Pulmonary Rehabilitation Information Leaflet

Transcription

1 Community Respiratory Services Luton Treatment Centre Vestry Close Luton LU1 1AR Tel: Notes Pulmonary Rehabilitation Information Leaflet We hope you have enjoyed the pulmonary rehabilitation programme and have noticed the positive effects of regular exercise on your health. This booklet includes a lot of the information you have received during the rehab talks Oct 2018 (v1.2) July 2018 July 2021

2 Handy Tips.. How to keep myself well. Don't smoke Take daily exercise and pace myself Eat a good balanced diet Drink plenty of fluids Always have enough medications and never run out Take all medication as prescribed Make sure I have my annual flu vaccine EXERCISE can help improve muscle strength and endurance. This will improve the ability of the muscles to function more efficiently resulting in less breathlessness. This can result in an improved exercise tolerance. Exercise should form a core part of the management of patients with chronic lung disease. Pulmonary Rehabilitation is highly effective in helping to introduce exercise to people with lung disease in a supportive environment, whilst also providing education on how to manage and live with lung disease. Once someone has completed a Pulmonary Rehabilitation course, they are strongly encouraged to continue with exercise at home or at a local leisure facility. What happens when we breathe? The Respiratory System We breathe in oxygen (O 2 ) from the air and breathe out carbon dioxide (CO 2 ). As we breathe in, the air enters the lungs and the alveoli, where oxygen then moves from the alveoli, into the blood. Chronic lung disease can affect the normal mechanism of breathing, resulting in breathlessness. This impacts on all aspects of life and can cause stress, anxiety and difficulty with daily activities. Useful Information and Contact Details Luton Community Respiratory Nurse Team: ccs-tr.lutonrespiratory@nhs.net Pulmonary Rehabilitation Team: ldh.tr-ldhpulmonaryrehab@nhs.net Breathe Easy Groups Luton & District Meet on the 2nd Thursday of the month 2pm-4pm Meet at the Peter Newton Pavilion (Skimpot Road, Dunstable) Tel: Disability Resource Centre Poynters Road, Dunstable British Lung Foundation Website: Pulmonary Fibrosis Trust Website: Luton Social Services: Keech Palliative Care Centre Experts in symptom management following a referral from a health care professional the patient is offered a nurse assessment. The types of services offered Doctors clinics for symptom control and ongoing monitoring of symptoms Nurse led clinics for symptom control and emotional support Non-Malignant Palliative Respiratory Programme Ascetic drainage for malignant disease Fatigue Management Programme Specialist social worker advice and support Complementary therapies Music therapy Art therapy Spiritual support Psychosocial emotional support Support with future planning Carers drop-in group Hydrotherapy pool

3 Smoking and your lungs Smoking causes significant and irreversible damage to your lungs. Even if you only smoke 1 a day the damage can still occur. What is in a cigarette There is much support for those wishing to give up smoking including Nicotine Replacement Therapy NRT (gum, patches, inhalers etc) as well as medications that can be prescribed by your GP and counselling/group sessions. Please approach your health care professional if you wish to discuss giving up smoking. Live Well Luton Its never too late to stop smoking Understanding your condition COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term to describe lung diseases including emphysema, chronic bronchitis and chronic asthma. Emphysema Is a disease that affects the alveoli (the little air sacs) that causes shortness of breath. The walls of the alveoli become weakened and rupture which causes larger air spaces instead of lots of little ones. This reduces the surface area and in turn the amount of oxygen that gets into the blood. Chronic Bronchitis Chronic bronchitis describes chronic inflammation of the airways. It often causes an increase in phlegm and swelling which causes narrowing of the airways. Some of the symptoms include cough, wheeze, increased phlegm and breathlessness. Chronic Asthma Chronic asthma may occur due to long standing severe asthma. Over time the airways become fixed and narrowed. This can cause cough and breathlessness and often more phlegm. Interstitial Lung Disease This is a restrictive lung disease which comes in over a hundred different forms. Over a period of time the lung tissue becomes thickened and scarred which is called fibrosis. Because of this scarring it is harder for the oxygen to get into the blood stream. Interstitial Lung disease can Bronchiectasis This is a condition where some of the tiny airways in your lungs become enlarged. This enlargement causes a build up of excess mucus in the lung that can make the lungs more vulnerable to infection. As well as excess phlegm it can cause a persistent cough and breathless. Bronchiectasis is treated with pulmonary rehab, inhalers and good chest clearance techniques. Although these chronic lung diseases cannot be cured they can be managed to prevent it from worsening: Stop smoking Pulmonary Rehabilitation Medication Vaccinations Chest clearance techniques Early recognition of chest infections Good diet/hydration

4 Breathlessness and Exercise Being short of breath goes hand-in-hand with having a chronic lung disease, however it is not just the condition of the lungs that determine how breathless someone will be. After noticing that physical exertion is causing someone to be breathless, they may try and limit the amount of exertion they do to avoid being short of breath. This can then cause them to be anxious or worried about being breathless, so often that results in even less exertion. Over time this can lead to a loss of physical fitness, which causes the muscles to be less efficient and this will lead to even greater levels of breathlessness on even less exertion. It is common to hear from patients with chronic lung disease that they are getting more and more breathless but according to their lung function tests (spirometry) their lung condition has not worsened, so the worsening breathlessness is more likely to be as a result of the factors described above. So how can we improve things? Nutrition Being a healthy weight is important for many reasons. Being overweight can put increased pressure on bones, joints, your heart and circulation as well as decreasing your mobility and making breathing more difficult. However, being underweight can mean that you have an increased risk of breaking bones and picking up infections, as well as a general sense of weakness in your muscles. Healthier eating does not necessarily mean you have to eat less; it s about achieving a healthy balanced diet Eat regular meals breakfast, lunch and dinner Reduce snacking between meals Eat more fruit and vegetables Choose lower sugar / lower fat products Review your portion sizes at mealtimes Fist sized portion of potato, pasta, rice or 2 slices of bread Palm sized portion of lean meat, fish or other protein sources Malnutrition can refer to under nutrition (being underweight or losing weight) or over nutrition (being overweight or obese). Malnutrition is an imbalance of energy, protein and other nutrients that causes adverse effects on the body Weigh yourself monthly if you can, or ask your doctor or nurse to weigh you at your appointments, as your weight is a good indicator of what is happening in your body If you are unable to weigh yourself, be aware of visual signs of your weight decreasing, for example jewellery and clothes becoming looser If you continue to lose weight or you struggle to eat enough during periods of illness, even if you are overweight, seek advice from your doctor or nurse We have various advice leaflets about weight loss and nutrition, so do not hesitate to contact us.

5 Stress Management and Energy Conservation Stress can make the symptoms of lung disease (e.g. breathlessness) worse. Stress can be caused by a wide range of factors and is very individual; what causes stress to one person won t necessarily affect someone else. The body responds in a variety of ways to stress and anxiety and if not managed it can result in long term physical and emotional responses from the body. Tips to manage stress: Be aware of signs and causes of stress Don t allow difficult situations to overwhelm you Be realistic and be flexible Take one step at a time Take action- talk about it Get rid of stress in a positive way (exercise) Keep as active as possible Give yourself time for relaxation Energy Conservation If you can make tasks that you HAVE to do, such as washing and dressing, easier then you will not use as much energy, leaving you with more energy to do activities that you WANT to do. This can have a positive impact on your level of stress and anxiety as you have more energy to enjoy life. You can achieve this by using a combination of techniques: Practice breathing control and positions of ease to help make your breathing as efficient as possible. Knowing when to breathe in and out can also make tasks easier. Breathe in on the easiest part and breathe out on the hardest Take your time with all activities. If possible spread tasks throughout the day or week rather than trying to get them all done at once. Take breaks during activities and use levels of breathlessness as a guideline to know when to slow down/stop. Simplify your activity/task by Avoiding long periods of standing Slide rather than lift Minimise arm movements above shoulders Use an assistive device e.g. long handled shoe horn. Breathing Exercises There are a number of different breathing techniques that are taught to patients with lung disease; some are to manage breathlessness and some to help with sputum (phlegm) clearance. Exercises to help manage breathlessness Breathing Control - Breathing control means breathing gently, using the least effort. It will help to use breathing control when short of breath or feeling fearful, anxious or in a panic. By using breathing control the effort of breathing is reduced. How to do breathing control Get into a comfortable, relaxed position. Make sure that arms are supported. Breathe in gently through your nose and breathe out through your nose, if you can. If you cannot breathe out through your nose breathe out through your mouth instead. Try to let go of any tension in your body with each breath out Gradually try to make the breaths slower Closing your eyes may help you to focus on your breathing and help you to relax Do not force your breath Positions of Ease These are positions that you can use when you are breathless to help reduce the time it takes to recover your breathing. When you are using any of the positions below, it is important that you try and relax and reduce any tension in the upper part of your body (including your arms).

6 Chest Clearance Exercises Clearing your chest effectively is an important part of managing your condition. The most effective way to do this is using the Active Cycle of Breathing Techniques (ACBT). ACBT consists of 3 different breathing exercises: 1. Breathing control: (see exercises to help manage breathlessness) 2. Deep breathing: Take a slow, deep breath in through your nose and release slowly out of your mouth. 3. Huffing: Take a deep breath and then squeeze air quickly from your lungs, out through your open mouth and throat, as if you were trying to mist up a mirror or your glasses. Use your tummy muscles to help you squeeze the air out, but do not force it so much that you cause wheezing or tightness in your chest. My Symptoms My symptoms are normal for me Mild Flare-Up I am more breathless than normal but I have no fever and there is no change in the colour of my phlegm. Moderate Flare-Up I am more breathless than normal and coughing up more phlegm, or my phlegm has changed colour. I am much more breathless despite taking my reliever medication. Severe Flare-Up My breathing is much worse despite treatment. Plan of Action I will continue to take my usual medication. I will use my reliever medication. I will continue to use my medication as prescribed and I will also use my rescue pack. Steroids Antibiotic I will tell my GP or healthcare Professional within 2 days of starting this treatment. I will call my GP the same day as soon as my symptoms become this bad. If I cannot call myself I will ask someone to call for me. **To Remember** Do I feel worse than usual? Symptoms may include.. Increased breathlessness Increased phlegm or change in colour. Increased chesty cough What can I do?... Continue or increase your inhalers Start your rescue pack Keep calm and do your breathing and relaxation exercises I must remember?... Contact your practice nurse, or respiratory service team If symptoms are severe call 999 in an emergency. If you use your rescue pack please inform the GP to keep it topped up. You may be advised by a Physiotherapist to perform these in a postural drainage position or to do in sitting. You should perform chest clearance for 5-10min, twice daily as a minimum. I have chest pain or high fever. If I cannot wait to see my doctor, I will call 999 straight away. If I am too breathless I will ask someone to call for me.

7 Managing Exacerbations/Flare Ups There are many things you can do to help manage your chronic lung condition as mentioned throughout this booklet. Managing your condition when you are well is important but it is also very important to manage your lung condition effectively when you are unwell. An important part of this is being aware of the signs and symptoms of an exacerbation/flare up. The easiest way of recognising an exacerbation is to know and understand your normal symptoms i.e. sputum colour, degree of breathlessness. This way it is easier to identify when there is a change. If exacerbations are treated appropriately and promptly, then often admission to hospital can be avoided. If you are unsure as to whether to start your rescue pack, contact your GP/Practice Nurse and ask to speak with them over the phone to discuss further. The table on the page opposite is helpful to show you what to do in the case of a flare up or exacerbation Medication Medications prescribed for chronic lung disease help to improve respiratory symptoms - such as breathlessness, wheeze and cough, and quality of life. These medications can be given in different forms: inhalers, nebulisers, tablets/ syrups and sometimes oxygen. These medications need to be taken regularly and correctly to be fully effective. Remember that different medications are prescribed for different conditions and may not apply to you. Reliever Medications (Bronchodilators) These are inhalers which relax muscles in the airways (bronchi) to open them up (dilate) as wide as possible. They are quick acting (5-15 min) and short duration (4-6 hours) Examples include : Salbutamol (Ventolin) and Terbutaline (Bricanyl) Side effects include: fine tremors in hands/knees, increased heart rate, restlessness and headaches. Also available via nebulisers in larger doses Anticholinergic inhalers (bronchodilator) Another type of inhaler to open up airways. There are two types: Short acting and Long acting. Short acting: Ipratropium bromide (Atrovent) Works within mins and lasts for 3-6 hours Side effects: irregular heart beat Also available via nebuliser in larger doses. Theophylline Is a bronchodilator taken as a twice a day tablet Also known as Slo-Phyllin, Uniphyllin, Nuelin, Phyllocontin and Aminophylline Side Effects: nausea/vomiting, headache, fast heart beat Need regular blood tests to make sure you have the right dose, too much or too little can make you unwell.

8 Carbocisteine (aka Mucodyne) Is a mucolytic, meaning it thins mucous in the lungs, making it easier to cough up Taken as a capsule, one or two, up to 3 times a day, sometimes increased in exacerbation. It is also available in liquid form If it doesn t help after 4 weeks trial, its not for you Medications to help manage anxiety related breathlessness Opioids Morphine has shown to help reduce breathlessness when it is given in in small amounts (2.5mg) in liquid form. This is usually under controlled supervision. Anxiolytics They have also shown to help to reduce anxiety and improve breathlessness. Examples of anxiolytics: Diazepam and Lorazepam. Dual Bronchodilators These are a new class of inhalers used to treat the symptoms of breathlessness associated with chronic lung disease They combine 2 long acting bronchodilators Each bronchodilator acts on different receptors in your lungs Research shows that these inhalers may improve symptoms of breathlessness and quality of life for patients diagnosed with a chronic lung condition. Steroid Inhalers Drugs that are taken every day to reduce swelling and inflammation of the airways. Available as Single Dose steroids or Combination inhalers Single Steroid Inhalers Used mainly for patients with asthma. Taken twice daily, 1-2 puffs Side effects: Oral thrush, dry mouth Combination inhalers These inhalers combine two medicines a corticosteroid and a long lasting bronchodilator] They help to reduce breathlessness and inflammation in the airways. Side effects: Oral thrush, dry mouth Spacers or Areochambers This is a tube-like device that can be used with your pump inhalers only. It helps to make sure you receive more of the medication and stops the excess from staying in your mouth or throat. Oral Steroids A short course of oral steroids is useful in reducing the effects of a flare up. The usual dose is 30mg for 7or 14 days. In some cases this can be reduced slowly every 3 days. Steroids have many side effect include muscle weakness, vertebral weakening, diabetes, Cushing's and thinning of the skin. Additionally, steroids can increase the risk of pneumonia in patients with COPD Note: If you are diabetic, you may need to monitor your blood sugar levels regularly if you have been started on a course of steroids. You will need to contact your GP/ Diabetes team if your levels are too high. Antibiotics A course of antibiotics is given for 5-10 days for an infective flare up. An infective flare can be recognised by fever, changes in your sputum colour, amount and/or testing your blood for infection. Prophylactic (preventative) antibiotics may also be given to patients who have regular infections, for example Azithromycin which is taken 3 times a week. This will be commenced by your Chest physician/ or your GP in some cases.