Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airflow limitation, making breathing increasingly difficult. This disease includes chronic bronchitis and emphysema, affecting the airways and air sacs. Because COPD causes persistent shortness of breath, managing symptoms often includes non-pharmacological interventions like proper body positioning. Optimizing a resident’s position can significantly improve breathing efficiency and overall comfort by using gravity and mechanics to the body’s advantage.
Positioning for Acute Breathlessness
When a resident with COPD experiences a sudden increase in shortness of breath (dyspnea), the immediate goal is to stabilize the upper body to help the lungs expand. The most effective position for rapid relief is often the Tripod Position. To achieve this while sitting, the resident should sit on the edge of a chair and lean the upper body forward at roughly a 45-degree angle.
The hands or elbows should rest on the knees or a stable surface, such as a table or chair arms, to provide support. This stabilizes the shoulder girdle, allowing the chest and neck muscles to focus on pulling the rib cage up and outward for breathing. A variation involves leaning forward while standing, resting the hands on a countertop or wall. This forward lean helps the diaphragm descend, increasing the volume of the chest cavity for better air exchange.
Positioning for Rest and Sleep
Positions for rest and sleep focus on sustained comfort and preventing symptoms from worsening when lying down. Elevating the head and upper body is necessary to allow gravity to assist in diaphragm movement and reduce pressure on the lungs. This is typically achieved using the Semi-Fowler’s or High-Fowler’s position in a bed.
The Semi-Fowler’s position raises the head of the bed to a 30 to 45-degree angle, while High-Fowler’s raises it further to 60 to 90 degrees. This upright angle prevents abdominal organs from pushing against the diaphragm, which occurs when lying flat. For residents who prefer side-lying, a lateral position with the head elevated and a pillow supporting the chest and neck can be used. Side-lying may also promote the drainage of mucus.
Understanding the Mechanical Advantage
The physical positions recommended for COPD optimize the mechanics of respiration, particularly the function of the diaphragm. When a person with COPD is upright or leaning forward, gravity helps pull the abdominal contents downward. This downward pull allows the diaphragm, which is often flattened and less efficient due to lung hyperinflation, to move further down when contracting.
The increased downward movement of the diaphragm creates a larger space within the thoracic cavity for the lungs to expand, maximizing inhaled air volume. Furthermore, forward-leaning positions stabilize the upper body, shifting the function of accessory breathing muscles. Muscles like the pectoralis major and minor can then lift the rib cage more effectively to assist with inhalation, rather than being used for postural stability. This mechanical shift reduces the overall work of breathing, conserving the resident’s energy.
Practical Aids and Safety Considerations
Implementing proper positioning relies on simple tools to maintain stability and comfort. Wedge pillows or specialized body positioners can be used in bed to maintain the Semi-Fowler’s position and prevent sliding. For residents in long-term care settings, adjustable hospital beds allow caregivers to easily change the head-of-bed angle for optimal breathing.
Caregivers must ensure that positioning aids do not restrict the resident’s chest or abdomen, which would limit diaphragm movement. Frequent repositioning, even slight adjustments, is required to prevent skin breakdown and pressure injuries when the resident is confined to bed or a chair. While positioning helps manage symptoms, it is not a substitute for prescribed medications or oxygen therapy, and any worsening of breathlessness requires prompt medical attention.