Fall injuries aren't something that most people think much about on a day-to-day basis, let alone take specific measures to avoid. But as people who have experienced a serious fall injury can attest to, falling is a very serious threat that many adults just can't afford to ignore.

Your risk of falling inevitably increases as you age, but your risk may be even higher if you have COPD. That's because, while COPD doesn't cause falls directly, it does cause a variety of physical effects that can significantly increase your risk of having a fall.

Studies show that people with COPD are both more likely to experience accidental falls and more likely to get severely injured from falling compared to similarly-aged adults without COPD. And this is no minor risk; according to the CDC, falls are the leading cause of injury-related and accidental death in adults over the age of 65.

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Fortunately, many—if not most—falls are avoidable, and there are plenty of ways to reduce your risk of falling if you have COPD. And since the place that you're most likely to experience a fall is at home, thoroughly fall-proofing your house is one of the best things you can do to prevent accidental falls.

That's why we created this guide to explain everything you need to know to get started fall-proofing your home for COPD. In it, you'll learn how to identify common fall hazards and make a variety of practical safety improvements to fall-prone areas in your home.

We'll also take a closer look at the link between COPD and falling to help you better understand the magnitude of the risk. You'll learn about how COPD exacerbates fall risk factors, how it affects recovery from fall injuries, and how people with COPD can benefit from fall-proofing in a variety of different ways.

Our goal is to show you that fall-proofing is worth the effort and provide you with practical fall-proofing knowledge that you can put to use in your home right away. We hope that the strategies, tips, and resources in this guide will inspire you and empower you to make your home a safer environment for living with COPD.

COPD & Falling: What's the Risk?

Every year, more than one quarter of adults over the age of 65 have a fall. Among people with COPD, the rate is significantly higher: studies show that COPD patients are 55% more likely than non-COPD patients to have a history of falling, and that they have about 85% more falls, on average, compared to people without COPD.

While the association between COPD and falling might seem strange at first, it makes sense if you consider the multitude of ways that COPD can affect your balance and mobility. For example, COPD symptoms (like shortness of breath) can make you feel lightheaded and unsteady, while COPD-related health complications (like osteoporosis) can increase your risk of breaking a bone if you fall.

COPD is also associated with numerous well-known fall risk factors (PDF link), including muscle weakness, dizziness, lightheadedness, and fatigue. It's also associated with an increased risk of getting injured from falling, and a more difficult time recovering from injuries caused by falls

In the following sections, we're going to take a closer look at these and other COPD-related fall risk factors to better understand the relationship between falling and COPD. We'll also discuss how COPD impacts recovery, and why fall injuries tend to be more serious in people with COPD.

How does COPD make you more susceptible to falling?

It might seem surprising that COPD, as a respiratory condition, could affect your risk of falling. However, COPD is a complex disease that has a wide variety of effects on the body, many of which can affect your balance and susceptibility to falls.

If you or someone you love has COPD, understanding these effects can give you a better idea of what kinds of fall hazards you need to look out for. It can also help you focus your fall-prevention strategy on the things that are most likely to pose a danger to people with COPD.

COPD Symptoms

COPD symptoms can make you feel dizzy, lightheaded, or even drowsy at times, which can easily throw off your balance and make you more likely to fall. This could happen during a bout of coughing or breathlessness for example, or when you're feeling fatigued.

COPD Medications

Certain COPD medications can also make you dizzy or drowsy, which increases your risk of accidents, including falls. The risk might be even higher if you take other medications (e.g blood pressure medications) or take multiple medications (including over-the-counter medications) that interact with one another or have compounding side-effects.

Other Health Complications Caused by COPD

COPD can cause a variety of other health problems that can increase your risk of falling, usually because they affect your ability to balance or reduce your physical strength. For example, chronic hypoxemia (low blood oxygen levels) is a common COPD complication that can cause you to frequently feel lightheaded and unsteady on your feet.

COPD also increases your risk for a variety of cardiovascular problems (such as high blood pressure and right-sided heart failure) that can lower your blood oxygen levels and make you feel dizzy as well. The worst thing about dizziness from low oxygen levels is that it tends to strike during physical activities (e.g. walking, standing up, and climbing stairs), which is when you need your balance the most.

Having COPD can also interfere with your ability to do activities that help you maintain muscle strength and balance, including exercise, eating, and getting enough sleep. Many people with COPD also suffer from Vitamin D deficiency, which is another known risk factor for falls.

What's more, some research suggests that having COPD can reduce balance and stability irrespective of the factors mentioned above. While researchers are still unsure why that is, some believe it could be related to a kind of nerve damage (peripheral neuropathy) that is relatively common in people with COPD.

How Does COPD Increase Your Risk of Injury (from Falling)?

In addition to increasing your chances of falling, COPD also increases your chances of getting seriously injured when you fall. The main reasons for this are muscle weakness and osteoporosis, both of which are quite common in people with COPD.

Muscle Weakness

COPD makes it difficult to exercise and stay active, which (in addition to other factors, like inflammation and malnutrition) often leads to physical decline. One of the biggest contributors to this decline is the loss of muscle mass and resulting muscle weakness, which is a major risk factor for falls.

Muscle strength is not only important for maintaining balance, but also for being able to “catch yourself” and avoid getting hurt when you fall. This can cause you to fall harder or land in a way that causes you to get injured; e.g. on top of a hard object or on a fragile bone or limb.

Osteoporosis

People with COPD also tend to have risk factors that make them more prone to osteoporosis; these risk factors include things like older age, poor nutrition, lack of exercise, and chronic inflammation (a common symptom of COPD). Some medications used to treat COPD symptoms—particularly steroid medications, including steroid inhalers—can also increase the risk of bone density loss and osteoporosis over time.

Osteoporosis weakens your bones and makes them more brittle, which can cause them to break from even little accidents like minor bumps and falls. One study found that COPD patients were 50% more likely to have osteoporosis than people without COPD and were 1.6 times as likely to have suffered a major osteoporosis-related bone fracture.

Unfortunately, people with very severe COPD symptoms often have trouble eating and exercising enough to keep their bones and bodies strong. Because of this, those with advanced COPD tend to have a higher risk for osteoporosis, muscle weakness, and getting severely injured from a fall compared to those with milder COPD symptoms.

To learn more about COPD and osteoporosis, check out our guide on that topic here.

How COPD Can Make Recovery Harder After a Fall

Having a chronic health condition like COPD can make recovering from injuries harder, even injuries that are completely unrelated to COPD. The opposite is true as well: unrelated injuries can make your COPD worse by making it harder to to take care of yourself and manage your COPD.

A fall injury that makes it difficult to walk or requires hospitalization, for example, could prevent you from exercising for weeks or even months at a time. In the time it takes to recover, you could lose much of your strength and endurance as well as the many other health benefits you get from regular exercise.

This alone can have far-reaching health consequences, including worsened COPD symptoms and an increased risk of developing other health problems like heart disease. Long periods of inactivity can also increase your risk of falling in the future due to decreased muscle strength, balance, and increased COPD symptoms like breathlessness and fatigue.

What's more, if you have a fall that requires you to be hospitalized, having COPD could complicate your treatment. It could make certain procedures like surgery more risky, for example, or limit the number of medications that doctors can safely prescribe you in addition to the medications you're already taking for COPD.

Being hospitalized can also be dangerous in and of itself because it can increase your risk of getting sick from certain types of infections (e.g. hospital-acquired pneumonia) that can be especially deadly for people with COPD. Unfortunately, because COPD weakens the lung's defenses against infection, COPD patients are particularly vulnerable to respiratory infections both in general and during prolonged hospital stays.

As you can see, falls can result in more than just a single injury; they can set off a chain of consequences that can affect your strength, your mobility, and your ability to manage your COPD long term. That's why avoiding accidental falls is vital for maintaining your physical independence and maintaining a good quality of life as you age.

The Benefits of Fall-Proofing: Why It's Worth the Hassle

Fall-proofing can do more than just prevent falls and fall injuries; it can make your home a more comfortable—and more accessible—place to live with COPD. It can help you conserve energy, stay independent, and even build up the confidence to do a wider range of activities around your home.

Now that you better understand how COPD can make you vulnerable to falling, you can hopefully see why fall prevention for COPD patients is such a serious concern. Now, let's take a look at what you can gain from fall-proofing, and why it's more than worth the time and effort it takes to fall-proof your home.

Reduced Risk of Injury and Hospitalization from Falls

It goes without saying that the main point of fall-proofing is to reduce the risk that you (or someone else in your household) will fall and get injured in your home. However, we do want to emphasize why preventing falls is so important by showing you how bad even a “minor” fall can be.

First, it's important to know that serious fall injuries among older adults are very common. CDC research shows that one-fifth of falls cause serious injury, and that 3 million older adults are admitted to the emergency room for fall injuries every year.

Second, you should know that even ground-level falls (falls from standing height or lower) can result in a wide range of serious injuries, including broken bones and head injuries. These injuries can require long recovery periods, long hospital stays, and sometimes even serious medical procedures like surgery before they can fully heal.

Unfortunately, recovering from fall injuries is often especially difficult—and particularly lengthy—for older adults and people with chronic diseases like COPD. Injuries in older adults are also more likely to result in permanent health problems, including muscle weakness, loss of physical mobility, and chronic pain.

The lasting effects from fall injuries can lead to further physical decline can make it difficult—or impossible—to return to the life you had before. In this way, fall injuries can have huge, long-term effects on your quality of life even long after they heal.

It's also important to acknowledge that some people never make it out of the hospital or home recovery because they die of their injuries or complications during recovery. In fact, studies show that deaths from falls in adults over the age of 65 have steadily increased in recent years.

Increased Confidence At Home

One of the more difficult parts of living with COPD is the gradual decline in physical ability, which can have a huge effect on just about every part of your life. Along with that often comes a sense of fear and vulnerability that can further restrict what kinds of activities you do.

Studies show that a large number of senior adults restrict their activities for fear of falling, and that this can have a significant negative effect on their quality of life. It's often not even a conscious decision; you just slowly start to limit yourself to the areas and activities that feel safest, not realizing what you've given up along the way.

You might be surprised at how much fall-proofing can improve your sense of safety and security at home. It can even boost your sense of confidence in your own abilities and help you feel less limited by COPD.

Increased Comfort & Convenience at Home

Making the effort to fall-proof your home will not only make it safer, but also much more functional and comfortable to use. That's because getting rid of fall hazards makes your home easier to navigate in general, which is a particularly important benefit for people with COPD.

This can make a huge difference during COPD exacerbations or anytime your feeling breathless and fatigued. It can also help reduce the stresses of daily life just a little by making it easier to get around when you're in a hurry or have your hands full.

More Energy and Independence

Fall-proofing can help you adapt your home environment to one that's much better suited to your mobility needs. In this way, fall-proofing can allow you to do more activities independently and generally expand the range of activities that you can do safely in your home.

For example, fall-proofing often involves adding practical tools (like shower chairs and handlebars by the toilet) that make it easier to do regular household tasks. This can allow you to live more independently and do more everyday things around the house on your own.

By making your home more accessible, fall-proofing can also help you conserve energy, which is often in short supply for people with COPD. Then, you can use that saved energy on other things, allowing you to do more and accomplish more throughout the day.

How to Fall-Proof Your Home For COPD

Now that we've covered the basics of why fall-proofing is important, it's time to learn exactly how to fall-proof your home for COPD. In the following sections, we'll go through all the major steps of fall-proofing, showing you plenty of practical strategies you can use to address a wide range of fall hazards in your own home.

But that's not all; toward the end of this guide, you'll find a curated list of expert resources and thorough fall-proofing checklists you can use. And in the very last section, we'll discuss a variety of other things (besides fall-proofing) that you can do to improve your balance and reduce your risk of falling if you have COPD.

How to Make Your Floors Fall-Proof: It's All About Where You Step

The surfaces you walk on have a major impact on your balance and fall risk, which is why the majority of fall-prevention strategies focus on floors. That includes the floors themselves as well as the obstacles that end up on them, such as furniture, doorway thresholds, power cords, and rugs.

Unfortunately, no matter what kinds of floors you have or how clean you keep them, walking on them will always carry some risk. However, you can reduce those risks substantially by eliminating trip hazards and making simple—yet effective—safety improvements to your floors.

Beware of Rugs

When you think about floor fall hazards, rugs probably aren't the first things that come to mind. But even though they might seem harmless, rugs are the most common—and possibly most dangerous—trip hazards in the home.

Studies show that rugs cause a significant number of fall injuries. In the US alone, nearly 17,400 adults over the age of 65 have to be treated for fall injuries associated with rugs every year.

However, not all rugs are created equal; some rugs are much more likely to cause falls than others, and—in some situations—certain types of rugs can actually help prevent falls. The difference comes down to a few different factors: what kind of rug you're using, where you place it, and what you're using it for.

Throw rugs, for example, are particularly easy to trip on, especially when their edges get curled up, folded, or frayed. Additionally, most throw rugs are not (or cannot be) secured in place properly, meaning they can easily shift, slip, and bunch up under your feet.

On the other hand, non-slip rugs can be safe to use on hard flooring, as long as they're properly designed and they firmly stay in place. In fact, non-slip rugs can actually help you avoid slipping on slick patches on floors that tend to get wet, like your entryway, bathroom, or in front of the kitchen sink.

Unfortunately, even non-slip rugs can be a trip hazard, especially if they're bulky, damaged, or poorly placed. That's why it's important to only use rugs where they're really needed, and to carefully consider whether a particular rug's potential safety benefits are worth its potential risks.

One thing that all fall-prevention experts agree on, however, is that getting rid of loose, decorative throw rugs should be a first priority when fall-proofing any home. When it comes to non-slip rugs, however, evidence is mixed, though many experts agree that non-slip rugs can be beneficial when used cautiously and sparingly on potentially-slippery floors.

Here are some basic rules and criteria for using non-slip rugs safely in your home:

• Only use non-slip rugs with rubber backing that firmly grips the floor.
• Choose thinner rugs over bulky ones; it's more of a trip hazard the farther it sticks up from the floor.
• Ideally, you should use non-slip rugs with tapered edges that sit flush (or as flush as possible) with the floor.
• Only use non-slip rugs on hard floor surfaces where they can get an adequate grip and stay in place (e.g. tile, hardwood, acrylic, smooth concrete, etc.)
• Consider placing non-slip rugs on hard-floored areas near places that get wet, which can include your entryway, bathrooms, any anywhere else that's near a water source like a shower, washer, or sink.
• Make sure the floor is completely dry before placing a rug; any moisture trapped underneath the rug (e.g. from water splashes or mopping) could cause the rug to slip.

Keep Up With Floor Maintenance & Repairs

Keeping your carpet and other flooring in good repair should always be a top home maintenance priority, especially for people with mobility-limiting conditions like COPD. Unfortunately, damaged flooring is one of those inconvenient problems that far too often get ignored.

People often put off floor repairs due to the expense and/or effort it takes to complete them, not realizing how big of a risk they are taking. In reality, floor damage

If you've spent much time at all reading about COPD online, you've probably come across articles and advertisements for “natural” therapies and alternative treatments for COPD. These include things like vitamin supplements, lung detox cleanses, and unconventional medical treatments (like stem cell therapy) that claim to relieve COPD symptoms, regenerate lung function, or even cure chronic lung disease.

These treatments might seem promising at first glance, but the vast majority of “alternative” COPD treatments just don't live up to the hype. Most are unproven, dis-proven, or simply have very little, if any, real health benefits to offer at all.

However, the hope (however false) that these treatments offer is undeniably—and understandably—enticing to many people with COPD and other chronic respiratory diseases. The appeal is even stronger for patients struggling with severe breathing symptoms who don't get the results they want from conventional treatments for lung disease.

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Because of this, it's no wonder that many people with COPD and other chronic health conditions turn to “natural” and alternative treatments for relief. Unfortunately, even though many of these treatments (e.g. vitamin supplements) might seem harmless, they can be risky and even dangerous in ways that you might not expect.

In this post, we're going to take a look at some of the most popular “natural” and alternative COPD treatments to see whether they work as advertised and what they're all about. We'll do our best to take an objective approach that considers both the available research on each “treatment” as well as expert reviews and opinions on how safe and effective the therapy is.

We'll also discuss some simple strategies that can help you recognize dubious treatments and unreliable health advice in general. That way you can better protect yourself from all kinds of health and disease misinformation, not just the stuff related to COPD and respiratory disease.

Recognizing & Understanding COPD Treatment Scams

Lots of people are interested in the idea of “natural” or “alternative” medicine, and its a particularly common topic to stumble upon online. And while some of these treatments do have some proven benefits, most of them don't meet the standards required to qualify as a valid treatment for COPD.

Unfortunately, figuring out what works and what doesn't isn't easy, especially in the murky waters of social media and amid the explosion of health product endorsements online. Let's take a closer look at this phenomenon and how it can lead well-meaning people to spread misinformation that exploits the hopes of people suffering from COPD and other chronic health conditions.

Misinformation Can Be Sneaky: Beware of What You Read Online

You can find ads, articles, and social media posts making untrue claims about dubious COPD treatments in just about every corner of the internet—often right alongside valid information about proven COPD treatments. Without further investigation, it's impossible to tell what's legitimate, what's inaccurate, and what's a downright scam.

This is especially difficult when misinformation is posted with good intent by well-meaning people who believe it to be true. After all, health, disease, and disease treatment are all extremely complex topics that take a great deal of experience and expertise to fully understand.

There are also bad actors who intentionally peddle false treatments in order to take advantage of patients, caregivers, and loved ones seeking alternative solutions for their health problems. They deliberately twist the truth by misrepresenting science and cherry-picking data to make their “treatments” sound more legitimate or effective than they really are.

Unfortunately, the internet is the perfect environment for misinformation to spread and multiply, a fact that scammers and snake oil salesman are all too eager to exploit. It allows them to not only spread their lies with little pushback, but also reach a massive audience of people with minimal effort and expense.

That's why you should never take endorsements for natural, alternative, or novel COPD therapies at their word; always take the time to investigate and verify first. Fortunately, there are plenty of expert resources that can help us better understand the science behind these “treatments” and determine which ones are legitimate and what's too good to be true.

We consulted a large number of academic studies and other expert resources for this guide, and you'll find the links to all these sources sprinkled throughout the following sections. For even more information about COPD treatments and how to manage your COPD symptoms, check out our large repository of practical COPD guides in our Respiratory Resource Center.

The Different Flavors of COPD Treatment Scams

Natural and alternative COPD treatments (whether legitimate or sham) aren't limited to any particular type or category. Just as legitimate COPD treatments take several different forms (e.g. medication, diet & lifestyle changes, etc), you can find alternative treatments that fit each of those categories and more.

For the sake of this guide, we're going to group the most common natural and alternative COPD treatments into four different categories. This lets us more easily compare alternative treatments with common characteristics and tease out the differences between those that work and those that don't.

Here's a quick summary of the four main types of natural and alternative COPD treatments you're likely to come across online:

• Supplements & Nutrition-Based Treatments: These include specific vitamins, herbs, and other supplements that advocates claim can relieve COPD symptoms or improve the disease itself in some way.
• Lung “Detox” Treatments: These are treatments that claim to cleanse your lungs (and therefore make them healthier & relieve respiratory symptoms) by getting rid of toxins or other supposedly harmful substances from your lungs.
• Lifestyle remedies: These include activities, habits, and lifestyle changes that are claimed to relieve COPD symptoms or otherwise improve the disease.
• Stem Cell Treatments: These are cellular therapies involving stem cells—usually offered by private clinics—that are advertised to reduce lung disease symptoms or reverse the course of COPD.

Measuring The Merits of Alternative Treatments for COPD

It's important to acknowledge that evaluating disease treatments is a complicated and nuanced process. It's involves not only determining if a treatment works, but how it works, how well it works, and if the potential benefits are worth the potential risks.

It often takes years of research and expert analysis to evaluate a new treatment, and the answers are often not clear cut. That's why we have to consider a spectrum of possibilities for natural and alternative COPD treatments, including the possibility that some treatments might have marginal benefits even if they don't live up to the promises that the people promoting the treatments make.

For each treatment we discuss in this guide, we'll present a brief overview of the available research and what that research means for people with COPD. Our goal is to give you a better idea of each treatment's overall effectiveness and whether or not it has proven merit as a treatment for COPD.

Keep in mind that what we've included in this guide is just a snapshot of all the available information out there on these topics. It is not a comprehensive guide, and it's certainly not meant to be a substitute for professional medical advice.

It's always best to consult your doctor or other specialists involved in your treatment who know the most about your particular health needs. They can offer the best advice about what kinds of medications, supplements, and other treatments are right for you.

A Note on Conventional Medicine

Because the point of this guide is to identify unproven or “sham” COPD treatments, we won't be talking much about “conventional” COPD treatments in this guide. Treatments used in standard COPD healthcare—such as inhalers, antibiotics, and steroid medications—have already been thoroughly vetted by experts and are widely accepted as the most effective ways to treat COPD.

In this guide, we're focusing instead on non-traditional remedies: things that are not usually considered to be a standard part of COPD healthcare. Almost by definition, these remedies haven't (yet) met the high standard of evidence that medical experts generally require before incorporating a treatment into conventional medical care.

In this guide, we'll attempt to untangle which—if any—of the most popular natural and alternative COPD remedies actually have any merit, as well as which ones are dangerous, disproven, or downright scams. We'll also discuss some of the common fallacies and science misinterpretations that underlie many these false health claims.

If you're interested in learning more about conventional COPD treatments, we've included links to several guides on the topic below. These guides will give you a more in-depth look at all the major COPD therapies, including the research on why, how, and how well the treatments work.

• How Supplemental Oxygen Therapy Treats COPD
• How Antibiotics Work to Treat COPD Exacerbations
• How COPD Inhalers Work: An In-Depth Look at Long-acting and Short-acting Bronchodilators
• How Steroid Medications Work to Treat COPD

A Note on Self-Prescribing Natural & Alternative Treatments

While we will continue point this out in specific examples throughout this guide, we think think it's important to emphasize how risky is can be to start any kind of natural or alternative treatment on your own. “Natural” does not mean harmless, and even the most benign-sounding natural and alternative “treatments” can come with some serious risks.

For example, one 2015 study found that there is an average of 23,000 emergency room visits every year in the US related to dietary supplements alone. Other studies have found that some “natural” and herbal supplements were tainted with potentially dangerous prescription drugs (you can find a list of these products here on the FDA's website).

That said, many natural and alternative treatments are available right over the counter at your local pharmacy or grocery store. But just because they're widely available doesn't mean they work (or that they're safe), which is why it's always best to talk to your doctor before starting any kind of new health treatment— even if it's just a “natural” vitamin supplement or dietary routine.

Even if you do decide to go ahead and start a new treatment without your doctor's input, it's still very important to let your doctor know. Your doctor needs accurate, up-to-date information about your health to give you the best possible treatment, and that means he needs to know about every medication, vitamin, supplement, natural remedy, and alternative treatment you use.

Nutritional Supplements & Herbal Treatments for COPD: Do They Work?

If you've ever taken a look at the supplement aisle at your local grocery store or pharmacy, you've probably noticed the rows and rows of supplements on sale. If you take the claims on the bottle at face value, it seems like there's a supplement for everything from anxiety and depression to digestive issues and chronic pain.

Supplements are by far the most popular category of natural treatments. This is no wonder since they're available just about everywhere and make such appealing claims. They're used by wide variety of people—both healthy and unhealthy—to treat an astonishingly wide variety of health conditions and concerns.

Supplements touted as COPD treatments are claimed to bestow a variety of different benefits including better lung function and reduced COPD symptoms like breathlessness and fatigue. Unfortunately, research on these treatments tends to come up with weak, disappointing, or inconsistent results.

That said, many supplements are relatively harmless and inexpensive, which is why so many people are willing to give them a try, even if they don't get concrete results. Polls show that 86% of Americans take supplements, while only 24% of them have a diagnosed nutrient deficiency.

In the following sections, we're going to take a closer look at some of the most popular categories of supplements for COPD. These include: vitamin & mineral supplements, herbal supplements, and anti-oxidant supplements.

Vitamin & Minerals Supplements: 7 Dubious “Natural” Remedies for COPD

Vitamin and mineral supplements are a tricky issue, because they definitely do have a legitimate benefits for some people in some situations. The problem is that they're often useless—and sometimes even harmful—when self-prescribed.

Most supplements are only proven to work when prescribed by a doctor for very specific conditions, such as confirmed nutrient deficiencies and complications of certain diseases. That means that, unless they're specifically recommended by your doctor, over-the-counter supplements are not likely to have any beneficial effect on your COPD.

Generally, most people only need enough vitamins and nutrients to meet the minimum threshold for what their body needs to function. In most cases, taking extra vitamins and nutrients beyond that threshold doesn't “enhance” the body's functioning—they just go to waste.

The same logic applies to “superfoods” and other nutrient-rich foods that are touted as having specific health effects. While eating healthy foods is important, eating any one specific healthy food generally isn't; you can get just as good of results from eating a balanced diet made up of a wide variety of different healthy foods.

Of course, some people with COPD have nutrient deficiencies, and certain types of nutrient deficiencies are more common in people with COPD. The main problem with vitamin and mineral “remedies” for COPD is that they're not advertised as a treatment for a deficiency—they're claimed to have specific health effects all on their own.

In most cases, those claims are unsubstantiated; though research has found that some vitamins are correlated with improved COPD symptoms, they usually fail to find any causal link between taking vitamin supplements and improvements COPD.

Here's how one research review put it: “Although there are many studies that associate vitamins with improvement in lung function tests, there is no clear evidence of the benefit of vitamin supplements. Most studies regarding supplements showed no benefit of multivitamin supplementation in symptoms, spirometric function or hospitalization for COPD.”

But for the sake of of debunking some common natural COPD remedy myths, let's take a closer look at some of the most common vitamin and mineral remedies touted as treatments for COPD.

Vitamin D

Vitamin D is probably the most frequently recommended supplement for COPD. This is partially because people with COPD have a higher-than-average incidence of vitamin D deficiency, but also because vitamin D is known to play an important role in immune system function and general respiratory health.

Proponents of vitamin D sometimes claim that vitamin D supplements can improve breathing function, reduce exacerbations, and relieve other symptoms of COPD. This idea is supported by research that has found improvements in some patients' COPD symptoms after giving those patients supplements (or injections) containing vitamin D.

However, studies that actually measure patients' vitamin D levels before the start of vitamin D treatment have repeatedly found that the only patients who benefit are the ones who started out deficient in vitamin D. This indicates that vitamin D supplements don't improve general, baseline COPD symptoms, but rather symptoms that have been exacerbated by a vitamin D deficiency.

Even so, there is some discussion in the medical community about whether or not it's worth it to recommend vitamin D supplements to patients as a preventative measure against vitamin D deficiency. That's because minor vitamin D deficiencies (often referred to as “vitamin D insufficiencies”) are relatively common, and because vitamin D supplements are relatively safe in doses up to 2,000 IU (or 50 mcg) daily.

Ultimately, however, the only COPD patients who are likely to benefit from vitamin D supplements are those who are not getting enough vitamin D in the first place. Since most people get up to 90% of their vitamin D from the sun, you might have a higher risk of being deficient if you have don't spend much time outside or you don't get enough of the right kind of sunlight where you live.

If you think you might be deficient in vitamin D, the first step is to schedule an appointment with your doctor. Depending on the circumstances, your doctor might recommend formally testing your vitamin D levels or he might treat you for a deficiency based on your symptoms and risk factors alone.

Magnesium

Magnesium is an essential mineral that plays an important role in lung function and breathing, and some studies have even found correlation between low magnesium levels and an increased risk of COPD exacerbations. Because of this, it's no surprise that magnesium supplements are frequently touted as a natural treatment for COPD.

Unfortunately, while intravenous magnesium is considered a valid COPD treatment for patients hospitalized with COPD exacerbations, there is no evidence that magnesium supplements have any benefit for people with asthma or COPD. In fact, some research suggests that taking too much magnesium can have respiratory side effects that could be particularly dangerous for people with respiratory diseases.

One the most serious potential side effects is pulmonary edema, which causes the lungs to fill up with fluid and can lead to acute respiratory distress. Another danger of magnesium is that it interacts with many common medications (e.g. by making them less effective), including antibiotics, blood thinners, and medications used to treat osteoporosis, high blood pressure, and heart disease.

Because of these and other risks—and the fact that there's little or no evidence of benefit—magnesium supplements are not generally recommended for the general public or for people with COPD. Despite this, research shows that up to one third of COPD patients might be deficient in magnesium, and magnesium supplements are considered to be relatively safe in doses of up to 350mg daily daily (for adults).

However, this doesn't mean that you shouldn't still talk to your doctor before starting magnesium supplements, even if you think that you're magnesium deficient. It's important to get your doctor's opinion on whether magnesium supplements are safe for your condition and to make sure that they won't interfere with any other medications you take.

Calcium

Calcium is a mineral that's often included in lists of natural supplements and treatments for COPD. This is likely because it's an important nutrient for preventing osteoporosis, which is a condition that's especially common in older adults and people with COPD.

Unfortunately, this leads some to mistake calcium as a type of COPD treatment, despite the fact that calcium doesn't have any kind of direct impact on COPD or its symptoms. However, osteoporosis can cause injuries and mobility difficulties that can significantly effect your ability to manage your COPD.

If you don't get enough calcium, your bones can start to lose density, which makes them brittle and weak. This can lead to a variety of detrimental health effects—including instability, falls, bone fractures, and loss of physical mobility—that can lead to a downward spiral of poor health and worsened COPD.

The best way to make sure you're meeting your daily calcium requirements (about 1,200 mg daily for older adults) is to eat calcium-rich foods like dairy and calcium-fortified foods.

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

Exercise tests are an effective way to not only measure physical strength and endurance, but also how well you can breathe. They can reveal vital information about your lung function, your oxygen levels, and your general physical abilities.

This can help you and any health professionals you work with better understand and treat your disease. Because of this, both doctors and fitness specialists use a variety of different exercise tests to evaluate people with COPD and other lung conditions.

Why Take an Exercise Test?

If you have COPD, your doctor might ask you to take an exercise test for a several possible reasons, including to measure how severe your symptoms are, what kind of exercise you can tolerate, and to determine what kinds of treatments can help. They are also useful for monitoring general lung function and tracking improvements or decline in your ability to exercise over time.

Exercise test results also serve as a good measure of how your disease and respiratory symptoms affect your mobility and your everyday life on a practical level. Because of this, they are especially useful for evaluating people with advanced COPD, who often suffer from shortness of breath so severe that normal daily activities become a struggle.

There are many different types of exercise tests, each designed to measure your physical and respiratory abilities in a different way. The results can be used for a variety of different purposes, including to measure COPD symptoms, to design personalized exercise programs, and to determine whether or not a patient needs supplemental oxygen therapy.

That's why, in this post, we're going to introduce you to the five most common exercise tests that medical and fitness specialists use to evaluate COPD and other respiratory diseases. We'll explain what these tests are, how they work, and what each test can tell you about your health.

With this knowledge, you'll know what to expect and how to prepare the next time your doctor wants you to complete an exercise test. Most importantly, however, this will also give you the vocabulary and the information you need to actually read your test results and understand what they mean for you.

Field Walking Tests Versus Laboratory Tests

There are two main categories of exercise tests: field walking tests and laboratory tests. Laboratory tests are usually done on a treadmill or exercise bike in a lab, while field walking tests are performed on flat ground, usually in a large, open space.

Lab exercise tests tend to be more intense because the exercise machine sets the pace and pushes you to keep moving continuously. This makes it more difficult to pause, slow down, or stop for a rest during the test.

During most field walking tests, however, you can set your own pace, pause, and take breaks as often as you need to. That's why, in many cases, field walking tests are better suited for people with chronic respiratory diseases, who often have serious physical limitations and low exercise tolerance.

Laboratory exercise tests can also get pricey because they require an exercise machine and other specialized equipment (e.g. electrocardiogram sensors). On the other hand, field walking tests can be done with minimal equipment, making them a simpler and less expensive choice.

In this post, we are going to focus mainly on field walking tests, since they are the simplest and most common types of exercise tests used for people with COPD. However, we will also discuss one lab-based test, the cardio-pulmonary exercise test, which many researchers consider the most accurate and reliable form of exercise testing.

We'll go over each test in detail so you'll know what to expect from an exercise test and how to interpret your results. We've also included some extra tips at the end of this article to help you prepare for your exercise test.

The following sections include: the 6-minute walk test, the incremental shuttle walk test, the endurance shuttle walk test, the sit-to-stand test, and the cardio-pulmonary exercise test.

The 6-Minute Walk Test

The 6-minute walk test (abbreviated 6MWT) is a simple test that measures how far you can walk in 6 minutes. This is one of the most frequent types of exercise tests used for people with COPD and other respiratory conditions.

The results give you a general idea of how well your lungs function and how much physical endurance you have. This can be used to determine how much your disease affects your ability to get around and help your doctor determine the best course of treatment.

6-minute walk tests are often done multiple times for comparison, especially before starting a new COPD medication or another type of therapy. In that case, you will take one test before beginning the treatment and another shortly after in order to see if your test results change.

How the 6-minute Walk Test Works

To complete this 6-minute walk test, you will simply walk on hard, even ground for exactly 6-minutes straight. The goal is to measure how much distance you can cover in that time without pushing yourself too hard.

Before the test, you will sit and rest for about ten minutes so the test technician can get a baseline measure of your heart rate, blood pressure, and blood oxygen saturation. Then, the technician will ask you to rate your breathlessness via a standard scale, such as the Borg scale.

The Borg scale allows you to choose from a range of numbers, one to ten, with higher numbers representing more severe shortness of breath. To use it, you simply match the symptoms you feel with the number that best describes them on the scale.

This helps you quantify your breathlessness in a consistent way that you and your doctor can use to measure changes over time. Breathlessness scales are used all the time in COPD evaluations, including regular check-ups and other types of exercise tests.

After taking down your breathlessness rating, the technician will start a stopwatch timer and have you begin walking on the track. To complete the test, all you have to do is continue walking until the timer reaches six minutes.

You should try to walk as far as you can, but you may pause for breath or stop walking any time you need to. However, the timer will keep running and any rests you take will affect your test results.

During the test you may also use supplemental oxygen, if you're prescribed it, and any walking aids (such as a cane or walker) that you normally use to get around. Just make sure to bring the same aids for future exercise tests so your results will be consistent.

Let the technician know if you feel too exhausted to finish or experience any severe or dangerous symptoms. Intolerable shortness of breath, chest pain, and leg pain are all urgent indications that you should stop the test.

When you make it to the six minute mark, the walking part of the test will be over and you can sit down to rest. The technician will record the total number of laps you completed, ask you to rate your breathlessness again, and record your heart rate, blood pressure, and blood oxygen saturation once more.

What the Results of Your 6-Minute Walk Test Mean

The results of the 6-minute walk test reflect your general respiratory health and give you a baseline measure of your physical ability. The primary result of the test is your 6-minute walk distance (abbreviated 6MWD).

Interpreting Your 6-minute Walk Distance Score

A longer 6MWD indicates better exercise tolerance and better lung function, while shorter distances indicate poorer exercise tolerance and lung function decline. Research shows that you need to increase your distance by about thirty meters (about 98 feet) in order to determine that you've made a significant improvement.

You can also compare your 6-minute walk distance to standard reference values in order to see how your results compare to healthy people of your age, sex, weight, and height. Your doctor may provide you with a table of reference values, or you can plug your 6MWD into this online calculator.

Since walking is a light and simple activity that's part of normal living, the 6-minute walk distance is considered an excellent measure of how much your disease affects your everyday life. Studies show that short distances (especially distances less than 150 meters) are associated with more severe respiratory disease, more severe mobility limitations, and a higher risk of death.

Interpreting Your Breathlessness Scores

Your breathlessness scores are also important, because they specifically measure how severe your COPD symptoms are and how they change in response to light physical activity. If there is little change in your breathlessness score throughout the test, this indicates that you tolerate exercise relatively well.

On the other hand, a significant increase in breathlessness indicates that light physical activity puts a lot of strain on your lungs. This is a sign of low exercise tolerance and more advanced COPD.

Interpreting Your Heart Rate Measurements

In general, the lower your resting heart rate is, the better your cardiovascular fitness. That's because your heart rate is a good indication of how hard your heart has to strain in order to do it's job.

A lower heart rate means that your heart can pump your blood effectively with fewer beats. This usually indicates better exercise tolerance and better physical endurance.

A faster heart rate means that your heart has to work harder in order to pump enough blood around your body to meet your body's needs. This indicates low cardiovascular fitness and lower exercise tolerance.

A fast resting heart rate can also be a sign of other health conditions, including high blood pressure and narrowed arteries caused by cardiovascular disease. It can also indicate that your blood oxygen levels are low, which can be caused by poor lung function.

Low blood oxygen levels force your heart to pump blood faster, which often resulting in a higher resting heart rate. As a result, your heart rate and blood oxygen saturation readings can help your doctor determine how well your lungs are working.

Studies even show that resting heart rate can reliably predict the severity of a person's COPD. Higher resting heart rates are associated with more advanced COPD and a higher risk of death from the disease.

Interpreting Your Oxygen Saturation Reading

Another important measure is your blood oxygen saturation readings, which are usually recorded before, after, and sometimes during the test. This number is usually written as your SpO2%, and it can tell you if, and to what degree, basic exercise causes your oxygen levels to drop.

When your blood oxygen saturation falls to low—below 95%--it is known as hypoxemia, a potentially dangerous condition that requires treatment (often with supplemental oxygen therapy) to correct. This happens when your lungs can't absorb enough oxygen to supply your body with the full amount that it needs.

Some people with COPD experience chronic hypoxemia, meaning their blood oxygen levels tend to be too low most of the time. Hypoxemia tends to get more severe as COPD progresses, and the severity of hypoxemia is a good indication of how advanced your COPD is.

Blood oxygen saturation readings are also the main determining factor when deciding whether or not someone needs to use supplemental oxygen. In most cases, people with COPD and other chronic respiratory diseases begin supplemental oxygen therapy when their oxygen levels fall below about 90%.

However, some people with COPD only experience low blood oxygen saturation when they exercise, a condition commonly referred to as exercise-induced oxygen de-saturation. This can be difficult to catch during normal check-ups and exams, since it only occurs during physical activity.

Because of this, exercise tests like the 6-minute walk test (and especially the incremental shuttle walk test, which we'll discuss next) are useful for catching exercise-induced hypoxemia in people with respiratory diseases. By recording your oxygen saturation levels at different points during the test, it can reveal whether or not exercise causes them to drop.

Putting it All Together

All of this information helps your doctor determine how severe your symptoms are and make a more accurate prognosis for your disease. For instance, a variety of studies have shown that, in general, lower 6MWT scores in people with COPD are associated with a higher risk for hospitalization or death.

This isn't surprising, since studies have long shown that physical activity and exercise are vital for maintaining health, breathing efficiency, and physical mobility in people with COPD. Because of this, exercise capacity is generally a pretty good predictor of how advanced the disease is and what kinds of outcomes you can expect.

In many cases, however, the primary purpose of the 6-minute walk test is to establish a baseline to compare future 6MWT results against. Then, repeat tests will reveal how your endurance, which is representative of your overall lung function, improves or declines over time.

The Incremental Shuttle Walk Test

The incremental shuttle walk test (abbreviated ISWT) is another walking exercise used to measure both lung function and physical endurance. However, the ISWT is slightly more challenging than the 6-minute walk test because it pushes you to walk more quickly and for a longer period of time.

The goal of the ISWT is to see how many times you can walk up and down a short track while steadily increasing your speed. You'll be supervised by a technician who will record basic data about your heart rate, oxygen levels, and breathing symptoms at regular intervals during the test.

The goal of the test is to measure your lung function as you progressively work up to your maximum exercise capacity. This gives you a solid measure of your endurance and how your oxygen levels change as you increase your exercise intensity.

Like the 6-minute walk test, you may need to take the ISWT on more than one occasion in order to see if the results change. This is particularly useful for measuring whether or not a new medication, exercise program, or other treatment is helping you or not.

How the Incremental Shuttle Walk Test Works

To take an incremental shuttle walk test, you will walk on a course made up of two cones placed about thirty feet apart on hard, flat ground. The full path you walk from cone to cone is exactly ten meters (or about 32 feet) in length.

Each time you complete a trip from one cone to another, you've finished a single increment, or shuttle. When you take the test, you will complete multiple shuttles one after the other at gradually increasing speeds.

Before the test, your doctor will tell you when and if you should use your bronchodilator and other medications on the testing day. To be safe, you should always bring your bronchodilator medication, your supplemental oxygen (if you use it), and any walking aids you normally use.

In order to keep the test consistent, incremental shuttle walk tests are always led by a tape of recorded audio instructions. Although you will have a test technician to help you, the recording will be your main source of instruction throughout the test; it will tell you exactly when to start and set your walking pace.

As you walk, the recording will play tones (or beeps) in a steady rhythm to match the beat of your steps. To complete each shuttle, you will walk in time with recording, taking one step each time you hear a beep.

The tones will play slowly at first but speed up slightly every minute, forcing you to increase your walking pace gradually throughout the test. The recording is also timed so that you have to complete each full shuttle in a specific amount of time before an end tone plays.

As you walk, the technician running your test will record several physical measures at regular intervals, including your heart rate (in beats per minute), your blood oxygen saturation (written as SpO2 %), and what degree of breathlessness you experience. You may stop the test at any time if it becomes too difficult to breathe or if you get too exhausted to continue.

The incremental shuttle walking test ends when you can no longer go on or when you can no longer keep up with the pace set by the recording. Once you finish, the technician will immediately record your blood oxygen saturation, heart rate, and breathing symptoms again.

Then, after you've had two minutes to rest, the technician will take all these measurements one final time. He will also record the final number of shuttles you walked and your reason for stopping the test.

Check out this video to see an example of how an actual incremental shuttle walk test is performed.

What the Results of Your Incremental Shuttle Walk Test Mean

At the end of your incremental shuttle walk test, the results will show your SpO2, heart rate, and breathlessness at each minute during the test. It will also state why you had to stop the test and the total number of shuttles you were able to complete.

These are important measures that can tell you a variety of things about your physical fitness and your overall respiratory health. Some of these measures are very similar to the ones taken during the 6-minute walk test, so we will go over them only briefly again here.

Interpreting Your Blood Oxygen Saturation Scores

As we discussed earlier in this post, your blood oxygen concentration, or SpO2, tells you how much oxygen is in your blood. This indicates how well your lungs are functioning; an SpO2 above 95% is considered normal, while anything less indicates that you have hypoxemia.

One of the most important things an incremental shuttle walk test can reveal is how your blood oxygen saturation changes throughout the course of the test. This can reveal whether or not you experience exercise-induced hypoxemia and help your doctor determine the best way to treat it.

Compared to the 6-minute walk test, the ISWT is generally more intense, so it allows you to see how your oxygen saturation levels respond to heavier amounts of exercise. It also gives you a wider range of data points to analyze, since it measures your oxygen levels at regular intervals from rest all the way up to your maximum pace.

Interpreting Your Breathlessness Scores

For some, the change of seasons is not always a positive thing. Seasonal Affective Disorder (SAD) is a condition that affects about 5 percent of U.S. adults each year and it’s associated with depressive episodes that correlate with the change of seasons.

While seasonal affective disorder isn’t exactly a household name, it can have potentially serious side-effects for anyone who experiences it. SAD isn’t simply a change of mood, it’s actually a type of major depressive disorder (MDD). What this means is that in order to be diagnosed with SAD, a patient needs to exhibit similar symptoms to major depression. This includes symptoms such as feelings of hopelessness or worthlessness, low energy, and loss of interest.

Another important thing to note is that people who are already diagnosed with a chronic illness such as COPD are at a higher risk of experiencing SAD, and it may have an effect on how you manage SAD as well. In this post, we’re going to discuss everything you need to know about treating, coping with, and preventing seasonal affective disorder if you have COPD or another debilitating lung condition. If you have any questions, please feel free to leave them in the comment section or consult your doctor.

What is Seasonal Affective Disorder (SAD)?

SAD is a mental health condition that’s characterized by depressive episodes that change with the seasons. Most often, the symptoms increase in the fall and winter and decrease in the spring and the summer. This is because the reduced sunlight associated with fall and winter causes disruptions in your body’s natural circadian rhythm which can lead to feelings of depression. In rare instances, however, someone may experience SAD during the spring or summer months.

Seasonal affective disorder can be a debilitating condition. It’s not uncommon for someone to experience SAD and be unaware that their depressive episodes are linked to the seasons or they may believe that everyone experiences depression in the fall or winter. While it is true that the change of seasons affects us all in some way, it’s uncommon for it to lead to disruptions in your daily life such as chronic fatigue, difficulty concentrating, or feelings of hopelessness.

According to a study done by the University of Copenhagen, people who contract SAD show differences in the way that they regulate the neurotransmitter serotonin which has a significant effect on your mood. The researchers studied both SAD patients and healthy patients and found that the former had higher levels of the serotonin transporter (SERT) which leads to a greater removal of serotonin in the body. The SAD patients had an average of 5% higher SERT levels in the winter months as opposed to healthy patients who showed no significant change.

Unfortunately, mental health conditions like SAD are a little more complicated than an imbalance of chemicals in the brain. There are millions of chemical reactions that occur in the brain at any given moment, all of which culminate to create your overall feelings and mood. So, it’s unlikely that increasing serotonin levels will be the end all be all solution. This is why mental health disorders are often treated with a variety of methods like medication, exercise, therapy sessions, and more.

While rare, summer and spring SAD is still very much a reality. However, while it’s normally caused by shorter days, colder weather, and less sunlight in the winter, summer SAD is caused by the opposite — longer and hotter days. Another factor involved is summer and spring allergies which can last many months and keep people relegated to their homes.

One common occurrence in people with summer SAD is that they get too little sleep. Longer daylight hours and shorter nights means that many people are getting less sleep than they should be getting. To mediate this, your doctor may offer a revised sleep schedule, or he/she may prescribe you melatonin supplements that make up for your body’s low supply.

What Are the Symptoms of SAD?

SAD symptoms may vary from person to person and they can range in severity from mild to severe. Possibly the most common symptom of SAD is feeling unmotivated, demoralized, or hopeless. We’ve all had days where we feel like we don’t have the strength to do something productive, but for someone with SAD, these feelings may persist over the course of several weeks or months.

Another symptom of SAD is difficulty sleeping and/or feelings of restlessness or fatigue after waking up in the morning. A lot of the time, sleeping difficulties are attributed to high anxiety or chronic pain which tend to be common in COPD patients. Sleeping problems should be dealt with sooner rather than later because long-term sleep deprivation can lead to mood changes, a weakened immune system, an increased risk of heart disease, and many other negative health effects. 

One final symptom of seasonal affective disorder is feeling uninterested in things that you used to enjoy. Everyone has hobbies that they like to pursue. These hobbies help us feel complete and keep our minds off of anything negative that we might be experiencing in our lives. But when you have SAD, these hobbies can feel more like a chore rather than a relaxing activity.

What Are the Causes of SAD?

As aforementioned, the causes of SAD are complex and it’s still heavily debated as to what the primary causal factor of SAD is. Thus far, however, scientific research has led us to believe that there are three factors that contribute to the onset of seasonal affective disorder: poor regulation of the neurotransmitter serotonin, an overproduction of melatonin, and low vitamin D production.

What Are the Risk Factors of SAD?

Since one of the major causes of SAD is a lack of sunlight, it goes without saying that where you live has a significant impact on whether or not you will contract it. Since the amount of winter daylight decreases the farther you are away from the equator, you’re more likely to experience SAD if you’re at least 30 degrees north or south. 

Genetics also plays a role in seasonal affective disorder. If you have parents who have a history of depression or high anxiety, you might be at higher risk of experiencing SAD or other major depressive disorders. 

How Are SAD and COPD Connected?

COPD and SAD are not directly related. In other words, just because you have a chronic respiratory disease does not necessarily mean you will develop SAD or any type of depression for that matter. However, due to the symptoms associated with these conditions, it can be very difficult to cope with both COPD and SAD at the same time. It can also be difficult for doctors to diagnose SAD in COPD patients because these two conditions share many symptoms.

COPD is a chronic and debilitating lung condition that’s primarily caused by cigarette smoking. It’s characterized by trouble breathing, fatigue, and increased mucus production. COPD is a progressive disease meaning it gets worse over time and patients may experience “exacerbations,” a period of time where COPD symptoms suddenly get worse. A carefully planned treatment regime is essential for managing COPD.

According to the International Journal of Chronic Obstructive Pulmonary Disease, depression is common among COPD patients. Around 40% have either clinical depression or severe depressive symptoms. In addition to this, many people with COPD experience anxiety which tends to get worse as respiratory symptoms progress. 

How Should a COPD Patient Cope with SAD?

The best way for COPD patients to cope with SAD is to manage the symptoms of COPD. More often than not, COPD patients develop a sense of doom and gloom when they realize that their symptoms are getting worse instead of better. Rather than letting these thoughts take control, take some time to evaluate how you’re approaching your disease, and be open about what you’re experiencing with close friends and family members.

Pulmonary Rehabilitation

Pulmonary rehabilitation is paramount when it comes to managing respiratory symptoms such as breathlessness, fatigue, and chest pain. Not only does pulmonary rehabilitation strengthen the lungs, but it improves the strength of every muscle in the body. And since muscle strength is a key factor in preventing CO2 retention, it also plays an important role in preventing symptoms of anxiety and depression.

One of the reasons that it’s so difficult to maintain a pulmonary rehabilitation routine throughout the fall and winter is because the weather can prevent us from getting outside. Most people prefer exercising outdoors, but if you have COPD, cold weather can exacerbate your symptoms. So if this sounds like you, be sure to plan your pulmonary rehabilitation activities indoors. A study from Harvard found that just 35 minutes of low- or high-intensity exercise is linked to reduced odds of depression.

Maintain a Healthy Diet

Many people are surprised to find that their diet has an immense impact on the health of their lungs, and by proxy, their mental health as well. While a “healthy diet” looks different for just about everyone, your doctor has likely set you up with a dietary regime that’s high in fiber, healthy fats, and protein. This is pretty standard for COPD patients, but it may vary slightly depending on your situation.

One way to maintain a healthy diet in the fall and winter is to have your groceries delivered. Rather than having to go out in the cold and search the store for everything you need, you can take your time and select food online that meets your dietary needs. This is also a great way to avoid the temptation of buying food that doesn’t meet your COPD treatment plan.

Be Open With Your Doctor

It’s not always easy being open and honest about the things you’re feeling or experiencing. But when it comes to something as serious and debilitating as seasonal depression it’s important to find some way to let others know about it. If you don’t feel comfortable speaking directly to a health professional, you can talk to a friend or loved one who can contact them for you. 

One of the most effective ways of treating seasonal affective disorder is through cognitive behavioral therapy (CBT). This is a type of psychotherapy that aims to identify and correct habits that can lead to a negative state of mind. CBT has a wide range of uses including addiction prevention, stress reduction, depression prevention, and learning techniques to cope with chronic conditions like COPD.

Another treatment your doctor may prescribe to treat SAD is light therapy, also known as phototherapy. Just like this sounds, it’s a type of therapy that exposes you to light that’s designed to mimic sunlight. Typically, you will be told to use this device right when you get up or periodically throughout the day. You should notice your mood improving over the course of several days or weeks.

Last but certainly not least, you may be prescribed medication for SAD. Antidepressants like bupropion are designed to prevent depressive episodes in people with a variety of different conditions. Keep in mind that there are always side-effects with antidepressants and they may interact poorly with your respiratory symptoms, so be sure to use them only as your doctor prescribes.

Take on More Responsibilities

One of the worst symptoms of depressive disorders like SAD is that they make it feel like it’s impossible to take on the challenges of the day. Whether we’re faced with a difficult family matter or something pertaining to our disease, it’s hard to know where to begin if you can’t find the motivation to do it.