WE PROVIDE THE FIRST FEW PAGES OF THE BOOK, INCLUDING THE CONTENT SO YOU CAN HAVE A REAL "FEEL" OF THE BOOK

VIJAI P. SHARMA, PhD
Script Editor: Beth C. Baker

The COPD Workbook For Severely Challenged COPDers can be used independently, or as a companion guide to the video program Stretching Breathing Exercises Adapted For People With Severe COPD.

The workbook offers an exercise program and wellness tips that are specifically designed for people with COPD. If you are a person with COPD, this can be an important self-care tool for you! If you are someone who has a loved one with COPD, you can help them with these tips for breathing, exercising and self-care.

This workbook contains significantly more material than could be included in the video. Among other things, it offers tips for self-help and personal psychological support. It includes breathing tips, safe exercise tips and ideas on constructing a “self-designed” fitness development program to suit your individual needs.

There is a wide range of built-in choices and flexibility that makes the program adaptable to your level of fitness now, and as your ability increases. We hope this tool serves you as well, as you develop your plan for health, fitness and efficient breathing.

DISCLAIMER
Vijai Sharma, PhD, is a clinical psychologist and a person with emphysema. Even though he made this program after consulting physicians, respiratory therapists and physical therapists, you should consult your own doctor regarding your specific condition.
User assumes the risk of injury resulting from the exercises or the advice offered here. The National Emphysema/COPD Association, Vijai Sharma, sponsors, distributors or sellers will not be responsible or liable for any injury, loss, or negative effects resulting from, or in connection with, the instructions or advice expressed in this workbook or in the Stretching Breathing Exercises Adapted For People With Severe COPD video.
Consult an exercise specialist for an exercise program that is particularly suited for you. Engage regularly in other activities and exercises such as walking, biking, hiking, using a rowing machine, weight training, cross country training, etc. in order to reduce stress and live a healthier, more active life.

THE COPD WORKBOOK

Important Safety Information and Introduction 6
Prevent Acute COPD Flare-ups! 13
Help for Coughing: Try Huff Coughing! 17
Tools for Safe Exercise 22
Hardiness Scale 23
Breath Consciousness 25
Be “Heart Smart” 27
Tips for Safe Exercise 30
List of Exercises 33
Instructions for the Exercises 35
Cool Down:Relaxed Breathing and Relaxation 61
Select the Most Suitable Exercise Regimen for You 64
Appendices
1. Pursed-Lip Breathing 114
2. Diaphragmatic Breathing 121
3. Tips for Everyday Life 127
4. Worries, “Blues” and Other COPD “Demons” 131
5. Introduction to the Video 139

IMPORTANT SAFETY INFORMATION
USE CAUTION!
Not all exercises are suitable for everyone; some may result in injury. We do not know your specific condition, so consult your doctor prior to attempting any of the exercises. This program is not intended for bedridden patients. A bedridden patient should go through a formal physiotherapy program and be able to sit in a chair before participating in this exercise program.

READ and WATCH FIRST!
We recommend that you first review the guide carefully and watch the entire video a time or two before attempting any of the exercises.

FEEL HASSLED BY BREATHLESSNESS, TENSION & STRESS?
Learn pursed-lip breathing, diaphragmatic breathing and relaxation from this workbook and/or the video prior to attempting other exercises. They can be found in the “Restore, Nourish and Relax” segment as “Head and Neck Relaxation,” “Facial Massage” and “Pursed Lip Breathing”. We hope that practicing these techniques will provide you relief from tension and give you some control over shortness of breath.

MASTER PURSED LIP BREATHING
Master the art of pursed lip breathing (PLB) before you attempt the exercises! Don’t merely watch or read about it. If you don’t already know PLB, refer to exercise # 3 “Pursed-Lip Breathing (PLB) ” and # 19 “Pursed-Lip Breathing and Relaxation” in this workbook. If you have the video, view and practice item # 3 “Pursed-Lip Breathing,” which is included in the section “Restore, Nourish and Relax” or view and practice the “Cool Down Pursed-Lip Breathing and PLB & Relax” segments at the end of the exercise program. Never force or strain. Listen to your body. If you feel unusually short of breath, dizzy or uncomfortable, stop and take a break. When done correctly, this exercise program may, in time, help to strengthen muscles and reduce shortness of breath.

Attempt the exercises in this program if you:

• Can walk at least 300 feet*, with or without supplemental oxygen, on level ground, in 6 minutes without becoming breathless.
• Have oxygen saturation 92 or more, with or without supplemental oxygen.
• Have attended a pulmonary rehab program and learned to exercise within safe limits. This is preferred.

If you don’t walk 300 feet in 6 minutes, YET, or are out of practice, start walking. Check our WALK TALK on the next page. In the initial phases, have someone assist you until you can stand and walk across the room without feeling dizzy or very short of breath. When you have someone to assist you, wear a stout belt and have your “assistant” hold the belt firmly in the back at all times.

Stay with the “Restorative Exercises”, the first three (3) exercises until you can walk a few minutes and not feel out of breath. Then proceed to the next exercises shown in this program.

If you are already walking some but are not used to exercising, start with a 5-minute exercise session! Stay with the first five exercises for a couple of weeks until you build strength and stamina! Above all, check with your doctor as to which exercises will be suitable for you.

THE HUFF COUGH TECHNIQUE

First, to deflate the excess air from your lungs, slow your breathing way down. Maintain a gentle, prolonged exhalation over three or four breaths.

Now, take in a slow, comfortably deep breath (but not a maximum deep breath).

At this juncture you must concentrate on keeping your glottis (“voice box”) open, and your mouth shaped like a loose “O.” If the glottis is kept open, it is impossible to build-up a high pressure cough.

Now, exercise a short, abrupt, relatively gentle “mini-cough” with a sudden contracting of your abdominal muscles. Try to imagine a centralized contraction, from just below your ribs to the umbilicus. Done correctly, this produces a soft sound, like a “huff,” hence the name huff cough. Note how different this is from the typical sharp barking sound of a normal cough, which only leads to bronchial compression and doesn’t help to clear the mucus from the lungs. A long, hard, repetitive cough therefore is just wasted energy.

At the end of the huff, take in a quick, partial breath of air, known as “rapid partial inspiration”. Try to feel the breath being sucked into the bottom of your chest and abdomen. This, again puts some air out past the offending mucus, and opens up the collapsed airways, in preparation for the next huff cough. Do not take in a deep breath as you did at the beginning of this exercise.

Repeat the huff cough a second time.

Once again, at the end of the second huff cough, take in a quick, and even smaller partial breath (rapid partial inspiration).

Repeat the huff cough for a third time. Sometimes you may find that third Huff Cough to be difficult. When this happens, perform only two huff coughs.

At the end of the huff cough sequence, using progressively smaller cough volumes, you should feel that most all of the air is out of your lungs. This is because you were not taking in the same sized deep breaths between the coughs. This decreasing change in lung volume will help to further squeeze phlegm from your lungs.

Finally, take in a forced, full (but not maximal) breath of air deep into your lungs. Keeping the glottis open, give a single, hard, forced huff cough. This should result in phlegm being produced to where it can be expectorated.

What has happened here?

The two or three (preferably three) huff mini-coughs loosened small peripheral bronchial mucus, and progressively brought it into the large bronchial tubes. Then the larger forced huff cough resulted in final expectoration.

FAILURE TO EXPECTORATE THE PHLEGM

Sometimes the final forced huff cough brings sticky mucus only part way up, where it gets hung, causing a coughing attack. This can be hard to control and very distressing.

If you find yourself in this situation, don’t panic and try to force the phlegm out with a series of hard coughs. Instead, stay calm and try to suppress your coughing spasms. Concentrate on taking slow, deep breaths with long expiration times. You may also try Pursed Lip Breathing. Rest yourself, and regain your strength. A sip or two of water often helps with cough control. This situation almost always produces a temporary state of lung hyperinflation, so it is very important for your recovery that you concentrate on lung deflation as noted above.

Then repeat the huff cough sequence as needed. Sticky phlegm is often the culprit causing this problem, so increase your clear fluid intake for the next few days, until your urine becomes consistently less yellow. This is done to moisten the phlegm and encourage looser sputum.

Remember, always examine your sputum, preferably immediately in a tissue for close inspection, so you know what your “normal” phlegm looks like. Do this regularly every day with the early morning phlegm, and at least once later in the day, or more frequently if you think your sputum is becoming abnormal. Examine all sputum if it is decreasing in amount, getting thicker or stickier, or if it becomes slightly opaque, or dirty yellowish or greenish in appearance. This may be the warning sign of early bronchial infection, which requires prompt medical attention.

HUFF COUGH TECHNIQUE SUMMARY

1. Lung Deflation (several breaths, or with breathing belt and/or respiratory squeeze assist)
2. Deep breath in.
3. Huff cough #1, with lung deflation, followed by rapid partial inspiration.
4. Huff cough #2, with further lung deflation, followed by rapid partial inspiration.
5. Huff cough #3, with still further lung deflation, down to near the bottom of your lungs
6. Deep breath in.
7. Single abrupt and forced Huff Cough for final expectoration.
8. Repeat as necessary after a brief rest if clearance is not complete.
9. Examine your sputum in a tissue, at least twice a day.

You have four “friends” to help you!
1..Deep., slow breathing: breathe deeply and correctly!
2..Stretching: get in the habit of stretching your entire body!
3. Walking: walk daily at least once!
4..Exercise: exercise daily!

Deep and slow breathing, stretching, walking and exercise can help with COPD. These four friends can help build stamina and open the airways. If you’re congested, they may get the mucus flowing and reduce the excess mucus. Form the habit of exhaling more fully. Constantly remind yourself to do diaphragmatic breathing. Start pursed-lip breathing as soon as you notice the first sign of unfavorable change in your breathing. Engage regularly in other activities and exercises such as walking, biking, hiking, using a rowing machine, weight training, cross country training, etc. in order to reduce stress and live a healthier, more active life.