Yoga in COPD: Results of Two New Studies

Yoga in COPD: Benefits with Yoga at Home 

Background: Yoga is a form of physical movement and posture that includes meditation and spirituality. The word – yoga – means “to add,” “to join,” “to unite,” or “to attach.” There is limited information about the practice of yoga in COPD patients.

Pranayama is a traditional yoga practice of controlling breathing. In general, the focus is on slowing and extending the breath, particularly during meditation. It emphasizes that when you breathe in, you bring in energy to your body; and when you breathe out, you allow stress to leave your body.

Example of Pranayama yoga in COPD

Woman in yoga pose

Pranayama is more than simple awareness of the breath. It involves specific rhythms and techniques to bring the following benefits.

  • Calms the mind, reducing worries and anxieties
  • Improves focus and attention, removing brain fog
  • Increases energy, bringing enthusiasm and positivity
  • Boosts the immune system
  • Rejuvenates the body and mind
  • May even slow down the aging process

 

Dr. kanminsky is first author of study of yoga in COPD

David Kaminsky, M.D., Professor of Medicine at the University of Vermont College of Medicine

Studies: Two recently published studies evaluated yoga in COPD performed at home. 1. Dr. David Kaminsky and colleagues at the University of Vermont College of Medicine evaluated whether the practice of pranayama, or yoga breathing, could be done at home as an alternative to pulmonary rehabilitation. There were two groups of patients with moderate to severe COPD. One group participated in pranayama yoga plus education for 12 weeks; the other group received education alone.

The study was published on-line on July 17, 2017, in the Journal of Alternative and Complementary Medicine.

Drr.Donisky is first author of study on yoga in COPD

DorAnne Donesky, RN, Ph.D., NP, Adjunct Professor of Physiological Nursing at UCSF School of Nursing

2. Dr. Donesky and colleagues at the Department of Physiological Nursing, University of California in San Francisco, evaluated whether those with COPD and heart failure could perform yoga at home. One group participated in one hour of TeleYoga classes two times a week. Yoga instructions were provided by live video connected to home televisions using the Internet. In the other group, each participant received educational materials by mail and a weekly phone call to discuss education information.

This study was published on-line on June 27, 2017, in the Journal of Alternative and Complementary Medicine.

Example of yoga to improve breathing. Can also be used as yoga in COPD

Women performing Bhastrika yoga

Results: Study 1. Those in the pranayama group increased the distance walked in six minutes by an average of 31 meters, while the education group had a decrease of 16 yards after 12 weeks. This difference was almost statistically significant. Both groups improved shortness of breath with activities. Study 2. There were 14 participants with COPD and heart failure. Those who received TeleYoga were able to safely participate in the classes, found the 8-week program enjoyable, and were less short of breath with activities.

Conclusions: Study 1. This pilot study demonstrated that pranayama yoga in COPD patients was associated with improved exercise tolerance.  Study 2. Despite frailty, those with both COPD and heart failure were able to perform yoga safely at home using instructions on television.

My Comment: You may wish to consider the benefits of yoga in COPD  either by itself or in addition to your current exercise program.

? Enough Progress in Pulmonary Rehabilitation

Dear Dr. Mahler:

I have stage 4 copd with a fev of 26. I have been going to pulmonary rehabilitation, and today was the 17th time. The woman that runs it said I’ve not improved enough. I’m O2 dependent need 6 liters at exercise. Day one I exercised 23 min. Day 2 32 min. Every day after is 40 min plus weights and  bands. I went from 1.0 on the si-fit to 1-3, weights 2 lbs to 3 lbs. I’m not sure how much I should be doing, I thought I was doing good from starting at no exercise at all.

Hope you can help.

Linda from Ascutney, VT

Dear Linda:

With most pulmonary rehabilitation programs, the first visit, or possibly a screening visit, is spent discussing the goals of the program for each person.  Did the “woman that runs it,” whom I assume is the pulmonary rehabilitation coordinator, ask about your individual goals?

Also, I would ask her what she expects as far as improvement for you.  Generally, changes from your baseline, or starting point, are most important to assess benefit.

Woman with COPD doing arm curls with hand weights.

Woman with COPD doing arm curls with hand weights.

Certainly, your increase in exercise time (? on the treadmill) from 23 minutes to 40 minutes is impressive. This represents a 74% percent improvement.  Also, the increase is hand weights from 2 to 3 lbs (+50%) is quite good.

An important benefit of pulmonary rehabilitation is improvement in doing daily activities. Do you find certain daily tasks have become easier? Or can you do something for a longer time period before you experience shortness of breath?

Once again, I would talk directly to the rehabilitation coordinator about your concerns. From the information that you have provided, it appears that you are making substantial progress. Keep up the hard work.

Best wishes,

Donald A. Mahler, M.D.

 

 

Narcotics for Distressful Breathing

A Review of Different Studies

Ekstrom and colleagues reviewed the effects of narcotics on relief of distressful breathing and exercise ability in the March 24, 2015, issue of the Annals of the American Thoracic Society.

Based on the results of 8 studies involving those with COPD, narcotic medications (usually morphine) given as a pill or by a shot (injection) reduced the severity of breathing difficulty. The benefit of narcotic medications given as a solution in a nebulizer was considered to be “low.” Narcotic medications had no effect on the exercise ability of the patients with COPD (13 studies).

Comment: Narcotic medications are used routinely for reducing pain. This review confirms that narcotic medications, mainly morphine, are effectively for reducing breathing difficulty. Usually, narcotics are used when breathing difficulty becomes persistent and distressful despite use of the best available treatment for COPD. This includes inhaled bronchodilators, possible use of an inhaled corticosteroid, oxygen if indicated, and pulmonary rehabilitation if appropriate.

Before a trial of morphine, your doctor should discuss the goals of using morphine as well as possible side effects of the medication. Side effects may include drowsiness, sleepiness, nausea, upset stomach, and constipation.