COPD exacerbation plan


figure ? COPD action plan. Source
Patients with COPD should know how to manage an exacerbation. The best way to do this is for them to have an agreed COPD action plan (Australian & New Zealand lung foundation, 2007). This should be reviewed regularly by the patient and their treating medical practitioner. For a copy of the action plan, see the link below.
In using this plan, the patient and the medical practitioner should be very clear on the plan and instructions, and a crisis management plan should be very strong to prevent delays in treating a severe exacerbation. It is a good idea prior to discharge of a patient to ensure that they have an up to date management plan, and assist the patient where required to discuss this issue with their treating doctor. Early intervention however may prevent the need for hospitalisation.
A checklist for treating health professionals can be found at the link below, and is based on the COPDX action plan (Australian & New Zealand lung foundation, 2010).

Monitor health

Patients should monitor their own health status and seek medical advice early if they feel unwell. This includes monitoring for increased sputum production and colour of sputum. Where sputum starts to change colour, for example turn green, they should see their GP early to prevent or lessen severity of exacerbation. In addition, patients should understand environmental conditions that contribute toward an exacerbation and wherever possible avoid those conditions. An example of this would be exposure to extremely cold night air in winter, or bush fire smoke in summer.

Where a patient is still smoking, they should be encouraged to stop, as continued smoking will serve to worsen their condition (Booker, 2010: 17). There are many supports available to assist with smoking cessation from accessing the advice of a GP to telephone assistance organisations such as quit line.
If a patient is in hospital with an exacerbation of COPD, and they identify to you that they still smoke, you may be able to refer them to your hospital’s drug and alcohol liaison service.

Exercise and weight monitoring


figure ? Exercise and weight loss. Source

Evidence has revealed that regular exercise can improve lung function, reduce dyspnoea and improve overall health and wellbeing (ZuWallack, 2008; Carr, Hill, Brooks, and Goldstein 2009). During an exacerbation, this process should commence with a program of pulmonary rehabilitation. Evidence demonstrates that pulmonary rehabilitation followed by regular exercise reduces severity of exacerbations, improves dyspnoea (Carr, et. al, 2009), improves quality of life (Paz-Dıaz, Montes de Oca, Lopez & Celli, 2006), and has a positive effect on other co-morbidities that contribute to the patient’s clinical condition, including mental health issues. It also has a positive effect on reducing frequency of hospital admissions or length of stay where admission is required (Eaton, Young, Fergusson, Moodie, Zeng, O’Kane, Good, Rhodes, Poole & Kolbe, 2009). An advantage of maintaining some form of activity with COPD is weight control, which will serve to assist in controlling or limiting the effects of COPD, and assisting with other co-morbidities that are related to COPD (ZuWallack, 2008). A decrease in adipose tissue will also have benefits in maximising use of respiratory muscles and thoracic space.

An exercise program can be developed under medical supervision through a pulmonary rehabilitation program, and should be tailored to the individual. Exercise programs are also contingent on the severity of COPD that a patient is currently experiencing.

Use of Bronchodilators


Figure ?. Bronchodilators Source

This area has been covered extensively in the page ‘how do I deliver a bronchodilator’. However, the patient should have good technique in administering their bronchodilators to ensure accurate administration. It is important to firstly check your own knowledge in use of bronchodilators, and then educate your patients in the most accurate way to deliver their medication. This is especially important if they are using metered dose inhalers. A patient should be assessed in their technique prior to discharge as part of a good discharge plan.

Energy Conservation


Figure ? Stop and take time to slow your breathing.Source

It is important for patients to conserve energy by taking rests in between activities or when they feel dyspnoea affecting them. This is particularly important if they feel unwell or fatigued. Use of pursed lipped breathing may be an advantage to increase the length of time required to exhale and enhance gas exchange. For a useful fact sheet on breathing techniques and energy conservation from the lung foundation of Saskatchewan, see the link below:

The need to rest is difficult for many patients, because it has impacts in the patient’s lifestyle and family dynamics (Kanervisto, 2007: 1503). Patients experience feelings of isolation, depression and a decline in their estimations of self worth. Families feel greater strain as a remodelling of their lifestyle is required to accommodate a person with COPD. It is important to involve a discharge planner/coordinator in your patients care as some assistance in the form of physical and emotional supports may be required to assist the family in caring for a person with COPD.