Getting Started

• Know Your Lungs
  Are you troubled by coughing and wheezing? Are you often short of breath? Do you wonder, "What's wrong with me?" Then read Know Your Lungs.
• Help Your Medicines Help You
  Do you know what your medicines are for, how to get the best results from them, and what side effects they may cause? See Help Your Medicines Help You.
• Use Your Breathing Aids
  Would breathing machines, humidifiers, other equipment help or hurt your lungs? To find out, read Using Your Breathing Aids.
• Put Yourself in Control
  Would you like to learn how to overcome breathlessness, breathe in more fresh air, and make your energy last through the day? Read Put Yourself in Control.
• Exercise and Keep Active
  Has shortness of breath limited your activity? Is it time to get your body back in shape to do the things you'd like to do? Read Exercise and Keep Active.
• Avoid the Troublemakers
  What's hurting your lungs? Air pollution? Infection? Allergies? Cigarette smoke? Weather? Feel better now, and prevent future damage by reading Avoid the Troublemakers.
• Eating to Feel Better
  Do you need a special diet or new eating habits? Read Eating to Feel Better.
• Keep Living Your Life
  Do you sometimes feel afraid or depressed? Do your family members understand your illness? Do you know where to turn for help? Read Keep Living Your Life.

Know Your Lungs

What Do Your Lungs Do?

When you breathe in and out, they: Bring fresh oxygen into your bloodstream. Remove carbon dioxide, a waste product.

How do they do it?
When you breathe in, your chest expands. Your lungs expand, too, sucking in air. When you breathe out, your lungs return to their smaller size, pushing stale air out.

What went wrong?
If you have chronic bronchitis, airways in your lungs have become narrow and partly clogged with mucus. If you have emphysema, some of the air sacs deep in your lungs have been damaged. They cannot push out stale air and bring in oxygen to your bloodstream.

What are the symptoms?
Some warning signs of both diseases are coughing, bringing up mucus, wheezing, and breathlessness.

How do I know which lung disease I have?
Your doctor may want to take some tests. Other illnesses can cause the same symptoms. Often, there is more than one cause. Many people have both chronic bronchitis and emphysema. Your doctor can find out what your problem is.

Will I get better?
There is no miracle drug or surgery for emphysema and chronic bronchitis. But you can take steps now to improve your breathing and feel better.

How do I start?
The first step to helping yourself is to see a doctor. If you're already under a doctor's care for chronic bronchitis or emphysema, use this booklet to help you follow through on your treatment and to learn ways to feel and live better.

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Taking Control
"I was huffing and puffing so hard that I had to stop halfway up the stairs to my office. That's when I finally broke down and went to the doctor. He took some tests and said I had chronic bronchitis and emphysema. I didn't even know what emphysema was. When I found out there was no cure, I quit the doctor. I didn't want a bunch of medicines, and I didn't want him to tell me to quit smoking. Lots of people smoke all their lives and never get sick. I was really down in the dumps. My wife, Helen, didn't understand, and she was worried. I'd be gasping for breath, and she'd be asking me, "What's wrong? What can I do?" You can't talk when you're out of breath, and it was frustrating to have her asking questions. Finally, I went back to the doctor, and Helen went with me. He explained to us what was happening in my lungs. He ordered some medicine and sent me to respiratory therapy and physical therapy. I learned how to get up those stairs to my office, and we both learned what to do when I get short of breath. I'm trying to quit smoking, but it's the hardest thing I ever did. Living with these things is hard work, but I'm taking it one day at a time, and I'm doing better now."

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Help Your Medicines Help You

There are several kinds of medicines that may help you control and live with lung disease.

You and your doctor need to work together to find the best medicines and the right amounts for you. That isn't always easy because no two persons with lung disease are alike. You may have to try many products before you find which ones help you most.

You'll get the best help from your medicine if you, your doctor, and your pharmacist work together as a team.

Isn't it my doctor's job to worry about my medicine?
Your doctor's part is to decide which medicines to use and to give you directions for using them. The rest depends on you.

How can I work with my doctor on medicines?
Your doctor needs to know how your medicines are affecting you. Carefully report good effects and also any unwanted effects.

Do your best to take your medicines on time and in the correct amounts. If you want to stop taking any medicine for any reason or if you want to take more or less than directed, be sure to discuss it with your doctor first.

Tell your doctor about all the medicines you use. Include prescriptions from other doctors and over-the-counter products, even if you don't use them every day. Don't forget cough medicines, sprays, nebulizers, aspirins, laxatives, antacids, estrogen, vitamins, and food supplements. When you get a new prescription, ask your doctor or pharmacist if this will affect the use of your other medicines.

Keep the medicines in a box or tray separate from others you may have. Keep them in the containers they come in. If you go to a hospital emergency room, take them with you. That can save time and avoid mistakes.

Tell your doctor if any medicine is too expensive for you to keep buying. There may be a cheaper substitute.

What are you taking?
Several kinds of medicines may be used to treat chronic lung disease. Make sure to write the names and directions for each of your medications, as well as the group they belong to, and keep your list in a handy place. Ask your doctor or nurse to help you.

Bronchodilators are for opening your airways to let more air in and out. They come in several forms, including pulls, liquids, and sprays. Tell your doctor if they make you feel nervous, if you can't sleep, or if your stomach is upset. To help avoid side effects, be sure to use them no more often than your doctors tell you to.

Steroids can reduce swelling in the airways and can ease breathing. Inhaled steroids are usually prescribed in aerosol form and are taken with an inhaler. Taken this way, the risk of side effects is extremely small.

When asthma is more severe, steroids may have to be taken in pill form. But steroids taken in pill form can have unwanted effects, especially if you use them for a long time. They can cause stomach ulcers, fullness in the face, weakened skin and bones, a tendency to bruise easily, and increased risk of infection. They slow down the work of your adrenal glands. If you stop taking steroids suddenly, you could become seriously ill. Steroids must be stopped gradually to give your adrenal glands a chance to catch up again. When using steroids, follow your doctor's directions carefully, and immediately report any unwanted effects.

Oxygen comes in tanks and small units you can carry. If you have too little oxygen in your blood, your doctor may order extra oxygen for you to breathe at home. Small units with shoulder straps can be carried outdoors to let you be more active.

Some people refuse to use oxygen because it makes them feel self-conscious or because they believe it is only for patients who are very sick. Today oxygen therapy is often used for persons with heart and lung diseases who aren't well enough to be at home. Using a portable unit is a lot like using crutches, glasses, or a hearing aid.

Oxygen therapy isn't for everyone, but, if your doctor orders it for you, it can be a safe way to help you be more active and less short of breath than without its aid.

Treat oxygen like any other medicine. Don't hesitate o use it if your doctor says you need it. And don't use more than your doctor prescribes.

Antibiotics are for treating infections caused by bacteria. The antibiotics are taken by mouth or are injected with a needle. When you need an antibiotic, your doctor will choose the best one for attacking the kind of infection you have. If you think you're getting an infection, call your doctor right away. Don't wait. Don't take a medicine left over from another illness or one that was ordered for someone else. Your doctor will tell you how many days to take your antibiotic. Don't stop early, even if you feel better. Tell your doctor if your antibiotic upsets your stomach or causes a skin rash. Ask your pharmacist if there are special instructions with your medicine, such as to avoid milk or take it on an empty stomach.

Diuretics (water pills) are used to get rid of extra fluid in your body. Your doctor will decide whether you need them. You may be able to manage a fluid problem simply by cutting down on the amount of salt you eat. Tell your doctors if diuretics cause weakness or muscle cramps.

Potassium supplements may be needed, especially if you're taking diuretics. Diuretics can cause your body to lose potassium. Instead of prescribing supplements, your doctor may suggest high-potassium foods like orange juice, bananas, dried fruits, and skim milk.

Vaccines are important to help avoid influenza (flu) and pneumonia. Those lung diseases can be dangerous for you. Get an influenza shot every year in October or November. Get a pneumonia shot, too. Most people only need a pneumonia shot once. Ask your doctor about revaccination. Both of these shots are covered by Medicare.

Sedatives and tranquilizers can help you relax and sleep. But they can also dangerously slow your breathing if you take too many. Be sure that the doctor treating your lung disease knows about any sedatives or tranquilizers you take. If you think you need more than the amount prescribed, ask your doctor.

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Use Your Breathing Aids

Several kinds of devices are used to treat lung disease. Most of them help put medicines, oxygen, or moist air deep into the lungs and help clear mucus out of your airways. Perhaps you're wondering if you should be using a breathing aid. If you know what each kind is for and how it works, you'll be able to discuss your needs with your doctor. If you're already using one of the devices, this information may help you get more benefit from it.

Nebulizers
A nebulizer or inhaler is a sprayer made to deliver a mist of medicine that you can breathe deeply into your lungs. A certain dose of medicine comes out in each puff of the inhaler when you squeeze it.

Other kinds of nebulizers plug into electric outlets in the wall and operate with compressed air or oxygen. Your medicine goes in a special cup in a liquid form. The compressed air oxygen turns the medicine into a mist.

If your doctor orders a nebulizer for you, a nurse or respiratory therapist will show you how to use and clean it. Here are some steps to follow when using a hand-held nebulizer.

1. Assemble your device for use.
2. Empty your lungs by breathing out slowly through pursed lips
3. Put the end of the nebulizer just in front of your mouth.
4. Keep your mouth open so that you can breathe in extra air. That helps carry the medicine deep into your airways.
5. Squeeze firmly to spray the medicine while you begin to take a slow, deep breath.
6. Hold your breath for at least a few seconds. That lets your medicine settle, so you don't breathe it out.
7. Breathe out slowly through pursed lips.
8. Stop to cough up mucus.
9. Repeat as often as your doctor directs.
10. Rinse your mouth with water or mouthwash. Swallowing medicine could upset your stomach.

Tell your doctor if you feel you need nebulizer treatments more often than they're prescribed.

Many physicians and pharmacists suggest placing the inhaler an inch or two away from the mouth. Then, with your mouth open, your lips covering your teeth, and your tongue out of the way, breathe out. Then spray while inhaling slowly and deeply. Hold your breath for ten seconds, then exhale. Wait at least one minute before spraying again. This allows the first puff to open your airways and the second puff to go down more deeply.

Your doctor and pharmacist may also provide a "spacer" or "holding chamber" that makes your inhaler easier to use and helps you get more benefit from your medicine.

Oxygen
If there is too little oxygen in your blood, your doctor may order oxygen equipment for you to use at home.

Oxygen is a medicine. You need to take the right amount at the right times. To do that, you need to understand how to use the equipment that delivers the oxygen to your lungs.

If you're using oxygen equipment at home, a nurse, respiratory therapist, or technician will show you: how to use the equipment. how to take care of it. how to tell when it's time to order more.

Your doctor will tell you: what kind of equipment to use. the flow rate you should set it for. when to use it and for how long.

Never set the flow rate higher or use oxygen more than your doctor says to. Too much oxygen can damage your lungs and even slow your breathing.

For Safety:
Your oxygen tank will not explode or burn. Oxygen does not burn, but it does help other things burn faster. To prevent fires: There should be no smoking in the room where oxygen is being used. Keep the tank at least 10 feet from an open flame, gas stoves, pilot lights in water heaters and furnaces, and wood-burning stoves. Keep the tank at least 10 feet from electrical equipment that may spark.

Humidifiers and Vaporizers
If your fluid intake is low, dry air can make the mucus in your lungs sticky and hard to cough up. When mucus stays in your lungs, it clogs your airways and supplies a place for infections to grow.

A humidifier or a vaporizer puts moisture in the air. When you breathe in, it helps soften and loosen the mucus. Then you can cough it up.

But a humidifier or a vaporizer can also become the place where germs grow. The equipment must be checked carefully, at least once a week, according to the directions that come with it.

The best way to thin mucus is to drink more fluid. A humidifier or vaporizer may not be necessary unless your doctor limits your fluid intake. Ask your doctor to be sure.

Other Equipment
Some other kinds of equipment are sometimes used at home. They should be used only with your doctor's approval.

Air filters or purifiers may be of limited use, especially if allergies complicate your lung disease. But some of those devices produce high levels of ozone, a gas you shouldn't breathe. Check with your doctor and medical equipment supplier before buying one.

Electric vibrators or percussors may be recommended if chest vibration is part of your home physical therapy routine and if your home helper is unable to do it without this aid.

Suction equipment is used to remove mucus after some kinds of surgery and in some cases when other treatments don't work well to remove mucus.

Before you buy:
Ask your doctor's advice before you spend your money on any device to treat your lung disease. Some products being advertised are not helpful and may be dangerous for you. And insurance companies will not pay for devices you buy without a prescription.

If your doctor prescribes a breathing aid, shop as you would for a new power tool or washing machine. Ask suppliers about prices and especially about service. Find out how they handle the need for repairs and replacement parts.

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Taking Control
"All the experts on getting old say that you're supposed to have a hobby when you retire. Like stamp collecting. Well, I have one they never write about. I collect medicines. Pills in every shape and color, gooey syrups, fancy sprays -- you name it, and I've got it lined up on my bathroom shelf.

Even before my doctor said I had chronic bronchitis, I was the best customer at the drugstore. Everything advertised to stop a cough or clear up congestion ended up in my shopping cart. Then, after I got really sick and landed in the hospital, I came home with a pile of prescriptions.

It's not that I like popping pills. Until a few years ago, I hardly ever touched one. But when you're sick, you expect to take some medicine and snap back. After a while, I felt like the guy in the commercials who buys all the wrong stuff.

Fred, a guy I see sometimes at the clinic, said he didn't have much luck with medicine until he started using it with a breathing machine. He uses it every day, he said, and couldn't get along without it.

I figured the machine must be the answer for me, too. Well, I asked the doctor, but I didn't get a big machine. Instead, he ordered a little sprayer with a big name -- a metered-dose inhaler, they call it. He said it probably would do just as much for me as the machine does for Fred. That was hard to believe, but I'll give anything a good try.

The inhaler was good -- too good, in a way. It helped me breathe better, but it felt so good that I wanted to use it more often than the doctor said to. If I did that, he said, it might stop working or upset my stomach. So I stick to my schedule, and between treatments I practice breathing exercises if I'm short of breath.

Now that I'm getting some real help, it's time to scrap most of my medicine collection. I've given up looking for a magic pill or a super machine to solve my breathing problems. Getting the best prescriptions and treatments for me and taking them every day along with my exercises is beginning to make me feel like part of the human race again. Now I'll have to find myself a new hobby."

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Put Yourself in Control

Do you sometimes feel you can't get your breath? Do you huff and puff when you climb stairs or work hard? Do you awaken at night feeling breathless?

When you're short of breath, you may feel nervous and try to breathe faster. More air may get trapped in your lungs, and then you feel worse.

Control your breathing
Don't gasp for air. Instead, follow these steps:

1. Relax. Let your neck and shoulders droop.
2. Breathe in slowly.
3. Purse your lips in a whistling position, and blow out slowly and evenly. Try to take at least twice as long to blow out as you did breathing in.
4. Relax. Repeat the pursed-lip breathing until you no longer feel breathless. If you get dizzy, rest for a few breaths.

When to do it
Practice pursed-lip breathing several times a day. Tie it to times that are easy for you to remember. Make it a habit. For example, it may be easiest for you during coffee breaks or television commercials or while you read the newspaper each day.

Use pursed-lip breathing whenever you do anything that makes you short of breath, such as climbing stairs, bathing, or doing housework. If you're short of breath, do pursed-lip breathing to help free your lungs of stale air. Then you can breathe in more fresh air.

During the night, if you have a breathless spell, sit with your feet on the floor, and do pursed-lip breathing until you feel better.

How does it work?
The problem in your lungs is trapped, stale air. Before you can breathe in fresh air, you need to get the old air out. That's hard because of clogged, narrow airways or damaged air sacs deep in your lungs or both. When you breathe out slowly through pursed lips, you keep up the air pressure in your airways. That helps them stay open so that you can breathe out more stale air.

When you need to cough, cough to clean your airways.

Control your cough
Coughing spells can make you feel tired, frightened, and short of breath. When it happens in public, you may feel embarrassed. You can control your cough and make it useful. A cough is useful when it brings up mucus and helps clear your airways. A useful cough should not tire you or take your breath, or embarrass you. When you feel a cough coming on, follow these steps:

1. Breathe in deeply.
2. Hold your breath for a few seconds.
3. Cough twice, first to loosen mucus, then to bring it up.
4. Breathe in by sniffing gently.
5. Get rid of mucus. Use strong tissues or paper towels. Swallowing mucus can upset your stomach.

The best position for coughing usefully is to sit with your head slightly forward, feet on the floor.

When to do it
Every time you feel like coughing, follow the above steps. Do not try to keep yourself from coughing. Check with your doctor before using any cough medicines. Your goal is not to stop coughing. It is to use your cough to help clear your airways whenever you need to.

How does it work?
When your airways get clogged with mucus, you have an urge to cough to get rid of it. To move the mucus, you need a strong jet of air behind it. A useless, hacking cough happens when you keep coughing because of a tickle in your throat, but you don't have enough air to move the mucus. Your cough seems out of control, and you feel helpless. When you learn to cough from deep in your lungs, you put air power into your cough. Read the next section on how to take a deep breath.

Take a deep breath
More than anything, you want to breathe fresh air deeply into your lungs. Your diaphragm is a muscle that can help you do that. Singers and athletes learn how to use the diaphragm to breathe better. You can learn, too. It can be one of the most important ways you can help yourself.

Follow these easy steps:

1. Relax. Let your neck and shoulders droop.
2. Rest both hands on your abdomen.
3. Breathe in through your nose and let your abdomen come out as far as it will. Keep your upper chest relaxed.
4. Breathe out slowly through pursed lips. If you feel dizzy, wait for a few breaths before trying it again.

Important: To be sure your diaphragm is moving properly, ask your doctor, nurse, or respiratory therapist to go through the exercise with you.

When to do it
Practice deep breathing with your abdominal muscles and diaphragm every day as often as you can think of it. Do it whenever you're short of breath. Practice it first while you are lying down or sitting, then while you're walking. The more you do it, the easier it will become.

Do it during normal activities -- when you're eating, talking, bathing, dressing, or working. Your goal is to make it a habit to move your diaphragm more than most people do with every breath, and to do it without tiring. The muscles you use in doing that should go stronger while your breathing becomes deeper and easier.

How does it work?
Your goal is to get trapped, stale air out of your lungs so that more fresh air can get in. Your diaphragm is a large muscle under your lungs. It moves down as you breathe in. As you breathe out, it pushes up on your lungs. That helps push the stale air out. You can use the muscles in your abdomen to move the diaphragm. You may be getting too little help from those muscles and relying too much on your upper chest muscles to do your breathing. But your chest muscles don't work as well as the diaphragm does.

Learning to move your diaphragm more as you breathe will give you more push power to empty your lungs. Then you'll be able to breathe in more deeply than you did in the past.

While you're learning deep breathing, put your hands on your abdomen. Breathing in should expand your abdomen, pushing your hands out.

When exercising the lower chest muscles, use your hands to feel your lower rib cage moving as you breathe deeply.

Exercise your chest muscles
Deep breathing is easier when you use all your breathing muscles. The muscles around your lower rib cage are probably tight. The following exercise helps you get them moving. It will help your lower lungs expand better and make it easier for you to breathe deeply.

To exercise those muscles, follow these steps:

1. Place your hands on the sides of your lower chest.
2. Breathe in slowly through your nose. Your lower chest should move your hands out. Keep your shoulders and upper chest relaxed.
3. Breathe out slowly through pursed lips. Your hands should move in. Practice that exercise several times a day for a few minutes at a time. Rest if you feel dizzy.

Note: Exercise is helpful in some types of lung disease and not in others. Be sure to check with your doctor, nurse, or respiratory therapist before making it part of your daily program.

Clean your lungs
Is mucus in your chest making it hard for you to breathe? Clearing the mucus from your airways every day will help you breathe more easily. And it will help you prevent infections and stay out of the hospital.

Important: No two cases of lung disease are exactly the same. Some people have very little mucus unless they have an infection. Others may have more mucus.

You can help clear mucus in your lungs with a controlled cough. Some people may need even more help to clear their lungs. Ask your doctor if it will help to drain mucus from your lungs. If the answer is yes, you will get special directions from your nurse, respiratory therapist or physical therapist on the best positions to use to drain your lungs.

Relax to breathe more easily
When it's hard to breathe and you can't do what you want to do, you may feel fearful or angry. Those feelings are natural, but they increase your shortness of breath. Even when you don't feel upset, your muscles may be tight, making it harder for you to breathe.

To make your breathing easier, try this way to relax:

1. Sit upright in a chair. Let your arms hang loosely at your sides. Breathe deeply, slowly, and evenly.
2. Clench your fists. Shrug your shoulders. Tighten your arms. Count to two. (Don't hold your breath.)
3. Let your shoulders fall down. Open your hands, and let your arms hang loosely. Count to four. Keep breathing deeply.
4. Tighten your legs and feet. Count to two.
5. Completely relax. Let all your muscles go loose from your tongue to your toes. Count to four.

When to do it
Practice relaxing for five minutes twice a day and any time you feel yourself getting tense or breathing hard.

How does it work?
To breathe and to move, you use muscles. Stiff, tense muscles are harder to move than are relaxed muscles. Tense muscles waste energy. You need more oxygen to spend more energy on tense muscles than on relaxed muscles. You try to breathe faster to get more oxygen. Then you feel breathless.

When you do the above relaxing exercise, you help yourself move and breathe more easily. And you save energy for the things you want to do.

Manage your energy
Consider these facts: It's good for you to be active. You can stay active if you learn to pace yourself. When you learn to control your breathing while you work, you'll be able to do more and to feel more comfortable. A little brain work can cut down a lot of muscle work. Most of us waste an amazing amount of energy every day. Finding easier ways to do things is not lazy; it's smart.

You'll be able to do more yourself if you follow these steps:

1. Breathe deeply with your diaphragm. Do the hardest part of the job while you're breathing out. For example: Lifting: Breathe in slowly. Lift and place the object while you breathe out slowly. Pushing or pulling: Breathe in slowly. Push or pull the object while you breathe out slowly. Repeat until the job is done. Walking uphill or upstairs: Stop and breathe in slowly. Walk a few steps while you breathe out slowly. Keep your breathing even, with the same number of steps during each breath.
2. Pace yourself. Move slowly and easily. Stop and rest often. Think about relaxing your muscles, and take a few breaths before you start again.
3. Space your activities. Break down your big jobs into smaller steps. Put restful activities between steps. For example: If bathing and dressing make you short of breath, bathe before breakfast, and dress afterward. Never plan a heavy day. Spread large chores throughout the week.
4. Make every task easier. You're your own manager. Think of energy as money. You have only so much; you should spend it carefully to make it cover all your needs. Think of easier ways to do the things you want and need to do. To get started, try these ideas: Don't stand when you can sit, and don't hold your arms up when you can rest them. If shaving tires you, put a mirror on a table. Sit and rest your elbows. Relax and breathe through pursed lips while you shave. Sit on a high stool to iron clothes or prepare food. Where can you save energy by sitting? Plan your steps. Keep a basket or sack at the bottom of the stairs to collect the items that must go upstairs. Make one trip instead of three or four. Move things closer to where you use them. (Do you run for tools, medicines, canned goods?) Try to notice which jobs make you short of breath. While you're resting, think of ways to make your task easier. Are there services in your community to help with meals, transportation, or housework? Ask your doctor, your nurse, or call your local American Lung Association®. Cut out some of the work you can do. You can clean some rooms or wash the car half as often as you do now. Let the dishes air dry. What do you do that can be cut out or done less often? Make bathing easier with a bath seat; use a terrycloth robe instead of towels; shampoo in the shower. Ask your doctor, nurse, or physical therapist about occupational therapy and other booklets that can help you plan your work to save you energy.
5. Delegate. Like any good manager, you can get some jobs done by giving them to other people to do. Can a family member take one of those trips up the stairs for you? Can you have trash picked up, instead of hauling it yourself? Can a young person in your neighborhood take on some of the hard jobs for a reasonable fee?

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Exercise and Keep Active

One of the best things you can do for yourself is get some exercise or activity every day. You don't have to put on a leotard or go to the gym to exercise, but it's important to stay active.

Inactivity is a vicious cycle. Some people with lung disease try to exercise and get short of breath so they stop/ Sometimes you may feel too tired to do many of the things you like to do. If you've been in the hospital or you've been sick at home, your body may be weak and out of shape. Pretty soon, it seems impossible to exercise because of muscle weakness, fatigue, and shortness of breath.

You can build yourself up with exercise and get back in shape. Exercise is important to: Build and maintain strength. Maintain the flexibility of your bones and joints. Build stamina and be able to increase the amount of activity you can do.

If you have trouble starting and keeping to an exercise plan, remember to pick an exercise or activity that you enjoy. And remember to talk to your doctor, respiratory therapist or physical therapist about the right exercise program for you. You may already be doing exercise and activities that are great for you like walking, dancing, or gardening. Anything that keeps you active counts!

Don't worry if you can only exercise for a short amount of time at first. At the beginning of a program, you may only exercise for a few minutes. Your goal is to increase the amount of time you can exercise. Keep an exercise diary and track your improvement and your "work outs".

When you exercise, follow these steps:
Clear your lungs of mucus by coughing.

Practice relaxing and deep breathing for a few minutes. Continue deep breathing as you exercise. Try to keep breathing out twice as long as you breathe in. Counting as you breathe can help. Breathe in: 1-2. Breathe out: 1-2-3-4. Remember not to hold your breath.

Start with a warm-up period, including stretching and reaching exercises.

If you feel tired or short of breath at any time while you're exercising, stop and relax a few minutes, then continue. Remember, being short of breath isn't bad, it means your lungs are working hard. Even conditioned athletes get short of breath during exercise.

End your exercise with a cool-down period, a time of less intense or easier activity.

How much is too much?
One way to tell if you're getting enough exercise and not too much is to take your pulse. Your pulse rate when you've been exercising should be about 20 beats higher than it is when you've been resting. If it rises more than 20 beats, you may be pushing yourself too hard. If it's much less than 20 beats higher, you can do more exercise -- work harder. Ask your doctor how much exercise is right for you.

What kind of exercise should you do?
Walking is one favorite way people with lung disease exercise. It's a good exercise to start with because it's easy. You can walk inside or outside, and you don't need any special equipment. Walking is an enjoyable way to build up and strengthen your body. Here are some steps for a simple walking program.

1. Start with a short daily walk as far as you can go without getting short of breath. Outdoors is best if the weather is good, but you can walk in the house or inside a shopping mall or store.
2. Walk with your arms hanging loosely, your chest and shoulders relaxed.
3. Breathe slowly, using you diaphragm while you walk. Try to breathe out for twice as long as you breathe in.
4. Find an easy, even speed. Take the same number of steps for each breath. For example, two steps while you're breathing in and four steps while you're breathing out will give you six steps to each breath. Find the number of steps that works best for you. The number may change from day to day.
5. Try to walk a little farther each day, even if it's only a few feet. But don't push yourself too hard. If you become short of breath, stop and rest and practice pursed-lip breathing. Some people carry a portable camp stool in case they want to sit down along the way.

How does it work?
Walking and other exercise use many muscles, including your heart and breathing muscles. As you work them, they slowly become able to do more work with less oxygen. That means you don't have to breathe in as much air to do the same amount of work. You're stronger and can do more before you feel tired.

Walking is a good exercise to begin with, but think about other exercise or activities you enjoy. Once you are feeling stronger, you may be able to go back to dancing, golfing, swimming and other fun activities. Exercising with a friend or family member can make the activity even more enjoyable.

When to exercise
Make two daily appointments with yourself to exercise. The secret of success is doing it every day. The best times are in the morning and in the late afternoon or evening after you've cleared your lungs of mucus.

Talk to your doctor, respiratory therapist, or physical therapist about a specific exercise program. With your doctor's order, a physical therapist will set up an exercise program for you with stretching and strengthening exercises. Ask for pictures of the exercises so you can take them home with you and follow them. Check to see if your local hospital offers a pulmonary rehabilitation program -- a program that includes exercise for people with lung disease.

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Taking Control
"The first time I heard about doing exercises at home, I knew I wasn't interested. A lot of things were happening to me. I was in the hospital and feeling awful. I was told that my lungs were bad and that they would never be completely well again. I was tired of treatments and medicines and all the things that go with being sick. I wanted to go home and get away from it, not take it with me.

But at home I had trouble sleeping and more trouble getting through the day. I began to think that, if a workout in the morning and one at night could help me work and sleep better, it might be worth it.

The physical therapist helped me plan my breathing exercises and a strength-building routine according to my doctor's directions. It took me 45 minutes, morning and night, to go through it all, besides my daily walk with my dog. I felt a little better at first but not much. I'd made up my mind to stick with it for 10 weeks to give myself a chance, and I made myself do it.

After a few weeks it was getting easier, more of a habit. And before the 10 weeks were up, I knew I was doing better. Even my wife, Betty, noticed it. I could take longer walks and do more work without running out of wind. I often find myself breathing the right way without even trying. And Betty says I'm not so horrible to have around the house these days.

Whenever I feel like quitting, I just remember what I was feeling like when I started. The routine is hard work, but it's worth it."

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Avoid the Troublemakers

Do you know what affects your lungs and makes your breathing worse? If you do, you can get rid of some of the causes and gain controls over others.

What is air pollution?
Dirt and fumes are constantly added to the air you breathe. Much of that pollution comes from industrial smokestacks and automobiles. Some household products like cleaners, paints, glues, and aerosol sprays also pollute your air. Cigarette smoke is a dangerous indoor pollutant.

How does air pollution hurt me?
When dirt lands on your skin, you can wash it off. But when you breathe it into your lungs, they can't get rid of it all. Some dirt stays in your lungs, where it builds up and can cause infections and lung damage.

In polluted air, some gases, such as carbon monoxide, are poisonous and can rob your blood of oxygen. That's one reason you feel worse on days when air pollution is heavy.

What can I do about air pollution?
Avoid places with very dirty air, such as traffic jams, parking garages, dusty work areas, and smoke-filled rooms.

Avoid breathing in smoke from cigarettes, pipes, and cigars. Ask smokers to respect your need for clean air.

Avoid using strong chemicals and aerosol sprays.

During smoggy spells, check your radio or television news for air pollution alerts.

What should I do on days when air pollution is heavy?
Stay indoors with the windows closed whenever possible. Circulate air with an air conditioner. Ask your doctor if an air filter or purifier would help you.

Relax. Avoid heavy work and dust-raising activities.

Call your doctor if your condition becomes worse or if you feel you need to change the amount of medicine you're taking.

Weather
Does weather affect my lung disease?
It can. Cold air puts an extra strain on your lungs. To warm the air, breathe in through your nose. Cover your nose and mouth with a cold-weather mask available at drugstores, with a warm scarf, or, at least, with your hand.

In cold weather, avoid the extra strain that cold air puts on your lungs.

Damp weather makes some people feel worse. And weather that causes air pollution to build up is bad.

Should I move to a warmer climate?
Moving won't cure your lung disease. You may feel a little better, especially if you're enjoying the move and your outlook brightens. But before making the long-distance move for your health, make a long visit to see if it will be worth the trouble and expense.

However, if you live in an area more than 3,500 feet above sea level, moving to a lower altitude may lead to easier breathing.

Infections
Infections in your lungs are dangerous troublemakers. They can make you seriously ill quickly. Infections are a major reason that people with a lung disease enter hospitals.

How can I avoid infections?
Keep up-to-date on your influenza (flu) and pneumonia vaccinations.

Keep your body healthy with daily exercise, a variety of foods, and enough sleep so that you can fight off the germs that cause infections.

Keep your lungs as clear of mucus as you can. Drink enough fluids, and follow your physical therapy program carefully. Infections grow easily in mucus.

Avoid crowds and people with colds. Handle colds carefully and watch for danger signs.

What are the danger signs?
Suspect an infection, and call your doctor if:
You have fever or chills. You're more short of breath, or you're wheezing more than usual. You have more mucus, or it's thicker than usual, or its color changes. You notice swelling in your ankles or around your eyes. You gain a few pounds overnight. You lose your appetite, feel dizzy or sleepy, or have headaches.

What should I do if I have an infection?
Take the medicine your doctor orders exactly as directed. Don't stop before your doctor says to, even if you feel better.

Carefully follow your doctor's directions for clearing your lungs of mucus.

Report right away to your doctor if your condition gets worse.

Avoid big infections. Give your doctor time to treat them before they spread.

Cigarettes
Before cigarette smoking became common, chronic bronchitis and emphysema were rare diseases. Now they're among the leading causes of disability in the United States, mostly because of cigarette smoking. If you smoke, consider these facts:

When you smoke
Smoke dries the linings of your airways and makes them sore.

You breathe in nicotine, tars, and poisonous gases such as carbon monoxide. Nicotine cuts down your flow of oxygen by narrowing your blood vessels. The gases paralyze your cilia, the tiny hairlike sweepers in your airways that help clean out dirt and mucus.

When your cilia can't work, smoke leaves behind more dirt, and it causes your lungs to make more mucus than usual. Then your airways get clogged.

Old mucus in your soft, warm lungs makes the perfect place for infections to grow.

In cigarette smoke, carbon monoxide, a poisonous gas, robs your blood of oxygen. You feel tired and short of breath.

Irritation from smoke deep in your lungs can cause your air sacs to stretch and break. That damage can't be repaired. As more air sacs break, your lungs can put less than the needed amount of oxygen into your blood, and your condition keeps getting worse.

When you stop smoking
The minute you stop smoking, your body goes to work to repair the damage to your airways.

After a period of coughing up excess mucus, your cough will lessen or disappear. That may happen in a couple of days, or it may take up to a few weeks.

With your airways more open, you will breathe easier.

Your lungs will put more oxygen into your blood, and you'll feel less tired than when you smoked.

Your lungs will be better able to defend themselves against infection.

Your blood circulation and your senses of taste and smell will improve.

You'll probably be able to do more work or exercise without shortness of breath.

You can look forward to a longer, healthier life.

You can be proud of yourself for winning a tough struggle.

Your example will help others make the decision not to smoke.

Does all that mean I have to give up smoking?
Yes. But no one else can make that decision for you. After looking at the facts, you must decide for yourself whether or not to smoke. There's no question that it's best for your health to stop smoking, but the choice is yours. Are you willing to give up cigarettes for healthier lungs?

Whether you quit "cold turkey" or taper off is up to you. Quitting for good is what is important. Even one or two cigarettes a day can cause more trouble for your lungs. Most importantly, don't give up if you don't succeed at first. Many people find it takes more than one try. But you can do it. Your local American Lung Association® has Freedom From Smoking materials, videos, and group programs to help you.

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Taking Control
"'I've smoked for years, and now it's one of the few pleasures I have left.' That's what I told the doctor and everybody else who started telling me I should quit smoking. With all the things I couldn't do anymore, I felt I had a right to relax with a cigarette when I wanted to. Besides, I'd been more nervous since I'd been sick, and smoking seemed to help calm my nerves.

I didn't want to believe it when the respiratory therapist told me, 'Gladys, all your medicines and all your treatments together can't do you as much good as you can do yourself by throwing out those cigarettes.' I hoped she was wrong. But the more I learned about my lung disease, the more often I ran into one hard fact: Cigarette smoke was hurting my lungs. I tried to ignore that fact, but it kept coming up again.

I knew I had to make a choice between cigarettes and better health. I was putting the decision off, but I've never been good at fooling myself. I knew that avoiding a decision was the same as deciding to keep smoking. Then I made up my mind. I called the American Lung Association® for advice. After smoking my last cigarette for the night, I soaked the rest of them under the faucet so that they wouldn't tempt me in the morning, and I threw them out. The next few days were hard but not as bad as I'd thought they'd be. I went through a pile of mints and wrote a stack of overdue letters to keep my hands busy. After meals, I took a short walk instead of lighting up.

Sometimes I would start feeling a little sorry for myself. But then I'd think: It was my decision to stop smoking. It was the best decision for me. I'm sticking with it.

I live alone, so I didn't have the problem of other smokers in the house. But I didn't have anyone here to encourage me either. So, using my letters and some phone calls, I told some of my friends I'd quit. That seemed to make my decision even more final.

I don't cough and wheeze as much as I used to, and I got through the winter with no trouble from infections. And I have more energy than when I smoked.

It's a good feeling to know I'm doing what's right for me. I'll never be sorry I quit."

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Eat to Feel Better

Eating to Feel Better
Good food, like good medicine, works to heal and repair your body and make it stronger against disease. That's true for everyone, but it's especially important for you because your eating habits may be affecting the way you breathe.

Some food puts your body in better condition and makes breathing easier. Others can make your condition worse.

Your daily meals also make a large demand on your time, your energy, and your income. By planning healthier and easier mealtimes, you can help yourself not only to better breathing but to a more enjoyable quantity of life.

What mealtime changes could help you? Read this with a pencil in hand to underline the ideas you might use. Then ask your doctor for recommendations. For instance, you may need more fat and fewer carbohydrates than someone without lung disease.

Which foods do you choose?
Are you missing some of the foods your body needs to strengthen or repair itself? Most of us choose our foods from habit, without much thought for what they do for us. Be sure your daily meals include a variety of foods.

Most Americans could eat better by adding more grains, fruits, and vegetables. Cutting out some of the junk foods like soft drinks, packaged cakes and cookies, alcoholic drinks, and salty snacks also helps.

It will be easier to make changes in your meals if family members join you. A healthier diet will be good for them, too. What could you change for a better balance?

Are you short of breath at mealtimes?
You can lose interest in the best of foods if shortness of breath makes eating hard work for you. Try these tips:

Eat six small meals a day instead of three big meals. That will cut down on the extra oxygen you need to chew and digest each meal. It need not mean extra work to prepare the extra meals. Just set aside foods that can be eaten between your cooked meals, foods like salads, fruit, breads, milk, and desserts.

Eat slowly, and chew foods well.

Try to keep breathing evenly while you chew. Stop if you need to. Relax and take a few deep breaths.

If you're very short of breath in the morning, plan a liquid instant breakfast rather than skip the meal.

If you're overweight, your extra body fat may be interfering with your breathing and demanding more oxygen. Ask your doctor or dietitian for a safe weight-reducing meal plan.

Avoid gas-forming foods if they bloat your abdomen. The following foods may bloat your abdomen, making it harder than usual for you to breathe:

Peas	Melon
Broccoli	Onions
Cabbage	Raw apples
Corn	Cauliflower
Turnips	Cucumbers
Beans (except green beans)	Brussels sprouts

Do you feel weak?
If your illness has made you less active than in the past, your muscles may be getting smaller and weaker. To rebuild muscles, you need extra protein from milk products and meats and vitamins and minerals from fruits, vegetables, and grains.

Weakness may also result from diuretics (water pills) that cause your body to lose potassium. Your doctor may suggest that you add more high-potassium foods to your diet.

Foods high in potassium include:

Milk	Dried fruits
Potatoes	Oranges
Bananas	Fresh pineapple
Beef	Orange juice

Is your stomach upset?
If stomach upset often keeps you from eating or keeping your food down, your doctor needs to know. It could be a reaction to a medicine or another condition that needs treatment.

It may help you to take bronchodilators and other lung-clearing treatments at least an hour before meals. Then the effects from the medicine will be at their peak by the time you eat.

Do you have a poor appetite?
If you don't feel like eating, ask yourself why.

Is your medicine turning off your appetite? If you think it is, check with your doctor. Ask if the medicine may be taken with milk or meals. A different form of medicine or a change in the time you take it may be helpful.

Do you have a tea-and-toast habit? Poor nutrition can cause a poor appetite. Good meals will stir your appetite back to life. If poor appetite is causing you to lose too much weight, your doctor may suggest a food supplement.

Are your feelings about your illness taking away your appetite?

Perhaps you think of meals as a social time, a time to enjoy. If you're depressed about being ill, you may feel like pulling back from those old pleasures. Without good food, you become even weaker, shorter of breath, and more depressed than ever.

It may help you to think of eating as one way you can take control over your health and strength. Sharing your feelings with a close friend or a family member may help you cope with them.

Has your doctor told you to cut down on salt?
Sometimes eating salt can cause your body to hold too much water. Some people get used to eating food without added salt and come to like them that way. If you find saltless foods too boring:

Ask your doctor to suggest a safe salt substitute.

Add flavor to food with herbs and spices. Use: Thyme, rosemary, basil, or sage in meats, fish, soups, and sauces. Vinegar or lemon juice in fish, vegetables, and salads. Caraway seeds or sage in breads, noodles, and pork. Cinnamon or nutmeg in breads, fruits, and pastries.

Is cooking good meals too much work for you?
If you're the family cook or if you live alone, you may be thinking that the advice to eat better meals means too much extra work. Perhaps you're depending on fast foods or convenience foods to make mealtimes easy. But many of those foods are high in salt, fats, and sugar and low in the vitamins and minerals you need.

Good-for-you fast foods

Cereals	Fresh fruit
Milk	Cheese
Eggs	Tuna (salt-free)
Applesauce, canned	Dried fruit
Yogurt	Ice cream
Fruit juice

Vegetables that need no peeling include baked potatoes, tomatoes, summer squash, asparagus, spinach, broccoli, and leafy greens.

Meats and fish are easy to prepare when they're baked or broiled.

If you prepare food ahead of time, you'll feel rested and able to enjoy your food at meals.

In some areas, meal plans are available, such as Meals on Wheels. Ask your visiting nurse or hospital social worker. Or call your local American Lung Association®.

Do you drink enough liquids?
Drinking plenty of liquids helps keep your mucus thin and easy to cough up. That makes breathing easy and aids in preventing infections. Because of some other medical conditions, some persons should not drink extra liquids. Check with your doctor.

Do you use alcoholic beverages?
Alcoholic drinks have no food value, but they are high in calories. Too much alcohol can slow your breathing. Alcohol should never be used with sedatives or tranquilizers.

Do you need extra vitamins?
If you eat all the foods you need, extra vitamins aren't needed or helpful. If you do take vitamins, a multivitamin tablet taken once a day is enough. Vitamins labeled "extra strength," "therapeutic," "geriatric," or "natural" cost more but give you no extra help. If you need any special vitamins, your doctor will prescribe them.

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Keep Living Your Life

Being ill affects every part of your life. Your daily activities, your ability to work, your relationships with other people, and even your deepest beliefs and feelings about yourself are touched.

How can you handle all those changes? Will they control your life, or will you be able to take control of them? Are there ways you can find satisfaction and pleasure in your life, despite the changes? How much, really, needs to change?

What problems do you need to deal with so you can get on with living your life?

Are you able to work?
Some people with lung disease retire early from their jobs and go on disability pensions. Whether or not you need to leave your job depends on how much physical activity your work requires and how much your lungs will let you do. If only one part of your job presents a problem, like climbing ladders, a slight change in duties may solve it. If not, perhaps your employer can transfer you to a less active position.

If a complete change of work is needed, your state employment service or vocational rehabilitation divisions may have programs to help you.

Even retired people need meaningful, interesting work. Hobbies are simply jobs people do for fun. Many hobbies -- like sewing, painting, and crafts -- result in products that can make valued gifts or bring in extra income. For example, a retired man makes bird feeders and has a waiting list of orders. Another starts garden plants indoors for sale. A woman on a disability pension tutors schoolchildren in reading.

Is work a problem for you? What are your choices? If you need financial advice or help, get in touch with the nearest office of the Social Security Administration, Department of Social Services, or Office on Aging.

Are you having family problems?
Long-term illness puts a strain on the family. It causes worry, and it often means changes in roles. A wife may have to go out to work and meet expenses. Or a husband may have to take over some of the housework. The ill spouse is apt to feel guilty and frustrated. Sometimes a person shows guilt or frustration by becoming hard to get along with. Tempers flare, tears flow, and it's hard to understand all the feelings that are showing themselves.

The first step is to share your feelings honestly with each other. For example, one might say, "I feel angry when I see you doing work that should be mine. But I'm not angry at you. I'm angry at my disease and at myself."

The spouse might reply, "I couldn't understand why you've been so grouchy. I felt you didn't appreciate me." Then they begin to understand each other.

Have you had a heart-to-heart talk lately with those you're closest to? How do they feel about your illness? Can you understand their viewpoints?

Often, family problems started long before the illness began, and the strain of illness is just bringing them out. If your family tensions are too deep and too complex for you to work out, ask your doctor or your American Lung Association® to refer you to a family counselor.

Does being ill make you feel guilty?
Whenever a sad event happens -- an accident, a death, an illness -- people tend to think, "What could I have done differently?" If you have a lung disease and you've been a smoker, you're apt to feel guilty or regretful about your smoking. Those thoughts will pull you down unless you set them aside. Think about the present and the future. What can you be doing now to make today and next year brighter? If your past smoking troubles you, it's not too late to stop.

Are you having sexual problems?
Having to cut down on your physical activity may be causing you and your spouse some concern about your sexual relationship. It isn't necessary for you to give up that part of your life, but it may be another area where you'll need to make changes. Here are some hints that may help:

Talking, holding, touching, and kissing are ways to express sexual feelings. Those activities don't usually make you short of breath, and extra time spent that way can be satisfying.

Plan to have sexual intercourse at your best time of the day or evening, usually an hour after taking your lung-clearing treatments. Wait a few hours after having a large meal or alcohol.

Breathe deeply with your diaphragm. If you get short of breath, try pursed-lip breathing to help you prevent breathlessness during intercourse.

Choose a position that requires the least effort, such as side by side.

Create relaxed surroundings, and allow plenty of time.

Are you worried about dying?
Everyone with chronic disease thinks about his own death. Those thoughts can be very troubling. Perhaps you've asked your doctor about those thoughts but didn't get much information. But remember: It's not possible for a doctor or anyone else to tell you exactly what will happen in your future.

A person with chronic lung disease who stops smoking and gets proper medical care will slow down the progress of the disease and may recover enough to live a normal life span. Many people with chronic lung disease live a long time and eventually die of other causes.

Lung damage from emphysema can't be reversed, but future damage can often be lessened. And many patients with chronic bronchitis improve greatly.

One reason it's so hard to know what the future holds is that, in some ways, it depends on how you choose to live your life.

If you'd like help to cope with your feelings, talk with your minister, priest, rabbi or social worker, or ask your doctor to refer you to a counselor.

Are your friends disappearing?
People who have been ill for a long time often say that their friends have stopped coming around. Loneliness hurts. Enjoying social activities and the company of other people is a vital part of normal life.

But friendships are like houseplants. They must be cared for, or they die. When you don't have enough energy to do all the things you need to, it's easy to let social activities go by. Perhaps you find it embarrassing to go out or invite friends in because you become breathless or have coughing spells.

If your life is getting lonely:
Learn the ways to control your breathing and coughing so that you'll have the confidence to go out.

Don't put your social life last. Spend some of your energy to see your friends. Plan activities with them that are relaxing, such as card games, shows, and just visiting.

You don't want to wear out your friendships with talk about your health, but tell your friends enough so that they'll understand your need to cough sometimes or to stop and catch your breath. You'll feel more at ease if they understand.

Keep active in organizations you belonged to before you became ill. Attend at least some of your church, synagogue, or club meetings, and stay involved.

Ask your American Lung Association® if there is a in your area where you can meet new friends who share some of your problems.

Are you able to travel?
As long as you are able to be up and around at home, there's no reason why you can't take a trip. You can't get away from your lung disease, but, since you're the manager of your medical care, you can take it with you. Here are some hints to make your trip easy and enjoyable.

Before you leave
Tell your doctor about your trip, and get extra medicines to carry with you. If you'll be taking a breathing machine or oxygen container on an airplane as luggage, get a note from your doctor, and notify the airline well in advance of your trip.

If you'll need oxygen, arrange in advance with a supplier. If you're flying, most airlines won't allow you to use your own oxygen equipment, but they'll supply oxygen for a fee if you make arrangements in advance. (However, you may take portable equipment with you checked as baggage.)

You can buy adapters in radio-electronics stores that will let you use electric machines in foreign countries or let you plug them into an automobile cigarette lighter.

Your doctor may be able to give you the name of a doctor to see in case you need medical help while you're traveling.

Your travel agent or the chamber of commerce where you'll be visiting may be able to give you information about medical facilities in the area. You might ask also about drinking-water safety, flu epidemics, and pollens if you're allergic to them.

Don't pack all your medicines in one place. Carry some on your person in case your luggage is lost.

Write your daily schedule for taking medicines, treatments, and so on. Take the schedule along, and check yourself each day. It's easy to forget old routines in new surroundings.

Plan an easy schedule. Be sure your traveling companion is prepared to go at your pace.

While you're away:
Enjoy your meals, but avoid overeating and overdrinking.

In cities of high air-pollution areas, travel at night or early in the morning if possible.

Don't push yourself too hard. It's better to visit the same place twice than to try to see too much in one day.

Avoid any allergy triggers, like pollen or feather pillows.

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Taking Control
"I was nervous the day Harold came home from the hospital. I knew we'd both have a lot to get used to. For the first time, we couldn't look forward to his going back to work. After struggling for two years to keep his supervisor's job at the bus depot, he finally gave up and took early retirement. The fumes and bad weather were just too much for him.

To make up for his smaller than expected pension, I took a part-time job at the school cafeteria. I don't mind the work. In fact, I like getting out for a while each day and meeting new people. I thought it was the perfect answer to our money shortage, too.

But Harold seemed to hate my job. I couldn't understand it. He took so long with his breakfast that I couldn't pick up his dishes before I left. When I came home in the afternoon, he'd say, 'What took you so long?' He wasn't at all interested in hearing about my day. Not only that, his breakfast dishes were still all over the kitchen, and everything from the lunch I prepared ahead of time for him was on the coffee table. Harold sat like a lump of lead in front of the TV.

I was angry and hurt, but I tried not to show it. The doctor said that Harold should avoid tension and excitement. I was worried sick about him, but I had to hide that, too.

One afternoon, Harold told me he'd heard an announcement on TV about a breathing workshop. He wanted to try it.

We almost didn't make it to the first meeting. After dinner, Harold showered, shaved, and dressed. He tried to put on his shoes, but he was so short of breath that he had to stop. 'Forget it; it's not worth it,' he whispered, after he caught his breath.

That had happened so many times that I wanted to cry. 'We have time to rest a few minutes before leaving. Let's not give up,' I urged him.

We got to the workshop after all, a little late. We took seats in the back. Looking at all the people in the seats in front of us, I realized for the first time that we weren't alone with this problem.

I noticed Harold watching the nurse intently as she talked about ways to control breathing. I realized than how frightening it is for him to feel unable to breathe.

Later, Harold and I sat and talked about the feelings we both have about his disease. I learned that Harold was feeling like a poor husband, unable to work and too worried about his breathing to make love. Even my cheerfulness about my job made him feel unneeded and grumpy.

Harold seemed surprised when I told him how much I needed his support and need to have him interested in my day and how very much I still need his love. We've started having people over to visit, and he really enjoys their company.

We even started talking about the little things. I don't try to rush Harold through his breakfast now, and he picks up his dishes. In fact, Harold has found a number of things he can do in the house while I'm gone. That gives me time to take his walk with him after I get home from work.

Since we've started sharing our feelings with each other, we both feel more relaxed and hopeful about our future. I'm seeing a new side of Harold, and I admire his courage.

We've still got a lot to learn. Harold decided to sign up for the pulmonary rehabilitation program at the hospital. I'm going, too, so we can help each other."

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Are You Ready to Begin?

It's natural for you to worry about your lungs and what the future may bring. One way to cope with those fears is to have a plan -- to know how you're dealing with the problems that worry you. Check yourself. Are you following all the steps to get control of your lung disease? If not, are you ready to begin?

Are you under the care of a doctor who knows about lung disease?

Do you understand what's happening in your lungs?

If you use breathing aids, do you follow all the directions for use and cleaning?

Do you practice deep breathing and follow a daily exercise routine?

Have you stopped smoking?

Do you watch for signs of infection and report them to your doctor?

Do you know what each of your medicines is for, and do you take them carefully, according to your doctor's directions?

Are you eating a variety of foods to keep your body strong?

Do you keep active and involved in life?

You can take control!

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