PERF, The Pulmonary Education and Research Foundation, is a small but vigorous non-profit foundation.  We are dedicated to providing help, and general information for those with chronic respiratory disease through education, research, and information.  This publication is one of the ways we do that.  The Second Wind is not intended to be used for, or relied upon, as specific advice in any given case.  Prior to initiating or changing any course of treatment based on the information you find here, it is essential that you consult with your physician.  We hope you find this newsletter of interest and of help

We Get Mail:

Many of the questions we receive, and problems we are asked about, in emails or phone calls are repeated again and again.  Since these problems seem common we will combine some of these communications and our answers to them. The letter below is a composite of several letters we have received in the past few months.

Several emails said something like this:  My husband has emphysema.  I am concerned about his drinking.  He has 2 or 3 shots a day.  Most days he skips breakfast and sometimes even lunch, but then he starts drinking in the afternoon. He gets sleepy after he drinks, and takes a nap.  If we go out for dinner he’ll have more to drink.  When we get home he will stay up for a little while, but then will go to sleep early.  He sleeps a few hours, but then wakes up and sometimes is up the rest of the night.  He doesn’t do any exercise at all.  Does his drinking make his COPD worse?  How important is exercise and diet for someone with a lung condition?  I am worried. (Signed a loving wife)

Dear Loving Wife,

We appreciate your concern.  Your questions about alcohol, sleep patterns and the value of exercise and good nutrition in COPD are very important.  It is impossible to cover such a large area in a letter but we will give you a few brief facts, to help you better communicate your problems to your physician.

Many physicians approve of their patients having a glass of wine with dinner at night.  However larger amounts of alcohol can cause problems.  A reactive depression is not uncommon in patients with COPD.  Alcohol can be a form of self-medication used to provide short-term relief for these feelings of depression.  Ironically, however, it may cause even more depression.  Alcohol is a respiratory depressant.  The alcohol may temporarily, for a very short time, relieve symptoms of shortness of breath.  However, especially in someone whose breathing is already compromised, it can potentially cause serious problems.  With the respiratory system already compromised by COPD, the additional respiratory depression caused by alcohol can increase the build up of carbon dioxide, the waste product of the body. This can result in sedation over and above that caused by the alcohol.  Large amounts could even cause unconsciousness.  In severe COPD, the body no longer adequately responds to this build up of carbon dioxide with an increased breathing rate to get rid of this waste product, which is the function of the lungs.  Alcohol also interferes with the sleep pattern.  While it may help someone get to sleep, it often causes wakefulness a few hours later.  The amount of alcohol that can cause this rebound effect varies with the individual.  As doctors who specialize in sleep medicine can tell you, sometimes even one glass of wine with dinner can cause sleep problems for some patients with COPD.  Naps during the day can prevent sound sleep at night.  It also sounds like your husband is replacing food with the empty calories of alcohol.  We urge you and your husband to discuss this with your physician, seriously focusing on this important problem. 

     It is increasingly clear that good nutrition is very important.  Vitamin pills can’t take the place of a balanced diet.  For patients with severe COPD we sometimes recommend 5 small meals a day rather than 3 large ones, to help prevent shortness of breath after eating, which some patients come to fear.  Your physician can tell you about additional specific recommendations such as the need to restrict the sodium in the diet. A multivitamin every day is usually recommended.  While coffee and tea have some bronchodilator effect, their side effects can make many people nervous and interfere with sleep. 

     Ongoing research is making it clear that good nutrition is especially important in COPD.  In most parts of the world those with COPD tend to be very thin, frail and malnourished, which is a serious problem.  When doctors from other parts of the world see American patients they find it hard to believe they are suffering from emphysema since so many of our patients are obese.  Is this better than being too thin?  No, it is not.  Now in addition to suffering from obstructive lung disease there also may be a restrictive component caused by excess weight and a large abdomen compressing the diaphragm.  Many women remember how short of breath they became in the last months of pregnancy because of a similar problem with a very different cause. 

     There is no longer any doubt that a regular exercise program, while good for all of us, is absolutely essential for those with COPD.  It is clear that even the most limited patient can achieve dramatic improvement by gradually increasing daily exercise.  One of the benefits of exercise is that it helps control depression.  It also helps patients sleep better, as is often seen after a pulmonary rehab program.  Starting an exercise program is very difficult for most people to do on their own.   However, an article on our website about how to get started exercising is worth reading and may be of help.  To locate this go to the PERF website at www.perf2ndwind.org.  Look in the Education column on the left hand side of the Home page.  There is an article on “The Importance of Proper Breathing Techniques” that is worth reading but go on to the next page where you will find “Starting an Exercise Program”.  Print this out for yourself.  

     A good pulmonary rehabilitation program can be of great help with learning how to breathe better and control shortness of breath.  It is very worthwhile, not only in starting an exercise program, but also in overcoming the depression so commonly seen in patients at the beginning of rehab.  The combination of exercise, better understanding of the problem of COPD, and finally being able to take charge and do something positive can make a huge difference.  Learning that you are not alone, that others have the same or even worse problems, and that there is so much that can be done to live a better life makes a huge difference for the patients in rehab as well as for their families. 

     A newsletter can only offer general advice.  To address your specific problems, we advise you to make an appointment with your physician.  You may wish to make a double appointment to allow enough time.  Your physician has access to all the records and can take a history and perform a physical examination.  This physician is your best source of help for specific answers.  Don’t be afraid to ask questions!  Be honest with your problems, since the problem that isn’t defined can’t be helped.  Nothing you say will be a surprise, a shock, or something your doctor has not heard before.  There is help available with support, medications, information and pulmonary rehabilitation.  Realizing that you have a problem is the first step in solving that problem.  You already are on your way.  Good luck to both of you!

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Here is another composite letter of questions we often get concerning altitude and the value of moving to a different climate. 

Sharon writes, “I have COPD and bronchiectasis and am wondering what to do.  I live in Denver where the medical care is excellent.  While I am not on oxygen, my lung functions are gradually getting worse. Should I move to sea level and live with my family in Hawaii to avoid using oxygen?

Dear Sharon,

     This is a question that only you can answer.  Many factors need to be considered, such as leaving behind a support system, friends and a neighborhood that you love.  How much do you enjoy being in Hawaii when you visit?  Have you ever stayed for more than a few weeks?  There is no doubt that the medical care for pulmonary patients doesn't get much better than it does in Denver.  However, there are also very good hospitals and pulmonologists in Hawaii depending upon where in Hawaii your son lives. He needs to check the availability of oxygen and how long it takes to get to a medical center if he lives on one of the less populated islands.

     Being at sea level can make a big difference in oxygen needs, but this is something you need to discuss with your physician.  It is certainly possible that even in Denver you may not need oxygen in the foreseeable future.  If you have an asthmatic component, the increased mold in that moist climate can exacerbate symptoms or even create new ones for some people.  The increased humidity in itself is a problem for some, especially those with bronchiectasis, while helpful for others.  Denver has a very dry climate so that will be a big change for you.  Do you feel better when you visit your family in Hawaii?

     Perhaps your physician can help you with some of these questions also.  There are many things to consider before anyone makes such a big move.  While we haven't given you a specific answer I hope we have given you some things to think about.  

Good luck!

Do you have a question about respiratory disease that has been bothering you? 
If so, feel free to write and ask us, either through our web site or by mail.
We answer all of your letters.

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