Author Archives: Jackie Aim

Oral steroids and side effects

Prednisolone tablets

If you are prescribed oral steroid tablets these will be a higher dose than the inhaled form. For this reason they are prescribed in short courses rather than continually. If you are prescribed a course of oral steroids you should complete the course or seek advice from your doctor or asthma nurse if you have any side effects.

If you have any of these conditions and you notice a change after taking oral steroids, tell your doctor.

Stomach ulcers – tell your doctor if you have stomach pains.
Weight gain.
Muscle weakness.
Blood clots.
Cushing’s disease.
Hypothyroidism.
Glaucoma.
Skin thinning or bruising.
A serious infection you have not had treated.
Herpes infection of the eye.
Intolerance of some sugars (e.g. galactose or lactose).
If you develop an infection or come into contact with someone who has chicken pox, shingles or measles speak to your doctor. Steroids may reduce your body’s ability to defend against these infections.

Information

It is important that your healthcare team review your medication on a regular basis to ensure you are on the correct treatment to minimise the risk of long term effects.

Information on other side-effects can be found in the Patient Information Leaflet in the pack of your medication or through the following website: Medicines.org – eMC.

Practical tips from people living with COPD

The following are quotes and tips from people like you living with COPD;

A chum from our group came with me to see a lawyer about the legal stuff – it helped.

Once I had talked about it (and done the forms!) – I felt so relieved – I could then forget about it all.

I found starting with the practical stuff (wills, funeral plan, power of attorney) made it then easier to talk about the harder stuff (treatment interventions, emotional).

I started the discussion with my family by emailing them some links to good websites and saying I wanted to talk about stuff on them.

Don’t wait until you are ill to talk about the tricky stuff – do it well ahead.

Difficult conversations – tips from people who are living with COPD

The following quotes and tips are from people like you who are living with COPD.

It’s hard but …. talk to your family about your future and what you want to happen when you are ill.

If it’s too hard then write letters to people instead.

Make sure you have someone to talk to – sometimes not a family member is best – friend, minister, advice line…

I couldn’t speak to those I love best at first – we spoke at our group about it and then it was easier.

Making choices – tips from people who are living with COPD

The following quotes are from people like you who are living with COPD.

Just ask them (health care staff) how this diagnosis will affect your life span (and reassure them you really want to know).

Don’t wait until you are ill to talk about the tricky stuff – do it well ahead.

I found starting with the practical stuff (wills, funeral plan, power of attorney) made it then easier to talk about the harder stuff (treatment interventions, emotional).

I couldn’t speak to those I love best at first – we spoke at our group about it and then it was easier.

It’s hard but …. talk to your family about your future and what you want to happen when you are ill.

What is asthma control?

Good asthma control	Difficult to control asthma
No daytime symptoms. No night time awakening due to asthma. No need for rescue medications. No exacerbations/flare ups. No limitations on activity including exercise. Normal lung function (FEV1 and/or PEF >80% predicted or best) with minimal side effects.	Persistent symptoms. Frequent exacerbations or flare ups. Reduced lung function and may have changes to structure of the lungs. Little improvement despite high doses of asthma treatment.

A small proportion of people with asthma, around 5%, will still have difficulty controlling their asthma even though they are following all the advice and taking all the medication correctly. This can be very challenging for you and your respiratory team. Referral for specialist hospital review and further specialist testing is sometimes required.

Self management

Take careful notes of when your asthma is at its worst or any conditions which increase your symptoms. This information can be useful for the specialist team to pin point causes. Working in partnership with your asthma team is key.

Reliever – tablets

Theophylline tablets and capsules

Theophylline tablets or capsules are used to open the airways. Theophylline is used less often than inhalers. This is because there are many other medicines and substances (e.g. smoking and alcohol) and some other medical conditions which interact with it, affecting how theophylline works in your body.

Side effects from theophylline can occur quite quickly if the dose is not at the right level in your body, for example: nausea, sickness, diarrhoea, palpitations and headaches. Sometimes you will have blood tests to check the level of theophylline in your blood. This will make sure theophylline is at a safe level for your body.

If used as directed alongside inhaled bronchodilator and steroids, theophylline can provide relief for asthma which has not been well controlled using inhalers alone. The medicine is usually taken every 12 hours and it is important that the tablets are swallowed whole and not chewed. Theophylline is in a slow release form and chewing the tablets would prevent slow release. The capsules can be swallowed whole or the pellets which are inside the capsule can be emptied out and swallowed with soft food such as yoghurt.

The medicine will be prescribed by brand and you should stick with the same brand of theophylline each time, for example

Nuelin SA tablets.
Slo-phyllin capsules.
Uniphyllin Continus tablets.

Your pharmacist will know this and ensure you get the same brand when dispensing your prescription.

Self management tips from people living with COPD

Female therapist laughing with 2 male members of the pulmonary rehabilitation class

The following quotes are from people like you who are living with COPD. They are talking about self management and what works for them.

Try and go to bed each night feeling you’ve achieved something and if you feel you haven’t then promise (to yourself) to do something tomorrow.
Don’t get stuck thinking about what you can’t do – remember and celebrate what you CAN do.
Having something to look forward to each day gives me impetus. (goal setting)
Dreams can become reality – or at least bits of them can! So dream of what you want to do and go for it…..
Remember the Tortoise and the Hare story – go canny to win!
There is always something you can do – remember wee steps to success.
Remember the less you do – the less you want to do!
Tiredness can be your body telling you to get up and do something.
Doing things with someone helps – you promise to do it – so you stick to the plan as you don’t want to let them down!

How hard should I exercise

How hard do you push yourself? Rate yourself on the scale below
Scale		Definition
	0	Completely normal
	1	Very slightly breathless
	2	Moderately breathless
	3	Hot and moderately breathless
	4	–
	5	Hot and somewhat severely breathless
	6	–
	7	Hot and severely breathless
	8	–
	9	–
	10	Couldn’t be more hot and breathless

You should aim to work at a moderate level. When working at a moderate level you will be warm and short of breath to the point you would not be able to sing but still able to complete a short sentence. This equates to somewhere between 3 and 5 on the scale.

Visual relaxation

Park scene showing a group of people walking and cycling

Visualisation relaxation is another way to help you feel calm and relaxed.

This relaxation is used to create a picture in your mind. We all daydream sometimes or we let our thoughts wander. You can use this skill to create a pleasant relaxing image. This helps to relax your body and distract you from any worries you may be feeling. If you are focused on your ‘visual picture’ in your mind, you cannot focus on your worries and stresses.

Everybody will have their own special picture which may help them to feel relaxed such as:

A walk in the woods or sitting by a loch.
Lying on a beach on a sunny deserted island.
A picnic in a meadow.
Sitting beside an open fire.
Looking out over a favourite view.
Baking in the kitchen, with the scent of bread or cake coming from the oven.
Sometimes you might find it more pleasant to recall a favourite childhood memory.

Only you know what image helps you to feel relaxed. It will help to image as much detail about your special place as possible.

Listen to the audio clip. You can also download this clip to your laptop, desk top , tablet or mobile phone. (click the arrow on the right below the words sound cloud to download) You could also print off the transcript but do not try to read as you are trying to relax, just listen to the instructions on the clip.

Duration: 13 minutes 19 seconds
Voiceover: Grainne O’Brien, Specialist Psychology Practitioner, NHS Lothian

View audio transcript

In this relaxation exercise we are going to be creating an image in our mind, taking a journey to a beach. It doesn’t matter if your mind wanders, just try and bring it back to my voice and the image we are creating…… To begin, I would like you to spend a little time getting into a comfortable position……..Loosen any tight clothing you may be wearing………..uncross your arms and legs…..Allow your body to sink into the chair, the bed or whatever is supporting you……
Once you are in a comfortable position, I would like you to close your eyes or gently lower your eyelids so your eyes are facing the floor towards the floor, whichever you are more comfortable with…………
Now bring your attention to your body……Relax your body by releasing any areas of tension…… take some time to scan your body and notice where your tension lays……..Feel your arms and legs becoming loose and relaxed……..Enjoy the feeling of resting, of being completely supported……… ..Make sure that your jaw is loose, that your teeth are not clamped together……….let your lips be slightly parted…..bring your attention to your shoulders and allow them to drop down away from your ears. It might be easier to shrug your shoulders up towards your ears and then let them fall down….. releasing any tension from your shoulders,… your upper body…….. and your lower body….. (longer pause)
Now we are going to focus on the breath. Bring your focus to your breathing, follow the breath as it comes in and out of your body……..(breathe out on tape….) …….observe the rhythm of your breathing…. You may want to try to breathe out for longer than you breathe in…… As you breathe out imagine your body growing limp and heavy. Each time you breath out imagine that you are letting tension flow out of your body and mind……… As you breathe in you can think “I AM…..” and as you breathe out, “RELAXED”, Try to get an even rhythm, with nice slow gentle breaths. “I AM ….RELAXED”……………………. (longer pause)

Remember- It doesn’t matter if your mind wanders as you are doing this exercise -….., just remember that this relaxation is for you, and bring your mind calmly back to the picture….
Feel your body giving up all tension…..becoming more relaxed…….and calm….. peaceful…………Now that your body is feeling a little more relaxed, I want you to imagine you are sitting on a bench looking out toward the ocean….. the weather is pleasant….you are feeling comfortable and warm…
You can hear the waves up ahead…. and smell the ocean spray…. the air is moist and warm…. you feel a pleasant, cool breeze blowing……
You look a little closer at the ocean…., you see the brilliant aqua colour of the ocean ahead….and feel the warmth of the sun upon your face……
There is a long stretch of smooth white sand…. The beach is wide and long and deserted….the sand is a very soft powder…. if you like you can imagine what the sand would feel like under your feet……, feeling the warm dry sand between your toes………
You hear the waves crashing to the shore….
And smell the clean salt water and beach….
You gaze again towards the water…. it is a bright blue-green….
See the waves washing up onto the sand….. and receding back toward the ocean…. washing up…. and flowing back down….. enjoy the ever-repeating rhythm of the waves…
The sand is warm……perhaps you notice the sensations upon your feet……………… as you get nearer to the sea, the sand becomes smooth, hard and damp….feel this new texture, the sand is completely smooth with only here and there a tiny glint of a pink shell………
You can feel the mist from the ocean on your skin…….and smell the salt in the air…….A wave washes over the sand towards you…. before receding….. more waves washing onto the sand and receding back………. …….
You notice the white sand under the water….completely smooth…. the water is a pleasant, warm temperature….
You decide to enjoy the ocean for a few moments….. notice how the sunlight dances on the water….. the warmth of the sun upon your face………..becoming more and more relaxed… allowing yourself to enjoy the ocean….
The sky is blue and clear of any clouds…….. you decide to enjoy this time out for a little longer…….. relaxing….. basking in the warmth of the sun on your body…….. listening to the rhythmic sound of the waves…….
You feel peaceful and relaxed…. allow all your stresses to melt away…. (longer pause)
Spend as long as you would like at this beach…. enjoying the sense of relaxation……..
when you are ready I am going to ask you to count from 5 to 1 in your own time and when you get to ‘1’ I want you to open your eyes….to stretch…..to yawn……. To slowly bring yourself back to the room….take your time……try to hold onto the sense of relaxation that you have created for yourself………………..

Simple relaxation

A woman stretching her arms out in front of her with her eyes closed

This form of relaxation uses the Mitchell method.

The technique gets you to focus your thoughts to be aware of what your body is feeling, where you are holding tension in different muscles and learning how to let go of that tension.

Listen to the audio clip. You can also download this clip to your laptop, desk top , tablet or mobile phone. (Select the arrow on right below the words sound cloud to download) You could also print off the transcript but do not try to read as you are trying to relax, just listen to the instructions on the clip.

Duration: 27 minutes 25 seconds
Voiceover: Louise Mason, Occupational Therapist, NHS Lothian

View audio transcript

I am going to talk you through a relaxation called simple relaxation.
Don’t try to do this relaxation if you have just eaten a meal.
When you choose to do it, think about the environment that you are relaxing in. Switch off any phones. Let other people know that you are about to relax so they don’t disturb you.
Think about your body. Think about if you are sitting or lying down. Are you comfortable? Are you well supported? Use extra cushions for support if needed.

Notice the points of contact that exist between your body and the chair / bed you are resting on.
Take time to settle your body, and your mind, for this period of relaxation.
You may still hear noises of life going on elsewhere, but put this to one side for just now and give yourself permission to take time out to practice relaxation.
You are going to work around your body, undertaking certain movements, slightly adjusting your positioning each time.

As you move through this relaxation exercise I will repeat each instruction for changing your positioning twice. Getting you to let go of the tension you may be feeling between each change in position.

Take time to notice and register your new position as accurately as you can, trying to concentrate on the new positions and how they feel. A more relaxed posture can be used to support more relaxed positioning at other times
Initially this will require concentration and practice, but it does become easier the more regularly you practice
Just remember The position of your body will vary each time you do the relaxation because each time you do it you will be starting from a slightly different position
What is important is the instruction to yourself. These instructions never change:
1. Move and Feel the release of tension
2. Stop
3. Feel the release of tension
4. Repeat once more
As you progress and feel comfortable practicing this relaxation you may wish to change the order in which you move around your body. This is ok, the important thing is to take your time to notice the relaxed position and to concentrate on what it feels like for you

I am going to start off at your feet and ankles and then slowly progress through your body.
So starting at your feet and your ankles,
MOVE and slowly push your feet away from your face. If sitting you may come onto the balls of your feet.
FEEL the stretch down the front of your legs and across your ankles. You may feel increased tension in the muscle at the back of your legs. Notice what that feels like.
STOP, and let your feet return to a comfortable position.
FEEL the slow release of tension in your muscles as they settle back into a comfortable position.

I am going to ask you to repeat that movement again.
MOVE and slowly push your feet away from your face. If sitting you may come onto the balls of your feet.
FEEL the stretch down the front of your legs and across your ankles. You may feel increased tension in the muscle at the back of your legs.
STOP, and let go, let your feet return to a comfortable position.
FEEL the slow release of tension in your muscles in your feet, around your ankles and in your lower legs as they settle back into a comfortable position. Take your time. Enjoy the sensation of your feet resting at the end of your legs.

I am now going to ask you to move your attention from your feet and your ankles to your knees and your thighs.
MOVE your knees, gently squeezing them together, and hold in this position.
FEEL the increased tension in the muscles of your thighs. Notice where you feel that increased tension.
STOP, and let go. Let your knees return to a comfortable position. Your knees may gently fall apart.
FEEL the slow release of tension in your thigh muscles as your legs settle back into a comfortable position.

I am going to ask you to do that once more.
MOVE your knees, gently squeezing them together, and hold in this position.
FEEL the increased tension in the muscles of your thighs. Notice where you feel that increased tension.
STOP, and let go. Let your knees return to a comfortable position. Your knees may gently fall apart.
FEEL the slow release of tension in your thigh muscles as your legs settle back into a comfortable position. Take your time. Enjoy the sensation of your legs relaxing.

I am now going to ask you to move your attention to your body. To your abdomen and your chest.
Gently MOVE, slowly pushing your body back into the support of the chair or the bed that you are on. Do that now. Just gently and slowly push your body back in to the support and feel the contact of your body against the support of the chair or the bed. Notice how the chair or the bed, how it feels supporting your body. Notice any increase in tension across your abdomen and chest, register how this feels.
STOP, and let go.
FEEL your body let go, and notice your body may slump forward slightly as you return to a comfortable position letting go of any tension you created. Gently move your body. Once your body is settled I am going to ask you to repeat this movement again.

Slowly pushing your body back into the support of the chair or the bed that you are on. Do that now. Just gently and slowly push your body back in to the support and feel the contact of your body against the support of the chair or the bed. Notice how the chair or the bed, how it feels supporting your body. Notice any increase in tension across your abdomen and chest, register how this feels.
STOP, and let go.
FEEL your body let go, and notice your body may slump forward slightly as you return to a comfortable position letting go of any tension you created. Let your body settle at rest.

I am going to ask you to take your attention to your shoulders. On your next outward breath gently
MOVE your shoulders. Let them drop towards your feet…. noticing any downward movement of your shoulders.
FEEL this movement, noticing it is a very small movement but your shoulders are further away from your ears. Notice how you feel in this position.
STOP, and let go.
On your next inward breath FEEL your shoulders bounce back slightly, trying to return to their starting position. This is perfectly natural.

I am going to ask you to repeat this movement so that on your next outward breath gently
MOVE your shoulders. Let them drop towards your feet…. noticing any downward movement of your shoulders.
FEEL this movement, noticing it is a very small movement but your shoulders are further away from your ears. Notice how you feel in this position.
STOP, and let go.
On your next inward breath FEEL your shoulders bounce back slightly, trying to return to their starting position. Just notice what this feels like around your shoulders, around your chest. As you breathe in and as you breathe out let your shoulders move slowly towards your feet, letting them relax.

I am now going to take your attention down from your shoulders down your arms to your elbows. Focus your attention to your elbows.

Gently MOVE your elbows out and open. Move your upper arms away from your body, not lifting them but FEEL the angle opening up at your elbows by moving your forearms away from your sides. Not a large movement, a small movement.
STOP.
FEEL your upper arms away from your body, and feel the wider angle at your elbows…. notice this new position, and then let go. Let your arms drop back to your sides.

I am going to ask you to do this once more.
Gently MOVE your elbows out and open. Move your upper arms away from your body, not lifting them but FEEL the angle opening up at your elbows by moving your forearms away from your sides. Not a large movement, a small movement.
STOP.
Let go and feel the difference in the position of your elbows now. Your elbows are no longer glued to your sides. There is a more open angle at your elbows.

DO NOT HURRY your way through this relaxation. Just take your time and notice the changes in your positioning and what this feels like.

I am now going to ask you to move your attention down from your elbows to your hands.
MOVE your hands, trying to keep your hand supported, gently stretch out your fingers long and wide. FEEL the space between each finger. Feel the stretch
STOP and let go. Let your hands rest, fingers long, resting against the support.
FEEL your fingers and thumbs stretched out and separated, touching the support of the surface they are resting on.

I am going to ask you to repeat this movement once more.
Stretch out your fingers long and wide. Feel that stretch across your palms and down your fingers. Then STOP and let go. Let your hands rest, fingers long. Take a moment to register the position of your hand. Register the space that is between your fingers. Take a moment to register what messages are travelling up through your fingertips to your brain. Pay attention to the texture of the surface that they are resting on. Is it rough or is it smooth? Is it warm or cool to the touch. Take a moment to notice what your fingertips are telling you that at other times of the day you are too busy to notice.

I am going to ask you now to draw your attention back from your hands, up past your elbows, back up to your shoulders. Don’t hurry, just take your time and notice what your body is telling you. Check the position of your shoulders. Are they still relaxed? Keep on moving up wards taking your attention to your mouth. You can carry a lot of tension around your jaw area without realising it.
Slowly MOVE your bottom jaw downwards, separating your lower teeth from your top teeth. As this happens you may feel the stretching of your skin over your cheeks.
STOP, and let go.
FEEL your separated teeth. Your lips may gently be touching or as you stop stretching your jaws may slowly return to their earlier position. Notice how this feels and let your tongue rest against your bottom teeth, noticing how this feels. Try to stop your teeth from clenching together.

I am going to ask you to repeat this movement again.

Slowly MOVE your bottom jaw downwards, separating your lower teeth from your top teeth. As this happens you may feel the stretching of your skin over your cheeks. Notice any changes you feel around your mouth and jaw.
STOP, and let go.
FEEL your separated teeth. Notice the position of your lips. They may gently be touching or as you stop stretching your jaws may slowly return to their earlier position. Notice how this feels and let your tongue rest against your bottom teeth, noticing how this feels.

I am going to ask you now to move your attention to your eyes.
MOVE – If you haven’t already done so, and you now feel safe enough to do so, gently close your eyes. FEEL your upper lids resting gently over your eyes.
STOP.
FEEL your eyelashes gently resting together; let your eyes and the associated muscles rest.

I am going to ask you to repeat this movement again.
Gently let your eye lids rest closed. Feeing your upper lids resting over your eyes. STOP. Notice what this feels like. Notice what it feels like with your eyelashes gently resting together. Enjoy the peace you have created.

Now think about moving your attention to the area above your eyebrows to your forehead. Think about gently smoothing away any frowns or worry lines. Trying to move away any stress or tension from this area with each outward breath. Breathing in and breathing out. Slowly moving the tension over the top of your head and feeling a smoothing sensation at the back for your neck. STOP, Take a moment. Feel the smoothing action across your forehead. Over the top of your head and down your neck.

Try this again. Think about gently smoothing away any frowns or worry lines. Move any of the stress or tension away from your forehead. Breathing in and breathing out. Slowly moving the tension away from your forehead. Take your time and enjoy this sensation.

Coming to the end of this relaxation. Take a moment to think about your breathing. Do not try to change the rate or the depth of your breathing but just notice the gentle rise and fall of your chest and your ribcage on each breath. Feel your lower ribs move gently outwards and upwards as you breathe in. As you slowly breathe out your ribs return to the starting position. Repeat this as many times as is helpful for you. Take your time. Use your outward breath to breathe out any hot spots of tightness or tension that you have found in your body. Take time to check over your body, repeating any or all of these movements as you see fit. Take your attention to the parts of the body where you feel the most tension. Use the change in position to help you relax. Make time to practice this relaxation on a regular basis. Remember, never rush from relaxing to standing and moving around. You have slowed your body down. Gently stretch to get your body moving. Stretch your fingers, rock your feet back and forward. Get your body slowly moving again. This is important after you have slowed your body down to prevent and dizziness.