Why am I More Short of Breath with Daily Activities?

More Short of Breath in Past Five Months

Dear Dr. Mahler:

I am writing because I am more short of breath with my usual activities. It has gotten bad enough that I have placed a chair between the kitchen and TV room to sit down and catch my breath.

My doctor has told me that I have “very severe COPD” based on my last breathing tests. I am taking Stiolto Respimat every morning, and use ProAir puffer 3 to 4 times a day, depending on how active I am. I have not had a chest infection for over 3 years, and am up to date on flu and pneumonia shots.

Pulmonary rehab can help with feeling of being more short of breath

Woman with COPD doing arm curls with hand weights.

This past summer I completed 10 weeks of pulmonary rehab, and really felt good and was able to do a lot more than before the program. Since then, I have been unable to exercise because my husband isn’t able to drive me to the hospital for maintenance phase of rehab. At my last visit, the PA told me that I had gained 7 pounds since August, and she could not find any evidence of a chest infection or a heart problem. Do you have any thoughts?

Marci from Rio Rancho, NM

Dear Marci,

Feeling more short of breath is a common problem for those with COPD. A chest infection or inhaling irritants in the air can cause breathing difficulty, but this should not last for five months as you report.

The five major causes for an increase in breathing difficulty in those with COPD over several months or longer are: anemia (low number of red blood cells); anxiety; deconditioning (or being “out of shape”); heart disease; or a gradual worsening of COPD.

Based on the information that you provided, it sounds like your reduced activities (deconditioning) and weight gain are the most likely reasons for the worsening in your breathing. To check for anemia, I suggest that you ask your doctor or PA whether it is reasonable to order a blood test called a complete blood count (CBC) that can determine whether you might have anemia.

These leaning positions help with feeling of being more short of breath

Leaning forward positions can help with breathing difficulty (figure from COPD: Answers to Your Questions, 2015; Two Harbors Press, Minneapolis)

Using a chair as a rest station is a good strategy. You might also lean on the back of the chair to help with breathing just as the man on the right is leaning on the end of a table. This leaning forward position stabilizes the shoulders and enables the neck muscles to assist the diaphragm with breathing.

Best wishes on being able to breathe easy.

Donald A. Mahler, M.D.

Is Fatigue due to My COPD? I feel Tired Most of the Time

I Have Fatigue Almost Every Day

Dr. Mahler:

I am 57 years old and feel fatigue and tired every single day. Although I have had shortness of breath for some time, my COPD was diagnosed four years ago before my hip replacement surgery. I take Advair and Spiriva daily and might use ProAir 1-2 times a day depending on activities. I work as a teacher’s assistant for 2nd graders, and am married to a supportive husband. The physician’s assistant whom I see doesn’t seem that interested. He simply says to stay active. Can my tiredness be due to my COPD or could it be due to something else?

Charlotte from Daytona, FL

Dear Charlotte,

Fatigue is a term used to to describe the general overall feeling of tiredness an a lack of energy. It is a common complaint and may be due to either a medical or psychological problem. Possible medical problems include a low number of red blood cells (anemia), an under active thyroid (hypothyroidism), an active infection, a sleep problem like insomnia or obstructive sleep apnea, and chronic fatigue syndrome. Anxiety and depression may also cause someone to feel tired.

A recent study evaluated factors associated with feelings of fatigue in 101 individuals with COPD and 34 healthy adults. The study was published in the October 2016 issue of Therapeutic Advances in Respiratory Disease (volume 10; pages 410-424).

Woman with fatigue

Woman with fatigue

Fatigue was more common in those with COPD (72%) compared with healthy individuals (56%). In general, those with COPD who had fatigue reported more shortness of breath with activities, had more anxiety and depression symptoms, and experienced worse quality of life compared with COPD patients who did not report feeling fatigued. Insomnia was also common in those who noted tiredness.

Charlotte – I suggest that you make an appointment with your health care provider to discuss your feelings of fatigue and tiredness. Ask to be tested for anemia, hypothyroidism, and an active infection. If these test are normal, then I suggest that you explore whether you have sleep difficulties, anxiety, or depression that might be contributing to your lack of energy.

I hope that this information is helpful. Best wishes,

Donald A. Mahler, M.D.