The repeated sirens and the tense security reality have these days become part of daily life in Israel. For more than a week now, many Israelis have been trying to navigate their lives between an emergency situation and a certain routine. For everyone this is a difficult and not simple period, but for people living with chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis and other lung diseases, this reality may become truly difficult and sometimes even unbearable. While most people mainly experience stress and mental pressure, among patients with lung diseases the situation may significantly complicate breathing and daily coping.
In Israel, nearly one million people live with chronic respiratory diseases of varying degrees of severity. This is a large group of patients for whom stress, sirens and physical exertion may also affect breathing. Some of them are forced to go down three or four times during the night to the shelter or to the parking lot near their place of residence. When this reality has already lasted almost two weeks and the end is still not visible on the horizon, a real concern arises about a deterioration in the condition of many patients.
The haze or the sirens – What causes an increase in symptoms?
It is known that stress is one of the factors that can lead to asthma flare-ups. The connection has been proven in various studies, and many patients describe it very clearly – when they experience significant mental stress or anxiety, their asthma goes out of balance. However, it is important to say honestly that even for us as physicians it is not always simple to separate between the different causes of the shortness of breath that the patient experiences. We are at the beginning of the campaign and therefore it is still too early to know whether there will be a real increase in flare-ups of respiratory diseases following the war.
In addition, in the recent period there were also other significant environmental factors, headed by the heavy haze that prevailed for many long days. For lung patients, and especially for patients with advanced respiratory disease, haze may cause severe and even life-threatening flare-ups. Polluting particles that remain in the air for several days can cause a significant deterioration in the respiratory condition and lead to flare-ups of asthma and chronic obstructive pulmonary disease.
Breathing exercises to ease the pressure
The connection between the respiratory system and states of stress and anxiety is very deep. In fact, the respiratory system is one of the first systems that responds to stressful situations. When the body experiences fear or stress, the sympathetic nervous system goes into action. The heart rate increases, the muscles contract and the breathing pattern also changes. Many people begin to breathe faster and sometimes also more shallowly.
In such situations people may feel that they are not able to get enough air into their lungs. This feeling can itself be stressful, and sometimes may even further increase the feeling of anxiety. Among people coping with chronic obstructive lung disease these sensations may be stronger, because a rapid breathing rate may lead to a mechanism of overinflation of the lungs (hyperinflation) and worsen shortness of breath.
Precisely because of the close connection between breathing and the nervous system, breathing can also serve as an important tool for calming down. When we slow the breathing rate and consciously deepen it, we activate the parasympathetic system (the system responsible for calming and balancing the body). Slow and deep breathing can help reduce the feeling of tension and gradually return the body to a calmer state.
It is important to emphasize that breathing exercises do not treat the lung disease itself, but they can certainly help in situations of anxiety or pressure that worsen the feeling of shortness of breath. For many patients, conscious control of the breathing rate can ease the sensation and help coping in moments of stress.
Stress or worsening of the disease – How can you tell?
One of the questions that repeatedly arises among patients is whether the shortness of breath they experience stems from the disease itself or from mental stress. The answer is that it is not always possible to distinguish between the two unequivocally, but sometimes there are characteristics that may guide us. When shortness of breath is related to mental stress, many patients describe a feeling of difficulty דווקא in getting the air in, as if something “closes” or presses on the chest and they are not able to get enough air in. In contrast, in obstructive diseases such as asthma or chronic obstructive pulmonary disease (COPD) the difficulty may be expressed in getting the air out of the lungs, and sometimes wheezing during breathing also accompanies it.
In any case, in the event of respiratory deterioration – one should contact the treating physician or an emergency center for evaluation. If it is a flare-up of asthma or chronic obstructive pulmonary disease, the treatment will include adjustment or increase of inhaler dosage, treatment with bronchodilators via inhalation, and sometimes also treatment with steroids, according to the treating physician’s instructions and the patient’s personal treatment plan.
Beyond the mental stress, for some lung patients the most significant challenge these days is actually physical – the ability to reach a protected space during a siren. A patient who sat with me only a few days ago told me that he lives on the seventh floor of a building without an elevator. In order to reach the shelter he needs to go down seven floors, and then climb them back up again. He told me simply: “There is no chance I can manage to do that. I sit at home and hope an Iranian missile does not hit me”. It is a moment that is difficult to forget as a physician, and it illustrates how complex the security reality is for some of our patients.
From physical activity to adherence to treatment
Patients with respiratory diseases need to prepare in advance for situations like these. One of the most important things is to make sure that the inhaler is within reach when entering a protected space. It is not always possible to know how long the stay in the shelter will last, and therefore it is important to arrive with all the necessary medications. In addition to the regular inhaler, it is recommended to also keep an inhaler for immediate relief. It is also advisable to ventilate the protected space (a fortified room or shelter) from time to time, between sirens, in order to allow ventilation and removal of dust and polluting particles from the closed space.
It is always important to adhere to the regular medication treatment, and especially during emergency periods. The regular treatment – inhalers taken several times a day or biological medications given by injection once every few weeks – should continue as usual. If there is a feeling that the disease is going out of balance, it is important to contact the treating physician and not postpone the examination.
In addition, it is very important to maintain a routine and physical activity as much as possible. When people stay at home for long periods without any physical activity, there may be functional deterioration. Even light physical activity inside the home can help maintain fitness and functioning.
Precisely during periods of stress it is important to continue the regular treatment, to be attentive to breathing and to maintain routine and activity as much as possible. For lung patients, even during complex periods like these – maintaining balance of the disease is critical.
Tips for lung patients during periods of sirens and stress:
1. Keep the inhaler within reach
When entering a protected space it is important to take with you the inhalers and regular medications. It is recommended to also keep an inhaler for immediate relief, in case of shortness of breath during the stay in the shelter.
2. Continue the regular treatment as usual
During emergencies – there are no instructions to change the medication treatment. It is important to continue taking the inhalers and medications according to medical instructions. If a worsening of symptoms appears, it is advisable to contact the treating physician.
3. Use breathing exercises for calming
Stress and anxiety can worsen the feeling of shortness of breath. Slow and deep breathing can help calm the body and ease the sensation.
4. Try to maintain movement and activity
Prolonged stay at home and lack of movement may impair functioning. Even light activity at home – a short walk or simple exercises – can help maintain fitness and functioning.
The author is a pulmonology specialist at Shamir Medical Center – Assaf Harofeh.