Fighting respiratory illnesses
The Asthma and Respiratory Foundation NZ launched its ‘‘Breathe Better’’ campaign this month. Throughout September, there have been events and promotions across the country aimed at increasing awareness of a whole range of respiratory conditions, including asthma, bronchiectasis, bronchiolitis, pneumonia, lung cancer, obstructive sleep apnoea and COPD.
Although hundreds of thousands of New Zealand adults are affected by COPD, it seems many people aren’t aware of it, and a high proportion of sufferers don’t even know they have it until it’s quite advanced, limiting the effectiveness of treatment.
COPD is the acronym for chronic obstructive pulmonary disease, and is the umbrella term for two separate though linked processes – emphysema and chronic bronchitis. In people with COPD, the airways and tissues of the lungs become permanently damaged, making it hard to breathe.
With emphysema, the small air sacs in the lungs are gradually destroyed so people struggle to absorb enough oxygen. In chronic bronchitis, the airways become narrower, with increased mucous production and inflammation, leading to an ongoing, ‘‘productive’’ (that is, producing phlegm) cough.
Symptoms that suggest COPD include:
❚ Breathlessness – with exertion to begin with, but in more advanced disease there will be breathlessness at rest as well.
❚ Cough, usually with a lot of mucous – initially this is most prominent in the mornings, but later on can be continuous.
❚ Wheezing or chest tightness.
❚ Tiredness – any slight effort can be exhausting due to the low oxygen levels and work of breathing.
❚ Blueness of the fingernails or lips.
❚ Unintended weight loss.
❚ Fluctuating symptoms – for lots of COPD sufferers their symptoms will wax and wane over time. This can mean they may have days or even weeks where their symptoms are quite manageable, but other times where they are particularly bad and simple things like getting out of bed and preparing a meal can be too difficult.
COPD is caused by exposing the airways to irritants and toxins – in New Zealand, the overwhelming cause is inhaling cigarette smoke, but other causes exist too, such as chemical or dust inhalation at work.
A small proportion of people with COPD will have an inherited condition known as alpha1-antitrypsin deficiency and will develop symptoms even without any inhalation of toxins through their life. In New Zealand, as with many other respiratory conditions, rates are highest among Ma¯ ori, Pasifika people and those living in areas of higher deprivation.
Staggeringly, COPD is the fourth highest cause of death in New Zealand, after ischaemic heart disease, strokes, and lung cancer – yet it is treatable, and if picked up early and managed well, most people diagnosed with COPD can control their symptoms and go on to live an active life.
The key thing in managing COPD is to stop all exposure to smoke. This includes passive smoking. Although stopping smoking can be incredibly difficult to do, there are plenty of effective products and medications available now to help, so please discuss with your health provider if you are worried about COPD, or are thinking about stopping smoking but don’t know where to start.
The next step is to manage your symptoms effectively so you can continue living the life you want to.
Medications available to help reduce symptoms include:
❚ Bronchodilators – these inhalers open up and relax the airways, making breathing easier. Depending on the severity of COPD they may be needed ‘‘as required’’ to relieve symptoms, or can be given as a longer-acting daily version to try to prevent breathlessness and coughing.
❚ Inhaled steroids – these drugs reduce the inflammation in the lungs and airways, and are used regularly to try to improve lung function and reduce the likelihood of exacerbations.
❚ Oral steroids – a stronger version of the inhalers, these are used short-term during exacerbations to reduce symptoms.
❚ LAMAs (long acting muscarinic antagonists)
– these drugs are another option if the above isn’t working, and can be used in combination with other inhalers.
Lastly, but of equal importance, is optimising your lung capacity by regular exercise. Participitating regularly in exercises that enhance your lung function, and improve your breathing, is key to not only ensuring you can do all the things that you love, but will actually reduce the likelihood of your COPD getting worse.
There are many ways you can do this – if your COPD is mild and in the early stages, you can use any form of exercise that you enjoy and is accessible that will enable you to breathe more easily.
Types of exercise that are particularly good for this are yoga and pilates, but anything aerobic will be helpful.
If you enjoy music, singing is an amazing and really fun way to improve your posture and breathing, and exercise your lungs – Wellington is lucky enough to have a choir specifically for those living with chronic respiratory conditions (Sing Your Lungs Out – check them out on facebook) but if you’re not living in the capital,
joining any regular choir, or even just singing in the shower in the morning, will give you some of those benefits.
For those with more advanced disease, most areas in New Zealand have local respiratory nurses who can organise specific pulmonary rehabilitation classes.
If your doctor doesn’t know how to access this, the Asthma and Respiratory Foundation will be able to help.
I would encourage anyone suffering from COPD to get in touch with the foundation – not only will they be able to point you in the right direction for resources such as this, but they will also put you in touch with a local support group where you can connect with other COPD sufferers.
For more information or support for COPD, or to donate to Breathe Better September, visit asthmafoundation.org.nz