions below, it is important that you try
and relax and reduce any tension in the upper part of your body (including your arms).
Page 5
Chest Clearance Exercises
Clearing your chest effectively is an important part of managing your condition. The most effective
way to do this is using the Active Cycle of Breathing Techniques (ACBT).
ACBT consists of 3 different breathing exercises:
• Breathing control: (see exercises to help manage breathlessness)
• Deep breathing: Take a slow, deep breath in through your nose and release slowly out of your
mouth.
• Huffing: Take a deep breath and then squeeze air quickly from your lungs, out through your
open mouth and throat, as if you were trying to mist up a mirror or your glasses. Use your tummy
muscles to help you squeeze the air out, but do not force it so much that you cause wheezing or
tightness in your chest.
You may be advised by a Physiotherapist to perform these in a postural drainage position or to do in
sitting. You should perform chest clearance for 5-10min, twice daily as a minimum.
Page 6
Medication
• Medications prescribed for chronic lung disease help to improve respiratory symptoms - such as
breathlessness, wheeze and cough, and quality of life.
• These medications can be given in different forms: inhalers, nebulisers, tablets/ syrups and
sometimes oxygen.
• These medications need to be taken regularly and correctly to be fully effective.
• Remember that different medications are prescribed for different conditions and may not apply
to you.
Reliever Medication (Bronchodilators)
To help your symptoms you can be prescribed an inhaler with a bronchodilator in it. A bronchodilator
helps relax the muscles in the airways or encourages them not to contract which allows the airways
(broncho) to open (dilate). These can be short acting or long acting to help relieve your symptoms.
Short Acting Beta Agonist (SABA)
An example of this may be Salbutamol, often the inhalers are blue in colour and work within 5-15
minutes and last for 4-6 hours.
Short Acting Antimuscarinic Antagonist (SAMA)
An example of this may be Atrovent, Starts working 30-60 minutes and works for 3-6 hours.
There are a range of inhalers that work over a longer period of time to allow you to manage your
symptoms to enable you to carry out day to day activities. Long acting inhalers typically work for 12
or 24 hours and are therefore taken once or twice a day. You must continue these even if you are
feeling well.
Long Acting Beta Agonist (LABA)
These encourage the airways to relax. An example of this may be Salmeterol, Formoterol
Long Acting Antimuscarinic Antagonists (LAMA)
These encourage the airways to prevent contracting. An example of this is Tiotropium, Aclidinium
Bromide.
Page 7
Dual Bronchodilators
These are a new class of inhalers used to treat the symptoms of breathlessness associated with
chronic lung disease.
They combine 2 long acting bronchodilators.
Each bronchodilator acts on different receptors in your lungs.
Research shows that these inhalers may improve symptoms of breathlessness and quality of life
for patients diagnosed with a chronic lung condition.
Steroid Inhalers
Drugs that are taken every day to reduce swelling and inflammation of the airways.
Available as Single Dose steroids or Combination inhalers
Single Steroid Inhalers
• Used mainly for patients with asthma.
• Taken twice daily, 1-2 puffs
• Side effects: Oral thrush, dry mouth
Combination inhalers
These inhalers combine two or more medicines – a corticosteroid and a long lasting bronchodilator]
• They help to reduce breathlessness and inflammation in the airways.
• Side effects: Oral thrush, dry mouth
Page 8
Spacer Devices
It is a tube-like device that can be used with your pump inhalers only. It helps to make sure you
receive more of the medication and stops the excess from staying in your mouth or throat.
Carbocisteine (aka Mucodyne)
• Is a mucolytic, meaning it thins mucous in the lungs, making it easier to cough up
• Taken as a capsule, one or two, up to 3 times a day, sometimes increased in exacerbation. It is
also available in liquid form
• If it doesn’t help after 4 weeks trial, its not for you
Theophylline
• Is a bronchodilator taken as a twice a day tablet
• Also known as Slo-Phyllin, Uniphyllin, Nuelin, Phyllocontin and Aminophylline
• Side Effects: nausea/vomiting, headache, fast heart beat
• Need regular blood tests to make sure you have the right dose, too much or too little can make
you unwell.
Medications to help manage anxiety related breathlessness
Opioids
Morphine has shown to help reduce breathlessness when it is given in in small amounts (2.5mg) in
liquid form. This is usually under controlled supervision.
Anxiolytics
They have also shown to help to reduce anxiety and improve breathlessness. Examples of
anxiolytics: Diazepam and Lorazepam.
Oxygen Therapy
Not all patients require oxygen just those that have been identified as having low oxygen levels on
specific test that are completed at the hospital. This can be prescribed if needed for long term use
or just on activity.
Page 9
Oral Steroids A short course of oral steroids is useful in reducing the effects of a flare up. The usual dose is 30mg for 7or 14 days. In some cases this can be reduced slowly every 3 days. Steroids have many side effect include muscle weakness, vertebral weakening, diabetes, Cushing’s and thinning of the skin. Additionally, steroids can increase the risk of pneumonia in patients with COPD Note: If you are diabetic, you may need to monitor your blood sugar levels regularly if you have been started on a course of steroids. You will need to contact your GP/ Diabetes team if your levels are too high. Antibiotics A course of antibiotics is given for 5-10 days for an infective flare up. An infective flare can be recognised by fever, changes in your sputum colour, amount and/or testing your blood for infection. Prophylactic (preventative) antibiotics may also be given to patients who have regular infections, for example Azithromycin which is taken 3 times a week. This will be commenced by your Chest physician/ or your GP in some cases. Managing Exacerbations/Flare Ups There are many things you can do to help manage your chronic lung condition as mentioned throughout this booklet. Managing your condition when you are well is important but it is also very important to manage your lung condition effectively when you are unwell. An important part of this is being aware of the signs and symptoms of an exacerbation/flare up. The easiest way of recognising an exacerbation is to know and understand your normal symptoms i.e. sputum colour, degree of breathlessness. This way it is easier to identify when there is a change. If exacerbations are treated appropriately and promptly, then often admission to hospital can be avoided. If you are unsure as to whether to start your rescue pack, contact your GP/Practice Nurse and ask to speak with them over the phone to discuss further. The table on the page opposite is helpful to show you what to do in the case of a flare up or exacerbation Page 10
My Symptoms Plan of Action **To Remember**
• Do I feel worse than
usual? Symptoms may
include…..
My symptoms are I will continue to take my
= Increased breathless-
normal for me usual medication.
ness
= Increased phlegm or
change in colour.
Mild Flare-up
= Increased chesty cough
I am more breathless than I will use my reliever
normal but I have no fever and medication. • What can I do?...
there is no change in the colour
of my phlegm. = Continue or increase
your inhalers
Moderate Flare-Up = Start your rescue pack
I will continue to use my
medication as prescribed and I
I am more breathless than will also use my rescue pack. = Keep calm and do your
normal and coughing up more breathing and relaxation
phlegm, or my phlegm has Steroids Antibiotic exercises
changed colour.
I will tell my GP or healthcare • I must remember?...
I am much more breathless Professional within 2 days of
despite taking my reliever starting this treatment. = Contact your practice
medication nurse, or respiratory ser-
vice team
I will call my GP the same day
as soon as my symptoms be- = If symptoms are severe
Severe Flare-Up come this bad. If I cannot call call 999 in an emergency.
myself I will ask someone to
• If you use your rescue
My breathing is much worse call for me.
pack please inform the
despite treatment.
GP to keep it topped up.
If I cannot wait to see my doc-
I have chest pain or high fever. tor, I will call 999 straight away.
If I am too breathless I will ask
someone to call for me.
Page 11Stress Management and Energy Conservation
Stress can make the symptoms of lung disease (e.g. breathlessness) worse. Stress can be caused
by a wide range of factors and is very individual; what causes stress to one person won’t necessarily
affect someone else. The body responds in a variety of ways to stress and anxiety and if not
managed it can result in long term physical and emotional responses from the body.
Tips to manage stress:
• Be aware of signs and causes of stress
• Don’t allow difficult situations to overwhelm you
• Be realistic and be flexible
• Take one step at a time
• Take action- talk about it
• Get rid of stress in a positive way (exercise)
• Keep as active as possible
• Give yourself time for relaxation
Energy Conservation
If you can make tasks that you HAVE to do, such as washing and dressing, easier then you will not
use as much energy, leaving you with more energy to do activities that you WANT to do. This can
have a positive impact on your level of stress and anxiety as you have more energy to enjoy life. You
can achieve this by using a combination of techniques:
• Practice breathing control and positions of ease to help make your breathing as efficient as
possible. Knowing when to breathe in and out can also make tasks easier. Breathe in on the
easiest part and breathe out on the hardest
• Take your time with all activities. If possible spread tasks throughout the day or week rather than
trying to get them all done at once. Take breaks during activities and use levels of breathlessness
as a guideline to know when to slow down/stop.
• Simplify your activity/task by
• Avoiding long periods of standing
• Slide rather than lift
• Minimise arm movements above shoulders
• Use an assistive device e.g. long handled shoe horn.
Page 12Nutrition
Being a healthy weight is important for many reasons. Being overweight can put increased pressure
on bones, joints, your heart and circulation as well as decreasing your mobility and making breathing
more difficult. However, being underweight can mean that you have an increased risk of breaking
bones and picking up infections, as well as a general sense of weakness in your muscles.
Healthier eating does not necessarily mean you have to eat less; it’s about achieving a healthy bal-
anced diet
• Eat regular meals – breakfast, lunch and dinner
• Reduce snacking between meals
• Eat more fruit and vegetables
• Choose lower sugar / lower fat products
• Review your portion sizes at mealtimes
• Fist sized portion of potato, pasta, rice or 2 slices of bread
• Palm sized portion of lean meat, fish or other protein sources
Malnutrition can refer to under nutrition (being underweight or losing weight) or over nutrition (being
overweight or obese).
Malnutrition is an imbalance of energy, protein and other nutrients that causes adverse effects on the
body
Weigh yourself monthly if you can, or ask your doctor or nurse to weigh you at your appoint-
ments, as your weight is a good indicator of what is happening in your body
• If you are unable to weigh yourself, be aware of visual signs of your weight decreasing, for exam-
ple jewellery and clothes becoming looser
• If you continue to lose weight or you struggle to eat enough during periods of illness, even if you
are overweight, seek advice from your doctor or nurse
We have various advice leaflets about weight loss and nutrition,
so do not hesitate to contact us.
Page 13Smoking and your lungs Smoking causes significant and irreversible damage to your lungs. Even if you only smoke 1 a day the damage can still occur. What is in a cigarette There is much support for those wishing to give up smoking including Nicotine Replacement Therapy NRT (gum, patches, inhalers etc) as well as medications that can be prescribed by your GP and counselling/group sessions. Please approach your health care professional if you wish to discuss giving up smoking, Live Well Luton 01582 757635 Its never too late to stop smoking Page 14
Useful Information and Contact Details
Luton Community Respiratory Nurse Team: 0333 405 3159
Email: ccs-tr.lutonrespiratory@nhs.net
Pulmonary Rehabilitation Team: 01582 718113/07775 025380
Email: ldh.tr-ldhpulmonaryrehab@nhs.net
Breathe Easy Groups Luton & District
• Meet on the 2nd Thursday of the month 2pm-4pm
• Meet at the Peter Newton Pavilion (Skimpot Road, Dunstable)
• Tel: Elaine - 01582 451587
Disability Resource Centre
Poynters Road, Dunstable. 01582 470 900
British Lung Foundation
Website: www.blf.org.uk
Pulmonary Fibrosis Trust
Website: www.pulmonaryfibrosistrust.org
Luton Social Services: 01582 547659
Keech Palliative Care Centre
Experts in symptom management following a referral from a health care professional the patient is
offered a nurse assessment.
The types of services offered
• Doctors clinics for symptom control and ongoing monitoring of symptoms
• Nurse led clinics for symptom control and emotional support
• Non-Malignant Palliative Respiratory Programme
• Ascetic drainage for malignant disease
• Fatigue Management Programme
• Specialist social worker advice and support
• Complementary therapies
• Music therapy
• Art therapy
• Spiritual support
• Psychosocial emotional support
• Support with future planning
• Carers drop-in group
• Hydrotherapy pool
Page 15Community Respiratory Services
The Poynt
Unit 2-3 Poynters Road
Luton,LU4 0LA
Tel: 0333 405 3159
Notes:
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0566 - July 2020 (v1.6)
July 2018
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