coping with chronic respiratory diseases...meat, fish, eggs, dairy products, beans, lentils, nuts,...

Liverpool Heart & Chest Hospital NHS Foundation Trust

Coping with Chronic Respiratory Diseases

Chronic respiratory diseases (CRDs) are diseases of the airway and other structures of the lung

Types of CRDs: Chronic Obstructive Pulmonary Disease (COPD) Bronchiectasis Asthma Interstitial Lung Disease (includes pulmonary fibrosis)

Causes of respiratory disease: Smoking (90% of all COPD cases)

Exposure to chemicals and dust/small particles eg. asbestos, aerosols

Environmental exposure eg. pollution

Alpha 1 antitrypsin deficiency (rare genetic condition)

How are CRDs diagnosed? Detailed clinical history

Spirometry (important to get this done every year)

Chest X-Ray, MRI, CT scan

Common symptoms of CRDs Cough (dry or productive)

Phlegm

Wheeze

Shortness of breath

Hyperventilation

Fatigue These symptoms can result in secondary problems, such as:

Low mood and depression

Anxiety

Challenging activities of daily living

Loss of libido

Changes in weight (weight loss or weight gain)

What can ‘The Breathe Programme’ help with? Support with and/or refer to smoking cessation service

Stopping smoking is the most important thing you can do and the most effective way of slowing further lung damage

Tailored and flexible exercise programme to improve your fitness so to feel more confident doing activities of daily living

Self-management of signs and symptoms


Better understanding of your disease

What to do if you are unwell

Learn breathing exercises to clear phlegm

Help you cope better with shortness of breath

Medication management and learn about the correct inhaler technique (common cause of inhalers not working effectively)

Managing stress and anxiety

Teach about the importance of vaccinations from your GP practice

Signs of a flare up/exacerbation: Increase in breathlessness or wheeze

Increase in phlegm

Change in phlegm colour

Increase in fatigue/tiredness

Loss of appetite

Reduced sleep

Dealing with an exacerbation of your CRD: Increase use of your blue inhaler if you feel you need it Collect a phlegm/sputum sample if possible (your GP practice will have sample pots) Commence rescue pack, if you have one Phone the GP practice

GP appointment / phone call from your GP / a prescription

You should hear back from your GP practice within 4 hours You should ALWAYS phone your GP even if you have started your rescue pack

What to consider during an exacerbation: Allow more time for doing activities

Increase rest time and use relaxation techniques

Use controlled breathing exercises, huff and cough to help clear phlegm

Eat smaller amounts more frequently

Increase fluid intake

Danger Signs- Call 999 If you are so breathless you cannot complete a sentence

Chest pain Confusion or drowsiness

For Further information visit: www.thebreatheprogramme.co.uk

Any 2 of these symptoms-

TAKE ACTION


The Weather and Your Health

The severity of your symptoms may change throughout the year because of a change in weather conditions. Keeping an eye on the weather forecast is an important part of managing your condition. Hot and cold weather alerts can be found on the Met Office website but will also be mentioned on TV and radio weather forecasts. Research shows strong link between cold weather and increased hospital admissions

http://www.metoffice.gov.uk

A cold alert will be put out if the temperature is expected below 2 degrees for 48 hours or heavy snow / ice. The UK is high up the European league for additional winter mortality, there is an 18% increase in preventable deaths in winter.

This means that we need to be better prepared for extreme temperatures: Plan ahead for shopping

Ensure your medications and rescue packs are stocked Ensure you have sufficient heating (gas/electric) Monitor indoor temperatures

Bedroom = 18°C Living room = 21°C

Why you may be at risk during the winter?

Cold air can cause narrowing of airways, leading to increase in breathlessness.

Windy days can make you feel more short of breath

Extreme temperatures may mean your infections/exacerbations take longer to recover.

It is important to act quickly and get treatment early.

If you are not improving go back for another GP review.

Higher risk of hospital admissions – especially if you have never been admitted before.

Protecting yourself in the winter Keep warm! Wear several layers, this traps warm air better than one bulky layer.

Wrap a scarf loosely over your nose and mouth to reduce the effect of cold air on the airways

Take your reliever inhaler 30 minutes before going out or planned activity

Reduce the number of trips outdoors when it’s very cold (less than 4 degrees)

If you start to shiver when you’re outside, keep moving or return inside


When indoors try not to sit down for more than one hour, get up and move around regularly.

Wear non-slip footwear

Have regular warm meals and hot drinks

Protecting yourself in the summer Observe forecast for high temperatures, humidity and pollen counts.

Wear loose cotton clothing and try to stay cool.

Open windows regularly – be mindful that outdoor pollutants and pollen are likely to enter the house

During a heat wave avoid going out in between 11am and 3pm, plan your day around this.

Use a fan.

Take cool showers or baths.

Drink plenty of fluids to avoid dehydration. Keep inhalers out of direct sunlight.

How can I protect my health and help avoid infections? Think of these things all year round:

Stop smoking- the most important thing you do to help your breathing regardless of the weather. Sources of support – GP, Practise Nurse, Smoke Free Liverpool

Ensure you do not run out of your medications, inhalers and rescue packs. Ask your GP about a rescue pack if you have frequent exacerbations/flare ups

Eat a healthy, nutritious diet to boost your immune system and maintain a healthy weight

Drink plenty of fluid to keep hydrated- 6-8 glasses / 1.5-2 litres per day

Tell your GP if you are feeling anxious or depressed as this impacts on your health

Being physically active can almost halve the risk of you having to go into hospital

Yearly flu injection

Liverpool Healthy Homes The Healthy Homes team provide free help and advice to local people who are

struggling to pay their energy bills and heat their homes. Telephone number: 0800 0121 754

The Breathe Programme / Pulmonary Rehabilitation- You can attend twice a year!



Exercise and Chronic Respiratory Disease

Why is being active so important to me? • The fear of getting out of breath may put you off doing any activity that may make

you more breathless • In fact…being active can improve your breathing and quality of life • If you increase your fitness you will get less out of breath doing every day activities

like shopping, climbing the stairs, doing housework

Vicious Cycle of Inactivity

Recommended Activity Levels for adults, including those with lung disease

Aerobic Exercise 150 minutes a week moderate intensity exercise

Plus… Strength Training 2 days per week

Top Tips Choose exercises and activities that you enjoy, this will help you keep motivated Exercise with a friend or partner this may make it more enjoyable

You feel breathless

You become fearful of activity that makes you

breathless

You avoid activities that make you feel

breathless

You do less activity

Your muscles become weaker

Reduced exercise capacity


Aiming to work at moderate intensity 3 on the RPB scale Talk test – able to hold a conversation without gasping for breath Aerobic activities work your heart and lungs. Your body

warms up, your heart beats faster and your breathing is

quicker and deeper than normal. Examples of aerobic

exercises: swimming, cycling, water aerobics, brisk

walking, dancing, gardening.

Strength exercises are counted in repetitions and sets.

Perform 8-12 exercises which target all the major muscle

groups You can fit this into your daily life, for example by

carrying shopping bags. You could also do yoga or use

body weight exercises, weights or resistance band

exercises.

Remember to warm up and cool down

Rate of Perceived Breathlessness (RPB)

0 NOTHING AT ALL

0.5 VERY, VERY SLIGHT

1 VERY SLIGHT

2 SLIGHT

3 MODERATE

4 SOMEWHAT SEVERE

5 SEVERE

6

7 VERY SEVERE

8

9 VERY, VERY SEVERE

10 MAXIMAL

Do Not Exercise If… • You have a chest infection or are on antibiotics • You do not have your blue inhaler or GTN spray with you

STOP if you get any sudden symptoms, including: chest pain or tightness, feeling dizzy, feeling increasingly wheezy. Seek advice from a health care professional

What happens after The Breathe Programme? Home Exercise Programme Exercise for Health Website: https://www.liverpool.gov.uk/lifestyles/services/gp-referrals/ Healthiness Call: 0151 728 8874 Website: http://healthinessltd.co.uk/ Walking for Health Call: 0151 233 6355 Website: https://www.walkingforhealth.org.uk/walkfinder/liverpool-fit-for-me-walks. LiveWire Liverpool Health Trainers Call: 0300 00 32 32 2 Website: https://livewireliverpool.co.uk/



Breathlessness Management

Active cycle of Breathing Technique

ACBT

Tips

Hold each deep breath for 2-3 seconds

Huff (Like you are steaming up a mirror)

Start with a short huff and then a long huff

Try to do this every morning or when you need to clear your chest

May be easier after using reliever (blue) inhaler

Pursed lips breathing

Breathe out with your lips pursed, as if you're whistling

This slows your breathing down and helps to make your breathing more efficient

Ideal to use to help recover your breathing following exertion

Blow As You Go

Breathe out when you're making a big effort, for example: Stretching your arms above your head Reaching for something on a shelf Bending down Going up a step or stairs Standing up

Breathing control

3-4 deep breaths

Breathing control

3-4 deep breaths

Huff

Cough


OR during the hardest part of any action BLOW as you GO

What causes breathlessness?

How much oxygen your body needs depends on what you are doing

E.g. If you are walking upstairs or carrying shopping, your lungs need more oxygen. To get more oxygen you will breathe more quickly – giving a feeling of breathlessness

Breathlessness is a normal body reaction

Positions of Ease

Use these positions to assist in relieving breathlessness

If you cannot sit down, try to find something to lean against or rest on

You may benefit from a few extra pillows at night during an exacerbation

Remember…

If you are unwell:

You may need to use your blue (reliever) inhaler more often

Allow yourself more time for day to day activities (dressing/washing)

You may need more time to clear your chest in the morning

Use your breathing techniques (ACBT) throughout the day

Your body will need more rest to recover from an exacerbation Contact your GP/Respiratory nurse if you are taking antibiotics and/or steroids and

not improving


https://www.medexpress.co.uk/clinics/asthma/ventolin-inhaler


Nutrition and Chronic Respiratory Disease

Carbohydrates

Bread, rice, pasta, potatoes, noodles, couscous, etc… All meals should be based around this food group

Essential for energy

Helps regulate hormone and blood sugar levels (affects mood and concentration)

Choose high fibre or wholegrain products, such as brown pasta or wholemeal bread, which keeps us feeling fuller for longer, protect your heart and keep your bowels moving

Protein

Meat, fish, eggs, dairy products, beans, lentils, nuts, tofu and soya

1 portion is 2-3oz meat, 3-4oz fish, and 1 small tin of beans

Proteins are the body’s building blocks and are essential for growth and repair, it’s important for your immune system

Choose low-fat or lean meats and poultry

Oily fish such as salmon, mackerel, sardines, herrings and fresh tuna are rich in omega-3 oils, aim for eat two portions of fish per week, one of which is oily

Fats

Know your fats!

Fats are an important part of our diet; they provide the body with energy and some important vitamins

Eating too much fat can be unhealthy

Choose unsaturated fats such as olive oil, nuts, and avocados. Unsaturated fats can lower cholesterol levels

Limit saturated fats; choose lean meats, fish and low fat dairy. Saturated fats can increase cholesterol levels

Oils contain a range of vitamins, such as vitamin A and E which are important for fighting infections, choose unsaturated oils and use in small amounts

Dairy (important source of calcium)

Milk, cheese, yogurt and fromage frais

2-3 portions per day 1 portion = 1/3 pint of milk, matchbox size of cheese, 1 yogurt


Fruit and Vegetables

Minimum 5 a day (can be fresh, frozen, tinned or dried)

Ideally eat a variety of colours

Contains vitamins, minerals and antioxidants

Helps keep the immune system strong

Prevents constipation, reduces cholesterol

Fluid

6-8 glasses, 1.5-2 litres per day

Transports nutrient and oxygen to cells

Prevents constipation

Helps loosen secretions

Helps to flush out toxins

Improves concentration

Foods containing lots of fats and sugar… Eat in moderation!

Fizzy drinks, sweets, chocolate, cake, biscuits, donuts, crisps, pastries, burgers and sausages, pizza, fried food

Tips

Eat little and often

Eat slowly

Avoid overeating and foods that cause gas or bloating, a full stomach or bloated abdomen

might make breathing uncomfortable

Rest before meals

Sit upright

Use convenience food like ready meals, frozen/tinned vegetables, jacket potato,

sandwiches, beans on toast, soup etc…

Cook in bulk

Keep the cupboard stocked

Allow others to help with meal preparation

Meals on Wheels, Wiltshire Farm Foods



Managing daily activities, stress and anxiety

Chronic Respiratory Disease is associated with high levels of anxiety and stress that can

negatively affect your quality of life. Ultimately the feelings of stress and anxiety are a

normal thing to feel when faced with a long term lung condition.

Feelings of stress and anxiety are common due to:

Worries about physical health and medical condition

Feelings of loss of control

Lifestyle changes and physical limitations due to pulmonary disease

Why does it affect me? Breathlessness can feel very threatening and trigger anxiety

When our bodies think it is in danger an automatic mechanism springs into action, this is called the “fight or flight” mechanism, it is a normal reaction and not dangerous

Adrenaline will cause increased heart rate and breathing rate

When triggered by breathlessness it is not very helpful and makes you feel ill

Anxiety

Worrying thoughts

'If I'm out of breath, it's dangerous'

Physical symptoms

Avoidance Sitting down,

not doing anything

Short term: relief

Long term: ↓ confidence

↓ activity ↑ symptoms of

anxiety

Stress Shortness of

breath

Anxiety

starts

Breathing and heart

rate becomes faster

Shortness of

breath

increases

Anxiety

increases

Breathing becomes

even more rapid

Anxiety and

Avoidance

Behaviour:

A vicious circle


Coping mechanisms Learn about your condition and how to manage your symptoms

Support mechanisms (family and friends, Breathe Easy)

Avoid smoking, alcohol and drugs

Stay active

Eat a healthy diet

Plan ahead and use pacing techniques

Energy conservation

Relaxation techniques

Make an appointment with your GP if your symptoms are severe

Planning Schedule events or appointments for times that are best for you

Leave time for inhalers and medications in morning

If you struggle with fatigue later in the day, try not to plan things for this time

Pacing It is common for people living with chronic respiratory disease to rush activities that they know they find difficult, so they can ‘try and get it over and done with’.

Use pacing techniques on stairs and slopes, stop for rest before becoming breathless

Do not rush- take your time of activities that you find difficult

You are likely to manage to do more within a day when working at a slower pace

Energy conservation If you are having an exacerbation or flare up of symptoms, or have more severe respiratory disease, you are likely to be fatigued and struggle to do activities. It is important to conserve your energy as you will not have an endless supply, be willing to think about doing things differently.

Spread out the time you spend on a task, you do not have to do it all in one go

Sit down to do tasks or alternate sitting and standing

Consider the storage of items within the home, for example, store items that you use regularly at chest level

Learn how to say no and delegate things to others if needed

Community Occupational Therapists can assess for adaptations and equipment to help make things easier for you at home

Relaxation Take 15 minutes a day to yourself, no distractions, calming music ‘Me Time’ Breathing Control Get in a comfortable, supported position Relax your shoulders, arms and hands, with both feet flat on the floor Breathe in gently through your nose (letting your stomach rise) and breathe out

through your nose or mouth Try to feel more relaxed each time you breathe out

Relaxation audios are available on the website


coping with chronic respiratory diseases...meat, fish, eggs, dairy products, beans, lentils, nuts,...

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