877.809.5515 www.knowingmore.com [email protected]

A Disease Process Module: UNDERSTANDING COPD

©1998-2016 May be copied for use within each physical location that purchases this inservice.

Developing Top-Notch CNAs, One Inservice at a Time

Inside This A Disease Process Module: Inservice: Understanding COPD

What Is COPD? 2 TAKE A DEEP BREATH! How Do the Lungs 3 Work? Take a slow deep breath in through your nose. Expand your lungs. Hold Symptoms of COPD 4 it for the count of five. Now slowly What Causes COPD? 5 blow the air out through your mouth. The Facts about 6 Smoking Breath in and breath out. You don't even have to think about it when So, what do you think happens to What’s It Like to 7 you are healthy and strong. people who simply cannot take a deep Have COPD? Breathing in brings healthy oxygen breath? What Doctors Know 8 into your body. Breathing out Lung damage that results from COPD about COPD removes poisonous carbon dioxide does just that. It makes the vital act of from your body. Treatment for COPD 9 breathing extremely difficult, Oxygen in your lungs is picked up by sometimes painful and completely Client Care Tips 10-12 your blood. Oxygenated blood is inefficient. pumped by the heart to every cell in The result is decreased brain function the body. leading to dementia, muscle wasting,  Your brain needs oxygen to organ failure, and anxiety. think, dream, invent, talk, love, and sing! COPD is the fourth leading cause of death in the United States right now,  Your muscles need oxygen to but is expected to become the third walk, run, lift, wave, hug, and leading cause of death by 2020. dance!  Every organ in your body needs There is no cure for COPD. But, there © 2016 In the Know, Inc. are some things you can do to help. www.knowingmore.com oxygen to function properly. May be copied for use within Keep reading to find out how COPD  Taking a slow deep breath even each physical location that damages the body, how it is treated has the power to relax you when purchases this inservice from and managed, and how you can best you're feeling, anxious, fearful, or In the Know. All other copying help your client deal with the changes or distribution is strictly stressed out! prohibited. that come with a diagnosis of COPD. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 2 WHAT IS COPD?

THE TERM COPD STANDS FOR:  CHRONIC BRONCHITIS is an inflammation inside the breathing Chronic tubes in the lungs. When these Obstructive tubes get inflamed, air has a hard Pulmonary time passing through. A thick Disease mucus is produced and coughed OTHER PROBLEMS up. COPD is a chronic disease, which means CAUSED BY COPD: that it continues over a long period of  EMPHYSEMA affects the tiny air COR PULMONALE: time. And it’s obstructive, because it sacs in the lungs. These sacs lose blocks the passage of air, making it hard their elasticity—like an overused  With COPD, the to breathe. COPD is a pulmonary rubber band. Stale air gets heart has to work disease, which means that it affects the trapped in them, making it harder very hard to pump lungs. to breathe. This causes shortness blood into the of breath and a cough. narrow passages of COPD is also a progressive and irreversible the lungs. After a disease. This means that it gets worse Remember...most clients with COPD while, the heart over time and that a person with COPD have some combination of both becomes enlarged. won’t get better (once there has been chronic bronchitis and Clients with cor damage in the lungs). emphysema. But, it pulmonale may get doesn’t really matter tired easily, have an COPD is made up of two similar if Mr. Smith’s COPD abnormal heart beat conditions: chronic bronchitis is mostly bronchitis and suffer from and emphysema. Both of these or Mrs. Brown’s chest pains. lung conditions keep the lungs COPD is mostly from working properly—and PNEUMONIA AND emphysema. Just prevent a person from OTHER CHEST think of these two breathing normally. INFECTIONS: conditions as Many clients with COPD have COPD—and follow  Pneumonia is an both chronic bronchitis and the tips given in this infection of the lung emphysema at the same inservice to help tissue. When lungs time—so their lungs have your clients live a have been damaged double the trouble! higher quality of by COPD, they can life. become infected easily.

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers! A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 3 HOW DO THE LUNGS WORK?

ALVEOLAR SAC ALVEOLI A FEW LUNG TRACHEA FACTS

BRONCHI  The lungs are large and cone-shaped. They look like giant BRONCHIOLES sponges and are grayish-pink in color.

 In adult lungs, there are 600-800 million tiny air sacs (called alveoli).

Each time a person breathes, air People with COPD aren’t able to use  Together, both your enters the nose and airways. It goes their breathing muscles properly. In lungs weigh about through the trachea to the lungs. addition, their lungs don’t work very 2.5 pounds. Then, the air goes through the well!  Lungs move all the bronchi to the bronchioles which  The walls of the small airways and time. spread out like the branches of a tree. the tiny air sacs become damaged  If a person’s lung From there, millions of very small and less flexible. tissue was spread airways carry the air to tiny air sacs  The airway walls thicken, causing out, it would just called alveoli. From these tiny air large airways to shrink and small about cover a tennis sacs, the air is absorbed into blood airways to become totally blocked. court! vessels. In addition, mucus plugs up the  The right lung has  In a normal lung, air has no airways and tiny air sacs three sections—but problem getting through to the air throughout the lungs. the left lung has sacs because the muscles that  “Stale” air gets trapped in the only two. wrap around the airways are very lungs. This stale air takes up room loose and thin. This gives the  The average adult that should be used by fresh air. airways plenty of room to open breathes about up.  These blockages make it really 25,000 times every hard for air to move in and out of day. By the age of  When the airways are open, it’s the lungs. 70, the average easy for air to move in and out of adult will have the tiny air sacs. In other  As a result, people with COPD have taken at least 600 trouble getting the oxygen that words...it’s easy to breathe! million breaths! their bodies need. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 4 SYMPTOMS OF COPD

Early symptoms of COPD often start out OTHER SYMPTOMS OF COPD WHAT IS A mild and do not cause much concern. MAY INCLUDE: SMOKER’S COUGH? Over time, as the symptoms worsen Tiny hairs (called cilia) and fail to resolve, lung damage begins  Fatigue, depression, and anxiety. line the healthy to occur.  Weight loss. respiratory tract and help There are four main symptoms of  Enlarged chest (also called “barrel to move mucus from the COPD: chest”). lungs up through the trachea to the back of the 1. CHRONIC COUGH that may  Too little oxygen can cause COPD throat. produce mucus. This is usually the clients to have a bluish color to their earliest symptom. It can start out skin, lips, and nails. This is known as the mild, then gradually increase in “ciliary elevator.” It’s just frequency and produce more and  Headache, irritability, and problems like an elevator in a tall more mucus. (See section on thinking and learning. building, except mucus is the passenger! “Smoker’s Cough.”) 2. SHORTNESS OF BREATH with WARNING SIGNS THAT COPD When you feel the need minimal exertion. This usually IS GETTING WORSE INCLUDE: to clear your throat, you remove this mucus. develops later on and continues to  More or less mucus than usual. get worse as COPD progresses. Most people just swallow  A change in the color of the it back down. It’s 3. CHEST TIGHTNESS. mucus—from clear to brown, completely normal. As lung yellow, or green. damage Smoking damages the cilia by gunking it up, progresses,  A change in the stickiness of sort of like getting maple breathing the mucus—from less to more syrup in your hair. When becomes more sticky. this happens, the ciliary difficult. There  Blood in the mucus. elevator can no longer may be a  Increased shortness of remove the mucus from feeling of breath. the lungs. painful tightness in the  Ankles that swell up So, instead of just chest. suddenly. clearing the throat, the smoker has to cough, 4. WHEEZING or  An unusual gain or loss of sometimes forcefully, to a whistling weight. get the mucus out. sound that occurs while breathing  Being extra tired. is common if the airways become The cough is always worse first thing in the swollen or blocked.  Having morning headaches, dizzy spells, restlessness, and morning after a long

sleeplessness. period of inactivity. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 5

WHAT CAUSES COPD?

COPD is usually caused by long term  AIR POLLUTION: For smokers, air PREVENTION IS THE exposure to things that irritate the pollution can be a factor, too. It can KEY lungs, and over time, cause irreversible lead to the development of COPD damage. and it can make the symptoms of Having COPD impacts COPD worse. your client's life in many  SMOKING: By far, ways. Most COPD cigarette smoking is the  HISTORY OF patients say their main cause of COPD! In INFECTIONS: condition limits their the United States, 85 People who have ability to work, do percent of COPD cases a history of household chores, and are related to smoking. childhood sleep. respiratory  SECONDHAND SMOKE: Since there is no cure infections like Non-smokers who are for COPD, the best colds, exposed to secondhand defense is prevention! pneumonia, or acute bronchitis may smoke are also at risk. Living with a be more likely to develop COPD. Encourage your clients smoker, or working in an enclosed who smoke to quit! The area like a restaurant or bar that  HEREDITY: Heredity also plays a benefits of quitting are allows smoking increases the role in COPD. There is a type of immediate! likelihood of developing lung emphysema called AAT (alpha 1 Most public places like infections and bronchitis which can antitrypsin) that runs in families. restaurants and lead to COPD. AAT is a substance that helps hospitals are now protect the lungs. Some people  CHEMICALS AND DUST: COPD can smoke-free because of are born without AAT and when also be caused by occupational laws that were put in this happens there is a good chance exposure, meaning that some place to protect people that they will have emphysema. people get COPD from their from secondhand The number of Americans with workplace. Chemical fumes and smoke. AAT emphysema is small. organic dusts (like grain, cotton, Laws banning TV and wood, metal, and coal dust) can magazine ads that contribute to COPD. promote cigarettes have reduced the Most smokers are NOT concerned about the number of young effects of smoking on their health even though people who ever start nearly half of all smokers have one or more smoking. symptoms of COPD. OSHA protects people  Why do you think smokers are in denial about who work with harsh the effects of smoking on their health? chemicals by requiring  Why do you think is it so hard for smokers to protective gear like quit smoking? masks and ventilation while on the job. A Client Care Module: Understanding COPD ©2016 In the Know, Inc. Page 6 THE FACTS ABOUT SMOKING

Have you ever wondered exactly what’s  Carbon Monoxide—an odorless, FAMOUS PEOPLE in a cigarette? Believe it or not, colorless toxic gas. In small doses, it WHO DIED FROM cigarettes and cigarette smoke contain causes increased heart rate, and SMOKING-RELATED over 4000 chemicals! At least 63 of shortness of breath. DISEASES these chemicals are known to cause  90% of people with smoking- cancer in people. Here are just a few of  Desi Arnaz—actor on related diseases began smoking “I Love Lucy” (died in the ingredients that you’ll find in just when they were teenagers. one cigarette. 1986 of lung cancer)  The CDC (Centers for Disease Control  Humphrey Bogart  Acetone—a chemical used in nail and Prevention) rates secondhand polish remover. —actor (died at age smoke as the most dangerous 57 of cancer of the  Ammonia—a chemical used in indoor pollutant. esophagus) cleaning solutions. (It’s added for  Approximately 4.5 million teenagers flavor.)  T.S. Elliot—poet and in the United States are cigarette writer (died in 1965 of  Lead—a very poisonous metal. It smokers. emphysema) can cause serious damage to the  Around 22 million American women  Betty Grable—movie brain, kidneys, red blood cells, and are smokers. nervous system. actress (died at age 56  Smoking during pregnancy causes of lung cancer)  Nicotine—the chemical that makes babies to be born too small and/or cigarettes so addictive. Many  Amanda Blake— too early. It’s also responsible for actress on believe that it’s more addictive than about 10% of all infant deaths. heroin! “Gunsmoke” (died at  According to the American age 60 of throat  Formaldehyde—a chemical that’s Lung Association, over 430,000 cancer) used to preserve dead Americans die each year from  Babe Ruth—baseball bodies. smoking-related diseases. Formaldehyde is player (died at age 53 known to cause  Secondhand smoke kills of nose/throat cancer) cancer and other at least 3,000 non-smokers  Walt Disney— problems. every year. animator (died at age 65 of lung cancer) The benefits of quitting are IMMEDIATE:  Andy Kaufman—  After 20 minutes, blood pressure can return actor (died at age 35 to normal. of lung cancer)  In 8 hours, oxygen levels return to normal.  In just 48 hours, all nicotine is gone from the body.  In 3 days, bronchial tubes relax and energy levels increase. A Client Care Module: Understanding COPD ©2016 In the Know, Inc. Page 7 WHAT’S IT LIKE TO HAVE COPD?

COPD develops gradually over a long period of time. It  When he turns 47, Jim finally sees a doctor who usually takes years of cigarette smoking before diagnoses COPD and starts Jim on some symptoms become noticeable. Keep in mind that not treatments. Jim notices a little bit of improvement everyone with COPD will progress in the same at first—less coughing and fewer episodes of way...and the severity of symptoms can vary from shortness of breath. He decides it’s okay to person to person, too. continue smoking—just a few cigarettes a day.

COPD might develop something like this:  In his early 50s, Jim starts to slowly get worse. His COPD is progressing—in spite of medical  Jim started smoking cigarettes when he was 19. treatments. Jim has repeated coughing attacks Now, he’s 27. His wife wants him to quit smoking, and constant shortness of breath. He loses his job but Jim hasn’t noticed any symptoms and can no longer support his family. of lung damage, so he keeps on smoking.  Now, each time Jim has a coughing attack, it takes longer and longer for him to feel better.  At age 31, Jim starts to develop a (Unfortunately, his lungs suffered a lot of damage chronic cough. Sometimes he before he finally went to a doctor. This makes it coughs up a small amount of mucus. harder to manage the COPD.)  When Jim turns 40, he begins to  By age 55, Jim’s damaged lungs notice some occasional shortness barely work. He has to gasp for every of breath. As the years go by, breath of air. Jim dies at the young age of his shortness of breath gets 56—leaving a wife and two teenaged worse and worse. children.

UNDERSTANDING THE THREE LEVELS OF COPD

1. MILD COPD 3. SEVERE COPD

 Beginnings of a chronic cough.  Severe shortness of breath with even the smallest amount of exercise.  Excess mucus production.  Coughing continues to get worse and there is  There may be no other early signs of COPD. too much mucus.

 Respiratory infections get worse and tend to 2. MODERATE COPD keep coming back.  Shortness of breath after moderate exercise.  Skin may have a bluish color to it.  Coughing happens more often and mucus  Chest may get larger—taking on the shape of a production increases. barrel. A barrel chest occurs when the lungs stay  Frequent respiratory infections like pneumonia. overinflated because of poor air movement out of the lungs. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 8 WHAT DOCTORS KNOW ABOUT COPD

The earlier that COPD is detected the better! Early Doctors look carefully for symptoms of COPD. After a treatment may help slow down the disease—at least a complete medical exam, including questions about little bit. the client’s health (like, “Do you cough every day?” or “Do you ever feel short of breath?”) the doctor will most Recent advances in technology have put the tools to likely order certain tests: detect lung damage, in its earliest stages, into the hands of Primary Care Doctors. Now, during a routine  Pulmonary Function Tests (PFTs) measure the physical exam, many doctors can perform a simple amount of air the lungs can hold and how quickly test, called Spirometry, right in the office! air moves in and out of the lungs.

 Any person 45  A blood test called Arterial Blood Gas (ABGs) years of age or measures how good the lungs are at getting older who oxygen into the bloodstream. currently smokes  A Pulse Oximetry test also measures the amount or recently quit of oxygen in the blood—but without using any should have a needles. It uses light spirometry test waves instead. The performed, even test is done by if there are no putting a special clip symptoms. on a person’s finger,  Spirometry earlobe, or forehead. testing is quick, easy, and painless. The person  Chest x-rays and simply takes a deep breath and exhales into a CAT scans. These machine that is connected to a computer. The tests show lung damage. They may not be helpful computer gives the doctor an immediate report in the early stages of COPD. on the health of the lungs. Doctors often perform these tests on several different Unfortunately, doctors say that many people ignore days. Then, the doctor compares the results to see if the warning signs of COPD. The symptoms are there, the diagnosis of COPD is correct. but people don’t pay attention to them because they are so mild. For example, they may think it’s normal A person with COPD will probably have these tests to become short of breath as they get older. Or they done regularly to check if the disease is getting may believe that their cough is just a little “smoker’s better...or worse. cough”—and that it’s not serious.

Because symptoms tend be so mild, it can be very difficult for doctors to catch COPD early on. Researchers are still looking for better ways to detect COPD. Someday they hope to develop tests that can So, most of the time, doctors diagnose COPD after the tell who is likely to get COPD. This would allow client’s lung function has been cut in half! By then, doctors to begin treatment before permanent much of the damage has been done. damage occurs. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 9 TREATMENT FOR COPD

So far, there is no cure for COPD, but there are several  Expectorants help loosen and get rid of mucus ways to help manage the symptoms. from the airways.

If people with COPD follow a complete lung care  Antibiotics help fight bacterial infections. They program , it can help lessen their disability, reduce are usually given at the first sign of infection— attacks, keep them out of the hospital, and maybe when mucus changes from clear to yellow or even help prevent some early deaths. But, no therapy green. There are many different types of can stop COPD from getting worse once the lungs antibiotics. have been damaged.  Diuretics (sometimes called “water pills”) help the Home oxygen therapy can improve the quality of life body get rid of extra fluid. for people with advanced COPD—and may help them survive longer. This treatment decreases shortness of  Digitalis strengthens the force of each heartbeat. breath, improves heart function and tolerance to Some other treatments include lung reduction exercise—and generally helps people feel and think surgery and transplant surgery. Lung reduction better. surgery removes the damaged areas of the lung so Oxygen requires a doctor’s prescription and is that the normal parts can function better. Transplant considered a medicine. Oxygen usually comes in a surgery involves putting the healthy lungs from a tank or humidifier and reaches the client through a person who has died into the chest of a person with face mask or nose tube. COPD. Remember: the best treatment is to try to prevent  Since tanks can hold only a few hours worth of oxygen, a machine called a concentrator can be the disease in the first place. One of the most useful. (A concentrator pulls oxygen out of the air. important steps is to stop smoking! Not smoking It’s about the size of a regular TV.) almost always prevents COPD from developing and quitting smoking often slows it down.  There are portable liquid oxygen systems and tanks, too, which clients can carry over their Another way to treat symptoms is to avoid shoulders or push in a cart. environmental hazards like pollution, second-hand smoke, strong odors, and weather changes. These Other medications used for COPD include: hazards can make COPD worse.

 Bronchodilators help open the airways. Inhalers Other treatments that help get rid of extra mucus are the most common way for adults to get this include chest percussion (lightly tapping the chest and medication. back), controlled coughing, and using special inhalers.  Steroids help reduce mucus production and inflammation Special breathing techniques— of the airway walls. Your such as pursed lip breathing—may client might take steroid pills also help lung function. (See or use a steroid inhaler. Breathing Activity Handout.) A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 10 TIPS FOR HELPING YOUR CLIENT WITH COPD

HELPING WITH MEDICATIONS  Clean the canister by removing the medication canister from the mouthpiece and rinsing the Watch your clients when they use their inhalers. It’s mouthpiece and cap in warm water. It’s best to do important that they know how to use them properly. this in the evening so the mouthpiece can “air dry” Let your supervisor know if you think they may be overnight. using them wrong. If you notice that your COPD clients are mixing their Using an inhaler seems simple, but you would be medications with other prescription and/or over-the- surprised at how may people forget to take off the cap! counter medications, let your supervisor know When an inhaler is used the wrong way, less medicine immediately! Mixing medications can cause gets to the lungs. To use an inhaler, COPD clients unexpected and sometimes serious side effects. should: OXYGEN SAFETY  Shake the inhaler for five to ten seconds and remove the cap. Breathe out all the way. Hold the  It’s very important not to inhaler one or two inches in front of the mouth smoke near oxygen. (about the width of two fingers). Breathe in slowly Encourage your clients and and deeply through the mouth while pressing their family members not down on the inhaler one time. Hold their breath to smoke at all. and count to 10 (if possible).  If your client is using  If a spacer or holding chamber is being used, the oxygen, make sure the equipment is being used opening of the spacer actually goes in the mouth correctly. Call your supervisor if the client seems (just between the lips). The medication is sprayed to need help. into the spacer. The client breaths in slowly and  Encourage your clients to change the nose tubes deeply for a count of 5, and then removes the (nasal cannulas) often, especially if the prongs spacer from the mouth and holds the breath for 10 become dirty or uncomfortable. seconds (if possible).  If your clients have portable oxygen units, make Ask to see your client’s inhaler. If you notice a sure they know exactly how much oxygen they “powder” around the hole where the medicine comes have so that they don’t run short during an out, the inhaler needs to be cleaned. outing.

Many people with COPD fear any type of exercise, believing that exercise will make symptoms worse. In fact the opposite is true! Regular, low impact exercise can actually help strengthen the lungs, improve endurance, and reduce anxiety.  Recent research shows YOGA may be the perfect exercise for people suffering from symptoms of COPD. Yoga can be done sitting or standing. It involves slow fluid movements with controlled breathing.

 Talk to the nurse, doctor, physical therapist, and your client about adding yoga to the COPD treatment plan! A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 11 MORE TIPS FOR HELPING YOUR CLIENT WITH COPD

ACTIVITY/ENERGY CONSERVATION  Slow down and encourage your clients not to do things too fast. A slow, steady pace uses less  Encourage your COPD clients to control their energy. You can help, too, by not rushing them to breathing. It’s helpful to use breathing control hurry and finish their activity. Be patient. during physical activities to help reduce shortness of breath and fatigue. (See Breathing Activity  Encourage your clients to do one activity at a time Handout.) and to use slow, smooth movements. Rushing could make them more uncomfortable.  Encourage your clients to sit for as many activities as possible. Believe it or not, sitting uses 25% less  Suggest that your clients use “tools or gadgets” to energy than standing. help conserve energy. For example: Use long- handled grabbers to avoid reaching or bending  Help your clients do their most important chores over, and use small push carts to carry things or activities first—when they have the most around. energy.

 Try not to let your clients with COPD do too much WEATHER-RELATED TIPS in one day. Ask them what they want or need to do that day and then help them decide what they  Remember that cold weather and high winds can can realistically get done. be bothersome to a client with COPD. Encourage your clients to take precautions like wearing a  Remind your clients that you are there to help. scarf over the nose and mouth to warm the air Some tasks may be too hard for them to do alone before breathing in. or they may dislike doing something. You can do it for them and this will help them save some  Encourage your clients to dress in layers. This energy. helps maintain body heat.  When organizing your client’s area, put items your  Remind your clients to avoid air pollution. client uses most often within easy reach—and Encourage them to remain indoors if the air keep them at waist or shoulder level. quality is poor. Even low amounts of ozone can  Let your clients know that it’s best to alternate worsen respiratory diseases. difficult and easy tasks...and to alternate activities with rest periods.

You are caring for a 67 year old woman who has COPD. She becomes short of breath with very little activity and is becoming frustrated and depressed because she can’t seem to do anything for herself anymore.  You know there are certain times of the day when your client has more energy and endurance.  How can you help? Think of three creative solutions to help with energy levels, depression, and discouragement.  Share your ideas with your co-workers and supervisor. A Client Care Module: Understanding COPD © 2016 In the Know, Inc. Page 12 MORE TIPS FOR HELPING YOUR CLIENT WITH COPD

NUTRITION GENERAL SAFETY

 Eating well-balanced meals is very important.  Encourage your clients to get a flu shot every year! Encourage your COPD clients to eat properly. People with COPD are more likely to get the flu and they will be sicker for much longer than  If your clients experience shortness of breath someone who doesn’t have COPD. during mealtimes, you can suggest that they: eat several small meals instead of three big ones; rest  Have your clients check with their doctor about before eating; eat slowly and chew foods well; getting a one-time pneumonia vaccination, too. breathe evenly when chewing; take plenty of time  Remind your clients to be cautious about being to eat; and avoid hard to eat foods. with people who are sick with colds or the flu.  If your clients don’t feel like eating, you can These infections are passed easily from one suggest that they try: eating small amounts of person to another. high calorie foods; drink fluids after eating; and  Avoid wearing strong perfumes or using strong- have liquid meals or soft foods. smelling cleaning fluids around clients with COPD.  Staying hydrated is important, too. Encourage  Many people with COPD also have allergies or your clients to drink plenty of fluids. This is a good asthma. If your clients suffer from allergies, try to way to keep the mucus loose so that it can be be aware of the things that bother them—such as brought up by coughing. house dust, pollen, strong odors, cigarette smoke,  If you cook for your client, remember to use the and pets. Help them avoid these allergy exhaust fan or make sure there is good ventilation “triggers.” in the kitchen.  Watch your clients for signs of breathlessness. If EXERCISE you see that they are short of breath, have them stop and rest in a comfortable position. Tell them  It’s important for your COPD clients to get some to breathe in and blow out slowly through their type of exercise—even if it’s only a short, slow- mouths. (See Breathing Activity Handout.) paced walk.  Remember...encourage your clients and their  Remind your clients to check with their doctor family members not to smoke. Tell them that over before starting any type of exercise program. one million smokers successfully quit the habit  It’s always a good idea for your clients to exercise each year. Of course, it isn’t easy to quit. Most in moderation—so they avoid doing too much. smokers make five attempts to stop before they actually do it. But, there are plenty of products on  Be sure to remind your COPD clients to take rest the market to help, such as nicotine patches, periods during exercise time. nicotine gum, nicotine nasal spray, and nicotine  Never let your clients exercise on a full stomach! It inhalers. Offer praise and support when your takes too much energy. clients quit smoking. (And be a good example yourself by not smoking!)