This document outlines a home care chronic disease prevention program focusing on COPD. It includes 9 modules covering various chronic diseases. The COPD module defines COPD, describes how it impacts lung function, and discusses causes, symptoms, diagnosis, classification, treatment including medications and lifestyle changes, and warning signs. The goal is to educate patients on COPD management and promote healthy behaviors.

1. Home Care Chronic DiseasePrevention Program Melanie S. Bunn RN,MS A collaboration of Duke University, Division of Community Health and University of South Carolina, School of Medicine

2. Homework review What did you do? What happened as you did that? Why do you think that happened? Here’s what might have happened. How does this impact the next time you try this?

3. Chronic Disease Prevention Program Module 1:Health/Illness, Vital Signs, Exercise, Nutrition Module 2: Motivational Interviewing Module 3: End of Life Module 4: Heart Attack Module 5: COPD Module 6: Stroke Module 7: Hypertension Module 8: Diabetes Module 9: Congestive Heart Failure

4. Chronic Obstructive Pulmonary Disease (COPD)

5. Objectives Discuss how the lungs work and the impact of COPD on respiratory function Describe healthy lifestyle choices for the person who has COPD Demonstrate use of motivational interviewing with the person who has COPD

6. Other names for COPD Emphysema Chronic bronchitis

7. Lung function Normal lungs are like a sponge The holes in the sponge are where the lungs are able to exchange carbon dioxide that the body produces, for oxygen Air (oxygen) travels down the windpipe (trachea) through the bronchi (breathing tubes) to the bronchioles (smaller tubes) to the alveoli (sacs) where oxygen and carbon dioxide are exchanged

8. Lung function (continued) The body needs oxygen to function The airways and air sacs are normally elastic and springy The tubes are normally open and able to clear dirt/debris that enters the lungs

9. Anatomy of the lungs Photo of lungs

10. What is COPD? Lung disease in which the lungs are damaged Typically occurs in smokers, but may happen with other environmental exposures and hereditary conditions

11. What is COPD? Breathing tubes that carry air in and out of the lungs are obstructed In COPD air sacs lose their elasticity and so they collapse or don’t inflate properly In COPD the breathing tubes are blocked with mucous and become swollen so air cannot move in and out

12. COPD facts 14 million people in the United States have COPD Develops slowly Not contagious Fourth leading cause of death in the United States There is no cure

13. Causes Exposure to pipe, cigar, tobacco smoke Exposure to second hand smoke Exposure to heavy air pollution Exposure to heavy dust Exposure to chemical/toxic fumes Genetic conditions

14. Signs and symptoms Wheezing Coughing Sputum production Shortness of breath Chest tightness

15. Diagnosis Clinical symptoms Chest x-ray Lung function tests

16. Classification At risk- breathing test normal, mild symptoms Mild- breathing test shows mild limitation, increasing symptoms Moderate- person will typically seek care for symptoms, shortness of breath with significant exertion, lung tests abnormal Severe- shortness of breath with limited activity, lung tests abnormal

17. Treatment Eliminate exposure to things that cause COPD Quit smoking Exercise and pulmonary rehabilitation Inhaled medications to open the breathing tubes or decrease the inflammation Oxygen Pneumococcal and flu vaccines

18. Medications Inhaler use Spacer use Discuss use

19. Meter dose inhaler Abbreviated MDI Aerosolized medicine in canister in plastic holder

20. Spacer Plastic tube that attaches to the inhaler Makes the use of the MDI easier Ensures delivery of the medication to the lungs

21. Meter dose inhaler/spacer use Remove the cap from the inhaler and from the spacer Shake the inhaler well Attach the inhaler to the spacer Exhale deeply Purse lips around the mouthpiece Take a slow breath in Hold breath for at least ten seconds

22. Meter dose inhaler/spacer use Wait two to three minutes Repeat process Rinse mouth after use if using a steroid inhaler

23. Warning symptoms Increasing shortness of breath Increasing coughing and wheezing History of fever

24. Warning signs* Increased wheezing Decreased pulse ox Fever ( greater than 101 degrees Fahrenheit) Increased pulse (greater than 100) Decreased pulse (less than 60) Increased respiratory rate *ALL vital parameters are determined by RN supervisor and are patient specific

25. Other warnings Not taking medications