COPD Course

CHAPTER: COPD Self-management

1. Explain COPD self-management
   1. Describe self-management
   2. Explain the goals of self-management
   3. Discuss the benefits of self-management including the evidence to support self-management
   4. Describe the skills for successful self-management
   5. Describe self-management interventions including the characteristics of self-management interventions
   6. Describe the components of COPD self-management interventions
   7. Collaborate with a COPD patient to develop a self-management plan
2. Describe the Living Well with COPD (LWWCOPD) program
   1. Explain the role of the LWWCOPD program
   2. Describe the contents of the LWWCOPD program
   3. Utilize LWWCOPD resources to support COPD patient self-management
3. Implement a self-management program
   1. Counsel a COPD patient on self-management

CHAPTER: COPD Introduction

1. Describe COPD
   1. Explain the key features in the definition of COPD
2. Explain the pathology, pathogenesis, and pathophysiology of COPD
   1. Differentiate between the inflammatory processes seen in COPD vs asthma
   2. Explain the factors that contribute to expiratory airflow limitation
   3. Describe the role of lung hyperinflation in COPD in terms of:
      1. Development
      2. Dynamic hyperinflation
      3. Consequences
   4. Distinguish between ventilation and perfusion and describe how this may be altered in COPD
3. Examine the epidemiology of COPD
   1. Identify the prevalence of COD in Canada and worldwide and distinguish among:
      1. Men
      2. Women
   2. Describe the morbidity and mortality of COPD in Canada and worldwide
   3. Explain the burden of COPD in terms of:
      1. Economic
      2. Social
   4. Explain the economic burden of undiagnosed COPD
4. Describe the risk factors that influence the development and progression of COPD
   1. Explain the role of the following risk factors in the development and progression of COPD:
      1. Environmental
      2. Exposure to particles
      3. Tobacco smoke (including Environmental Tobacco Smoke)
      4. Marijuana
      5. Electronic Cigarettes
      6. Occupational exposures
      7. Air pollution
   2. Host
      1. Genes
      2. A1AT
      3. Age and gender
      4. Lung growth and development
      5. Asthma/bronchial hyperreactivity
      6. Chronic bronchitis
      7. Infections
      8. Physical activity
      9. Nutrition
   3. Other
      1. Social determinants of health

CHAPTER: COPD Diagnosis

1. Explain the factors to consider when making a diagnosis of COPD
   1. Discuss the key considerations in the diagnosis of COPD including:
      1. Characteristic symptoms
      2. Patient history
      3. Physical Examination (PE)
      4. Spirometry
   2. Describe the characteristic symptoms of COPD
      1. Dypsnea
      2. Cough
      3. Sputum production
      4. Wheezing and chest tightness
   3. Conduct a comprehensive patient history
      1. Explain the components of a comprehensive initial patient history.
      2. Demonstrate how to take a comprehensive initial patient history
      3. Interpret the pertinent and relevant data from a comprehensive patient history
      4. Establish educational needs (knowledge, skills, and behaviors) of the patient and his/her family
2. Discuss the role of the Physical Examination (PE)
   1. Explain the components of a Physical Examination (PE) in the diagnosis of COPD
   2. Describe the limitations of PE findings for the diagnosis and severity of COPD
3. Explain the role of spirometry
   1. Explain the use of spirometry in the diagnosis of COPD
   2. Describe the following lung function measurements in spirometry:
      1. FEV1
      2. FVC
      3. FEV1/FVC
   3. Describe the lung function criteria required to diagnose COPD
   4. Explain the importance of quality assurance when performing spirometry
   5. Explain the concept of Lower Limits of Normal (LLN)
   6. Distinguish spirometry patterns in terms of:
      1. Normal
      2. Obstructive
   7. Describe lung capacities and volumes in normal lungs and in the presence of COPD
   8. Identify the criteria for when spirometry testing is recommended
   9. Describe a validated test for recommending spirometry i.e. the Lung Health Test
   10. Explain when further lung function testing is required
   11. Explain who can conduct and interpret spirometry
   12. Complete RESPTREC^®’s Spirometry Course, endorsed by CTS, CRHP, and FPAGC to conduct quality spirometry (Optional - recommended for those conducting quality spirometry)
4. Explain the role of additional investigations for the diagnosis and assessment of COPD including:
   1. Imaging (CXR, CT)
   2. Pulmonary Function Testing (lung volumes and diffusing capacity)
   3. Oximetry and ABG’s
   4. Exercise testing
5. Describe Alpha-1 Antitrypsin (A1AT) deficiency
   1. Explain the following related to alpha-1Antitrypsin (A1AT) deficiency:
      1. Genetics
      2. Prevalence
      3. Targeted testing
      4. Diagnosis
   2. Discuss the distinguishing features of asthma and COPD
      1. Differentiate between the common characteristic features of asthma and COPD
      2. Explain the features of asthma-COPD overlap (ACO) and examine the current management strategies based on the existing evidence and practice guidelines
      3. Describe the clinical features of ACO
      4. Discuss the rationale for initial treatment of ACO
   3. Discuss other diseases which can mimic COPD
      1. Differentiate among the clinical features of other diseases which can mimic COPD
6. Conduct a comprehensive patient history
   1. Explain the components of a comprehensive initial patient history.
   2. Demonstrate how to take a comprehensive initial patient history
   3. Interpret the pertinent and relevant data from a comprehensive patient history
   4. Establish educational needs (knowledge, skills, and behaviors) of the patient and his/her family

CHAPTER: COPD Severity and Assessment of Exacerbation Risk

1. Determine COPD severity and exacerbation risk
   1. Explain the goal of assessing COPD severity and exacerbation risk
   2. Describe the parameters and various measurement tools used to classify COPD severity and exacerbation risk:
      1. Airflow limitation/obstruction
         1. Breathlessness
         2. Health Status
      2. Exacerbation history
   3. Describe the parameters used in the GOLD ABE Assessment Tool
   4. Explain the components and clinical utility of the BODE Index
2. Explain the common multimorbidities that can coexist with COPD
   1. Explain the common multimorbidities that can coexist with COPD:
      1. Cardiovascular disease (CVD)
         1. Atrial fibrillation (AF)
         2. Heart failure (HF)
         3. Ischemic heart disease (IHD)
         4. Hypertension
      2. Osteoporosis
      3. Anxiety and depression
      4. Lung cancer
      5. Infections
      6. Metabolic syndrome and diabetes
      7. Bronchiectasis
      8. Impaired cognitive function
      9. Altered nutrition
      10. Obesity
      11. Pulmonary hypertension/Cor-pulmonale
      12. Muscular dysfunction
      13. Frailty

CHAPTER: COPD Management

1. Identify approaches to the comprehensive management of COPD
   1. Describe the CTS guidelines approach and goals to the comprehensive management of COPD
   2. Explain the continuum of management in the CTS guidelines comprehensive management of COPD
   3. Explain the GOLD approach to the treatment of stable COPD
2. Discuss tobacco cessation approaches
   1. Describe nicotine addiction and withdrawal
   2. Describe the Canadian trends in tobacco use
   3. Describe the benefits of tobacco cessation for patients with COPD
   4. Describe the levels of tobacco cessation interventions, for example:
      1. Self-directed
      2. Brief
      3. Intensive
   5. Describe the following brief intervention approaches:
      1. 5 As
      2. Very Brief Advice (VBA)
   6. Discuss the following tools to assess readiness to change and nicotine dependence:
      1. Readiness Ruler
      2. Fagerström Test for Nicotine Dependence (FTND)
      3. Heaviness of Smoking Index (HIS)
   7. Describe models of behavior change and motivational communication including:
      1. Transtheoretical Model
      2. Health Belief Model
      3. Confidence/Conviction Model
      4. Motivational Interviewing
   8. Develop a quit plan for tobacco
   9. Discuss pharmacotherapy options in tobacco cessation
   10. Identify tobacco cessation resources including counselling services available in the patient’s community
3. Discuss home exercise programming
   1. Explain the key messages for counselling on the benefits of exercise
   2. Counsel a patient on a home exercise program including:
      1. When to exercise
      2. Where to exercise
      3. How to exercise
   3. Discuss the resources available to support home exercise programming
4. Discuss pharmacological treatments for COPD
   1. Explain the CTS guidelines goals for optimal pharmacotherapy
   2. Discuss pharmacotherapy options with the COPD patient:
      1. Type and function of the medication
      2. The medications available in Canada
      3. Generic/brand name
      4. Devices/Dose
      5. The side effects of the medication
   3. Explain the recommendations for therapy for each of the following classes of medication:
      1. Inhaled short-acting muscarinic antagonists (SAMA)
      2. Inhaled short-acting beta2-agonists (SABA)
      3. Combination inhaled short acting bronchodilators (SAMA/SABA)
      4. Inhaled long-acting muscarinic antagonists (LAMA)
      5. Inhaled Long-acting beta2-agonists (LABA)
      6. Combination inhaled long acting bronchodilators (LAMA/LABA)
      7. Combination inhaled corticosteroid and inhaled Long-acting beta2-agonists (ICS/LABA)
      8. Phosphodiesterase inhibitors:
         1. roflumilast (PDE-4)
         2. theophylline (non-selective)
      9. Oral glucocorticosteroids
      10. Macrolide
      11. Mucolytic
5. Describe the recommended and suggested vaccinations for eligible patients with COPD
   1. Explain the recommendations for vaccinations for eligible patients with COPD
   2. Explain the CTS recommendations for vaccinations for eligible patients with COPD
6. Describe inhaled medication delivery devices used in COPD
   1. Explain the impact proper and improper inhaled delivery device technique
   2. Explain the selection considerations when recommending an inhaled delivery device
   3. Demonstrate proper technique and care for the following delivery devices:
      1. Breezhaler
      2. Diskus
      3. Ellipta
      4. Genuair
      5. Handihaler
      6. Metered-Dose Inhaler (MDI)
         1. With valved holding chamber
         2. With Valved holding chamber and mask
      7. Respimat
      8. Turbuhaler
      9. Nebulizer
   4. Access appropriate resources on medications and inhaled delivery devices for health care professionals and patients
   5. Explain the Direct Instruction Model (DIM) and demonstrate how to use it in skill based teaching
7. Discuss acute exacerbation of COPD (AECOPD)
   1. Explain the following factors as they relate to AECOPD:
      1. Definition
      2. Impact
      3. Causes
      4. Assessment
   2. Explain how to manage AECOPD including:
      1. Goals of Treatment
      2. Management (in the community and home)
      3. Potential indications for hospital assessment or admission
      4. Management in acute care
      5. Hospital discharge and Follow-up
   3. Discuss the action plan as a self-management tool including:
      1. Describe the purpose and what an action plan is
      2. Counsel patient on the use, implementation and follow-up of an action plan
   4. Describe the recommendations/suggestions on how to prevent/decrease AECOPD as they relate to:
      1. Non-pharmacological therapies
         1. Vaccines
         2. Pulmonary rehab
         3. Education, Case management and Action plan
      2. Pharmacological inhaled therapies
      3. Pharmacological oral therapies
8. Describe Pulmonary Rehabilitation (PR)
   1. Define PR
   2. Explain the goals and benefits of PR
   3. Discuss the selection criteria for PR
   4. Describe the components of a PR program
      1. Exercise
      2. Education and Self-management
   5. Summarize the CTS Clinical Practice Guidelines for PR
   6. Discuss the current trends in PR in Canada with respect to:
      1. Access
      2. Models of PR program delivery
9. Describe Long Term Oxygen Therapy (LTOT)
   1. Explain hypoxemia and its effects
   2. Explain the benefits of LTOT for COPD patients
   3. Describe the testing required to assess the need for LTOT in COPD patients
   4. Explain when LTOT is indicated for COPD patients
   5. Describe the various LTOT delivery systems and explain for each:
      1. Advantages
      2. Limitations
      3. Application
   6. Counsel patients on the following considerations related to LTOT:
      1. General recommendations
      2. Safety
      3. Travel
10. Discuss additional management interventions for COPD (surgery, airway clearance techniques, refractory dyspnea, advanced care planning)
    1. Explain the surgical treatment options available for the management of severe COPD including interventional bronchoscopy
    2. Discuss the evidence surrounding airway clearance techniques (ACTs)
    3. Describe the following ACTs:
       1. Breathing techniques
       2. Manual techniques
       3. Exercise
       4. Mechanical devices
    4. Discuss current unproven/investigational therapies in COPD
    5. Explain refractory dyspnea including the mechanism and qualities of dyspnea
    6. Describe the tools available to assess dyspnea
    7. Examine the CTS practice guidelines for the treatment of refractory dyspnea in advanced COPD
    8. Describe Advanced Care Planning (ACP)
    9. Explain the features of advanced disease in COPD
    10. Explain the components of ACP including:
        1. Advance Directives (ADs)
        2. Goals of Care
        3. Palliative Care
        4. Hospice Care
    11. Discuss Medical Assistance in Dying in Canada
    12. Discuss the PLISSIT model to address sexuality with patients with COPD
11. Discuss the importance of monitoring and follow-up
    1. Explain the importance of monitoring and the components of a follow-up visit
    2. Conduct a follow-up visit
    3. Describe when to refer to a Respirologist

Participants must meet the following entrance criteria:

• hold a degree/diploma in a recognized health care profession and work in the health care field
• scope of practice includes counselling clients

If there is a question regarding met criteria, acceptance to the program will be made on an individual basis and at the discretion of the RESPTREC^® Management committee.

The original content for the RESPTREC^® COPD Educator Course was develped in 2005 and since that time has been updated many times to reflect the most recent published guidelines.

In light of changes to many best practice guidelines for COPD the RESPTREC^® COPD Educator Course was re-written in 2016.

A wide range of representatives from health disciplines and endorsing agencies were involved in this re-write and included: the Canadian Thoracic Society (CTS - COPD Clinical Assembly and authors of guidelines and publications), Canadian Respiratory Health Professionals (CRHP), Family Physician's Airways Group of Canada (FPAGC), The Lung Association, clinicians, researchers, certified respiratory educators, pharmacy, respiratory therapy, nursing and physical therapy.

RESPTREC^® would like to acknowledge the extraordinary contribution the following individuals of the COPD Educator Course Expert committee have made to the development of the current course curriculum.

COPD Educator Course Expert Committee

• Dr. Jean Bourbeau MD, FRCPC
  • Representing Living Well With COPD
• Dr. Gordon Dyck, MD
  • Representing FPAGC
• Dr. Donna Goodridge, BScN, MN, PhD
  • Representing the CTS
• Dr. Paul Hernandez, MD, CM, FRCPC
  • Representing the CTS
• Noel Pendergast, MPH, BPEd, RRT, CRE
  • Representing CRHP
• Shelly Hutchinson, RN, BSN, MN, CRE
• Trent Litzenberger, BScPT, BSPE, CRE
• Dr. Darcy Marciniuk, MD, FRCPC, FCCP
• Jan Neumann, BPT, CRE
• Kristine Petrasko, BScPharm, CRE
• Donna Turner, RRT, CRE
• Lori Nagy, Administrative support

The hours invested in completing this course can be included in your continuing professional education learning portfolio.

Accredited Study Credits

The Canadian Society of Respiratory Therapists

Title: COPD Management Course
Number of CEUs: 20
Date Accredited: 2023-06-22
Accreditation Expiry Date: 2025-06-30

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