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All Education Summaries

Table of Contents

Session 1: Coping with COPD

Session 2: Coping with COPD II

Session 3: Oxygen Therapy

Session 4: Pulm Hygiene

Session 5: COPD & Your Mental Health 

Session 6: COPD & Your Mental Health II

Session 7: COPD & Your Mental Health III

Session 8: Pulm Hygiene II

Session 9: Inspiratory Muscle Rehabilitation

Session 10: Cardiovascular Fitness

Session 11: Exacerbations

Session 12: Cardiovascular Fitness II

Session 13: Energy Conservation

Session 14: Sleep Hygiene

Session 15: Nutrition

 

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Session 1

Coping with COPD Group Session I

Pre-Session Notes:
Topics:
  1. Introducing Pranayama Breathing

  2. COPD Pathophysiology

  3. Introduction to Breathing Techniques

  4. Introduction to Physiologic Sigh

  5. Introduction to RPE Scale

  6. Introduction to Talk Test

 

Breakdown:

  1. Introducing Pranayama (4-7-8) Breathing: 4-7-8 Breathing is a pranayama/yogic style of breathing for mindfulness and for breath control. This is a helpful strategy to calm the body before sleep or to use when feeling anxious and stressed. To perform: 1. Slowly inhale through the nose for 4 seconds. 2. Hold the breath for 7 seconds. 3. Slowly exhale for a count of 8 seconds. 

 

  1. COPD Pathophysiology:  Explain how COPD affects the lungs and airways, including the concept of airflow obstruction and gas exchange issues.

 

  1. Intro to Breathing Techniques:

Understanding COPD and Its Impact on Breathing

  • Explain why effective breathing techniques are an important tool for regulating

  • Diaphragmatic Breathing

    • Explain the concept of diaphragmatic breathing and its benefits.

    • Demonstrate the technique: 

      • Sitting comfortably

      • One hand on the chest, the other on the abdomen

      • Breathe in through the nose, feeling the abdomen rise

      • Breathe out through pursed lips

  • Pursed-Lip Breathing

    • Explain how pursed-lip breathing helps to prolong exhalation and prevent airway collapse

    • Demonstrate the technique: 

      • Inhale slowly through the nose then

      • Exhale slowly through pursed lips as if blowing through a straw

  • Physiologic Sigh

    • Using this technique to help patients drop in and center themselves. Helping to oxygenate and calm down

    • Demonstrate the technique:

      • Inhale through the nose

      • A 2nd sip of air through the nose and hold the air for a few seconds

      • Exhale through the mouth

 

4. Intro RPE scale

  • Rate of Perceived Exertion, is a way for people with COPD (Chronic Obstructive Pulmonary Disease) to gauge how hard they are working during physical activity, based on their own feelings of exertion

  • The RPE scale typically ranges from 0 to 10, where 0 means no exertion at all, and 10 means the maximum effort possible. For COPD patients, this scale helps to self-monitor and control the intensity of exercise, ensuring they are working out within safe and beneficial limits.

 

5. Intro to Talk Test

  • A quick and easy way for patients to gauge their exertion and become better acquainted with their ideal training zone. Helping them understand what that zone feels like, as it is a little uncomfortable.

  • Ask them to say a short sentence like “I know these exercises are doing me good” 

  • If they have no issue saying the sentence without stopping for air; they are not working hard enough

  • If they cannot even begin the sentence because they are so out of breath, they are working much too hard

  • They should be able to say the sentence, with a some difficulty but overall be able to get the sentence out

 

II. Inhaler Technique Group Session I

Pre-Session Notes:
  1. Have example inhalers on hand

  2. Ask your patients to bring their inhalers to session.

Begin Session with a Pranayama Breath
Topics:
  1. Types of Inhalers and Their Uses – Guide with images for types of inhalers and uses 

  2. Inhaler Technique – Step by step video guide + static slide as follow up

  3. Monitoring and Adjusting Inhaler Use – alignment "quiz"  + video

    1. “Remote video monitoring of inhaler use in the home environment is possible with a mobile video application that gives us a better insight into the most common inhaler mistakes performed by patients at home.”

 

Breakdown:

Overview with model showing the step by step of how to use your inhaler

  1. What are the different types of inhalers? Therapist to show examples or infographic

    1. Metered-Dose Inhalers = portable, handheld divides that deliver a specific amount of medication in aerosol form 

      1. Medication Types

    2. Dry Powder Inhalers = devices that deliver medication in powder form

      1. Medication types

    3. Soft Mist Inhalers = slow moving mist, easier to inhale

      1. Medication types

      2. Prompt: Which type of inhaler do you have? 

  2. Inhaler Techniques 

    1. Preparation Steps:

      1. Check expiration date 

      2. Prime the inhaler – if new or hasn’t been used in a while, spray a few test puffs into the air

    2. Techniques – now that you’ve identified which inhaler type you have, let’s discuss the best way to use each kind. 

      1. MDI – 

        1. shake inhaler 

        2. breathe out fully 

        3. seal lips around the mouthpiece 

        4. press canister while inhaling slowly 

        5. hold breath for about 10 seconds 

        6. Exhale

        7. **Tip: be sure to time breath with medication release

      2. DPI – 

        1. Load the dose

        2. Exhale away from the device

        3. Inhale sharply and deeply

        4. Hold the breath for up to 10 seconds

        5. Then exhale

        6. **Tip: it is important to employ a strong, fast inhalation

          1. Using a Spacer with MDIs:

            1. Benefits: Improves medication delivery to the lungs, reduces side effects.

            2. Demonstration: How to attach the spacer and use it correctly.

      3. SMI – 

        1. Turn the clear base

        2. Open the cap

        3. Breathe out

        4. Seal lips around the mouthpiece

        5. Press the dose-release button

        6. Inhale slowly

        7. Hold breath for 10 seconds

        8. Then exhale

        9. **Tip: Slower inhalation is required with SMIs; also it is important to coordinate button press with inhale

      4. After use: 

        1. rinse mouth (especially after using steroid inhalers to prevent thrush)

        2. clean inhaler to prevent clogging and ensure correct dosage

      5. Troubleshooting:

        1. Inadequate dose delivery

        2. Coughing after inhalation: adjust technique or timing

 

  1. Monitoring & Tracking Doses


 

Session 2

Coping with COPD Group Session II

 

Pre-Session Notes

Begin with Pranayama Breathing

 

Topics:

  1. Reminder of Pranayama Breath

  2. Intro to Oxygen & Medications

  3. Reminder of RPE Scale

  4. Triggers & Considerations

  5. My COPD Action Plan 

 

Breakdown:

  1. Reminder of Pranayama Breath

  2. Intro to Oxygen & Medications

  • Info on common COPD medications, how and when to use them, potential side effects, and the importance of adherence

    • bronchodilators, steroids, combination inhalers

 

  1. Reminder of RPE Scale

 

  1. Triggers & Considerations

  1. Home Environment Modifications:

  • Air Quality: Use of air purifiers, avoiding smoke and strong fragrances, and maintaining good ventilation.

  • Humidity Control: Using a dehumidifier if the air is too moist or a humidifier if too dry, as extreme humidity levels can affect breathing.

  • Dust and Allergen Reduction: Regular cleaning to reduce dust mites and pet dander, using hypoallergenic bedding, and minimizing carpeting where possible

  1. Managing Daily Activities:

  • Energy Conservation Techniques: Teaching pacing and planning methods to prevent fatigue, like sitting while doing chores and taking frequent breaks.

  • Adaptive Tools and Equipment: Using tools like shower chairs, long-handled reachers, and easy-to-wear clothing to reduce strain and conserve energy.

  • Meal Preparation: Simple and nutritious meal planning, including easy-to-prepare recipes that require minimal effort.

  1. Travel Tips and Considerations:

  • Pre-Trip Planning: Consulting with a healthcare provider before traveling, especially if traveling by air or to places at high altitudes.

  • Medication Management: Keeping a detailed medication list and ensuring an adequate supply for the duration of the trip, including extra in case of delays.

  • Oxygen While Traveling: Arranging for oxygen supply if needed, understanding airline policies for traveling with oxygen, and planning for power sources and backups.

 

5.      My COPD Action Plan – Go over the worksheet and explain how to put together a

plan. Have this done by next week.


 

Session 3

Oxygen Therapy

Pre-Session Notes:

Begin with Pranayama Breathing
Topics:
  1. Reminder of Pranayama Breathing

  2. Oxygen Therapy & Delivery

  3. Safety

  4. When to call your Dr.

Breakdown:

  1. Oxygen Therapy & Deliver

Info on different kinds of oxygen and the nasal cannula. Tips on how to use the cannula or face mask and how to treat dryness or irritation from using oxygen

  1. Safety

While oxygen is generally considered safe, there are some hazards to watch out for:

  1. Do not drink alcohol or take drugs that relax you while using oxygen..

  2. Be aware of tripping hazards. Make sure you are careful when you are moving around.

  3. Oxygen is a fire hazard. It will make a flame burn hotter and faster.

  4. NEVER smoke or vape or let anyone else smoke or vape while you are using oxygen.

  5. Keep oxygen at least 6 ft (2 m) away from flames, sparks, or heat sources.

  6. Keep a fire extinguisher at home within easy reach.

  7. Keep oxygen tanks upright.


 

  1. When to Call Your Doctor

Let your doctor know if you:

  • Feel short of breath.

  • Feel restless or confused.

  • Feel very tired.

  • Feel like you are not getting enough oxygen.

 


 

Session 4 

Pulmonary Hygiene I

Pre-Session Notes:
Begin with Pranayama Breathing

 
Topics:
  1. Intro to Pulmonary Hygiene

  2. Respiratory Muscle Training

  3. Breathing Techniques

    1. Relaxed Breathing

    2. Huffing

  4. Suctioning

  5. Manually Loosening Secretions

  6. Postural Drainage

  7. Risks + Considerations
     

Breakdown:
  1. Intro to Pulmonary Hygiene

    1. Pulmonary hygiene consists of exercises and procedures that can help people clear their airways of mucus and other secretions. Many people with COPD do not clear secretions effectively and these techniques can help.  When mucus is allowed to build up in the warm, moist environment of the lungs, it can become a hotbed for bacteria, leading to infection and increasing the risk of COPD exacerbation.

  2. Respiratory Muscle Training

    1. What is Inspiratory Muscle Training

      1. Inspiratory Muscle Training (IMT) is a regimen of exercises that aim to strengthen the muscles involved in the inhalation process. These exercises typically involve breathing against resistance, which enhances muscle strength and endurance.

      2. For COPD patients, weakened respiratory muscles can lead to increased difficulty in breathing and reduced oxygen intake. IMT specifically targets these muscles to improve their function, which can significantly benefit individuals with COPD by enhancing their breathing efficiency and reducing symptoms.

 

  1. Explaining the Intercostal Muscle Groups

    1. The primary muscles involved in breathing include the diaphragm and the intercostal muscles. The diaphragm is a large, dome-shaped muscle located at the base of the lungs, which contracts during inhalation, causing the lungs to expand. The intercostal muscles are located between the ribs and also assist in expanding and contracting the chest cavity.

    2. In COPD, the airflow obstruction and the struggle to exhale fully can lead to over-inflation of the lungs:

    3. Respiratory muscles have to work harder: Because the lungs are not as efficient in moving air in and out, the muscles that help you breathe have to do extra work. This can make them tired, just like how your legs get tired after a long walk.

    4. Muscles can weaken over time: With COPD, since your breathing muscles are overworked, they can start to get weaker. It's similar to how a rubber band might lose its stretch if it's stretched too much.

    5. Breathing becomes more effortful: As these muscles get weaker, it becomes harder for you to catch your breath. This can make everyday activities more challenging because you might feel out of breath doing simple things like walking or climbing stairs.

    6. Risk of muscle wasting: If the muscles aren't used properly or are constantly tired, they might start to shrink or waste away. That's why keeping them strong and healthy is very important.

  2. Breathing Techniques

  3. Benefits of IMT for COPD Patients

    1. Improves respiratory muscle strength and endurance:

    2. "IMT makes the muscles you use to breathe stronger and more stamina-packed. It's like leveling up your breathing muscles so they can do their job without getting tired quickly."

    3. Enhances breath control and efficiency, leading to reduced breathlessness:

    4. "This training helps you control your breathing better and use less energy to breathe. It means you won't feel as out of breath when you do things like walking or playing."

    5. Increases exercise tolerance and overall quality of life:

    6. "With stronger breathing muscles, you can do more activities without feeling worn out. It helps you have more fun and enjoy life without getting slowed down by breathing troubles."

    7. Potential reduction in the risk of respiratory infections:

    8. "Stronger breathing muscles can also help keep your lungs clearer and healthier, which might mean you get sick less often with colds or other lung problems."

  4. Demonstrate Techniques

    1. Diaphragmatic Breathing

    2. Pursed Lip Breathing

    3. Pranayama 4-7-8 breathing

    4. Sniffing Technique

 

  1. Diaphragmatic Breathing: 

    1. Position: Sit comfortably or lie down, placing one hand on your chest and the other on your abdomen.

    2. Technique: Breathe in slowly through your nose, focusing on making your stomach move out against your hand while keeping the chest as still as possible. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips.

    3. Repetitions: Start with 5 minutes a day, gradually increasing to up to 10 minutes, twice a day.

 

  1. Pursed-lip Breathing: Technique: Step-by-step guide on practicing pursed-lip breathing.


    1. Technique: Inhale slowly through your nose and exhale slowly through pursed lips, as if you're blowing out a candle. This technique can be applied during any activity, especially when you feel short of breath.

 

  1. Progressive Resistance Training: Gradually increasing resistance to strengthen inspiratory muscles, including the use of specific devices like threshold IMT devices.

 

  1. The Sniffing Exercise:

    1. Position: Comfortable sitting or standing.

    2. Method: Take a quick, short inhalation through the nose, like a sniff, followed by a slow, controlled exhalation through pursed lips.

    3. Purpose: This exercise helps strengthen the diaphragm and improves the ability to inhale quickly.

    4. Method: Inhale deeply through your nose and exhale like you’re inflating a balloon through your mouth, inflating it as much as possible without strain.

    5. Note: This exercise should not cause dizziness or discomfort. If it does, take a break and breathe normally.

 

  1. Breathing Techniques

    1. These exercises can relax airways after a coughing fit or help clear them without the need for a big cough. Here are two breathing exercises that can help you clear your airways:

    2. Relaxed Breathing: Relaxed breathing technique (repeat 4-5 times per day)

      1. Relax your neck and shoulders.

      2. Place one hand on your stomach.

      3. Exhale as slowly as you can through your mouth.

      4. Breathe in slowly and deeply, making sure to keep your shoulders down and relaxed.

 

  1. Huffing: This exercise requires you to “huff” by breathing hard out of your mouth, as though you were creating fog on a mirror.  Try huff coughing after you use your bronchodilator medication or any time you feel mucus (congestion) in your airways.

    1. Sit on a chair or the edge of your bed, with both feet on the floor.

    2. Tilt your chin up slightly and open your mouth.

    3. Take a slow and deep breath until your lungs are about 75% full.

    4. Hold your breath for two to three seconds. This gets the air behind the mucus.

    5. Exhale slowly but strongly. This moves mucus from your smaller airways to your larger ones. This is the “huff” part of huff coughing.  This can be done in one hard push, or in a few short bursts.

    6. Repeat one or two more times.

    7. Follow with one strong cough to clear the mucus from the larger airways. This should allow you to cough the mucus up and out.

    8. Perform these steps two or three times depending on how much mucus you have.

    9. Avoid breathing in quickly and deeply through your mouth after coughing. Quick breaths can interfere with the movement of mucus up and out of the lungs and cause uncontrolled coughing.

 

  1. Suctioning: In suctioning,  a thin, flexible tube is used to remove secretions from your airway. One end of the tube is attached to a vacuum while the other end is placed into your airway. This can be uncomfortable, but only takes about 10 to 15 seconds. If you need more than one session at a time, you’ll get a break in between each one. This is usually done in a clinic or hospital setting but can also be done at home.

 

  1. Manually Loosening Secretions

There are a few techniques to apply pressure to your chest or back to loosen secretions.   They are usually done at home with the help of another person.  You should talk with your clinical team on which of these techniques, if any, are right for you before trying them.  They are usually not best for people who are frail or dealing with sore ribs.

 

Percussion 

In percussion, someone else strikes your chest or back with cupped hands, making sure all parts of both lungs are covered. This repeated contact helps to break up thick secretions in the lungs.  This is also called clubbing or clapping.  

 

Vibration

Vibration is similar to percussion but is done with flat palms instead of cupped hands. The person performing the procedure keeps one arm straight, with the palm of the hand on your chest or back. Then they place the other hand on top of the flat hand and move it rapidly from side to side to create a vibration.


 

  1. Controlled Coughing: With COPD, your cough reflex may have been weakened by long-term exposure to an irritant (typically cigarette smoke), making it harder to clear your lungs.  Coughing keeps your airways clear and is a defense mechanism against substances that you may have breathed into your lungs from the environment. But coughing too much or too forcefully can cause the airways to spasm and possibly collapse, inhibiting expectoration. It can also make you tired, making further coughing difficult.  Controlled coughing can help you cough safely and effectively.  You may want to cough into a tissue and note the color, thickness, and look of what you bring up. If you notice any significant changes, let your clinical team know.

    1. Sit upright in a chair or on the edge of a bed. Place your feet firmly on the ground, lean forward a bit, and take a few deep breaths to help your body to relax.

    2. Fold both arms across your belly and breathe in fully through your nose.  Breathe in slowly by gently sniffing throughout the time you breathe in. This will prevent mucus from being pushed back down into the airways.

    3. As you exhale, lean forward a little more and press your arms against your belly. 

    4. Open your mouth slightly and cough two or three times. Each cough should be short and sharp and you should feel your diaphragm move upward. The first cough loosens the mucus, while the second and third coughs are responsible for helping bring the mucus up and out of the airways.

    5. Rest and repeat if necessary.

 

  1. Postural Drainage

This relies on gravity to clear out airways.  It’s especially helpful in the morning for clearing secretions that have built up overnight. Sometimes, it’s combined with other pulmonary hygiene methods, such as breathing exercises or vibration.  There are many ways to do postural drainage, depending on the area that needs clearing. Some common ones are:

  • Turning from one side to the other to move secretions around.

  • Elevating your head to promote mucus drainage.

  • Putting your head and chest down so that gravity can drain lung secretions into the airway, where they are suctioned out or coughed up.


 

  1. Risks + Considerations

    1. If, at any point, your pulmonary hygiene routine is making you feel short of breath, dizzy, faint, or generally unwell, stop what you are doing and rest.  If it does not help, contact your healthcare provider immediately. It’s also helpful to teach family and friends around you how to do these techniques so they can help you.


 

Session 5

Mental Health & Your Disease

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Managing Your Emotions

  2. Intro Anxiety + Panic

  3. Intro Depression

  4. How Your Emotions Can Affect Your Disease

  5. Takeaway + Staying Healthy

  6. When to Call the Doctor
     

Breakdown:
  1. Managing Your Emotions

    1. Having COPD can affect your mood and emotions for several reasons:

    2. You cannot do all the things you used to do.

    3. You may need to do things much slower than you used to.

    4. You may often feel tired.

    5. You may have a hard time sleeping.

    6. You may feel ashamed or blame yourself for having COPD.

    7. You may be more isolated from others because it is harder to get out to do things.

    8. Breathing problems can be stressful and scary. 

    1. All of these factors can make you feel stressed, anxious, or depressed.  Anxiety and depression are both more common in people living with COPD than they are in the general population.  In fact, 2 out of 5 people with COPD have depression.  If you are having low mood, you are not alone.

 

  1. Unfortunately, they often go unrecognized and untreated by patients, caregivers and healthcare providers. Taking care of your emotional health does more than just improve your mood. Research shows that managing anxiety and depression can increase your ability to continue with your COPD treatment plan, improve your physical health and reduce your medical costs.

  1. Intro Anxiety + Panic

    1. Clinical anxiety is defined as constant worrying and expecting the worst in a way that makes it hard to function.  A panic attack is a sudden episode of intense fear or anxiety. Panic attacks and anxiety can also cause you to have shortness of breath or change your normal breathing pattern. When this happens, you become trapped in a cycle when your shortness of breath triggers anxiety- making it more difficult to breathe.

  2. Intro Depression

    1. Clinical depression is a feeling of deep sadness or emptiness that lasts longer than a couple of weeks. It affects your ability to enjoy your work, recreation, family and friends. Depression is a serious illness that affects more than just your mood. If left untreated, it may greatly affect your ability to stay active and enjoy your life.

  3. How Your Emotions Can Affect Your Disease

    1. Having COPD can change how you feel about yourself. And how you feel about yourself can affect COPD symptoms and how well you care for yourself.  Depression saps your energy and motivation. 

    2. When you are depressed or anxious, you may be less likely to:

    3. Eat well.

    4. Exercise.

    5. Take your medicines as directed.

    6. Follow your treatment plan.

    7. Get enough rest or sleep. Or, you may get too much sleep or be too inactive.

    8. People with COPD who are depressed may have more COPD flare-ups and may have to go to the hospital more often.  For example, feeling “down” all the time can make it hard for to follow your treatment plan. You may find that it’s easy to forget your medications or not exercise. You may even turn to alcohol, cigarettes, or other unhealthy habits to cope, which can cause more harm to your body.

  4. Takeaway + Staying Healthy

    1. There is a lot you can do to help you manage the emotional burden of COPD.

    2. It can be easy to feel alone.  Remember that you aren’t the first person to feel this way. 

    3. Stay involved. Do not isolate yourself. Make time every week to spend time with friends or attend social events.

    4. Practice positive daily health habits. Get up and get dressed every morning. Move your body every day. Exercise is one of the best stress busters and mood boosters around. Eat a healthy diet and get enough sleep every night.

    5. Talk it out. Share your feelings with trusted family members or friends. Or talk with a clergy member. Do not keep things bottled up inside.

    6. Join a support group for people with COPD. A quick search on the Internet can give you many options. There are forums and discussion groups where members can share their feelings to an understanding group of peers. 

    7. Follow your treatment plan. When your COPD is well-managed, you will have more energy for the things you enjoy.

  5. When to Call the Doctor

Contact your doctor if:

  1. You hear voices or other sounds that are not there.

  2. You cry often for no apparent reason.

  3. Your depression has affected your work, school, or family life for longer than 2 weeks.

  4. You have 3 or more symptoms of depression (listed above).

  5. You think one of your current medicines may be making you feel depressed or anxious. Do not change or stop taking any medicines without checking with your doctor.

  6. You think you should cut back on drinking or drug use, or a family member or friend has asked you to cut back.

  7. You feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.

  8. You should also call your doctor if your COPD symptoms get worse, despite following your treatment plan.

  9. If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.  You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.


 

Session 6

Mental Health & Your Disease II | Stress

Pre-Session Notes:
Begin with Pranayama Breathing
 
Topics:
  1. Tools to Manage Your Mental Health

  2. Clinical Anxiety

  3. Panic Disorder

  4. Stress + Breathing

  5. Dyspnea cycle

  6. Ways to Relax
     

Breakdown:
  1. Tools to Manage Your Mental Health

    1. Helping patients understand the different kinds of anxiety and stress and that they are not alone, and it is an understood sensation and range of feelings.

    2. There are things you can and should do to protect your emotional health. While you cannot get rid of all the stress in your life, you can learn how to manage it. These suggestions may help you relieve stress and stay positive.

      1. Know your triggers: Identify the people, places, and situations that cause stress. Knowing what causes you stress can help you avoid or manage it.

        1. Do not spend time with people who stress you out. Instead, seek out people who nurture and support you. 

        2. Go shopping during quieter times when there's less traffic and fewer people around.

        3. Do not take on too much. Take care of yourself by letting go and learning to say no. For example, perhaps you typically host 25 people for Thanksgiving dinner. Cut it back to 8. Or better yet, ask someone else to host. If you work, talk with your boss about ways to manage your workload so you do not feel overwhelmed.

      2. Build healthy habits:

        1. Learn to maximize your energy and to breathe during activity, so you can do more.

        2. Start exercising, so your body can start to handle more activity. Being active may make you short of breath. Even so, it is good for your lungs. Exercise can strengthen the muscles that help you breathe. Even a little bit helps your lungs.

        3. Eat healthy. Eat the right amount of food to keep a healthy weight. Your health care provider may refer you to a dietitian or nutritionist.

        4. Rest well. If you have trouble sleeping at night, don’t use sleeping pills or over-the-counter medicines without talking with your health care provider first.

      3. Protect your lungs:

        1. Prevent lung infections. Get vaccinated as directed by your health care provider.

        2. Stop smoking and stay away from secondhand smoke. Cigarette smoking is the main cause of COPD. Stopping smoking is the most important step you can take to treat COPD. If you need help stopping smoking, talk with your health care provider.

        3. Breathe in clean air. Try to stay away from smoke, chemicals, fumes, and dust. Don’t let anyone smoke in your home. Stay indoors on smoggy days.  

        4. Follow your treatment plan. When your COPD is well-managed, you will have more energy for the things you enjoy.

      4. Stay social: 

        1. Do not isolate yourself. Make time every week to spend time with friends or attend social events.

        2. Get up and get dressed every morning.

        3. Talk it out. Share your feelings with trusted family members or friends. Or talk with a clergy member. Do not keep things bottled up inside.

  2. Clinical Anxiety

    1. You may have generalized anxiety disorder if you have the following symptoms for 6 months or longer:

      1. Feeling restless, on edge or irritable

      2. Difficulty concentrating

      3. Uncontrolled worry or fear

      4. Sleep difficulty

  3. Panic Disorder

    1. Panic disorder is associated with heightened episodes of anxiety called panic attacks. Symptoms of a panic attack include:

      1. Fast heart rate

      2. Sweating, trembling or shaking

      3. Feeling like you're going to choke

      4. Scattered thoughts

      5. Feeling out of control, like you're spinning

    2. Panic attacks can come on unexpectedly or can occur as the result of a trigger, such as difficulty breathing that goes along with COPD. Because some panic disorder symptoms are similar to symptoms of COPD, it can be difficult to distinguish between a panic attack and a COPD flare-up. Often shortness of breath can lead to scary feelings and increased anxiety, and panic attacks can develop.

  4. Stress + Breathing

    1. Practice relaxation exercises: 

      1. Learn to stop an attack with pursed-lip breathing, diaphragmatic breathing, and relaxation methods. 

      2. Deep breathing, visualization, letting go of negative thoughts, and muscle relaxation exercises are all simple ways to release tension and reduce stress.

      3. Do belly breathing and pursed-lip breathing every day. These 2 exercises can help you breathe better. Try to do each exercise for 5 to 10 minutes every day.

      4. Practice mindfulness and distraction.   Try to take your mind off of your breathing when you are having trouble by meditating or doing something you enjoy.

  5. Dyspnea cycle

    1. Understanding the dyspnea cycle

      1. When it’s hard to breathe, it’s natural to get anxious and start to panic. This makes you even more short of breath. This sequence is known as the dyspnea cycle, and it’s common among people with chronic lung disease. 

      2. When you’re short of breath, your breathing muscles get tense. It’s hard to take a deep breath. You may worry that you’re not getting enough air. Then you start breathing faster and become more short of breath. You may even start to panic, which makes symptoms seem worse. Often, people with chronic lung disease try to prevent this cycle. They limit their activity, stay at home, and don't do anything that could cause shortness of breath. You don’t have to live this way. 

  6. Ways to Relax

    1. When you find yourself getting stressed or anxious, do your best to relax. This will help you break the dyspnea cycle.. Do pursed-lip and diaphragmatic breathing. 

    2. Pursed-lip and diaphragmatic breathing

      1. Sit in a quiet, comfortable place

      2. Relax your neck and shoulder muscles.

      3. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.

      4. Breathe in (inhale) slowly through your nose for two seconds with your mouth closed so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.

      5. Purse (pucker) your lips as though you're going to whistle or gently blow on a hot drink.

      6. Tighten your stomach muscles, so that your stomach moves back in as you exhale. The hand on your upper chest must remain as still as possible.

      7. Breathe out (exhale) slowly and gently through your pursed lips for four or more seconds.

 

  1. Progressive muscle relaxation

    1. Start by lying or sitting down. Relax your entire body. Take five deep, slow breaths. 

    2. Lift your toes upward. Hold, then let go. Pull your toes downward. Hold, then let go.

    3. Next, tense your calf muscles, then let go. 

    4. Move your knees toward each other. Hold, then let go.

    5. Squeeze your thigh muscles. Hold, then let go.

    6. Clench your hands. Pause, then let go.

    7. Tense your arms. Hold, then let go.

    8. Squeeze your buttocks. Pause, then let go.

    9. Contract your abdominal muscles. Pause, then let go.

    10. Inhale and tighten your chest. Hold, then exhale and let go.

    11. Raise your shoulders to your ears. Pause, then let go.

    12. Purse your lips together. Hold, then release.

    13. Open your mouth wide. Hold, then let go.

    14. Close your eyes tightly. Pause, then release.

    15. Lift your eyebrows. Hold, then release.

 

Session 7

Mental Health & Your Disease III | Depression

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. How Your Emotions Can Affect Your Disease

  2. Signs of Depression

  3. Coping + Staying Healthy

  4. When to Call Your Doctor
     

Breakdown:
  1. How Your Emotions Can Affect Your Disease

    1. Subtopic

      1. Description

  2. Signs of Depression

  3. Coping + Staying Healthy

  4. When to Call Your Doctor

 

Session 8 

Pulmonary Hygiene II

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Re-Intro to Pulmonary Hygiene

  2. Spirometry

  3. Controlled Coughing

  4. Risks + Considerations
     

Breakdown:
  1. Re-Intro to Pulmonary Hygiene

    1. Reminder of last Pulm Hygiene session

      1. Description

  2. Spirometry

  3. Controlled Coughing

  4. Risks + Considerations

 

Session 9

Inspiratory Muscle Rehabilitation

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. What is Inspiratory Muscle Training

  2. Explaining the Intercostal Muscle Groups

  3. Breathing Techniques

    1. Boxed Breathing

    2. Pursed Lip Breathing

    3. Activated Breathing

    4. Diaphragmatic Breathing
       

  4. Breakdown:

  5. What is Inspiratory Muscle Training

    1. Inspiratory Muscle Training (IMT) is a regimen of exercises that aim to strengthen the muscles involved in the inhalation process. These exercises typically involve breathing against resistance, which enhances muscle strength and endurance.

    2. For COPD patients, weakened respiratory muscles can lead to increased difficulty in breathing and reduced oxygen intake. IMT specifically targets these muscles to improve their function, which can significantly benefit individuals with COPD by enhancing their breathing efficiency and reducing symptoms.

 

  1. Intercostal Muscle Groups

    1. The primary muscles involved in breathing include the diaphragm and the intercostal muscles. The diaphragm is a large, dome-shaped muscle located at the base of the lungs, which contracts during inhalation, causing the lungs to expand. The intercostal muscles are located between the ribs and also assist in expanding and contracting the chest cavity.

    2. In COPD, the airflow obstruction and the struggle to exhale fully can lead to over-inflation of the lungs:

    3. Respiratory muscles have to work harder: Because the lungs are not as efficient in moving air in and out, the muscles that help you breathe have to do extra work. This can make them tired, just like how your legs get tired after a long walk.

    4. Muscles can weaken over time: With COPD, since your breathing muscles are overworked, they can start to get weaker. It's similar to how a rubber band might lose its stretch if it's stretched too much.

    5. Breathing becomes more effortful: As these muscles get weaker, it becomes harder for you to catch your breath. This can make everyday activities more challenging because you might feel out of breath doing simple things like walking or climbing stairs.

    6. Risk of muscle wasting: If the muscles aren't used properly or are constantly tired, they might start to shrink or waste away. That's why keeping them strong and healthy is very important.

 

  1. Breathing Techniques & Benefits of IMT for COPD Patients

    1. Benefits of IMT for COPD Patients

      1. Improves respiratory muscle strength and endurance: IMT makes the muscles you use to breathe stronger and more stamina-packed. It's like leveling up your breathing muscles so they can do their job without getting tired quickly.

      2. Enhances breath control and efficiency, leading to reduced breathlessness: This training helps you control your breathing better and use less energy to breathe. It means you won't feel as out of breath when you do things like walking or playing.

      3. Increases exercise tolerance and overall quality of life: With stronger breathing muscles, you can do more activities without feeling worn out. It helps you have more fun and enjoy life without getting slowed down by breathing troubles.

      4. Potential reduction in the risk of respiratory infections: Stronger breathing muscles can also help keep your lungs clearer and healthier, which might mean you get sick less often with colds or other lung problems.

    2. Demonstrate/Practice the following Breathing Techniques

      1. Diaphragmatic Breathing

      2. Pursed Lip Breathing

      3. Pranayama 4-7-8 breathing

      4. Sniffing Technique

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Session 10

Cardiovascular Fitness

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Cardiovascular System

  2. Safety Thresholds + Training Zones

  3. Safety Thresholds + Training Zones

  4. Benefits of Enhanced Oxygenation

  5. 6MWT
     

Breakdown:
  1. Cardiovascular System

    1. COPD and Cardiovascular System:

    2. COPD can affect the heart and blood vessels, leading to an increased risk of cardiovascular diseases such as heart attack and stroke. This is partly because COPD can lead to lowered oxygen levels in the blood, causing the heart to work harder.

    3. Illustrate how COPD can lead to decreased oxygen levels, increased heart workload, and thus a higher risk of cardiovascular diseases.

      1. Increased Risk of Heart Disease: Explain how COPD can lead to higher risks of heart conditions like coronary artery disease due to low oxygen levels and systemic inflammation.

      2. Hypertension and COPD: Discuss the link between COPD and the development of pulmonary hypertension, which can strain the heart.

      3. Arrhythmias: Detail how COPD exacerbations can lead to irregular heart rhythms, impacting overall heart health.

 

  1. Safety Thresholds + Training Zones

    1. Target Heart Rate Zones: Provide guidance on calculating and staying within safe heart rate zones during exercise (e.g., using the formula: 220 - age x 60% to 80% for moderate-intensity activities).

    2. Oxygen Saturation Levels (SpO2): Emphasize the importance of maintaining SpO2 levels above 90% during exercise; recommend the use of pulse oximeters to monitor these levels.

    3. Recognizing Warning Signs: Educate on symptoms that indicate overexertion or danger, such as chest pain, severe shortness of breath, dizziness, or palpitations.

    4. Symptoms Monitoring Chart: A checklist or chart for patients to use to monitor their symptoms during exercise, helping them understand their limits.

    5. TRAIN, RPE Review: Go over principles and infographics to ensure understanding

    6. Goal Setting Exercise:

      1. Introduce Goal Setting with SMART Criteria: Guide patients to set Specific, Measurable, Achievable, Relevant, and Time-bound fitness goals.

      2. Routine Activities as Exercise: Encourage patients to view household activities like cleaning or gardening as opportunities for light cardio exercise

 

  1. Benefits of Enhanced Oxygenation

    1. Improving cardiovascular fitness is crucial for COPD patients as it can help enhance the efficiency of oxygen usage in the body, reduce symptoms, improve quality of life, and decrease the risk of heart diseases.

      1. Cardiovascular fitness is the ability of the heart, blood cells, and lungs to supply oxygen-rich blood to the working muscle tissues and the efficiency of these tissues to use oxygen to produce energy for movement.

      2. Improved cardiovascular fitness can:

        1. Enhances the efficiency of oxygen uptake in the lungs.

        2. Increases the heart's ability to pump blood more effectively.

        3. Improves the muscle's capability to utilize oxygen, thereby reducing the overall demand for oxygen.

    2. Enhanced Oxygenation benefits you by

      1. Reduced workload on the heart and lungs: With improved cardiovascular fitness, the body can achieve more with less effort, easing the strain on the heart and lungs.

      2. Increased exercise tolerance: Enhanced oxygenation enables COPD patients to perform daily activities and exercise with less fatigue.

      3. Improved overall health and wellbeing: Better oxygenation supports the functioning of all body systems, contributing to improved energy levels and quality of life.

      4. Improvement in Heart Rate: Regular cardiovascular exercise can help in lowering the resting heart rate and improving heart rate variability, which is often compromised in COPD patients.

      5. Blood Pressure Regulation: Exercise can aid in better blood pressure management, reducing the risk of hypertension-related complications.

    3. Everything we’re doing in pulmonary rehabilitation is helping improve your cardiovascular fitness

      1. Regular, moderate-intensity exercise: Walking, cycling, or water aerobics, tailored to their current fitness level and with their healthcare provider's approval.

      2. Breathing exercises: Techniques like pursed-lip breathing to improve oxygen intake.

      3. Strength training: To enhance muscle efficiency in using oxygen.

      4. Consistent monitoring: Using pulse oximetry to monitor oxygen levels during activities.

  2. 6MWT

A simple step-by-step visual guide on how to perform the six-minute walk test, including how to measure distance and monitor symptoms.

  • The 6-minute walk test (6MWT) is a simple exercise test used to assess the aerobic capacity and endurance of patients, including those with chronic obstructive pulmonary disease (COPD). This test measures the distance an individual can walk quickly on a flat, hard surface in a period of 6 minutes. It's widely used in clinical settings due to its simplicity and minimal requirement for equipment. 

Here's a step-by-step guide tailored for patients with COPD:

  • Prepare: Ensure a clear, flat path to walk, wear comfortable shoes and clothes. Have a stopwatch, a chair nearby if you need to rest, and your pulse oximeter. Make sure you are wearing comfortable shoes and clothing, and that there are no obstacles in your way.

  • Rest Before Starting: Sit quietly for 10 minutes before you begin.

  • Baseline Measurements: Record baseline measurements such as heart rate, blood pressure, and oxygen saturation levels. 

  • Walk: At the start signal, walk as far as you can for 6 minutes at a pace that is brisk but sustainable. You shouldn't run or jog.

  • Monitor Yourself: Pay attention to how you feel. It’s okay to slow down, stop, and rest if needed, but the clock will keep running.

  • Conclude: When time is up, stop walking. Note the distance you’ve covered. Note any rest periods and symptoms experienced.

  • Report: Share your distance, post-test measurements of heart rate, blood pressure, and oxygen saturation and how you felt during the test with your healthcare provider.

  • Recovery Monitoring: Allow the patient to rest until their vital signs return to baseline levels. Continue to monitor for any adverse reactions.

 

Session 11

Exacerbations

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. What is an Exacerbation

  2. Triggers + Causes

  3. How to Track Symptoms

  4. What to do if an Exacerbation Happens
     

Breakdown:
  1. What is an Exacerbation

  1. Defining an Exacerbation: Comparing exacerbations to 'bad lung days' where symptoms get worse than usual “a lung attack”. It is a worsening of COPD symptoms beyond normal day-to-day variations, often acute in onset. 

  • Explain if theses symptoms persist for longer than 48 hours, this is when they should get in touch with their care team

  • Impact: Can range from mild to severe and, in serious cases, may necessitate hospitalization.

 

  1. Key Symptoms to Watch: 

  1. Increased Shortness of Breath: More intense and frequent than usual, making daily activities more difficult.

  2. Increased Cough and Mucus Production: Change in the amount, thickness, or color of mucus (often becoming yellowish, greenish, or brownish).

  3. Fatigue and Weakness: Feeling more tired and weak than usual, impacting the ability to perform tasks.

  4. Wheezing or Chest Tightness: Increased chest discomfort and wheezing sounds during breathing.

 

  1. Triggers + Causes

    1. Respiratory Infections: Viral or bacterial infections in the lungs are common triggers.

    2. Environmental Factors: Air pollution, weather changes, exposure to allergens, or irritants like smoke and strong odors.

    3. Non-Adherence to Medication: Missing regular COPD medications can lead to worsening symptoms.

    4. Other Health Issues: Conditions like heart failure or pulmonary embolism can exacerbate COPD symptoms.

 

  1. How to Track Symptoms – USE WORKSHEET

  • Symptom Diary Tutorial: Show how to track symptoms daily using a simple app or diary.

  • Red Flags: Emphasize symptoms that signal an exacerbation is starting, like sudden breathlessness or waking up at night due to coughing.

  • Rapid Response Plan: A step-by-step guide on what to do when these red flags appear.

 

  1. What to do if an Exacerbation Happens

    1. Discuss the steps to take how to call for help and seek medical attention, calling Doctor or 911 if necessary.

 

Session 12

Cardiovascular Fitness II

 
Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Safety Thresholds + Training Zones

  2. Reminders for Training Properly (TRAIN)

  3. Reminders for Training Properly (RPE)

  4. Reminders for Training Properly (Talk Test)

  5. Reminders for Training Properly (SMART)

  6. Setting Goals
     

Breakdown:
  1. Safety Thresholds + Training Zones

    1. Subtopic

      1. Description

  2. Reminders for Training Properly (TRAIN)

  3. Reminders for Training Properly (RPE)

  4. Reminders for Training Properly (Talk Test)

  5. Reminders for Training Properly (SMART)

  6. Setting Goals

 

Session 13

Energy Conservation

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Importance of Energy Conservation

  2. The Basics of Energy Conservation & Mastering the Art of Pacing
     

Breakdown:
  1. Importance of Energy Conservation

    1. COPD fatigue can make accomplishing even the smallest tasks a challenge, but it doesn’t have to stop you from enjoying your life.

    2. Energy conservation techniques are designed to streamline your home, schedule, and lifestyle so that you can do more with the energy you have.

    3. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

      1. Activities of daily living or ADLs are basic self-care tasks that help you maintain and improve your quality of life. These tasks may include bathing, dressing and grooming. 

        1. Activities of Daily Living (ADL)

        2. Washing and bathing

        3. Mobility- walking/stair climbing

        4. Dressing and grooming

        5. Intimacy

      2. Instrumental activities of daily living or IADLs require more planning and are tasks needed for daily living like cooking and shopping. These often require more energy.

        1. Shopping

        2. Meal preparation

        3. Housekeeping

        4. Medication management

      3. ADLs and IADLs are important because often with chronic health conditions like COPD, it may be difficult to complete these without assistance. Talk with your healthcare provider about any challenges you are having with ADLs and IADLs because it can cause your COPD to worsen and make it unsafe for you to be living independently. Your healthcare provider may refer you to a pulmonary rehabilitation program where you can learn more about managing your COPD.

 

  1. The Basics of Energy Conservation & Mastering the Art of Pacing

  1. The 5 Ps

  1. Pace yourself – Take breaks or rest between activities. Keep a slow and steady pace to avoid rushing. It is important to rest BEFORE you become fatigued as it will take you longer to recover once you get to a point of feeling overtired or "all done in."

  2. Planning ahead – Try not to do too many "heavy" tasks all in one day. For example, avoid doing your laundry, grocery shopping, and going to an appointment all in one day. Space these activities out.

  3. Position yourself – Position yourself upright when sitting and standing. Try to avoid bending or reaching excessively because that can cause shortness of breath and fatigue. Avoid staying in one position for too long as this can be fatiguing as well.

  4. Prioritize your activities – Decide what is important for you to do and what can be done later. Do the activities that are most important or need to be done when you have the most energy.

  5. Pursed lip breathing – Pursed lip breathing is an exercise that helps you slow down your breathing so you can inhale and exhale more air. Practice pursed lip breathing daily until it becomes natural for you to use.

B) Breathing Exercises - 

  1. Pursed breathing: Next time you do something that typically makes you pant, you can try inhaling slowly through your nose and exhaling through pursed lips. This might feel unnatural at first, but you will get better at it the more you practice.

  2. Diaphragmatic breathing: For this technique, start by sitting or lying comfortably on your back. Place one hand on your chest and one on your stomach. Inhale through your nose as far as you can, focusing on your abdomen expanding. Hold your breath for two seconds then exhale slowly through your mouth for about six seconds.

C) Tools to Save Energy

  1. Control your breathingIt’s natural to pant when faced with strenuous activity, but this actually wears you out faster. Panting overworks your diaphragm and causes you to have less oxygen (and more carbon dioxide) in your lungs.

    1. Breathing techniques can help fight fatigue. They regulate your breaths and stabilize the balance of oxygen and carbon dioxide in your lungs.

    2. Try some of the breathing techniques we just learned

    3. In addition to helping you regulate your breaths, practicing diaphragmatic breathing regularly can help strengthen your diaphragm.

    4. You can practice diaphragmatic breathing for five to fifteen minutes at a time, so long as you feel comfortable. Some people may feel lightheaded after a diaphragmatic breathing session, so it’s best to relax a little afterward and not stand up too quickly.

  2. Avoid Unnecessary Tasks

    1. If you find yourself easily tired by everyday tasks, be strategic. Combine tasks to get more out of your efforts, or forego unnecessary ones done purely out of habit.

    2. For instance:

  1. Wear a terrycloth robe to save yourself the extra task of toweling after bathing.

  2. Allow your dishes to air dry rather than drying them by hand.

  3. Sit instead of standing to do your hair, shave, or put on your makeup.

3) Organize Your Activities

  1. Keeping your schedule simple can be the difference between getting through a day comfortably or giving up midway through.

  2. As a rule, do your most strenuous activities at the beginning of the day when you have the most energy. If you have multiple strenuous tasks to do in one day, try to start with one strenuous task, then tick a lighter task off your to-do list before moving on to the next strenuous one.

  3. Keep your schedule flexible and give yourself extra time for each task so that you can take breaks if needed.

  4. If you know you have a day when a chunk of time will be taken up with, say, a social engagement, shift a few tasks to another day (or eliminate them entirely) so you don’t overwork yourself trying to get things done in less time.

4) Reorganize Your Closets and Shelves

  1. Reorganize your closets, shelves, and drawers so that things you use most frequently are between waist- and shoulder-height. This will prevent you from having to do a lot of bending or stretching to reach them.

  2. This goes for everything—your clothes, laundry supplies, cookware, cleaning supplies, and so on.

  3. If possible, keep all items in the area that you use them most often to avoid walking back and forth to retrieve them. And don’t be afraid to put items where they are convenient rather than where they are “supposed” to be.

5) Choose Clothing Strategically

  1. When it comes to shopping for clothes, remember that it’s all about the details. Choose clothing items that balance style with practical elements that making putting them on less tiring.

  2. For example, look for clothes that use zippers instead of buttons, and choose items that open in the front instead of those that you have to pull over your head. Opt for self-fastening shoes instead of ones with laces, or go with a pair of slip-on flats or loafers.

  3. Tight or form-fitting clothes place extra pressure on your diaphragm and make it harder to breathe. Instead, choose loose-fitting clothes made of light-fabrics like cotton. You will want to avoid compression socks too, as tight socks can easily restrict blood flow to your feet.

6) Keep Duplicates of Frequently Used Items

  1. Double up on certain household items to avoid lugging them around the house. If you don’t want to spend twice the amount on cleaning supplies, you can purchase empty bottles, split the cleaning supplies you already have, then place them in strategic areas.

  2. For example, if you have a two-story home with a bathroom on each floor, you can keep a separate set of household cleaners in each bathroom as well as the kitchen. You might want to consider keeping one vacuum on each floor, too.

  3. If you can splurge, take advantage of modern technology by purchasing an autonomous vacuum cleaner. These robots connect to an app on your smartphone so that all you have to do is press a button and let them do the work.

7) Prepare Meals in Advance

  1. See if you can find one free day per week to prepare a week’s worth of meals in advance. Simply package individual-size portions in separate containers and store them in the freezer for the coming week.

  2. Then, when hunger strikes, all you will have to do is pop a serving into the microwave for a hot and easy meal. This is a great opportunity to invite friends or family who offer to help you, as they can easily contribute to the grocery shopping or preparation.

 

8) Rest After Each Meal

  1. Feeling a little tired after you eat is normal, but COPD can amplify the fatigue and shortness of breath that comes with mealtime.

  2. Eating triggers a few biochemical processes that make you feel sleepy. Most notably, eating causes your glucose (blood sugar) to spike—an effect that can make you feel quite sluggish.

  3. In response to this spike, your body ramps up insulin production to convert glucose into energy. You will feel less tired once insulin does its job, but it can take a few hours for the food you ate to give you energy.

  4. Combat this effect by giving yourself more time to enjoy your meal and relax afterwards. Take smaller bites, chew slowly, and use pursed-lip breathing while you eat if you feel short of breath.

  5. You may find it helpful to designate a block of time for each meal. Keep your mealtimes consistent and avoid making plans after you eat.

  6. There’s no harm in holding off on doing the dishes until your energy returns, either. Allow yourself some time to simply unwind and digest with a puzzle, a book, or a nap if you need.

9) Invest in a Foldable Shopping Cart

  1. If you’re not keen on using an electric shopping cart, or your local store doesn’t offer one, consider getting a foldable shopping cart with wheels.

  2. Store it in your trunk for trips to the grocery store. If you find the cart helpful, you can also keep one around your house to carry multiple items from one room to the next.

 

10) Maintain Good Posture

  1. Good posture conserves energy, while excessive stooping places extra stress on your back, shoulders, and hips. Poor posture wears you out faster than if your shoulders, spine, and hips are properly aligned.

  2. When moving heavier items, use proper body mechanics or, better yet, ask a friend to help.

 

11) Practice Relaxation Techniques

  1. When you relax, you help restore energy to the body. Make a point of scheduling rest periods throughout the day, ideally by laying on your back, slowing your breathing, and concentrating on relaxing your muscles.

  2. Explore techniques such as meditation, Ujjayi breathing, or progressive muscle relaxation. You’ll be surprised at how much they help.

 

12) Ask for Help

  1. Delegate tasks that are too strenuous for you, such as scrubbing floors, moving furniture, or washing the car. If you don’t ask for help, they might not realize you need it.

  2. Not everyone will understand your limitations or appreciate what you are going through, but there’s nothing wrong with letting them know. Reach out. You’ll be surprised how many people are willing to help if you just ask.

 

Session 14

Sleep Hygiene

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. COPD & Sleep 

  2. Overlap Syndrome: COPD + Obstructive Sleep Apnea

  3. How Do I Sleep with COPD?
     

Breakdown:
  1. COPD & Sleep

Explain the connect for those who it is relevant to, that COPD can sometimes be overlapping with Sleep Apnea. But for everyone, there are known effects which can worsen sleep quality. Emphasize the importance of sleep for those with COPD.

  1. Nicotine Use

Smoking, vaping, and chewing tobacco can all make sleep worse.   Nicotine is a 

stimulant that keep you awake.  There are also other ingredients in tobacco products that can keep you awake.

  1. Medications

Some of the medications used to treat COPD, like theophylline, can cause you to stay awake.  If you are having trouble sleeping, review your medications with your clinical team to see if your medications are part of the problem.

  1. Pain

Many people with COPD suffer from chest and other pain.  Pain at night makes sleep 

Hard.  If you are having pain at night, talk to your clinical team about whether pain medicine, physical therapy, or other remedies are right for you.

  1. Depression + Anxiety

Up to half of people with COPD suffer from anxiety, depression, or both.  Anxiety and 

depression both make it hard to sleep.  If you think or know that you have anxiety or depression, talk to your clinical team about therapy and medication.  

  1. Overlap Syndrome: COPD + Obstructive Sleep Apnea

    1. Obstructive sleep apnea (OSA) is a condition in which people have gaps in breathing during sleep.  COPD does not increase risk for OSA, but they are often seen together because OSA is very common.  OSA causes frequent and sudden nighttime awakenings, as well as drops in blood oxygen levels. 

      1. Description

  2. How Do I Sleep with COPD?

Here are some tips to improve your sleep:

  1. Position Yourself Well: 

    1. Laying flat can make it tough to breathe with COPD.  

    2. Try two or three pillows under your head and back when you lay down to elevate your lungs.  Just make sure you are well supported and comfortable.

  2. Nap Smarter

    1. Short naps (less than 40 minutes) and early naps (6 hours before bed) are better. A short nap can restore energy, but a long nap or a late nap can keep you awake at night.

  3. Start a Routine

    1. Setting a bedtime and sticking to it trains your body to sleep.  A relaxing routine - like taking a bath, reading , or having a (decaffeinated) cup of tea for 30 minutes before you sleep trains your mind that it is bedtime.   

  4. Make a Sleep Haven

    1. A dark, quiet, and cool bedroom will help you get to sleep and stay there.  If it’s bright in your room, consider using an eye mask to block the light.

  5. Try white noise

    1. Many people sleep better with just a little noise to drown out their thoughts and sounds from other rooms or homes.  You can use a fan or other machine, or a white noise app on your phone or tablet.

  6. Eat earlier

    1. Avoid eating or drinking late in the day. You want to give your body time to digest and avoid waking up during the night to use the bathroom.  Choose healthy foods, like fruits and vegetables, and avoid fatty foods for better sleep.

  7. Skip the caffeine

    1. Just one cup of tea, coffee, or soda a few hours before bed can make it tough to sleep.  Avoid caffeine at least 4 hours before bed to avoid trouble sleeping.

  8. Avoid excess alcohol

    1. While you may feel sleepy after a beer or glass of wine, alcohol disrupts your deep sleep. Limit to 1-2 drinks in a night to avoid this effect.

  9. Get moving 

    1. Exercise is essential for good sleep. 30 minutes of moderate exercise, like a brisk walk, will help you sleep.   Just make sure it isn’t right before bedtime! 

  10. Unplug

    1. Blue light before bed keeps your mind stimulated.  Cut off phone, computer, and tablet use at least 30 minutes before you turn in.

  11. Quit smoking, vaping, and chewing tobacco

    1. Nicotine is a stimulant that can interfere with sleep.   Of course, it’s best to quit completely.  But if you are not ready to do that, avoid nicotine at least 1 hour before bed time.  

  12. Consider Oxygen

    1. Many people with COPD drop their oxygen saturation in deep sleep.  This triggers the body to wake itself up.  Talk to your clinical team about whether nighttime oxygen is right for you.

 

Session 15

Nutrition

Pre-Session Notes:
Begin with Pranayama Breathing
Topics:
  1. Importance of Nutrition in COPD 

  2. Challenges and Barriers to eating for COPD patients
     

Breakdown:
  1. Importance of Nutrition in COPD 

    1. Factors for lung health: 

      1. Increased metabolic rate, extra weight puts more pressure on lungs, can cause sleep disorders

      2. Weight:

        1. Check Your Weight – Get in the habit of weighing yourself regularly. The scale will alert you to weight loss or gain. You should see your doctor or dietitian if you continue to lose weight or if you gain weight while following the recommended diet. There are health complications that can result from being underweight or overweight. 

        2. A well-nourished body is better able to handle infections. When people with COPD get an infection, it can become serious quickly and result in hospitalization. Good nutrition can help prevent that from happening. If illness does occur, a well-nourished body can respond better to treatment.

        3. 35% of inpatients with COPD and 21% outpatients have “malnutrition”

    2. How Does Food Relate to Breathing? 

      1. The process of changing food to energy in the body is called metabolism. During metabolism, oxygen and food are changed into energy and carbon dioxide. Carbon dioxide is a waste product that you exhale. Breathing requires more energy for people living with COPD. Your muscles may require 10 times more calories than someone without COPD. 

 

  1. Challenges and Barriers to eating for COPD patients

    1. Addressing the challenges/barriers to balanced eating for COPD patients

      1. If you find yourself short of breath while eating or right after your meals, try these tips:

        1. Rest just before eating.

        2. Eat slowly, take smaller bites of food. 

        3. Sit upright while eating.

        4. Take a break in between bites and practice deep breathing exercises. 

        5. Eat more food early in the morning if you're usually too tired to eat later in the day.

        6. Avoid foods that cause gas or bloating. They tend to make breathing more difficult.

        7. Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets your lungs fill with air and empty out more easily.

        8. If drinking liquids with meals makes you feel too full to eat, limit liquids with meals or drink after meals.

        9. Consider adding a nutritional supplement at nighttime to avoid feeling full during the day.

      2. Nutrition Tips:

        1. Rest just before eating. 

        2. Eat slowly; take smaller bites of food. 

        3. Sit upright while eating. 

        4. Take a break in between bites and practice deep breathing exercises. 

        5. Eat more food early in the morning if you’re usually too tired to eat later in the day. 

        6. Avoid foods that cause gas or bloating. They tend to make breathing more difficult. 

        7. Some examples of foods that may cause gas include: beans, lentils, cabbage, broccoli, cauliflower, bok choy, brussel sprouts, bran, dairy products containing lactose, fructose (found in some fruits and used as a sweetener in certain products), sorbitol (a sugar substitute), and carbonated beverages 

        8. Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets your lungs fill with air and empty out more easily. 

        9. If drinking liquids with meals makes you feel too full to eat, limit liquids with meals or drink after meals. 

        10. Consider adding a nutritional supplement at nighttime to avoid feeling full during the day.

      3. Tips for choosing foods:

        1. The foods you eat provide your body with nutrients like carbohydrates, fats and proteins.

        2. Eating a diet with less carbohydrates and more fat may help you breathe easier. When your body metabolizes carbohydrates, it produces more carbon dioxide for the amount of oxygen used. When your body metabolizes fat, it produces the least.

      4. Tips for making food easier to chew:

        1. To make foods easier to chew:

        2. Cook vegetables until they are soft.

        3. Cook foods in liquid such as broth, water or juice until soft.

        4. Mince or grind meats.

        5. Dip breads in liquid.

        6. Eat pasta, mashed potatoes, thick soups, creamed soups, and casseroles.

        7. Try fruit smoothies or milk shakes (there are non-dairy options)

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