I am a single mother, aged 45, just dia­gnosed with emphysema from smoking. I find it impossible to go out­side in cold weather since my chest feels so tight. I get breath­less doing every­day jobs such as vacu­um­ing. I used to be very act­ive. I have no car and little money. Could you give me some advice?

To keep the worst effects of your emphysema at bay and have a reas­on­able qual­ity of life, you’ll need to take a life-​long approach to man­aging your dis­ease. If you can hold on to a pos­it­ive out­look and be self-​disciplined about your life­style, you will feel and stay much health­ier.

Emphysema gradu­ally des­troys the tiny ves­sels in the lungs that fil­ter oxy­gen into the blood­stream, mak­ing it ever harder to get enough oxy­gen to allow the body to work effi­ciently. Not only is breath­ing hard work, but so is everything else because muscles that are starved of oxy­gen are like a car run­ning on empty: they simply can’t func­tion. So you end up feel­ing exhausted after the smal­lest bit of effort.

One of the most fright­en­ing aspects of a lung dis­ease such as emphysema is the extreme breath­less­ness that can make you think you are suf­foc­at­ing – lit­er­ally gasp­ing for breath. As you have no doubt begun to real­ise, your lungs will find cer­tain envir­on­ments much harder going than oth­ers, so try to avoid extremes of tem­per­at­ure or humid­ity and keep away from dusty, smoky or pol­luted places.

Your GP may be able to help in two spe­cific ways. First, ask if you could be referred to a physio­ther­ap­ist who can advise you on good breath­ing tech­niques and exer­cises. Even if you are breath­ing rel­at­ively nor­mally now, this dis­ease tends to change the way you breathe, from deep and relaxed to shal­low and tight breath­ing, which is not help­ful. Early advice can help you get good breath con­trol, which in turn can reduce stress and anxi­ety.

Second, ask if your GP will put you on an “exer­cise refer­ral” scheme. This will give you access to a qual­i­fied instructor and gym at very low cost. It is essen­tial that you now start to develop a life-​long exer­cise habit, in order to pre­serve as much fit­ness and energy as you can. Don’t be fooled: activ­ity may make you more tired at first, but inactiv­ity will rap­idly weaken your body and leave you feel­ing much worse.

Lung dam­age often con­trib­utes to heart con­di­tions fur­ther down the line, so your num­ber one exer­cise pri­or­ity should be car­di­ovas­cu­lar ( aer­obic) activ­ity, such as cyc­ling, a row­ing machine in the gym or brisk walk­ing (tread­mill or out­doors). At first you may only man­age a couple of minutes, but this should improve over time, with prac­tice and expert guid­ance from your instructor.

Swimming can also be great, but it will depend on whether your lungs can tol­er­ate the humid­ity and/​or chem­ic­als (eg chlor­ine) in the pool.

Strength work, espe­cially for your back, chest and arm muscles, will help, as will flex­ib­il­ity exer­cises. You will also cope much bet­ter if you are not over­weight and eat­ing nutri­tious food.