It has recently become apparent that patients with COPD commonly suffer skeletal muscle dysfunction, which may be the main cause in the reduction in exercise tolerance.
COPD patients tend to reduce their levels of physical activity as it causes unpleasant effects and results in a vicious cycle where a reduction in physical fitness leads to further impairment of muscle function
Skeletal muscle dysfunction is very common in patients with COPD, and may play an important role in limiting exercise performance. Muscle strength and endurance are both decreased and the muscle is more easily fatigued. Muscle atrophy is largely responsible for the reduction in muscle strength but deconditioning is of major importance as well as nutritional depletion, and steroid use. COPD may also produce a systemic inflammatory response that may adversely affect skeletal muscle function.
Muscle strength is seen to be decreased in patients with COPD and particularly in the lower limbs. An important factor is muscle wastage; either through medical reasons or a lack of exercise due to breathlessness. Muscle endurance and the length of time the muscles can be used also decreases significantly. In biopsies the ratio of different muscle fiber types are altered in COPD patients and type IIa convert to type IIb, resulting in reduced muscle endurance, increased fatigue and a reduction in muscle mass. The number of capillaries within the muscle is also significantly lower in COPD patients as well as the number of mitochondria. Enzymes that are required for metabolism within the muscles are also decreased in COPD patients. This all results in less oxygen reaching the muscle cells and metabolism and function of the cells being adversely affected.
Medications such as steroids which are used to treat exacerbations can also cause muscle wastage. Short-course doses are beneficial to the patient but long-term multiple short-courses requires further study.
Malnutrition is also common with COPD where 35% are less than 90% of their ideal body weight. This results in a reduction in muscle mass and metabolic functions are disrupted. Nutritional supplements however are not a substitute for eating a balanced, healthy and high in calories food plan. Patients can tend to either put on weight from a lack of mobility or lose weight from the increased energy required to breath and a reduction in appetite due to the difficulty of eating and breathing with breathlessness and the need for constant oxygen supplementation.
Deconditioning from disuse is believed to be the major contributing factor in the skeletal muscle dysfunction observed in patients with COPD. When healthy individuals undergo a training program to increase fitness levels physiological and morphological changes are seen and results in muscle larger in mass with increased oxidative capacity and more efficient in its ability. From previous studies it was thought that COPD patients could not reach the same levels of increased muscle efficiency when undergoing the same training program. However studies have shown that a certain level of intensity and duration needs to be reached before the muscle will begin to improve.
Exercise training will improve skeletal muscle function in those with COPD and pulmonary rehabilitation is shown to improve endurance capacity and quality of life, however the type of exercise training should be further studied and bespoke personal exercise plans developed for individuals to to get the maximum potential from their exercise.
Oxygen therapy is provided for patients to help them to breathe but long-term oxygen therapy has been shown to help improve muscle function and metabolism. It also reduces the potential harm of deconditioning as patients on oxygen therapy tend to be more mobile and physically active as they benefit from the positive benefits of supplemental oxygen.
Muscles require constant use, a balanced supply of metabolites from our diet and oxygen in order to work efficiently. Studies have shown that oxygen therapy not only directly affects muscle function positively but it enables patients to be more physically active and exercise more frequently and for longer, which in turn reduces potential deconditioning and helps to build up muscle mass, strength and efficiency.
REFERENCES: www.ncbi.nlm.nih.gov and www.respiratory-research.com
Many people who suffer from COPD also struggle with anxiety. When you have trouble breathing your brain triggers a response to warn you that something is wrong which can cause panic and sensations of anxiety. Also people find they suffer anxiety due to worrying and being stressed about the condition and prognosis as the disease worsens as well as being linked to depression which many COPD patient’s suffer from. Medications used to treat COPD can also trigger anxiety too.
The Breathlessness-Anxiety Cycle
It is often a vicious cycle where feeling breathless can cause panic and anxiety, which in turn makes it more difficult to breathe. This cycle can be difficult to break and the symptoms of COPD become indistinguishable from the symptoms of anxiety. Many are confused and make lots of trips to the doctors. Many people avoid enjoying social and leisure activities that can cause breathlessness out of fear from potentially experiencing anxiety that may be caused.
Having some degree of anxiety when you have a chronic disease can be a good thing. It can make you pay attention to your symptoms and follow your treatment plan. It can also warn you when you need to seek medical attention, but too much anxiety can severely impact the quality of your life.
Coping With Anxiety
Coping with anxiety can be tricky especially as many medications have a negative impact on your health if you are suffering with COPD as they can cause decreased rate of breathing and interact with other COPD medications.
Your doctor can help you to determine what medication will work best for you. Some people with COPD find relief with non-addictive anti-anxiety medications which don’t interfere with breathing.
Medications are helpful but their effectiveness will be increased by other means of reducing anxiety. Ask your doctor about referral to a pulmonary rehabilitation program, where you will receive education about COPD and get help with coping strategies to deal with your anxiety. One of the most important things that you learn in pulmonary rehabilitation is how to breathe more effectively.
Breathing techniques such as “pursed lip breathing” can help to take the work out of breathing, slow your breathing down, keep your airway open for longer—and help you to relax. To do pursed lip breathing, you simply relax your upper body, and then breathe in slowly through your nose to the count of two. Then with lips pursed as if you were going to whistle, you breathe out slowly through your mouth to the count of four.
Many people with COPD find that individual counselling is effective in reducing anxiety. One common type of therapy called cognitive behavioural therapy helps people with anxiety symptoms decrease them through learning relaxation techniques and breathing exercises.
Group counselling, such as support groups can also help you to learn how to cope with COPD – and your anxiety – and being with others who have some of the same problems can help you to feel less alone.
Many find that if they are in the breathlessness/anxiety cycle then by immediately treating the breathlessness can instantly lessen the feelings of anxiety. By having a portable oxygen concentrator you have access to your oxygen wherever you are, whatever you’re doing and if needed can use it when you are feeling short of breath. Knowing that you have the portable concentrator to hand can also in itself reduce your anxiety levels and help prevent episodes as you have that security and peace of mind that if your anxiety or COPD symptoms suddenly flare up that you have something close to hand to instantly resolve it.
Many patients with advanced lung cancer can sometimes feel short of breath even when they are on oxygen and showing that they have an acceptable oxygen level of over 90%. There are a few reasons why this can happen.
If your oxygen level drops below 88% this signals to the brain that you need more oxygen and initiates dyspnea (shortness of breath) and a sense of air hunger. This signal is also triggered when other pulmonary test levels are low. The Vital Capacity is how much air there is from the beginning to the end of a breath and the FEV1 is a measure of how much air you can forcefully exhale in one second. Even when your oxygen levels are good at 90% if any of the other values are low then the body can sense dyspnea.
The use of an inhaler can be very effective in improving the Vital Capacity and FEV1 and can immediately improve breathing symptoms and stop the feeling of shortness of breath due to the effect the inhalers have on widening the airways.
Also many patients can be not very physically fit due to a combination of the medical illness, age and obesity. Introducing more exercise into daily life can help to improve cardio/respiratory fitness thereby improving the Vital Capacity and FEV1 and helping to reduce the frequency of periods where you feel short of breath.
Low blood counts (anaemia), heart disease and advanced kidney disease are conditions that can also cause dyspnea even if your lungs are working effectively.
Vital capacity and FEV1 are pulmonary tests that your doctor can perform to see how effectively your lungs are working so regular check-ups are important and your doctor can help ensure that if you suffer from these situations that they are treated to help improve your breathing. Some patients find that when these other factors are dealt with that they are less reliant upon their oxygen.
If you suffer from bouts of breathlessness then there are things you can do to help yourself:
• If you smoke, get help to quit.
• Try some breathing techniques. If you practise these and use them every day, they will help you when you are active and getting breathless. They will also help you manage if you get short of breath suddenly.
– Blow as you go: breathe out when you are making a big effort, such as standing up, stretching or bending.
– Pursed-lips breathing: breathe out with your lips pursed as if you were whistling.
• Be more physically active. Physical activity could be walking, gardening, walking the dog, housework or swimming as well as going to a gym. If you have a lung condition, you can be referred to a pulmonary rehabilitation (PR) programme by your doctor, and if you have a heart problem there are cardiac rehabilitation services too. These classes help you to get control over your breathlessness, get you fitter and are also lots of fun.
• Drink and eat healthily and manage your weight. If you are carrying excess weight you will require more effort to breathe and move around, and it will be more difficult to get control over your feelings of breathlessness.
• Get treatment if you feel stressed or anxious.
• Use the right medication in the right way. If you use inhalers, tablets or liquids to control your breathing ensure you know how and when to take them correctly.
• Ensure your oxygen flow rate is correct. Another reason why regular check-ups are important so your doctor can monitor your oxygen requirements and adjust your oxygen flow rate accordingly for your oxygen concentrator.
References: http://www.coalitionforpf.org and http://www.blf.org.uk