Living with Bronchiectasis
A practical guide to understanding Bronchiectasis,
treatment and lifestyle choices
About this guide
This guide includes
information which will help
you to understand your
chronic respiratory condition.
It will also help you to learn
how to control your
symptoms so that you can
manage your condition
better and have an improved
quality of life.
The information in this guide
has been written by
specialists in respiratory
care.
Your healthcare professional
may help you to work
through this guide so that the
information in it is personal
to you. The details that are
filled in will not only be useful
to you, but to healthcare
professionals involved in
your care.
You should speak with your
healthcare professional
before you do anything
different from the advice they
have given you.
It is not meant to replace
face to face contact with
your healthcare professional
or any of the advice they
give you.
You may also choose to
share this with your family
and friends so that they can
help you and learn to
understand about your
condition too.
Helpful tip
If you have any questions
while you are using this
guide speak to your
healthcare professional as
they will be able to help you.
My information
In this section there is:
•
Your details
•
Your medical record
•
Useful contacts
•
Appointments planner
My details
Medical details
NHS number (if known):
_________________________________________________
GP name:
_________________________________________________
GP number:
_________________________________________________
Hospital consultant name:
_________________________________________________
Nurse/physiotherapist name:
_________________________________________________
Respiratory team number:
_________________________________________________
Out of hours number:
_________________________________________________
My medical record
The health problems I
have are:
The date I was
diagnosed was:
The treatment I am
having is:
You can use this page to record your medical information
such as other health problems and any allergies you may
have.
My useful contacts
You can use this to record telephone numbers that will be
useful to you.
Name
Telephone number
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The British Lung Foundation
Helpline: 03000 030 555, Monday to Friday, 9am - 5pm
www.blf.org.uk
Email: [email protected]
My appointments planner
You can use this planner to record when your medical
appointments are.
Appointment
Date
Time
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About Bronchiectasis
In this section there is information on:
•
What is bronchiectasis?
•
The causes and symptoms of bronchiectasis
•
Diagnosis
•
Treatment
•
Infection management
•
Sputum samples
•
Infection record
•
Self management
•
Chest clearance exercises
•
Going into hospital
What is bronchiectasis?
Bronchiectasis is an
irreversible lung condition
usually caused by repeated
inflammation or infection of
the airways.
Air passes into the lungs via
the windpipe which divides
into a series of branching
airways (bronchial tubes).
The airways contain tiny
glands which produce small
amounts of mucus. This
helps to protect your lungs
by trapping any dust and
germs that you breathe in.
Tiny hairs called cilia line the
airways and help to clear the
mucus by sweeping it to the
back of the throat.
Small amounts of mucus are
normally swallowed without
noticing, but if there is a lot
of mucus it can cause you to
cough.
In bronchiectasis the
bronchial tubes become
enlarged and distorted and
the bronchial walls are
damaged, resulting in the
lungs’ complex cleaning
system being less effective.
This leads to a build-up of
mucus in the lungs, resulting
in an increased risk of chest
infections and potential for
progression of
bronchiectasis.
The causes and symptoms of bronchiectasis
What are the causes of
bronchiectasis?
There are several known
causes, including:
• Severe lung infections
such as tuberculosis
(TB), whooping cough,
pneumonia or measles,
which can damage the
airways at the time of
infection
• Conditions of the
immune system which
lower your ability to
fight infections
• Some inherited
conditions, e.g. cystic
fibrosis, primary ciliary
dyskinesia
• Acid from the stomach
which is regurgitated
and inhaled can
damage airways.
Inhaling poisonous
gases may also cause
damage
• Some diseases that
cause inflammation in
other parts of the body
can occasionally cause
inflammation and
damage in the lungs
and lead to
bronchiectasis
e.g. rheumatoid
arthritis, ulcerative
colitis, crohn's disease,
coeliac disease
However, in many cases an
obvious cause cannot be
identified.
What are the common
symptoms?
Symptoms of bronchiectasis
may include:
• Persistent cough
• Regular production of
phlegm (sputum),
which may be thick,
sticky and difficult to
clear
• Repeated chest
infections
• Breathlessness,
particularly when
exerting yourself
• Wheeziness
• Runny nose and
catarrh
• Feeling generally tired
The severity of these
symptoms can vary from
person to person.
Diagnosis
If your symptoms suggest
bronchiectasis then you may
be referred to a Respiratory
Specialist by your GP.
A diagnosis of
bronchiectasis can be
confirmed by a CT
(Computerised Tomography)
scan. This involves using an
x-ray machine and a
computer to produce
detailed pictures of sections
of your body. You will be
asked to lie still on a scan
table which moves through a
scanner. The radiographer
will be in a separate room,
but will be able to see you
and provide you with any
instructions through a twoway microphone.
The test is painless and will
help your doctor to diagnose
your condition.
Once your scan has been
completed you will be able to
resume your normal
activities.
Other tests may also be
performed to provide
information on diagnosis and
ongoing management, e.g.
• sputum test to check
for specific infections
• blood tests to assess
the immune system
• breathing tests to
assess lung function.
Treatment
There is currently no cure for
bronchiectasis. Treatment is
aimed at reducing chest
infections and further lung
damage.
• Regular exercise such
as walking, cycling or
swimming can help to
loosen and clear the
mucus from your chest.
This will also improve
your overall lung
fitness. You may be
referred to a pulmonary
rehabilitation
programme (see
‘Lifestyle
Management’).
• Chest physiotherapy
may be required if you
are having difficulty
clearing the sputum
from your lungs. This
might involve
instruction and advice
on specific breathing
techniques, postural
drainage (a technique
that takes advantage of
gravity to help clear the
airways), or in some
cases provision of a
simple device to assist
with chest clearance
further.
• It is important to keep
up to date with your
immunisations e.g. flu
and pneumonia.
Sometimes you may
also need additional
injections to help boost
your immune system.
• Antibiotics are used to
treat or prevent chest
infections (see
‘Infection management’
for further information).
• Medicines which help
to reduce inflammation
are sometimes used.
Your doctor will advise
you further if these are
appropriate. If you
suffer with
breathlessness you
may be prescribed an
inhaler to help relieve
your symptoms.
• In rare cases where the
lung damage is small
and localised you may
be offered a referral to
a chest surgeon for
assessment to see if an
operation can be
performed to remove
the affected area.
Infection management
When you have
bronchiectasis there will be
times when you suffer from
chest infections. It is
important that you are able
to recognise when you have
an infection so that you are
able to get it treated
promptly and avoid further
damage to your lungs.
Symptoms of chest
infections may include:
• Change in colour,
quantity or thickness of
sputum for more than
24 hours
• Foul tasting sputum
• Increased shortness of
breath compared to
normal
• Increased difficulty in
clearing your chest
• Increased chest
tightness/wheeze
combined with any of
the above symptoms
• Generalised tiredness
or decreased appetite
combined with any of
the above
If you suffer from these
symptoms for more than
24 hours it is vital that you
start a course of antibiotics.
These should usually be
given over a period of
10 - 14 days to ensure the
infection is fully cleared. It is
therefore important that you
complete the full course of
antibiotics as prescribed.
If chest infections are slow to
improve or if you suffer
repeated infections you may
be asked to do a sputum
sample. This is to make sure
that you are being treated
with the most appropriate
antibiotic for the infection
that you have.
Sometimes if you have a
severe infection you may
cough up some blood
streaked sputum. If this
happens seek advice as
soon as possible.
Sputum samples
Sending off a sputum
sample before starting
antibiotics can help
identify whether bacteria
are present and aid
effective use of antibiotics.
Performing a sputum
sample
You will need a sterile
specimen pot, form and
specimen bag. These can be
obtained from your doctor’s
surgery.
Useful tips:
• Do not remove the lid
of the specimen pot
until you are ready to
cough up your sputum
• Replace the lid
immediately after taking
the sample
• Only cough one lot of
sputum into the pot.
Do not be tempted to
reuse the pot. A small
quantity in the bottom
of the pot should be
adequate.
• If doing an early
morning sample, take
sample before
breakfast
Once you have taken your
sample, fill in the date it was
taken on both the form and
pot.
• Avoid using the first lot
of sputum you clear
that day
Take your sample to the
doctor’s surgery in time for
the sample collection - check
collection times with your
own surgery.
• To avoid food
contamination make
sure you have cleaned
your teeth before you
have taken the sample
If you cannot get your
sample to surgery in time for
the collection, store it in the
fridge and deliver for the
next collection.
Sputum sample results
The results are routinely sent
to your doctor’s and are
usually available after 5
working days.
The results may lead to your
doctor prescribing
antibiotics.
If you become more unwell
whilst awaiting results,
please contact your doctor
and inform them that a
sample has been sent, as it
may be possible to obtain
the results sooner.
Helpful tip
Use the Infection record to
keep a record of your
sputum test results.
Date
No
No
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Antibiotics
used?
Name of
antibiotics
Length of
course
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
Admission
to hospital
Recording your infections can help to plan your future care.
Number of
Sputum
days in
test results
hospital
Infection record
Self management
Understanding and
controlling your symptoms is
an important part of
managing bronchiectasis.
Your healthcare professional
will be able to give you
individual advice on how to
control your symptoms.
If you can control your
symptoms it should give you
more confidence to manage
your condition.
There are different ways in
which you can control your
symptoms, these include:
• Learning about your
condition
• Knowing what your
normal symptoms are
and learning to
recognise when they
are changing
• Knowing what to do if
your symptoms change
and what works for you
• Knowing when to get
help
• Not forgetting to take
your medication
Helpful tip
Your respiratory action
plan will help you to
recognise when your
symptoms are changing and
what action you need to
take.
Chest clearance exercises
These exercises will help you to clear sputum/phlegm from
your chest.
Alternate exercises 1 and 2 below until you have loosened
the sputum. Only when the sputum is loose proceed to
exercise 3.
Exercise 1
• With relaxed shoulders place your hand on the lower
part of your chest at the front and breathe in gently
through your nose
• As you breathe in, feel your hand move away from you.
On breathing out you should feel your hand return to its
resting position
• You should feel a slight pause before you start your
next breath in
• Aim to do at least 6 of these breaths
Exercise 2
• Take a long, slow deep breath in through your nose,
hold for 3 seconds, then sigh the air out slowly through
your mouth
• Repeat 3 times
• Try to keep your shoulders relaxed whilst taking your
deep breaths
• Try not to cough during these exercises
Exercise 3 (huffing)
• Take a steady breath in
• With your jaw relaxed and mouth open blow warm air
out quickly onto your hand (as if you are trying to steam
up a mirror)
• No more than 2 huffs together is advised to stop you
from feeling dizzy and to avoid bouts of wheezing and
coughing
• Only cough if you have loose sputum which has not
cleared with a huff (exercise 3)
• Inappropriate and excessive coughing can be
counterproductive
•
If your chest still feels congested restart the cycle with
exercises 1 and 2 and continue until you feel that it is
clear
If you are having difficulty
clearing your chest properly
or having repeated infections
it would be advisable to see
a respiratory physiotherapist
- you can ask your GP to
refer you.
A physiotherapist will assess
and teach you the most
effective way for you to clear
your chest to minimise future
infections.
Helpful tip
Drinking regular fluids may
make your sputum easier to
clear. Please see fluid intake
advice in healthy diet section
of ‘Lifestyle Management’.
Going into hospital
It is important to take all
relevant information about
your condition and current
medication with you
whenever you go to hospital,
either as an inpatient or
outpatient.
Taking this guide and your
respiratory action plan with
you will help healthcare
professionals to know more
about the medication you
take and the care you have
been receiving by different
people - remembering to
keep it up to date and taking
it with you will help everyone
involved in your care.
Medication
Take your usual supply of
medication with you when
you go into hospital as they
may not routinely stock your
medication.
Ask staff on the wards to
write down the times when
you should take your
medicine as part of your care
plan.
Always ask if you are unsure
about anything to do with
your medication.
Benefits
Depending on how long you
are in hospital for may affect
your benefits.
Contact the Department for
Work and Pensions for more
information and advice on
what to do about your
benefits while you are in
hospital.
Discharge planning
Plans for discharge may
start as soon as you are
admitted to ensure that
everything is in place for
when you get home. Follow
up care may include visits
from community nurses as
well as outpatient
appointments.
If you have been struggling
to manage at home before
your admission and feel you
may need more help or
support, discuss your
concerns with the ward staff.
Medication
In this section there is information on:
•
Medication
•
Antibiotics record
•
Vaccination record
•
Oxygen therapy
Medication
Any prescribed medication
will be based on your
individual symptoms. The
most common medications
used are antibiotics to treat
infections (see ‘Infection
management’ section).
If antibiotic treatment is
required it is usually given in
the form of tablets. In certain
cases however, it may need
to be given as a course of
intravenous (IV) therapy in
hospital. IV therapy involves
putting a needle in your arm
and giving antibiotics via a
drip.
Long term antibiotics
If you continue to have
repeated chest infections
despite following all of the
management advice you
have been given, it is likely
you will need assessment by
a respiratory consultant or a
respiratory nurse practitioner
at the hospital.
You may be recommended
to have preventative
antibiotics long term to try
and reduce infections.
These may be given as
tablets or via a nebuliser and
you will be given advice/
instruction regarding this at
the time.
Some patients with
bronchiectasis can become
‘colonised’ with a particular
bacterium. This means that
certain bacteria are
constantly present in your
lungs without necessarily
causing you the symptoms
of infection.
A decision regarding
whether any treatment is
indicated will be made by the
respiratory team, taking into
consideration your
symptoms at that time. If you
are experiencing symptoms
and feeling unwell, antibiotic
treatment may need to be
given as a course of IV
therapy in hospital.
Helpful tip
Use the Antibiotics record
to record what antibiotics
you are given and when you
need to take them.
Antibiotics record
You can complete this record to help you to know what
antibiotics you are taking and when you need to take it.
The medication I am
taking is called:
I need to take this
medication:
Helpful tips for taking medicines
Always take antibiotics as prescribed and complete the full
course
Speak with your doctor, nurse or pharmacist immediately
about any medication side effects that are worrying you.
Mucolytics
What do they do?
Mucolytics help to thin
sputum. This makes it easier
to clear it from your chest.
They may also help to
reduce exacerbations (flare
ups).
Mucolytics can be called
either:
• Carbocisteine
(Mucodyne)
• Mecysteine (Visclair)
What are the side effects?
Mucolytics have very few
side-effects, but in rare
cases they may cause
gastric symptoms.
Vaccination record
You can use this to record when you have had your
pneumonia and flu vaccinations
Date
Vaccination given
Signature
Oxygen therapy
In healthy lungs oxygen
enters the bloodstream from
the tiny air sacs (alveoli) in
the lungs and carbon dioxide
leaves the bloodstream in
the same way.
In people with bronchiectasis
the lungs are scarred which
may affect the exchange of
oxygen and carbon dioxide
in the lungs.
If your bronchiectasis
worsens it may be necessary
to have your oxygen levels
checked.
You will need to be referred
to the Oxygen Assessment
Service for tests for this.
These tests will look at the
oxygen and carbon dioxide
levels in your blood to see if
oxygen will be of benefit and
to establish what is a safe
level for you.
If you are recommended to
have long term oxygen
therapy the assessment
team will advise you of the
amount of oxygen you
require and the duration to
wear it.
Your healthcare professional
can check your oxygen
levels with a pulse oximeter,
which is a device which
shines a light through your
finger.
It is important you stick to
this prescription as oxygen
can have side effects if not
controlled.
The test is pain free and only
takes a few minutes.
It is also important to keep it
at the prescribed dose, and
not be tempted to increase
the flow rate yourself.
If the oxygen level in your
blood is less than 92% when
you are well and not exerting
yourself, you may benefit
from long term oxygen
therapy.
Oxygen is a drug and needs
to be treated like all other
prescriptions.
It is not a treatment, it is
purely given to prevent
further damage to the heart
and lungs.
Oxygen has been found to
be of no benefit if the oxygen
level is more than 92%.
Smoking is not allowed near
an oxygen supply as it is a
fire hazard - oxygen and a
naked flame will cause a fire.
Speak to your healthcare
professional to find out more
about the Oxygen
Assessment Service.
Useful information
Oxygen therapy does not treat breathlessness.
It can make breathlessness worse.
Fan therapy direct to the face can help to ease
breathlessness
Oxygen therapy is not a treatment as such, it is used to
prevent deterioration of heart function
Lifestyle Management
In this section there is information on:
•
Looking after yourself
•
Smoking
•
Exercise
•
Pulmonary rehabilitation
•
Healthy diet
•
Managing anxiety, panic and depression
•
Setting yourself goals
•
Goal setting planner
•
Planning for the future
•
Support groups
•
Education
•
Getting help with money
•
Travel
•
The weather
•
Relationships
Looking after yourself
Keeping well
Here are some tips to help
you to keep yourself well:
Act early if you feel your symptoms are getting worse - follow
your respiratory action plan
Protect yourself from colds
Have your flu jab every year
Make sure you are up to date with your pneumonia
vaccination
Avoid crowded places when coughs and colds are going
around
Avoid sudden changes in temperature
Cover your mouth and nose with a scarf when you go out on
cold days
Stay as active as you can
Eat a healthy, well balanced diet
Don’t run out of medication
Smoking
Smoking is a common cause
of chronic respiratory
conditions. This is because
tobacco smoke contains
thousands of poisonous
chemicals and toxins, and
when breathed in, many of
them settle in the lungs
causing disease.
Tar in cigarette smoke can
damage the lungs by
causing narrowing of the
small tubes (bronchioles),
and damaging the small
hairs (cilia) that help protect
the lungs from dirt and
infection.
Cigarette smoke also
releases substances into
your bloodstream that can
damage other organs.
Passive smokers breathe in
the smoke that is exhaled
from people who smoke. If
passive smokers have lung
conditions, this can increase
their problems.
Stopping smoking
Stopping smoking can make
a huge difference to your
health.
Even if you have a fairly
advanced chronic respiratory
condition, by stopping
smoking you are likely to
benefit and prevent further
progression of the disease.
Stop smoking services are
available locally and provide
free, confidential advice and
support for people who
would like to stop smoking.
These are offered either face
to face individually, in a
group or by telephone
support.
Useful information
To find out about your local
stop smoking service speak
to your healthcare
professional.
Lung function
0
25
50
75
100
25
Death
Disability
Age (in years)
50
Regular smoker
FEV1 (% of value at age 25)
Stopped at 65
Stopped at 45
Never smoked
75
The benefits to your lungs if you stop
smoking
Exercise
Maintaining a good level of
fitness and exercise is
extremely important to our
health and wellbeing.
Most people with chest
problems get breathless very
easily which can be
frightening and can put you
off trying to exercise.
Unfortunately if you avoid
exercising your muscles get
out of condition. They then
require more oxygen to
work, making you more
breathless than necessary.
If this is not addressed, it
can lead to a sedentary and
socially isolated lifestyle.
It is possible, however to
recondition your muscles by
exercising.
Exercise needs to be regular
and at a sufficient level to
make your breathing harder
and your heart rate faster.
You can use your
breathlessness management
strategies to help control and
slow your breathing down
more quickly after
exercising.
Consistent regular exercise
over a period of 4 - 6 weeks
should lead to an
improvement in your
breathing and levels of
tiredness.
Exercise needs to be
continued regularly to
maintain its effects in the
longer term.
Talk to your healthcare
professional if you require
more advice or support and
consider attending a
pulmonary rehabilitation
programme.
Helpful tip
Use the exercise planner in
this section to help you to
keep a record of any
exercise you do.
Exercise planner
Writing down and recording what exercise activities you do
will help you to plan when to do exercise and also help you to
increase your fitness levels.
Use this planner to keep track of any exercise you do.
The exercise I am
going to do:
Example:
Walk to the shops to get a
paper
When I am going to do it:
Example:
Every morning, 7 days a week
Pulmonary rehabilitation
Pulmonary rehabilitation is a
group based programme of
individualised exercise and
education for people affected
by chronic respiratory
conditions.
Pulmonary rehabilitation is
an important part in the
management of people with
chronic respiratory
conditions whose symptoms
are impacting their everyday
activities.
The programme is delivered
over a 6 week period with
twice weekly supervised
exercise and education
sessions covering many
different topics related to
respiratory conditions.
The aims of the programme
are to:
• Reduce the impact of
your symptoms and
improve your quality of
life
• Maximise muscle
strength and endurance
by providing an
individualised exercise
programme and
ongoing exercise
options. This helps to
reduce breathlessness
and fatigue to make
day to day activities
easier
• Teach you about your
chest condition and
how best to manage
your symptoms
Useful information
To find out more about
pulmonary rehabilitation
speak to your healthcare
professional.
Healthy diet
Good nutrition is important.
Your body needs a varied
and balanced diet to ensure
it is receiving adequate
nutrition. Having a balanced
diet can help you fight
infection, strengthen the
immune system and reduce
any hospital stays.
Common problems
associated with chronic
respiratory conditions, which
can have an impact on your
food intake may include:
• Increased shortness of
breath
• Feeling tired
• Reliance on oxygen
• Taste changes
Some people find that they
have a small appetite and
are losing weight, while
others experience no change
in their appetite and a
decrease in mobility
contributing to weight gain.
The Body Mass Index (or
BMI) is a way of seeing if
your weight is right for your
height.
The actual calculation is your
weight (in kilograms) divided
by your height (in metres
squared).
It is not dependent on sex,
age or muscle mass, but
generally is considered a
good indicator.
• Under 20kg/m² =
underweight
• Dry mouth and bloating
It is vital that you manage
your diet to address these
issues and to ensure that
you get the most out of the
food you are eating.
• 20 - 25 kg/m² = healthy/
desirable weight
• 25 - 30 kg/m² =
overweight
• 30 - 40 kg/m² = obese
• Over 40 kg/m² =
morbidly obese
(WHO, 1998)
If you are underweight
If you have a poor appetite
and/or you are feeling full
quickly: aim to eat little and
often, aiming for 3 regular
meals and snacks between
meals daily.
If you are breathless while
eating: choose foods that
are easier to chew as they
require less effort. Sit up
straight when eating to ease
the pressure on the lungs.
High energy foods
• Butter and margarine
• Syrup
• Jam
• Oil
• Marmalade
• Fried foods
• Puddings
• Cream and cream
cakes
If you are a slow eater: do
not feel that you have to
rush, chew your food well
and eat slowly. If you find
that your food or drinks are
going cold, you could use a
plate warmer or mug
insulator.
• Pastry
• Peanut butter
• Crisps
• Mayonnaise
• Salad cream
If you are continuing to
lose weight: aim to increase
the amount of energy and
protein in the diet without
necessarily increasing the
volume of food eaten. This is
also called food fortification.
• Biscuits
• Sugar
• Honey
High protein foods
• Meat
How can I fortify my
meals?
• Aim for 1 pint of full
• Fish
• Cheese
• Eggs
cream milk per day.
• Make fortified milk by
adding 4 tablespoons
of powdered milk to
each pint of milk.
• Milk
• Add butter, cream and
• Yoghurt
cheese to potatoes,
soups and sauces.
• Beans and pulses
• Use mayonnaise, salad
• Nuts
cream and butter in
sandwiches.
• Add butter, margarine
or oil to potatoes and
vegetables.
• Top dishes with grated
cheese.
• Add cream, custard or
ice cream to puddings
and fruit.
If you are overweight
Eat regularly: aim to have
3 meals a day - if you skip
meals you are likely to eat a
lot more and snack on high
calorie snacks.
Reduce your fat intake
• Choose semi skimmed
or skimmed milk, low
fat yoghurts and
cheeses.
• Choose leaner types of
meat.
• Use less oil and butter
when cooking.
• Avoid frying. Instead
steam, bake, boil and
grill.
Eat 5 portions of fruit and
vegetables per day
One portion =
• an apple
• 2 plums
• a handful of berries
• 3 tablespoons of
vegetables
• This includes fresh,
frozen, dried, canned
and juiced varieties.
• Do not add butter,
margarine or creamy
sauces to cooked
vegetables or use
mayonnaise or salad
cream on salads.
Instead try a vinaigrette
dressing.
Portion sizes
• Composition of your
Reduce your sugar intake
• Reduce fizzy drinks
and aim for sugar free
alternatives.
• Use a sweetener where
appropriate.
• Limit intake of cakes,
biscuits, sweets and
chocolate.
plate should be ¼
protein foods e.g. meat,
¼ starchy carbohydrate
e.g. potatoes, rice,
pasta and ½
vegetables or salad.
• Try eating from a
smaller plate.
• Take time over your
meals and chew well.
Limit alcohol
• Alcohol is high in
calories. Aim to drink
less or opt for water,
fruit juice or sugar free/
slimline mixers or soft
drinks.
• Caffeinated drinks in
large quantities can act
on the kidneys to
increase fluid loss.
Decaffeinated drinks
can help to reduce this
effect
• If the weather is hot or
Fluid intake
• The most effective way
to keep sputum thin
and to help chest
clearance is to drink
plenty of fluids.
• The recommended
daily amount for adults
is 2 litres (4 pints) per
day. This is equivalent
to 8 standard mugs of
hydrating fluid.
• Most drinks are
hydrating fluids,
however alcohol is a
dehydrating fluid and
will therefore need
replacing with
additional hydrating
fluids.
you have a fever/
infection, fluid intake
should be increased by
approximately 50% to
3 litres (6 pints) per
day. This is equivalent
to 12 mugs per day.
• If you suffer from heart
or kidney problems,
please check the
advice given above
with your own doctor to
see that it is safe for
you.
Managing anxiety, panic and depression
What is anxiety?
Anxiety is an unpleasant
feeling when you feel
worried, uneasy or
distressed about something
that may or may not be
about to happen.
What is panic?
To panic is to be quickly
overcome with a feeling of
fear or worry. This is usually
a consequence of anxiety.
Causes
Many things can trigger
anxiety or depression such
as stress, health or life
issues.
It is not unusual for people
living with a chronic
respiratory condition to suffer
from these at some point.
The effects of anxiety and
depression can be varied.
Some may result in physical
symptoms such as:
What is depression?
Depression is a persistent
low mood, feeling bad about
yourself and feeling
hopeless about the future.
• Chest tightness
• Quick shallow
breathing
• Rapid heart rate
• Panic attacks
Some may affect the way
you feel or think such as:
• Sense of fear
• Lack of concentration
• Constant worrying
• Irritability
Some common symptoms
are:
• Feelings of
hopelessness
• Lack of energy to take
care of yourself
• Loss of interest in the
things you used to
enjoy
Dealing with anxiety and/
or depression
Recognising that there is a
problem is the first step in
dealing with it even if you are
not sure what is causing the
problem.
Listed below are suggestions
to help you:
• Talking - sharing your
problems can help you
to find the right support
for you.
• Relaxation - planned
relaxation calms
anxiety and helps your
body and mind to
recover from stress.
• Exercise - helps to
release natural
chemicals in the brain
which can lead to a
feeling of wellbeing.
• Self management -
using a problem solving
approach to deal with
stress and worries can
help you to recognise
and address triggers
more effectively.
If you have ongoing
concerns over your mood
speak to your healthcare
professional.
To help relieve a panic/breathlessness attack
1. Find a position where you can allow your shoulders to
relax e.g. leaning forwards with your arms resting on a
table or your lap.
2. Become aware of your out breath - it is likely to be quite
short at first.
3. You may find it helpful and beneficial to quietly say "er"
or "mm" on the out breath.
4. Gradually try and lengthen the out breath by increasing
the length of time you say “er” or “mm”.
5. You do not need to focus on the breath in, it will happen
automatically following your breath out.
6. Once your breathing rate has slowed down enough,
relax in a sitting position (preferable with your head and
shoulders supported).
This may take several minutes to achieve depending on
the degree of your breathlessness.
Setting yourself goals
You might have stopped
doing some things as you
feel you are unable to do
them. Or you may want to do
more but are unsure if you
can.
Setting yourself goals will
help you to organise your
time so that you can make
the most out of your life and
manage to do the things you
would like to do.
They will also help to
increase your confidence as
you try to achieve the goals
you have set yourself.
There are key stages to
setting goals:
1. Decide what you would
like to do
2. Decide how you are
going to do it
3. Plan when you are
going to do it
You will also need to look at
how important it is that you
achieve the goal and how
confident you are that you
will achieve it.
How do I set myself goals?
The process of setting goals
will allow you to choose what
you actually would like to
achieve. It will help to create
long term aims and short
term motivation.
Helpful tip
Use the goal setting
planner in this section to
help you to set and achieve
goals. If you need help,
speak to your healthcare
professional.
To help set yourself goals
Speak with your healthcare professional before you start to
set yourself goals. They will be able to help you to plan what
is possible for you to achieve.
Don’t do too much, too soon. Start off slowly and see what
progress you make - this will help to increase your
confidence.
Change the activities that you do so that you keep it
interesting.
Plan to do the activities when you feel at your best, as energy
levels change on a daily basis.
Reward yourself when you have achieved a goal, this will
help to keep you motivated.
Goal setting planner
Use this planner to help you to set yourself goals.
What I would like to do:
How important is it that you achieve this goal on a scale of
1 to 10? Circle the number below.
1
Not important
2
3
4
5
6
Very important
7
8
9
10
How am I going to do it?
When am I going to do it?
How often am I going to do it?
How confident are you that you will be able to carry out your
goal? Circle the number below.
1
Not confident
2
3
4
5
6
Very confident
7
8
9
10
Planning for the future
When living with a long term
condition it is common to
think about the future.
This may be something that
you find difficult to do, but
there are people who can
support you with this.
If you can take steps to plan
for your future, it will help to
bring peace of mind to both
you and your family.
Planning for the future may
involve asking questions
about what will happen if
your condition gets worse
and what plans you may
need to have in place.
These plans may include:
• Organising finances
• Writing a will
• Treatment and care
options
Planning for the future will
involve you and your family
making important decisions.
These decisions should be
made before any situations
arise. This will help all the
people who are involved in
your care to carry out your
wishes.
Part of this care is to identify
not only the physical needs
of the patient (such as
shortness of breath), but
also the psychological, social
and spiritual needs.
It is important to tell your
healthcare professional how
you are feeling and how your
lung condition is affecting
your everyday life.
One of the main symptoms
of chronic lung conditions is
shortness of breath, which
can contribute to reduced
mobility, poor appetite and
tiredness.
Another common problem
can be depression. Some
people feel anxious or
irritable and unable to sleep
properly at night.
Your healthcare professional
may be able to adjust your
treatment to help improve
your quality of life and may
also be able to refer you to
other healthcare
professionals who can help.
There are specialists in
palliative care who can
provide help to improve your
symptoms along with helping
you and your family to cope
with your illness.
Treatments offered include
medication, relaxation
techniques, complementary
therapies, and day care,
which can provide social
support and ongoing reviews
of your symptoms and
problems by a dedicated
team.
Gaining a better
understanding of your
condition may help you to
become more involved in
your own treatment,
decision-making and future
planning. It may also help
you to gain more control
over your condition.
Support groups
People with chronic
respiratory conditions and
those that care for them can
often feel isolated.
Having a good social
network is important for
people with chronic
respiratory conditions and
support groups offer people
the chance to make that
happen.
There are a number of
support groups for people
with chronic respiratory
conditions across
Derbyshire. Some of these
groups are part of the British
Lung Foundation charity and
others are independent
groups.
These support groups offer
people the chance to meet
others in similar
circumstances, share
learning experiences and
offer mutual support.
Each support group is open
to all people affected by lung
conditions including families,
friends and carers.
They arrange different
outings, education activities
and social gatherings
throughout the year.
Education
Education programmes offer
you an opportunity to learn
more about your condition,
the skills you need to help
manage the problems that
are associated with your
condition and give you the
opportunity to mix with
others in similar situations to
you.
Living with Long Term
Conditions Programme
This is a free 6 week, NHS
self-management
programme for people living
with any long-term health
condition.
It aims to help you to take
more control over your
condition by learning new
skills to manage it better.
It covers areas such as:
• Dealing with pain and
extreme tiredness
• Coping with feelings of
depression
• Problem solving
Getting help with money
There are a number of
benefits that are available for
people with chronic
respiratory conditions.
You may be entitled to
benefits if you:
• Cannot work because
of your condition.
• Have care needs
because of your
condition.
• Are caring for someone
with a condition.
• If you have a great deal
of difficulty getting
around you may be
eligible for a 'blue
badge' for your car.
• You may find it helpful
to talk to someone for
advice about which
benefits you may be
entitled to.
Travel
If you are planning to travel
abroad, talk to your
healthcare professional
before booking your holiday.
Travel insurance
Some insurance policies do
not cover pre-existing
medical conditions.
Most people with a chronic
respiratory condition have no
problems when flying, but for
some people their blood
oxygen levels can fall
causing them to be unwell.
For these people it is
possible to arrange a flight
assessment.
It is worthwhile shopping
around for travel insurance,
there are specialist
insurance companies that
offer insurance to people
with a pre-existing medical
condition.
If you are found to need
oxygen for the flight you will
need to check with the airline
before booking your holiday.
Some airlines can charge for
this service.
It is a good idea to take extra
supplies of medication with
you on holiday. Discuss with
your healthcare professional
the possibility of taking
rescue medication in case
your condition gets worse.
Keep your medication in
your hand luggage when
flying to ensure you have it
with you if needed.
The British Lung
Foundation has information
on travel insurance and
details of companies that
may provide insurance.
The weather
Changes in temperature and
the weather can affect
people with chronic
respiratory conditions,
resulting in symptoms
becoming worse.
The best way to manage this
is to follow a healthy lifestyle,
keep yourself and your home
warm in winter and avoid
extreme changes in
temperature.
Plan for the winter
Outside
• Wear several thin
layers of clothes
instead of one thick
layer
• Wear a hat, gloves and
scarf to keep warm
Food
• Ensure you have an
essential food supply in
the house to cover you
over the bad weather
conditions
Inside
• Try to keep the rooms
in your house warm
(21°C)
• Keep your bedroom
windows and curtains
closed
• Check your heating
system is working
correctly
Immunisations
• Ensure you have a
pneumonia vaccination
and a yearly flu jab
Plan for the summer
Outside
Fluid intake
• Drink plenty of fluid - at
least 8 glasses a day
• Stay out of the sun,
especially when it is at
its hottest between
11am and 3pm
• Try to stay in the shade
as much as possible
• Wear light, loose fitting
clothes and a hat
Inside
• Keep the curtains
drawn at home to help
keep the rooms cooler
• At night, open windows
to allow cool air into the
room
Keeping cool
• Splash yourself with
cold water throughout
the day or take cool
showers/baths
• Use a fan
Relationships
Many people with chronic
respiratory conditions find
that the condition affects
their sex life. They also find
that they are afraid to
express their sexual needs
to their partner for fear of
triggering a bout of
coughing. They may also
feel guilty about not
responding to their partner’s
needs.
To help reduce these
misunderstandings it is
important to discuss these
feelings with your partner.
Most problems come from a
lack of communication with
each other.
There are many
misunderstandings about
sexual activity when you
have a chronic respiratory
condition. Some of these
include:
The only caution that needs
to be taken is if you are
extremely breathless at rest.
If this is the case then sexual
activity may make you
anxious. Speaking to your
healthcare professional may
help.
• That it may be
dangerous to undertake
sexual activity because
of being breathless
• Sexual activity has to
be spontaneous where
both partners play an
active role
• Sexual problems
experienced by patients
are a result of the
condition
There is no reason why you
should not be able to still
have a loving relationship
with each other.
Suggestions to encourage affection
Talk to your partner about your concerns and ways in which
you may be able to prevent the appearance of your
symptoms.
Build up your tolerance to effort by walking or exercising.
Plan your sexual activities for the time of the day that is best
for you (usually mid or late afternoon).
Wait at least 2 hours after a big meal.
Never rush things.
Allow your partner to play a more active role.
Use your inhalers 30 - 60 minutes before sexual activity and
do your chest clearance exercises to reduce wheezing and
coughing.
Keep your medication close at hand.
Ensure the atmosphere is relaxed and get the temperature of
the room just right for you.
Use methods such as pursed lip breathing and diaphragmatic
breathing to control shortness of breath.
Try different positions which least compress your chest.
Any external organisations and websites included here do not necessarily reflect the views of
the Derby Hospitals NHS Foundation Trust, nor does their inclusion constitute a
recommendation.
Reference Code: P1660/1683/04.2015/VERSION1
© Copyright 2015 All rights reserved. No part of this publication may be reproduced in any
form or by any means without prior permission in writing from the Patient Information Service,
Derby Hospitals NHS Foundation Trust.