reference guide for group education - lwwcopdv~se… · • shortness of breath can cause anxiety...

Session 2Breathing Management

➤ Anxiety-Breathlessness Cycle ➤ Breathing in COPD➤ Managing Shortness of Breath

– Pursed-lip Breathing Technique – Body Positions

➤ Airway Clearance – Coughing Techniques – Active Cycle of Breathing Technique – OPEP devices

Reference Guide forGroup Education

2nd Edition 2019

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Education Plan and Methods

Session Length: 1 h - 1 h 15 m• Introduction

• Working phase

1. Understanding the link between shortness of breath and anxiety: The Anxiety-breathlessness cycle. Interactive lecturing.

2. How breathing works in COPD. Interactive lecturing.

3. Managing shortness of breath.

3.1 PLB technique: at rest. Demonstration and practice.

3.2 PLB technique: on exertion. Demonstration and practice.

3.3 Body positions to reduce SOB. Demonstration and practice.

3.4 S.O.S. in an acute attack of SOB. Demonstration and practice.

4. Airway clearance techniques to remove sputum from your lungs.

4.1 Coughing technique.

4.1.1 Coughing technique benefits. Interactive lecturing.

4.1.2 Controlled cough technique. Demonstration and practice.

4.1.3. “Huffing” technique. Demonstration and practice.

4.2 Active cycle of breathing technique

4.1.1. Active cycle of breathing technique benefits. Interactive lecturing.

4.1.2. Active cycle of breathing technique. Demonstration and practice.

4.3 OPEP Devices

4.1.1. Function and benefits of OPEP devices. Interactive lecturing.

4.1.2. Demonstration and practice of the different devices (OPEP). Demonstration and practice.

5. Assessment of participants’ level of self-efficacy. Group discussion.

• Closing of the session

BREATHING MANAGEMENT IN COPDSESSION SUMMARY

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Living Well with COPD™ Resources 1. Modules : • “Managing your breathing and saving your energy”, p. 4-24 • “Managing your stress and anxiety”, p. 7-82. Educational flipchart: • Section “Breathing techniques” • Section “Positions to reduce SOB” • Section “Airway clearance techniques” • Section “Stress management”

Additional Resources1. Board/Flipchart

Environment1. Use a quiet and comfortable room for 10 to 15 people. Ensure proper ventilation.2. Place the chairs in a semi-circle around the board.

Human Resources1. One healthcare professional (a physiotherapist if possible)


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Introduction• Presentation of the facilitator• Identification of the expectations and interests of the group • Review of the important aspects of the COPD pathophysiology, symptoms and impact. Make

links with the present session• Establishment of common goals for the session

Working Phase – Educational Interventions1. The Anxiety-breathlessness cycle

Use a poster of the “Anxiety-breathlessness cycle” taken from the educational flipchart section “Stress Management” to support your teaching.

Introduce the Anxiety-breathlessness cycle in COPD. Explain the impact of anxiety over the control of shortness of breath and the need to break this vicious cycle.

Suggested script for the facilitator:• The main symptom of COPD is shortness of breath.• Shortness of breath can cause anxiety and even panic attacks.• Anxiety makes you breathe faster, which increases your shortness of breath, and as a result,

you become more anxious.• Many COPD sufferers choose to stop doing activities because of their fear of dying from

breathlessness.• The less you do, the less you are in shape. You will experience more fatigue, shortness of

breath and anxiety.• This is the anxiety-breathlessness cycle.When you have COPD, nothing will make shortness of breath go away completely. However, regularly practicing the techniques taught in this session will help you to better manage your anxiety and shortness of breath.

1.1 UNDERSTANDING THE LINK BETWEEN SHORTNESS OF BREATH AND ANXIETY: THE ANXIETY-BREATHLESSNESS CYCLE

Present this section in an interactive way

LifeExperiences


2. How breathing works in COPD

Perform the following exercise with the participants in order to make them feel their breathing.

Suggested exercise for the participants:• Take a few minutes to feel your breathing. Put one hand on your stomach and the other on

your chest. Describe what you feel.Explain to participants how breathing works and the impact of air trapping on the lungs.

Suggested script for the facilitator:How breathing works• Respiration involves two phases: inspiration (movement of air into the lungs) and expiration (movement of air out of the lungs).• The diaphragm is the major muscle of respiration. When the diaphragm contracts (goes

down), the chest expands so the air is pulled into the lungs. When the diaphragm returns to its normal position (goes up), air is pushed out of the lungs.

When you have COPD, air is trapped inside your lungs• Air trapping: Because of airway obstruction and a loss of lung elasticity, your lungs do not

fully empty and air is trapped.• Breathing becomes more difficult: As a consequence of air trapping, the diaphragm has to

work more and its movement is less efficient. In addition, accessory muscles, from the neck, ribs and stomach start to be used more for breathing.

• You experience shortness of breath: Because of air trapping in your lungs, you have trouble breathing in new air, and you develop shortness of breath.

Being constantly short of breath can make you feel frightened and exhausted. In fact, shortness of breath is one of the major symptoms of COPD leading to anxiety and disability. The important thing is to control your shortness of breath so that it does not control you!If you reduce air trapping, you will allow air to get into your lungs more easily, and as a result, you will feel less short of breath. Your medications can help you reduce air trapping in the lungs, and so can certain breathing techniques and body positions.

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2.1 BREATHING IN COPD: INSPIRATION/EXPIRATION; AIR TRAPPING AND SHORTNESS OF BREATH Present this section in an interactive way

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3. Managing shortness of breath

Use a poster of the “Pursed-lip breathing technique” taken from the educational flipchart section “Breathing Techniques” to support your teaching.

Evaluate the existing knowledge of participants with respect to pursed-lip breathing.

Suggested question: • Have you heard about the Pursed-lip breathing technique? If yes, are you using it? How and

when?Present the goal, benefits and points to remember of the Pursed-lip breathing technique. Demonstrate the steps of the technique.

Suggested script for the facilitator:Pursed-lip breathing is one technique that can help you feel less short of breath.

Goal:With this technique, you breathe out slowly, which allows you to exhale more air, thus leaving less air trapped inside your lungs.

Benefits:1. Reduces breathing frequency and shortness of breath.2. Helps you return to your normal breathing pattern after exercise.3. Improves your ability to perform different activities.4. Increases your sense of control over your own breathing.Steps:1. Inhale slowly through your nose until you feel that your lungs are filled with air.2. Purse your lips as you would if you were whistling or about to kiss someone.3. Exhale slowly while keeping your lips pursed. Make sure to take longer to breathe out than you did to breathe in. Remember to keep your lips pursed.

Do not force your lungs to empty.

3.1 PURSED-LIP BREATHING TECHNIQUE: AT REST Demonstration and practiceLife

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Points to remember: • The focus should be on expiration.• Expiration should be made longer, but not forced.• First master this breathing technique while at rest. Then you will be able to use it with activities requiring effort.

Ask the participants to demonstrate back the technique. Provide them constructive feedback and reinforcement on the performance of the technique.

Demonstrate the use of Pursed-lip breathing technique with activities requiring effort. Suggested script for the facilitator:Pursed-lip breathing technique – on exertionLearning how to inhale through your nose and slowly exhale through your lips can help to reduce shortness of breath when you are doing a physical activity. Sometimes, applying the Pursed-lip breathing technique may seem to take too much time. However, you will actually end up saving time, since you will take fewer and shorter breaks because you will be less short of breath.You can apply pursed-lip breathing to various physical activities:

WALKING• Inhale 1…2…• Exhale 1…2…3…4Suggestions:• Make sure the outdoor temperature is not too hot or cold.• Wear comfortable shoes and clothing.• Relax your muscles.• Walk only as fast and as far as you can while respecting your own limits.• Do not hold your breath.• Stop as often as you need to.

Note to the facilitator: Some patients do not normally breathe through the nose, but through the mouth (because of obstruction, congestion, etc.). For them, the focus should be made on exhaling through pursed lips and using more time to breathe out than to breathe in.

3.2 PURSED-LIP BREATHING TECHNIQUE: ON EXERTION

Demonstration and practiceLife

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CLIMBING STAIRSIf you suffer from severe shortness of breath:• Inhale at rest.• Climb one step while exhaling and stop for inhaling. Repeat for each step.If you are able to climb some steps:• Inhale at rest.• Climb 3-4 steps while exhaling, stop for inhaling.If you are able to climb at least a flight of stairs:• Inhale at rest.• Climb 3-4 steps while exhaling.• Climb 2 steps while inhaling.• Climb 3-4 steps while exhaling, etc.Suggestions:• Wear slip-resistant shoes.• Keep stairs free of obstacles.• Keep one hand over the railing for security.• Do not pull the railing to climb.• Climb slowly.• Stop as needed.• Do not force your exhalation.• Respect your own limits.

Have participants practice in front of you (walking, climbing stairs) according to the steps, while integrating the pursed-lip breathing technique. Provide them constructive feedback and reinforcement on the performance of the techniques learned.

Use a poster of the “body positions” taken from the educational flipchart section “Breathing Techniques” to support your teaching.

Evaluate the existing knowledge of participants with respect to body positions.

Note to the facilitator: Again, it is important to focus on taking longer time to exhale than to inhale but without forcing the exhalation. For some patients, counting to 3 on exhalation (instead of 4) will be enough.

3.3 BODY POSITIONS TO REDUCE SHORTNESS OF BREATH

Demonstration and practice Life

Experiences


Suggested question:• Do you think the way that you stand or sit can affect your breathing? If yes, how?

Present the goal, benefits and points to remember of the body positions to reduce shortness of breath. Demonstrate the five body positions.

Suggested script for the facilitator:Body positions to reduce shortness of breath Poor posture – with shoulders tensed or hunched over – can also lead to increased shortness of breath, because your chest cannot expand to its full capacity. Changing your body position while sitting or standing can help you breathe better.

Goal:• To offer relief to accessory muscles and improve diaphragm function.

Benefits:1. Help the diaphragm to move easier.2. Help reduce shortness of breath.

Points to remember:• Use pursed-lip breathing with the different body positions.• Lean your chest forward slightly. This will lessen pressure against your diaphragm, allowing it to relax more.

BODY POSITIONSSitting StandingSitting position A • Place both feet on the ground• Lean your chest forward slightly• Rest your elbows on your knees• Rest your chin on your hands

Standing position A• Lean your chest forward slightly• Rest your hands on your thighsStanding position B• Rest your elbows on a piece of furniture• Rest your head on your forearms• Relax your neck and shouldersSitting position B

• Place both feet on the ground• Lean your chest forward slightly• Rest your forearms on a table• Rest your head on a pillow

Standing position C• Rest your hands on a flat surface• Avoid “grabbing the table” while assuming this position. This can overwork some of your accessory breathing muscles, and cause breathlessness if you hold the position too long.

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Have participants practice the different body positions in front of you according to the steps, while integrating the pursed-lip breathing technique. Provide them constructive feedback and reinforcement on the performance of the techniques learned.

Suggested questions:• Did your breathing change when you used one of the body positions previously described?• How did it feel different?

Explore participants’ experience in managing an attack of shortness of breath.

Suggested question:• What do you do when you experience an acute episode of shortness of breath?Present the goal, benefits, and points to remember of the S.O.S. technique. Demonstrate the steps of the technique.

Suggested script for the facilitator:S.O.S. in an acute attack of shortness of breathExperiencing an acute attack of shortness of breath can be frightening for people with COPD. Learning to stay calm during an attack can get your breathing – and anxiety – back under control.

Goal:• To bring your breathing back to normal during an acute attack of shortness of breath.

Benefits:1. Learn how to control shortness of breath.2. Help reduce the panic associated with an attack.

3.4 S.O.S. IN AN ACUTE ATTACK OF SHORTNESS OF BREATH

Demonstration and practiceLife

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Steps:1. Stop and find a comfortable position.2. Stay as calm as possible; relax your shoulders.3. Introduce the pursed-lip breathing technique: inhale through your mouth if you cannot through your nose; purse your lips to exhale.4. Slow down your breathing by taking more time to breathe out than you did to breathe in. Do not force your lungs to empty.5. Continue to exhale slowly while keeping your lips pursed; start to inhale through your nose if you have not been able to do it so far.

Continue to pursed-lip breathe for at least 5 minutes.

Points to remember:• Make sure that you master well the pursed-lip breathing technique while at rest before using

it during an acute attack of shortness of breath.• It is very important that you give yourself the space and time to get your breathing back to

normal. Remember to slow down your breathing.


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4 Airway clearance techniques to remove sputum from your lungs4.1 COUGHING TECHNIQUES

Use a poster of the “Airway clearance techniques” taken from the educational flipchart to support your teaching.

Evaluate the existing knowledge of participants with respect to airway clearance techniques.Suggested questions:

• Did you know that some airway clearance techniques could help to better clear your lungs?

• How can learning to properly clear the secretions from your lungs help you breathe better and save your energy?

Explain the benefits of different airway clearance techniques.

Suggested script for the facilitator:

When you have COPD, your airways can be blocked with thick, sticky mucous or sputum. Not only does this make it harder for you to breathe, it also provides a breeding ground for infections.

Airway clearance techniques, therefore, are important, because they help to remove sputum from your lungs. A regular hacking cough, however, will not do the job.

There is a proper way of coughing, just as there is a proper way of breathing.

4.1.1 COUGHING TECHNIQUE BENEFITS Present this section in an interactive way

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Goals:• To mobilize and remove sputum from your lungs while using less effort.

Benefits:1. Prevents infections caused by an accumulation of sputum in your lungs [1,2,3].2. Reduces shortness of breath caused by sputum blocking your airways [1,2,3].

Points to remember:• Avoid coughing in small fits.• It is important to save energy.

Here are the different techniques you can use to mobilize and remove sputum from your lungs [4]:• The controlled coughing technique and “Huffing” technique help to expel sputum.• Active cycle of breathing technique• Oscillating positive expiratory pressure (OPEP) devices help mobilize bronchial sputum.

These techniques and/or devices should be integrated into your treatment regimen.


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Demonstrate the steps of the controlled cough technique.

Suggested script for the facilitator:Controlled cough techniqueSteps:1. Seat yourself in a comfortable position.2. Lean your head slightly forward.3. Place both feet firmly on the ground.4. Inhale deeply through your nose.5. Cough twice while keeping your mouth slightly open. The first cough will loosen your sputum. The second cough will move the sputum up into your throat. Spit the sputum out into a tissue. Check the colour of your sputum. If there is a change in your sputum colour, follow your doctor’s recommendations. If there is blood in your sputum, talk to your doctor.6. Take a break and repeat once or twice if there are no immediate results.

Have participants practice the controlled cough technique in front of you according to the steps. Provide them constructive feedback and reinforcement on the performance of the techniques learned.

4.1.2 CONTROLLED COUGH TECHNIQUE Demonstration and practiceLife

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Demonstrate the steps of the “huffing” technique.Suggested script for the facilitator:“Huffing” technique [4,5] Steps:1. Seat yourself in a comfortable position.2. Lean your head slightly forward.3. Place both feet firmly on the ground.4. Inhale deeply through your nose.5. Exhale in short, non-forceful bursts while keeping your mouth open, as if you were trying to make mist on a window.6. Repeat once or twice.

Note: Avoid forceful expiration.

Have participants practice the “huffing” technique in front of you according to the steps. Provide them constructive feedback and reinforcement on the performance of the techniques learned.

4.1.3 “HUFFING” TECHNIQUE Demonstration and practice Life

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Here are some more suggestions to help you remove sputum from your airways:1. Sputum can accumulate in your airways overnight. You should try to do these

airway clearance techniques each morning at least 10 minutes after using your short-acting bronchodilator.

2. Similarly, to get a good night’s sleep, you can use these techniques in the evening before bed or before dinner.

3. Repeat these coughing techniques as needed throughout the day, e.g. before going out.

4. Avoid bursts of coughing. This wastes energy and causes shortness of breath.5. Keep these sputum mobilization techniques in your routine, even if you have very

little.6. Pay particular attention to proper hydration, which can help liquefy your sputum.7. Move regularly. This helps to mobilize your sputum.


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4.2 “ACTIVE CYCLE OF BREATHING” TECHNIQUE

Present the goal and benefits of the active cycle of breathing technique.

Suggested script for the facilitator:Active cycle of breathing technique

The objective of this technique is to mobilize and eliminate the most amount of sputum as possible and it is divided in three phases:

• Controlled breathing• Slow deep breathing• “Huffing” technique (or controlled coughing, as needed)

The controlled breathing phase consists of taking normal breaths at your rhythm. It is important to keep your shoulders and chest relaxed and to breathe from your stomach, if possible. Controlled breathing should be done until you feel relaxed and ready to move on to the more active phases of the cycle.

Chest expansion exercises consist of taking 3-4 slow, deep breaths and, if possible, holding your breath for 3 seconds after each breath.

“Huffing” technique can be repeated 1-2 times, as needed, at the end of each active cycle.

4.2.1 “ACTIVE CYCLE OF BREATHING” TECHNIQUE BENEFITS Present this section in an interactive way

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Demonstrate the steps of the active cycle of breathing technique [6].

Steps:1. Seat yourself in a comfortable position, shoulders and neck relaxed.2. Controlled breathing: Place one hand on your stomach. Breathe at your own pace until you feel relaxed and ready to move on to the more active phases of the cycle (20-30 seconds). You should feel your hand move as you breathe. Use the nose for inspiration to make breathing more comfortable.3. Slow deep breathing: Then take 3-4 slow, deep breaths (with the belly). If possible, hold your breath for 3 seconds after each breath. 4. Repeat steps 2 and 3 once.5. End with controlled breathing.6. Proceed with the “huffing” technique.

The complete Active cycle of breathing technique needs to be repeated until the “huffing”technique no longer produces any sputum, or if you feel fatigued.

In general, the complete cycle lasts between 10 to maximum 30 minutes, but theduration will vary from one person to another, even from one day to the next. Yourhealthcare professional will determine with you the length and frequency of the sessionsaccording to your needs (i.e. your treatments may last longer, or you may need moretreatments in a day during exacerbations).

This technique can be performed in many different positions. With the help of yourhealthcare professional, you will be able to determine the position(s) in which thetechnique is most effective for you.

Have participants practice the “active cycle of breathing” technique in front of you according to the steps. Provide them constructive feedback and reinforcement on the performance of the techniques learned.

4.2.2 ACTIVE CYCLE OF BREATHING TECHNIQUE Demonstration and practiceLife

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4.3.1 FUNCTION AND BENEFITS OF OSCILLATING POSITIVE EXPIRATORY PRESSURE (OPEP) DEVICES Present this section in an interactive way

Evaluate if the patients use OPEP devices to eliminate their sputum.

Suggested script for the facilitator:

Do you already use devices to help you remove your sputum? If yes, which ones?

Explain how OPEP devices work and the benefits of these types of devices.

When you exhale through an OPEP device, the device creates a resistance against your breath, which keeps your airways open. At the same time, the device emits vibrations that are transmitted to your respiratory tract and allow you to mobilize as much sputum as possible. Once the secretions are mobilized, it is easier to expel them.

Goal:• Prevent premature closure of the airways by exhaling with resistance.• Better mobilization of sputum due to the effects of vibration created during exhalation in the device.

Benefits:1. Increases your ability to eliminate sputum with less effort2. Offers more autonomy. The devices can be used at any time you choose without any medical assistance.

4.3 OSCILLATING POSITIVE EXPIRATORY PRESSURE (OPEP) DEVICES

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Here are some examples, currently available in Canada, of OPEP devices that your healthcare professional may suggest you use:

Acapella® device Aerobika® device Flutter® device

It is possible that you will use a different device. Refer to your healthcare professional to discuss the benefits and techniques of use.

Note: Some people cannot use OPEP devices. Discuss with your healthcare professional the conditions that may or may not allow you to use one of these devices [1,3,7,8]

Note to the facilitator: Assess with the patient, and use the patient’s record, to determine whether the following contraindications to the use of OPEP devices are present: pneumothorax, right heart failure, difficulty in increasing respiratory work, recent skull, face, mouth or

esophagus surgery, hemoptysis, chronic sinusitis, internal ear disorders [1,3,7,8].


Technical Features

Acapella® Device Aerobika® Device Flutter® Device

Can be used in any position

Breathe in and out through the device

Can be disassembled forcleaning

Adjustable resistancesettings

Dishwasher safe

Several disinfection options

Can be used with a nebulizer

Adapted from Bourbeau, J., Mcivor, R. A., Devlin, H. M., Kaplan, A., Bourbeau, J., Mcivor, R. A., Kaplan, A. (2019). Oscillating positive expiratory pressure (OPEP) device therapy in Canadian respiratory disease management: Review, care gaps and suggestion for use respiratory disease management: Review, care gaps and suggestion for use. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine.

(choice and duet models)

(choice and duet models)

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4.3.2 DEMONSTRATION AND PRACTICE OF THE DIFFERENT DEVICES (OPEP) Demonstration and individual practice

LifeExperiences

Present each OPEP device.Ask if there are any patients who use these OPEP devices. Organize individual sessions to go over the use and maintenance techniques as well as the specifics of each device.

Demonstrate each step of the technique for use and maintenance of the Acapella device, then practice this technique [9,10].Demonstrate each step of the technique for use and maintenance of the Aerobika device, then practice this technique [11].Demonstrate each step of the technique for use and maintenance of the Flutter device, then practice this technique [8].

Notes to the facilitator:Individual assistance will be required to ensure that:• The patient can generate an expiratory flow of 10 L/min for 3-4 seconds using a peak flow or spirometry test.• The patient should continue treatment for 10-20 minutes with the “huffing” technique every 10 minutes.• It is not recommended to proceed with the treatment 30 minutes before going to bed because it is possible that there may be some sputum left in the airways causing the patient to cough.


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Notes to the facilitator:If the patient uses the Acapella device:• It is recommended to use the green Acapella device if the patient’s expiratory flow rate is ≥ 15 L/min for 3 seconds.• It is recommended to use the blue Acapella device when the patient’s expiratory flow rate is < 15 L/min for 3 seconds.• During the first use the expiratory resistance dial must be turned counterclockwise to the lowest level of flow resistance and frequency. The adjustment is then made to optimize the vibratory pressure felt by the patient in his chest.If the patient uses the Aerobika device:• It is recommended to start with the lowest resistance setting and adjust according to the patient’s ability to inhale and exhale through the device in a ratio of 1:3 or 1:4 for at least 10 minutes without the patient getting tired.• The resistance indicator adjustor must always be checked by the patient to verify it’s at the level prescribed by the healthcare professional.• The treatment should be done twice a day and increased to 3 or 4 times a day during an exacerbation. • There are no side effects related to use, so the patient can use it more often in they wish.If the patient uses the Flutter device:• During the first use, the body of the device (connected to the cone) must be held horizontally to the ground, which allows the ball to bounce and roll to produce the vibrations. The angle at which the device is held will then be adjusted, by moving the cone slightly upwards or downwards, in order to optimize the pressure \ felt by the patient in his chest. To determine the best possible vibration pressure, the healthcare professional places one hand behind the patient’s back and the other on his chest while the patient breathes through the device.


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5. Assessment of participants’ level of self-efficacy

Evaluate participants’ self-efficacy for managing their breathing by using breathing and coughing techniques as well as body positions to reduce shortness of breath.

Suggested questions:

• Do you feel capable of using your pursed-lip breathing technique in your daily activities?• Do you feel capable of applying body positions to reduce shortness of breath?• Do you feel capable of managing your breathing during an acute attack of shortness of breath?• Do you feel capable of using coughing techniques to clear sputum from your airways?• Do you think the techniques taught in this session can help you to better manage your shortness of breath?

If participants feel capable of managing their breathing, ask them to continue applying the techniques taught in this session.If some participants do not feel capable of managing their breathing, make sure to refer these participants to their resource person to see them on an individual basis to investigate the reasons and reinforce the use of the techniques taught in this session.

5.1 ASSESSMENT OF PARTICIPANTS’ LEVEL OF SELF-EFFICACY FOR MANAGING SHORTNESS OF BREATH Present this section using group discussion

LifeExperiences


CONTRAT

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Closing the session• Answer the questions of the participants.

• Summarize the points to remember and ask participants to repeat them.

• Learning contract: Ask the participants to review and practice at home each one of the different techniques taught in the present session (at least one technique each day).

• Evaluate the satisfaction of the participants with regards to the present session. Ask the group about the level of general satisfaction; use an evaluation questionnaire that can measure the level of response to the group expectations in terms of: development, length, content, methods, facilitator and environment.


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References[1] Bourbeau, J., Mcivor, R. A., Devlin, H. M., Kaplan, A., Bourbeau, J., Mcivor, R. A., Kaplan, A. (2019). Oscillating positive expiratory pressure (OPEP) device therapy in Canadian respiratory disease management: Review, care gaps and suggestion for use respiratory disease management: Review, care gaps and suggestion for use. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. https://doi.org/10.1080/24745332.2018.1558426

[2] Chantal Girard. Nouveautés dans les techniques de dégagement des sécrétions. InfoRQESR, septembre 2016, p.4

[3] Olse, M. F., Lannefors, L., & Westerdah, E. (2015). Positive expiratory pressure and Common clinical applications and physiological effects. Respiratory Medicine, 109, 297–307. https://doi.org/10.1016/j.rmed.2014.11.003

[4] Cystic Fibrosis Foundation. Coughing and Huffing. Retrieved from https://www.cff.org/Life-With-CF/Treatments-and-Therapies/Airway-Clearance/Coughing-and-Huffing/

[5] Mcilwaine, M., Bradley, J., Elborn, J. S., & Moran, F. (2017). Personalising airway clearance in chronic lung disease. European Respiratory Review, 26, 160086. https://doi.org/10.1183/16000617.0086-2016

[6] Pryor, J. A. (2018). Airway Clearance Techniques. In Physiotherapy for People with Cystic Fibrosis: from Infant to Adult (5th ed.). Retrieved from https://www.ecfs.eu/sites/default/files/general-content-files/working-groups/IPG CF_Blue Booklet_5th edition 2018.pdf

[7] Lannefors, L. (2018). Positive Expiratory Pressure (PEP). In Physiotherapy for People with Cystic Fibrosis: from Infant to Adult (5th ed.). Retrieved from https://www.ecfs.eu/sites/default/files/general-content-files/working-groups/IPG CF_Blue Booklet_5th edition 2018.pdf

[8] Suter, P. (2018). Oscillating PEP – Therapy. In Physiotherapy for People with Cystic Fibrosis: from Infant to Adult (5th ed.). Retrieved from https://www.ecfs.eu/sites/default/files/general-content-files/working-groups/IPG CF_Blue Booklet_5th edition 2018.pdf

[9] Acapella Instructions for Use. Retrieved from http://www.acapella-pep.com/Using_ep_41.html

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References[10] Les Solutions en Kiné Respiratoire par Portex. Les Solutions en Kiné Respiratoire par Portex. Retrieved from https://www.previmed.ca/upload/ecommerce-document/catalogue/brochure_kinerespiratoire.pdf

[11] Aerobika: Oscillating Positive Expiratory Pressure Therapy System, Trudell Medical International. Accessed on: Sept. 2, 2019. [Online]. Available: www.trudellmed.com

BreathWorks toll-free helpline 1-866-717-COPD (2673)

www.lung.ca/breathworks

ACKNOWLEDGEMENTSThis session has been developed in collaboration with the

Multidisciplinary Team of the Pulmonary Rehabilitation Program PEP at the Montreal Chest Institute.

Authors of the 2nd edition:

D. Nault, BSc, RN, MSc • M. Sedeno, BEng, MM • M.È, Séguin, RT • J. Bourbeau, MD, MSc, FRCPC • S. Gagnon, MD • C. Girard, BSc, PT • A. Hatzoglou, BSc, PT • I.

LeClerc, RN • S. Lessard, PharmD, MBA, CRE, CTE • G. Pazienza, BSc, PT

Authors of the 1st edition:

D. Nault, RN, MSc • M. Sedeno, BEng, MM • A. Hatzoglou, PT • J. Bourbeau, MD, MSc, FRCPC

Last Update – September 2019

reference guide for group education - lwwcopdv~se… · • shortness of breath can cause anxiety...

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