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34 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 9 energy in the effort of breathing. A person with advanced COPD puts closer to 50 percent of resting energy into this job and must do this every minute, 24 hours a day. For this reason, both eating and sleeping become extremely challenging. As the condition progresses to emphysema, shortness of breath, wheezing, and rales (a characteristic bubbling, rasping sound of air moving through a narrowed passage) may occur. The patient may develop a habit of pushing air out through pursed lips; this is an attempt to push against increasing back pressure in the lungs. The diaphragm becomes permanently flattened, which forces the abdominal organs downward. Some people with COPD develop "barrel chest" (that is, the intercostals hold the rib cage out as wide as possible). TREATMENT FOR COPD COPD is irreversible. If it is diagnosed and treated early, further progression can be slowed or stopped, but damaged lung tissue does not regenerate. The first course of action in treating COPD is to remove any irritating stimulus, which is usually cigarette smoke. Medication can dilate the bronchi and take pressure off the alveoli, remove mucus and edema from the lungs, and ward off potential lung infections. Long- term steroidal anti-inflammatories carry a number of possible side effects, however. Patients are strongly urged to be vaccinated against pneumococcus pneumonia and to get a yearly flu vaccine, because they are at higher risk for serious lung infections than the general population. Oxygen supplementation may be recommended during sleep or following exercise. In addition, doctors may prescribe continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) devices. Lung volume reduction surgery removes damaged portions of the lung. This increases thoracic capacity and improves cardiovascular function. Lung transplants are a last-ditch option that has been successful for some patients; emphysema is the leading reason for lung transplants. CAN MASSAGE THERAPY HELP? Logic suggests that massage therapy may help people with COPD by reducing unnecessary tension in thoracic muscles to allow for easier breathing. Stimulating local circulation in the extremities might also be helpful for people who live with this condition. Maybe tapotement over the chest could help loosen sticky mucus so it can be coughed away. In addition, massage may be a useful adjunct to whatever exercises patients might be given to help preserve and prolong lung function. The science supports this logic, up to a point. A recent review of seven research articles came to the conclusion that "manual massage therapy" can be a useful option for people with stable COPD when offered alongside physical therapy and exercise (Polastri et al., 2019). Specifically, they found predictable benefits in forced expiratory volume, the perception of dyspnea (shortness of breath), and improvement in 6-minute walking tests. They also found that it was impossible to draw any stronger conclusions because of the scarcity of consistent findings in good- quality research about this question. A different project found more benefit: this study looked at 12 patients who received a single session of a "soft tissue massage therapy protocol" (Cruz-Montecinos et "Clients with advanced COPD cannot lie prone or supine. Even side-lying can be hard, because their shoulder muscles are often really painful. Also, if they have taken a lot of steroids to manage inflammation, their bones will be porous and brittle. I have found it's best when I just work with clients on a regular chair—not even a massage chair. They sit, and if they want, I give them a big pillow and they can lean forward against my table. They don't want pressure on their sternum. The body mechanics are harder on me, but people with advanced COPD can only take 10–15 minutes of massage at most." "For many of us with lung disease, some essential oils can trigger a coughing attack and an allergic reaction that causes a tight chest, difficulty breathing, and swelling and redness of the face or body where it's applied. This happened to me when a massage therapist gave me a neck and shoulder massage with lotion that had essential oil in it. Just because some essential oils are said to be 100 percent pure does not mean they are all safe or that everyone can handle them."

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