You probably don't expect to ever have to take classes to learn how to breathe. But that is exactly what participants in pulmonary rehabilitation do in order to once again climb stairs, pick up their grandchildren and generally be as active as possible despite living with chronic lung disease that causes shortness of breath and fatigue.
More than 35 million American are currently living with lung diseases such as chronic obstructive pulmonary disease, which includes emphysema, chronic bronchitis, bronchiectasis and asthma, as well as restrictive lung conditions such as interstitial lung disease. These diseases are incurable and tend to worsen over time, so treatments are given to ease symptoms and slow the progression of the disease. But while pulmonary rehab does not have an impact on the lungs themselves, it can have a dramatic effect on how well people can function with limited lung capacity. Rehab can help participants feel less out of breath and get them into better physical and emotional shape, so they spend less time sitting in hospitals and doctors' offices. Instead, many participants are able to spend their time cooking for themselves or walking next store to chat with a neighbor.
"Pulmonary rehab can improve someone's life by changing what they are able to do," says Lana Hilling, a fellow of the American Association of Cardiac and Pulmonary Rehabilitation (AACVPR) and coordinator of the John Muir/Mt. Diablo Health Systems pulmonary rehabilitation programs in Concord, Calif. "It can mean difference between staying at home and becoming socially isolated and becoming an active participant in life again."
Pulmonary rehabilitation generally consists of six to 12 weeks of group classes led by a respiratory therapist. Pulmonary rehab teams usually include health professionals from different fields: You may find a physician, a physical therapist, an occupational therapist, a nurse, a psychologist and a dietician. Programs are generally, but not always, covered by insurance.
Breathing Basics
Classes often start out with the training designed to help people breathe better. "Most patients breathe very inefficiently," explains Trina Limberg, an AACVPR board member and the director of the pulmonary rehabilitation program at the University of California, San Diego.
People with COPD, for example, have trouble getting air out of their lungs. When airways are damaged, they lose their elasticity and may collapse when someone exhales, trapping air. The trapped air makes it hard to breathe and limits the amount of oxygen that one can inhale. In rehab, patients are taught a technique called pursed-lip breathing, where someone breathes in through their nose for two to three counts and then exhales through pursed lips as if they were blowing out a candle. This technique puts pressure on the airways so they stay open longer, and helps force trapped air out.
Focusing on breathing, particularly counting breaths, calms people down and allows them to get control of their breathing. "When you get short of breath, you have a tendency to panic and breathe faster," Hilling says. "If you're hyperventilating, you're not getting any trapped air out at all."
This technique and others can also assist people with inflamed lungs or mucus in their lungs, such as those with chronic bronchitis and some people with asthma. Likewise, breathing techniques can help people with restrictive lung disease, who have difficulty expanding their lungs. Participants also learn how to pace themselves and apply the breathing techniques to everyday living by exhaling when opening a door or lifting an object, for example, rather than holding their breath.
Getting in Shape
While people with chronic lung disease have varying levels of lung capability, respiratory therapists say that most are very out of shape from years of avoiding activities that made them feel short of breath. Their lack of activity, in turn, has made any physical activity that much harder. Exercise is a key part of pulmonary rehab both to strength the muscles and help the muscles use oxygen more efficiently. "If the muscles are in better shape, they are utilizing oxygen better, so people have less shortness of breath and less muscle fatigue," Hilling says.
According to Limberg, participants are given individualized exercise prescriptions based on what their bodies are capable of doing and other conditions they may have, such as osteoporosis, a bone thinning condition that the steroids taken by some people with COPD can trigger or worsen. The exercise prescriptions often involve treadmill walking or stationary biking for lower body endurance training. Upper body endurance exercises can be done seated. In Limberg's classes, participants may do continuous motion arm exercises such "wax on, wax off," or "breaststroke." Strength training can include sits-ups and or marching in place to improve "core strength" and the use of three- or four-pound free weights for bicep and tricep curls.
With the supervision pulmonary rehabilitation provides, participants can build up strength safely—and they can continue to exercise at home or in maintenance programs that may be offered following pulmonary rehab. "If you walked into a gym and saw some of these people exercising, you'd be surprised to learn they have lung disease," Hilling confirms.
Information and Support
Other crucial parts of rehab are the education and psychological support components. One of the frustrating aspects of having a chronic lung disease is that you are vulnerable to chest and respiratory infections, which can set you back and even damage the lungs further. In pulmonary rehab, people are reminded of how they can lower their risk of infection, with frequent hand washing or the use of hand sanitizers, for example, and how to assess their symptoms so they can get treated for infections as soon as possible. In some programs, dieticians offer recommendations for food preparation and eating, which can be difficult if people have shortness of breath, fatigue and a diminished appetite.
Participants are also given a forum where they discuss their feelings about their disease; some may be referred for counseling. "It's very common for people to battle anxiety and depression," Limberg says. "You thought you were going to enjoy retirement and now all you're doing is going to doctors' appointments." Additionally, when the body's tissues don't get the oxygen they need, it can create anxiety.
But in pulmonary rehab, she says, the emphasis is what people can do. And, for many, these programs can help them take a deep breath and start a more independent life.
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