This week I had a wonderful opportunity to work with a new patient in pulmonary rehab. She had been managing her condition for years and I must say… doing an excellent job of it despite a few health-related setbacks. I was in awe of how this sweet lady had taken a well-rounded approach in her wellness and living a full life. Performing assessments with new patients is such a fun experience for me. I love hearing how people with lung conditions have been managing their lung diagnosis (whether new or old), what inspires them, and what proactive things they have done to impact their health. I am going to share a few things from her story (while maintaining her anonymity) that I thought were helpful ideas and how we decided to “tweak” or "tune"certain things to make living with her lung condition a bit easier.
1. She primarily uses her “rescue” inhaler to rescue her shortness of breath.
Sometimes it takes an act of Congress just to get my patients to fish their inhalers out of the depths of their purses or medicine cabinets, blow the dust off of it, and use it. So, I was happy to hear that my new patient admitted that she does use her inhaler when she gets out of breath. However, if you have been reading my blog for a while you know that I don’t particularly love the idea of referring to it as a “rescue inhaler.” (However, I know that most all of my patients refer to it as such so as to not confuse you all… I’ll follow suit.) In talking to my new friend, I found out that along with the breathlessness that she also experiences some anxiety (which as we all know is completely natural). My suggestion was that instead of always using the inhaler to rescue her breathing, that she attempts to use it more to PREPARE herself for activity. She mentioned to me that she recognizes that certain activities like walking long distances cause her to be breathless. Our plan is that she prepares for this activity by using her inhaler beforehand. She will find that she will be able to deliver a quality treatment if she is able to use the inhaler before her breathing becomes labored. I mentioned that using it prior to an activity that causes her to be breathless might help her get through the activity with less breathlessness, possibly reducing recovery time, and therefore allowing her to reduce the level of anxiety that her breathlessness causes. However, in contrast, I urge you all to use it to for a rescue (if needed) if you haven’t had an opportunity to use it to prepare.
2. Reminders of proper inhaler use.
As we talked further, I always like to cover proper use of inhaled medication. I have had patients in the past give themselves two quick sprays and think they have given themselves an effective breathing treatment. Let me just say that using your inhaler like Binaca (breath spray) is not an adequate way of administering your inhaler. Here is the way I instruct “rescue inhalers” or meter dose inhalers.
1. Start off with a large cleansing breathto open any airways that you haven’t been using in a resting state.
2.Shake your inhaler well to mix its contents.If you haven’t used your inhaler in months, sometimes they recommend dispensing a puff (or wasting a puff) in the air to prime the inhaler and blow out any dust that might have collected in the actuator. I’m not going to insist on this because I realized that many of my patients are on fixed incomes and that medications are expensive and for many of my patients… every puff counts.
3. Take another deep breath in and blow out slowly.
4. Right before you take your next breath in, hold the inhaler up to your mouth and form a seal with your lipsaround the mouth piece.
5.Press down on the actuator and breathe in AT THE SAME TIMEwith a medium speed.
6. Remove the inhaler from your mouth and hold your breathfor at least 7-10 seconds.
7. When you are ready, slowlyblow out
8. DO NOT immediately administer another puff if prescribed. Wait a FULL 1-2 minutesbefore administering next puff.
3. Her oxygen concentrator is loud and keeps her awake.
My patient was doing an excellent job of using her oxygen at night (to which I was so pleased). Getting used to using anything while sleeping definitely takes some adjustment. Many of my patients are plagued with frequent “wake ups” requiring them to use the bathroom etc. So when you have a noisy concentrator preventing you from falling back to sleep quickly, it can wreak havoc on the total number of sleep hours that you get. Oxygen concentrators also tend to produce a bit of heat and many people enjoy a cool bedroom for sleeping in. Our plan after talking it through is to move the concentrator to a spare bedroom. The tubing on most of these units can extend 50 feet which should give her ample length to run to her room. Remember: you want to avoid placing the concentrator in a small closet because it needs ample space for air intake and cooling. Also, I want to remind everyone that oxygen concentrators need routine service to replace filters and sieve beds. You will want to try and keep track of scheduling this yourself instead of relying on your homecare company to do it for you. Frequent servicing will keep your concentrator operating at this optimal condition and prevent excess noise that may occur from clogged filters etc.
4. She’s participating in yoga and “toning” classes at her fitness facility.
One of the hardest things (even for myself) is enjoying exercise. I often find that my new patients want to return to their “pre-diagnosis” selves as far as their physical fitness yet they often ask, “how long do I need to continue to exercise?” Exercise is one of the key components to maintaining your health and wellness so the prescription for it is “forever.” It was amazing to hear that this new patient of mine really enjoyed exercising. I loved the fact that she had been diligent about attending these classes. The yoga was helping her with strengthening, deep breathing, and stretching. The toning class consisted of strength training as well. She was enjoying the friendly atmosphere and that all of these classes were geared to seniors therefore “doable” for most lung patients. However, one thing was missing from her exercise routine and that wasendurance training. Endurance training whether it be walking on a treadmill, biking, etc. is incredibly important to a person with a lung condition. Often times out in the real world it’s not how fast can we do the activity but can you actually get the activity done? For instance, it’s not how fast you can grocery shop… it’s… can you do it and finish it? It’s not how fast you can walk into a restaurant… it’s… can you get from your car to the front door? After doing a 6-minute walk test, I could tell that endurance needed to be our focus. Therefore, the plan is for her to continue to attend the fitness classes that she loves but work with me to increase endurance and build confidence doing it.
5. She didn’t own a pulse oximeter.
When you are prescribed oxygen for home use, I would recommend you investing in this piece of home medical equipment which lets you know your heart rate and oxygen saturation. This fabulous new patient of mine was participating in fitness classes etc. but had no way of monitoring her heartrate and oxygen levels. There was some concern from family members that she didn’t recognize when she was experiencing shortness of breath until it was “severe” in their eyes. One thing I have noticed over the years, is that when someone has been living with a chronic lung condition for years, their idea of normal shortness of breath becomes skewed. Their family members start to notice they are breathless more while the patient can feel “no different.” It’s eye opening for some lung patients to hear that their family members feel as though their breathing is becoming more and more concerning. So, because many people with chronic lung conditions become accustomed to their breathlessness, the pulse oximeter keeps the guessing game in check by giving them an objective way of figuring out if their heart rate and oxygen is within normal limits. These little devices are fairly affordable at around $30 (as opposed to years ago you couldn’t find one less than $200). One of my earlier blog posts was on pulse oximetry so if you are interested in knowing more, feel free to check out that post as well. Most of my patients pick them up at places like Amazon (my fave), Walmart, and various drugstores.
Thanks for reading!
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