When you have finished viewing the video, click on the "X" box in the upper right corner to exit the video.
To return to the main program, click on the back arrow.
At the end of the consultation with a new COPD / Emphysema patient I usually told them:
"I can't help you, but I can show you how to help yourself."
Yes, this was rather harsh, but it did get their attention. And No, nobody got up and walked out on me, though I did wonder about this possibility a few times.
This deliberate strategy was a realistic technique to hopefully set the stage for the pulmonary rehabilitation program to follow. Patients are usually oriented to the belief that their doctor is simply going to provide them with some pills, and that by taking these medications their health problems will be resolved. True, taking medications in many disease conditions will resolve their problems. However, for the COPD / Emphysema patient nothing could be further from the truth. Effective therapy for these patients is critically dependent on patient understanding, cooperation, and various respiratory skills. It requires the patient to become a part of a team effort, with their doctor and therapists.
I then told them the first crucial lesson to be learned is:
"Every breath of air first begins by getting the old stale air out, to make room for the fresh air."
This is a very counter-intuitive message to patients, as their natural focus is to get air IN, to relieve their dyspnea. To persuade patients as to the importance of properly exhaling their last breath, it is helpful to describe the residual last breath in derogatory terms such as "dead air" or "foul air" or "old bad air" and similar terms. The object is to change the patients focus from inspiration to expiration. Indeed, and as you will learn in greater detail in lessons to come, the expiration phase of breathing is the most crucial and difficult to learn.
And finally, I gave them some simple instructions for a much abbreviated breathing control program. Most of the time patients obtained at least some immediate measure of dyspnea relief, and if they did it was an excellent beginning. I could then advise them this was a favorable sign for better things to come, when they had developed more advanced breathing control skills. The instructions are as follows:
"Sit back in a comfortable easy chair (or if in bed, propped up on at least three pillows). Relax, you can't breathe properly if you are tense and anxious. Breathe gently, and rhythmically. Slow down your breathing. Concentrate on breathing OUT, and MAKE YOUR EXPIRATIONS LONGER. When you breathe in, take in a gentle, slightly larger breath, and try to place, and try to feel the air going down to your lowest lateral ribs, directly in line with the anterior portion of your arm pits."
A good trick to get the very important proper chest movement is as follows. Raise your elbows up, with fingers hanging down. Now, curl your fingers backward, so the back of your fingers are facing the floor. Then, place the back of your fingers on the very lowest ribs (next to your abdomen), directly under your arm pits.
As you breathe in, try to direct your breath toward your fingers, and feel this part of your lower chest moving out and sideways. Try to imagine putting all of your breath into this part of your chest.
Try it. It may not work the first few times, but keep trying. A friend or spouse coaching you with these instructions, and putting their hands on your lower chest in the manner as described above, may help to get you started.
And if you do have some success with these primitive instructions, this is indeed a sign of better things to come, when your chest is mobilized and working better, and you have mastered some breathing skills.