COPD Program - Group session 1

May 2013

- YOUR EXPECTATIONS - BEING HEALTHY WITH COPD - OBJECTIVES

The program Living Well with COPD

Your expectations

• What are your expectations as a result of taking part in this group education program?

Being Healthy with COPD

• Even if you have COPD, a chronic illness, you can still be healthy.

• Knowing your disease and taking charge of it on a daily basis will help you live better with your COPD.

Being Healthy with COPD

• What does health mean to you?

• What do you do to stay healthy?

Introduction to the program Living Well with COPD • Preventing your symptoms and

taking your medications.

• Managing your breathing and saving your energy.

• Managing your stress and anxiety.

• Adopting and maintaining a healthy and fulfilling lifestyle.

• Developing and integrating a Plan of Action into your life.

Session Agenda

1. COPD definition

2. Action plan – « I feel Well»

3. Medications – Their action

4. Inhalation techniques

5. Breathing managing

Normal lung

COPD - definition

What does COPD mean?

• COPD means “chronic obstructive pulmonary disease”.

What happens when someone has a COPD?

COPD - Obstructive Chronic Bronchitis

COPD – Emphysema

COPD – Signs and symptoms

What are the signs and symptoms of obstructive chronic bronchitis?

• Sputum every day • Frequent coughing • Wheezing • Shortness of breath when exercising or during daily activities.

What are the signs and symptoms of emphysema? • Shortness of breath when exercising or during daily activities.

COPD – Main cause

Can you name the primary pollutant that can damage your lungs?

• Cigarette smoke is the primary pollutant and the leading cause of COPD.

• Many people who suffer from COPD are current or former smokers.

- INTRODUCTION TO THE ACTION PLAN - ACTION PLAN SECTIONS - « I FEEL WELL»

Action plan

Action plan

Your Plan of Action will help you to: • Better recognize your everyday respiratory symptoms.

• List what you are doing every day to remain well, including taking your medication as prescribed.

• Recognize a worsening of your respiratory symptoms and the situations that can trigger it.

• Know what to do to prevent a worsening of your respiratory symptoms and start treatment as soon as possible if that happens.

• Know when and whom to call if your symptoms get worse and/or do not improve.

A Plan of Action includes the following sections

• Contact list

• « I feel well »

• « I feel worse » (additional treatment if needed)

• « I feel much worse »

• « I feel I am in danger »

Contact list

Let us look at your Plan of Action when you FEEL WELL

What are your usual

respiratory symptoms ?

Let us look at your Plan of Action when you FEEL WELL

What are the healthy

behaviours to develop?

What is my regular

treatment?

- THEIR ACTION COPD medications

Taking your medication

• Which medications are used for the treatment of COPD (inhalers

and pills)?

• Which COPD medication must be used in case of emergency?

• Do you know how COPD medications act inside the lungs?

• Do you believe that the medication you take for COPD is effective? • Do you believe that it is necessary to take your COPD medication

regularly?

• What are the concerns you have in regards to the medications you take for your COPD?

Medications used to treat COPD

• Bronchodilators – the most important medications in COPD - They open up the airways, prevent and relieve shortness of breath on exertion.

Medications used to treat COPD

• Anti-inflammatories - Reduce inflammation and swelling in your airways and can be helpful to prevent exacerbations (worsening of respiratory symptoms); in COPD, inhaled anti-inflammatories need to be prescribed in combination with a bronchodilator.

• It is important to rinse your mouth after taking this medication to avoid thrush (yeast infections).

Medication used to treat COPD – during an exacerbation • Oral Anti-Inflammatory (Prednisone) - Usually prescribed for short

periods (1-2 weeks) when your respiratory symptoms get worse (exacerbations).

• Antibiotics - Are useful in treating respiratory infections and can be used with COPD medications during an exacerbation.

- INHALATION TECHNIQUES COPD medications

Inhalation devices

• Which inhalation devices are you using? Can you please show them to me?

• Do you find it difficult to use inhalation devices? Which one and why?

• Do you feel uncomfortable in taking your inhaled medication in public?

Metered-Dose Inhaler

1. Remove the cap 2. Shake the device 3. Exhale normally

4. Seal your lips around the mouthpiece

5. Inhaling slowly through your mouth

6. Press down once on the canister

Metered-Dose Inhaler

7. Continue to breathe in slowly and deeply until your lungs are full

8. Hold your breath for 5-10 seconds and breathe out.

9. Rinse your mouth

Maintenance and Cleaning 1. Once a week, clean the cap and plastic container, without the

canister, by soaking them in warm, soapy water. 2. Rinse and allow to air-dry.

3. The canister should be kept away from heat sources and cold. Roll the canister between the palms of your hands to warm it up.

Estimate quantity left in the device 1. Shake the inhaler and listen for movement sounds.

2. Some MDI have a dose-counter.

MDI (Metered-dose inhaler)

Metered-Dose Inhaler with a Spacing Device

1. Remove the caps 2. Shake inhaler

3. Connect it to the spacing device

4. Exhale normally

5. Place the spacing device in your mouth and press down on the canister once

6. Breathe slowly in and out 4-5 times in a row and breathe out.

7. Rinse your mouth

Spacing device

Maintenance and Cleaning

1. Clean the spacing device prior to the first use and once a week after as per the manufacturer instructions.

• If you have an infection, clean it more often.

2. If your spacing device has a good maintenance, it can last for one or two years depending on the type.

3. Keep the spacing device in a safe place to assure that no strange object will fall inside the chamber.

Dry powder inhalers

1. Open the device 2. Load the device

3. Exhale normally

4. Place the inhaler in your mouth, inhale quickly and deeply

5. Hold your breath for 5-10 seconds

6. Breathe out and rinse your mouth

Dry powder inhalers

Maintenance and Cleaning

• Wipe the mouthpiece with a clean dry cloth.

• Always keep the device closed, at room temperature in a dry place, to protect it against humidity.

• Never immerse the inhaler in water or exhale within the inhaler to avoid humidity entering the device and preventing from proper functioning.

Inhalation Technique for dry powder inhalers with capsules

1. Open the device 2. Open the mouthpiece

3. Place a capsule in the centre chamber

4. Close the mouthpiece

5. Press the button and release

6. Exhale normally away from the device

Inhalation Technique for dry powder inhalers with capsules

7. Breathe in slowly and deeply

8. Hold your breath for 5-10 seconds

9. Breathe out and rinse your mouth

Dry powder inhalers with capsules

Cleaning (Diskus)

• Clean once a month or as needed. • Open the dust cap and the mouthpiece in order to open

the base.

• Rinse the inhaler with warm water in order to eliminate powder residues (do not use soap).

• Allow the device to air dry thoroughly.

Cleaning (Breezhaler) • A new device is provided at each medication renewal.

Advantages of a proper use of inhalation devices • What are the benefits of using your inhalation devices

correctly?

• What are the advantages of using a spacing device with your inhalation aerosol?

• What can you do to use properly your inhalation devices?

Reminder : Ask your resource person, or your pharmacist, to verify your inhalation technique at each visit.

Questions?

- BREATHING TECHNIQUES - BODY POSITIONS

Breathing management

Shortness of breath in COPD

• Why do you feel short of breath when you have COPD?

• When you have COPD, air remains trapped inside your lungs.

Pursed-lip breathing technique

With this technique, you breathe out slowly, which allows you to exhale more air, thus leaving less air trapped inside your lungs.

If you reduce the air trapped in your lungs, you will allow fresh air to enter more easily, consequently you will be less short of breath.

Pursed-lip breathing technique

Walking

• Inhale 1…2… • Exhale 1…2…3…4

Climbing stairs

If you suffer from severe shortness of breath: • Inhale at rest. • Climb one step while exhaling, and stop for inhaling. Repeat for

each step. If you are able to climb some steps: • Inhale at rest. • Climb 3-4 steps while exhaling, stop for inhaling.

If you are able to climb at least a flight of stairs: • Inhale at rest. • Climb 3-4 steps while exhaling. • Climb 2 steps while inhaling. • Climb 3-4 steps while exhaling, etc.

Carrying parcels

• Before lifting a heavy object, inhale through the nose.

• Bend down and pick up the object while exhaling through pursed lips.

• Use pursed-lip breathing while carrying the object. Repeat the process when putting the object down.

• Always bend at the knees, keeping your back straight.

Body positions

Goal: • To offer relief to accessory muscles and improve

diaphragm function.

Benefits: 1. Help the diaphragm to move easier.

2. Help reduce shortness of breath.

Sitting

Standing

S.O.S. in an attack of shortness of breath Goal: • To bring your breathing back to normal during an acute attack

of shortness of breath.

Benefits: 1. Learn how to control shortness of breath. 2. Help reduce the panic associated with an attack.

Point to remember: • Give yourself the space and time to get your breathing back to

normal.

S.O.S. in an attack of shortness of breath

Steps: 1. Stop and find a comfortable position.

2. Stay as calm as possible; relax your shoulders.

3. Introduce the pursed-lip breathing technique: inhale through your mouth if you cannot through your nose; purse your lips to exhale.

4. Slow down your breathing by taking more time to breathe out than you would to breathe in. Do not force your lungs to empty.

5. Continue to exhale slowly while keeping your lips pursed; start to inhale through your nose if you have not been able to do it so far.

6. Continue to pursed-lip breathe for at least 5 minutes.

Questions?

Acknowledgements • Mrs. Maria Sedeno, Living Well with COPD • Mr. Michel Lebel, Living Well with COPD and Network Case Manager, Centre-West

region • Mrs. Esther César, Network Case Manager, North region • Mrs. Kathy Noël, Network Case Manager, East region • Mrs. Lorraine Isabelle, Network Case Manager, West region • Mrs. Nathalie Poupart, Network Case Manager, South-East region • Mrs. Lyse Millette, Network Case Manager, Centre-East region • Mrs. Cathy Dresdell, planning, programmation and research agent, Agence de la

santé et des services sociaux de Montréal • Mrs. Édith Lemay, planning, programmation and research agent, Agence de la santé

et des services sociaux de Montréal • Mrs. Lucie Des Groseillers, administrative technician, Agence de la santé et des

services sociaux de Montréal • Mrs. Élodie Cornier, administrative agent, Agence de la santé et des services sociaux

de Montréal