Avoiding the Hospital When You Have COPD

The principles for managing chronic obstructive pulmonary disease (COPD) are pretty simple: Eat healthy, avoid cigarette smoke, take medicine, and use oxygen (if you need it) as your doctor prescribed. Following the basic steps, though, may not be enough.

A bad day with COPD can mean it's harder to breathe than usual. An acute exacerbation -- those symptoms that put you in the "red zone," like fever, shaking chills, confusion, chest pain, and coughing up blood -- can land you in the hospital. That's more likely when you've had at least three flare-ups in the past year or you have severe COPD (even without a flare-up).

You can't change the severity of your COPD, but you can take steps to lower your odds of having a flare and ending up in the hospital in other ways.

Eat Smart

Americans tend to idealize being thin. But not having enough "meat on your bones" (for example, being 5’5” tall and weighing 120 pounds or less) isn't healthy when you have COPD. Good nutrition keeps up your strength, so you can move air in and out of your lungs, and also helps your body fight infections.

Generally speaking, a diet with more fat and fewer carbs will help you breathe easier, because fat turns into less carbon dioxide as your body breaks it down.

When your weight is low, that means whole milk and whole-milk cheeses and yogurt are better. Eat more nuts, beans, and lentils. Choose complex, rather than simple, carbs including whole-grain breads, crackers, rice, pastas, and fresh veggies and fruits. Drink plenty of water, which can help thin your mucus.

If you're underweight because you have a hard time eating:

  • Have smaller meals and high-protein, high-calorie snacks throughout the day.
  • Choose food that's easy to chew, and take your time, breathing between small bites.
  • Eat high-calorie foods first, and your main meal early in the day.
  • Avoid things that cause bloating, like fizzy drinks and fried or greasy food.
  • Use your prescribed oxygen while you eat.
  • Drink water when you're done.

Talk to your doctor or a dietitian about the best eating strategy for you.

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Keep a Positive Attitude

Hundreds of studies link stress with a weakened immune system, and when you have COPD, that could mean flare-ups and trips to the hospital. Anxiety and depression can lead to flares and hospital stays, too. What's worse is that you may not realize you're dealing with these mental health concerns, because it seems normal to you.

Let your doctor know if you:

  • Worry most days
  • Are restless and easily irritated
  • Often feel sad or hopeless, and that affects your daily life

Medication and different types of therapy can treat mental health issues, which may improve your chances of staying out of the hospital.

A sunnier outlook and feeling good about yourself can help you stay on track with the things you need to do to take of your COPD. Simple practices can foster a sense of peacefulness and lift your spirits:

  • Listen to soothing or cheerful music
  • Watch a funny movie
  • Turn off the news
  • Avoid people or conversations that upset you
  • Meditate or use guided imagery
  • Do gentle yoga or tai chi

 

Stay Connected

It can't hurt to build your network of friends, either. Social interaction isn't just nice -- it's important to your health, like taking your medicine. Research shows that people with COPD who live alone are likely to be admitted to the hospital for an exacerbation.

If you're able to get around fairly well:

  • Check out free programs at your local library or community center.
  • Shop or browse in brick-and-mortar stores instead of getting what you need online.
  • Take a class that keeps you on your feet, if you can, such as cooking or tai chi.
  • Find a volunteer opportunity that speaks to you.

If your illness limits you:

  • Schedule one phone call a day to a family member or friend.
  • Take a class where you can sit, such as drawing or history.
  • Host low-effort gatherings at your home, like a potluck card game night.
  • Check if you're eligible for the local Meals on Wheels program.

You could also join a COPD support group, either in person or online, to be part of a community that can understand what's happening so you don't feel so alone.

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Get Your Body Moving

Regular physical activity is an important key to managing COPD. Even a daily short walk can make a big difference in your symptoms and quality of life. And it may help keep you out of the hospital.

Exercise can lower your heart rate and blood pressure, which makes your body better at using oxygen. (That means your lungs don't have to work so hard.) Cardio helps strengthen your chest muscles, which makes breathing a little easier.

Does the idea of exercise seem crazy? Ask your doctor if you're a candidate for pulmonary rehab. It's a program that gets you exercising under the guidance of an expert team, including a respiratory therapist. Afterward, you should be feeling better and ready to exercise on your own.

Call the Doctor

Maybe you try to tough it out when you get sick. Or you rarely call the doctor because you "hate to be a bother." You'll need to break out of those mindsets. A flare-up of COPD isn't something you should wait to run its course.

Talk to your doctor and find out which symptoms they want to hear about, such as:

  • More wheezing or coughing than usual
  • Breathing that's shallower or faster than usual
  • More mucus
  • Different color mucus (yellow, green, tan, or bloody)
  • Fever
  • Confusion
  • Very drowsy
  • Swelling in your feet or ankles

These can be warning signs that you're about to have an exacerbation -- or are already having one. A prescription for medicine, such as antibiotics or steroids, may help you get better at home instead of in the hospital.

Different ways of treating mild exacerbations are also being tried, like in-home care supervised by a respiratory nurse with help from a hospital team. Studies of comprehensive care management programs, where a coordinated team from your doctor to your respiratory therapist to an equipment provider all work together, suggest this approach may help prevent hospital readmissions.

Don't Make It Worse

The most common cause of a COPD flare-up is poor air quality, indoor and out. So clean up your air.

Start by removing clutter, which attracts dust mites. Get your air conditioner inspected for mold and mildew. Consider using an air filter. Avoid fumes from cleaning products, perfumes, and paint, which may trigger flare-ups. Stay away from tobacco smoke and pet dander.

Wash your hands often, and use hand sanitizer when you can't. Use your own pen at the doctor's office.

Make sure you're using your medications, including oxygen, correctly and when you should. At your next visit, ask for a refresher about when and how they're most effective. Tell your doctor if you have trouble paying for any treatment or are bothered by side effects.

During cold and flu season, get a flu shot, especially if you live in a care facility or home with a lot of other people.

WebMD Medical Reference Reviewed by Paul Boyce, MD on February 06, 2019

Sources

SOURCES:

International Journal of Chronic Obstructive Pulmonary Disease: "Risk factors of hospitalization and readmission of patients with COPD exacerbation -- systematic review."

My COPD Action Plan, v2, American Lung Association, 2016.

American Family Physician: "Management of COPD Exacerbations."

Cleveland Clinic: "Nutritional Guidelines for People with COPD," "Have COPD? Exercise Helps Keep You Out of the Hospital," "COPD General Medication Guidelines."

American Lung Association: "Nutrition and COPD."

COPD Foundation: "What is a COPD Exacerbation?" "Having Trouble Eating with COPD?" "Coping with COPD."

Psychological Bulletin: "Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry."

American Journal of Respiratory and Critical Care Medicine: "Impact of Anxiety and Depression on Chronic Obstructive Pulmonary Disease Exacerbation Risk," "Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation: EFRAM Study."

European Respiratory Journal: "Anxiety and depression in end-stage COPD."

Harvard Medical School: "How stress affects seniors, and how to manage it."

Respirology: "Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD."

Chronic Respiratory Disease: "What really matters to patients living with chronic obstructive pulmonary disease? An exploratory study."

Chest: "COPD Readmissions: Addressing COPD in the Era of Value-based Health Care."

Norwegian Institute of Public Health: "Intermediate care units and Hospital at home for acute exacerbations of COPD."

CDC: "Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities."

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