The following was taken from page 64 of the AARC Times November 2007...

by Regina Rigney, CRT

The journey to my new friendship began about six months ago in the little town of Waynesboro, MS. It was a typical afternoon at work, and I was called for a new patient who was very short of breath. Upon arrival to his room I learned he was one of our frequent COPD patients, even though this was my first time having him as a patient. After introducing myself, I discovered he was the most polite man I had ever met. I knew then that this was the start of a new friendship that I hoped would lead to him feeling better and having a better understanding of how to control and live with COPD.

Mr. JB was a 62-year-old man who made frequent visits to the hospital, especially now that his COPD was at the end stage. At our facility we do a thorough assessment, inquiring not only about the patient’s physical state but his history, which in this case revealed that Mr. JB had been a smoker for years and retired from a profession of auto body work and paint. He did quit smoking 12 years ago, and I congratulated him for that accomplishment.  He was taking breathing medication that apparently was not helping him. I assured him that we would look into the right combination of medications to find something that would help him feel less short of breath. Gathering up all the information available was the beginning of my mission to help Mr. JB with his COPD and to give my newfound friend some relief.

In completing my assessment and reviewing the chart, I learned he was on an inhalation solution  of ipratropium bromide with albuterol sulfate, fluticasone propionate with salmeterol xinafoate, and tiotropium bromide. He also took an albuterol inhaler between therapies to try to get some relief. My first plan of attack was to assess his ability to use his inhalers. He indeed was not able to take in a deep breath, nor was he holding his breath long enough to enable the medicine to distribute. Also, he did not have a spacer to aid in the distribution of the medication. Therefore, the medicines were just going to the back of his throat. He tried really hard to get the technique down so he could get the full benefit of the inhalers, but to no avail.

I told Mr. JB that we would work together to get him breathing better. I provided a spacer with clear instructions, then assessed his ability for usage. After just a couple of therapies he said he could tell a big difference. He was able to talk with me without having to stop and catch his breath. Education was the key to my patient breathing easier. His gratitude to me was worth it all. 

My next plan of action was to assist him in obtaining a productive cough. The cough was loose; yet with all the effort he could muster up, the phlegm would not come.  Our department provided him with a flutter valve to assist him with a productive cough. We had him view a video, with discussion of usage, which led to his breathing better. Each time he had therapy, we made sure that he remembered how to use the apparatus. We stressed the importance of continuing to use the equipment provided and educated him on how to clean it for infection control in the home. 

By the next day, he was able to go home. He was able to breathe much easier even on exertion. Just taking the time for teaching and care made his life more pleasant and enjoyable. 

Having any type of disease, but especially one like COPD, can be tough and hard to cope with from day to day.  Mr. JB chose to make his life the best that he could even when he felt at his worst. He also proved that with proper management from good teamwork you can control your disease instead of letting the disease control you.

Regina Rigney is a therapist at Wayne General Hospital in Waynesboro, MS."