Physical Therapy Guide to Chronic Obstructive Pulmonary Disease (COPD)

In chronic obstructive pulmonary disease, the airways in your lung lose their normal shape and elasticity and can become inflamed. The result is that the airways are less efficient at moving air in and out of your lungs. Primary risk factors for developing COPD include:

• Smoking.
• Inhaling toxic substances.
• Indoor and outdoor pollutants.
• Genetic/environment interactions.
• Respiratory insult to the developing lungs during prenatal or early childhood stages of life.

Current research indicates that COPD is no longer considered a “smoker’s” or “older person’s” disease.

The most common types of COPD are:

• Chronic bronchitis—a chronic inflammation of the medium-size airways, or “bronchi” in the lungs, causing a persistent cough that produces sputum (phlegm) and mucus for at least 3 months per year, in 2 consecutive years.
• Emphysema—a condition in which small air sacs in the lungs called “alveoli” are damaged. The body has difficulty getting all of the oxygen it needs, resulting in shortness of breath (“dyspnea”) and a chronic cough.

In addition to causing breathing difficulty, COPD results in cough, sputum production, and other symptoms. The disease can affect the whole body and lead to:

• Weakness in the arms and legs.
• Balance problems and increased risk of falls.
• Nutritional problems (weight loss or gain).

People with COPD are likely to have other health problems that can occur at the same time or be related to COPD, such as:

• Reduced blood supply to the heart (ischemic heart disease).
• High blood pressure (hypertension).
• Depression.
• Lung cancer.
• Osteoporosis.
• Diabetes.
• Congestive heart failure.
• Coronary artery disease.
• Atrial fibrillation.
• Asthma.

Over time, COPD leads to a progressive decline in physical function because of increased shortness of breath (dyspnea) and loss of muscle strength. There are 4 stages of COPD — mild, moderate, severe, and very severe — based on measurements of the amount or flow of air as you inhale and exhale. People with COPD may need to take medications or may require supplemental oxygen.

Your physical therapist will perform an evaluation that includes:

• A review of your history, including smoking history, exposure to toxic chemicals or dust, your medical history, and any hospitalizations related to your breathing problems.
• A review of your medications.
• Assessment of what makes your symptoms worse, and what relieves them.
• Review of lung function test results that may have been performed by your physician.
• Muscle strength tests of your arms, legs, and core.
• Walk tests to measure your exercise capacity.
• Tests of your balance and your risk of falling.

Pulmonary rehabilitation, including exercise training for at least 4 weeks, has been shown to improve shortness of breath, quality of life, and strategies for coping with COPD. Your physical therapist will serve as an important member of your health care team, and will work closely with you to design a program that takes into account your goals for treatment. Your physical therapist’s overall goal is to help you continue to do your roles in the home, at work, and in the community.

Improve Your Ability to Be Physically Active

Your physical therapist will design special exercises that train the muscles you use in walking and the muscles of your arms, so you can increase your aerobic capacity and reduce your shortness of breath. You may also use equipment, such as a recumbent bike, treadmill, or recumbent stepper to improve cardiovascular endurance.

Research has shown that strength training in people with moderate to severe COPD increases muscle mass and overall strength. Your physical therapist will provide strengthening exercises for your arms and legs using resistance bands, weights, and weighted medicine balls

Improve Your Breathing During Activity

People with COPD often have shortness of breath and reduced strength in their “inspiratory muscles” (the muscles used to breathe in). Your physical therapist can help you with inspiratory muscle training, which has been shown to help reduce shortness of breath and increase exercise capacity. Your physical therapist can instruct you in pursed-lip and diaphragmatic breathing, which can help make each breath more efficient, and helps to reduce shortness of breath during your physical activities.

Improve Your Balance

The decrease in function and mobility that occurs with individuals who have COPD can cause balance problems and risk of falls. People who require supplemental oxygen can be at a greater risk for a fall. If balance testing indicates that you are at risk for falling, your physical therapist can help by designing exercises aimed at improving your balance, and helping you feel steadier on your feet.

One of the most important ways to prevent COPD is to stop smoking, which also can delay the onset of COPD, or delay the worsening of breathing difficulty. If you are a smoker who has a cough or shortness of breath but whose tests don’t yet show a decline in lung function, you may be able to avoid a diagnosis of COPD, if you stop smoking now! The American Lung Association offers an online Freedom From Smoking® program for adult smokers. Your physical therapist also can help you get in touch with local smoking cessation programs.

If you already have COPD, your physical therapist can guide you to help slow the progression. The therapist will show you how to continue an exercise program at home or at a fitness center after you’ve completed your physical therapy treatment. Regular exercise that is continued after pulmonary rehabilitation for COPD helps slow the decline in quality of life and shortness of breath during activities of daily living. It has been found that patients who continue exercising after completing a pulmonary rehabilitation program, maintained the gains that had been made, whereas those who stopped their exercise program had a major decline in their exercise endurance and physical functioning.

When COPD is accompanied by excessive body weight, breathing can be more difficult. Excessive weight can also inhibit the ability to exercise and decrease overall quality of life. Your physical therapist can help you manage your weight, or prevent unnecessary weight gain by designing an exercise program specifically targeted to your current abilities. Your physical therapist also can also refer you to a dietician for help with proper nutrition to support a healthy lifestyle.