Chronic Obstructive Pulmonary Disease (COPD) is the name for a number of different lung diseases, including chronic bronchitis, emphysema and chronic obstructive airways disease. Millions of people around the world are struggling to breathe on a daily basis, but help is available for people living with COPD to reduce the impact it can have on their lives.
For almost a decade, Elisabeth Bennetts, has been working closely with patients in Rowcroft Hospice’s Outpatient Centre, teaching them crucial breathing techniques to help them improve their way of life. It has been something very close to her heart, but she has now decided that after almost ten years, it’s time to hand over the reins and take a step back from her much valued course.
Here is her personal account…
Breathlessness is a very distressing symptom for patients whose lung capacity is reduced and compromised by disease. Recognising the need for input into the management of these symptoms, Lorna Gray, a Community Nurse Specialist at the hospice, and I embarked on preparing a management programme for patients and family. Three years on from its inception, and after a few ‘false starts,’ the opportunity arose to set up breathlessness management sessions.
The six week sessions started in Autumn 2005, running every Thursday for two hours. I was responsible for the overall provision of the sessions, with particular emphasis on the patients learning effective breathing techniques, enabling them to manage and control their breathlessness rather than being managed and controlled by it. The sessions were provided by the Multi-Disciplinary Team (MDT), who consisted of a Physiotherapist, Complementary Therapist, Occupational Therapist and a Nurse – the Transport Manager was also part of the team.
I was asked to give the course a name and suggested ‘Breath of Fresh Air’ which soon became known as ‘BOFA’.
During that six week period, the BOFA sessions included:
- Learning good, effective breathing techniques
- Using these techniques to improve daily activities (walks, stairs etc.)
- Coping strategies to manage anxiety/panic attacks
- Fatigue management
- Use of equipment to reduce fatigue and breathlessness
- Nutrition, in the context of breathlessness
- Various relaxation techniques
- Balance between exercise and rest
- Tips to assist with clearing mucous secretions and managing a cough
Ten years on, these sessions are still being provided in the Outpatient Centre and are of great value to a number of patients.
The course became known mainly through the patients who had attended telling other health care professionals of the positive impact it had on their daily living. Referrals soon increased with many coming from community matrons who mainly referred patients with advanced COPD. We also received referrals from GPs, District Nurses, Respiratory Nurse Specialists, the Rowcroft Community Team and even some Pharmacists. The number of referrals gradually increased with as many as 14 to 16 per month. Some of these were not appropriate for the course so were either seen on a one-to-one basis or referred to another service. There were usually four to eight patients attending each course with some coming with a carer or relative (who were encouraged to come to at least the first and last sessions to fully understand and learn good breathing techniques, and give us their feedback). The only patients we didn’t see were those with asthma, who were not appropriate for the course.
At the first session some patients were apprehensive, and for some it was difficult to be part of a group. I always tried to meet and greet each patient as they arrived and take them to their allocated seat. This first session began with introductions to the MDT and to each other, they were encouraged to talk about how their breathlessness affected them and the impact it had on all aspects of their life. This soon helped them to realise that there were others who had the same problems and issues and enabled them to feel part of the group.
At the final session they were asked to evaluate the course by completing a questionnaire where they were encouraged to write comments. Members of the team also documented any remarks, which were appropriate, that patients gave during the sessions. They usually told us about their experience of the course and how it helped them and the impact on their quality of life. Most explained the benefits of being part of a group and some even exchanged telephone numbers/email addresses. One group, which included four ladies from Teignmouth, met together regularly in each other’s homes for a cup of coffee and a chat.
The response of every patient who has attended BOFA has always been positive with some outstanding responses regarding the improvement in quality of life.
In 2013 we revised and re-evaluated the course and the results are available from the hospice. I reduced my working days and ‘handed over’ BOFA to a recently appointed Physiotherapist. This was a very difficult decision as I have enjoyed every aspect of the course from assessment of patients, organising and planning, to delivering the sessions. But I am confident that BOFA will continue under its new management and the course will be developed over the years to come.
A big thank you to my wonderful colleagues who encouraged and supported me over the years, especially the members of the team presenting and supporting the sessions, without whom BOFA could never have been so successful.