Lungs affected by COPD are very sensitive, particularly to things like respiratory irritants, physical strain, and less-than-ideal breathing conditions (such as hot or humid air). Because of this, if you have COPD, you've probably noticed that your COPD symptoms tend to flare up in certain environments or when you do certain things.

Many common habits and everyday activities can trigger COPD symptoms, and your lungs tend to get even more sensitive to these things as the disease progresses. Because of this, a vital part of learning how to manage your COPD symptoms effectively is learning how to protect your lungs from these triggers.

In some cases, that means going out of your way to avoid—or find a different approach—to activities and situations that can make your symptoms worse. Recognizing these situations can be a bit tricky, however, because many things can affect your lungs without causing obvious or immediate symptoms.

For every COPD trigger that you notice, there are likely others that you don't. Unfortunately, the hazards you don't know about can actually be the most dangerous; you can expose yourself to them over and over again without even realizing they pose a risk.

For example, most people with COPD know they're supposed to stay away from cigarette smoke, but many don't realize that using common household cleaning solutions can also harm their lungs. And that's just one of a plethora of lesser-known activities that can harm your lungs and/or exacerbate COPD symptoms.

In this guide, we've put together a list of more than a dozen different activities that can be dangerous or risky for people with COPD. We cover the little things—like sleeping in the wrong position at night—and the bigger, complex issues, like dangerous eating habits and ignoring serious symptoms that could signal a medical emergency.

Some of the things you see on this list might seem familiar, but you're bound to learn something new as you go through this guide. Our goal is to help you recognize at least a few activities that you didn't know were risky before, and to provide you with some practical tools and techniques you can use to protect yourself from those hazards in the future.

You'll find links to many expert online resources throughout this guide that you can use to learn even more about COPD hazards and what you can do to avoid them. We've also provided links to several other practical COPD health and wellness guides from our Respiratory Resource Center, where you can find even more detailed advice and information that expands on many of the topics covered in this post.

Activities & Habits You Should Avoid if You Have COPD

Cooking Without Ventilation

Many people don't realize that cooking releases smoke, oils, and other pollutants into the air that are harmful to your lungs. In fact, research shows that people who cook often—and are thus exposed to these fumes repeatedly over time—have reduced lung function, increased respiratory symptoms, and a higher risk for developing COPD.

Even short-term exposure to cooking fumes can affect your lungs and make your COPD symptoms worse. Prolonged or repeated exposure is even more risky and has the potential to cause additional long-term damage to your lungs.

This is why it's important to use proper ventilation while you cook, especially if you or anyone in your household has COPD. This can not only substantially reduce your exposure to respiratory irritants while you're cooking, but it also prevents the pollution from building up inside your home.

If you have windows in your kitchen, opening them up before you start cooking is one simple way to ventilate the room. This isn't the most efficient form of ventilation, but it will allow the fumes to drift outdoors instead of staying trapped in the room.

You can ventilate your kitchen even more efficiently if you help the air current along using a fan (facing out the window) or a built-in kitchen vent. Some kitchens also have vent hoods installed directly over the stove to whisk away cooking fumes straight at the source.

However, kitchen vents and fume hoods only work this way if they are actually connected to a pipe that takes the air outside. Unfortunately, some “vents” that come in kitchens—especially those installed under cabinets and wall-mounted microwaves—are nothing more than recirculating fans that blow the fumes right back into the room.

To learn more about how to reduce indoor air pollution, check out our guide on How to Improve Your Air Quality at Home.

Drinking Alcohol Before Bed

While there's no blanket rule saying that people with COPD shouldn't drink, you should still be a little extra cautious with alcohol if you have COPD. One reason for this is that alcohol can cause a side effect known as respiratory depression, which causes you to breathe more slowly and take more shallow breaths than you normally would.

Mild respiratory depression also happens naturally during certain stages of sleep, which is another reason why many people with COPD have increased shortness of breath and difficulty sleeping through the night. If you drink alcohol too soon before bed, it can suppress your breathing even further, making it even harder to breathe effectively while you're asleep.

This is particularly dangerous if you have a health condition like sleep apnea or COPD that also affects your ability to breathe during the night. These conditions also cause nighttime breathing problems that significantly increase your risk for nighttime oxygen desaturation (PDF link), which happens when your blood oxygen levels fall too low while you sleep.

When you add a respiratory depressant like alcohol to the mix, you're even more likely to have trouble breathing and experience low blood oxygen levels at night. Unfortunately, because it happens while you're asleep, you might not even realize that you're not getting enough oxygen at night until it starts to take a toll on your health.

In the short term, nighttime oxygen deprivation can trigger uncomfortable morning symptoms (including headache, fatigue, and shortness of breath) that can linger throughout the day and make your COPD symptoms worse. Over the long term, nighttime oxygen desaturation can put you at risk for more serious health problems like cardiovascular damage and cognitive decline.

This is why, if you have COPD, you should be extra careful about not only how much alcohol you drink, but also when you drink it. That means drinking in moderation, avoiding alcohol too close to bedtime, and being careful not to mix alcohol with other medications that can cause respiratory depression (including opioids, sleeping pills, and other sedative medications).

Showering Without Ventilation

Showering is a difficult activity for many people with COPD. The physical exertion of showering makes many people feel breathless, and it tends to get worse as the heat and humidity from the shower fill up the room.

This can be difficult cope with every time you need to bathe, but ventilating your bathroom can make it much easier to bear. That's why, before you start your shower, you should always make sure there's a way for the heat and humidity to escape.

You can do this by opening a bathroom window or, ideally, using a proper ventilation fan. If your bathroom doesn't have either, it might be worth considering getting one installed; too much humidity doesn't only make it harder to breathe, but it also encourages mold growth.

Mold tends to grow in enclosed spaces where humidity lingers, and it's a serious respiratory hazard that makes COPD symptoms worse. In order to keep your home safe, you should always vent excess humidity and look out for signs of mold growth, especially in places like bathrooms, basements, walls, ceilings, and around water faucets and pipes.

Taking Over-the-Counter Medications (Without Your Doctor's Permission)

When you have a chronic disease like COPD, you have to be very cautious about what drugs and medications you take. Even things that might seem harmless, like supplements or over-the-counter medicines, have the potential to cause dangerous side effects or interact negatively with other medications.

For example, many cold medications, allergy medications, and decongestants that you can buy at the store can cause mild respiratory depression. This side-effect is usually not too much of a concern for healthy people, but it can worsen breathing problems in people with COPD.

It's also important to be aware that certain circumstances can amplify the side-effects of over-the-counter medications, which is why you should always read the directions and warnings for every medication you take. Fore example, medications that usually only cause mild respiratory depression can cause moderate to severe respiratory depression if you take them at night, in large does, or in combination with another medication that lists respiratory depression as a potential side effect.

This highlights the danger of drug interactions, which happens when you take two medications (or a medication and a supplement) that have different effects on your body when they're combined compared to when you take them alone. Depending on the type of interaction, this can make a medication less effective, make its effects stronger, or cause additional side effects to appear.

To be on the safe side, you should never take any new medications or supplements without getting input from your doctor first. Additionally, you should always tell your doctor about every medicine, herbal product, and supplement you take, no matter how small or insignificant you think it might be.

Smoking

Smoking is a huge lung hazard—one of the biggest—and it's important to bring up even though it might seem obvious to some. We want to emphasize that quitting smoking is always beneficial for your health, no matter how many years you've been smoking and no matter how advanced your COPD has become.

Unfortunately, many people with COPD don't think it's worth it to quit. It's a common misconception that it won't make much of a difference to stop smoking once you've already developed a smoking-related disease.

However, this way of thinking is not only false, but downright dangerous. Quitting smoking at any time has numerous short-term and long term benefits for your overall health and your COPD.

Research suggests that quitting smoking can actually improve your COPD symptoms, slow down lung function decline, and generally slow down the progression of the disease. On the other hand, continuing to smoke while you have COPD can worsen your COPD symptoms, make your lungs more prone to infection (PDF link), and cause you to have more frequent COPD exacerbations.

Smoking can also affect your baseline breathing ability, as COPD patients who smoke have quicker lung function decline (PDF link). What's more, COPD isn't the only smoking-related disease you can get; if you continue smoking, you increase your risk for lung cancer, cardiovascular disease, lung cancer, diabetes, stroke, and more.

There's a reason that quitting smoking is considered a vital, first-line treatment for COPD, and you shouldn't take it lightly. Even though quitting smoking is hard (really, really hard!), it's more than worth all the work it takes to make it happen.

And don't worry! You don't have to figure it out all on your own; there are tons of quit-smoking resources out there you can use for help.

If you'd like to learn how to get started or how to find all the quit-smoking resources you could ever need, check out our comprehensive, 3-part guide on how to quit smoking:

• Part 1: Overcoming Doubts & Finding Resources to Help You Quit
• Part 2: Coping with Nicotine Withdrawal & Choosing a Quit Smoking Medication
• Part 3: Taking the First Steps & Strategies for Staying Smoke Free

Doing Dusty, Dirty, & Hazardous Jobs

Pretty much all allergens and small particulates, including dust, pollen, and mold, can harm your lungs and trigger COPD symptoms if you breathe them in. Many chemicals emit lung-toxic fumes as well, and they can come from unexpected places, including household products and home construction materials like treated wood, varnishes, and paint.

Because of this, people with COPD should generally try to avoid going dirty jobs, particularly work that kicks up dust (and other airborne particles) or might expose you to chemical fumes. This includes many types of home maintenance projects, including home repair, renovations, and heavy cleaning projects around the house.

Whenever possible, you should ask someone else to help you with these jobs—or at least the most risky parts—so you don't have to put your already-compromised lungs at further risk. If you have the means, you should consider hiring professionals to do hazardous construction, renovation, and cleaning jobs (e.g. mold removal) for you.

You should also take care with materials that can release hazardous fumes into your house, including many types of paints, lumber, adhesives, and even new carpets and flooring. If you can't avoid them while they're being installed or used in your home, consider staying somewhere else for awhile until the fumes have time to dissipate.

If you have no other choice but to do a risky project on your own, make sure you wear respiratory protection and—most importantly—that use the appropriate type of respiratory protection for the job. Some things are fine to do with dust masks while others require full respirators for safety, and if you choose the wrong equipment it might not offer any protection at all.

To learn more about the correct type of respiratory protection equipment to use for various jobs, you can reference this guide from the US Occupational Safety and Health Administration (OSHA).

Going Outside When Air Pollution is High

Research shows that air pollution can have a significant impact on people with COPD; it can worsen breathing symptoms, increase your risk for exacerbation and hospitalization, and even increase your risk of death. Because of this, you should do your best to be mindful about when you go outside and try to stay indoors when your local pollution index is high.

You can find your current air pollution levels by checking your city's air quality index (AQI), which you can get from your local weather station or by looking up your zip code on airnow.gov. The air quality index is an simple, color-coded scale that tells you how healthy or unhealthy the outside air is to breathe.

In general, anytime air pollution rises above the yellow (moderate) zone, you should do two things: First, you should avoid spending time outside, and especially avoid doing any exercise or strenuous activity outdoors; that's because, when you exert yourself, you breathe in more air—and thus and more pollution—compared to when you're at rest.

Second, you should keep your doors and windows shut as much as possible on high-pollution days. You can still air out your home when air pollution is low, but if you don't check your local AQI first, you could accidentally invite all kinds of outdoor pollution to enter your home.

When you do exercise outside or do other activities outdoors, you should try to schedule them for times when air pollution is the lowest; often this is in the earlier and later hours of the day. You should also try to keep your plans flexible, that way you can easily reschedule them if the air quality ends up being too poor.

It helps if you familiarize yourself with the air quality patterns in your area, including how pollution levels tend to change throughout the day. If you look up your local air quality report on airnow.com, you can also get a breakdown of recent hour-by-hour trends.

(Image text: To see data on pollution trends in your area, you can look up your local air quality report on airnow.gov and click the button “local trends.”)

If you have seasonal allergies, you should also avoid spending too much time outside when pollen levels are high. You can look up your city or zip code on pollen.com to get all kinds of helpful allergen information, including your local pollen report, future allergen forecasts, and a breakdown of the types of pollen most prevalent in your area.

Cleaning with Common Products

Studies show that many household cleaning products release harmful fumes and aerosols that irritate your lungs and even cause permanent lung function decline. Ammonia and bleach, for example, are both lung irritants that are used in a wide range of different cleaning products.

If you have COPD, you should try to limit your exposure to these and other lung irritants as much as you can to avoid triggering COPD symptoms and doing further, unnecessary damage to your lungs. Instead, choose products that don't contain strong chemicals like ammonia and bleach, and try to find products labeled as having reduced irritants, including fewer fragrances and VOC's.

You can use the EPA's safer chemical ingredient list for reference of what types of chemicals you should seek out and which ones you should avoid. You can also look for cleaning products with the EPA's “Safer Choice” label, or browse through the EPA's catalog of these products online.

Another alternative is to make your own cleaning solutions at home using common—and safer—household products like vinegar, water, baking soda, and soap. You'll find that most cleaning jobs don't require anything fancy and can be done with simple mixtures you can make yourself at home.

To learn more about how to make your own DIY cleaning products, check out this guide on how to reduce chemical irritants in your home. There, you'll step-by-step instructions for making alternatives to several different types of commercial cleaning products, including a scrubbing solution, all-purpose cleaner, and grease-cutting solution.

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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

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Keeping up with healthy habits is not an easy task; for many, it's a lifelong process—and sometimes a lifelong struggle—to stay on track. If you have a chronic health condition like COPD, it can feel downright overwhelming to shoulder the pressure of having to live a healthy lifestyle while also managing your disease.

If you don't have a solid plan and an organizational structure to guide you, it's nearly impossible to handle all those moving pieces on your own. That's why every person with COPD needs some kind of self-management system, and keeping a personal health diary is one of the easiest ways to establish such a system.

A health diary is simply a written or digital system for collecting, tracking, and analyzing all kinds of useful information about your health. Depending on how you use it, it can be a powerful tool for building new, healthier habits and staying on top of your COPD treatment routine.

In this post, we're going to show you how to create your own health diary from scratch, using an assortment of simple tools and health tracking techniques. We'll also show you plenty of ways you can utilize your health diary for practical purposes, such as motivating yourself to stick to an exercise schedule or remembering to take all of your medications on time.

The goal of this guide is to explain everything you need to get a functional health diary started, including how to collect useful data for your journal using a variety of different health measuring tools and data recording methods. We'll even walk you through the process of designing your own health tracking charts, spreadsheets, graphs, and other approaches to organizing and analyzing the information you collect.

What is Health Tracking, and Why Should You Do It?

Health tracking is a general term that refers to recording information about your body or actions you take regarding your health over a period of time. The system you use to record this data can take many forms, but is often referred to as a personal health diary or health journal.

You can make a health diary out of just about any medium that can store information: a blank notebook, a series of digital documents, a spreadsheet, a mobile app, and more. There's no single “right way” to do it, and there's a wide range of health-tracking methods you can choose from (many of which we'll teach you how to use throughout this guide).

You can use your personal health journal to track and store just about any information you want to, and it can be as brief, detailed, creative, or minimalistic as you'd like. The specific techniques and organizational methods your use are less important than finding a system that works for you and that suits the subject matter in your journal.

You can adapt a health journal to just about any disease or purpose, and different people keep them for all sorts of different personal and functional reasons. Doctors often recommend health diaries as self-management tools for patients with chronic health problems, especially those that are difficult to manage, like COPD.

In research and healthcare settings, health diaries are sometimes referred to as “clinical diaries,” “patient diaries,” or “self-management diaries.” These are used by doctors, researchers, and other healthcare professionals, too, to collect specific health data on their patients and closely monitor their conditions.

What's the Point of Tracking Your Health?

At its core, health tracking is all about collecting data that helps you (and/or your doctor) learn more about your health. This data can include objective health readings, like your weight, or subjective analyses like how energetic you feel throughout the day.

These records can give you and your doctor a clearer picture of what you're tracking than you could get from memory alone. In fact, some degree of health tracking is all but required for people who need to keep a close eye on a chronic disease like COPD.

Another key part of tracking your health is finding ways to actually use the data you collect to improve your health in some way. Most of the time, this involves looking for patterns and trends in the data and using what you've learned to adjust your habits and plan for the future.

For example, you could use a food diary to keep better track of your diet so you can look back over it later to find areas you can improve. Or, you could use a medication tracker to record when you take your COPD medications so that you can look at those records later to know when you should take your next dose.

Recording your choices in your journal is also a form of accountability that can push you to make the kinds of choices that you'd feel proud to write down. In this way, a health journal can be a powerful motivational tool if you're trying to change your habits or improve your health in a specific way.

Why Should People with COPD Keep a Health Diary?

Anybody can benefit from tracking their health, but it's especially useful for people who need to manage chronic health problems like COPD. A health diary can help you with just about any aspect of COPD management, including monitoring COPD symptoms, keeping your treatment schedules straight, and making healthy changes like exercising more, quitting smoking, and reaching a healthy BMI.

If you have COPD, your ability to succeed in all of these areas can have a huge impact on your quality of life and the course of your disease. This makes it all the more important to have a dedicated health tracking system to help you manage your well-being.

Here are a few of the major benefits that keeping a health journal can have for people with COPD.

It eases the burden of managing your health

Just like using planners and lists can help you manage your work routine, tracking your health and your COPD treatments in a journal makes it easier to manage your COPD. It can also help ease some of the mental burden of COPD management, especially if you tend to have a lot of worry or anxiety about your health.

Having a place to write things down and easily reference them later frees up time and mental energy that you'd otherwise be using to keep track of it all in your head. It also makes it easier to detect problems that might cause you worry, such as signs of exacerbation and worsening disease.

A health diary lets you know what's going on with your body so you can spend less time stressing about what might be happening. All of this can help you feel more secure and more in control of your health; this is especially important during uncertain times like the current COVID-19 pandemic, which is particularly scary for people with COPD and other conditions that make them vulnerable to serious disease.

It can help you set and track your health goals

Keeping a health journal doesn't just help you learn about your health; it can also be a powerful tool for improving your health and reaching your COPD treatment goals. In fact, health and habit trackers are an integral part of effective goal-setting, and they can make all the difference when you're trying to make a healthy lifestyle change.

Your health journal not only helps you asses you where you are at now, but also where you're going and how things change over time. It provides a practical framework to help you organize your objectives, visualize your progress, and make sure you're on the right track to reach your goals.

Because of this, health tracking is a particularly valuable tool for people with COPD, who often need to make major health and lifestyle changes because of their disease. For some people, this means completely overhauling their current routine, something that's incredibly difficult to do without a well-structured plan.

That's where your health journal comes in; when you're making a major habit adjustment, you need a place to write down your goals, record your progress, and keep track of all the steps you need to take along the way. While this might sound like an obvious strategy, it takes a lot of planning and work to get it right, and a reliable health tracking system can be your key for success.

It can help your doctor monitor your treatment

Unless you have a miraculous memory, it's impossible to remember all the little details about your health, habits, symptoms and other important things your doctor might need to know. Human memory is notoriously unreliable, especially when it comes to details, which isn't ideal when your doctor needs correct information to properly treat you and your COPD.

However, you won't need to rely on memory if you have a health journal to record that information (e.g. your daily COPD symptoms) as you go. Then, you'll have accurate records that you can reference or bring to your doctor so he'll have more precise and nuanced information with which to evaluate your health.

It can help you recognize the signs of lung infections and COPD exacerbations

Keeping a close eye on your symptoms is the best way to catch COPD exacerbations, which often start with a slight uptick in respiratory symptoms. Unfortunately, this change is often subtle; many people don't notice it at first and, as a result, miss the opportunity for early treatment.

This is why many doctors encourage COPD patients to keep a written log of their symptoms and how they fluctuate over time. This makes it much easier to track subtle changes in your symptoms that can help you identify—and more accurately pinpoint the start of—a COPD exacerbation.

How to Use a Health Diary if You Have COPD

One of the great things about a personal health diary is that it can be essentially whatever you want it to be. It could be a simple log book, a planner, a habit-tracking chart, all of these things together, or anything in between.

It all depends on which health attributes you (or your doctor) are interested in tracking, and what you plan to do with the data you store. However broad or narrow your focus, you can tailor your personal journal to fit just about any particular need.

For example, your diary could help you manage healthy habits and work toward healthy goals, like eating healthier, exercising more, and taking your medications on time. You could also use a health diary to track and monitor certain aspects of your health, such as your weight, your physical activity, or your energy level from day to day.

You might also have specific health concerns that you want to monitor, such as your oxygen levels, blood pressure, or intake of specific nutrients. It's also a great way to keep track of your COPD symptoms and watch for patterns and triggers that could help you learn how to better manage your disease.

In the next sections, we're going to show you how you can use a health diary for a wide range of practical purposes, with a special emphasis on your diary can help you monitor and improve your COPD. We'll also introduce you to a variety of different tools and methodologies that can help you gather all kinds of useful data to record in your journal.

What To Record in Your COPD Health Diary

Information About Your Diet

An integral part of a healthy diet is keeping track of what you eat, and sometimes memory just isn't good enough to do the job. It's easy to underestimate unhealthy food choices or guess your calories wrong, which is why recording what you eat in a diary is one of the best ways to get an accurate picture of your dietary health.

This is especially important if you're trying to make changes to your diet, whether you're trying to lose weight, make healthier choices, correct a nutrient imbalance, or limit certain foods. These are changes that many people with COPD have to make after their diagnosis, since weight and diet can have a significant impact on your ability to breathe.

Because of this, doctors often prescribe special diets (e.g. low-salt or low-carbohydrate diets) and set target weight goals for COPD patients as part of their treatment. Unfortunately, people with COPD often have an extra hard time maintaining a healthy weight and diet, and often need extra help to succeed.

A health diary can provide that extra support by helping you track your food choices and manage a diet plan. This helps you understand your eating habits better, which is the first step to finding ways to improve it. It also forces you to think about your dietary choices more often, which helps you stay accountable to yourself and mindful about what you eat.

You can also use your health diary to schedule your diet and coordinate your meal routine. It can help you with everything from making shopping lists and meal planning to food prep and ingredient management.

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Used right, your health diary can help you develop dietary discipline and establish long-term habits that can not only help you reach your diet goals, but also maintain those healthy habits once you get there. Over time, this can make a huge difference in your overall health and your quality of life with COPD.

Here are some different ways you could use your health journal to track and manage your diet:

• Keep a simple food diary: Keep a log of the types and approximate amounts of all the foods and beverages you eat and drink throughout the day.
• Track your micro/macro-nutrient intake: This requires a more detailed log of what you eat and drink that includes nutritional information and precise portion sizes. Luckily, free food tracking applications can do most of the work for you (e.g. nutrient calculations, daily/weekly totals, trend analysis, etc.) as long as the information you enter is accurate and complete.
• Make a weekly meal schedule: Plan your diet ahead of time by working up a meal schedule for the coming days or weeks, either on your own or with the help of a doctor or dietitian. It could be as simple as a list of meal options to choose from or a detailed chart specifying exactly what you plan to eat for every meal each day.
• Track specific nutrients over time: Determine which nutrients you want to keep track of (e.g. things you're trying to limit, like saturated fat or salt) and keep a running total of how much of that nutrient is in the foods you eat throughout the day. Then, you can map the totals you're interested in (e.g. from each meal, each day, each week, etc.) onto a simple chart or graph to get a better picture of how your intake of that nutrient varies over time.

Information About Your Medication

People with COPD often take several medications and have complicated treatment schedules that require a great deal of discipline every day. This is a major source of stress for many COPD patients, and often results in occasional missed doses and other treatment mistakes.

Unfortunately, poor medication management can have serious and lasting health consequences for people with COPD, including worsened breathing problems and more frequent COPD exacerbations. That's why, if you have COPD, it's absolutely vital to have a system in place to help you keep track of your medications and take them correctly every day.

This is a perfect job for your health diary, which can be an invaluable tool for scheduling, remembering, and managing complex treatment plans. Whether you use a pen and paper or a mobile medicine tracking application, keeping a medication diary can reduce treatment errors and help you keep your schedule straight.

In fact, research shows that patients who keep medication diaries, even very simple ones, are more likely to take their medication correctly. Studies also show that health diaries can be valuable tools for patient-doctor coordination; it can help your doctor learn more about how you're using your medications (e.g. how often you need to use your rescue inhaler), how well you're adhering to prescribed treatments (e.g. how often you miss doses), and what—if any—changes need to be made to your treatment plan.

A medication diary can also relieve a great deal of stress associated with having to keep track of all your treatment details in your head. It gives you a reliable place to offload it all—your treatment schedules, coordinating difficulties, and any other details you stress about—so you don't need to worry or keep it in the back of your mind all the time.

Here are some ideas for how you can use your health diary to track and manage your medications:

• Make a minimalistic medication tracker: Make a simple list or chart of all of your doses of medication for the day or week, and mark them with the corresponding date at time after you take each dose. This helps you keep track of which medications you have and haven't taken already so you're less likely to skip or double up on doses. (We'll give you more detailed step-by-step instructions for how to make a medication tracker later on in this guide).
• Keep an oxygen therapy log: Keep a running total of the number of hours you use supplemental oxygen in your journal every day. You can also record more detailed information, like the time when you start and stop using oxygen, to get a fuller picture of how you utilize oxygen throughout the day.
• Make a basic medication log: Write each of your medications across the top of a page or chart, and mark down the the date and time you take each dose under the name of the corresponding medication. This can be particularly helpful for tracking your usage of as-needed medications (like rescue inhalers) that require spacing doses a certain length of time apart.

To learn more tips and techniques for managing your COPD medications, check out our guide on the topic here.

Your Physical Symptoms

As most COPD patients know, keeping close track of your symptoms is a key part of monitoring and managing COPD effectively. In fact, many doctors recommend using a logging system to record what symptoms you have and how severe they are every day.

Keeping a symptom log in your health diary can help you get to know your baseline COPD symptoms better and learn more about how—and possibly why—your symptoms change over time. This information is useful for several different reasons, including for gauging the pace of COPD progression (as indicated by worsening symptoms) and for evaluating how your symptoms respond to different treatments and medications.

Tracking your symptoms can also help you identify COPD exacerbations and monitor their course over time. Your records can also yield additional insight into the length, cause, and the nature of your COPD exacerbations, information that could help you and your doctor determine the best course of treatment.

Here are some ideas for how to use your health journal to track your COPD Symptoms:

• Keep a minimalistic daily symptom diary: At the end of every day, write down the date and some basic information about the symptoms you've experienced that day: e.g. describe them in a couple of sentences, rate them using descriptors like mild, moderate or severe, or jot down a couple bullet points.
• Make a daily symptom tracking chart: Decide on a scale to use for rating the overall severity of your COPD symptoms (e.g. via a numerical scale from 1-5, or a color-coded marking) and record your daily ratings in in a pre-made chart or graph.
• Track your symptoms individually: Make a list of all the symptoms you tend to experience regularly, and (separately) rate the severity of each one every day. Alternatively, you could simply mark a “yes” or “no” for each symptom or only list the the symptoms you experienced that particular day.
• Record your symptoms during everyday activities: Rate your symptoms and/or write down some notes about how you feel after everyday activities like cleaning, taking a walk, cooking a meal, etc. This can help you better understand the impact your COPD symptoms have on your life and identify ways to reduce or eliminate the burden caused by the most difficult tasks.

Instead of making your own, you can use a variety of pre-made symptom tracking templates available online, like this minimalistic tracker or this printable weekly symptom tracker (PDF link) from alnursing.org.

Your Exercise and Physical Activity

Getting plenty of exercise is an important part of COPD treatment, but it's one of lifestyle changes that people with COPD tend to struggle with the most. And that's not just because COPD symptoms make doing physical activities difficult, but also because building new exercise habits is hard thing for anyone to do—especially in older adulthood, which is when most people get diagnosed with COPD.

Unfortunately, the stakes are much higher for COPD patients, who have to maintain an active lifestyle to live a good quality of life. Getting regular exercise can make the difference between staying physically independent as your COPD progresses, and not having the endurance to do even light household tasks on your own.

Because of this, any tool that can help you stay active is worth using, and anything is better than giving up. You're much likely to succeed if you have a system—like a health journal—to guide you and help you overcome the additional physical challenges caused by COPD.

For example, you could use your journal plan out your exercise goals, your strategy for reaching them. You can also log your physical activities in your journal so you can track your progress and improvement, which can help you stay accountable and motivated to keep working toward your goals.

Here are a few ideas for how you can use your health journal to track your exercise habits:

• Keep an exercise log: Every day, take some time to write down any exercise or physical activities you've done throughout the day.
• Make a basic exercise planner: Make a chart or calendar in your health journal to keep track of when you need to work out as well as what type of workout you plan to do.
• Create an exercise habit tracker: Make a simple chart or graph to track information about your activity, such as the types of physical activities you do, your dedicated work-outs, or the number of minutes/hours of exercise you do throughout the week.

Your Mood and General Mental Well-being

Using your health journal to track your mental well-being is a great way to get more in tune with your emotions, including how you're coping mentally with COPD. It's also a great way to keep tabs on mental illnesses like anxiety and depression, which tends to affect people with COPD more often than people without the disease.

There's a wide range of mental health journaling methods to choose from, ranging from simple diary entries to complex mood and emotion-tracking spreadsheets. The simpler and briefer techniques make it easy to find trends and patterns quickly, while the more open-ended methods allow you to explore and express your thoughts in a deeper way.

A simple daily mood tracker, for example, can help you find patterns and possibly even identify triggers that affect your emotional well-being. You could also use your diary to keep tabs on specific feelings and psychological symptoms, such as anxiety, anger, or feelings of hopelessness and despair.

Of course, there's always the traditional personal diary format where you simply write down your thoughts however feels best to you at the time. Any technique will do as long as you have an idea of what kinds of personal struggles or mental traits you'd like to monitor or explore.

One of the most difficult parts of living with COPD is coming to terms with the ways it can change your life and limit your activities. This is especially true for working adults, who often have to make difficult decisions about how to continue working—and if they should continue working—while managing their COPD.

While the answer to this question varies significantly from person to person, many people with COPD are able to continue working for many years after their COPD diagnosis. However, coping with work and a chronic disease can be a major challenge, and it only gets harder in the later, more serious stages of the disease.

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That's why we created this guide all about how to overcome those challenges and maintain a healthy, balanced work life with COPD. In it, you'll learn how to address some of the most common difficulties that people with COPD face in the workplace and how to prioritize your mental and physical well-being while keeping up with the demands of your job.

In the sections below, we cover everything from how to deal with health-related absences and minimize COPD symptoms at work to what kinds of accommodations you can request from your employer to make your job easier to manage. We also discuss how to how to evaluate and make adjustments to your work-life-health balance to make sure that it's working for you.

Whether you're a person with COPD who is currently working or considering working in the future, it's important to know your options and what kinds of difficulties you're likely face. Every person's path will be different, but everyone can benefit from strategies for coping with COPD in the workplace and making adjustments along the way.

Can You Work When You Have COPD?

It's only natural to worry about your ability to continue working and keeping your job after you've been diagnosed with COPD. Certainly, COPD symptoms can interfere with many aspects of daily life, and they can reduce or eliminate your ability to do work activities you could do before.

Of course, COPD symptoms and physical abilities vary significantly from person to person, and so does the ability to work a steady job. For instance, mild COPD symptoms might not affect your everyday life much at all, while very severe COPD symptoms can make it difficult to endure even light activities, like walking up stairs or getting ready for work.

How Does COPD Affect Your Ability to Work?

How much COPD affects your work life depends largely on the severity of your COPD symptoms and the demands of your particular job. It also depends on how, and how quickly, your COPD progresses, as well as what kinds of complications (like COPD exacerbations) you experience along the way.

For example, you might be able to work a physically-demanding job in the early stages of the disease, but it's likely to get much more difficult—and eventually too difficult—to endure those physical tasks as the disease gets worse. If you have a sedentary desk job, however, you might be able to handle the work even with moderate to severe COPD.

According to the CDC, nearly fifty percent of people with COPD reported having some kind of physical activity limitation related to their health, and nearly forty percent said they have serious difficulty walking or climbing up stairs. It's not hard to imagine how such limitations could impair your working ability in general and significantly reduce the types of physical work you can do.

Another problematic COPD symptom for working adults is fatigue, which can sap your energy and make it incredibly difficult to bear the strain of working for hours and hours day after day. This is true even for work that doesn't require any major activity; it doesn't take much to overtax yourself when you're living with chronic disease.

One study on COPD patients in Canada found that 64 percent of participants with COPD reported working at a slower pace than usual and 36 percent reported having to postpone work. A significant percentage also experienced problems with concentration (64%) and decision-making (57%) at work.

COPD can also affect your sleep, your diet, your mental endurance, and other aspects of your life that can, in turn, affect your energy level and your ability to cope with stress. This can make it especially difficult to keep up with the demands of long working hours or of fast-paced jobs.

How Common is it for People with COPD to Work?

Unfortunately, there's not a lot of detailed data about working adults and COPD, or how long COPD patients usually work after diagnosis. However, research does shed some light on a few key ways that COPD affects patients' working lives.

One study, for example, found that about 62% of US adults with COPD between the ages of 55 and 75 were still employed, and concluded that people with COPD “had an elevated risk for leaving work prior to age 65” compared to adults without chronic respiratory conditions. Other studies have found that working ability among people with COPD is strongly associated with airflow limitation and shortness of breath, as patients with more severe breathlessness are less likely to be employed.

One of the most comprehensive analyses of COPD and working ability was conducted by the CDC in 2013 and explored the types of “employment and activity limitations” experienced by adults with COPD. It found that nearly one quarter (24.3%) of adults with COPD in the US report being unable to work, compared to only 5.4% of adults without COPD.

Other studies confirm that people with COPD tend to retire earlier, on average, and are even less likely to be employed than people with other chronic health conditions like heart disease, diabetes, hypertension, and cancer. This results in an average lifetime loss of about $7,365 per person from early retirement, and—among adults still working—a loss of about $880 per year due to absences from work.

But even though employment numbers are lower than average among people with COPD, it's important to note the significant number of people with COPD who do have jobs. At least 38 percent of US adults with COPD are able to continue working beyond the age of 55, and about three quarters report that they still have the ability to work (even if they are not currently employed).

Can You Get Fired for Having COPD?

Many people with chronic diseases like COPD worry that their health problems could cause them to get fired from their job. Whether or not this can happen is a complicated questions that depends on a lot of legal definitions and case-by-case determinations.

In general, you can't be fired just for having COPD, especially if your COPD is severe enough to cause you to be disabled. However, your employer might be able to fire you if your COPD symptoms (or another medical condition) makes you unable to do your job.

Who can get fired for what reasons is a tricky issue that depends on a whole web of regulations and legal definitions. If you have questions about whether or not you can be fired for your health condition, or if you believe you've been fired unlawfully, it's best to talk to a lawyer that specializes in wrongful termination.

Should You Work with COPD?

Ultimately, whether or not you continue working is a personal decision that only you and your doctor can make. Whatever you choose to do, it's important to follow your doctor's advice and make sure that your decision doesn't interfere with your ability to take care of your health.

Is Your Current Work-Health Balance Sustainable?

All working adults can benefit from pausing once in awhile to take a good, close look at their work-life balance. This gives you the chance take stock of where you are and where you're going, and to re-evaluate your goals and expectations for your career.

This kind of self-examination is even more important for people with chronic diseases like COPD, who have to balance their working life, their personal life, and their special health needs. On top of that, they have to deal with the strain of chronic health problems that make them even more susceptible to the negative health effects of working, including mental burnout and physical fatigue.

If you are a working adult with COPD, asking yourself some key questions about your work life can help you evaluate whether or not what you're doing right now is working for you. As we go through some of these questions in the following sections, think about what your ideal work-life-health balance might look like, and consider how closely your current balance aligns with the one you'd like to achieve.

Your answers to these questions can also help you identify areas of your life that might need to change in order to establish a healthier equilibrium that's more in line with your needs. Then, in the following sections we'll introduce you to a variety of practical tools and strategies that can help you make those changes, get better support in the workplace, and maintain your ability to work as long as possible.

If you'd like to skip straight ahead to those tips now, you can do that by clicking here.

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Does your work expose you to anything that could be harmful to your lungs?

People with COPD are particularly vulnerable to respiratory irritants, which can worsen COPD symptoms and do additional damage to your lungs. That's why it's important to minimize your exposure to these hazards as much as possible—especially in places like your workplace, where you spend a great deal of time.

Unfortunately, there are many different jobs that expose you to respiratory hazards like dust, heavy air pollution, noxious chemical fumes, and smoke. Some of the more obvious culprits include jobs in fields like construction and manufacturing, but they're far from the only ones; simply working with common cleaning chemicals like ammonia and bleach, for example, can expose you to toxic fumes that are known to both cause COPD and exacerbate COPD symptoms.

Here are some additional questions to help you identify your level of exposure to respiratory hazards at work:

• Do you experience worsened respiratory irritation, coughing, or shortness of breath at work?
• Do you often handle hazardous chemicals (e.g. pesticides, solvents, adhesives, etc.) or cleaning products at work?
• Do you work around vehicles or machinery that release smoke or exhaust fumes?
• Does the air at your workplace smell like smoke or contain visible amounts of smoke, dust, or other airborne substances?
• Does your workplace provide appropriate safety equipment (e.g. dust masks, respirators, or fume hoods) in situations that could exposure to respiratory hazards on the job?

Does your job exacerbate your COPD symptoms?

Effective symptom control is a key part of COPD treatment that can even reduce your risk for serious health complications like COPD exacerbations and rapid lung function decline. That's why it can be dangerous to work a job that triggers your COPD symptoms or makes them more difficult to control from day to day.

This can happen if your work tasks require physical exertion that's beyond what you can handle or makes you feel so exhausted that it saps all your energy for the day. Even if you your job tasks themselves don't cause you any particular trouble, working in an of itself can still cause a great deal of stress and fatigue, both of which can have a particularly detrimental effect on your health if you have COPD.

Here are some additional questions to help you evaluate how your work affects your COPD symptoms:

• Are your COPD symptoms usually worse at work than they are at home?
• Does your job require you to do activities that are more strenuous than your doctor recommends?
• Do you feel significantly more fatigued or breathless on days that you work (including after work) compared to days that you do not work?
• Does work-related fatigue interfere with your ability to exercise or do other activities that are beneficial to your health?

Does your work inhibit your ability to manage your COPD symptoms?

Even if your COPD symptoms aren't a major problem at work, they're bound to affect you on the job from time to time. When they do, it's important that you work in an environment that allows you to do what you need to treat your symptoms on the job.

That means being able to use your rescue inhaler as needed and keep up with other treatments, including using supplemental oxygen and taking your medications on time. You should also be able to slow down and take rests when needed, and take other reasonable steps to minimize your symptoms at work.

Here are some additional questions to help you evaluate your ability to control your COPD symptoms on the job:

• Can you slow down or stop to rest if you feel too breathless or fatigued?
• Can you take the day off if you feel too sick to come in to work?
• Does your work schedule allow you take all of your medications and other COPD treatments on time?
• Do you ever miss medical appointments or have to delay medical treatments because of work?
• Do you forget to take your medicine more often on days that you work?
• For oxygen therapy users: Does your job prevent or discourage you from using your oxygen as needed or as your doctor prescribed?

What can you do to improve your work life?

If you answered any of the above questions unfavorably, then it might be time to make a change. What kind of change that is depends on the nature of the problem, how severely it affects you, and what kinds of options are available to you in your particular job or career.

But now that you have a better idea of what a healthy work-life balance looks like, you can start to explore what you can do to achieve a better balance for yourself. To help you get started, we've compiled a list of effective tools and techniques that people with COPD can use to improve their work lives and get the support they need to continue working sustainably with COPD.

As you read through the tips and techniques in the following sections, think about the problems you've identified in your working life so far and take note of any ideas that resonate with you. Then, take some time to consider how you can adapt those ideas into personalized solutions that can help you overcome the particular challenges you face.

Strategies for Surviving and Thriving at Work With COPD

Know How to Talk to Your Employer About Your COPD

Everyone has the right to keep their health and their medical records private, but there are many situations in which it can be beneficial to talk to your employer about your COPD. In fact, it might even be necessary to discuss your health condition if you need to request special allowances or accommodations because of your COPD.

If you do decide to tell your employer about your condition, it's important to explain your situation in an accurate and compelling way. That means knowing—and being able to present—all the relevant details about your disease, including:

• your disease diagnosis
• your symptoms, including how severe they are, how they affect your life, and how they affect your work
• your treatments, especially those that could impact your work or attendance
• potential accommodations that could help you in the workplace
• anything else that might be relevant to your job or your requests

Educating your employer about your health and the challenges it causes opens up a dialogue in which both you and your employer can work together to resolve your problems and needs. Telling your employer about your struggles might also make your employer more understanding if problems crop up in the future regarding your health condition and how it affects your work.

Remove COPD Triggers from Your Work Space

Many common, everyday substances can cause respiratory irritation, including fragrances, cleaning products, air pollutants, and more. People with COPD tend to be much more sensitive to these irritants than the average person; for some, even the mildest irritants can trigger COPD symptoms and make it harder to breathe.

These symptoms can interfere with your job performance and persist even outside of work, making it generally more difficult to keep your COPD symptoms under control. Frequent exposure to respiratory irritants can even cause additional lung damage over time and increase the frequency of COPD exacerbations.

For all of these reasons and more, respiratory irritants in the workplace can make a job miserable—and potentially even dangerous—for people with COPD. Luckily, it's usually possible to reduce sources of respiratory irritation significantly by making simple, non-disruptive changes to your working environment.

You can start by paying close attention to your COPD symptoms when you're at work and looking for patterns that might help you identify things that make your symptoms worse. As you go about your work, keep an eye (and your nose) out for potential sources of respiratory irritants, such as strong odors, noxious cleaning chemicals, and second-hand smoke.

If you notice that something in particular is bothering you, don't be afraid to speak up, but be ready to offer up reasonable solutions to the problem. If you explain your sensitivities and show consideration for your coworkers' comfort and needs, you shouldn't have too much trouble getting your employer and colleagues on board.

Here are some examples of steps you could take to reduce respiratory irritants in your workplace:

• Ask your employer to enforce policies that limit second-hand smoke in and immediately around the workplace.
• Politely ask your coworkers not to wear or bring heavily-fragranced products to work (e.g. scented lotions, candles, air fresheners, perfumes, etc.).
• Ask your employer to replace hazardous chemical cleaning products (e.g. cleaners containing ammonia and bleach) with safer cleaning products that emit fewer harmful fumes. To learn more about safer cleaning alternatives, check out our guide on Cleaning with COPD.

Ask for Air Quality Improvements at Work

If you work in an office or another indoor environment, the air quality in the building can have a major effect on your COPD. Because you spend so much time at work, it's important to make sure the air in your workplace is clean and healthy to breathe.

Unfortunately, even if you eliminate the obvious COPD triggers in your workplace, there could be other, hidden sources of indoor air pollution, such as mold, radon gas, and even common pest control products. Because these indoor air pollutants are often invisible or difficult to find, it might take some investigation to determine if—and why—your workplace's air quality is poor.

The easiest way to figure this out is to get the air tested by a professional, especially if you're still experiencing lung irritation in the workplace after removing more obvious causes. You might even be able to get a free air quality test in your workplace if you request one from your state's OSHA On-Site Consultation Program.

You could also look into your work building's cleaning and maintenance practices to see if they're doing their due diligence to keep air quality issues at bay. If their current measures aren't satisfactory, you could request that they make improvements or modifications that will make the air in the building safer or more comfortable to breathe.

Potential air quality improvements include:

• Improving the building's ventilation and air filtration system
• Using humidifiers or de-humidifiers to control the amount of moisture in the air
• Implementing measures for damp and mold control
• Testing your workplace for radon gas and (if needed) installing a radon mitigation system
• Reducing or altering the use of noxious chemicals (like pesticides) in and around the building
• Inspecting and maintaining safe emission standards for appliances and machinery that generate pollution (e.g. the building's furnace)

Though many employers are reluctant to make these kinds of changes, it might be worth reminding them that cleaner air and a healthier working environment benefits everyone, not just you. Nobody is immune to the negative effects of poor air quality in the workplace, even if the effect's aren't as obvious or immediate on people with healthy lungs.

To learn more about how to improve the air quality in your workplace, check out our guide to reducing indoor air pollution or this guide to workplace air quality from the EPA.

Prepare for Workplace Absences

When you have COPD, it's inevitable that you will miss work occasionally for doctor's appointments, exacerbations, out-patient treatments (like pulmonary rehab), and other health-related reasons. As your COPD progresses and your healthcare needs increase, you might need to take even more frequent—and more lengthy—absences from work.

Unfortunately, the ability to take leave from work—and the impact that taking leave can have on your career and finances—varies significantly from person to person. In some workplaces, taking time off work is heavily stigmatized or discouraged, making it difficult for many to take medical leave even when it should be allowed.

Employers tend to be more accommodating, however, when they know about absences ahead of time. That's why you should always let your employer know as early as possible when you know that you'll need to take time off work—except in the case of an unanticipated illness or emergency, of course.

This will ensure your employer has plenty of time to arrange for your absence and ensures that you have enough time to take all the proper steps to request leave. It also gives you a chance to get ahead on your workload or find other ways to smooth over any disruptions your absence might cause.

Here are some ideas for making your absences from work easier for yourself, your coworkers, and your employer:

• Discus

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

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