Authored by BlueAngel on
Thursday, June 24, 2004
This entry should be of interest to those of us who have respiratory problems (i.e. COPD, Asthma, etc) and are curious about how our diets help or compromise our already stressed respiratory systems.
This information is presented in an easily understood format for both the patient with respiratory problems as well as the caregivers. Rotech Company is at the forefront of providing these educational tools.
What About Food?
Food! Everyone wants to know about food. After all, we have to eat it to stay alive. However, we do much more than eat food. We celebrate with it. We get consolation from it. We use it as a way to communicate with others. And we certainly have strong feelings about which foods we like and which we do not like. No matter how you think of food, one thing is sure, you must eat food to get the nutrition needed for life. This lesson will answer some of the most common questions concerning your diet and COPD.
· Is my breathing affected by the food I eat?
· I don’t want to eat because I’m always full.
Why is that?
· If I don’t eat as much as my doctor wants me to, will it really hurt me?
· Should I stay away from too much water if I have a problem with fluid in my legs and feet?
· Should I go on the diet I read about in a magazine?
· What if I don’t have the energy to cook or much of an appetite?
· Should I use food or vitamin supplements?
· What if I’m overweight?
Is my breathing affected by the food I eat?
There are several things about your diet that can affect your breathing. Some of them might be 1) a lack of readily available energy, 2) muscle/weight loss, 3) bloating after eating, 4) too much weight 5) poor fluid management
Also, if you do not eat enough food for the energy you need every day, then that energy will come from either stores of fat or from muscle tissue. Any time muscle is lost, it affects your breathing by making your breathing muscles weaker. Weak muscles do not work as efficiently as strong muscles do, and they use more oxygen to do their job.
Finally, some foods produce a lot of gas during digestion and can cause bloating, making your breathing more difficult. Foods that cause an excessive production of gas during digestion may include broccoli, cauliflower, other cabbage related foods, and cooked beans. You should avoid foods that cause you to feel bloated and have to work harder at your breathing.
You only need to avoid foods if they cause a problem for you. Some have believed they must avoid milk products because they increase mucus production, but this is unfounded. Unless your doctor has restricted your diet for some other reason (eg, low-sodium, low-fat, ulcer), eat the foods that you like.
First of all, people who suffer from COPD often use six to ten times more energy for breathing than others use for the same job. If you do not eat enough food to supply that added need, then you may run out of energy for other activities during the day.
I don’t want to eat because I’m always full. Why is that?
As discussed earlier, moderate to severe COPD often results in lungs that grow larger with too much stale air. The diaphragm gets pushed down toward the belly, and that causes a full feeling. If you eat too much, then your stomach gets tight and it gets even harder for your diaphragm to do its work of breathing.
The solution to this problem is to increase your number of meals during the day and decrease your portion sizes.
If I don’t eat as much as my doctor wants me to eat, will it really hurt me?
As discussed earlier, if you do not eat enough, it could lead to muscle and weight loss. But it could also cause critical deficiencies in proteins (what the body uses to repair and maintain tissues), fats (essential fats are important to your body and can only be added through food), vitamins (the things that help to turn food into energy, and minerals (building blocks used by the body to maintain bodily functions and manufacture bone, blood, and teeth).
Malnutrition and weight loss have been shown to be risk factors for infection, hospitalization, and failure of your lungs. If eating a large meal causes you to feel bloated, a solution to the problem is to eat several small, well balanced meals throughout the day. Focus on eating higher calorie foods. End the day with a nice bowl of ice cream.
Should I stay away from too much water if I have a problem with fluid in my legs and feet?
Many people mistakenly reduce water intake in an effort to deal with swelling in their extremities. In fact, too much fluid in swollen extremities is often due to something other than drinking too much water. Not drinking enough water can actually make the problem worse.
Water helps you to digest food and get rid of waste. But COPD can cause you to produce too much mucous. Plenty of water in your diet will help to keep that mucous thin so it can be moved out of your lungs more easily. Mucous in your lungs traps a lot of germs, so getting it out is very important. Never underestimate the importance of drinking enough fluids.
Drinking 8-10 glasses of fluid per day is about right. Alcohol should be avoided in excess but a single drink (1 oz of liquor, 4 oz wine, or 12 oz beer) is acceptable and evidence exists that it may even be beneficial. Always discuss your entire diet with your doctor as there may be other reasons to restrict your fluid and diet (eg, salt-, alcohol-, fat-restriction).
If you haven’t already guessed, there are many ways to get more fluids into your diet—water is just one of them. Be sure to ask your doctor about drinking more fluids. Drinking fruit juice, a milkshake, or even a beer with your meal in place of water is a good way to increase your calorie intake. <(Please check with your physician about drinking any alcoholic breverages, including beer. The reason being that some of the medicines you are prescribed might not be compatible with alcohol.)
Should I go on the diet I read about in a magazine?
There are a million and one diets going around out there. You should not pay attention to any of them without showing them first to your physician. Supplements or vitamins should never be added to your diet before consulting your doctor because some supplements can cause problems with your medications. In fact, the best way to ensure a healthy balance of vitamins and minerals is to follow a well balanced diet using small meal sizes several time a day and by drinking plenty of water between meals.
What if I don’t have the energy to cook or much of an appetite?
Prepare nutritious foods that require less energy to fix. Fix a large portion and freeze some to heat up later. Convenience foods (eg, pre-cooked, ready to eat) can provide good alternatives but you do have to watch sodium levels if you are on a salt-restricted diet.
"Meals on Wheels” can be an inexpensive and nutritious option if you don’t cook. Casserole meals save energy by being an entire meal in one dish, cutting the energy needed to prepare the meal and to clean up.
Many patients have a problem with a poor appetite. Some medications can upset the stomach (eg, theophylline), but the most common cause of poor appetite is swallowing mucus. If you cough up mucus or have sinus drainage, avoid swallowing the mucus as much as possible.
Should I use food or vitamin supplements?
High calorie supplement drinks can be useful when you are unable to eat well (eg, during an illness). Special formulations for people with breathing problems are available but any quality supplement is probably fine for COPD patients at home. Eating a good meal is best but drinking a high-calorie, high-vitamin drink can substitute when necessary.
Vitamin supplements (eg, one a day) may be helpful, especially when diet is lacking in proper vitamins. There is some evidence that increased intake of Vitamin C (500-1,000 mg/day) and beta- carotene (it produces Vitamin A and E) can be helpful.
What if I’m overweight?
For other patients with COPD, their problem might be the opposite- they are overweight. Obesity (> 20% over ideal body weight) can also have a negative impact on breathing and general health. Obesity restricts the movement of the chest and decreases lung volume. It can predispose the patient to other problems including high blood pressure, diabetes, heart disease, and obstructive sleep apnea. If you are overweight, a responsible weight loss program under your physician’s guidance can be helpful.
Proper nutrition is important to everyone but especially the patient with breathing problems. Find the diet that is best for you and practice it on a daily basis in order to improve your general health and breathing. Talk to your doctor when you have questions. Taking these steps can help you in your goal to breathe easy.
Study Questions About Your Diet
Circle the letter that best answers each question.
1. T or F Many people who suffer from COPD should pay close attention to eating enough food because they use much more energy to breathe than other people do.
2. Which of the following foods produce more gas and thus can cause bloating as they are digested?
a. Steak
b. Milk
c. Cabbage
d. All of the above
3. Which of the following eating patterns is best when you suffer from COPD.
a. Two big meals per day.
b. Two small meals per day.
c. Three regular meals per day.
d. Three light meals per day with three snacks between those meals.
4. T or F If you swallow mucous, that could cause you to loose your appetite.
5. Getting plenty of liquids in your diet will
a. cause your feet to swell.
b. thin out your airway mucous.
c. not make any difference.
d. mean you’ll have to drink water to get all the needed fluid.
6 .T or F A “once per day” vitamin and mineral supplements is probably a good idea for people with COPD.
http://www.rotech.com/respiratory/v2/health hyper/diet/diet2/nn4/diet2.htm
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Authored by BlueAngel on
Sunday, May 16, 2004
Weather and Breathing is an article in the Breathe Easy Newsletter for Rotech Healthcare, Inc. The Newsletter is published quarterly dedicated to providing helpful information to people who have breathing difficulties . Also it is helpful to those who must provide care to such individuals.
"HEALTH (Home Education and Activity Leading To Health) is an educational program we have developed to provide education to home respiratory patients on how to better care for their disease and improve their overall health.
Breathe Easy, HEALTH, and the other patient resource materials provided here are presented by Greg Spratt, BS, RRT, CPFT, Clinical Director for Rotech.
The Rotech family of hometown companies is dedicated to providing our patients with practical and useful information, as part of our mission to help our patients lead more comfortable and productive lives.
If you have specific topics you would like to see discussed in future issues of Breathe Easy, or as a special HEALTH study, please contact us at www.Rotech.com"
Breathe Easy is a quarterly newsletter dedicated to providing helpful information to those with breathing difficulties.
© 2002, Rotech Healthcare Inc Volume 11, Issue 1
Weather and Breathing
Every patient with COPD or other breathing problems knows that the weather can impact how they feel on any given day. I’ve even known those that swore they could predict the weather based upon how they felt. Why does weather impact our breathing? More importantly, can we do anything to counteract it?
Very little information is available on this phenomenon. A Medline search (this is an internet tool that searches all indexed medical journals back to 1966) revealed several articles on weather and asthma, and one article on COPD.
The articles on weather and asthma focused on outbreaks of asthma flare-ups during periods of thunderstorms, especially in the late spring and early summer. These studies, conducted in Australia and Great Britain, did seem to find a correlation between spring storms and increased problems with asthma. Researchers speculate the phenomenon may have two possible causes. The most likely is related to the downdrafts of cold air that occur with these storms. These strong wind currents stir up more grass pollen, which can cause problems for those with allergies to the pollen.
A second theory relates to the weather itself. Researchers found a correlation between the temperature drop that occurs during these storms and asthma flare-ups. Previous research had noted possible association between asthma and rainfall, high humidity, high pressure, high and low temperature, and lightning strikes.
Since there is a shortage of published information on weather and COPD, let’s take a “common sense” approach to the question based upon our knowledge of airflow dynamics, physics, and physiology. One thing is certain; perception of the effects of environment varies greatly from patient to patient. While one patient feels best in a hot, dry environment, another may feel a humid environment is preferable. Though there are some generalizations that can be made, the “perfect breathing conditions” vary from one patient to another.
Temperature
Changes in temperature seem to affect the level of dyspnea (the sensation of shortness of breath). How could temperature have an effect?
Extreme hot or cold conditions stress the entire body. In an effort to maintain a constant body temperature (98.6 degrees Fahrenheit), you expend additional energy to warm or cool your body. This additional energy requirement also increases the amount oxygen your body is using (ie, oxygen is required to create the additional energy). Since you are using more oxygen, this may further deplete your blood oxygen levels and increase your sensation of shortness of breath.
Breathing hot or cold air can also have a drying or irritating effect on the airway causing bronchospasm (contraction of the smooth muscle that surrounds the airway). Bronchospasm decreases the size of the airway and thus makes it more difficult to get the air in and out of the lungs, increasing shortness of breath.
Many patients notice increased wheezing or shortness of breath when going out into cold air. This is especially true in asthmatic patients where “cold air- induced bronchospasm” is well recognized. However, many COPD patients experience a similar response to cold air.
A Finnish study demonstrated that exposure of the body to cold air had a more deleterious effect on breathing than just breathing cold air. Although breathing cold air through a mask while in a warm room did decrease lung function, placing the patient in a cold environment further reduced airflow.
Humidity
High humidity is also a cause of increased complaints of shortness of breath. There are a few possible explanations for this phenomenon.
The amount of humidity in the air (water content) on the oxygen concentration. As water content increases, this reduces the oxygen content (called partial pressure) of oxygen in the air. Thus it would make sense that during humid conditions, less oxygen is available in the air. There is only one problem with this reasoning, the air we breathe is heated and humidified by our upper airway (ie, nose, mouth, throat, windpipe and larger bronchial tubes). By the time the air reaches the air sacs in the lungs (called alveoli), it is 100% saturated with humidity, even when we breathe very dry air. So breathing dry air versus humid air has no effect on the partial pressure of oxygen reaching our lungs.
A second explanation is more likely. As humidity increases, the density of the air increases. More dense air creates more resistance to airflow in the airway resulting in an increased work of breathing (ie, more shortness of breath).
Another possible explanation is that as humidity increases, the prevalence of many known airborne allergens increases. Dust mites and molds both increase in high humidity. My wife never experienced asthma symptoms in her life until we moved into an old house with a damp, moldy basement. She also had difficulty breathing anytime we visited the Climatron (a large, tropical dome with lots of humidity and mold) at our local botanical garden.
Barometric Pressure and Elevation
As barometric pressure drops, less oxygen is available in the air. This is the same principle that causes a decrease in oxygen level as you travel to higher elevations. The total pressure is less and so the oxygen component is less.
When barometric pressure drops, as when a storm front passes, barometric pressure can change 30-40 milimeters of mercury (ie, The units are in mm of mercury [abbreviated mmHg] or “torr” when measuring air pressure). Although the effect on the partial pressure of oxygen that reaches the air sacs in the lungs is small (maybe 5-10 mmHg), a change of just a few points could increase shortness of breath.
Circulating Air
Some patients express relief of their shortness of breath by having air circulating. Many patients will run a fan all of the time. On the other hand, I have talked to patients that did not feel like it helped and some that even said it made them worse. One lady in a pulmonary rehab program had difficulty exercising on an “Air-Dyne” bicycle because it generated too much air movement.
Allergens and Irritants
Other environmental conditions can increase breathing problems. Both indoor and outdoor air pollution have been demonstrated to increase the need for hospitalization in asthma and COPD patients. Although it is difficult to control the air pollution in your area, (unless you decide to move), it is possible to improve air quality inside your home.
Common sources of allergens inside the home include pets (usually fur bearing), molds, dust, and cockroaches. Irritants may include smoke, sprays, perfumes, cleaning chemicals, or anything else that produces a smell, fume, or mist. With today’s home construction resulting in homes with less air circulation (eg, drafts), indoor air pollution is a growing concern. Some speculate it is partially responsible for the increase in asthma and COPD cases.
What Can I Do?
Although it is not possible to control your weather conditions, you can still take steps to control your environment. Here are some tips that may be helpful.
1. Although you should be doing so already, be even more committed to using all medications and oxygen exactly as ordered by your doctor.
2. During very hot or cold weather, arrange your schedule to go out during times with more moderate temperatures. In the summer, try to do your outdoor activity during the early morning or late evening hours when the conditions are more tolerable. In the winter, try afternoon when it’s warmer.
3. Use an air conditioner to control indoor temperature. A second benefit of the air conditioner is that it removes a great deal of humidity from the air as it cools it. If an air conditioner is not available, use fans and open windows to circulate the air during hot days. Special programs are available in many communities to offset the cost of fans, air conditioners, and even the cost of electricity for the elderly or those with health problems. Check with your area agencies for the elderly for resources in your area.
4. When going outside during the winter, wear clothing (eg, scarf) over the nose and mouth to trap warm air and prevent inhaling cold-air. Cold-air masks are available to cover the nose and mouth. Breathing through your nose is more effective than your mouth in warming the air before it reaches your airways.
5. Many people go as far as to travel to more favorable climates during periods of difficult weather. If you are considering moving, try going to the new area for an extended period before making a permanent move. Many people have been disappointed after moving when improvements in breathing don’t occur and now they are away from their friends and family.
6. When possible, decrease allergens/irritants by removing items from your home that produce them.
7. Air filters are available to filter air and they are effective in removing airborne allergens although their role in improving breathing for patients is questionable. The most effective types are those that use a HEPA filter and that have a high air filtration rate.
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Authored by BlueAngel on
Saturday, May 15, 2004
Breathe Easy Breathe Easy Breathe Easy is a quarterly newsletter dedicated to providing helpful information to those with breathing difficulties. © 2002, Rotech Healthcare Inc Volume 11, Issue 2.
This newsletter is published in an effort to help educate people with respiratory problems as well as their care givers and the general public. We have found it is an useful tool to help understand the different processes required to breathe as well as the medications used to achieve this goal.
Take Down The Swelling to Breathe Easy
When people hear the term “steroids” there is often a negative response. “Steroids, I don’t want to take those. Don’t they have all kinds of nasty side effects?” The truth is that when used properly, steroids can play an important role in controlling asthma and COPD without major side effects.
Steroids are produced naturally by the body. Many different types of steroids are produced by the adrenal gland (a gland that lies on top of each kidney). Steroids produced by the adrenal gland (called corticosteroids) include:
- Aldosterone, which helps to control the balance of fluid and minerals in the body;
- Cortisol, which controls energy production and the body’s response to stress
- Sex Hormones such as estrogen and testosterone
The steroid medications used for treating respiratory problems are most closely related to cortisol and fall into a class of steroids referred to as the glucocorticoids. These medications can bring several benefits including:
Benefits of Steroid Medications
In both asthma and COPD, inflammation (swelling) in the airways plays a major role in difficult breathing. When the airways are exposed to an irritant (eg, tobacco smoke) or something you are allergic to (eg, animal dander), they become red and swollen.
The swelling causes the air passages to become smaller, making it more difficult to get air in and out of the lungs. Steroids help to reduce and control swelling in the airways, making breathing easier.
Steroids also help by making the airways more responsive to medications that open the airways such as albuterol and decreasing the amount of fluid in lung tissue. They may also make the airways less prone to bronchospasms (muscle around the airway contracting and constricting the airway).
Steroids in Asthma and COPD
Inhaled steroids are the frontline treatment for any patient with persistent asthma. Studies have shown many clinical benefits in asthma including reduced symptoms (eg, wheezing, cough, etc.), A swollen airway has a smaller passage for airflow making it more difficult to breathe. A normal airway has an open passage for airflow. improved airflow, reduction in airway sensitivity and prevention of exacerbations (episodes of worsening that require extra treatment, hospitalization or an ER visit). Steroids may also prevent permanent changes to the airway that can occur when asthma is poorly controlled.
Although not all COPD patients benefit from steroids, some do. The Global Initiative for Chronic Obstructive Pulmonary Disease or GOLD, sponsored by the National Institute of Health and World Health Organization, released standards for the management of COPD in 2001. These standards suggest that inhaled steroids should be used in COPD for patients that continue to have symptoms on bronchodilators (eg, albuterol, ipratropium). They recommend a 6-week to 3-month trial of inhaled steroids with spirometry testing before and after the trial to determine if an improvement in lung function is noted.
GOLD also recommends use in patients with moderate to severe COPD that have frequent episodes of worsening requiring extra treatment such as antibiotics or steroid pills or shots.
Benefits noted by some of the clinical studies include improved air movement, decreased symptoms (shortness of breath, cough, etc.), fewer exacerbations (episodes of worsening that require extra treatment, hospitalization or an ER visit), increased walking distance, and reduced risk of mortality (ie, death).
Steroids can be delivered in several ways but the two most common ways are by pill or by inhaling continued from page 1 the medication. When taken by pill, a relatively large dosage is required for enough of the medication to reach the lungs and have the desired effect. Dosages of 10 - 20 mg per day or more are commonly used. Taking the larger dosage is what leads to many of the more serious side effects associated with steroids such as osteoporosis, diabetes, slow wound healing, and facial swelling.
When taken by inhalation, because the medication is being inhaled directly into the airways, the dosage required is much less, generally less than 1 mg or about 1/20th of the dosage taken by pill. Because the dosage is much less, the chance of any serious side effects is reduced dramatically. Although uncommon, the most common side effects of inhaled steroids include sore throat, hoarseness, and an increased risk of a yeast infection in the mouth, which can be reduced by rinsing the mouth out after inhaling the medicine.
The most common types of inhaled steroids are listed BELOW Steroids can be taken by inhaler or nebulizer. If you are already taking other medications by nebulizer, it may be possible to include the steroid in your normal nebulizer treatment. If you are taking multiple inhalers, it may be possible to combine all inhaled medications into one convenient nebulizer treatment.
Most insurance carriers, including Medicare, provide coverage for nebulizer medications when medical necessity requirements are met. If you would like more information, please talk with your physician or feel free to call us for details.
COMMON STEROID INHALERS
Beclomethasone
- Vanceril, (R),
- Beclovent(R),
- QVAAR(R)
Budesonide -
- Pulmicort Turbohaler(R),
- Pulmicort Respiles (R)
Flunisolide
- Aerobid (R)
Fluticasone
- Flovent(R)
- Advair(R)
Triamcinolone
- Azmacort(R)
Why Clean My Equipment?
With every piece of equipment, it is very important to clean and maintain it to achieve the optimal results. Always follow the guidelines provided to you when you received the equipment. If you are unsure of what cleaning and maintenance you should be doing, contact us and we’ll be happy to provide you with instructions.
Proper cleaning and maintenance has many benefits.
1. Equipment containing moisture is always a potential area for germs (bacteria, viruses, etc.) to grow. This risk is increased when we breathe or cough into the equipment as germs can be introduced. Regular disinfection of nebulizers, humidifiers, tubing, masks, and other equipment reduces the risk of contamination that could lead to infections.
2. Normal cleaning also keeps the equipment functioning correctly. During normal use, nebulizers, humidifiers, and other equipment may become clogged with salt or other sediments preventing proper function. Failure to clean filters on compressors, concentrators, and CPAP units may cause them wear out faster and malfunction. Cleaning helps keep everything in good working order.
3. Even with proper cleaning, some materials (masks, tubing, cannulas, nebulizers) can break down with normal use, resulting in equipment that may not function properly. Change all disposable equipment (nebs, tubing, masks) as recommended to ensure proper operation.
Proper cleaning and maintenance is a big step toward keeping oyour equipment functioning properly and helping yourself to Breathe Easy.
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