Call Your Home Health Nurse and/or Physician. Call 911. Self Management for COPD COMMUNITY HEALTH AND COUNSELING SERVICES

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1 COMMUNITY HEALTH AND COUNSELING SERVICES Self Management for COPD Call Your Home Health Nurse and/or Physician Call 911 Sputum (phlegm) that increases in amount/color or becomes thicker than usual Unrelieved shortness of breath Increased coughing/wheezing that continues after taking medications Unrelieved chest pain Increased swelling of ankles and/or feet Increased shortness of breath with activity Weight loss or gain of 3 pounds or more Fever of oral or 99.5 under your arm Increase in number of pillows needed Any other unusual feeling that bothers you Wheezing or chest tightness Increased or irregular heart beat Change in color of your skin, nail beds, or your lips turn gray or blue Mental changes Chest pain that worsens when you breathe or cough

2 COMMUNITY HEALTH AND COUNSELING SERVICES HEALTH SERVICES DEPARTMENT CHRONIC OBSTRUCTIVE PULMONARY DISEASE WHEN DO I NEED TO NOTIFY MY DOCTOR? You need to call your doctor for: increased difficulty with breathing temperature 101 F orally (or 100 F rectally) or greater lack of planned response to medications an increase in the amount of sputum a darkening in color of sputum (yellow-green-brown tints) MEDICAL APPOINTMENT FOLLOW-THROUGH It is very important that you schedule and keep your doctor appointments. Your doctor has ordered home care to supplement his or her care, not to replace it. Your doctor is the only person who can make changes in your medication and order tests that may be indicated. WHAT CAN I DO TO SLOW DOWN THE DISEASE PROCESS? To slow down the disease process and keep the disease from getting worse: Stop smoking if you are a smoker. Follow your doctor s instructions. Take all medications as prescribed. Avoid drafts, people with respiratory infections, and air pollution. Maintain a well-balanced diet (eat frequent, small portions). Discard tissues into a plastic bag. Drink an adequate amount of fluids. 2 to 3 quarts unless fluids are restricted by your doctor. Conserve your energy. Plan extra time for your routine activities. Take rests between activities. Avoid extremes in temperature. Accept assistance that is offered. Do only what must be done. Arrange chores to allow sitting as much as possible, i.e., while shaving, cooking. Avoid stair climbing. Practice breathing enhancers: Sit upright and lean forward when it is difficult to catch your breath. Inhale slowly and deeply through your nose and hold for two to three seconds. Then, support your abdominal muscles and cough deeply. Repeat the deep breathing and coughing three times. Do this exercise at least four times a day.

3 Relax and purse your lips as you exhale when breathing is more difficult. Make sure you get an Influenza vaccine in the fall of every year and that you have received a pneumonia vaccine. WHAT IS CHRONIC OBSTRUCTIVE PULMONARY DISEASE? Chronic obstructive pulmonary disease is also know as COPD. There are two types of COPD, which are more commonly referred to as emphysema and chronic bronchitis. In the chronic bronchitis type, the bronchioles (breathing tubes) leading to the lungs develop thickened membranes that secrete large amounts of sputum and pus. In the emphysema type, the tiny alveoli (air sacs) within the lungs become inelastic and sometimes break open and trap air. In both cases breathing becomes very difficult because air that is taken in cannot be expelled completely. WHAT ARE THE SIGNS AND SYMPTOMS OF THE CHRONIC BROCHITIS TYPE OF COPD? The signs and symptoms include: shortness of breath wheezing on expiration (breathing out) history of many respiratory infections productive cough, especially in the morning. WHAT ARE THE SIGNS AND SYMPTOMS OF THE EMPHYSEMA TYPE OF COPD? The signs and symptoms are: shortness of breath that becomes worse on exertion rare productive cough rare respiratory infections decreased breath sounds as heard with a stethoscope WHAT CAUSES COPD? COPD is caused by: smoking air pollution untreated airway infections

4 Your Metered -Dose Inhaler How To Use It Using a metered-dose inhaler is a good way to take asthma medicines. There are few side effects because the medicine goes right to the lungs and not to other parts of the body. It takes only 5 to 10 minutes for inhaled beta 2 -agonists to have an effect compared to the liquid or pill form, which can take 15 minutes to 1 hour. Inhalers can be used by all asthma patients age 5 and older. A spacer or holding chamber attached to the inhaler can help make taking the medicine easier. The inhaler must be cleaned often to prevent buildup that will clog it or reduce how well it works. The guidelines that follow will help you use the inhaler the correct way. Ask your doctor or nurse to show you how to use the inhaler. USING THE INHALER 1. Remove the cap and hold the inhaler upright. 2. Shake the inhaler. 3. Tilt your head back slightly and breathe out. 4. Use the inhaler in any one of these ways. (A and B are the best ways. B is recommended for young children, older adults, and those taking inhaled steroids. C is okay if you are having trouble with A or B.) A. Open mouth with inhaler 1 to 2 inches away. B. Use a spacer (ask for the handout on spacers). C. Put inhaler in mouth and seal lips around the mouthpiece. 5. Press down on the inhaler to release the medicine as you start to breathe in slowly. 6. Breathe in slowly for 3 to 5 seconds. 7. Hold your breathe for 10 seconds to allow the medicine to reach deeply into your lungs. 8. Repeat puffs as prescribed. Waiting 1 minute between puffs may permit the second puff to go deeper into the lungs. NOTE: Dry powder capsules are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece and inhale very fast. CLEANING 1. Once a day clean the inhaler and cap by rinsing it in warm running water. Let it dry before you use it again. Have another inhaler to use while it is drying. Do not put the canister holding cromolyn or nedocromil in water. 2. Twice a week wash the L-shaped plastic mouthpiece with mild dishwashing soap and warm water. Rinse and dry well before putting the canister back inside the mouthpiece. CHECKING HOW LONG A CANISTER WILL LAST 1. Check the canister label to see how many puffs it contains. 2. Figure out how many puffs you will take per day (for example, 2 puffs, 4 times a day = 8 puffs a day). Divide this number into the number of puffs contained in the canister. That tells you how long the canister should last. Example: Canister contains 200 puffs You take 2 puffs, 4 times a day, which equals 8 puffs/day = 25. The canister will last 25 days.

5 Spacers - Making Inhaled Medicines Easier To Take Unless you use your inhaler the right way, much of the medicine may end up on your tongue, on the back of your throat, or in the air. Use of a spacer or holding chamber can help prevent this problem. A spacer or holding chamber is a device that attaches to a metered-dose inhaler. It holds the medicine in its chamber long enough for you to inhale it in one or two slow deep breaths. The spacer makes it easy to use the medicines the right way (especially if your child is young or you have a hard time using just an inhaler). It helps you not cough when using an inhaler. A spacer will also help prevent you from getting a yeast infection in your mouth (thrush) when taking inhaled steroid medicines. There are a variety of spacers. There are many models of spacers or holding chambers that you can purchase through your pharmacist or medical supply company. Ask your doctor about the different models. HOW TO USE A SPACER 1. Attach the inhaler to the spacer or holding chamber as explained by your doctor or by using the directions that come with the product. 2. Shake well. 3. Press the button on the inhaler. This will put one puff of the medicine in the holding chamber. 4. Place the mouthpiece of the spacer in your mouth, and inhale slowly. (A face mask may be helpful for a young child.) 5. Hold your breath for a few seconds and then exhale. Repeat steps 4 and 5. If your doctor has prescribed two puffs, wait between puffs for the amount of time he or she has directed and repeat steps 2 through 5. How to Use and Care for Your Nebulizer A nebulizer is a device driven by a compressed air machine. It allows you to take asthma medicine in the form of a mist (wet aerosol). It consists of a cup, a mouthpiece attached to a T-shaped part or a mask, and thin, plastic tubing to connect to the compressed air machine. It is used mostly by three types of patients. children under age 5 patients who have problems using metered-dose inhalers patients with severe asthma. A nebulizer helps to make sure you get the right amount of medicine. Routinely cleaning the nebulizer is important because an unclean nebulizer may cause an infection. A good cleaning routine keeps the nebulizer from clogging up and helps it last longer. (See instructions with nebulizer.)

6 Directions for using the compressed air machine may vary (check the machine s directions), but generally the tubing has to be put into the outlet of the machine before it is turned on. HOW TO USE A NEBULIZER 1a. If your medicine is premixed, measure the correct amount of medicine using a clean dropper and put it into the cup. Go to step 2. 1b. If the medicine is not premixed, measure the correct amount of saline - using a clean dropper - and put it into the cup. Then measure the correct amount of medicine using a different clean dropper and put it into the cup with the saline. (Do NOT mix the droppers; use one for saline and another for the medicine.) Put an S for saline on one dropper with nail polish. 2. Fasten the mouthpiece to the T-shaped part and then fasten this unit to the cup OR fasten the mask to the cup. For a child over the age of 2, use a mouthpiece unit because it will deliver more medicine than a mask. 3. Put the mouthpiece in your mouth. Seal your lips tightly around it OR place the mask on your face. 4. Turn on the air compressor machine. 5. Take slow, deep breaths in through the mouth. 6. Hold each breath 1 to 2 seconds before breathing out. 7. Continue until the medicine is gone from the cup (approximately 10 minutes). 8. Store the medicine as directed after each use. CLEANING THE NEBULIZER Don t forget: Cleaning and getting rid of germs prevent infection. Cleaning keeps the nebulizer from clogging up and helps it last longer. Cleaning Needed After Each Use 1. Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. The outside should be wiped down. Rinse the mask or mouthpiece and T-shaped part - as well as the eyedropper or syringe - in warm running water for 30 seconds. Use distilled or sterile water for rinsing if possible. 2. Shake off excess water. Air dry on a clean cloth or paper towel. 3. Put the mask or the mouthpiece and T-shaped part, cup, and tubing back together and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer. 4. Disconnect the tubing from the compressed air machine. Store the nebulizer in a ziplock plastic bag. 5. Place a cover over the compressed air machine. Cleaning Needed Once Every Day 1. Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. 2. Wash the mask or the mouthpiece and T-shaped part - as well as the eyedropper or syringe - with a mild dishwashing soap and warm water. 3. Rinse under a strong stream of water for 30 seconds. Use distilled (or sterile) water if possible. 4. Shake off excess water. Air dry on a clean cloth or paper towel. 5. Put the mask or the mouthpiece and T-shaped part, cup, and tubing back together, and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer. 6. Disconnect the tubing from the compressed air machine. Store the nebulizer in a re-sealable plastic bag. 7. Place a cover over the compressed air machine. Cleaning Needed Once or Twice a Week

7 1. Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Wash the mask or the mouthpiece and T-shaped part - as well as the eyedropper or syringe - with mild dishwashing soap and warm water. 2. Rinse under a strong stream of water for 30 seconds. 3. Soak for 30 minutes in a solution that is one part distilled white vinegar and two parts distilled water. Throw out the vinegar water solution after use; do not reuse it. 4. Rinse the nebulizer parts and the eyedropper or syringe under warm running water for 1 minute. Use distilled or sterile water if possible. 5. Shake off excess water. Air dry on a clean cloth or paper towel. 6. Put the mask or the mouthpiece and T-shaped part, cup, and tubing back together, and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer thoroughly. 7. Disconnect the tubing from the compressed air machine. Store the nebulizer in a resealable plastic bag. 8. Clean the surface of the compressed air machine with a well-wrung, soapy cloth or sponge. You could also use an alcohol or disinfectant wipe. NEVER PUT THE COMPRESSED AIR MACHINE IN WATER. 9. Place a cover over the compressed air machine. COPD BREATHING TECHNIQUES BREATHING TECHNIQUES If you have COPD, you have to learn to get the most out of your breath. A great place to learn about breathing techniques is in a respiratory rehabilitation program. Respiratory rehabilitation programs are specially designed for people with COPD. They teach breathing techniques, as well as how to exercise, and they give you a chance to practice with the group. Learn more about respiratory rehabilitation programs and how to find one in your area. WHAT TO DO IF YOU RE SHORT OF BREATH Being short of breath can feel scary. It helps if you know what to do. If you re short of breath: Stop and rest in a comfortable position Get your head down Get your shoulders down Breathe in through your mouth Blow out through your mouth Breathe in and blow out as fast as is necessary Begin to blow out longer, but not forcibly use pursed lips breathing if you find it effective Slow your breathing down Begin to breathe through your nose Begin diaphragmatic breathing Stay in this position for 5 minutes longer COMFORTABLE POSITIONS IF YOU RE SHORT OF BREATH Sitting: Sit with your back against the back of the chair. Your head and shoulders should be rolled forward and relaxed downwards. Rest your hands and forearms on your thighs, palms turned upwards. Do not lean on your hands. Your feet should be on the floor, knees rolled slightly outward. Follow the steps above until your breathing is normal.

8 Sitting: Lean back into the chair in a slouched position, your head rolled forward, shoulders relaxed downward. Rest your hands gently on your stomach. Keep your feet on the floor, knees rolled outward. Follow the steps above until your breathing is normal. Sitting: Place a pillow on a table and sit down, arms folded and resting on the pillow. Keep your feet on the floor or a stool, and rest your head on your arms. Follow the steps above until your breathing is normal. This position may also be used standing, arms resting on kitchen counter or back of chair, not leaning, knees bent slightly, one foot in front of the other. Standing: Lean with your back to the wall, a pole, etc. Place your feet slightly apart and at a comfortable distance from the wall, head and shoulders relaxed. Follow the steps above until your breathing is normal. HOW TO CONTROL YOUR BREATHING If you know how to control your breathing, you can stay calm when you re short of breath. Pursed-lip breathing and diaphragmatic breathing will both help. These breathing methods prevent or reduce the trapped air in your lungs, and allow you to breathe in more fresh air. Pursed Lip Breathing Breathe in slowly through your nose for 1 count Purse your lips as if you were going to whistle Breathe out gently through pursed lips for 2 slow counts (breathe out twice as slowly as you breathed in). Let the air escape naturally-don t force the air out of your lungs Keep doing pursed-lip breathing until you re not short of breath Diaphragmatic Breathing Put one hand on your upper chest and the other on your belly just above your waist Breathe in slowly through your nose-you should be able to feel the hand on your belly moving in as you exhale (breathe out) HOW TO COUGH UP PHLEGM: CONTROLLED COUGHING People with COPD usually have extra phlegm (mucus) in their lungs. If you have phlegm, cough it up. If the phlegm stays in your lungs, it can clog your smaller airways, making it hard to breathe. The phlegm could also become infected. It s important to get the phlegm out. Controlled coughing helps you clear the phlegm from your lungs. Here s how to do it: Sit down, make yourself comfortable Lean your head forward slightly Place both feet firmly on the ground Inhale deeply using diaphragmatic technique (push your abdomen out while inhaling) Try to hold your breath for three seconds While keeping your mouth slightly open, cough out twice. You should feel your diaphragm pushed upward while you do this. The second cough is to move the phlegm towards the throat after you have moved it with your first cough. Spit the phlegm out into a tissue. Remember to check the color; if the phlegm is yellow, green or brown, or has blood in it, call your doctor. Discard the tissue. Take a break and repeat once or twice if necessary

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