One of the most common complaints I hear from patients with chronic obstructive pulmonary disease (COPD) is shortness of breath on exertion. This can be when the patient is involved with an activity such as mowing the grass or working around the house, or it can be noticed when walking up the stairs rapidly or walking down and up the driveway to get the mail or paper. Shortness of breath at these times is not just inconvenient but also frightening.
Patients will often reach for their “rescue inhaler” and try to relieve their symptoms with several inhalations. The relief noted with this approach is often more psychological than medical. At these times the solution is not to increase airflow with bronchodilator medication but to “decompress” the lung to allow more room for breathing. In patients with COPD rapid breathing causes the lungs to become hyper-inflated. Because of the narrowed airways in COPD, patients do not have enough time to empty their lungs of each breath when they are breathing rapidly. The result is some of each breath being “trapped” in the lung, and with each breath more and more air is trapped resulting is overinflated lungs without any room to breathe. Inhaler medication taken at this time does not really get down into the lung’s airways to work. The shortness of breath is not being caused by the inability to get air in but the inability to get air out. For the solution, stay tuned for my article next week.