DEAR DR. DONOHUE: I see where you often recommend exercise for people with COPD. My husband has it and refuses to exercise. Would you be more specific about how such people should exercise? – K.M.

ANSWER: COPD is chronic obstructive pulmonary disease. It encompasses a number of illnesses. Its two most common ailments are emphysema and chronic bronchitis. Emphysema is destruction of air sacs, the delicate structures through which air and its oxygen pass to get into the blood. Shortness of breath is its cardinal symptom. Chronic bronchitis is inflammation, irritation and narrowing of bronchi – airways. They fill with thick mucus. Cough is the primary sign of chronic bronchitis. Usually the two – emphysema and chronic bronchitis – coexist.

All COPD patients must first get the approval of their doctors before they exercise. Many times, hospitals sponsor exercise programs for these patients, and the programs are generally called pulmonary rehabilitation. Your local hospital might have such a program. A supervised program is the best kind of program for COPD patients.

First off, your husband and his fellow patients have to be taught how to diaphragm breathe. If they lie on the floor and put a hand on their stomach, they can tell if their diaphragm is working well if their hand and stomach stick out when they breathe in. Diaphragm breathing is important for everyone, but especially for a COPD patient.

During exercise, COPD patients should inhale through the nose and take four seconds to do so. They should breathe out through their mouth with the lips puckered up as though they were going to whistle. Exhaling should take about six seconds.

Walking is an appropriate exercise. Walk until shortness of breath forces a rest. Once breathing has returned to normal, continue to walk. If only a minute of uninterrupted walking can be managed at first, fine. Slowly lengthen the time before resting until a goal of 20 uninterrupted minutes is finally reached. That can take six months.

The COPD booklet goes a long way in explaining these illnesses and how to deal with them. Readers can order a copy by writing: Dr. Donohue – No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My running partner takes sodium bicarb before he runs. He says it gives him a real boost. If this is for real, I’ll try it. – K.V.

ANSWER: When a person exercises at high intensity for a short time, there’s a buildup of lactic acid. Lactic acid tires muscles and causes muscle pain, so it forces people to stop what they’re doing. The idea behind sodium bicarb is to neutralize lactic acid buildup.

You and your friend are running long distances, not short sprints. There should be no lactic acid buildup in events of long duration. Sodium bicarb would not have any benefit for you.

Even in events of great intensity, where there is a lactic acid buildup, the evidence that sodium bicarb is helpful is on shaky ground.

I bet the benefit your friend gets from his sodium bicarb comes from a placebo effect.

DEAR DR. DONOHUE: My wife broke a rib while rowing a boat. Is this common? I have never heard of such a thing. – D.D.

ANSWER: Trauma – a fall or blow to the chest – is not the only cause of broken ribs. Repetitive exercise can break bones, including ribs. Such breaks are called stress fractures.

I am not happy with leaving your wife’s broken rib at this. I think matters should be looked into more deeply. She should see if she has any condition that leads to broken bones. Osteoporosis is the condition I have in mind.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.