Many patients with COPD (e.g., emphysema and asthma) may suffer from periodic episodes of dyspnea (shortness of breath), particularly with physical exertion or when in contact with allergens. Whenever a patient’s normal breathing pattern is interrupted, shortness of breath can occur. It is helpful to teach a patient how to monitor his or her level of shortness of breath and to prevent episodes of dyspnea by controlled breathing techniques, pacing activities, and becoming aware of what activity or situation precipitates a shortness of breath attack.

Pacing is the performance of functional activities, such as walking, stair climbing, or work-related tasks, within the limits of a patient’s ventilatory capacity. Although some patients may understand intuitively the limits to which functional activities can be pushed, others must be taught to recognize the early signs of dyspnea. If the patient becomes slightly short of breath, he or she must learn to stop an activity and use controlled, pursed-lip breathing until the dyspnea subsides.
Procedure
• Have the patient assume a relaxed, forward-bent. A forward-bent position stimulates diaphragmatic breathing (the viscera drop forward and the diaphragm descends more easily). Use bronchodilators as prescribed.

• Have the patient gain control of his or her breathing and reduce the respiratory rate by using pursed-lip breathing during expiration. Have the patient focus on the expiratory phase of breathing while being sure to avoid forceful expiration.

• After each pursed-lip expiration, teach the patient to use diaphragmatic breathing and minimize use of accessory muscles during each inspiration.

• Have the patient remain in a forward-bent posture and continue to breathe in a slow, controlled manner until the episode of dyspnea subsides.

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