Chronic Obstructive Pulmonary Disease (COPD) And Breathlessness

Patient Information Leaflet

Chronic Obstructive Pulmonary Disease (COPD) And Breathlessness - A guide to energy conservation

What is Occupational Therapy?

• Occupational Therapists support people to overcome challenges in completing everyday tasks or activities.
• An activity can be anything from washing or dressing, washing up dishes, folding clothes or taking part in hobbies, like dancing, or socialising.
• Occupational therapists will look beyond your diagnosis and its limitations and identify new opportunities that will change the way you feel about the future.

How can Occupational Therapists help you?

• They will look at the impact of your COPD and your environment and identify different ways that could help you carry out your activities.
• Identify what assistive equipment you might need to improve your independence.
• Examples of assistive equipment are mobility aids such as:
  • Walking sticks and wheeled zimmer frames
  • Toileting or bathing aids
  • Aids for the bed
• They will promote and maintain your independence and self-management.
• They will refer you to community teams for ongoing support.

What is COPD?

• COPD refers to a group of lung conditions that cause breathing difficulties. This includes:

  • Emphysema: a condition that damages the lung air sacs
  • Chronic bronchitis: long-term inflammation of the airways.

• A good way to understand what COPD is:

  • Chronic - long-term condition

  • Obstructive = narrowed airways

  • Pulmonary = affects the lungs

  • Disease = medical condition

What is Breathlessness?

• Your body needs more oxygen and energy when you do something that requires physical effort.
• Getting out of breath is normal.
• However, some people can feel out of breath when they are not doing anything or exerting themselves.
• They feel like they can't control their breathing.
• This unpleasant and uncomfortable breathing sensation can be upsetting and tiring for people.
• Breathlessness is a very personal experience.
• It can be worsened by feeling tired or being worried and can affect the way you perform your daily activities.

Breathing Techniques

1. Pursed-lips breathing (also called Candle Breathing)

• This can be used to help you control your breathing.
• Gently breathe in through your nose and then purse your lips as though you are going to blow out a candle.
• Blow out with your lips in this position.

2. Blow-as-you-go

• This technique can make tasks easier and can be used while doing something that you find makes you breathless.
• Breathe in before you do something that makes you breathless, then breathe out while you're doing the thing that makes you breathless.
• For example, breathe in before standing up then breathe out as you stand.

3. Paced breathing

• This technique is useful when you are exercising/active.
• As you walk or move, count to yourself (for example, take a breath in before moving, and after walking 1-2 steps, breath out).

What to do when you are breathless and feeling scared

• Try to Stay calm.
• Sit down if possible.
• Lean forward (on a table, against a wall etc).
• Relax your shoulders and stomach muscles.
• Do pursed lip breathing and try to exhale as long as possible.
• Do some deep breathing. Do not do more than five deep breaths at a time.
• Use a handheld fan.
• Relaxation or mindfulness techniques may ease your feelings of tension and anxiety.

What is Energy Conservation?

• For people with COPD, completing tasks such as washing, dressing, and housekeeping requires you to use more energy.
• This may leave you feeling short of breath or feeling tired.
• Energy conservation is a way of doing tasks simply so that you do not use up all your energy.
• By using energy conservation techniques, you will have more energy to use during the day, feel less tired and put less strain on your body.
• Your therapist will also consider equipment that will support you in carrying out your day-to- day activities.

Energy Conservation Techniques aim to:

• Use your energy carefully.
• Prioritise/ using energy for tasks that are important for you.
• Reduce fatigue.
• Adopt energy-efficient body postures.
• Increase your independence.
• Finding easier ways to complete tasks.

The Five P's of Energy Conservation

1. Planning ahead

• Remember not everything has to be done every day or all in one day.
• Try to plan ahead and spread these tasks out over the day or throughout the week, to stop yourself using all your energy in one go.
• Aim to have times set out to rest across your day and week.

2. Pacing

• This means breaking tasks down into smaller more manageable chunks with rests.
• Try to do the more difficult tasks when you are feeling your best and allow yourself enough time.
• You'll recover quicker if you work on a task until you feel tired rather than exhausted.

3. Prioritise

• Do the tasks that are important to you and try to remove unnecessary tasks.
• Don't be afraid to ask for help, ask yourself can someone else do the housework or shopping to allow you to do things that bring you joy.

4. Positioning

• Having a good posture when completing tasks will save you energy.
• An example of this is sitting rather than standing when showering or washing up.

5. Positive Attitude

• Some days will be easier than others.
• Don't beat yourself up if you haven't completed all the tasks, you set out to do.
• Be kind to yourself as negative thoughts and emotions about ourselves will add to your tiredness and fatigue.

Tips for energy conservation

• Take frequent breaks.
• Plan the day. Switch between tasks which require more energy during the day or week.
• Do not schedule too many tasks in one day.
• Allow enough time to complete the task.
• Use good posture and body mechanics.
• Prepare objects prior to starting the task and keep them within reach.
• Avoid excessive reaching, bending, twisting.
• Do tasks that matter to you.
• Ask for help with tasks such as housekeeping, shopping etc.
• Use equipment to make the task easier.
• Do not wait until you are short of breath or tired before you stop and rest.
• Plan to take regular breaks.
• Sit when you are completing tasks when you can.
• Do not aim to complete tasks post meals.
• Try to get enough sleep.
• Try different ways to complete tasks and find what works for you.

Washing yourself

• If you have been prescribed oxygen it is safe to use the nasal prongs in the shower/bath.
• Do not move or place oxygen machines in/near the water.
• Allow time for the task.
• Gather all items you need before starting.
• Open the bathroom window or door to reduce steam.
• Sit to dress/undress, wash, shave and for drying.
• Have a strip wash on alternative days if able.
• Immediately after showering put on a dressing gown or use a small towel to soak up water rather than using a heavy bath towel.
• Use electric appliances such as toothbrushes or shavers if able.
• Use equipment (Your therapist will assess your needs for this).
• Limit bending and reaching.
• Avoid aerosol deodorants try to use roll-ons instead.
• Wear clothes that are easy to put on and avoid tight clothing.

Dressing yourself

• Sit to dress and undress (or putting on make-up).
• Allow time for the task.
• Gather all items you need before starting.
• Wear clothes that are easy to put on and avoid tight clothing.
• Dress lower half first if able to avoid restricting your movement.
• Use dressing aids or a foot stool to limit bending.
• Consider slip on shoes.
• In cold or windy weather use a warm scarf to cover your mouth and breathe through your nose.
• This will help warm the air before it enters your lungs and can help stop your symptoms worsening.

Walking or exercising

• Take medication, if possible, before you begin exercising or an activity.
• Take regular breaks.
• Walk until you feel tired but not exhausted.
• Use your breathing techniques.
• Use a handheld fan.

Stairs

• If you find stairs difficult, try to reduce the number of times you do this.
• Try to breath in before each step, when you have both legs on the step, then breath out and repeat.
• Climb 4-5 steps at a time, rest for 30 seconds then repeat.
• Have a chair near the top/bottom of the stairs where you can sit and rest if needed.

Cooking

• Spread food preparation tasks throughout the day.
• Get all the items ready before you start.
• Sit down where possible to wash up, prepare vegetables and mix ingredients.
• Cook large quantities of food and freeze them to be used at a later date when you are feeling fatigued.
• Use ready-made meals to reduce meal preparation.
• Position the items you use most in easier to reach places and closer together to minimise reaching and bending.
• Fill your kettle using a plastic jug.
• Use a kitchen trolley to move items between rooms.
• Use appliances to save your energy such as the dishwasher or microwave.
• Sit regularly while preparing or checking food.
• Buy pre-pared vegetables.

Shopping

• Have a break before starting your food shop.
• Plan your shopping list by food aisles.
• Use a high trolley rather than a basket.
• Shop at quieter times.
• Take your time going around the shop.
• Pack similar items together so it will be easier to unpack.
• Spread heavier items across shopping bags.
• If you are tired put the perishable items away first, then rest. You can finish the task later.
• Consider online shopping or asking family/friends to help.

Household Cleaning

• Plan to spread tasks throughout the week.
• Get all the items ready before you start.
• Empty rubbish bins regularly.
• Try to do a mix of heavy and light tasks in a day.
• Rest between tasks.
• Sit where possible such as for ironing or polishing.
• Avoid aerosols that trigger your breathlessness.
• Soak dishes overnight.
• Use a long-handled brush and dustpan.
• Clean one room or part of a room at a time.
• Use a long-handled reacher to put thing in/out of the washing machine and dryer.
• Consider using a clothes horse.
• Ask family, friends or pay someone to help with more difficult tasks such as vacuuming and changing bed sheets.