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How does a healthy Pulmonary System work?

(Thanks to the text, Exercise and Respiratory Disease, for the diagram.)

With every breath we take, our pulmonary system is hard at work, exchanging air from the outside with the air in our lungs. As air enters, the nose and mouth filter, warm and humidify it. It then reaches the pharynx, passes through the larynx, and then into the trachea. It continues to be cooled as it passes into two bronchi which are the main channels to the lungs.

Within the lungs, the air moves into smaller branches called bronchioles which move the air to the final branches, the alveoli (tiny air sacs). It is here — in the more than 300 million alveoli — where oxygen and carbon dioxide are exchanged between the lungs and the blood. How much air we breathe in (known as lung volume) varies between 4 and 6 litres, about the amount of air in a basketball.

At rest, our breathing rate is about 12 breaths per minute. During exercise, our breathing rate may reach as much as 50 breaths per minute. Obviously, healthy lungs make it easier to exercise.

What is COPD?

COPD stands for chronic obstructive pulmonary disease. As with heart disease, it is not one condition, but instead refers to a group of lung diseases — emphysema and chronic asthmatic bronchitis being the two most common — that block airflow while exhaling.

A person with emphysema has difficulty exhaling because the lungs have lost their ability to expel air easily and remain partly filled with stale oxygen. Emphysema destroys the alveolar walls and the air spaces near the bronchioles.

By contrast, chronic bronchitis affects mainly the conducting airways. Inflammation of the trachea and bronchial tubes are caused by either cigarette smoke or another type of pollutant.

While COPD is the most prevalent pulmonary disease, there are other respiratory illnesses that come under the COPD umbrella. Asthma is one of these. As well, there are a number of restrictive lung diseases — conditions which restrict the airway — which include scoliosis, pulmonary fibrosis, and muscular dystrophy, among others. This page, however, will restrict the discussion to emphysema and chronic bronchitis.

What are the risk factors for COPD?

Genetic factors are responsible for a small number of cases of emphysema, but the majority of people with emphysema or chronic bronchitis are or were cigarette smokers.

Other risk factors include air pollution (either in the home, in the city environment, or at your workplace), childhood respiratory infections, and secondhand smoke. If you have asthma, it is considered to also be a risk factor for COPD.

How will I know if I have COPD?

Unfortunately, the symptoms for COPD may take years to develop and symptoms may be missed in the early phases. Dyspnea (shortness of breath) is the major symptom of emphysema, but fatigue, wheezing, and chest tightness also might occur.

Symptoms of chronic bronchitis include an excessive production of mucus, a recurrent cough, a need to clear the throat, shortness of breath upon exertion, and wheezing.

If you have any difficulties breathing, you should see your doctor immediately.

Once diagnosed, what can be done to manage the disease?

The main goal is symptom relief, as this disease can not be reversed. You can consider many strategies, but they would include breathing techniques and exercise.

Three breathing techniques which are particularly helpful are:

• Pursed-Lip Breathing: Breathe in slowly through the nose, purse the lips into a whistling position, and blow out slowly and evenly. Time yourself and see how long it takes you to expel all the air from your lungs.

• Diaphragmatic Breathing: Rest both hands on the abdomen, breathe in through the nose. This will expand the lungs and push the diaphragm down, pushing the internal organs slightly aside. That will cause the stomach to appear to rise — and you should be able to feel this with your hands. When you have no more air to breathe in, breathe out slowly through pursed lips.

• Chest Expansion: Place yours hands on the sides of the rib cage with your fingers pointing to the front. Relax, lower your shoulders, and breathe in slowly through the nose. You should feel your hands move out. Then breathe out slowly through pursed-lips. You should feel your hands move in.

Is it all right to exercise with COPD?

The short answer is yes, as exercise has proven to be beneficial. However, most individuals with COPD will have reduced breathing rate which can lead to hyperinflation, making breathing less efficient. Gas exchange may not work well and this can lead to hypoxemia (decreased oxygen in the blood).

There is no doubt that exercise is beneficial to those who are dealing with pulmonary disease, but it's important to understand the disease, be aware of symptoms, and follow some basic rules.

Here are some general tips for those who want to exercise:

• Get medical approval: Speak with your doctor before starting an exercise program. Consider what type of exercise you will be doing and how your medication might need to be adjusted before, during, and after exercise.
• Always warm-up and cool-down.
• Stay well hydrated.
• Exercise in a well-ventilated facility.
• Avoid extreme cold.
• Monitor your exercise by checking your heart rate, using the talk test, or perceived exertion scales.
• Cardiovascular exercise: Start with exercise that can be sustained within a reasonable comfort for several minutes. Increasing duration will be a major goal, and this can be achieved more easily through intermittent exercise.
• Resistance Training: Focus on endurance and task-specific exercises. Perform movements that are taxing enough to slightly increase breathlessness. Follow the basic general rules of resistance training. Avoid overhead training.
• Use Breathing Techniques: Pursed-lip breathing may help to control oxygen levels and reduce shortness of breath. Exhaling during the most difficult part of an exercise may also be helpful.

When should exercise stop or not occur?

You should be the judge of your own condition and how you feel. However, some symptoms should be strong warning signs to either not exercise at all, or to stop exercising during a routine.

Do not exercise in the following situations:

• Symptoms are already there before exercise.
• The environmental conditions are inappropriate.
• During an illness or fever.
• When excitement or stress has increased breathing rates.

You should end your exercise and seek medical advice immediately if any of these symptoms occur while you are exercising:

• Increased breathlessness or wheezing
• Change in colour, or increased thickness of sputum
• General fatigue
• Dizziness, lightheadedness, or faintness
• Mental confusion or loss of coordination
• Pallor, cyanosis (blue colour), mottling or gray colouring
• A cold sweat
• Failure to increase heart rate with an increased workload
• Ankle or leg swelling
• Excessive tachycardia
• Chest pain or palpitations
• A change in blood pressure

SOURCE: Exercise and Respiratory Disease by Sharon Peachey Sheremta and Gwen Hyatt.

See also:

• Good Breathing
• Seeing your Doctor: When should you go?
• Perceived Exertion Scale: How to Tell when you are "in the zone"

This article is part of a series about various health conditions and the benefits of exercise. The other articles are:

• Exercise and Allergies
• Exercise and Arthritis
• Exercise and Asthma
• Exercise and Balance
• Exercise and Cancer
• Exercise and Chronic Pain
• Exercise and Circulation
• Exercise and Dementia
• Exercise and Diabetes
• Exercise and Heart Disease
• Exercise and Hypertension
• Exercise and Lifestyle and Older Adults: Recent Research
• Exercise and Mood
• Exercise and Osteoporosis
• Exercise and Our Brain
• Exercise and Pain vs. Burn: Will it ever stop hurting?
• Exercise and Parkinson's
• Exercise and Sleep
• Exercise and Stroke
• Exercise and Viruses: Exercise Immunology

I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.