Ask Mark …


Gene from California comments he is continually losing weight and asks for Mark’s advice.

Mark recommends, Daily calories you should consume are based on your age, sex and how active you are, but are approximately 1,800–2,200 per day. Those with COPD should consume up to 50% more calories per day to supply energy for their added work of breathing.

You should have a goal to take in 3,000 calories per day and might benefit from a consult with a nutri- tionist who is well versed in consid- erations for calorie intake – and the difficulties those with COPD have. You could add healthy fats like olive oil; eggs; lean meats; nuts and feel free to delve into ice cream, puddings and custards. Nutritional shakes and smoothies may help too.

You don’t want to slide down the slippery slope towards critical nutritional risk because of weight loss. Mortality and morbidity (death and health difficulties) increase sharply when one drops to 95% and below of one’s ideal body mass. Good luck with the weight gain!


Phillip from EFFORTS asks if there has been success with exercis- ing 3–4 times a day for short periods.

Mark explains, “Intensity” is what really determines the bene- fit from multiple shorter-duration exercise periods during the day. If you build the intensity such that it is somewhere above what it would be during the similar longer, single exercise period, then you can assume benefit will be comparable.

The difference between one long exercise period and the same total duration in shorter periods is the “warm-up” time at the beginning of each workout – the time required to reach maximum average calorie burn. If the intensity is the same between the several short periods and the long single period, then the duration of “actual conditioning” will be comparatively less with the several periods as opposed to the one long period. If you up the inten- sity, you up the conditioning return during the minutes of the shorter exercise periods.


Jean from Iowa asks about the most effective way to treat depres- sion in those with COPD?

Mark responds, I find much of the depression that accompanies COPD is effectively resolved when one is involved in a rehabilitation effort – whether in a formal pulmonary rehab program or on one’s own – and begins to see the positive benefit it has for them. Long ago some very smart psychologists noted that those who have lost function and quality of life became depressed as a dynamic of that loss. The feeling that they will not be able to live their life as they expected, with regard to con- tinued independence and adequate function, frequently left a feeling of hopelessness. Once they “get back on their feet” and gain improvements, much of the depression resolves. It is then that any continued or underly- ing psychological problems can be better identified and more effectively treated.

Drugs and/or psychotherapy are often ineffective, leaving clinician and patient scratching their heads as to why. When function and condi- tioning are improved, the depression may resolve without the use of either therapy or medication.


Would an oxygen mask with a bag attached be appropriate for use at home?

Mark explains, This is called a non-rebreather mask, which will give you a much higher percentage of oxygen than you can get from a cannula. It has a valve that prevents the air you exhale from entering the bag. It is intended to be used with oxygen flow rates of at least 10 LPM to ensure your exhaled carbon diox- ide is removed from the mask. The flow is usually started at 15 LPM.

Remember, regardless of the de- vice you use to deliver your oxygen, you should measure your oxygen saturation with an oximeter to deter- mine if your flow is adequate.