The Vest

http://www.thevest.com/airway-clearance/impaired.asp.  



I used The Vest today at pulmonary therapy and I want one!   It was so much better than having someone pound on your back to loosen the junk in your lungs!
UPDATE:  I used the machine for a few months at home and it works great but my insurance company would not approve the full cost of use.   Even though I accepted delivery of the machine with the understanding that if insurance didn't cover it then they'd have to take it back, it turned into a problem with HillRom.  I repeatedly asked them to pick up the machine because I couldn't afford the almost $1200 per month charge.  They said I'd agreed to a payment plan which I hadn't.
Finally they sent a box for me to return it. They say I owe about $2300.  I disagree.  We'll have to see who kept better documentation.

Impaired Airway Clearance

When mucus secretion and mucus clearance are not in balance, excessive airway mucus can cause serious problems. This condition is called impaired airway clearance.

Excess, often sticky mucus may accumulate in the airways in conditions as varied as cystic fibrosis, cerebral palsy, and chronic obstructive pulmonary disease bronchiectasis. Retained secretions are a universal problem in people with artifical airways (tracheostomies) or those who depend on assisted ventilation.

As a consequence of retained mucus, breathing becomes labored. More energy and effort are required to take in vital oxygen and to exhale carbon dioxide. Although underlying causes are diverse, consequences are the same: vulnerable individuals are caught up in the vicious cycle of recurrent, ever-worsening episodes of inflammation, pulmonary infection, increased production of excess mucus, and airway obstruction, lung damage, and respiratory failure.

People at risk for impaired airway clearance have one or more of the following problems:

Ineffective Ciliary Clearance

Normal cilia beat in a coordinated unidirectional fashion to mobilize mucus and clear particulate matter from the airways. Damaged or poorly functioning cilia perform this function inadequately or not at all.

Ciliary impairment is associated with conditions including:

• Cystic fibrosis
• Primary ciliary dyskinesia
• Kartagener syndrome
• Status post heart-lung or lung transplantation
• Smoking or exposure to second-hand smoke

Excessive or Abnormal Mucus Production

Certain disorders and/or their treatments can cause excess mucus production and, in some cases, mucus that is abnormally thick and sticky. Large quantities of mucus, or mucus with altered physical properties, may overwhelm the mucociliary apparatus, inhibiting normal airway clearance.

Abnormal amounts of mucus with altered physical properties may imbe present in:

• Cystic fibrosis
• Bronchiectasis
• Asthma
• Chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis
• Mechanical ventilation

Impaired secretion clearance can occur as a result of any event or dysfunction that disrupts normal airway clearance mechanisms.

Ineffective Cough

Cough function may be weak or ineffective in diseases and conditions where:

• Diaphragm muscle weakness or spinal deformity diminishes ability to inhale
• Poor coordination of the expiratory muscles compromises expulsive force and mucus shearing.
• Poor coordination of the bulbar muscles impairs closure of the glottis and the ability to build up
  intrapleural pressure

Cough function is frequently impaired in:

• Neuromuscular diseases, such as muscular dystrophy, spinal muscular atrophy, and multiple sclerosis
• Neuromotor conditions including cerebral palsy, spinal cord injury, and severe traumatic brain injury
• Individuals who depend on mechanical ventilation
• Individuals who have received heart and/or lung transplants

Dysphagia/Aspiration/Gastroesophageal Reflux

Dysphagia, or difficulty in swallowing, is a consequence of anatomical abnormalities or weakness of the muscles associated with swallowing. Gastroesophageal reflux occurs when a defective lower esophageal sphincter allows stomach contents to surge backwards into the esophagus. Aspiration involves the inhalation of secretions, vomit, or foreign material into the lungs. Because saliva and gastric contents contain bacteria, aspiration introduces microorganisms into normally sterile airways.

Seizures

Seizures are disorders of cerebral function characterized by sudden, attacks of loss of consciousness and motor control. There is a risk of aspiration during seizures.

Conditions associated with dysphagia/aspiration/gastroesophageal reflux include:

• Neurologic and neuromuscular disorders including cerebral palsy and muscular dystrophy
• Seizures
• Developmental delay
• Disorders of the esophagus
• Endotracheal intubation and tracheostomy

Immobility

Some individuals are unable to exercise because of diminished exercise capacity, neuromuscular weakness or neuromotor dysfunction. As a result, they cannot maintain adequate aerobic capacity, chest 

bellows function, and lung volume.

Conditions associated with immobility include:

• Spinal cord injury, quadriplegia
• Severe cerebral palsy and/or developmental delay
• Advanced muscular dystrophy, spinal muscular atrophy, severe spina bifida
• Dependence upon assisted ventilation

Restrictive Lung Disease

Fixed or diminished lung volumes and vital capacities characterize restrictive lung disease. In conditions where respiratory muscles are weak or the spine and thorax are deformed, the ability to take a deep breath, to generate expiratory force, and to cough effectively are often affected.

Restrictive lung disease occurs commonly in:

• Muscular dystrophy
• Spina bifida
• Spinal muscular atrophy
• Severe cerebral palsy

Obstructive Lung Disease

Obstructive lung diseases include conditions where airway size is decreased as a result of structural changes,bronchospasm and/or excess mucus — limiting the ability to exhale.

Obstructive lung diseases include:

• Bronchiectasis
• Chronic Bronchitis
• Alpha₁-antitrypsin deficiency
• Asthma
• Cystic fibrosis
• Primary ciliary dyskinesia
• Kartagener syndrome

Learn more about airway clearance:

• What is Airway Clearance?
• Normal Airway Clearance
• The Need for Airway Clearance
• Vicious Cycle of Airway Clearance

High Altitude Simulation Test

High Altitude Simulation Test (HAST) is a test that can determine the need for supplemental oxygen in patients who are going to be traveling by air or at higher altitude.  If you have a chronic lung disease (COPD, emphysema, chronic bronchitis, severe asthma), and you are considering a trip by airplane, or a trip to a higher elevation, you may need this test.  If you are alread on supplemental oxygen, you may still need testing.  This is simply the safest and most accurate way to determine if you will need oxygen at higher altitudes, and exactly what level of oxygen keeps your oxygen saturation in the safe range.  The FAA regulates that airplanes maintain a cabin pressure of bewteen 8,000 to 10,000 feet above sea level.  Rather than get into barometric pressure and partial pressure of gasses, this simply means that available oxygen has just dropped by about 6% compared to sea level.  The air we breathe at sea level contains 21% oxygen, but when flying, or at elevations of 8,000 feet above sea level, the air now has about 15-16% oxygen (compaired to sea level).  In the past, we would simply guess based on a patient's oxygen saturation.  If a person had an oxygen saturation above 95%, they were good to go, if not, they may need some supplemental oxygen in-flight.  Many hospitals and pulmonary function labs now offer HAST to accurately determine the need for high altitude oxygen, as well as the exact amount that will keep patient's safe when flying or traveling at higher altitudes.  If you are already on home oxygen, testing can determine what level you will need in-flight.  The test can be done several different ways, but basically, a mixture of nitrogen and oxygen is delivered to the patient to simulate the available oxygen at high altitudes.  During this time, the patients vital signs are closely monitored, as is the oxygen saturation.  If the saturation drops below a set point, usually 85-88%, supplemental oxygen is titrated to keep the saturation in a predetermined range (usually 88-90%).  Some guidelines recommend other screening, such as a 6 minute walk, arterial blood gasses, and other testing to determine the need for HAST, but the bottom line is there is a better way than simply guessing and estimating the need and the amount of oxygen needed for lung patients who travel by air, or those who plan to travel to higher elevations. 

Pulmonary Function Tests from MedLinePlus

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation.

How the Test is Performed

Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time.

For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. Sometimes you will be asked to inhale the substance or a medicine to see how it changes your test results.

Lung volume measurement can be done in two ways:

• The most accurate way is to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.
• Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume.

To measure diffusion capacity, you breathe a harmless gas, called a tracer gas, for a very short time, often for only one breath. The concentration of the gas in the air you breathe out is measured. The difference in the amount of gas inhaled and exhaled measures how effectively gas travels from the lungs into the blood. This test allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream.

How to Prepare for the Test

Do not eat a heavy meal before the test. Do not smoke for 4 - 6 hours before the test. You'll get specific instructions if you need to stop using bronchodilators or inhaler medications. You may have to breathe in medication before or during the test.

How the Test Will Feel

Since the test involves some forced breathing and rapid breathing, you may have some temporary shortness of breath or lightheadedness. You breathe through a tight-fitting mouthpiece, and you'll have nose clips.

Why the Test is Performed

Pulmonary function tests are done to:

• Diagnose certain types of lung disease (such as asthma, bronchitis, and emphysema)
• Find the cause of shortness of breath
• Measure whether exposure to chemicals at work affects lung function
• Check lung function before someone has surgery

It also can be done to:

• Assess the effect of medication
• Measure progress in disease treatment

Normal Results

Normal values are based upon your age, height, ethnicity, and sex. Normal results are expressed as a percentage. A value is usually considered abnormal if it is less than 80% of your predicted value.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Different measurements that may be found on your report after spirometry include:

• Expiratory reserve volume (ERV)
• Forced vital capacity (FVC)
• Forced expiratory volume (FEV)
• Forced expiratory flow 25% to 75%
• Functional residual capacity (FRC)
• Maximum voluntary ventilation (MVV)
• Residual volume (RV)
• Peak expiratory flow (PEF).
• Slow vital capacity (SVC)
• Total lung capacity (TLC)

What Abnormal Results Mean

Abnormal results usually mean that you may have some chest or lung disease.

Some lung diseases (such as emphysema, asthma, chronic bronchitis, and infections) can make the lungs contain too much air and take longer to empty. These lung diseases are called obstructive lung disorders.

Other lung diseases make the lungs scarred and smaller so that they contain too little air and are poor at transferring oxygen into the blood. Examples of these types of illnesses include:

• Extreme overweight
• Fibrosis of the lungs
• Lung cancer
• Sarcoidosis and scleroderma

Risks

The risk is minimal for most people. There is a small risk of collapsed lung in people with a certain type of lung disease. The test should not be given to a person who has experienced a recent heart attack, or who has certain other types of heart disease.

Considerations

Your cooperation while performing the test is crucial in order to get accurate results. A poor seal around the mouthpiece of the spirometer can give poor results that can't be interpreted. Do not smoke before the test.

Alternative Names

PFTs; Spirometry; Spirogram; Lung function tests

References

Hegewald MJ, Crapo RO. Pulmonary function testing. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 24.

Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 85.

Update Date: 12/12/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Browse the Encyclopedia

Air Travel With Oxygen

Airline Travel With Oxygen

Quick link: POC Information

Airline travel is available to persons who require in-flight supplemental oxygen. Negotiating the many obstacles, however, can be challenging. As an oxygen user it is your responsibility to make your own arrangements. Patience, perseverance and having the appropriate information available will help you plan your trip. A helpful tip: keep written information in front of you, note with whom you speak, and write down contact information. Airline policies are subject to change without notice. It is recommended that you notify the airline at the time of reservation and 48 hours before flight time that you will be flying with oxygen to verify its policy, and that you carry a copy of the policy and your oxygen prescription with your airline tickets while traveling.

ADVANCE PLANNING IS ESSENTIAL

Your trip begins with the airline. Each airline has its own policy for on-board oxygen transport and in-flight oxygen usage. You will need to contact the individual airline for their current policies regarding oxygen. For general information about traveling with oxygen, click on:www.airlineoxygencouncil.org. You must carry your prescription for oxygen and your Doctor's letter approving air travel with you at all times. Many of the airlines have their own airline specific medical form for your Doctor to fill out. These are generally good for one year. A helpful tip: keep your other medications, prescriptions and forms with you while traveling and not in your checked baggage.

You must carry your prescription for oxygen and your Doctor’s letter approving air travel with you at all times. Many of the airlines have their own airline specific medical form for your Doctor to fill out. These are generally good for one year. A helpful tip: keep your other medications, prescriptions and forms with you while traveling and not in your checked baggage.

Effective May 13, 2009 the Department of Transportation final rule "Nondiscrimination on the Basic of Disability in Air Travel" contains air carrier requirements regarding the use of respiratory assistive devices on aircraft. In the final DOT rule, section 382.133 generally requires that air carriers conducting passenger service must permit someone with a disability to use an FAA-approved portable oxygen concentrator (POC) on all flights (on aircraft originally designed to have a maximum passenger capacity of more than 19 seats) unless the device does not meet applicable FAA requirements for medical portable electronic devices and does not display a manufacturer’s label that indicates the device meets those FAA requirements.

There are now 21 portable oxygen concentrators approved by the FAA to carry on board your flight.Approved POCs include:

• AirSep Focus
• AirSep Freestyle 5
• AirSep FreeStyle
• AirSep LifeStyle
• Delphi RS-00400
• DeVilbiss iGo
• LifeChoice by Inova Labs
• LifeChoice Activox by Inova Labs
• Inogen One
• Inogen G2
• Inogen One G3
• International Biophysics Life Choice
• Invacare XPO2
• Invacare Solo 2
• Oxlife Independence
• Oxus RS-0400
• Precision Medical EasyPulse
• Respironics EverGo
• Respironics Simply Go
• Sequal
• SeQual SAROS

They can be stowed under the seat in front of you during flight and can be battery powered when not plugged into an electrical socket if available and the Airline allows. Remember: YOU must confirm with your airline carrier 48 hours prior to flight time that you will be bringing on board and using a POC.

NOTE: YOU ARE NOT ALLOWED TO USE ANY OTHER PERSONAL OXYGEN SYSTEMS ON BOARD. FILLED OXYGEN TANKS (LIQUID OR COMPRESSED GAS) CANNOT BE CHECKED AS BAGGAGE ON ANY AIRLINE. Some airlines may allow empty oxygen equipment to be stowed in baggage but it must be verified as empty and the regulator removed. Check with your airline ahead of time to see if they will allow empty systems/tanks as stowed or checked baggage.

Once you have decided on your oxygen needs, you will need to contact your oxygen provider to see if they can provide you with a POC approved for air travel. If not, you will have to rent or purchase one independently - see POC Information for more details. You will need sufficient battery power to cover pre-flight, in-flight and post-flight time. Remember you will need to arrive at the airport 1 – 2 hours ahead of your flight time. At Gate Check-in you must have battery power for at least 50% longer than your scheduled flying time. For example – if your flying time is 3 hours, you will need 4 ½ hours of battery power) You will need to cover your travel time to the airport, airport waiting time, your flight time and the time it will take you to deplane, pick up your checked baggage and travel to your final destination. Plan ahead for any possible delays. Non-Stop or direct flights will keep the battery time to a minimum.

The Department of Transportation (DOT) provides public tips on safe carriage of batteries and battery-powered devices such as medical equipment. For information on how to safely travel with oxygen equipment batteries, please visit the DOT web site.

You may want to contact your insurance carrier to determine coverage for your oxygen needs while traveling.

At the Airport you will need to pass through Airport Security. If you are traveling with an approved POC, that will need to be identified on the POC itself. All TSA approved oxygen systems can safely be x-rayed if requested. If you are traveling with a portable oxygen system, you will be allowed through the security area after inspection and may take the system to the gate. If the system is not an approved POC you may NOT be permitted to take it onto the airplane and will need someone with you to remove it from the airport. If you do not use an approved POC oxygen supply you will need to arrange for an oxygen supply at your destination. It is very important that you are familiar with the Transportation Security Administration (TSA) guidelines for “Travelers with Disabilities and Medical Conditions” before you go to the airport. Go the TSA website @ http://www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions for this information.

The International Air Transport Association (IATA), of which virtually all US airlines with international routes are members, has a medical manual which includes forms and procedures for documenting medical conditions. Included is a FREMEC (frequent medical travelers medical card) from, which seems designed to streamline the medical clearance process across member airlines. The medical manual can be found here. The IATA site is www.iata.org.

Traveling with CPAP, Bi-Level Device or a Non-Invasive portable ventilator:

If your Physician requires you to travel with CPAP, Bi-Level Device or a Non-Invasive portable ventilator, here is an excellent resource to watch: Traveling with Trilogy: Taking it on the Road.

Other Modes of Travel With Oxygen

Traveling on Amtrak and Cruise Ships:

If you are traveling on an Amtrak train or want to take a cruise, check out these links for their policies and guidelines before booking your trip.

Amtrak: http://www.amtrak.com/accessible-travel-oxygen-equipment

Carnival Cruise Lines: http://www.carnival.com/legal/guests-special-requirements.aspx

Holland America: http://www.hollandamerica.com/assets/cruise-vacation-planning/AccessToExcellence.pdf

Royal Caribbean: http://www.royalcaribbean.com/allaboutcruising/accessibleseas/otherNeeds.do

Top Ships for Cruisers with Disabilities: http://www.cruisecritic.com/articles.cfm?ID=105

Please help us keep this list current. If you are aware of an updated policy, please contact us at:ExecOffice@homeoxygen.org

HAVE A GREAT TRIP!

Air Travel With Portable Oxygen Concentrators

What You Need to Know About Flying With POCs.     By Nancy Parode, About.com Guide

While the Air Carrier Access Act obliges air carriers in the U.S. to accommodate passengers with disabilities, there is no regulation requiring airlines to provide medical oxygen during flights. Oxygen is considered to be a hazardous material, and airlines will not allow passengers to carry it onto an airplane. While airlines may, if they wish, provide supplemental medical oxygen, most do not, and the few who do (American Airlines, United Airlines and Alaska Airlines, as of this writing) assess per-flight segment setup charges for oxygen service.

Airlines may, however, allow passengers to bring portable oxygen concentrators (POCs) onto airplanes, as explained in Federal Aviation Administration (FAA) Advisory Circular Number 120-95 and Special Federal Air Regulation (SFAR) 106. These documents spell out the requirements for POCs and explain what air carriers may and may not require from passengers who need supplemental medical oxygen during all or part of their flights.

If you are taking an international flight, you may need to comply with two sets of regulations – for example, U.S. and Canadian rules – and you should contact your airline to be sure you understand all the procedures you must follow.

Approved Portable Oxygen Concentrators

If you need supplemental medical oxygen and plan to fly, you'll need to make sure your POC is on the FAA's approved list, which is published in SFAR 106. As of January 7, 2009, the FAA has approved the following portable oxygen concentrators for in-flight use:

AirSep Lifestyle

AirSep Freestyle

Delphi RS-00400

Inogen One

Invacare XPO2

Respironics EverGo

SeQual Eclipse

Portable Oxygen Concentrator Use

While FAA regulations do not require that you tell your air carrier about your POC in advance, nearly all airlines ask you to notify them at least 48 hours before your flight that you intend to bring a POC onboard. Some air carriers, such as Southwest and JetBlue, also ask you to check in for your flight at least one hour before takeoff.

In order to bring your POC onto the airplane with you, you'll need to furnish a copy of a physician's statement to your airline. You should check with your airline to find out whether you'll need to use a special form. Most air carriers require the statement to be written on your doctor's letterhead. Some, like American, AirTran and Delta, expect you to use their form. If you're flying on a code share flight, be sure you know the procedures for both your ticketing airline and the air carrier actually operating your flight.

The physician's statement must include the following information:

A statement about your ability to see, hear and respond to the warning signals on your POC, which are typically flashing lights and audible alarms. You must be able to understand the warning alarms and respond to them without help.

A description of your oxygen requirements – do you need medical oxygen during the entire flight, or only under certain conditions?

A statement describing the maximum oxygen flow rate you require while the aircraft is in flight.

FAA regulations also describe where passengers using POCs may sit and where they must stow their POC. Passengers using POCs may not sit in exit rows, nor may their POCs block another passenger's access to seats or to the airplane's aisles. You must be able to see the alarm lights on your POC when it is stowed. Ideally, you should keep your POC under the seat in front of you.

Powering Your Portable Oxygen Concentrator

Air carriers are not required to let you plug your POC into the airplane's electrical system. You will need to plan ahead and bring enough batteries to power your POC for your entire flight, including gate time, taxi time, takeoff, in-air time and landing. Almost all U.S. air carriers require you to bring enough batteries to power your POC for 150 percent of "flight time," which includes every minute spent onboard the aircraft, plus an allowance for gate holds and other delays. You will need to contact your airline to find out what your flight time will be, add in a reasonable estimate for delays and transfer times, and multiply that time by 150 percent.

Extra batteries must be carefully packed in your carry-on luggage. You must ensure that the terminals on the batteries are taped or otherwise protected from coming in contact with other items in your bag. (Some batteries have recessed terminals, which do not need to be taped.) You will not be allowed to bring your batteries with you if they are not packed properly.

Your POC and extra batteries are considered medical devices. While they will need to be screened by TSA personnel, they will not count against your carry-on baggage allowance.

Renting Portable Oxygen Concentrators

Several companies rent FAA-approved portable oxygen concentrators. If your POC is not on the FAA-approved list, you may wish to bring it along for use at your destination and rent a POC to use in-flight. Two companies that rent FAA-approved portable oxygen concentrators in the U.S. are OxygenToGo and Advanced Aeromedical.

The Bottom Line

The secret to successful travel with a portable oxygen concentrator is advance planning. When you begin to research flights, take a look at each airline's POC requirements. Notify your air carrier that you intend to bring a POC with you as soon as you book your flight. Make sure you understand how soon before your flight your physician should write the required statement (United has particularly restrictive rules) and whether it has to be on letterhead or an airline-specific form. Check on the length of your flight and be generous with your estimate of possible delays, particularly in winter or during peak travel times, so you will bring enough batteries with you.

By planning ahead and preparing for delays, you'll be able to relax both during your flight and at your destination.

Useful links

LUPUS

Great info about Lupus which often causes lung problems
http://www.Lupuscheck.com

http://blaminglupus.com/category/blaming-lupus-blog

http://thebutterflyprojectfoundation.blogspot.com/


IPF
http://ipftoday.com/news

http://studynursing.blogspot.com/2009/10/pulmonary-symptoms.html

http://ipftoday.com/blog1/2013/06/12/may-24-2013-reflux-medicine-boosts-survival-in-lung-disease/

http://www.lung.org/lung-disease/copd/connect-with-others/better-breathers-clubs/ 

I don't know if this works or the price but next week, at Pulmonary therapy, 
we are trying out their vest which supposedl vibrates the mucous out of the lungs
http://coughassistt70.respironics.com/patients/clearing_your_airways.html

GENERAL

Patientslikeme.com.    A site to connect with other people with the same illness you are dealing with.

~ A Break From Exercise. ~

If you're living with Chronic Obstructive Pulmonary Disease (COPD) or another chronic lung disease, you know it’s important to exercise, but did you know that sometimes it’s best to take a break? It’s true – you don’t want to overdo it because you could cause more harm than good. Here are some COPD exercise precautions from the Cleveland Clinic to help you know when to take it easy.

∙ Changes in medicine: Before you continue with your regular exercise program, talk to your doctor about how your new medicine might affect your ability to be physically active. Ask for advice regarding walking, jogging, swimming or other exercises that interest you.

∙ Feeling overly tired: Avoid exercising that day, or at least exercise at a lower level of exertion, if you feel more tired than usual. Pace yourself and slow down if you feel fatigued.

∙ Feeling ill: If you have a fever or aren't feeling well, don’t exercise.

∙ After a period of inactivity: After a few days of not exercising, start up your routine slowly to get your body used to it again.

∙ Isometric exercises: Isometric workouts involve straining muscles against other muscles, such as when doing pushups and sit-ups. Avoid these types of exercises when living with COPD.

∙ Outdoor workouts: Getting outside is great, but avoid outdoor workouts when it’s too cold or too hot and humid. When these conditions exist, stick to indoor activities, such as walking around the mall.

∙ Certain activities after exercise: Avoid lying down after working out because it reduces exercise tolerance. Also, don’t take a very hot or cold shower after working out.

∙ Steep inclines: Avoid hills when walking outside. If a hilly area is your only option, take it slow and keep tabs on your heart rate.

∙ Irregular heartbeat: Rest and get your heart rate back down. Check your pulse after 15 minutes and call your doctor if it’s still above 120 to 150 beats per minute.

∙ Feeling pain: If you feel chest pain or discomfort elsewhere, stop that activity. Ask your doctor for guidelines about “reading” your body.

Mucus or phlegm

Mucus or phlegm, is a sticky, thick substance that develops in your respiratory system when you have a cold, the flu, allergies or serious medical conditions such as cystic fibrosis or emphysema. While foods alone don't typically cause mucus, particular foods and beverages may make your symptoms worse. Getting sufficient rest, eating a nutritious diet and following your doctor's treatment recommendations, when applicable, are also important. If your symptoms are severe, unexplainable or long-lasting, seek medical guidance.

DAIRY PRODUCTS

While dairy products are valuable sources of protein and nutrients, such as calcium and vitamin D, they may contribute to mucus buildup. Drinking milk, for example, may make mucus thicker and more bothersome, according to MayoClinic.com. Dairy products are also potential food allergens, which may trigger mucus production in some people. For best results, limit or avoid milk, yogurt, cottage cheese, hard cheeses and foods prepared with dairy products, such as cheese-topped pizza, creamy soups, pasta Alfredo, cheesecake, pudding and creamy beverages such as hot chocolate and lattes.

GLUTEN

Gluten is a storage protein found in wheat, barley, rye. Gluten may trigger mucus production if you have cystic fibrosis, according to the University of Maryland Medical Center. The same may hold true if you have a gluten-intolerance or wheat allergy. If you suspect a correlation between gluten-containing foods, such as most commercially-prepared breads, bagels, tortillas, crackers, pretzels, pizza crust, pie crust, stuffing, cereals made with wheat, bran, rye or barley, and your symptoms, try replacing these foods with gluten-free carbohydrate sources such as potatoes, rice and corn or rice-based cereals. Since gluten is prevalent in countless foods, seek guidance and support from your doctor for best results.

RED MEAT

Red meat, particularly high-fat red meat, may also contribute to mucus buildup. Unless you have cystic fibrosis and require a high-fat, high-calorie diet, limiting red meat may help reduce your symptoms. According to Robert J. Green, natural health practitioner and author of "Natural Therapies for Emphysema and COPD," red meat, liver, poultry fat, egg yolks and processed meats, such as bacon and sausage, are particularly problematic for people with chronic obstructive pulmonary disease (COPD) --- one of the most common lung diseases. He explains that animal-derived protein can trigger or exacerbate your body's inflammatory response, regardless of your illness, and heighten mucus production and other symptoms such as pain, fever and exhaustion. Replace these foods with plant-based protein sources, such as legumes or fatty fish, which may reduce inflammation, for heightened benefits.phlegm, is a sticky, thick substance that develops in your respiratory system when you have a cold, the flu, allergies or serious medical conditions such as cystic fibrosis or emphysema. While foods alone don't typically cause mucus, particular foods and beverages may make your symptoms worse. Getting sufficient rest, eating a nutritious diet and following your doctor's treatment recommendations, when applicable, are also important. If your symptoms are severe, unexplainable or long-lasting, seek medical guidance.