Home Remedies Can Compliment COPD Medications

Many People With COPD Want The Best Of Both Worlds

Modern, state-of-the-art medications to help their lungs function at their best, plus herbal remedies that have been used for centuries to help clear the lungs. Keep in mind that herbal remedies have usually not been subjected to rigorous scientific testing. They may be used with, but never instead of, the medications your doctor has prescribed.

Howard Kravetz, M.D. is a retired pulmonologist who runs The Pulmonary Foundation, a health and exercise facility in Prescott, Arizona, for people with COPD. Dr. Kravetz has found that even though COPD patients are on multiple medications, the following safe, natural remedies may give an extra sense of comfort and well-being.

Peppermint Treat

This herb-tea favorite is a great way to start the day or reduce congestion before bed. Peppermint tea bags can be purchased at most health food stores, but for a stronger brew, buy the leaves from a reliable herb store. Peppermint may aggrevate reflux (gas) and related breathing problems; if so, discontinue use.

Essential Oil Rub

Essential oils are oils extracted from herbs. When added to a base oil, they can make a soothing balm for the chest that can help relieve congestion. They also smell a whole lot better than anything you will find in the drug store. Try this fragrant mix:

Combine ingredients in a glass bottle. Shake well to mix oils. Massage into chest and throat as needed.

Mini-Eucalyptus Sauna

Bring water to a simmer and turn off the heat. Add essential oil. Take pot off the stove and place on a heat-safe surface. Place your face over the pot, but not so close that the steam will burn you. Drape a towel over your face and head. Steam for 10 minutes or so to help clear congestion.

The Cayenne Tonic

This remedy is not for the faint of heart. But if you don’t mind adding a little spice to your life, this is a quick way to open up your bronchial passages.

Mix the sauce or pepper with the warm water and drink. Sip slowly at first if you are not accustomed to hot foods.

Q: I’m 55 and a pretty light smoker (about 5 to 10 cigarettes a day). I do have a morning cough and seem to get a lot of colds. How do I know if I have COPD?

A: First, understand that there is no safe level of smoking; I recommend that you stop completely as soon as possible. Second, although a "smoker’s cough" and frequent respiratory infections might be warning signs that your lungs are under stress, it’s not possible to diagnose COPD from symptoms alone in the early stages.

A breathing fitness test, known as spirometry, is the best way to find out if you have COPD. New lightweight spirometry machines are now available and, to date, about a third of primary care physicians can do this test in their offices. Others may refer you to a pulmonologist or pulmonary laboratory for testing.

A breathing fitness test is completely painless, safe, noninvasive, and takes only about 10 minutes. It tests for airflow obstruction and measures the volume and flow of air from fully inflated lungs.

The National Lung Health Education Program recommends that all smokers over age 45 and anyone who has shortness of breath, a wheeze, or a sputum-producing cough, be tested with spirometry. Many smokers who find out, to their relief, their lung fitness has not yet been compromised are encouraged to quit. If airflow problems are found on spirometry, early treatment and smoking cessation may be able to head off advanced COPD. So I encourage all smokers to have their lungs tested.

Q: My mother has been prescribed a COMBIVENT® (ipratropium bromide and albuterol sulfate) Inhalation Aerosol inhaler but doesn’t seem to be sure how to use it. What’s my role as instructor?

A: Metered dose inhalers (MDIs) are by far the most convenient way to deliver medication to the lungs. Consistent, regular use of the two medications combined in the COMBIVENT® inhaler reduces COPD breathing problems by opening both the larger and smaller airways of the lungs.

To those of us without breathing problems, MDIs seem quite easy to use. However, people with COPD often need to practice inhalation technique in front of a doctor or nurse, and with the help of a family caregiver. The most common mistake patients make is not continuing to inhale slowly after activation of canister. I’ve also seen patients use the inhaler upside down, spraying onto their chests rather than into their lungs, and even forgetting to take the cap off.

These problems are often due to nervousness and lack of coordination. Shortness of breath can make people with COPD very anxious about their breathing. And mechanical problems, such as difficulty removing the cap because of arthritis in the hands, can add to the difficulty.

A family member can be a big help in making inhaler use a calm, consistent procedure. First, make sure the patient has had good instruction from a doctor or nurse and also had a chance to use the inhaler under medical supervision.
At home, it’s a good idea to practice using the inhaler in front of a mirror, following these steps.

  1. Shake the canister.
  2. Take the cap off.
  3. Hold the canister upright.
  4. Open mouth, place mouth piece in front of open mouth, squeeze and inhale.
  5. Inhale slowly for one full breath.
  6. Repeat (the usual dose is two puffs of COMBIVENT® every 4 to 6 hours).

Answered by Thomas L. Petty, M.D.
Health One and University of Colorado Health Sciences Center
Denver, Colorado

Dont Volunteer Your Loneliness

Ten years ago, Jo-Von Tucker was diagnosed with moderately severe COPD. She has been on supplemental oxygen 24 hours a day ever since diagnosis. Ms. Tucker owns and operates a successful business, Clambake Celebrations, in Chatham, Massachusetts. She is founder, coordinator, newsletter writer, and publisher for the 125-member Cape COPD Support Group in Cape Cod, Massachusetts. Ms. Tucker is also co-author of a soon-to-be-published book, Courage and Information for Life with Chronic Obstructive Pulmonary Disease (New Technology Publishing, Onset, Massachusetts). Her main problem: "The days are simply not long enough to fit everything in!" She welcomes your correspondence at clam...@capecod.net.

Among the most threatening issues to confront the COPD patient are loneliness and a feeling that you are battling this chronic, progressive disease alone. These feelings develop easily from the self-imposed isolation that many of us experience.

During my research for the book I have written on lung disease from a patient’s perspective, I encountered so many COPDers who had simply resigned themselves to waiting at home for what they considered to be the inevitable... death. Furthermore, many medical professionals expressed the opinion that "people with COPD tend to just fade away."

Isolation occurs for many reasons. We may decide to stay at home, away from friends and family because of the hassles of carrying supplemental oxygen with us. Even on "good days" we fight fatigue and a lack of energy. Getting ourselves ready to be seen by an outside world involves energy-depleting activities, like showering, shampooing, dressing and other items of presentation. These are not small tasks to a sufferer of chronic lung disease. They can easily send us to the nearest chair, gasping for breath and grasping our puffers.

There is also the issue of embarrassment to deal with. Some patients are self-conscious about their oxygen equipment and paraphernalia. Others fear that an uncontrollable coughing or wheezing spell may attract unwanted attention in public. And nearly all of us suffer some embarrassment from the fact that we are unable to walk for even short distances before exhaustion sets in. If we venture out, we might even encounter a set of stairs, God forbid! And if all of these reasons aren’t daunting enough, there are days we just don’t feel well enough to exert the energy required to socialize.

In order to avoid all of these unpleasant circumstances, it may seem smartest, and easiest, to simply stay at home. Yet I believe that isolation, whether caused by circumstances or self-imposed, is a killer for people with COPD. The debility that results from confining ourselves to a sentence of loneliness and stark existence may take us away far sooner than even a series of exacerbations. Isolation must be fought and avoided with all of the strength we can muster — because the alternative is to give in to the dictates of a disease that won’t go away. And to allow it to cut us off from life way before our time!

Is Isolation Inevitable for People With COPD?

NO, a thousand times, NO! As patients we must realize that maintaining social contacts is a responsibility we have to our well-being and ourselves. We are the ones who must be aware of the importance of really living our lives, with all the quality that we can hold on to.

We can, and should, commit ourselves to a better fate. By being realistic about our abilities (as well as our liabilities), we can add more style and grace to our lives and give ourselves plenty of reasons to get up and out each day.

For a start, find ways to be with those individuals whose company you most enjoy! Create opportunities to see them for a lunch out, or invite them over for Scrabble® or Backgammon. Plan activities that will encourage you to gain exposure to the positive side of life. List them on your month-at-a-glance calendar, and allow yourself to anticipate the good times to come. Be sure that your days are filled with challenges (both physical and intellectual), and with activities and people that you love.

I encourage you to take control of your life, and to seek out ways to squeeze every drop of joy from it. Just imagine how much better you will feel for the company, for the action and vitality, and for the experience. Your heart will be lighter, as will the burden of your illness. C’mon. Join me!

The COPD Post-Rehab Work-Out

Less than an hour, three times a week, can put you on the fast track to easing your COPD symptoms and improving your overall health and well-being. Here’s how:

The first step is a pulmonary rehabilitation exercise program. If you have COPD and have not recently participated in a pulmonary rehabilitation program, ask your doctor or call the American Association of Cardiovascular and Pulmonary Rehabilitation (608-831-6989) for a referral.

Once you’ve completed a COPD rehabilitation exercise program, the next step is to make the most of your hard-won fitness benefits.

"Maintenance is one of the most important aspects of rehabilitation," explains Idelle Weisman, M.D., F.C.C.P., director of the Human Performance Laboratory at William Beaumont Army Medical Center in El Paso, Texas. "Without maintenance, you can lose program benefits in just 8 to 10 weeks."

To help you stay in shape, Weisman has created a simple workout that you can do at home. This routine is designed only for COPD patients who have recently completed pulmonary rehabilitation.

1. Getting Started

Never hold your breath or strain. As you work out, determine your personal threshold for fatigue and shortness of breath. Stop and rest if necessary. Adjust your oxygen requirements based on your previous experiences in your program. Begin with three sessions a week. Work your way up to five.

2. Warming Up: 6 minutes

A. Hold all stretches for 30 seconds.

Calf Stretch

Stand facing a wall. Rest your forearms on the wall, rest your forehead on your arms. Bend your right knee, leaning in and pressing your left leg straight out behind you with your heel on the floor. Repeat with other leg.

Thigh Stretch

Stand and rest your left hand on a wall for balance. Bend your right knee. Bring your foot up behind you. Reach around and grasp your right foot with your hand. Repeat with other leg.

Arm Stretch

Stand with feet slightly apart. Extend your left arm, then bring it across your chest, pointing to your right. Support outstretched left arm at the elbow with your right hand. Repeat with other arm.

Shoulder Stretch

Stand with feet slightly apart. Put your left arm over your head, bending the elbow so your hand is behind your head. Use right hand to apply slight pressure to left elbow. Repeat with other arm.

B. Low intensity warm-up: Slowly walk in place for about 3 minutes.

3. Hitting Your Stride: 25 to 35 minutes

Lower Body Endurance Training

Use a stationary bike, or take a walk on a treadmill or outside. Walk on flat surfaces, not hills. Start slow, then work up to a brisk, but comfortable pace. If on a treadmill or bike, set the program on manual, so that you can control your speed. Maintain a balanced pace for 20 minutes. Work up to 30 minutes, increasing your time as your strength allows.

Lower Body Cooldown

Slowly decrease the speed of your workout to the initial pace and maintain that pace for 3 minutes, until your breathing returns to an almost normal rate.

4. Working Your Arms: 7 to 10 minutes

Upper Body Strength Training

Take a dowel (a 2.2 lb. round, wooden pole available at any hardware store). Hold it so that your hands are almost in their natural position, at your sides. Then, lift the dowel to shoulder level, stretching your arms out in front of your body. Slowly lower it. Try for 15 to 20 lifts per minute, for 7 minutes.

Upper Body Cooldown

Gently slow the pace of your dowel lifts; maintain slow pace for 3 minutes, until your breathing returns to a near normal rate.

Asking For Help Doesn’t Come Easy To Many People With COPD

"Perhaps one of the greatest challenges we face in life is knowing when to give help and when to take it," says Jennifer Norton, Ph.D., a psychologist in the Department of Behavioral Sciences at Duke University in Durham, North Carolina. If you are living with COPD, creating an environment in which you have the right mix of independence and assistance can be the key to your happiness and your health.

However, achieving that balance and learning how to ask for help may mean opening your eyes to new ways of living, and changing long-held patterns in relationships with your family and friends. "Many people experience anger, frustration, depression and a fear that they will lose their independence when diagnosed with COPD, " says Norton, who is a counselor at Duke’s Pulmonary Rehabilitation Program. Close family members and friends may also wrestle with complex feelings.

The answer for patient and care provider, Norton explains, is to work through these emotions, so that you can make a smooth transition to mastering your new roles.

Often the first and toughest step is accepting the fact that you or your loved one does have a chronic illness. While this may impose new limits, life can still be rewarding. In this initial phase, Norton says it’s helpful to set goals. "Find things to look forward to in a week or a month." For example, deciding that on nice days you’ll do at least one outdoor activity or take an excursion, will help give you structure and bring joy and meaning to your life.

Here are Some Suggestions for Developing the Art of Accepting and Giving Care:

For Patients

Identify Your Fears. Sit Down and Ask Yourself

"Do I find it hard to ask for help?" If so, is it because you doubt that friends or family want to help you? Try asking them directly how they feel. "My experience has been that loved ones almost always want to help, they just may not know how to begin," Norton says.

Be Strong Enough To Voice Your Needs

Accepting assistance is not a sign of weakness or losing your independence. "It takes strength to ask for help," says Norton. The support of others will often make it possible for you to do more for yourself.

Be a Joiner

"Don’t isolate yourself. Get into a support group. It’s one of the most helpful things you can do," comments Norton. Seeing how peers have adjusted can be very encouraging.

Make a Difference

Turn adversity into opportunity. While COPD may limit your ability to contribute to your family as you did in the past, look for new tasks you can take on, in your home or in the outside world. "I have a patient who was walking through a local mall with his oxygen tank one day, when he noticed teens staring at him and making fun, while they puffed away on cigarettes," says Norton. "Rather than feel embarrassed, he went right up to them and explained that cigarettes were what destroyed his health. Now, he does what he can to help others stop smoking, which also makes him feel better."

For Caregivers

Get Involved

Many caregivers have questions about what to do and how to do it. It’s helpful to attend support group meetings and pulmonary rehabilitation program classes with the patient. Once you understand the issues related to living with COPD, you’ll feel more comfortable with your new responsibilities.

Allow Maximum Independence

"Even the most well-intentioned families may smother a COPD patient," Norton says. "Don’t create a situation in which you fetch every glass of water. You may end up exhausted or resentful and the COPD patient will not get the exercise he or she needs."


Talk It Out

Patient and caregiver should have a talk to clarify each person’s expectations, Norton advises. This is a good time to reassure each other and establish the basic principles of your caregiving arrangement.

Make a plan

"COPD is a condition that changes from day-to-day," Norton says, "so, it’s best for caregiver and patient to make an action plan." Schedule doctor visits and figure out what type of help will be needed and when. And most important, be prepared to re-negotiate and be flexible.

The benefits of successfully seeking support will be evident in no time. "The patients who do the best," Norton says, "are definitely the ones who open up and learn to manage their new situation."

Saving Your Strength For The Things That Count

When Grace England says, "I like to stay as active as possible," she's not just referring to puttering around the house. Despite a 15-year battle with severe COPD, this 63-year-old retired factory worker from Airton, Alabama, lives a full life. She seldom misses Sunday service or Wednesday night prayer meetings at her church. She loves to entertain her two-year-old great-grandson by singing along with Barney during their play dates. And, on occasion, she packs up her medication and oxygen concentrator and takes a weekend drive (100 miles each way!) to visit her brother. It's easy to see why fellow members of her Better Breather's group, at the Alabama Wiregrass Region American Lung Association, consider Grace an inspiration.

So how can other folks with COPD get some of Grace's get-up-and-go?

Here are her tips on becoming a master of energy management, along with some advice from Wendy Press, her support group's respiratory therapist:

Let Oxygen Work For You.

"I use oxygen about 98 percent of the time," Grace explains. Press thinks that's a good idea. "Oxygen gives your muscles the fuel they need to function properly. I encourage people with COPD to use their oxygen, even when they're in the shower."

Snuggle Dry

" Why waste energy wrestling with a towel? "Buy a big, thick, terry robe, slip it on after your bath or shower, and relax while you dry off," suggests Press.

Work Out When You Can

"I advise everyone to exercise," says Grace, who picked up the habit when she had to get in shape for lung-reduction surgery three years ago. "I try to use my treadmill and exercise bike whenever possible." "Walking is also great for people with COPD," adds Press.

Plan, Plan, Plan

"Don't let chores get ahead of you," says Grace. "And only do one big job -- like laundry or vacuuming -- each day."

Seek Support

"It really helps to talk to other people with COPD," says Grace. "Because no matter what you think you know about handling your condition, you can always learn more." To find a support group near you, call 1-800-LUNG-USA.

Make The Most Of Your Doctor Visits

In today's fast-changing health care system, doctor visits may be shorter and treatment recommendations more complex. So it's more important than ever that patients do their part to get the most out of every visit with a physician. Airwaves interviewed top health care experts to gather some concrete advice that you can apply at your very next visit to the doctor:

Think Things Through

"Some people freeze when they are actually sitting in front of the doctor," says Enid Silverman, R.N., director of Pulmonary Rehabilitation Programs at the Rehabilitation Institute of Chicago. "To be sure that you get the answers you need, write down all of your questions. Take that list to your appointment, and let it be your guide while you talk with your doctor."

Bring Your Doctor Up To Date

"Every COPD patient should expect their doctor to request a detailed review of their symptoms," says David Cugell, M.D., Baszley Professor of Pulmonary Diseases at Northwestern University Hospital in Chicago. "If your doctor does not ask, tell him anyway. It's your right to be heard."

Speak Your Mind

Improving communication is one of the best ways patients can influence their care, points out Alan Schwartz, M.D., and his colleagues in the new book Getting the Best From Your Doctor: An Insider's Guide to the Health Care You Deserve (Minneapolis: Chronimed Publishing, 1998). "You are 50 percent of the process. By improving your communication skills, your doctor might very well improve the way he communicates with you."

Tell The Whole Story

Help your doctor understand what you are really feeling. "Don't exaggerate or underplay your symptoms," says Enid Silverman. "And give the doctor some objective measurement of your condition. Instead of just saying you're short of breath, for example, note how often you're using your inhalers or pursed-lip breathing technique. If you've gone from two to four doses of medicine a day to taking six to eight, that's what your doctor needs to know," she says.

Hang Up The Habit

Don't be shy about asking for help in breaking the cigarette habit. If you have COPD and you still smoke, it's time to stop, says Dr. Cugell. "And it's important to avoid other unnecessary lung irritants, including secondhand smoke and exposure to paint and other chemicals and solvents."

Get it in Writing

"No one should assume that they automatically know how to use an inhaler," says Alan L. Plummer, M.D., chief of Pulmonary Diseases and Critical Care at the Emory Clinic and Emory University Hospital in Atlanta. "Request a counseling session on how to use an inhaler properly." In addition, always ask for written instructions about medication and at-home care. If you find yourself doubting that you really need three or four medications, ask for printed information about what each drug actually does for your body. That may help alleviate some of your concerns about taking prescription drugs.

Stick With The Prescription

Taking all of your medication, all of the time, is the best way to manage COPD. "A recent COPD drug trial showed that as many as 75 to 80 percent of the participants were not using their medications as indicated," says Dr. Plummer. Dr. Cugell agrees: "If a patient takes the recommended medication, they can slow the progression of COPD and probably improve their quality of life."

Get Some Attitude

"Some COPD patients put their energy into fighting the doctor and denying their need for medication," says Dr. Plummer. "That allows the COPD to run their lives." Instead, let your doctor know that you welcome help and that you plan to control the disease, rather than let it control you. Says Dr. Plummer: "Having the right attitude can make all the difference."

What Me, Meditate?

Does the idea of meditation seem too exotic or foreign to fit your lifestyle? People often think of meditation as an important tradition mainly in India and the Far East, but it is also part of the Judeo-Christian heritage.

Today, meditation helps many people, religious and not, cope better with the symptoms of chronic diseases, reduce daily stress, and regain a sense of peace and joy. By quieting the mind, meditation releases the "inner physician," allowing the body's inner "wisdom" to be heard. Awareness of our needs for exercise, rest, physical touch, and food is often drowned out by our worried thoughts, which can make us inattentive to those needs.

Meditation involves giving the mind a regular "time-out" from our thoughts. "Most people are already familiar with the state of meditation," says Joan Borysenko, Ph.D., director of Mind/Body Health Sciences in Denver. "It's the calm focus that occurs whenever you are fully engaged in doing something you enjoy -- reading a good book, making love, swimming, planting flowers."

People with COPD may prefer a meditation method that does not focus awareness on breathing, suggests Borysenko. "Breath-centered meditation may make you more anxious if it reminds you of your breathing problems." It may be better to choose a verbal method, such as repeating a centering prayer (like counting a rosary) or a focus word or phrase (mantra), such as "om," "shalom," "my time," or even "easy does it." Concentrated movement, such as walking meditation, Tai Chi, and yoga, are other options.

Whatever method they choose, beginners often find it difficult to concentrate at first. Deal with intrusive thoughts by pushing them aside ("I can think about that later") and reconcentrating on your focus word or movement. Borysenko quotes St. Francis's comment about wandering thoughts: "You can't stop the birds from flying back and forth over your head, but you can stop them from nesting in your hair."

Meditation classes and "centering prayer" groups, available in many areas, can help beginners get going. But it's also possible to start meditating on your own:

Recommended Reading

  1. Minding the Body, Mending the Mind. Joan Borysenko, Ph.D. (1988)
  2. Jewish Meditation. Aryeh Kaplan. (1985)
  3. Open Mind, Open Heart: The Contemplative Dimension of the Gospel. Father Thomas Keating. (1994)

AIRWAVES Welcomes Opinion Pieces About COPD.

"COPD" is your doctor's shorthand for "chronic obstructive pulmonary disease," a disease the American Lung Association calls "the fourth leading cause of death, and the third leading cause of disability, in the U.S."

I've got it.

And I've had it for 20 years.

I'm 69 years old, retired from a sales and marketing career, and married, with five offspring and seven grandchildren. And I need supplemental oxygen 24 hours a day. While I am "handicapped," and limited in both endurance and speed, I haven't stopped living. Thanks to a pulmonary rehabilitation program I completed three years ago, and to a continuing exercise program, I am able to do many things that once I could only hope for -- like shopping with my wife, cooking a meal, and toweling off after a bath.

The Internet has been another valuable source of support, for it has allowed me to find and "talk" to scores of other pulmonary patients. We've had to accept the fact that, try as they might, even those closest to us can't quite understand how much effort it takes to walk across the room or dress ourselves -- or just to breathe. Few of us have found a local support group of substance; most groups are superficial or meet only infrequently. So we use the computer to compare symptoms and therapies and, from time to time, to speak openly of our fear, despair, frustration, guilt, and loss of self-worth.

I'm convinced that long-term care for COPD patients must evolve from "rehab" to "wellness." We desperately need a continuing program of therapy and education to 1) improve our pulmonary and general health, relieve symptoms, and reduce hospital admissions; and 2) lengthen and improve the quality of our lives, give us the courage to again take control, and to play an active role in the management of our treatment.

My ideal COPD wellness program would couple weekly physical and pulmonary rehabilitation with the fostering of stable "peer-support" groups. Patients would participate long-term, in the same way we stay on maintenance drugs for life.

The Specific Goals of a Wellness Program for COPD Patients Should Be to:

Together, these strategies will help motivate many patients to expend the energy and the emotional resources essential to self-management of a chronic disease.

The value of such an approach has been proven by a recent study at the National Jewish Medical and Research Center in Denver. It found that two groups of asthma patients who completed a six-month "disease-specific case management" program required 50 percent and 72 percent fewer hospitalizations respectively, made 61 percent and 77 percent fewer emergency-room visits, and reduced lost work or school days (including both patients' and caregivers' days) by 68 percent and 81 percent.

The study suggests that the annual per-patient cost of my proposed weekly COPD wellness program would be far less than the cost of even one hospitalization. Savings on emergency-room visits alone could finance the program. Such a program should be supervised by a pulmonologist and conducted by respiratory therapists, with monthly reports (and immediate reports of any problems) going to each patient's individual physician. These reports would also offer a sound basis for developing "outcome data" (information on how well patients respond to treatment), which could in turn be used to improve overall care.

Many respiratory therapists share my conviction that the success of any program of pulmonary therapy depends as much -- or more -- on helping patients deal with their feelings and develop a hopeful attitude as it does upon purely medical and physical treatment. In the absence of such emotional and psychological support, COPD patients are much more likely to just give up, vegetate, and await the inevitable, ugly "end." Most pulmonary patients I've met on the Internet are yearning for at least a few more years of relatively active life. Given reasonable hope and meaningful support, we will spend the time, do the work, and practice the discipline necessary to achieve that goal.

How does this medication work? How long will I have to take it?

ATROVENT® Inhalation Aerosol makes it easier to breathe by keeping the larger and most important airways in the lungs open (dilated). It keeps the airways open by blocking the chemicals produced by our bodies that cause the airways to become narrow (contract). ATROVENT® Inhalation Aerosol also may help decrease mucous secretions that can block the airways.

The American Thoracic Society recommends ATROVENT® (ipratropium bromide) Inhalation Aerosol as first-line therapy for COPD with mild to moderate, continuous symptoms.

Studies show that ATROVENT® Inhalation Aerosol begins to improve breathing from the first day patients use the medicine.

Steady, regular use of the medication is the best way to keep your major airways open and decrease breathing discomfort. Studies show that ATROVENT® Inhalation Aerosol does not lose its effect over time. It remains effective in reducing airway obstruction with long-term use. Your physician is likely to recommend that you remain on ATROVENT® Inhalation Aerosol long-term to keep your COPD under control.

Q: Is it possible to become dependent on ATROVENT® Inhalation Aerosol? Will I need more medication after awhile?

I've been takingATROVENT® Inhalation Aerosol for about two years.

A: No, you cannot become dependent on ATROVENT® Inhalation Aerosol. The medication does not create either dependency or addiction and is safe for long-term use. Also, patients do not develop a "tolerance" for ATROVENT® Inhalation Aerosol as they can with some other medications over time. This means that as long as you take ATROVENT® Inhalation Aerosol, it will continue to dilate the airways and make breathing easier.

ATROVENT® Inhalation Aerosol is generally considered the first choice in inhalers for patients with COPD. Two puffs of ATROVENT® Inhalation Aerosol, four times a day is the usually recommended dosage. If additional help is needed, your physician may increase the dosage of ATROVENT® Inhalation Aerosol up to 6 puffs 4 times a day, or add another medication. It is safe to use ATROVENT® Inhalation Aerosol with other inhalers, including beta agonists and steroid medications. Click here to see Prescribing Information.

Q: I used to mix two drugs in a nebulizer. Now my physician has prescribed COMBIVENT® (ipratropium bromide and albuterol sulfate) Inhalation Aerosol. Are there any benefits to COMBIVENT® Inhalation Aerosol other than ease of handling?

A: COMBIVENT® Inhalation Aerosol combines two important medications that make breathing easier for people with COPD. One medication is the drug used in ATROVENT® (ipratropium bromide) Inhalation Aerosol the first-line treatment for COPD. ATROVENT® Inhalation Aerosol blocks the chemicals in the body that close (constrict) the larger airways. The second medication, albuterol sulfate, a "beta agonist," relaxes the muscles and opens the smaller airways. Thus COMBIVENT® Inhalation Aerosol opens both your larger and smaller airways.

For most patients, the use of COMBIVENT® Inhalation Aerosol metered dose inhaler is easier and more convenient than taking two separate medications or mixing them in a nebulizer. However, if you have both solutions available, ATROVENT® Inhalation Solution and albuterol solution can be safely mixed together in a nebulizer and used together. In addition, COMBIVENT® Inhalation Aerosol is less expensive than ATROVENT® Inhalation Aerosol and albuterol administered in separate inhalers.

Q: I've been on COMBIVENT® Inhalation Aerosol for about eight months now and wonder if I still need to use it four times a day, as my physician prescribed. Some days I don't feel like I need anything. Isn't it okay just to use COMBIVENT® Inhalation Aerosol when my symptoms are bad?

A: It is very important to use your COMBIVENT® Inhalation Aerosol inhaler as directed by your doctor, even on the days when you feel relatively good and have no distressing symptoms. Part of the reason you may feel a decrease in symptoms is because of your continuous use of two medications that keep your airways open and make it easier to breathe.

COPD is a chronic and incurable disease. Making sure to take your medications as directed everyday can help manage your symptoms.

Answered By Daniel Hilleman, Pharm D, Professor of Pharmacy, Creighton University, Omaha, Nebraska

At Home Energy Savers

Agnes Hudspeth likes to keep “everything at her fingertips” around the kitchen of her Texas home. She credits her physiotherapist, Rick Carter, PhD, a professor of medicine and physiology at the University of Texas Health Center in Tyler, Texas, with helping her to learn how to save time and strength while cooking or taking care of other domestic duties.

When she’s having a particularly good day, for example, Hudspeth prepares big pots of stew and lots of cups of pinto beans and lets them cook slowly overnight. “Anything I can do in bulk, I do,” she says. The next day she freezes individual portions, so that they can be thawed later on when she doesn’t feel up to cooking.

These days, many rehabilitation programs send patients, like Hudspeth, home with advice on the kinds of things they can do to improve life with COPD. Cleaning out household toxins is the first step to making sure you can breath easy at home. The tips below are designed to help you save your breath, while keeping your house-keeping workload light.

Here’s what Carter, who is also co-author of the new book Courage and Information for Life with Chronic Obstructive Pulmonary Disease (available at www.newtechpub.com), along with Julian Roy, the director of Pulmonary Rehabilitation at Halifax Medical Center in Daytona Beach, Florida, have to say:

Get Organized

Keep your house as clear of obstructions as possible. Move the coffee table and footstool out of the way.
Open up the space. If you’re using an oxygen tank or need a walker, your life will be easier if you can maneuver around.

Make it Easy on Yourself

Wellness Stategies

Home Healthy Home

Stroll down the housewares isle in any supermarket in America and you’ll see there’s a snazzy, high-tech solution for just about every type of chore. Air-fresheners now have dual action; with the help of a spray, your shower can actually clean itself; and there’s a specially treated dusting fabric that promises to whisk away dirt; with almost no help from you at all. Even spiffing up the family room can be accomplished by just snapping together easy-to-assemble furniture of just about every type.

Sounds Wonderful, Right?

Well, maybe, but in many cases these time-savers can be more trouble than they’re worth for people with COPD. This list should alert you to the worst offenders; we’ve also offered a few suggestions for keeping things fresh and clean, without putting your health at risk.

Look out for that label. Many lung irritants are hidden or unpredictable (such as perfumes), but quite a few also post strong warnings on package labels. Before you drop that new bottle of floor cleaner into your shopping cart look for these words: Lung Irritant or Flammable. Lung irritants can fall into many categories. Products that are flammable, like many aerosols, generally contain such solvents as alcohol that can wreak havoc on sensitive lungs, warns James Dickey, a scientist at the Washington Toxics Coalition in Seattle, Washington. Try nonaerosol products in pump bottles and keep other irritants out of your home altogether.

Wash without artificial scents. One of the strongest offenders for people with everything from asthma to COPD and other lung problems is a fairly innocent looking little piece of white paper called a fabric softener sheet. “The sheets emit exhaust from the dryer (which should be vented to the outside of the house, if possible); and many of the people we work with find them very irritating,” Dickey says.

Try good, old fresh air. Mountain scents, candle scents, spring scents…the list is endless, but all of these scents have one thing in common: They are the substances most likely to cause mild or severe symptoms in people with COPD and other lung ailments, explains David Cugell, MD, Bazely professor of Pulmonary Diseases at Northwestern University Medical Center in Chicago, Illinois. In addition, Dr. Cugell notes, perfumes are likely to mask other scents like mildew that, if left to grow in your home, can compromise your respiratory system.

Find out more about your furniture. One of the most dangerous, silent hazards people encounter today is not a cleaning product at all, but a product that many people choose because it’s convenient and inexpensive. Particle board or pressboard — the inexpensive, lightweight wood-like material that’s a mainstay of modern stereo cabinets, book shelves, bedposts, and other types of furniture — is the culprit.

“When the glue that holds the board together is exposed to humidity or heat, the board gives off a low-level of formaldehyde gas,” says Amy Duggan, manager of the Master Home Environmentalist Program at the American Lung Association of Washington State. “Making sure that these products are sealed with a cellulose-based paint is the best way to safeguard your lungs,” recommends Duggan.

Beware of heavy-duty cleaners. Two of the most important ingredients to watch for in any household product are chlorine bleach (which may also be called sodium hypo-chlorite on the label) and any type of ammonia, warns Dickey. Because manufacturers have become increasingly successful at masking the smell of bleach, Dickey says “Be sure to read the label carefully.” Even bleaches labeled “fresh scent” have the same amount of the irritating ingredient.

When it comes to ammonia, the less you are exposed to it the better. “Most window cleaners have only 1/10 of a percent,” Dickey explains, “but that’s enough to bring on symptoms in some people with lung disease.”

Get help with home improvements. When it comes to big jobs like painting the house, stripping furniture, or cleaning big household spills, it’s best for people with COPD to call an expert. Don’t take on the job yourself. But, even experts can leave behind products that produce fumes that are sure to cause you discomfort.

Dickey Suggests You Keep These Products Out of Your Home or Garage:

Get a Fresh Start

Steering clear of products that may cause lung problems does not mean you can’t have a home that’s fresh and clean. Here is a list of product lines that are less likely to cause irritation because they are most often free of solvents. They are available at most health food stores:

New Developments in COPD

by Thomas L. Petty, MD

What’s Going On In The World Of Treatments And Preventive Care For People With COPD?

In this issue, Contributing Medical Editor, Thomas L. Petty, MD, Chairman of the National Lung Health Education Program (NLHEP), gives us an update on new and noteworthy advocacy efforts and therapies. Dr. Petty is a professor of medicine at the University of Colorado Health Science Center in Denver.

These days, although many are still unaware that COPD exists, we have a wonderful opportunity:

We can increase the efforts to help people with COPD get an accurate diagnosis and appropriate treatment. COPD is one of the nation’s fastest growing health problems. It has become the number 4 killer of Americans. COPD is the only disease in the top 10 with occurrence rates that continue to rise.

The third National Health and Nutrition Examination Survey (NHANES III), reveals that a large number of cases of COPD go undiagnosed—even when patients are already exhibiting symptoms. Studies indicate that the best way to help people with the disease is to increase COPD awareness in communities and among medical care providers.

“Test Your Lungs, Know Your Numbers,” is the battle cry of the NLHEP. It is also a potentially health-saving message that you can deliver to your family and friends who may be at risk. Fortunately, new spirometry tests (using spirometers, devices that test lung health) are now available in many physicians’ offices and clinics. The tests have been developed in response to the NLHEP’s new initiative on the early identification of COPD.

There is also good news on the treatment front. Clinical trials are currently being conducted on a drug called tiotropium and on anti-inflammatory agents that will actually interfere with the basic, biological processes that result in emphysema and chronic bronchitis (COPD). To protect your health and quality of life, however, be sure to work with your physician to make use all of the highly effective therapies available for people with COPD today.

Fight the Flu

This year two new drugs, oseltamivir (a pill) and zanamivir (an inhaled aerosol), are available to help reduce the severity of influenza, a common problem for people with COPD. For the best results, the drug must be used in the early, symptomatic stages of the flu. Ask your doctor about them, but remember, they do not replace the influenza virus vaccine. Be sure to get your shot every fall. You should be given the pneumococcal vaccine approximately every 5 to 6 years.

Breathe Easier

Long-term oxygen therapy, with an emphasis on ambulatory oxygen, improves the length and quality of life for people with COPD. Now, new more compact oxygen devices that weigh only 3.5 pounds and last for up to 10 hours make travel easier and can dramatically increase your mobility. Pulmonary rehabilitation improves all stages of disease, including those in patients with only mild-to-moderate impairment who are already limited in their exercise tolerance.

Look at LVRS

Although lung volume reduction surgery (LVRS) is still being researched, it will help a select few with marked hyperinflation and loss of elastic recoil (the flexibility of the lung). LVRS can improve lung function and symptoms in some cases for as long as years. It is important to discuss this option with your physician to find out if it is right for you.

Live Smoke Free

You may have heard it before, but it’s important to remind COPD patients that kicking the cigarette habit is the only way to alter the early stages of COPD. The combination of bupropion and nicotine replacement drugs is even more effective than nicotine replacement or drugs such as bupropion (Zyban®) alone, even though these drugs can ease nicotine withdrawal symptoms for approximately 30% of patients. Nicotine replacement, nicotine gum, and nicotine patches are available in pharmacies without a prescription. Nicotine spray and nicotine inhalers require a prescription.

Stick to Your Meds

Following the step therapy program prescribed by your doctor, using bronchodilators with ipratropium, a beta agonist, or ipratropium with albuterol in combination (Combivent®), is convenient and effective. Theophyllines are also useful for some people with COPD to reduce respiratory muscle fatigue. Longer-acting bronchodilators, such as salmeterol (Serevent®), given twice daily, are also useful. Inhaled corticosteriods modify symptoms and improve the quality of life.

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