Palliative care is a type of treatment designed specifically to provide comfort and support to people with serious chronic diseases. Unfortunately, despite the many benefits it can offer COPD patients, palliative care is extremely under-utilized by people with COPD.

This is largely due to the fact that most people aren't familiar with palliative care options for people with chronic respiratory diseases. Even those that are, however, often don't realize when or if they are eligible for palliative care.

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Of course, it doesn't help that palliative care has gained a less-than-appealing reputation as a kind of hospice service for end-of-life care. To the contrary, palliative care is available for people with varying degrees of COPD severity; it's not just for those in the terminal stages of the disease.

In this post, we're going to do our best to bust that bad reputation and dispel the myths that discourage people with COPD and other chronic respiratory diseases from seeking palliative care. We'll also explore the specific ways that palliative care can help COPD patients and their loved ones better navigate the difficulties of living with chronic disease.

We'll even walk you through the process of getting into a palliative healthcare program and what you can expect when you start palliative care. We'll cover everything from how to know if you're eligible for palliative treatment, how to know if your insurance will cover it, and how to get in touch with palliative care specialists near you.

If you think that you or a loved one with COPD might benefit from palliative care, or you're just interested in learning more about what it has to offer, this post is meant for you. We believe that every person with COPD deserves top-notch treatment, and we hope that information in this guide will encourage more COPD patients to consider palliative treatment.

What is Palliative Care?

Palliative care is essentially a special branch of healthcare dedicated to helping people cope with the difficulties of living with severe and long-lasting illnesses. It includes a wide range of services that can be tailored to meet the specific needs and concerns of individual patients.

Here are some examples of common services and treatments offered through palliative care:

• Symptom relief (including both symptoms caused by the disease and side-effects of medications)
• Pain relief
• Emotional and psychological support
• Physical/occupational therapy

Palliative Care Versus Curative Care

Palliative care is often differentiated from “curative” care due to subtle—yet important—differences in how the two branches of medicine approach patient care. While curative care tends to focus on treating patients' underlying health problems (e.g. improving lung function and preventing exacerbations), palliative care focuses on improving patient comfort and quality of life (e.g. relieving chest pain and reducing breathlessness sensations).

Put another way, curative care practitioners are trained to balance the risks of medication and treatments with tangible health improvements (e.g. increased lung function and physical strength). Because of this, they are often more hesitant to prescribe treatments (e.g. oxygen therapy) when they aren't strictly necessary for the patient's health.

On the other hand, palliative care practitioners are specially trained to balance the risks of treatments with the patients' subjective well-being in addition to their physical health. This makes them better equipped to prescribe treatments that reduce pain and suffering resulting from complex, severe, and life-threatening illnesses.

That said, there is not exactly a hard line separating curative and palliative care. They are not mutually exclusive, for example, and there is often overlap between the treatments used in palliative and curative care.

Some people, particularly those those with chronic, lifelong diseases (like COPD), receive both curative and palliative care at the same time. Some only receive one or the other; for example, some patients with incurable illnesses (for which there is no known treatment) are solely treated with palliative care.

Some patients switch from curative to palliative care suddenly (e.g. after a major diagnosis) while others make a gradual transition from curative to palliative care. In the case of chronic diseases like COPD, this transition usually follows the progression of the illness, starting in the later stages of the disease.

Who Benefits from Palliative Care?

Palliative care is available for people with a wide range of health conditions, especially serious, chronic, and terminal diseases. Contrary to popular belief, however, you don't have to have a life-threatening condition to benefit; palliative care can help at any stage of a chronic illness, including the earlier stages of COPD and other chronic respiratory diseases.

Here's a list of some common health conditions that can be treated with palliative care:

• COPD and other chronic lung diseases (e.g. cystic fibrosis)
• Heart disease
• Both curable and incurable cancers
• Alzheimer's and dementia
• Multiple sclerosis
• AIDS

If you think you might be interested in palliative care, don't be afraid to bring it up with your doctor. It's never too early or too late to start the conversation and learn about palliative care options that can help you (whether now or in the future).

What Does Palliative Care Look Like?

Because palliative care is tailored to individual needs and circumstances, there is no one-size-fits-all approach. Palliative care can take many different forms and every person's experience receiving palliative treatment is unique.

Most commonly, palliative care is provided by hospitals, hospices, and long-term care facilities because these are the places that tend to treat patients with the most severe symptoms and advanced forms of disease. However, you can also get palliative care from outpatient facilities; in some cases, you can even get basic palliative treatments (such as pain relief) from your usual doctor and/or COPD treatment team.

Palliative Care for COPD

Now that you know what palliative care is and who it's meant for, let's take a closer look at what palliative care looks like specifically for people with chronic respiratory conditions like COPD.

In the following sections, we'll discuss how palliative care is administered to COPD patients, including specific treatments and benefits that people with COPD and other respiratory diseases can get from palliative care. This should give you a better idea of what to expect—and what you can look forward to—if and/or when you (or a loved one) decides to seek palliative care.

How Can COPD Patients Benefit from Palliative Care

Most of the palliative care treatments for COPD are aimed at relieving the burden of the physical and mental symptoms caused by their disease. The benefits of these treatments include:

• Reduced chest pain
• Reduced fatigue
• Reduced shortness of breath
• Improved physical comfort
• Improved sleep
• Improved mental health (e.g. reduced anxiety and depression)
• Improved overall quality of life

Here are some of common COPD symptoms that can be treated with palliative care:

• Chest pain
• Coughing
• Shortness of breath
• Poor appetite & difficulty eating
• Poor sleep
• Fatigue
• Anxiety
• Depression

Palliative care can also have a downstream effect that benefits your loved ones, especially those who have taken on caretaker roles. When your primary needs are being taken care of by palliative treatment, your family doesn't have to worry as much or shoulder as much of the care-giving burden, leaving more room to establish and strengthen normal friend and family bonds.

What Kinds of Palliative Care Treatments Are There for People with COPD?

Palliative care for COPD can include a wide variety of therapies and treatments. This includes treatments designed specifically for COPD and respiratory disease patients as well as generalized treatments designed to treat common symptoms (e.g. pain and fatigue) affecting people with chronic disease.

Generalized palliative care treatments that can help COPD patients include medications and physical therapies to relieve chest pain, muscle soreness, and physical fatigue. You can also get mental health support for psychological problems (e.g. health-related anxiety and depression), which are very common among people with COPD.

You can also get help with problems related to appetite and eating, which are common in people with advanced COPD. A palliative care team can, for example, get you working with dietary and nutrition specialists that can provide you with a tailored meal plan and personalized dietary advice.

COPD-specific palliative treatments include efforts to reduce the discomfort of breathing and shortness of breath with medications such as inhalers, opioid medications, and supplemental oxygen. It can also include physical therapy and respiratory disease education that teaches skills for managing symptoms and carrying out daily tasks.

There are also treatments for patients who struggle with shortness of breath while sleeping or otherwise have difficulty getting restful sleep. These include sleep-inducing medications and respiratory therapies (e.g. CPAP, BiPAP, and supplemental oxygen therapy) that help you breathe easier while you sleep.

Some treatments that palliative care can provide are not typically offered by doctors that practice curative COPD care. These include opiate medications, which studies show can significantly reduce shortness of breath in (some) severely breathless patients, especially those in the later stages of COPD.

Of course, opiates have many health risks and, ultimately, only treat diseases symptoms; they don't treat the underlying cause of the disease. This makes many curative healthcare practitioners hesitant to prescribe them in the absence of a compelling physical health need.

Palliative care specialists, on the other hand, are better equipped to evaluate the risks of opiates and other medications for patients compared to the subjective benefits (e.g. reduced patient suffering) even if they aren't exactly necessary to treat the disease. They are also specially trained to treat symptoms in the most complex and difficult situations, including in patients with multiple co-morbid diseases (a circumstance that is common among people with COPD).

In some cases, palliative care can offer COPD patients easier access to supplemental oxygen therapy, which is normally only prescribed to treat low blood oxygen levels. Patients receiving palliative care, however, are sometimes prescribed supplemental oxygen to relieve breathlessness, even if their blood oxygen levels aren't quite low enough to justify it on its own.

Myths and Misconceptions About Palliative Care

Palliative care is a commonly misunderstood healthcare service, which is likely due to the fact that relatively few people have had real-life experiences with palliative care. As a result, many people have false ideas about palliative treatment, including what it is, who it's meant for, and what kinds of symptoms it can treat.

These misconceptions discourage some people from seeking palliative care despite that they could benefit from it significantly. So, before we share some tips for how to get started with palliative treatment (the final part of this guide), let's take a minute to discuss—and bust—some of the most common myths about palliative care.

Palliative Care is Only for People Who Are Dying

Unfortunately, one of the main reasons why people with chronic diseases don't get palliative care is that they simply don't realize it's an option. Either they don't know that it exists, or they (mistakenly) assume that they're not sick enough; they think that palliative care is meant for other kinds of patients, not them.

That's because palliative care has a reputation of being just like hospice, a holdover from when that used to be what palliative care was for. As we mentioned earlier, palliative care originated as an end-of-life health service for terminally ill patients, and this is still a major function of palliative care today.

However, the scope of palliative care has expanded significantly over the years to include services for patients with a wide range of health conditions. As a result, palliative care is now available to people with less severe diseases, including people with any stage or severity of COPD.

Unfortunately, many people still make the false assumption that you have to be on your deathbed (or at least getting near it) to qualify for palliative care. Luckily, many healthcare professionals are aware of this problem and are working to raise awareness about the broad scope of palliative care.

Accepting Palliative Care Means I've Given Up

Some patients are afraid to accept palliative care (or even downright refuse it) because they're afraid of what it might mean. For some people, starting palliative care feels like they're losing or giving up something, or even giving in to their disease.

But the truth is that accepting help when you need it isn't a weakness, nor is it an admission of defeat. In fact, it's the farthest thing from it; it means that you're still willing to fight for your own well-being, that you still have hope your future and maintaining a good quality of life.

Of course, it can still be very scary to face the reality of living with a chronic illness, which is something you just can't avoid in palliative care. But ignoring it won't change reality or make anything better—it will only make things worse by discouraging you from getting the help and support that could allow you to live a happier, more comfortable life with COPD.

Palliative Care is Useless

Hopefully we've done enough so far to convince you that palliative care isn't useless, but it remains a common worry among those that are hesitant to accept palliative care. They worry that it's a waste of time, that it won't be able to help them, or that it's not worth the extra effort and expense.

Of course, while not everyone who gets palliative care will see major benefits, you shouldn't assume that it won't work without at least figuring out if it's true. As we've discussed already, palliative care can provide all kinds of worthwhile benefits to respiratory disease patients, ranging from improved breathing symptoms to increased appetite and more restful sleep.

Additionally, what we've talked about so far is far from comprehensive; palliative care can provide benefits for people dealing with all kinds of different symptoms, ailments, and diseases that we haven't mentioned in this guide. In fact, palliative care is designed to provide solutions for uncommon and difficult-to-manage symptoms which haven't (or can't) be adequately addressed by curative care.

No matter what symptoms or ailments you're suffering from, it's worth looking into whether or not they can be treated with palliative care. You never know until you try; worst case scenario, nothing changes. But in the best case scenario, you could get some real, meaningful relief.

How to Get Palliative Care for COPD and Other Chronic Respiratory Diseases

Getting palliative care is not always a straightforward process. It can be very difficult for people—especially those with chronic illnesses like COPD—to know when they need palliative treatment. And, even when you do, it's not always clear how to access that kind of care.

So, in these final sections, we'd like to take a closer look at what it takes to get palliative treatment for COPD. We'll discuss how to get process started, how to manage the costs of treatment, and everything else you need to know about how to secure palliative care for yourself or a loved one with COPD.

Talk to Your Doctor

If you are interested in palliative care, the first step is to talk to your doctor and/or your COPD treatment team to figure out when and if palliative care is appropriate. As we discussed earlier in this guide, the answers to those questions are different for every patient and depend on each individuals' circumstances and needs.

Unfortunately, there's no easy way to pinpoint an exact time in the course of COPD treatment when you should begin palliative care. That's why it's up to you and your COPD treatment team to figure out what's right for you.

As one research review on palliative care for COPD put it, “there is often no clearly identifiable point at which [COPD] management changes from active supportive therapy to palliative care, and it's usually a matter of experienced clinical judgment.” This is why it's important to discuss future treatment options with your COPD treatment team early on and throughout the course of your COPD care.

Clear and open communication with your treatment team is key for ensuring that they are aware of—and taking care of—all your healthcare needs. They will be an integral part of the process when and if you begin palliative treatment, so don't be afraid to communicate with your doctor(s) about where your treatment is headed and when you should start thinking about palliative care.

Get in Touch with a Palliative Care Specialist

If you are a COPD patient that only needs basic palliative treatment, your regular doctor and/or treatment team might administer those treatments on their own. In fact, many COPD patients receiving standard COPD care are receiving some kind of palliative treatment whether or not it's explicitly referred to as “palliative care.”

In cases where you need more extensive palliative support, your doctor might refer you to a palliative care specialist. If you need help, your doctor can get you in touch with palliative care services in your area that can offer the kinds of services you need.

You can also inquire about palliative care services anytime you are hospitalized or receiving treatment in an assisted living facility. You can also locate palliative care specialists near you on your own through your insurance provider's directory or by searching your city, state, or zip code in the web directory at Get Palliative Care.

Securing Insurance Coverage for Palliative Care

Unfortunately, we can't talk about the realities of accessing palliative care in America without also discussing the financial costs. Just like every kind of healthcare, palliative care can get expensive, and the vast majority of people don't have the up-front cash to handle major medical expenses on their own.

Because of this, many people's ability to get palliative care depends on whether or not their health insurance will cover the cost. And because health insurance benefits vary widely between different plans and providers (even Medicare plans can vary state by state), there's no way to know for sure what your insurance provider will cover without looking at your personal benefit plan.

Fortunately, most medicare and private insurance plans cover at least some palliative care services; unfortunately, not everyone qualifies for coverage. Medicare, for example, usually only covers palliative care for terminally ill patients who are nearing end of life and are no longer receiving curative care.

Some private insurance plans have broader criteria and will approve palliative treatment for patients in less severe circumstances. It all depends on your particular benefit plan, which is why it's vital to review all of your insurance plan's rules, benefits, and exceptions before starting palliative care.

If you are ever unsure about whether a particular healthcare service (palliative care or otherwise) is covered by your insurance, calling your health insurance representative directly is the best way to find out. The closer you work with your insurance company to cover all your bases, the less likely you are to get blindsided by surprise bills, claim rejections, and out-of-network fees.

Conclusion

Whether you're considering

For many people fighting chronic lung diseases like COPD, the hardest battles are not the physical ones, but the ones that happen inside the mind. Coping with a disease that disrupts your breathing—a basic life function—is far from easy, and it takes a major mental toll on many people with the disease.

Though COPD is usually thought of as a disease that affects the physical body first and foremost, it's known to come with a long list of psychological side-effects and risks. These include clinically-recognized disorders like anxiety and depression as well as other forms of mental and emotional distress that are a bit more difficult to quantify and define.

Many people with COPD find themselves consumed with worry, for instance, or over-focusing on the difficulties and losses in their lives. While this is a common, natural reaction shared by many people with chronic diseases, it's not a healthy, happy, or sustainable way to go through life long term.

Luckily, there are many healthy, effective tools for coping with COPD and the sometimes overwhelming emotional challenges of living with the disease. In this post, we're going to focus on one method in particular: gratitude exercises, which are proven to help improve happiness and emotional well-being.

Though little-known and under-appreciated, gratitude exercises are backed by a great deal of research that supports the idea that gratitude—when practiced correctly and consistently—can improve a variety of different aspects of mental health. In particular, gratitude exercises can make it easier to cope with misfortune and help you find more contentment and appreciation in life in spite of your COPD.

Why Gratitude?

At first glance, gratitude practice might sound like a strange solution for people who struggle to cope with the mental and physical strain of COPD. We understand how it might sound ironic—or even condescending—to suggest that people should feel grateful while dealing with a debilitating, chronic disease.

Certainly, we're not saying the people with COPD should be grateful for their disease, nor that people with COPD should feel any obligation to be grateful at all. However, gratitude is a recognized psychological intervention, and it's something that anyone can practice by doing simple exercises at home.

Practicing gratitude also doesn't mean you're supposed to feel grateful all the time. It's not meant to invalidate your feelings, replace negative emotions, or even drown out unpleasant thoughts. Instead, gratitude practice is meant to help you access more positive emotions in addition to the negative ones, and to help you see the good things even when the bad things are hard to see past.

According to one blogger who writes about their experiences with chronic illness, "It is not easy to feel thankful when we are chronically ill; in fact, sometimes we feel cheated out of life." However, she explains, that's all the more reason to practice gratitude, which, like any skill, can be honed and improved over time.

Practicing gratitude helps you look at the world through a different lens—one that helps you see beyond your struggles and recognize the good things in your life. In this way, gratitude practice helps you build a more positive outlook on life in general, which can help you keep hope and happiness alive no matter how bad things might seem.

What Does Gratitude Have to Do With Mental Health?

Research on gratitude shows that it has a variety of mental health benefits, and many people with COPD report finding comfort and relief in gratitude. Of course, that doesn't mean gratitude practice works for everyone, but it does suggest it's a worthwhile option for people who struggle with mental and emotional health because of their COPD.

Gratitude is an important concept in the field of positive psychology, a sub-set of psychological research that focuses on identifying traits and behaviors that support positive mental well-being. This area of psychology is all about strengthening positive traits (reinforcing the things that make people happy) rather than fixing negative traits (correcting the things that make people unhappy).

In the scope of positive psychology, the purpose of gratitude is not to treat any specific mental problem or disorder, but to help people cultivate habits and perspectives that promote better general mental health. Of course, we're not suggesting that gratitude practice is a substitute for mental health treatment, or that gratitude alone is enough to overcome the (often) enormous burden of COPD-related emotional distress.

While gratitude can be a helpful tool for those struggling with mental problems, it's not enough to treat serious emotional problems or mental illnesses on its own. If you suffer from a mental illness like anxiety or depression, or you are unable to cope with the mental burden of COPD on your own, you should first seek proper treatment from a trained mental health professional.

If you'd like to learn more about mental health treatment for COPD or other coping methods to try, check out the following guides from our respiratory resource center:

• Coping with COPD
• Mental health treatment options for people with COPD
• Mind-body exercises for COPD

What Does it Mean to Practice Gratitude?

We often think of gratitude as something we show to others, but gratitude is also something you can practice all by—and for—yourself. That's what this guide is all about: how gratitude as a personal practice can help you feel better and cope better with the mental difficulties that often come with COPD.

In the simplest sense, gratitude practice is simply the act recognizing positive things in your life. It's about seeing the good things through the bad and taking time to actively look for—and spend some time thinking about—things in your life that you can be thankful for.

Personal gratitude practice is not about expressing thanks to others; it's about using gratitude as a personal tool to improve your mental well-being.

More specifically, however, “gratitude practice” can mean doing structured gratitude exercises that help you “practice” gratitude in a more deliberate, goal-oriented way. These gratitude exercises (also known as “gratitude interventions”) are designed to help you harness the benefits of gratitude to improve your psychological health.

Gratitude exercises come in many shapes and forms, including written activities (such as gratitude journaling) and more abstract thought-based techniques (such as gratitude meditation) We'll show you how to practice these and other effective gratitude exercises a bit later in this guide.

Of course, it's possible to practice gratitude on your own without a strategy; however, studies suggest that you're likely to get more from your gratitude practice if you do it in a structured way. Gratitude exercises provide a framework to help you practice gratitude consistently and put the practice to work in your life.

As the authors of one study put it (PDF link), “relatively simple intentional changes in one’s thoughts and behaviors can precipitate meaningful increases in happiness.” That's what gratitude practice is all about: improving your mental well-being by taking deliberate actions to recognize and reflect on the things you have to feel thankful for.

How to Find Gratitude Under the Shadow of Chronic Disease

So far we've discussed the meaning of personal gratitude and what gratitude exercises are, but we haven't yet discussed what it really means to feel grateful, or what kinds of things you should feel thankful for when yo have COPD. These are personal questions that form the core of gratitude practice, and the answers depend on your depend on your experiences, your circumstances, and what you value in life.

Unfortunately, many people with COPD and other chronic diseases have faced so much misfortune that that they lose touch with what it's like to grateful. When your life is full of health problems and hardship, it can even feel impossible to find anything that you could feel thankful for.

However, times like these are often when you need the gratitude the most. Even if it seems like you don't have much to appreciate, doing gratitude exercises can help you fine-tune your gratitude senses and teach yourself how to recognize the good things, both big and small.

You'll likely be surprised at all the positive things you can find when you're actively looking for them instead of focusing on the problems and hardships in your life. With practice, you can learn to find joy and contentment in even the most mundane and unexpected places, like the pleasure of taking your first sip of morning coffee or the satisfaction of practicing self-care.

This is especially important for people with COPD, many of whom live with constant reminders of their disease and what their body can't do. Gratitude practice can teach you to love and appreciate your body more by helping you acknowledge all of the amazing, helpful things that your body can do.

That's what gratitude practice is all about—getting in the habit of looking out for the good things no matter how grim and hopeless your circumstances might seem. Sometimes it just takes some time to build up your gratitude muscle before you can break outside the box of negative thinking and explore the full positive potential in your life.

Just know that there is no right or wrong way to feel personal gratitude, and there's no right or wrong thing to feel grateful for. What matters most is what you think is worthy of gratitude, and how you can put those feelings of gratitude to work in your life.

The Benefits of Gratitude for People with COPD

The psychological sciences have long recognized the potential of gratitude to improve mental well-being, and it's been the topic of a great deal of studies over the years. In fact, there's a wide body of academic research on gratitude that spans the fields of positive psychology, mental health treatment, and quality-of-life improvements for people with chronic diseases.

Before we go on, however, it's important to clarify that there's an important distinction between looking at the benefits of gratitude (as an existing feeling or trait) versus the benefits of gratitude interventions (exercises that focus on gratitude and appreciation). Both are important for understanding how gratitude effects well-being, but they tell very different stories about what the benefits of gratitude mean.

Studies on the benefits of gratitude itself essentially describe the differences between people with different gratitude tendencies; they compare the well-being of people who have more gratitude to the well-being of people who have less. However, studies on the benefits of gratitude interventions actually measure how people's well-being changes in response to gratitude exercises, and how gratitude can be used to increase people's well-being.

In other words, the benefits of gratitude alone may only apply to those who are already grateful people; they don't tell us much—if anything—about what gratitude exercises can do. The benefits of gratitude exercises, however, can apply to anyone who completes a gratitude intervention, regardless of natural gratitude tendencies or baseline gratitude levels.

It's also important to note that, in general, the size of gratitude benefits tends to be modest; however, that doesn't mean that gratitude can't still have a significant positive effect on people's lives. Gratitude isn't exactly a game-changer, but it is an effective tool for building healthier mental habits and introducing more positive feelings and perspectives into your life.

Improved Emotional and General Well-being

Two things that research consistently finds about gratitude is that it tends to foster positive emotions and that people who feel more gratitude tend to have better mental health. Research also shows that gratitude exercises are associated with a variety of other benefits related to personal well-being.

Numerous studies, for example, have found that people who participate in simple, structured gratitude exercises—such as writing down what they're thankful for every day—tend to experience more positive emotions and fewer negative emotions than people who don't. Studies also show that gratitude interventions can increase people's general happiness and satisfaction with their lives.

One large meta-review that analyzed 38 high-quality gratitude studies offers a great summary of the effects of gratitude interventions, including how well they work and what their benefits are. The study identifies nearly a dozen specific benefits of gratitude practices, including:

• Increased gratitude
• Increased happiness
• More positive feelings
• Fewer negative feelings
• Reduced depression
• Increased well-being
• Increased life satisfaction
• Increased optimism
• Increased relationship quality

The meta-review also confirms that these positive effects aren't just temporary; in fact, they seem to be just as strong when measured at 6 months after the gratitude intervention as when they're measured just two weeks after the exercise is done. One study on older adults, for example, found that a two-week gratitude intervention resulted in improved well-being that persisted for at least 30 days.

This emotional boost is is something that many people with COPD could benefit from, particularly those who tend to feel hopeless or pessimistic about their condition. By helping you learn how to think and feel more positively, gratitude practice can help you break free from the cycle of negativity and despair that so often plagues people living with chronic diseases.

Increased Resilience

Research shows that gratitude is an effective tool for coping with hardship, including the hardship of living with chronic illness. One study, for example, found that feelings of gratitude are associated with a reduced risk of depression in people with chronic disease.

This is likely due to the the fact that gratitude fosters positive feelings, and positive feelings make it easier to cope when things get tough. This is part of the “broaden and build” model in psychology, which suggests that experiencing positive emotions creates a kind of “reserve” of positive feelings that you can use to help yourself feel better in times of need (PDF link).

In other words, doing activities (like gratitude exercises) that generate positive emotions now can make you more resilient to hardships in the future. This is particularly helpful for people with COPD and other chronic diseases whose lives are often filled with struggles big and small, both in the context of daily living (e.g. chronic discomfort and gradual physical decline) and in the context of managing their disease (e.g. hospitalizations and unpleasant treatments like oxygen therapy).

Gratitude exercises can help you build up the mental fortitude you need to cope with these struggles and get the most out of life. The stronger your mental health and skills in positive thinking, the better you'll be able to deal with whatever troubles that life (and COPD) throws your way.

Improved Relationships

Another benefit of gratitude that's worth mentioning is improved relationships. Several studies have shown that gratitude interventions can improve relationship quality and satisfaction, in part helping you appreciate your bonds with other people more.

This is an important benefit for people with COPD, who often feel isolated at a time when they need other people the most. Who knows? Practicing gratitude could help bring you closer to your loved ones or help you discover new sources of love and support that you didn't even know you had before.

Improved Sleep

A number of studies have investigated the impact of gratitude on physical health measures like blood pressure or sleep quality, but results so far are inconclusive at best. Unfortunately, there is very little research in this area, since most studies (understandably) focus on the mental health benefits of gratitude rather than physical health.

However, several studies suggest that gratitude interventions can improve sleep quality. This makes sense, since we know that gratitude can have a variety of psychological benefits, and research shows that sleep quality is closely connected to psychological health.

Other studies suggest that gratitude interventions might be able to improve other physical factors such as blood pressure, asthma control, or eating behaviors. However, based on the evidence found so far, many researchers doubt that these benefits are substantial, if they exist at all.

Improved Quality of Life for People with COPD

Unfortunately, very few studies have looked at the implications of gratitude and gratitude interventions for COPD patients specifically. Those that have, however, have come up with similar results to those found in other gratitude studies.

One study, for example, found that people with COPD who are predisposed to feel gratitude tend to have a better quality of life than those who don't share that trait. Researchers from one study specifically recommended gratitude exercises as a means for COPD patients to "work toward more flexible, positive thinking through the use of concrete tools."

This suggests that gratitude is not only beneficial for people with chronic diseases, but that gratitude exercises can be an effective tool for coping with COPD specifically. This is echoed in the personal testimonies of COPD patients (on sites like copd.net) who have found and hope and healing through gratitude.

To sum it all up, gratitude helps you appreciate what you have and feel more satisfied with your life and relationships, even when things are difficult because of your COPD. Doing activities that foster gratitude and other positive emotions can also also make you more resilient to adversity, making it easier to cope with health-related misfortunes such as hospitalization or COPD-related physical decline.

Potential Drawbacks of Gratitude Practice

While gratitude can be a helpful tool for good, it can sometimes backfire if used in the wrong way. For example, focusing on too much on gratitude—or letting it become a rigid way of thinking—can undermine other valid thoughts and emotions you have.

You might start to think “I shouldn't think these negative thoughts, I should feel grateful!” which can just make you feel guilty for feeling bad. That's why gratitude isn't supposed to be used to replace negative feelings, but rather to add more positive feelings and thoughts into your life.

You shouldn't ever feel pressured to feel grateful; it's okay to feel how you feel, even if you feel bad, and even if you have lots of things to be grateful for. In fact, it's important to let yourself experience unpleasant emotions without judgment or shame, and to make peace with your negative feelings rather than wishing them away.

According to the psychotherapist Katie Willard Virant, "to be thankful for what one possesses does not mean that one cannot simultaneously feel grief for what one has lost.” She explains how her experiences have taught her that gratitude does not necessarily put a stop to mourning, but rather “[places] it into a context that [makes] it more bearable.”

Another thing you should avoid during gratitude practice is comparing yourself to other people, which often leads to unnecessary judgment and guilt. For example, you might end up thinking, “Some people have illnesses that are worse than mine, so I shouldn't feel so depressed about having COPD!”

It's important to remember that your feelings—whatever they are—are valid, no matter whether or not other people have it better or worse than you. In fact, there's no need to pass any judgment at all about what you “should” or “shouldn't” feel grateful for. Whatever you can find to appreciate within yourself and your own circumstances is worthwhile, no matter what other people's circumstances might be.

As you practice gratitude, it's important to check in every once in awhile to make sure it's helping and working for you. Gratitude practice isn't for everyone, and it's only worth doing if it actually helps you feel better, not worse.

How to Practice Gratitude

Now that we've discussed the merits and reasoning behind using gratitude as a coping method for COPD, let's take a closer look at some different techniques for practicing gratitude. In the following sections, we'll introduce you to several simple gratitude exercises along with some helpful tips for how to get started on your own.

Like most types of mental health and coping techniques, everyone's experience is different, and different methods tend to work for different people. So, if you're new to gratitude practice (and even if you're not), you might need to try out more than one method before it sticks.

Gratitude works best when you practice it frequently; ideally, you should try to do a gratitude exercise every day or at least a few times per week. You might find it easier to make it a habit if you integrate the exercises into an existing daily routine, such as your usual self-care regimen or bedtime preparations.

Also keep in mind that none of these practices are set in stone; feel free to tweak, adjust, and combine these exercises—and any others you come up with—however you see fit. What's important is to find a technique that feels meaningful and resonates with you.

Daily Gratitude Reflections

Doing daily gratitude reflections is probably the easiest way to practice gratitude: all you have to do is spend a few minutes at the end of every day to think back on good experiences and the things you have to appreciate. It's a great place to start if you're new to gratitude practice since it's quick, simple, and doesn't take any special skills or supplies.

The goal of these reflections is to put yourself in a mindset of positivity and gratitude long enough to come up with at least a few specific things that you feel thankful for. Those things can be just about anything: something good that happened to you, something that's made you happy recently, or just about anything positive you've might have noticed or experienced throughout the day.

You might find these gratitude reflections more difficult some days than others, such as when you feel sick or things just aren't going your way. However, it gets easier to access feelings of gratitude—even on the bad days—over time as you practice putting yourself in the mindset of actively seeking out the good things in your life.

Gratitude Journaling

Gratitude journaling is one of the most common and well-studied methods for practicing gratitude. It's basically just like gratitude reflection but with one extra step: you have to write down the things you are thankful for, or at least write down your thoughts about good things you've noticed or experienced throughout the day.

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Living with a chronic lung disease like COPD means dealing with a lot of uncertainty. This includes small, everyday uncertainties (like “will my symptoms act up today?”) and broader unknowns about the long-term future of your health.

These uncertainties are amplified by the fact that COPD is progressive, which means that the disease inevitably gets worse over time. COPD patients have to live with the knowledge that their condition will worsen without knowing when or how it will happen, or what additional complications might eventually arise.

This is further complicated by the fact that COPD is, well... complicated. Every case of COPD is different, making it difficult to predict a patient's future outcomes or get an accurate timeline for the course of their disease.

What's more, COPD symptoms tend to fluctuate frequently, often without any obvious warning or explanation. This makes it difficult for many COPD patients to interpret their symptoms, which can cause a great deal of anxiety anytime those symptoms change.

That's why we created this guide to answer the the oft-asked question, “Is my COPD getting worse?” We'll start by exploring COPD progression, including how it works and what it looks like. Then we'll show you how to tell the difference between permanent COPD progression and the kinds of temporary symptom flare-ups that affect all COPD patients, even those with “stable” COPD.

Next, we'll walk you through a series of questions and real-life scenarios that can help you evaluate the progression of your own (or a loved one's) COPD. Then, we'll send you off with some practical tips to help you take a more active role in monitoring and managing your disease.

By the end of this guide, you'll know how to spot the signs of COPD progression and how to work with your doctor to get the best possible outcomes for your disease. But before we get too far ahead, let's take a moment to examine some key dynamics COPD progression, including how it happens, why it happens, and what you can (and cannot) do to slow it down.

COPD Progression: The Unfortunate Reality of Living With COPD

COPD progression is a fact of life for COPD patients, and this naturally causes a great deal of anxiety for many people with COPD. A major source of that anxiety is uncertainty about the future—the sense of not knowing when and how the disease will worsen, or how you will deal with those changes when they come.

And while it's not possible to get rid of that uncertainty entirely, knowledge can be a powerful mitigating force. The more you learn about COPD progression, the more prepared you'll be when it happens, and less scary and unfamiliar the future will seem.

In the following sections, we're going to take a closer look what COPD progression looks like and what causes COPD symptoms to get worse over time. We'll also look at some of the ways doctors and researchers predict future COPD progression, and how certain symptoms and risk factors are linked to slower or faster progression in people with the disease.

How COPD Progression is Measured: The 4 Main Stages of COPD

Doctors have a variety of ways to measure how severe a person's COPD is and, thus, how far the disease has progressed. Methods include tracking patients' symptoms, analyzing data from lung function tests, and using other data (e.g. symptoms, exacerbations, and medical imaging) to estimate the severity of the disease.

The most common method for determining COPD progression is known as “staging” or “grading,” which is a standardized technique for ranking the severity of COPD on a scale from 1-4. The most widely-used staging guidelines (known as the GOLD Criteria) allow doctors to quickly judge a person's COPD stage based primarily on the results of simple lung function tests.

In general, COPD symptoms get more severe and more numerous as you progress upward through the stages. For example, you might start out in stage 1 with some occasional breathlessness and coughing, but then acquire additional symptoms (e.g. persistent breathlessness, coughing, and fatigue) by the time you reach stage 3.

Other data can also be used to get a more in-depth picture of a patient's condition or to pinpoint specific health problems and complications. For example, doctors can often learn specifics about a patient's lung condition and function from x-ray images, CT scans, and analyzing other tissues and bodily fluids (e.g. lung fluids, sputum, and blood).

To learn more about the different stages of COPD progression, including what kinds of challenges, symptoms, and treatments to expect at each stage, check out the following guides from our Respiratory Resource Center:

• What You Need to Know About the 4 Stages of COPD
• 6 Things You Should Know if You're Diagnosed with Stage 1 COPD
• End Stage COPD: How to Plan and What to Expect
• 11 Things You Should Do After You're Diagnosed with COPD

Why Does COPD Progress?

Unfortunately, we simply don't know a lot about why COPD progresses and why it cannot be cured. For example, we don't know exactly why some people who smoke get COPD (and continue to degenerate) while others don't.

However, we do understand many of the mechanics involved in COPD progression, even if we can't always explain why they occur. These mechanics include chronic lung inflammation and the gradual accumulation of damage to tissues in the lungs.

Most of the time, COPD occurs after long-term exposure to lung irritants (like tobacco smoke) that damage sensitive lung tissues over time. In people with COPD, those damaged lung tissues never heal completely, but instead are left weaker and even more sensitive than before.

As a result, the lungs become extra susceptible to inflammation and disease, which causes even more damage and scarring in the lungs. This triggers a vicious cycle in which the lungs are perpetually inflamed and more and more tissues get damaged, making the lungs ever weaker and more sensitive with time.

Unfortunately, there's currently no way to stop or reverse this cycle, which is why COPD is a chronic, life-long, and incurable disease. Of course, that doesn't mean COPD is untreatable; there are many COPD treatments and medications that are effective at controlling COPD symptoms and even slowing down the progression of the disease.

It's important to note that COPD progression is not a smooth or linear process; it can speed up, slow down, or move in stops and starts. Some patients have faster disease progression than others, and some people stay “stable” for months or years at a time before experiencing any significant progression or worsening of their COPD.

Can You Predict COPD Progression?

There are a number of measurable factors that can help predict the likely short-term and long-term health outcomes (or prognosis) for people with COPD. For example, there are a number of risk factors that are linked to quicker disease progression, including:

• Severe COPD symptoms
• Lack of exercise
• Poor nutrition
• Frequent exacerbations
• Frequent hospital stays
• Heart disease

By analyzing these and other factors, it is possible to make educated guesses about things like life expectancy, the speed of disease progression, and how likely you are to develop certain health complications associated with COPD.

However, making these kinds of predictions is both difficult and imprecise. You would need a trained medical expert to come up with any kind of meaningful prediction about the future of your COPD, and even then it would only be an educated guess.

If you want to know more about your COPD prognosis and/or future health risks, you should ask your doctor or respiratory medicine specialist to go over your prognosis with you. An expert who's familiar with your health history and medical records should be able to explain your future health prospects and offer some insight into what your health future might be.

Can You Slow Down COPD Progression?

There has been a lot of research dedicated to figuring out how different COPD treatment methods affect patients' long-term outcomes, including whether or not they can slow down the progression of COPD. This research has identified a number of different treatments and lifestyle changes that are associated with slower progression of COPD, including:

• Quitting smoking
• Getting adequate exercise
• Maintaining a healthy weight
• Completing a pulmonary rehabilitation program
• Minimizing exposure to lung irritants (e.g. air pollution)
• Getting early treatment
• Taking COPD medications consistently and correctly
• Keeping symptoms under control
• Avoiding illnesses and exacerbations

It's important to note, however, that while all of these factors are associated with slower disease progression, it's not always clear whether or not they are directly causing progression to slow. It's difficult to tease apart the exact nature of the relationship; for example, does having well-managed COPD symptoms cause the disease to progress slower, or does having a slower-progressing disease make the symptoms easier to control?

Hopefully, future research can give us more insight into this question and provide new avenues for slowing disease progression in people with COPD. In the meantime, however, most experts agree that you can improve your COPD prognosis by doing the following things: quit smoking, stay active, get treated by a a qualified health professional, and be diligent about taking your medications and following your doctor's advice.

If you'd like to learn more about how to slow down COPD progression and improve your long-term prognosis, check out our guide: How to Take Control and Slow the Progression of Your COPD

What's Causing My Symptoms? How to Tell the Difference Between Permanent COPD Progression, Temporary Flare-Ups, and Acute Exacerbations of COPD

As we mentioned earlier, it's normal for COPD symptoms to fluctuate from day to day without any apparent reason, or to get worse for a period of months or weeks during a COPD exacerbation. This can make it hard to pinpoint the reason why your symptoms are acting up, including whether it's caused by a temporary or permanent change in your COPD.

Luckily, it is possible to determine the likely cause of an uptick in symptoms if you know what to look for. You just have to pay close attention to the nature, severity, and length of your symptoms, as well as the context in which they occur.

Minor Symptom Flare-Ups

Here we're using the term “minor symptom flare-up” to refer to the normal COPD symptom fluctuations that happen in just about everyone who has COPD. Essentially, we're talking about those days when you wake up and your symptoms are worse than usual, but then they get better within a couple days.

This can happen for all kinds of reasons—maybe the air pollution was especially bad that day or you exerted yourself too much the day before. Flare-ups can also happen for seemingly no reason at all; sometimes you just have bad COPD days.

Most of the time, flare-ups are nothing to worry about and you can get over them on your own. You might need to make some minor changes, like getting some extra rest or using your quick-relief inhaler more often, but you probably won't need any other medical intervention.

That doesn't mean you should take minor flare-ups too lightly, however; sometimes what seems like a minor flare-up can turn into a full-blown COPD exacerbation. It's best to treat flare-ups as a “watch and wait” situation: you shouldn't worry too much, but you shouldn't ignore it either in case it turns out to be something more serious down the line.

COPD Exacerbations

COPD exacerbations usually occur when you get sick with a respiratory illness, such as a bacterial lung infection or a simple cold or flu. This results in severe lung inflammation that causes COPD symptoms to worsen significantly for a period of time.

COPD exacerbations can last for weeks or months, and recovery usually requires extra medication or medical intervention. The increased symptoms usually go away when the exacerbation is over, though it can take a long time before they totally get back to baseline.

You can usually tell exacerbations apart from temporary symptom flare-ups because they last longer and tend to be more severe. However, exacerbation severity can vary quite a bit; some are minor and only require minimal intervention, while others are life-threateningly severe.

As a general rule of thumb, you should suspect an exacerbation if you experience worse symptoms (e.g. you feel more breathless, more fatigued, your coughing gets worse, etc.) that don't get better within a few days' time. If they get worse or persist without getting better, you should get in contact with your doctor or follow the corresponding instructions in your COPD action plan.

It's also important to not that, while COPD exacerbations in and of themselves are not a sign of COPD progression, they are linked to permanent COPD progression in a couple of different ways.

First, the frequency and severity of COPD exacerbations are often used as a measure of COPD progression, as they tend to get worse in the later stages of COPD. If you're having more frequent exacerbations, or having more severe symptoms during exacerbations, this could be a sign that your COPD is getting worse.

Exacerbations can also play a direct role in COPD progression, as severe exacerbations can cause irreversible lung damage and lung function loss. In general, the fewer exacerbations you experience, the lower your risk for the additional lung damage associated with exacerbations that, cumulatively, can result in quicker progression of COPD.

This is why preventing exacerbations is such a critical priority for doctors and patients managing COPD. It's also why it is so important to identify and treat exacerbations early, before they get to the point that they become difficult to treat and control.

COPD Progression

Compared to minor flare-ups and exacerbations, which tend to come on quickly, COPD progression is a long-term process that tends to happen over the course of months or years. That means you can't judge COPD progression based on just a few days or weeks of symptoms; you have to think long-term, on the order of several months, at least.

So if you've only been experiencing elevated symptoms for a few days or weeks, it's likely much too early to tell if they're caused by permanent disease progression. But if the symptoms persist for months and months without any sign of getting better, it could be a sign that your COPD is getting worse.

Unlike symptoms caused by minor flare-ups and exacerbations, elevated symptoms resulting from permanent COPD progression don't ever really go away. Instead, those symptoms become part of your new baseline—part of your normal, everyday symptoms that you experience as part of the disease.

Elevated baseline symptoms aren't the only sign of COPD progression, however. There are other changes that tend to come hand-in-hand with permanent COPD decline, namely more frequent exacerbations and lung function loss.

Research has well-established that people with COPD tend to experience more severe and frequent exacerbations as the disease progresses. In fact, exacerbations are considered to be “one of the most important predictors of the progression of COPD.”

Lung function is also closely tied to COPD progression. It's the primary criteria used to grade COPD severity and measure how quickly the disease get worse over time. Generally, the quicker your lung function declines, the quicker your COPD is progressing, and the quicker your symptoms will get worse over time.

Clues that Your COPD is Getting Worse: Signs to Watch Out For

In the following sections, we're going to go through some common scenarios that people with COPD experience. Each scenario reflects a situation or circumstance that could be a red flag that your COPD is getting worse.

While none of these scenarios is decisive on its own, each addresses a specific symptom, health complication, or another known indicator of worsening COPD. We hope that, by reviewing these life-like scenarios, you'll get a better idea of what worsening COPD can look like and be better able to recognize the signs of progression in your own life.

You're Spending More Time at the Hospital

Most people with COPD will have to be admitted to the hospital at some point to get treatment for an exacerbation or another complication of COPD. However, people with mild COPD rarely need hospital treatment; it's much more common in the mid-to-late stages of the disease.

People with moderate COPD might occasionally need to be hospitalized for exacerbations, though (depending on doctors' advice) some exacerbations can be treated at home. Those with severe disease tend to be hospitalized more frequently—and have longer hospital stays—both because their exacerbations tend to be more severe, and because treatment can be complicated by the presence of other health complications.

So, if you've been hospitalized for COPD for the first time recently, or have needed hospital treatment more often than usual, it could be a sign that your COPD is getting worse. Of course, it's also possible that you just had bad luck, especially if it's an isolated incident and not an ongoing trend.

More frequent exacerbations can also be a sign that you're not getting (or keeping up with) the treatment you need to properly manage your COPD. But if you're doing everything you're supposed to, and you're still having exacerbations more frequently than before, it's a strong indication that your COPD might be getting worse.

You Can't Get Around As Well as You Used To

People with COPD often struggle with physical exertion, including walking and standing for long periods of time. Mobility problems like this can be both a cause of COPD progression as well as a consequence of worsening COPD.

For example, worsening COPD symptoms (like breathlessness and fatigue) can make it harder to exercise, causing many patients to avoid physical activity. However, lack of exercise tends to make those symptoms even worse, leading to even more mobility issues and quicker physical decline.

This can make it difficult to tell whether mobility problems in COPD patients are simply a symptom of COPD progression or if it's the lack of physica

Mask-wearing is uncomfortable for just about everyone, but people with COPD and other breathing disorders have more reason than most to complain. Having a serious respiratory disease can legitimately make breathing through a face mask more difficult, even though face coverings are not actually dangerous for people with COPD (as most doctors agree).

Unfortunately, masks have become an unavoidable feature of daily life in many places, as they are a central part of the public health efforts to control the spread of COVID-19. This has left many people with COPD wondering how to cope with the discomfort of mask-wearing and, in some cases, even looking for exceptions or alternative solutions to wearing a mask.

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That's why we created this guide to address the logistics of masking for people with COPD. In it, you'll find a variety of practical strategies you can use to not only make wearing a mask more tolerable so you can enjoy outings and other activities without feeling breathless and fatigued.

Throughout this guide you'll find tips for coping with a variety of situations, including those that tend to be especially challenging for people with COPD (e.g. hot weather, prolonged masked outings, and using supplemental oxygen while wearing a mask). We'll also dissect the pros and cons of different kinds of masks, and how to choose one that is both effective and easy to breathe in with COPD.

Face Masks & COPD: What Every COPD Patient Should Know

We know that many people with respiratory diseases like COPD have questions and concerns about how wearing a mask affects their health and their breathing. Here are a few of the most common ones that you might have heard before or worried about yourself:

• Is it safe for people with chronic respiratory diseases like COPD to wear a mask?
• Can wearing a mask impair your breathing or reduce how much oxygen you get when you breathe?
• Can people with COPD and other serious respiratory disease get exempted from having to wear a mask?

So before we jump right into the “survival strategies” portion of this guide, we'd like to take a moment to address these and other common questions that people have about masking & COPD. If you'd like to skip ahead, you can click the following links to go straight to the sections on Choosing a Mask for COPD or Tips & Tricks for Making a Mask More Bearable.

Is it Safe to Wear a Mask if You Have COPD?

Despite the fact that wearing a mask can cause a great deal of discomfort, it's important to know that they're not actually dangerous for your health. In fact, some of the largest COPD & lung disease organizations in the US have gone out of their way to reassure patients that wearing a face covering is not only safe, but also important for people with COPD and other chronic lung diseases.

Organizations endorsing the safety of masking for COPD patients include:

• The COPD Foundation
• The American Lung Association
• The American Thoracic Society
• The American College of Chest Physician

It's important to note that the list above is far from comprehensive; a large number of healthcare networks and medical organizations across the country have endorsed masking as a means to reduce virus transmission.

Can Wearing a Mask Impair Breathing?

Since the advent of mask mandates, many people—especially people with respiratory diseases—have been concerned that wearing a face mask might impair their ability to breathe. Some have even claimed that wearing a mask can reduce blood oxygen levels or cause too much carbon dioxide to get absorbed into the blood.

The good news is that these concerns are unfounded; studies consistently show that face masks don't impair breathing—and that holds true for healthy adults, older adults, and people with chronic lung diseases (including COPD).

That's because both oxygen and carbon dioxide can pass through masks very easily; the molecules are many times smaller than the respiratory droplets that masks are meant to block. This means that breathing in a mask won't cause carbon dioxide to get trapped inside it, nor will it block oxygen from getting in.

This is confirmed by multiple studies that measured healthy participants' blood oxygen and carbon dioxide saturation while wearing a mask. These studies find that wearing a mask affects blood levels of carbon dioxide and oxygen minimally, if at all (even during exercise), and report a near-zero risk of any significant breathing impairment for the general population.

Studies on people with COPD, including those with severe lung impairment, show similar results. One study, for instance, found that COPD patients wearing masks experienced no significant decrease in oxygen levels (and no significant increase in carbon dioxide levels) both at rest and during physical activity.

One exception to this is N95 masks. Though they are very effective at preventing virus transmission, N95 masks create a lot more airflow resistance than a typical cloth or surgical mask.

Of course, this isn't a concern for the vast majority of people since N96 masks are meant for healthcare workers and are not recommended for general public use. As we discussed above, a regular cloth or surgical mask will not impair your breathing even if you have COPD or another serious respiratory disease.

If you'd like to learn more about research on mask safety and efficacy, check out this comprehensive analysis from the Scientific Advisory Group (PDF link).

Why is Wearing a Mask So Uncomfortable for People with COPD?

As we discussed in the section above, many studies have confirmed that masks do not actually impair your breathing. But that doesn't explain why wearing a mask can make you feel like it's harder to breathe.

To understand why that is, you have to know a few things about the mechanics of breathing; namely, that breathlessness is a sensation that can be triggered by a variety of different factors, some of which have nothing to do with how much oxygen you're getting or how well you can breathe.

One of these factors is airflow resistance, which affects how much effort it takes to pull air into your lungs when you breathe. Slight changes in airflow resistance (e.g. from breathing through a mask) can trigger feelings of anxiety and breathlessness even if nothing is actually impairing your ability to breathe.

This is a normal physiological reaction to airflow resistance that—in and of itself—isn't a cause for serious concern. It's essentially your body's way of alerting you in case you're actually suffocating; it just tends to be very sensitive, which can lead to false alarms.

So while it's important to pay close attention to your symptoms when you have COPD, it's also important to remember that shortness of breath is just a feeling and that it can have a totally benign cause. So even if the airflow resistance from wearing a mask might make you feel uncomfortable and breathless, you can confidently reassure yourself that it doesn't pose an actual risk to your health.

Can You Be Exempted from Mask Requirements if you Have COPD?

The short answer to this is a conditional yes; the CDC has acknowledged that people with disabilities that make it difficult to breathe in a mask (which could include some people who are disabled because of their COPD) may be exempted from wearing a mask. However, this isn't a blanket excuse for all COPD patients to forego mask-wearing; it just means that some COPD patients in some situations should get exemptions—not that all people with COPD should choose to not wear masks.

In fact, doctors strongly urge all COPD patients to wear a mask if they are able to, since people with COPD are more vulnerable than most to severe complications and death from COVID-19. As researchers wrote in an article published in the European Respiratory Journal, “Relieving respiratory patients from the obligation to wear masks could be highly deleterious for them, since by definition those patients with respiratory conditions who cannot tolerate face masks are at higher risk of severe COVID-19.”

Other medical professionals agree that everyone should wear a mask, regardless of medical condition, since masks have “no effect on respiratory mechanics.” As one doctor put it, “I believe that most people need education on proper use rather than exemption,” including fragile respiratory patients.

If you have COPD, you should be taking every reasonable precaution you can manage to avoid getting sick, including wearing a mask in situations where you're at risk of being exposed to other people's germs. This is especially important if not yet been fully vaccinated, or if you belong to a group for which the vaccine is known to be less effective (e.g. if you are an immunocompromised person or over the age of 65).

You should also keep an eye on your local and national health recommendations, which provide up-to-date guidance on masking and other COVID-prevention measures for both vaccinated and non-vaccinated individuals.

Unless your doctor advises against it or you absolutely cannot tolerate it because of your respiratory symptoms, the benefits of masking are likely to far outweigh any discomfort you might feel. However, that's not to say that the discomfort of wearing a mask is trivial; we don't want to downplay how absolutely miserable it can be.

That's why we're going to spend the rest of this post exploring a variety of different strategies you can use to minimize that discomfort and be able to wear a mask without feeling breathless or fatigued.

Choosing the Right Mask for COPD

The most important factor in mask-wearing comfort is the face covering itself. While this might seem like a no-brainer, finding a mask that fits right, works right, and doesn't create too much resistance when you breathe can be a difficult task.

Unfortunately, a lot of people wear uncomfortable masks that they don't like because they don't realize there are better options out there. But if you take some time to research (and even try out) different types of face coverings, you might be surprised at how much more comfortable the “right” mask can be.

Here are some of the main criteria you should consider when choosing a mask:

Mask Layers

Most face coverings are made up of multiple layers of fabric sewn together, a characteristic often referred to as the material's “ply.” A “three-ply” mask, for example, has three layers of fabric, while a “one-ply” mask has only one.

The number of layers your mask has will effect not only how well it filters out germs but also how comfortable it is to breathe in. The CDC recommends wearing a mask made of at least 2-ply fabric, which is a good middle ground between masks that are less effective (1-ply) and masks that create a lot of resistance when you breathe (e.g. 3-ply and up).

Mask Fit

How a mask fits on your face affects not only how comfortable it is to wear, but also how well it works at protecting you from germs. Unfortunately, many people wear masks incorrectly, increasing their risk of being exposed to other people's germs.

A well-fitting mask is one that fits snugly—but not too tightly—with all the edges sitting flat against your face. A mask that's too loose won't filter air correctly, while a mask that's too tight can be uncomfortable to wear for long periods of time.

Ideally, your mask should also have nose wire to help the mask fit around the curve of your nose without leaving gaps. The goal is to make sure you don't leave any space between the mask and your face that will allow unfiltered air to slip through.

You can help a loose-fitting surgical mask fit better by wearing a cloth mask over the top to hold it snug against your face. However, this method creates extra airflow resistance that might make it too uncomfortable for people with COPD and other respiratory diseases.

If you have a mask that fits too loose, you can always tie a knot in the ear loops to shorten them in a pinch. You can also get masks that that tie around the back of your head, which not only makes them conveniently size-adjustable but also reduces ear soreness (a common complaint about masks that cling to your ears).

Material & Mask Type

The material your mask is made of helps determine not only how effective it is, but also how comfortable it is to wear and breathe in. There are many different types of mask materials, but the types of masks recommended by the CDC for public use generally fall into one of two main types: cloth masks and surgical masks.

Reusable Cloth masks

Cloth masks are face coverings made from one or more pieces of woven fabric sewn together. The type of fabric varies, though most are made from cotton, polyester, and other fabrics commonly used in clothing.

Studies show that different types of cloth masks vary in how well they filter out germs (or, to be more precise, respiratory droplets that carry germs). However, this has less to do with what kind of fabric the mask is made of than how tightly woven that fabric is.

Fabric that's too light (e.g. mesh or see-through) doesn't make a very good filter, while fabric that is too dense can create too much resistance when you breathe. Unfortunately, finding a cloth mask that's both comfortable and effective is always balancing act: you want a mask that's dense enough to block as many droplets as possible while still being light enough to allow air to pass easily through.

Here are additional recommendations from the CDC regarding cloth mask materials:

• The mask should be made from a washable material (so it's easy to clean between uses)
• The mask should not be see-through (if you hold it up to a bright light source, the fabric should be woven tightly enough to block the light from shining through)
• The mask should not have holes, gaps, valves, or any other opening in the fabric that would allow air to go in or out without being filtered through the mask material first

Another important characteristic to consider when choosing a cloth mask is the “feel” of the mask material against your face. You want a mask made from a flexible, soft, high-thread-count fabric that doesn't cause any itching or irritation on your skin.

You might need to try out a few different types of masks before you find a design and material that works for you. You can also look for recommendations online by searching for “breathable” masks and reading reviews written by other people with respiratory diseases.

Disposable Surgical Masks

Surgical masks are made up of a special type non-woven fabric made from plastic (often polypropylene). This type of fabric makes a good face covering because it is acts as a decent filter while still letting air through relatively easily when you breathe.

Because of this, many people find surgical masks easier to breathe in compared to the relatively-heavy fabric required for cloth masks to be effective. Surgical masks also tend to be somewhat moisture-resistant, which helps them not get damp as quickly from the moisture in your breath.

There are several different types of surgical masks rated for different medical purposes as well as generic, non-medical “surgical masks” you can find at many stores. For the general purpose of protecting yourself when you're around other people and out in public, minimum protection surgical masks & most generic versions should work just fine.

You should, however, make sure that whatever surgical mask you choose is made from at least 2-ply fabric and has a nose wire at the top. Like all masks, your surgical mask should fit snug and comfortably on your face without leaving any gaps for unfiltered air to get through.

Cloth Masks vs Surgical Masks: Which One Should You Use?

Cloth masks and surgical masks are both approved by the CDC, so which type you choose to use is ultimately up to you. Both have their own benefits and drawbacks, and some might be better suited to certain people or situations.

One of the biggest benefits of cloth masks is that they are re-usable, which makes them very cost effective over time. However, washing cloth masks can be very inconvenient, especially when you need a fresh one every day.

Surgical masks, on the other hand, are single-use, which is very convenient; they're very low-maintenance and all you have to do is thrown them away after use. However, this also means that you have to keep buying new ones, which can get expensive and create a lot of extra waste.

It's also worth mentioning that some studies indicate that cloth masks don't work quite as well as surgical masks at filtering out the respiratory droplets that carry germs. However, even if they are somewhat less effective, experts agree that multi-layer cloth masks still offer a worthwhile amount of protection and remain an important tool in combating the spread of disease.

Many people use a combination of cloth and surgical masks, both separately and/or at the same time. For example, you might want to wear a cloth mask over a surgical mask for extra protection, or keep a box of surgical masks around just in case there's a time that you can't find a clean cloth mask to wear.

Tips & Tricks to Make Wearing a Mask More Bearable if You Have COPD

Now that we've covered the basics of how to choose a breathable mask, we'd like to share some additional tips that can make wearing that mask even more comfortable if you have COPD. In the following sections, you'll find more than a dozen practical strategies that can help take the edge off mask-wearing and help you avoid feeling anxious or breathless when you have to wear a mask.

Take Time to Rest

It's not fun to feel tired and short of breath when you go out to do something fun, which is why avoiding over-exertion is a common concern for many people with COPD. Unfortunately, for those who struggle with mask-wearing, it can be even harder to manage breathlessness and other COPD symptoms while wearing a mask.

Pay close attention to how you feel when you're out and about so you can catch the breathlessness early and take the time you need to rest. If you're out with other people, don't be afraid to excuse yourself for a few minutes or let them know when you need to slow down or take a break.

Take Mask Breaks

Many people with COPD and other respiratory diseases struggle wi

In this day and age, it’s harder than ever to navigate America’s convoluted health care system. At times it can feel like it’s impossible to find an answer to the simplest of questions. And other times, it can even feel like our own doctors, caretakers, or medical equipment providers are working against us instead of for us. What’s more, as we age, we face higher health insurance costs with fewer and fewer options for saving money along the way.

It’s not all grim, though! If you have chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), or any other respiratory illness that requires you to undergo oxygen therapy, there are many resources out there to help you answer your most burning questions. Most notably, our respiratory specialists here at LPT Medical are here to answer all your questions concerning oxygen delivery equipment and oxygen therapy in general.

Feel free to get in touch with us either by phone or email and ask us anything you need. Remember, there is no “silly” or “bad” question when it comes to your health. Chances are if you’re wondering something, there are other people in your situation who are wondering the same thing. In the meantime, continue reading to discover the answers to some of the most commonly asked questions about oxygen concentrators.

What is an Oxygen Concentrator?

An oxygen concentrator is a type of oxygen administration device used to treat a variety of respiratory ailments including COPD and cystic fibrosis. Oxygen concentrators are similar to oxygen tanks in that they deliver medical grade oxygen which is inspired via a nasal cannula or oxygen mask. Concentrators were introduced around the 1970s and portable versions became more widely available in the early 2000s.

COPD effects more than just your lungs and how well you can breath. It also influences your mental state causing irrational behavior or mood swings, and can even lead to depression and anxiety.

People with COPD can sometimes be irritable and come off as cranky. If you struggle with mood swings and other mental health issues that seem to be related to your COPD, this article is for you.

According to a review, “Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease (COPD) — A Review,” about 50 percent of people living with COPD exhibit symptoms of anxiety and depression. Another recent study in the USA reported that less than a third of COPD patients with major depression received the appropriate treatment.

Evidence suggests that people with COPD are very susceptible to depression, stress, and anxiety due to a number of reasons, one being that their life as they knew it, is over in some ways, but also a vicious cycle of COPD symptoms impacting mobility, independence, and other qualities of life. These anxious and/or depressed feelings can make it very hard for you to care for yourself and adhere to your treatment regime.

Introduction

Mental health in general is a delicate thing, something as normal as aging can initiate depression and anxiety in folks who have never had these mental illnesses before. This is something called environmental or situational depression, where outside factors influence the way someone reacts and feels emotionally. Clinical depression is a biological imbalance of chemicals in a person’s mind that makes them react and feel a certain way.

The fact is, everyone feels sadness because everyone goes through sad experiences. It is a natural human emotion. On the other hand, clinical depression is a serious condition that can have a profound impact on a person’s everyday life, and oftentimes for no reason at all.

Situational depression is known medically as “adjustment disorder with depressed mood.” In many cases it will resolve over time, and therapy sessions may be recommended in order to ease the recovery process.

As you read this article, it is important to categorize your own emotions based on this criteria in order to understand and get the best help for yourself. If you need help deciphering your symptoms from being clinical compared to situational depression, speak with your doctor or a mental health professional who is qualified to diagnose these illnesses.

You can also visit this source about the differences between situational depression versus clinical depression:

Click here

We want to preface this article by saying that we are not a mental health organization, nor do we specialize in any kind of therapy, however we work with oxygen users who are in some of the most severe stages of their pulmonary disease and we try to help them in the one way we are qualified to help: Providing the best, most reliable, and affordable oxygen equipment on the market along with educational resources. If you are interested in learning about any of our portable oxygen equipment, after reading this article you can reach us at 1-800-946-1201, or simply leave a comment on the blog so we can reach out to you! 

We have developed this article for our readers who may need to seek outside help for their mental health conditions, and we hope this article can help you find the resources in order to do so.

How does mental health impact people with COPD

There is a lot of research about the ways in which COPD patients suffer from depression and anxiety. In a study by The National Center for Biotechnology Information a study was conducted about COPD patients and how anxiety and depression can contribute greatly to COPD-related death, notably by reducing quality of life and lack of adhering to treatment.

Depression can inhibit a person’s ability to care for themselves, and when you have COPD it is so important to maintain a healthy exercise regimen, take all of your medications, and adhere to your oxygen therapy needs. If you are depressed you are less inclined to take the necessary measures in order to protect yourself from this chronic illness that will inevitably get worse over time, and even take your life.

Quality of life is an attainable goal for you even if you have COPD, but mental health and depression can get in the way of those goals. On top of that, depression and anxiety can be challenging to identify and furthermore treat because those symptoms often overlap with COPD symptoms.

Identifying depression, anxiety, and developing an appropriate treatment strategy is critical to reduce the number of times you have to go to the hospital to seek medical treatment and overall improve your quality of life.

Why do people with COPD struggle with mental health

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from your lungs. The symptoms include trouble breathing, excessive coughing, abnormal mucus production and wheezing. It is most commonly caused by long-term exposure to irritating gases or pollution, examples include cigarette smoke.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions are likely to occur together. Every individual's symptoms vary in severity. COPD is a chronic illness meaning there is no cure, and it gets worse over time.

Simply the concept of having COPD can be considered depressing, especially for people who have grown up to be very active or were capable of physical activities in their youth and now they cannot do the things they love. Becoming short of breath after accomplishing a simple task can leave you feeling helpless or dependent on others.

Symptoms of anxiety and depression include:

• Fatigue
• Loss of interest
• Persistent sadness or anxiousness 
• Inability to work, sleep, study, eat, or enjoy once-pleasurable activities

For people living with COPD depressive and anxious symptoms can have profound effects. Social isolation can cause anxiety and depression and on top of that the immobility that you might have already experienced as a result of breathlessness and lack of energy can be overwhelming to deal with. These cycles will impact your life in a very negative way.

Nevertheless, treatment is available and has been proven to increase the physical and mental state of COPD patients. These treatments include:

• Cognitive behavioral therapy
• Pharmacological treatments
• Self management
• Pulmonary rehabilitation relaxation therapy
• Eating healthy and good gut health

How to take better care of you mental health

Similarly to exercising in order to strengthen your lungs and increase your physical abilities, it is important for COPD patients to also take care of their mental and emotional health. This means adjusting and learning how to deal with depression and anxiety when it arises but also recognizing triggers before it's super obvious.

Seeking care for depression and communicating with your caregiver are two basic tactics you can try in order to help manage your mental state of mind. We will talk about more complex and effective ways for dealing with anxiety and depression in the sections below. Read on.

Pulmonary Rehabilitation

One of the most beneficial and most underutilized treatments for COPD along with depression and anxiety, is pulmonary rehabilitation. Pulmonary rehab has been shown in multiple studies to improve the depression and anxiety associated with COPD, and it can do more for those symptoms than any kind of medication in many cases.

A pulmonary rehab course is a general program that helps to improve your lifestyle and wellbeing as you are living with chronic lung conditions.

In a pulmonary rehabilitation course you will learn how to use exercise training in conjunction with medical therapy, nutritional counseling, COPD education, and psychological counseling and/or group support.

Pulmonary rehabilitation courses will provide you with a supervised exercise program that you can do inside and outside of the facility, two to three days a week, for up to three hours per day. Just having a place to go and things to do can be very meaningful and enjoyable. And on top of that you will start working towards goals which can also help with depression and anxiety.

While you are at pulmonary rehab you are often monitored by a respiratory therapist, a physical therapist and an occupational therapist. You may also be involved in some group therapy and exercise classes. This way you will learn about your condition and talk to others about the emotional and psychological challenges  all while getting physically stronger and more capable.

This is a space where other people are experiencing the same or in some cases worse symptoms than you are, and it is a great way to not feel alone in your diagnosis.

For more information on pulmonary rehabilitation and to find a program near you, visit the American Association or Cardiovascular and Pulmonary Rehabilitation

Pulmonary rehabilitation benefits are available through most major insurance companies.

Also you can find a document here that explains how to do exercises, COPD education, and how you can get into a pulmonary rehabilitation program.

Pharmacological treatments

A new study suggests certain antidepressants may increase the risk of death in people with COPD by 20 percent. These drugs have side effects that are very dangerous for people with COPD to experience such as, sleepiness, vomiting, and can negatively effect the immune system cells. All of these side effects can increase the likelihood of infections, breathing issues, and other unfavorable events, especially in patients with COPD because it can lead to an exacerbation and hospitalization.

The medical world is quick to resort to a pharmaceutical treatment instead of looking into lifestyle changes, including pulmonary rehabilitation and generating a support network. Given the risks of antidepressants for COPD patients, COPD advocates say that it’s worth considering alternative approaches to pharmaceutical treatment.

Personalized behavioral therapy

The main psychological intervention for mental illness and COPD is cognitive behavioral therapy (CBT). CBT is increasingly recommended in the management of people living with COPD and it can include pulmonary rehabilitation programs, which we discuss in the sections above and notably reduces anxiety and depressive symptoms. CBT also requires an upfront investment in hospitals with pulmonary patients in order to train nurses and hospital staff being capable of fulfilling the needs of patients with COPD—both physically and psychological.

Research has found that CBT was most effective in reducing anxiety symptoms in COPD patients and has a significant impact on their quality of life as well as their ability to keep physically active and can also improve survival in the long-term.

This is somewhat out of your control as a COPD patient because the hospital is responsible for investing in upfront costs that includes training nurses and finding resources to implement cognitive behavioral therapy for their patients.

It is believed that the implementation of personalized strategies to address your unique psychopathological traits is essential, but this requires a lot of work by your healthcare team and willingness and dedication of their institution as well. 

Self Management

Self management is a great way for you to address your mental health complications rather than depending on cognitive behavior therapy programs that might be outside of your means. Interventions have been shown to improve patients’ quality of life and reduce the number of emergency scenarios..

Self-management interventions vary in content, delivery, and intensity, which can make it difficult to determine what parts of these interventions are most effective. It is best for you to do what works for you and leave the rest.

Here are a few stages of self-management:

1. Noting what your normal symptoms feel like, and addressing any changes throughout the day or night
2. Being capable of determining when you are having more severe symptoms versus when you are having a serious exacerbation.
3. writing down and understanding which COPD symptoms initiate your moods
4. Setting up a rescue pack
5. Accepting your condition
6. Adjusting to a new normal
7. Slowing down the progression of your disease through diet, exercise, and oxygen therapy

Self managing your condition means monitoring your symptoms when stable and to take appropriate action when symptoms worsen. You can also be prescribed a rescue pack for when you are at risk of an exacerbation, this can ease you anxiety about having an exacerbation because you will feel more prepare and confident handling emergency situations.

Many illnesses, such as COPD, require an internal acceptance of the condition. You will have to come to terms with the likely course of the disease, as well as possible complications, and a different lifestyle.

As a result of breathlessness and other COPD symptoms, it is common to get complacent, and avoid exercise as an outcome of this complacency. This is reasonable in the beginning, but can be very harmful for your physical well-being in the long term, also causing unnecessary mental difficulties to develop.

Eating a well balanced diet

Eating healthy goes for anyone who struggles with mental health problems, not just people with COPD. Human gut health is closely related to our chemical receptors in our brains, the relationship is so strong that one influences the other directly, which is where the saying, “Go with your gut” came from.

There are strong links between digestion and your mood, digestion and your health, and even digestion and the way you think. This is because inside your gut is another “brain” like system, called the enteric nervous system (ENS).

The ENS is composed of more than 100 million nerve cells lining your gastrointestinal tract from esophagus to rectum. This system controls every part of your digestion: Swallowing, releasing enzymes that break down food, controls blood flow that helps with nutrient absorption, and elimination. Amazingly, while you ENS is digesting, it is also communicating with your brain.

It is known now that your ENS may trigger big emotional shifts, whereas before researchers thought it was only the other way around thinking that anxiety and depression contributed to gastrointestinal problems. Recent studies show that irritation in the gastrointestinal system may send signals to the central nervous system (your brain) that trigger mood changes and even depressive and anxious feelings.

So how does gut health relate to what is happening inside your lungs, and can the nature of COPD influence the health of your gut? In fact, your lungs and gut are closely related, studies have shown that there is a clear link between inflammatory intestinal conditions and inflammatory lung problems.

Many people with COPD also suffer from conditions that may be rooted in or contribute to poor gut health.

The conditions listed below are often experience in conjunction with COPD and will also impact your gut health:

Obesity

Diabetes

Mood disorders

Inflammatory and autoimmune diseases

Besides eating a well-balanced diet, there is not a lot else you can do in order to improve your gut health besides the potential capabilities of probiotics.

Probiotics

Probiotics are “good bacteria” that is supposed to increase the amount of infectious fighting bacteria that already lives inside your gut. These microbes fight infections and do a lot to contribute to the balance and well-being in your digestive tract. Therefore, probiotics are living microbes that you can take as a supplement or eating probiotic rich foods, in hopes that it will add to the healthy bacteria in your gut and fight off the unhealthy bacteria.

Probiotics are one of the mainstream media treatments for improving gut health. Research suggests that even more research needs to be done in order to prove any significant correlation between probiotics and how strong its contribution to a healthier gut. However, if you have COPD, and if your doctor agrees, taking probiotics can certainly help to maintain a healthier gut.

A healthier gut is going to contribute to less mood swings and hopefully help with depressive and anxious feelings as well.

Overview

Overall, COPD will inevitably affect your mood in more ways than one, and for most people with COPD they will also experience subsequent depression and/or anxiety due to their respiratory disease.

There are a number of reasons as to why you may experience depression or anxiety throughout your diagnosis. For many people feeling short of breath can lead to an anxiety attack and it is notoriously a symptom of an anxiety attack to have trouble breathing, a vicious cycle.

Many people also struggle with depression because of their immobility, and not having the correct oxygen equipment to move around freely and independently.

Exercise and social gatherings are two important aspects of a person’s mental health, and if your oxygen device is not portable or too heavy to maneuver, you would benefit from investing in a portable oxygen concentrator so you are capable of more activity.

Pulmonary rehabilitation is a great way for you to get involved with a community of people who are in similar situations to share and express feelings. It also offers you an educational program where you can learn about your disease, and understand exactly what is happening inside your lungs and body. Not only are you socializing and learning about COPD, you also learn how to do exercises that you can also do at home in order to stay fit or get in healthier shape.

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Even though antidepressants may seem like the most obvious answer to combat depression and even anxiety, the side effects can be very damaging for people who have COPD. COPD advocates would argue that doctors are too quick to resort to pharmaceuticals before they offer lifestyle advice, recommend a cognitive therapist, or seek a pulmonary rehabilitation course.

Actually writing down your COPD symptoms and your feelings everyday and addressing the changes you recognize is a form of self management, and this can be a very helpful tool in managing depression, anxiety, or regular mood swings. By noting your moods that correlate with COPD symptoms you will be able to recognize what aspects of COPD make you emotional. By noting all of your triggers you can be more likely to avoid such irritants, and actually develop a plan to react more effectively and more positively. Acceptance is another important step in self-managing, which will come with time and effort. Don’t give up and remember you're not alone!

Eating healthy is a crucial part of maintaining a healthy gut, and your gut health is directly related to your mood. Meaning bad gut health can influence mood swings and depressive and anxious feelings. Eating healthy is one of the easiest yet effective ways to combat mental health issues, and while it might not be the cure to your depression or anxiety it will certainly contribute in a positive way!

Like COPD, depression and anxiety affects everyone differently, you will have different experiences than others, it boils down to taking what contributes positively to your life and leaving out what does not work. This might mean trying a few methods before you start feeling any better, but never giving up.

COPD is not curable but it is treatable, and the mental side effects that come along with COPD can also be man