Greater Activity Levels in Those with COPD are Related to Active Loved Ones

Greater Activity Levels in COPD If Loved Ones Are Active

Background: Patients with COPD are less active compared with healthy subjects. This may be due to symptoms of

Greater activity levels possible with loved ones

Man pedaling stationary cycle being supervised by daughter

breathlessness and fatigue. Adopting a healthy lifestyle with more physical activity is one of the main goals of a COPD management plan. Family members and loved ones may play an important role in helping patients with COPD achieve greater activity levels.

Study: Mr. Mesquita, a physical therapist, and colleagues at the Department of Respiratory Medicine in Maastrict, the Netherlands, studied light and moderate to vigorous physical activity in 125 patients with COPD and a loved one over 5 days. The findings were published in the May 2017 issue of the journal CHEST, volume 151, pages 1028-1038.

Woman with COPD with greater activity levels.

Woman with COPD walking with grandson

Results: Patients with COPD spent more sedentary time (being inactive) than their loved ones. However, those patients with an active loved one spent more time in moderate to vigorous activities than did those with an inactive loved one after controlling for age, body mass, and severity of COPD.

Conclusions: The authors concluded that in general patients with COPD are less active than their loved one despite similar exercise motivation. Those with an active loved one have greater activity levels.

My Comments:  It is very common for those with COPD to reduce activities to avoid the unpleasant feeling of breathing difficulty or shortness or breath. This can lead to a downward spiral as shown below.

Greater activity levels

Downward Cycle of Breathing Difficulty Leading to Reduced Physical Activity and Deconditioning (“out of shape”). Taken from page 70 of COPD: Answers to Your Questions (with permission).


Getting started in a pulmonary rehabilitation program is one of the best ways to reverse this downward spiral. Studies clearly show that regular exercise provides greater benefits for those with COPD than any inhaler. I encourage you to be as active as possible.

Chronic Heart Disease Occurs Frequently in Those with COPD

Heart Disease and COPD – Shared Risk Factors

Study: A December 1, 2016, article in the American Journal of Respiratory and Critical Care Medicine (volume 194; pages 1319-1336) reviewed information about cardiac disease in those with COPD. (DOI: 10.1164/rccm.201604-0690SO)

COPD and heart disease share risk factors that include:

  1. Older age
  2. Cigarette smoking
  3. Physical inactivity
  4. Low-grade inflammation in the body
Heart disease can occur in different parts of the heart.

Diagram of the heart

Heart disease is more common in those who have COPD (from 10 – 30%) compared with the adult population (about 1 – 2%). It contributes to the severity of COPD and is a common cause for hospitalization and death. Both heart disease and COPD can cause the same symptoms – shortness of breath and fatigue.

The three most common heart diseases in those with COPD are:

  1. ischemic disease (narrowing of the arteries in the heart)
  2. heart failure (pumping action of the heart is impaired leading to fluid build-up in the lungs)
  3. atrial fibrillation (irregular heart rhythm).

Atrial fibrillation

Atrial fibrillation is a common heart disease in COPD

The curved arrows in the right and left atrium (upper chambers) in atrial fibrillation indicate chaotic electrical activity.

This is the most common heart rhythm problem in the general population as well as in those with COPD. The atria (two top chambers of the heart) beat irregularly AND the the ventricles (lower two chambers of the heart) do not work in sequence (together) with the atria. In those with stable COPD, atrial fibrillation occurs in 5 – 15%. In those with very severe COPD, it occurs in about 20 – 30%. Atrial fibrillation can cause shortness of breath, low energy, and a feeling of skipped heart beats. There is a risk for blood clots developing in the atria. Usually, anticoagulant medications (commonly called blood thinners) are recommended to reduce the risk of clots.

What Can You Do?

Certainly, you need to reduce risk factors for both heart and lung problems if possible. That means: do not smoke; be physically active; and do whatever possible to reduce inflammation in your body. I suggest that you view the October 17, 2016, post on my website under Frequently Asked Questions (FAQs). This post describes numerous foods that are anti-inflammatory and can boost the immune system.

Finally, I encourage you to be proactive and ask your health care provider whether any shortness of breath or fatigue that you might experience could be due to a possible heart problem in addition to COPD.




Emotional Intelligence is Associated with Wellbeing and Self-Management

Emotional Intelligence Is Important in COPD

Background: Emotional intelligence is the ability to understand and manage personal thoughts and feelings. It can influence your communication with others. It is a trainable skill that has been used in corporate business to improve well-being and performance.

first author of study evaluating emotional intelligence.

Dr., Roberto Benzo of the Mayo Clinic.

Study: Dr. Roberto Benzo from the Mayo Clinic studied 310 patients with COPD who were 69 years of age on average. The key breathing test (FEV1) was 42% of the predicted value on average. All subjects answered numerous questionnaires. The study findings were published in the Annals of the American Thoracic Society in January 2016 (volume 13, pages 10-16).

Findings: Emotional intelligence was significantly and independently associated with self-management abilities, quality of life (shortness of breath, fatigue, emotions and mastery) after adjusting for age and breathing test results.

Conclusions: Dr. Benzo and his team concluded that emotional intelligence is important for those with COPD. The authors commented that attention to it may address the current gap that exists in the treatment of emotional parts of COPD which is related to decreased quality of life and increased health care use.

Store employee tying shoe of elderly shopper.

Store employee tying shoe of elderly shopper

My Comments: I congratulate Dr. Benzo and his colleagues on addressing a novel feature of COPD that has not received much attention in daily care and management efforts.

Emotional intelligence affects:

  • Performance at school or work. Emotional intelligence can help you navigate the social complexities of the workplace, lead and motivate others, and excel in your career. In fact, when it comes to gauging job candidates, many companies now view emotional intelligence as being as important as technical ability and use testing before hiring.
  • Physical health. If you’re unable to manage your emotions, you probably are not managing your stress either. This can lead to serious health problems. Uncontrolled stress can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. The first step to improving emotional intelligence is to learn how to relieve stress.
  • Mental health. Uncontrolled emotions and stress can also impact your mental health, making you vulnerable to anxiety and depression. If you are unable to understand, be comfortable with, and manage your emotions, you’ll be at risk of being unable to form strong relationships which can leave you feeling lonely and isolated.
  • Relationships. By understanding your emotions and how to control them, you’re better able to express how you feel and understand how others are feeling. This allows you to communicate more effectively and forge stronger relationships, both at work and in your personal life.

Can Depression Affect my Breathing and COPD?

Depression Occurs in 25% of those with COPD

Dear Dr. Mahler:

I wanted to know your thoughts on whether depression can affect my breathing. I am 57 years old and have had COPD for about 3 years. I seem to be tired all of the time and get short of breath with little activity. I was treated for depression when I was in my 20s, but have been fine until about 3 months ago. I work as a teacher’s aide in a grade school in my town, and am now off for the summer. I quit smoking soon after I was told that I had COPD. I have an appointment with a nurse practioner in a few weeks. What do you think?

Karen from Tupper Lake, NY 

Dear Karen:

I encourage you to discuss your concerns with your health care provider. Being tired and feeling short of breath may be due to various causes including a low red blood cell level (anemia), low thyroid function (hypothyroidism), another medical problem, and a psychological condition. I suspect that the nurse practioner will order tests to check for these possibilities.

Man with depression

Man with depression

Depression is considered a mood disorder caused by changes in chemicals within the brain. According to the World Health Organization, it is estimated that 21% of women and 12% of men in the U.S will experience an episode of depression at some point in their lifetime. Recent reports from the United Kingdom and from the U.S. found that about one in four (25%) of those diagnosed with COPD suffer from depression over a three year period.

The risk of an episode of depression is related more to how may episodes you have had in the past rather than life stresses. Your previous treatment in your 20s simply means an increase in risk for another episode. That is why is important that your health care provider do a complete evaluation of all possible causes of your symptoms.

Effects of depression

Effects of depression

This condition can affect your thoughts, emotions, behaviors, and overall physical health. Typical feelings are sadness, hopelessness, guilt, moodiness, and loss of interest in friends and family. You may find that it is hard to concentrate or make decisions. It is common to withdraw from others, use drugs or alcohol to “numb yourself” in order to temporarily feel better, and miss work or other commitments. Other symptoms are lack of energy and changes in appetite resulting in weight gain or weight loss.

Depression is usually diagnosed by excluding other medical conditions and by your answers to a questionnaire. Once again, tell you health care provider how you are feeling and that you were treated for depression in the past.

Best wishes,

Donald A. Mahler, M.D.


Music Therapy Improves Breathlessness and Fatigue in COPD

Weekly Music Therapy Helps Those with COPD

Reason for the Study: Many of those with COPD are socially isolated. As a result, they are less physically active, are “out of shape,” and may have symptoms of depression.  The researchers proposed that music therapy would improve breathing difficulty, psychologically well-being, and quality of life.

Study: Researchers from Mt. Sinai Hospital in New York City studied a total of 68 patients with moderate to severe COPD. Age of the subjects ranged from 48 to 88 years. The study lasted 6 weeks. It was published in the December 2015 issue of the journal Respiratory Medicine, volume 109, pages 1532-1539.

  1. Study Group: Weekly therapy sessions included live music, visualizations, playing a wind instrument (like the horn, trumpet, or flute), and singing using breath control techniques led by certified music therapists. Subjects were encouraged to choose their own music and to be active in therapeutic activities.
  2. Control Group: Standard care (continuing current treatments)
Singing Group

Singing Group

Results:  Those in the Study Group reported improvements in depression symptoms and “mastery” of their COPD along with reduced levels of shortness of breath and fatigue compared with the control group.

Dr. Jonathan Raskin, Medical Director, Pulmonary Rehabilitation, Department of Medicine, Mount Sinai Beth Israel

Dr. Jonathan Raskin, Medical Director, Pulmonary Rehabilitation, Department of Medicine, Mount Sinai Beth Israel

Comments: Coauthor Dr. Jonathan Raskin added that, “Music therapy has emerged as an essential component to an integrated approach in the management of chronic respiratory disease.” Dr. Raskin suggested that such therapy combined with participation in a pulmonary rehabilitation program may provide additive benefits in the management of COPD.

Listening to music can release endorphins into the body. This may contribute to the “good feelings” that individuals report while listening to or singing songs, and playing an instrument.

I encourage you to watch the YouTube video below of the late Fred Knittle, then 83 years young singing the song “Fix You” as part of the Young@Heart chorus. He originally rehearsed this version of “Fix You” with his best friend, but his friend passed away before the performance. Fred decided to perform alone, aided by oxygen. You won’t forget this video.