On this page…
Introduction
Pulmonary rehabilitation is a programme of exercise and education for people who suffer with breathlessness due to chronic lung disease.
The aim of the programme is to increase your fitness levels to allow you to complete your daily activities more easily and to educate you on ways to manage symptoms and become more confident in managing your health condition.
St Helens pulmonary rehab offers a few ways to complete your rehab:
- Traditional face to face sessions: this consists of two classes a week for six weeks of approximately one to two hours each session. One hour will consist of individualised exercise and up to one hour of educational talks.
- Home based sessions with weekly telephone support: you will be provided with an exercise programme to complete at home for six weeks and we will provide you with any equipment you may require for the time you are under our care. Your exercise programme may be in the form of a paper booklet or if you are confident with technology we may be able to offer a digital programme for you to follow. You will receive weekly telephone calls from the team to support you with progressing your exercises and getting the most out of your programme.
- One to one supervised home based exercise sessions: For patients who are predominantly house bound we can offer one to one supervised exercise sessions at home where one of the team will visit once or twice weekly for a period of six weeks to complete your exercises with you and monitor progress.
- Education only programme: If you are currently unable to exercise but would like to attend education sessions for support with managing symptoms then we will do our best to facilitate this so please discuss with your therapist if this is something you would be interested in.
As well as attending pulmonary rehabilitation, you are encouraged to also complete exercises at home. At the end of the six week programme, a reassessment will be arranged with the physiotherapist to monitor your progress. This booklet contains information of the topics covered in the educational talks.
What is COPD?
COPD describes a group of lung conditions that make it difficult to empty air out of the lungs because of damage to the airways.
COPD is Chronic Obstructive Pulmonary Disease
- Chronic Long-term
- Obstructive Means blocked or obstructed airways
- Pulmonary Affecting lungs or airways
- Disease Medical condition impairing bodily functions
COPD is an umbrella term and comprises the following conditions:
Emphysema
The alveoli (air sacs) in the lungs are gradually destroyed, creating large air sacs, which are less able to absorb oxygen. This makes the lungs less elastic and cause a feeling of breathlessness.
Chronic Bronchitis
Bronchitis means inflammation of the bronchi which can lead to an increase in the amount of mucus (phlegm) in the airways which in turn may give you a chronic cough.
How do our lungs work?
We breathe in air through our nose or mouth. The air then travels down the trachea (windpipe) where it splits into two smaller tubes, one into the left lung and the other into the right lung. These tubes are called bronchi. These two tubes then divide into smaller tubes called bronchioles which then divide again to reach air sacs called alveoli.
It is in the alveoli that the oxygen is absorbed from the air, moved into the blood vessels and carried in the bloodstream around the body.
What causes COPD?
People can get COPD for different reasons, but most cases are related to smoking. Other causes include exposures to fumes and dust, air pollution and genetics.
The most important thing is to stop your lungs getting more damaged and to make the best of the lung capacity you have. Stopping smoking can help this as although it will not cure the condition it can help to prevent it from progressing further.
Symptoms of COPD
Shortness of breath- Excess production of phlegm (mucus)
- Chronic cough or ‘smoker’s cough’
- Wheeze, noisy breathing due to air being breathed through narrow airways
- Chest tightness
- Frequent chest infections.
Everyone will have different symptoms and some symptoms may trouble some people more than others.
How is COPD diagnosed?
There are several ways that your COPD can be diagnosed including:
- Lung function tests, spirometry
- Medical history
- Smoking history
- Family history
- Chest x-ray/CT scan
- Arterial blood gas test.
Other lung conditions with similar symptoms:
Bronchiectasis the airways have become irreversibly damaged due to the alveoli being abnormally dilated which affects the clearance of mucus.
Pulmonary Fibrosis occurs when the alveoli become thickened due to scarring which makes the lungs work harder.
Benefits of exercise
Exercising helps to improve our exercise capacity and can enhance the performance of activities of daily living.
Exercising regular has many benefits including:
- Reduce anxiety and depression
- Reduce the feeling of breathlessness
- Improve bone, muscle, tendon, and ligament strength
- Improves cardiorespiratory fitness
- Improved sleeping patterns.
The vicious cycle that increases breathlessness in patients with COPD is shown below:
- You feel breathless
- You become fearful of activity that makes you breathless
- You avoid those activities which make you breathless
- You do less activity
- Your muscles become weaker
- Weak muscles use more oxygen and are less efficient
- You feel breathless (the cycle repeats)
Avoidance of activity can lead to a loss of confidence, reduce physical fitness levels and increase social isolation.
Breathlessness is NOT harmful in a controlled form.
Exercise should be brisk enough to increase breathlessness. Participants should stop to rest. If breathlessness settles in three to four minutes, your exercise level is just right.
Managing breathlessness
Breathing control
Most people with COPD tend to breathe using the upper part of their chest, which is an inefficient way of breathing and requires a lot of effort and energy.
How can you change the way you breathe?
By using the lower part of your chest, that is, breathing from the diaphragm and relaxing your shoulders and upper chest, your breathing becomes more efficient.
- First you should relax in a comfortable, well supported position
- Try to relax your head, neck and shoulders
- Place one hand on your upper chest and one hand on your stomach just below your ribs
- Breathe in gently through your nose and then sigh the air gently out through your nose or mouth
- If you are breathing correctly, you will find that your stomach rises as you breathe in and falls when you breathe out.
- Your upper chest should remain still.
Try to practise this for a couple of minutes several times throughout the day and regularly ‘check’ your breathing to ensure you are breathing as efficiently as possible.
Methods to clear secretions
Breathing cycle: This is a cycle of different breathing techniques that can be used to help you clear secretions from your lungs and involves 3 techniques including: Breathing control (as described above), deep breathing and the forced expiration technique or huff.
Breathing control: Complete for 20 to 30 seconds.
Deep breathing: This technique expands your chest as far as possible allowing air to move behind any trapped mucus.
- Relax your shoulders and place both hands on your lower ribs
- Breathe in deeply through your nose and feel your ribs expand
- Breathe out gently through your mouth until your lungs feel empty
- Repeat three to four times.
The forced expiration techniques (huff): This technique encourages the sputum up through your airways till it can be cleared out when you cough (imagine you are steaming up a mirror).
Medium volume huff: This will move secretions that are lower down in the airways. Take a normal sized breath in, open your mouth wide and do a longer huff out until your lungs feel nearly empty.
High volume huff: This will move secretions that are high up in your larger airways. Take a deep breath in, open your mouth wide and huff the air out quickly. We would suggest that you complete these breathing exercises daily to help to clear any phlegm in your chest and you can use it a few times a day if your chest is more productive.
What can an occupational therapist do for me?
Do you have difficulty with any of the following:
- Putting your shoes or socks on
- Reduced confidence with hobbies you used to take part in
- Getting in or out of the bath or bed
- Mobilising up the stairs
This is where occupational therapy can assist, by providing advice and recommendations to assist with activities in our daily routine. An occupational therapist can assist you to be as independent as possible, as well as promoting your health and wellbeing. An occupational therapist will discuss and plan personal goals you would like to achieve.
An occupational therapist can:
- Prescribe aids and adaptions for the inside and outside of your home
- Advise and educate on your medical condition (COPD) and minimising the effect symptoms have on everyday lives
- Give advice on managing anxiety and depression
- Help adjust everyday tasks
- Give you methods to improve transfers, mobility and posture
- Advise on improving your sleep pattern and sleep hygiene
- Maintain or develop new hobbies and interests
- Ensure people who are at the end of their lives are as comfortable as possible
- Advise on benefits and completing forms
- Address concerns and provide advice on how to manage oxygen therapy with everyday life.
Nutrition
It is important that you eat a healthy, balanced diet to ensure that you are getting the nutrients that your body requires.
If you are eating well, you will feel more energetic, have healthy bowels and it will help to keep your body strong. Individuals with COPD have a decreased appetite due to breathlessness which can lead to weight loss. It is therefore advised to eat little and often, buy ready meals, store long life nutritious foods for days when you don’t feel well and have nourishing food and drinks.
Malnutrition is a common risk in patients with COPD which can affect the composition and function of the respiratory muscles and impairs muscle function.
The physiotherapist will be able to refer you to the dietician should you require further support.
Useful contacts
Pulmonary Rehabilitation Team: 01744 415 560
COPD Nursing Team: 0151 430 1553
Asthma and Lung UK: 0151 228 4723 or email: helpline
St Helens Wellbeing: 01744 371 111 or email: chcp
St Helens Talking Therapies: 01744 415 650 or website: www.merseycare.nhs.uk/our-services/st-helens/think-wellbeing
Carers Centre: 31-35 Baldwin Street, St Helens 01744 675615 or website: info
Contact Cares at St Helens Social Services: 01744 676 767
Our patients matter
Mersey Care NHS Foundation Trust aims to provide a high quality services which reflectthe needs of our communities. This means listening and responding to comments tohelp improve the services we deliver.
If you have any comments or concerns you can speak with a member of staff or contact our PALS and Complaints Team for Mersey Care NHS Foundation Trust
palsandcompaints
To request the leaflet in an alternative format or language please contact the Equality and Diversity Team.
Mersey Care NHS Foundation Trust
V7 Building
Kings Business Park
Prescot
Merseyside
L34 1PJ
0151 473 0303
Alternative Formats
You can use the accessibility toolbar at the bottom of your screen to change the text size and colour contrast on this page.
There is a “translate” button in the Accessibility toolbar, at the bottom of this page, however, this tool is automated and may not be accurate.
Speak to a member of staff if you wish to request this page in Braille or have any other questions about accessibility.
You can use the “print this page” icon at the bottom of the page to save or print a PDF copy of this leaflet.