Chronic obstructive pulmonary disease (COPD) causes damage to the airways that can’t be reversed, but you’re not powerless. Pulmonary rehabilitation (PR) can help you reduce shortness of breath as it improves many other aspects of your physical and mental well-being.
Pulmonary rehab is a supervised medical program that usually takes place in a hospital or clinic on an outpatient basis. Typically, people who are having frequent shortness of breath or trouble doing routine activities despite daily medication are eligible.
The length of time you’ll spend in PR varies, but you should expect to take part in two or three sessions each week for several weeks or even a few months. It’s well worth your time: Research has shown that people who complete such programs lasting 6 to 8 weeks reap significant improvements in breathing ability, exercise capacity, and psychological health. They’re also less apt to be have frequent hospital admissions.
Getting Started With Pulmonary Rehab
If your doctor has recommended PR, they may direct you to one or more locations in your community where this program is offered.
Once you’re enrolled, your first step will be to have a baseline assessment that will be used to shape some of the details of your rehab plan. A nurse, respiratory therapist, exercise, physiologist, or other provider will give you several tests. These may include the following:
- Cardiac stress test
- Pulmonary function test
- Walking test that measures how far you can walk in 6 minutes
Parts of Pulmonary Rehab
PR itself usually has several different parts that include education, training, and counseling related to improving your life with COPD.
COPD education
As part of your PR, you’ll learn about lung anatomy, how the lungs work, and how your specific condition impacts your ability to breathe. You will also learn about:
- Medication management, including the best time of day to take prescribed medications
- When to check your oxygen level with a pulse oximeter
- When to use supplemental oxygen
You’ll also learn how to adapt your daily activities so that you’re less likely to become breathless while doing them.
Breathing techniques
Feeling like you can’t breathe can be frightening as well as life-threatening if you don’t know how to respond. In PR, you’ll learn techniques that will make it easier to breathe and help keep your oxygen levels up. The techniques taught may vary by program but may include:
- Deep breathing, which helps you take in more fresh air
- Pursed-lip breathing, which helps you slow your breathing and stay calm when you’re starting to struggle
- Diaphragmatic breathing, which strengthens the muscles in the diaphragm that help you breathe
You may also learn controlled coughing, which is a technique that loosens mucus in the lungs and prevents airway collapse.
Exercise training
Exercise is crucial to keeping your lungs and the rest of your body as strong and healthy as possible. In PR, you’ll learn how to slowly and safely increase your activity level so you can feel your best. Some aerobic exercise, such as walking, biking, or swimming, will almost certainly be part of the equation. You’ll also use weights or resistance bands to build strength and do stretches to improve your flexibility.
Nutrition counseling
When you have COPD, you may lose muscle mass. Also, certain foods may be more apt than others to trigger breathing problems. For example, simple carbs like those you find in foods like cookies and chips can add to fatigue by causing your body to hold in more carbon dioxide.
During PR, a dietitian or other expert should review your current eating patterns. They’ll then offer suggestions about how to tweak them for better health. They may advise you to take supplemental calcium and vitamin D, limit sodium, and eat more or less fat. If you’re having trouble getting enough calories, your provider might suggest using a supplemental medical nutrition product.
Psychological counseling
Shallow breathing kicks off a stress response in the body. When you don’t get oxygen deeply into your lungs, you feel short of breath, which can make you anxious. It keeps your diaphragm from moving to its full range of motion, so you don’t get air deeply into your lungs. So perhaps it’s not surprising that 20-40% of people with moderate to severe COPD have anxiety or depression symptoms.
Counseling and support groups, which are often part of PR, can help. Some studies have shown that one type of treatment, called cognitive behavioral therapy (CBT), may help to relieve feelings of anxiety, but more studies are needed to know for sure if other techniques may work just as well.
Health Care Disparities and PR
Although PR is a key element in managing COPD symptoms for a lifetime, many people of color don’t take advantage of these programs, even when they’re available in their communities. Research has discovered that Black people with COPD are 31% less likely to receive PR compared to non-Hispanic white people. People in this group with lower incomes were 58% less likely.
There are several possible reasons for this, including structural racism in health care organizations, distrust of the health care system by people in these communities, and unawareness of the importance of PR by health care providers. Researchers are looking into ways to help more people of color know the benefits of PR and find ways to take part.
Covering the Cost
If you have COPD with moderate to severe symptoms, your health insurance company or Medicare will likely cover PR. But ask the coordinator for the specific program you’re joining to confirm cost and eligibility details.
Show Sources
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SOURCES:
American Lung Association: “Coping with COPD and Anxiety,” “How Pulmonary Rehab Helps You Breathe,” “Nutrition and COPD,” “Physical Activity and COPD,” “Pulmonary Rehabilitation.”
Cleveland Clinic: “Pulmonary Rehabilitation: Is It For You?”
COPD Foundation: “Nutrition for Someone with COPD.”
Journal of Medicine and Life: “Psychological Intervention – A Critical Element of Rehabilitation in Chronic Pulmonary Diseases.”
Mayo Clinic: “Mayo Clinic Q and A: Benefits of Pulmonary Rehabilitation for COPD and Other Lung Conditions.”
Harvard Health Journal: “Relaxation techniques: Breath control helps quell errant stress response.”
NIH National Heart, Lung, and Blood Institute: “Pulmonary Rehabilitation.”
University of Maryland Baltimore Washington Medical Center: “Breathing Exercises for COPD.”
Tuberculosis and Respiratory Diseases: “Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked.”
Chest: “Anxiety and Depression in COPD,” “A Geographic Analysis of Racial Disparities in Use of Pulmonary Rehabilitation After Hospitalization for COPD Exacerbation.”
Annals of the American Thoracic Society: “Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries.”
Journal of Thoracic Disease: “Muscle atrophy in chronic obstructive pulmonary disease: molecular basis and potential therapeutic targets.”
