The Cycle of Infections, Exacerbations, and Stress
Last updated: January 2023
So often I read in the groups of people being depressed and stressed due to the amount of exacerbation and infections their COPD has caused. Well, perhaps it's time you rethink that scenario. Maybe it is not your exacerbation and infections causing you to be depressed and stressed, but the weakening of your immune system caused by your stress that is the reason for your infections, exacerbation, and depression. Stress is not only a possible cause of frequent infections and exacerbations but is also a major factor in several other diseases.
Experiencing stress with COPD
We all experience stress due to things like the loss of a job, a move, death in the family, or chronic illness. When you have COPD our health is already negatively affected, so stress makes it worse. The body reacts to stress first by pumping adrenaline and then cortisol into the blood. The adrenaline and cortisol released by stress does serve a useful purpose: Put simply, the adrenaline increases you heart rate and alerts the mind, helping you to focus, and the cortisol contributes to tissue repair. The adrenaline rush for the stress response can occasionally cause health problems, but the more significant problem comes from the cortisol that is released.1
How this stress affects the immune system
Chronic stress exposes the body to an endless stream of cortisol which causes your inflammation to go wild. Acute inflammation that comes and goes signifies a well-balanced immune system. But symptoms of inflammation that don’t recede are telling you that the “on” switch to your immune system is stuck. The system's inability to regulate inflammation is a good predictor of who might get an infection or exacerbation. Under constant stress, the immune system produces levels of inflammation that lead to repeated infections and exacerbation of COPD. 2
Which COPD symptoms might be attributed to chronic stress?
I've read many posts, particularly from newbies, asking if this symptom or that symptom is suffered by all with COPD. Some of the other things that chronic stress could be responsible for are listed below.
It is well known that some people, when stressed, tend to eat more, particularly sweets. Many contribute side effects of medication as the reason for the weight gain. However, those under chronic stress experience a change in their metabolism, causing them to burn fewer calories. Stress also produces rises in the insulin levels and a decrease in fat oxidation, a process that produces fat storage. Excess cortisol is also related to abdominal fat.3
Older adults as well as those with a chronic illness experience a decrease in the amount of deep sleep and increase in waking up throughout the night. Stress aggravates this condition making it especially hard to get back to sleep. The lack of sleep weakens/damages memory and emotional control making it harder to handle stress. High cortisol levels may be one reason for waking up so often at night. Then our brains remind us of our problems causing more stress, and the inability to fall back asleep.
It is much slower when excessive cortisol is present. The more stress you're under, the longer it will take for a wound to heal.
Stomach ulcers and other problems
It is well known that ulcers can be caused by stress, but stress can also be a critical trigger for those with irritable bowel syndrome, indigestion, heartburn, ulcerative colitis, and Crohn's disease which is characterized by chronic inflammation.
Depression and stress are closely related
Stress throws several brain systems out of balance, negatively affecting the mood, appetite, sleep, and libido. Depression eventually takes on a life of its own, and many severely depressed people have permanently elevated cortisol levels. 4
The effect of stress on COPD patients
Stress is right up there with smoking when it comes to its effect on COPD. I have been a stage 4 for 18 years, almost died three times, and have been on and off hospice. Every time I go to my pulmonologist he shakes his head in amazement that I'm still kicking. The reason why I do so well is I don't stress the small stuff, I don't stress the large stuff either. I've learned there are things like the fact I have COPD is something I cannot change. No amount of worry and kicking myself in the a** because I smoked for 51 years is going to change the fact I have COPD, CHF, and nodules growing on my lung. So why stress about it? Stress kills and I intend (God willing) to be around another 18 years.
Since everyone has a unique response to stress, there is no “one size fits all” solution to managing it. No single method works for everyone or in every situation, so experiment with different techniques and strategies. Remember: if you can't change it, there is no use stressing over it. The one thing you can change that will help you tremendously is eliminating as much stress as possible.
Ways to reduce stress in your life
Maintaining a regular exercise routine
During exercise, the body releases chemicals called endorphins which interact with receptors in the brain to causing feelings of reduction in physical pain. An exercise routine does not have to be strenuous or get you short of breath. Keep your exercise within your physical limits. Just get yourself moving. You can find several videos on YouTube showing exercises that those with advanced COPD can do sitting down and they are fairly easy.5
Have a talk with yourself
"This feeling will pass." "I will get through this." "I am safe right now." "I am feeling stressed now, but I have the power to make myself calm."
Focus on what makes you feel calm and in control
Use pursed lips, diaphragmatic breathing, and meditation will help you feel more relaxed and slow your heart rate down. Go for a walk, spend time in nature, work in your garden, write in your journal, play with a pet, listen to music, curl up with a good book, or savor a warm cup of coffee or tea.
Focus on the positive
When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, and are still a part of your life. Family, children, grandchildren, friends for starters.
Adjusting your attitude
Set reasonable standards for yourself. You will never be able to do what you once did, so learn to be okay with what you can do, and let it be “good enough.”
I hope this helps some of you understand how important it is to get stress under control. Also, to let a lot of you who are new to COPD know that the symptoms you are asking questions about are common occurrences for the disease, particularly if you're under stress or depressed. Breathe deep and easy.
Editor’s Note: We are extremely saddened to say that on March 2, 2018, Mary Ultes passed away. Mary was an engaged advocate for the COPD community who strived to help people live fulfilling lives. She is deeply missed.
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