# Exercise as it relates to Disease/Long-term use of oral corticosteroids in treatment of COPD and exercise prescription
## What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) includes two respiratory conditions called Emphysema and Chronic Bronchitis, both of which are most commonly caused by long-term smoking, and typically affecting the population of 50 years and above.
* Emphysema refers to damage to the alveoli resulting in difficulty breathing
* Chronic Bronchitis is inflammation of the bronchi which causes mucus to build up in the airways resulting in a cough and sputum production
COPD is the third most prominent chronic illness in Australia with approximately two million people in the country being affected, and millions of dollars being contributed in health costs each year. The most common symptom of COPD is breathlessness whilst performing daily activities.
* Definitions
* Alveoli: air sacs in the lungs responsible for gas exchange of oxygen and carbon dioxide
* Chronic: symptoms lasting for more than a month
* Bronchi: the two main airways that branch into the left and right lungs
* Sputum: a combination of mucus and saliva

## How can COPD be Managed?

There are a number of lifestyle changes that can be made in order to manage your COPD better. These include:
* Joining a pulmonary rehabilitation program
* Quitting smoking
* Sustaining a healthy diet
* Understanding the dosage requirements and role of medications

## How does medication effect exercise?

There is a range of medications that can be taken to treat symptoms of COPD depending on severity. Each medication has their own side effects that need to be monitored during exercise:
* Short acting Bronchodilators (e.g. Ventolin) open up the airways to allow for an increased exercise capacity. However, they can cause increased heart rate and unsteady fine muscle movements. Therefore, the patient needs to exercise at a lower intensity and be aware that their fine muscles will be slightly weaker than normal.
* Inhaled steroids aid in the reduction of mucus production and swelling of the airways. When used over a long period of time can cause osteoporosis. While there are not many modifications that can be made to the exercise program, the patient needs to be aware of falls prevention during their sessions.
* Systemic steroids also reduce the swelling in the airways however they are mostly used in severe cases where inhaled steroids are unable to enter the lung. Adverse effects include insomnia, weight gain, bruise easily, osteoporosis, muscle weakness and decreased vision. The patient needs to be aware that insomnia can lead to clumsiness which can increase the risk of injury. This then has implications for the bruising easily osteoporosis, muscle weakness and decreased vision.

## What is Pulmonary Rehabilitation?

* Pulmonary Rehabilitation is a program organised by The Australian Lung Foundation, and run by a team of medical professionals for people with chronic lung conditions
* It is a combination of exercise and education sessions run over a period of eight weeks
* It aims to increase your ability to perform daily tasks and improve the capacity to participate in physical activities.

## What does it involve?

* The program is delivered twice a week with:
** Education sessions to provide information on how to manage life with a chronic lung disease
** A standard exercise program where each person is encouraged to work within their own limits
* A session will typically involve a low intensity form of cardiovascular activity. For example, a 30 minute walk followed by strength and balance exercises with relevance to daily activities

## What are the benefits of a Pulmonary Rehabilitation program?

* Improved lung capacity
* Stronger bones
* Increased mood
* Social opportunities
* Independence
* Sense of control over illness
* Improved quality of life
* Decreased severity of symptoms

## Further Information

The Australian Lung Foundation
* http://www.lungnet.com.au or 1800 654 301
Pulmonary Rehabilitation Program - The Canberra Hospital
* 02 6244 2154
World Health Organisation
* http://www.who.int/en/ or http://www.who.int/countries/aus/en/ (Australia)
Woolcock Institute of Medical Research
* http://www.woolcock.org.au/

## References

* 1 2 The Australian Lung Foundation.
* 1 2 The Australian Lung Foundation. (2003). COPD:Chronic Bronchitis and Emphysema Pamphlet. Australia.
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Queensland Government (Queensland Health) and The Australian Lung Foundation. (2008). Better Living with Chronic Obstructive Pulmonary Disease:A Patient Guide. Queensland, Australia
* 1 2 3 COPD Informtaion Pack,
* ↑ medsafe
* 1 2 3 4 5 6 7 8 9 Elizabeth Forbes, COPD Nurse Specialist, Chronic Care Program, The Canberra Hospital