Patient Education and Counseling
A key objective for patients with COPD is the prevention of exacerbations and hospital readmissions. Educating and counseling patients and their caregivers about their disease state and symptom management strategies plays a critical role in achieving this objective.
- After understanding the COPD basics, the Action Plan is the foundation to empower patients and caregivers to identify signs and symptoms of worsening COPD and actions to take. All patient education materials relate to the Action Plan. It may be preventative care, maintenance therapy, or treating an exacerbation.
- A good way to start the conversation is by asking patient open-ended questions (e.g, questions that start with what, how, and why) to determine what the patient already knows and identify their concerns. After addressing all concerns provide new information to the patient to build on what the patient already knows by filling in the gaps.
Every respiratory device requires special training to ensure that the recommended dose of medication is delivered to the patient's lungs and outcomes are optimized. Visit the Guide to Device Selection section of this website to learn more about the appropriate use of inhaled therapies and get tips to help patients get the most out of their medications.
- Review the proper inhaler technique videos, brochure and/or poster with patients. The most effective way of ensuring proper inhaler technique is to physically demonstrate it to patients and provide written instructions that explain proper technique.
- Ask the patient to show you how they use their device, correct their technique as appropriate, and repeat until proper inhaler technique is mastered. If the patient is unable to use one device properly it may be necessary to try another. There are many different inhalers and nebulizers available to allow for personalization of device selection.
Topic | Discussion/Counseling Points | Related Resources |
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COPD Basics |
Global Initiative for Chronic Obstructive Lung Disease (GOLD) Strategies defines COPD as a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
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For Patients
For Providers |
Topic | Discussion/Counseling Points | Related Resources |
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Action Plan |
There are many different COPD Action Plans available. Most follow the Stop Light format. Action Plans are helpful for patients to self-assess their normal symptoms to help identify early warning signs of worsening symptoms and appropriate actions.
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Topic | Discussion/Counseling Points | Related Resources |
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Inhaled Therapies |
The goal is to improve symptoms and prevent exacerbations. Proper selection of medication and delivery devices is essential and should take into account the patients cognitive and physical functioning. Medications: generally categorized according to if used as needed for symptoms or if used everyday regardless of how patient feels to help prevent worsening of symptoms.
Devices
Inhalers
Clean according to manufacturer specific instructions:
Nebulizers
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Topic | Discussion/Counseling Points | Related Resources |
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Vaccination schedules | GOLD Strategy and CDC recommends all COPD patients receive pneumonia vaccines (PPSV23 and PCV13) and annual Influenza vaccination (some possible exclusions apply). | |
Smoking cessation | Nicotine dependence is a chronic disease that most often requires multiple quit attempts to be successful. A quick assessment is to ask every patient every time about current tobacco product use (cigarettes, e-cigarettes, chewable tobacco, etc), ask how important quitting is and offer assistance. Provide a list of local programs, state tobacco quit line, and online resources. Consider medications, nicotine replacement or other therapies to improve cessation rates. |
Resources for patients to help stop smoking
Clinical Resources
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Screen for Alpha-1 antitrypsin deficiency | Alpha-1 antitrypsin deficiency (A1AT) is a genetic cause of emphysema and COPD. A1AT screening is indicated for any patient with fixed airflow obstruction by spirometry or evidence of emphysema seen on CT scan. Free testing kits are available through the alpha-1 foundation. |
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Lung cancer screening | Low dose computed tomography (LDCT) screening should be done in patients 55-80 years old with a ≥ 30 pack year history of smoking and who currently smoke or quit within the past 15 years. Pack years = (packs smoked per day) x (years as a smoker) |
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Nutrition | Instruct Patients to: Maintain healthy weight and well balanced diet. Drink at least 6-8 glasses of water throughout the day. Eat 4-6 small meals a day allows your diaphragm to move more easily and for you to breathe better. Eat complex carbohydrates, good sources of protein, and mono- and poly-unsaturated fats. Eat a variety of fruits and vegetables. Limit simple carbohydrates and sodium. |
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Breathing techniques |
COPD is a disease of expiratory airflow limitation. Special breathing techniques can help patients empty their lung to prepare for their next breath in. Some of the most common breathing techniques are pursed-lip breathing and diaphragmatic breathing. |
Breathing Exercises and Techniques for COPD |
Airway clearance techniques | Some patients may produce more mucous than others. Cough techniques may help remove mucous from airways. |
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Pulmonary rehabilitation | Pulmonary rehabilitation is just as important as medication therapy to improve symptoms, health status, and exercise tolerance. Pulmonary rehabilitation requires a provider’s referral. |
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Oxygen therapy | Exertional oxygen assessment will determine the patient’s oxygen need. A pulse oximeter can be used to monitor oxygen levels at rest and with ambulation. Patients may have oxygen delivered via concentrators at home. There are portable tanks and bags available for transportation and easy ambulation. |
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Energy conservation | Instruct patients to practice the 4 Ps (Prioritize, Plan, Pace, and Position) to help you use your energy for what you want to do. |
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Patient advocacy groups | Counsel patients to join COPD support communities and advocacy groups where they can find the tools and connections to stay active, healthy, and engaged in their treatment and care. |
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