Feeling Short of Breath With Exercise

Dear Dr. Mahler: I am frustrated because it seems like I can’t do anything without getting winded. I try to exercise by walking outdoors if it is nice outside, or else on my treadmill in the basement. But, I get short of breath so quickly. What should I do? I am 68 years old and have COPD for 4 years. I quit smoking when I was told that I had emphysema. My doctor has prescribed Advair twice a day and ProAir as needed. My insurance company recently switched me from Advair to Symbicort. Helen from High Point, North Carolina Dear Helen: Sorry to hear about your struggles with breathing. There are many reasons why your breathing may be worse, and it important to tell your doctor. You may wish to view another person’s question to me in June about “My breathing is getting worse” You may also wish to ask your doctor whether another bronchodilator medication might help your breathing. Both Advair and Symbicort are excellent medications, but you might also take another type of medication called a long-acting muscarinic antagonist (abbreviated LAMA). This type of medication works in a different way to open up your airways. There are a couple of different LAMA bronchodilators; these include tiotropium (Spiriva) and aclidinium (Tudorza) that could be tried as long as you do not have any problem with glaucoma or difficulty urinating. One strategy to improve your exercise tolerance is to stop and rest when your breathing becomes difficult when you are walking or doing some other activity. Then, after you “catch your breath,” start up again using pursed-lips breathing (pucker your lips to allow more air to be exhaled). You may also wish to slow down your pace. Continue this walk – rest pattern, and when you are finished, write down the number of minutes that you actually walked so that you know your baseline for comparison the next time that you exercise. The goal is to gradually increase the time that you actually walk and to decrease the time that you rest. You should aim for a total of 20 minutes of exercise. This can be achieved by 10 different periods of walking for 2 minutes each time, or 5 different periods of walking for 4 minutes each time. It is hoped that eventually you will be able to walk for 20 minutes without stopping. You may also wish to ask your doctor whether there is a pulmonary rehabilitation program available nearby. A nurse or therapist will evaluate your ability to exercise and will set you up with an exercise program. This can be especially helpful to get your started in a supervised setting. Best wishes, Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.