“The best time to plant a tree is twenty years ago. The second-best time is now.” – Chinese Proverb
If you are on this page, it is more than likely that you or someone you know have at one time or another, experienced the sensation of being short of breath due to respiratory disease, cardiovascular disease or both. Shortness of breath (SOB), also known
as dyspnea (pronounced disp-nee-uh) or air hunger, can be all encompassing and has the potential to undermine every aspect of your life, from the magnificent to the mundane.
There are few sensations in life that are as absolutely terrifying as not being able to catch your breath. In fact, most of us will do absolutely everything in our power to avoid that sensation at all costs, even at the expense of things we love, such as going to the theater, visiting with friends and family; even everyday activities such as taking a shower or grocery shopping; even having sex. Shortness of breath can deliver a tremendous blow to our self-esteem as well as our overall quality of life, but I don’t have to tell you these things. You already know them because you or someone you know has experienced them firsthand, and there are few greater teachers in life than firsthand experience.
Our mission in sharing this information is to teach you that for the overwhelming majority of people, being diagnosed with a respiratory disease is not a death sentence and your situation does not have to be hopeless, nor should it be. In fact, there are many things you can do to minimize your shortness of breath as well as to maximize your overall health and quality of life.
Our mission in sharing this information is not to sell you a bill of goods promising a quick fix or cure for your disease or an overnight solution to your shortness of breath. You didn’t get here overnight. You’re not getting out overnight either. We’re also not suggesting that managing your disease will be easy. It will not. But…if you follow the suggestions on this page, even some of the suggestions, some of the time, I promise you that you will begin to experience small (and in many cases, not so small) but noticeable improvements in your daily life, whether it be less shortness of breath, the ability to do more of the things you love, increased energy levels, or an improvement in your overall sense of well-being.
Many of these suggestions will work for many, if not most people. However, it is important to understand that when it comes to patient care and people in general, all of us are different and therefore, need to be treated as individuals. As such, there will always be exceptions to the rule that will require some adjustments or “tinkering” with the methodology.
SOB or dyspnea on exertion (DOE) is by far, the single most common presenting symptom of respiratory disease and almost always the symptom that causes people to seek medical attention. However, it is extremely important to note that shortness of breath can also be the consequence of many conditions besides respiratory disease; ranging in severity from the very serious, like cardiovascular disease, anemia, or renal disease; to the more benign, but still important-to-address conditions like gastro- esophageal reflux disease (GERD) or deconditioning due to inactivity (i.e. being out of shape); or it could be related to something else entirely.
My point in telling you this is that I don’t want you to make any assumptions or self- diagnoses as to the cause of your shortness of breath, without being sure that there aren’t other contributing factors that can potentially be harmful to you if left untreated.
With that in mind, it is essential that your physician perform a comprehensive workup of your symptoms before beginning any meaningful course of treatment or undertaking any significant lifestyle change such as cardiopulmonary physical therapy or pulmonary rehabilitation.
SOB can range in severity from barely noticeable to all encompassing. At times, you may not even be aware of your symptoms while at others, they may stop you dead (or at least, completely breathless) in your tracks. Depending upon where you are, what you happen to be doing, even who you happen to be with at the time, you may attempt to minimize or make light of your symptoms. You may even tell yourself (and others) little white lies such as: “I’m getting old” or “I’m out of shape” or “it’s not a big deal.” But you know darn well it is.
Typically, most people first begin to experience shortness of breath at high levels of exertion, during activities such as stair climbing or walking uphill. In New York City, the three things patients complain about most are climbing subway stairs, walking up the city’s many hills and inclines and running or walking quickly for the bus; or what we not- so-affectionately like to call “the NYC Pulmonary Triathlon.”
Human nature dictates that when we start to experience a certain symptom; any symptom, whether it be shortness of breath, chest pain, back, hip or knee pain; or any other physical (or emotional) distress, we will typically find ways to alleviate or minimize our discomfort; either by modifying the activity that causes us to be symptomatic (e.g. walking more slowly or taking more frequent rest breaks), or by avoiding the activity altogether (e.g. taking a different route or driving, instead of walking uphill or climbing the stairs).
Therein lies at least part of the problem. The fact is, once you start to avoid the activities that cause you discomfort (whether they be stair climbing, walking uphill or running for the bus), all of the muscles that you use to perform these activities (including, most importantly, the heart; as well as the respiratory and skeletal muscles), become weaker and more deconditioned. And when muscles become deconditioned, they don’t perform as well or use oxygen as efficiently. As a result, you begin to experience shortness of breath at lower levels of activity, and eventually, start to avoid those lower-level activities as well and so on and so on. This is what is known as the “Dyspnea Cycle.”
In addition to the muscles themselves, all of the body systems that are involved in performing these activities also become less efficient and when these systems don’t operate as well, you become even shorter of breath at even lower levels of activity and in turn, start to avoid those activities as well, beginning the cycle all over again. Sound familiar?
Our goal is to help you break this cycle in three ways. First, we will teach you more effective breathing techniques designed to increase your awareness of and give you greater control over your shortness of breath. Second, we will teach you how to exercise, both aerobically (e.g. treadmill, exercise bike, upper body ergometer) and anaerobically (e.g. strength training), so that your body becomes stronger and more efficient at using oxygen and you become less short of breath.
Last, but definitely not least, we will educate you about the various lifestyle factors that play a role in how well or how poorly you breathe, so that you can begin to reverse your shortness of breath as well as any other limitations or modifications you’ve had to make and that have wreaked so much havoc in your life.
Again, each person is different, and every situation is unique. Therefore, not all things will work for all people. However, our hope is that this information will help guide you and your healthcare team in determining which tools and techniques will work best for you and which ones won’t be as helpful, or not helpful at all.
The good news is that our team is comprised of some of the tippy-top experts in the field, most of whom have more than 30 years of experience in cardiopulmonary rehabilitation and several with more than 50. In sharing our collective experience with you, we hope to give you a direct link to the greatest source of information about your disease, in an effort to help you avoid some of the same pitfalls that others before you have had to deal with.
The other good news is that the overwhelming majority of the information being passed on to you has come directly from the source: other patients. They are the true experts in the field, who have experienced many of the same struggles as you and found ways to overcome them, even when it seemed like all odds were against them and you can too. It is my hope that by putting our collective knowledge and experience together in one comprehensive, yet easy to understand site for pulmonary patients, you will have at your disposal, a wealth of options to choose from, and that you too, will be able to experience your own little slice of “Ultimate Pulmonary Wellness.”
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