I need to know what I should do next.

I had a bad bout of pneumonia beginning of December. Two doses of anti's by intravenous. Went for a follow-up xray in January and Dr. said something still there but didn't want to do anything just yet.   Oxygen level okay.

Beginning of February eyes and sinuses burning and nose plugged.  After a few days eyes and sinuses cleared up but nose was running a lot.

That's all gone now.  What I'm left with is SOB and low to mid 80's for oxygen. Went to doctor and took 5 days Prednisone & 7 days Avelox.  Just finished Avelox and no improvement for SOB or oxygen.

On the top of my list of allergies is mould...snow, leaf and household.  Lower down on my list is pets and tree pollen Take Singulair daily since last Spring. We had dogs ..then didn't for 3 yrs....now got a yorkshire terrier. Supposedly the most hypo-allergenic. I bath her frequently.  We also discovered a roof leak and suspect mould in the walls.

My question: Does it sound like allergies to the dog or mould could be causing the SOB and oxygen problem?  or : did this last exacerbation cause it?
Will nebbing something work better than the Symbicort and Spiriva I am on now.

If this is allergy related I can do something about it...hoping nebbing will help.  I would like the last resort to be oxygen.

What should I try ..or get the doctor to try..next?  Thank you.         Sandra

A.  Hi Sandra,

Allergies, in and of themselves should NOT cause hypoxia unless you have severe breathing difficulties with them, like asthma that won’t improve despite inhaled bronchodilator and treatment with oral corticosteroids.

You could ask about Albuterol and Ipratropium Bromide for nebbing in between Symbicort and Spiriva, or for Albuterol by itself, since some feel you shouldn’t take Ipratropium Bromide AND Spiriva at the same time (There’s no harm in it.  The question is potential effectiveness AND interference between one and the other.)

 If I were your doctor and you were noting consistent pulse oximetry measurements that were less than 88 %, I’d want to do a blood gas to verify the accuracy AND to do it under those conditions during which you have observed the decrease.   In other words, if you are desaturating (dropping your oxygen level) during walking, then you should walk for a few minutes and then IMMEDIATELY have the blood sample drawn for the blood gas before you have been stopped for more than 15 to 20 seconds.   A resting blood gas when your resting saturation is 96 % will tell you nothing about what it drops to when you’re active.   So, the conditions and timing of the blood test are CRITICAL!

Beyond that, you haven’t given any information to make it possible to tell you more.   The other information you included is not pertinent or helpful to the primary question and issue as those things shouldn’t cause hypoxia. 

So, my best recommendation at this point is to ask for a blood gas under the conditions you have observed desaturation IF the desaturation persists until you can get seen by your doctor.

If the blood gas confirms hypoxia, supplemental oxygen is the only intervention you can expect to correct the hypoxia.

Best Regards,

Mark
 

Dear Mr. Mangus:  My boyfriend is newly diagnosed and is having huge denial about the whole situation.  He has quit cigarette smoking but refuses to give up marijuana.  What are your thoughts on pot and lungs?  Thanks so much.

Deborah

A.  Dear Deborah,

The evidence suggest strongly that smoking marijuana - - - and any similar plant substance, for that matter - - - produces irritation that, if produced often enough can result in chronic inflammation and ‘metaplastic changes’ (fancy term for changes in cell type) in the airways and chronic disease similar to tobacco smoking.  Sometimes folks will think that they are not likely to get hurt because the additives and chemicals with which tobacco is treated are not there.  Yet, pot from various sources tests positive for herbicides and insecticides that can do a number on your lungs.  Since you don’t know from where the product comes, the kind and degree of danger is not ascertainable. Mexico, a place from which a significant amount of product is grown and supplied allows use of insecticides long-banned in the USA.  Folks sometimes reason that since they don’t smoke as much pot or smoke it as often as they would cigarettes that they don’t get as much exposure and therefore the risk is reduced.  We don’t know that to be the case.  Evidence is pretty good that that is not a good or valid rationale.

 The bottom line is to continue smoking marijuana is simply a role of the dice with respect to potential consequences.  When one has been diagnosed with COPD, their chances on that dice roll are increased toward the losing side.  You didn’t say how old your boyfriend is or how his COPD has been diagnosed or how bad it is, much less how much pot he is smoking.  And severity of disease, current age and how much smoking IS a relevant factor in estimating risk, at this point.  If he has had a PFT, and his FEV-1 is reduced to less than 90 %, he is on a slippery slope, though he could cruise a long time without facing consequences.  But, as COPD progresses slowly over many years before reaching clinical significance AND because the consequences onset years down the road, he simply can’t assume that he will be unscathed by continuing to smoke the pot. 

In the end, you can only stress ‘your’ feelings and concerns.  If he decides that your concerns are valid enough to change his behavior, he will make that choice.  If not, then you are faced with the choice to stick with him or . . . well, you know.  If he continues to smoke the pot, he would do well to monitor his pulmonary function so that he can see his rate of decline/progression of the obstruction and disease.

 Best Wishes,

 Mark
 

Hi Mark;

I know this isn't along the lines of a question for an RT BUT; I've gotta ask.

There's been a lot of stuff lately on hand sanitizers and it not being good  because of germs, just like antibiotic overuse, (the bugs) can get immune to it.  BUT; if soap kills germs,  though I don't really know how; and hand sanitizer does the same thing.... Does that mean we shouldn't be using it (hand sanitizer)?

Many Thanks, Joel

A. Hi Joel

 The active ingredient in had sanitizers today is mostly Isopropyl alcohol.  There are anti-bacterial substances put into some sanitizers, but their value, effectiveness and influence in promoting resistance in bacteria is not the issue that antibacterial substances in soaps is because of the alcohol content.  Alcohol inhibits life and growth of many microbes.  They cannot adjust to it because of the chemistry of it all.  So, hand sanitizers are a good thing when used appropriately. 

When all is said and done good hand washing with soap and water and especially the running water and friction of rubbing your hands is still the staple means to cleanse them.  Hand sanitizers are a good step-in when washing is impractical or not possible.  But, they are a ‘bridge’ to the hand-washing action.  AND< above all, hand washing is STILL established as the single most effective means to prevent spread of disease-causing germs and infection.

 Best Regards,

 Mark

Additional Information was supplied:

"the only numbers that are on this reported that was dictated  by the Pulmonary that Dr. that reads the tests from the function test  are it says "small airways flow is reduced to 54%  predicted consistent with a small amount of obstruction. There is no convincing change following bronchodilator. Maximum voluntary ventilation is mildly reduced at 76% predicted. consistent with a very mild loss of lung reserve, not explainable by the normal FEVI/
 After  my daughter read it, she thought I misinterpreted it, as on the one test I did have to cough - so that test had to be over and he said it was O.K. -- I think this is why  it said " some difficulty in patient cooperation with FRC was noted"-one reason I was  having all this checked  as in Nov. I had a light case of the HINI or whatever it is called and this cough  developed and has hung on.  That is O.K. My husband smoked ,  and I guess the second hand smoke is as bad as if I had smoked."

A. Hi Sandy,

Don’t take the comments as criticism.  When we do PFT’s we must characterize the patient’s effort and ”cooperation” with performing the tests.  PFT’s are extremely “effort-dependent”.  Poor effort - - - whether it be because of bad coaching from the tester, subject weakness or illness or simply a bad day for the test subject, or even something like willful interference in attempts to obtain a valid test MUST be noted on the test form so that interpretation can take those factors into account.  Otherwise you could be made to look sicker or healthier than you really are.

So, in looking at your notes, there was a problem in your being able to fully cooperate with the maneuver to measure your FRC.  That test requires a breath hold and stillness for several seconds AND the ability to take in a breathe that is at least a minimum amount.  You may not have been able to take in such a deep breath OR to hold it for the full duration needed.  If that was the case, then the measurement would be ‘off’ from expected or normal.  The physician would need to know that the deviation from normal was clouded by the effort/cooperation difficulty. The bottom line you need to understand is that the tester was NOT complaining about negative behavior or attitude on your part.  He/she was simply explaining that you were unable to cooperate fully to give the best measurement and result on that test, so it’s results may be suspect.

Your mid to small airways flows are reduced by a little under half.  That usually suggests some kind of obstructive defect, though it doesn’t characterize it.  If you are not at risk for the ‘usual’ COPD issues, then you ‘could’ have a bit of asthma.  You don’t report other aspects of your PFT, so I don’t know if you were tested pre- and post-bronchodilator nor what response you might have had.  In any case, you can have a bit of reactive airways problem or asthma for many reasons without having a smoking history or other known reasons or causes.  And unless other key elements of your PFT are out of normal range by a significant amount, then you don’t appear to have too much of a problem

 I’ll close with an encouragement for you to get with your doctor and put your questions and concerns to him/her.  With the complete test results in hand, he/she can answer ALL your questions. 

 Best Regards,

 Mark

A.  Hi Bob;

Let me answer once for both questions posted.  Mucinex (Guaifenesin) is potassium Iodide, a drug which favors pulling water into the mucus via/through the tissues that line the bronchial tubes.  It seems to be doing what you want, Bob, in that it has made the mucus easier to cough up.  One never knows if they are “getting all the mucus up” when they cough.  But, that is really a moot point, in many respects because mucus is produced and secreted in response to irritation and the airways’ need to ‘flush’ or ‘cleanse’ themselves of dirt and other debris that can be found within the airways.  So, the process is dynamic.  It is ongoing.  And it is necessary, too!  So, your quest is to keep coughing and clearing what mucus accumulated within your airways as best as you can from moment to moment.  The Mucinex is good to help keep it looser and more mobile.

Now, some would suggest that you need to drink lots of water to help thin that mucus.  Every bit of empiric evidence I’ve ever seen suggests that all drinking the extra water ever does is increase one’s urine output.  BUT, there seems to be something in the act of drinking - - - especially hot fluids and also with a sipping technique - - - that helps to raise the mucus at those times.  So, you certainly might try drinking ‘some’ fluids to see if it helps.  The reason I bring up fluid intake is because many folks have problems with fluid retention and salt management.  And if they are encouraged to drink excessive amounts of fluid to try to help thin and/or mobilize mucus, they can compromise their fluid management efforts and actually cause increased fluid retention.  That can all go towards increased breathing difficulties and worsened heart function, while also thwarting the action of diuretics, if those are being taken for fluid management, as well.

Lastly, Mucinex is a commonly prescribed medication to help with mucus clearance and management.  So, you are in the mainstream taking it for the purpose you are taking it.

 Best Regards,

Mark

Hello Mark and Thank you for accepting questions.

My question is.... What's the difference between diaphragmatic breathing and stomach or belly breathing? Or is there a difference? For me my chest is all the same and flat!

Thanks, Fran

A.  Hi Fran,

There is no difference between diaphragmatic breathing and “belly” breathing, also called abdominal breathing, per se, at least not in theory. But in actuality, between the three terms, it is the term “diaphragmatic breathing” that is the most incorrect simply because there is NOT ONE BREATH taken by ANYONE that is not generated by the ‘diaphragm’. AND, try as anyone might, we have no ability to specifically control movement of the diaphragm in any direct or deliberate way.  The diaphragm is a muscle that works on autonomic nerve signals.  And all the fancy breathing techniques that have been devised and written about for decades are just so much malarkey when it comes to ‘actually’ influencing the movement of the diaphragm during breathing.! 

We can enhance effectiveness of our breathing using abdominal muscle maneuvers that pull on the diaphragm and pull work away from the upper chest respiratory accessory muscles.  That is a GOOD thing to do since those respiratory accessory muscles require up to many times the energy to help enhance ventilation while only producing that help with about 40 % efficiency!  (Respiratory Accessory muscles of which I speak are those found in the neck, shoulders, upper chest and upper back, among which are included the scalenes, sternocleidomastoid, trapezius and pectorals.)  So, we work harder for less return when we shift breathing work AWAY from the abdominal muscles toward the chest/respiratory accessory muscles.

If you try to use the “diaphragmatic” breathing techniques most commonly found in publications, you will find that you have great difficulty in properly using your abdominal muscles to enhance your breathing.  That is because most techniques recommend placing a weight of some sort on your belly, below your ribs, but above your navel.  To properly utilize your abdominal muscles, you must pull them DOWN toward your knees.  That exerts a piston-like action on the diaphragm, pulling it down and filling the lungs through ‘displacement’.  Indeed, several studies found that traditional techniques of “diaphragmatic breathing” using weights placed midway on the abdomen while the subject lays recumbent or partially recumbent results in paradoxical movement of the diaphragm and exhalation when inhalation is desired and vice-versa.  It is not automatic.  BUT, it can happen without the subject being aware of the opposite movements occurring.  As such, some sources de-recommend the technique. 

I have always advocated practicing abdominal breathing while standing upright and leaning against something that will support your weight.  One foot is place forward and just rests upon the floor below a bended knee while the foot farthest behind you supports your weight below a straight and stiffened knee.  Next, you bring your arms up and cross them above your shoulders.  You then place your forehead into your crossed arms and squeeze your shoulders into your ears.  This action ‘locks out’ the major accessory muscles and frees the abdominal muscles (the belly, as a whole) to do the work to breathe.  As you inhale, your belly drops toward the floor.  As you exhale, you pull your belly up into your chest to help compress your lungs for the emptying.  Of course, you do pursed lips breathing when you exhale.  (The folks on the EFFORTS list call this the “tripod” position.)

Some helpful activities to promote belly/abdominal breathing are blowing bubbles, inflating balloons, playing the harmonica, singing.  You get the idea . . .   Anything that makes you work your belly - - - the lower abdominal muscles - - - will enhance movement of the diaphragm.  The single most common “complaint” I get from folks whom I teach abdominal breathing to is that they feel like they’re not working hard enough to breathe when they do it correctly.  I laugh, because if you DO do it correctly, then you SHOULDN’T do much work at all.   And it certainly should NOT be as much work as you do with the traditional techniques of “diaphragmatic breathing”  

Best Regards,

 Mark

Two questions for you Mark if you don't mind. 

Out of curiosity I've measured my oxygen (with a pulse ox) when I go into one of my coughing episodes and it drops by about 5 (at least) points.  It generally returns within a few minutes afterwards but is that normal for COPDer's?

And; I find my abdominal muscles get quite sore some days from breathing. Guess I tend to use my stomach more than my shoulders or upper chest. I know that breathing with the lower muscles is good but.....should i be trying to learn to use my chest more?  (I was a singer in my younger days; breathing from my abdomen comes naturally)

Thank You, Carla

A.  Hi Carla;

Measurement of oximetry DURING violent maximal exertion as occurs with coughing jags is fraught with inaccuracy.  You have movement to contend with.  You have circulation changes that occur rapidly in succession during the coughing.  AND, you have the ‘potential’ for desaturation.  Without having the opportunity to observe your measurements as they occur, I wouldn’t be able to tell you if they are even valid/accurate.  After that, a five “point” drop, (I assume you mean “percentage points”) tells me nothing helpful without knowing from what it starts and to where it drops.  A five point drop from 99 or 100 % to 94 or 95 % is not a problem, under any circumstances.  But, a drop from 90 % to 85 % is another story - - - AND is NOT a good thing.  If you are dropping from 82 % to 77 % that’s REALLY a problem and a danger!  So, you see, I can’t tell you what the significance of your observation is, though I’ve given you some idea with my examples to be able to ascertain for yourself if you have a problem or not.  If it takes as much as 5 minutes for your saturation to return to normal, then you have further problems that suggest you need oxygen therapy or a higher dose of oxygen, IF those drops are from a starting point of 93% or less.

 Sore or not, you are breathing correctly when you use your abdominal (lower abdominal) muscles to generate the greatest portion of effort to breathe.  Use of chest muscles (accessory breathing muscles) is a VERY bad idea!  We try to discourage folks from deliberately trying to use their chest muscles to support breathing.  Those muscles eat up a ton of energy without returning near as much as abdominal muscles in terms of ventilation per unit of work.  There are times when I’ve encountered folks (medical professionals) who counsel and coach use of upper chest and accessory muscles.  Besides jumping into action to help them realize the error of their thinking and understanding, I try to have them practice and gain a feeling for abdominal breathing - - - and NOT by using the commonly recommended “diaphragmatic breathing retraining methods”, which are very counter productive for a LOT of folks and can actually lead to worse use of the ‘wrong set of muscles’ to generate breathing effort.  We like to use harmonicas, singing and other similar activities that cause the person to have to use abdominal breathing as exercises to enhance mastery and control of exhalation.

 As a singer, you have likely learned the BEST way to breathe.  Stick with it.  And be SURE to use pursed Lips Breathing when you exhale.  That can go a long way to reduce your breathing work and ultimately your soreness.

Best Wishes, 

Mark

I was told by my doctor before taking my spiriva and symbicort, to take 2 puffs of ventolin 5 mins thus opening the airways so that the spiriva and symbicort will work better.  However, somewhere else, I read that by taking the ventolin before, if clears the airways so that  the spiriva and symbicort have nothing to adhere to.  Could you please tell me how you would recommend taking my ventolin?
Bonnie

A.  Hi Bonnie,

While controversy continues to some degree and I am at the forefront of pushing for sensible and evidence-based change, your doctor echoes instructions that are trumpeted by many health care professionals.  Regardless of how many promote doing as he has recommended, it is plainly contrary to every bit of evidence available AND is without one shred of evidence to support its practice.  

If you take Ventolin before taking your Symbicort, you will block the effect of the “long-acting, beta-agonist” (LABA) medication in the Symbicort, because they BOTH occupy the same receptor sites within your airways.  Ventolin is a “short-acting, beta-agonist” (SABA), lasting only up to 6 hours.   When the Ventolin gets there first, it ties up the sites so the Symbicort’s LABA has no sites to bind with.  By the time the sites are again freed up, the Symbicort’s LABA has long since been shed from the lungs.  So, the bottom line is by taking the Ventolin first, you negate the potential benefit and effect of the Symbicort LABA. 

You should take the Symbicort by itself FIRST.  If after 30 minutes, you feel you really need more, THEN take the Ventolin.  What I think you’ll find is that the Symbicort by itself, is plenty and all you need.  In that case, your Ventolin becomes strictly a back-up/supplemental medication if and when you ever need a ‘pick-me-up between Symbicort doses.  Also, Never take the Ventolin within TWO HOURS before you are due to take the Symbicort.

Best Regards

Mark

Should everyone purchase an oximeter after being diagnosed with moderate approaching severe copd.  There is no pulmonary rehab available in my area.  I am short of breath  when exercising very little and I currently take Spiriva, Advair twice a day and Albuterol when needed.

Jacquie

A. Hi Jacquie, 

A pulse oximeter is only of use to someone whose oxygen level in their blood fluctuates such that there’s a danger it will drop too low, putting them at risk for attendant complications.  If someone has mild COPD, they usually do not have a problem with oxygenation.  The best way to know when you should acquire a pulse oximeter is when it is first detected that your oxygen level drops to around 90 % or less.  You should have your doctor (Pulmonary doctor, most likely) measure your oxygen with a pulse oximeter in his/her office - - - especially while you’re walking around, NON-STOP, for AT LEAST two minutes.  A measurement done while you are sitting quietly and comfortably at rest is NOT suitable to detect “exertional hypoxia” (low oxygen level during exertion).  Before you exhibit signs of “desaturation” (drops in your oxygen level) there is no advantage to having and/or using an oximeter.

 Best Regards,

Mark

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Q. Cooking Fumes  Posted January 24th/10

I can't stand smell of food cooking;  cuts my air off so then I get a anxiety attack and it is no fun;

 Thank you, Jim

A.  Hi Jim,

I’m not sure what your ‘question’ is, as everything you said is in the form of a statement.  So let me make some general observations and statements along with imparting a few suggestions to hopefully help the situation.  Different foods and methods of cooking will have different effects on breathing for those who have advanced COPD.  First, to suffer as you describe, Jim, one usually has a very reduced FEV-1 (measurement from your pulmonary function test).  Frying foods can be especially difficult.  But, boiling pungent foods like broccoli or kidneys, for instance, can assault your nostrils and literally take your breath away.  So, using caution to begin with is of utmost importance.  Provide the best ventilation and source of fresh air possible within the limits of the design of your kitchen.  Use you stove fume vent to pull odors out of the air as they rise from your cookware.  Avoid breathing the air near pungent foods, especially if you know they have a negative affect upon you.

If you use oxygen, be sure you are using enough to keep your saturation as high as possible to minimize low oxygen symptoms.  95 % and more is not unreasonable.  Be careful to use the oxygen safely around the active stove/oven.  If you use a rescue or ‘short-acting inhaler, try taking a couple of puffs from that before you begin cooking.

Best Wishes

Mark

Hi Mark,

Thank you so much for being a part of  this board, your help is so very much appreciated.

Mark I have asked my  Pulmo about rehab, and he said it will not do any thing for me, what do you think?   He said I am severe, and i only have my left lung, and have  COPD/ASTHMA/ E  I should  also mention I am very active, do all my own housework and shopping and cleaning, I get very SOBA, but I try my best.

 Thank you in advance.

Sincerely Linndie

A.  Hi Linndie,

I would opine that it is presumptuous of anyone to summarily dismiss the notion that pulmonary rehab would or would not do any good for anyone based upon their having severe COPD.  While I argue at times about the uselessness of spending our Medicare Dollars on rehab for someone who has no rehab potential, much less desire to regain lost, but retrievable function AND I am leery of just how early we can justify intervening with pulmonary rehab on a person who has no symptoms or demonstrable need for significant disease management, I still have to remain reserved as there is much to be learned to avoid complications and to slow progression.  In folks who are extremely debilitated, BUT who are enthusiastic about regaining function AND are willing and able to tolerate the discomfort along the way, I say: “Go for it!”  I have witnessed some incredible results in folks on whom I’d have bet upon failure.  Those are times when I am MOST happy to have been wrong!  I have also learned over 20 years at this that it is a treacherous path to tread when trying to make predictions without having “the writing on the wall.”

You sound like you’re fairly robust despite your deficits.  So, on the one hand there might not be much in the way of conditioning that you could gain.  Yet, if you do not now have an aerobic fitness program, then you are missing a key component that could improve your breathing, muscle function and oxygen utilization as well as carbon dioxide production.  More efficiently functioning muscles produce less carbon dioxide.  That reduces demand on the lungs to ventilate in order to clear carbon dioxide.  And that translates to potential improvement in breathing work and anxiety.  So, Pulmonary Rehab could be the catalyst to get you started on a walking program.  Doing your household chores and similar daily work is good.  BUT, it’s NOT exercise.  You need “sustained, repetitive motion over a continuous period of time” to constitute the kind of aerobic exercise that will give you the conditioning to allow you to continue to do those daily activities without out avoidable difficulties.

You say you only have your left lung.  Am I to surmise that you had your right lung surgically removed?  If so, you need to be mindful of one thing that SOOOOooo many physicians fail to consider.  Your pulmonary functions measurements will ALWAYS be only half of what is predicted - - - even if they’re normal.   The best you can achieve would be around 50 % of everything except for airflow measurements.  If you have asthma, airflow measurements will be reduced.  But, FEV1 and lung volume measurements MUST be interpreted against the knowledge that only one lung is being measured.  Finally, if indeed you have only your left lung and no right lung, your COPD may not be the main cause of your difficulty breathing.  Simply having only one lung limits your maximum exercise and exertion intensity levels.  That is because you only have at best, ½ the reserve you would if you had two lungs.

Ultimately, your doctor should At least allow you the opportunity to go be evaluated and even give pulmonary rehabilitation a try.  If you find it is not helpful, then you can always say you gave it a shot.  But, to summarily shun it does NOT seem to me to be in YOUR best interest.  What’s your doctor got to lose by letting you stick your toe in and test the water?

Best Wishes,

Mark

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Q.  SOB (Shortness of Breath) "after" Exertion      (Posted January17th, 2010)

I have a short little upgrade from my driveway to my house, and then about 5 steps to climb.  I am breathing fine until I get in the house when I become extremely SOB to the point of gasping for air.  I plb the whole walk, and of course when I'm trying to get my breath back.  Why am I not SOB during the walk but am when I stop?  Thanks!

Sue

A.  Hi Sue,

You ask a good question that is often asked by folks.  The simple answer is “lag time”.  But, there’s more to it.  When you begin the trek, you are breathing slower and easier.  As you go on during the trek, even though you are doing pursed lips breathing (PLB), you are developing an unavoidable problem that is related to the anatomical changes within your lungs as the result of your COPD.  That problem is “dynamic hyperinflation”.  It is, in simple terms “breath stacking that occurs when you progressively breather more air INTO your lungs than you breathe OUT of them as you walk along and especially when you climb those stairs.  By the time you reach the end of the trek, you have pushed your lung volume to a level that is much higher than when you are comfortable and at rest.  In doing so, you also reduce your “inspiratory capacity”, making it such that you have less room to work with to pull in each succeeding breath.  That invokes continued efforts from you to increase ventilation which is increasingly less possible.  During this time as well, your CO2 is increasing in in the air within your lungs.  More importantly, your pH (the reflection of the acidity or alkalinity of your arterial blood) decreases commensurately with the increase in CO2.  This invokes even MORE stimulus for you to try to increase ventilation.  Since you have a reduced capacity to further increase ventilation because of the over-distended state of hyperinflation that results during “dynamic hyperinflation”, your only recourse is to increase your anxiety level.  So, when you finish the climb and get into your house, these factors are all affecting you at their peak of influence.  You stop the activity and continue to PLB.  And, because you are no longer making the greater demands for ventilation on your lungs as you were during the trek, you begin to “unload” those hyperinflated lungs, returning them to their “resting volume”.  At the lower state of hyperinflation, you are able to return to more effective and comfortable ventilation as you return to expelling more air during exhalation than when during the activity AND you return to a lower respiratory rate.

When I teach more effective ways to breathe to my folks in pulmonary rehab, I stress that just because their legs and body have physically ceased activities like you describe, doe NOT mean their work to control their breathing has stopped.  I tell them that they must continue to be deliberate and controlled and try to increase the effectiveness of their breathing for up to several minutes after they stop, as just as it takes a couple of minutes to develop, it also takes a couple of minutes to resolve.  Dynamic hyperinflation may sound like a difficult and abstract phenomenon to understand.  But, it really is fairly simple.  And it is essentially part and parcel what is responsible for the breathing difficulties folks experience as their COPD advances.  The lower your FEV-1 is, the more subject you are to Dynamic Hyperinflation, especially as the demand of the physical activity you engage in increase.

Best Wishes,

 Mark