COPD Zone Tool & Action Plan
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1 COPD Zone Tool & Action Plan "I am doing well today!" reen Zone: ood Breathing Day Actions Additional Action Usual activity and exercise level Take daily medicines Plan Steps Made Usual amounts of cough and phlegm/mucus Use Oxygen as prescribed with you and your Sleep well at night Continue regular exercise/diet plan Physician: Appetite is good At all times avoid cigarette smoke, inhaled irritants "I am having a bad day or a COPD flare" ellow Zone: Bad Breathing Day Actions: More breathless than usual Continue daily medication I have less energy for my daily activities Use quick relief inhaler every hours Using quick relief inhaler/nebulizer more often Start an oral corticosteroid (specify name, does, and duration Swelling of ankles more than usual name dose duration More coughing than usual Start an antibiotic (specify name, dose and duration I feel like I have a "chest cold" name dose duration Poor Sleep and my symptoms woke me up Use oxygen as prescribed My appetite is not good et plenty of rest My medicine is not helping Use pursed lip breathing At all times avoid cigarette smoke, inhaled irritants Call immediately if symptoms don't improve If you have a home health nurse visiting call the home health agency Home Health Agency Phone # "I need urgent medical care!" ed Zone: Emergency Breathing Day Actions: Severe shortness of breath even at rest Call 911 or seek medical care Not able to do any activity because of breathing While getting help, immediately do the following: Not able to sleep because of breathing Fever or shaking shills Chest pains Coughing up blood This material was prepared by Healthcentric Advisors, the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSI_C3-1_201510_ Edition 1
2 When going out into the cold air cover your nose and mouth with a scarf. Also, don t use any petroleum based products on the face and/or lips. JANUA 2019
3 FEBUA 2019 It s Valentine s Day - Try to avoid strongly scented perfumes and candles that may trigger your COPD.
4 MACH 2019 Be sure to clear your oxygen filter weekly and keep the mouthpiece of your inhalers clean by wiping them regularly with a moist cloth.
5 APIL 2019 As trees and grasses begin to bloom, pollen levels rise so keep the windows closed! Pollen levels are highest at night.
6 MA 2019 Don t forget to rinse your mouth with water and SPIT IT OUT after inhaler use. If you have dentures/partials, rinse them off as well to avoid mouth sores.
7 JUNE 2019 Never leave your inhaler or oxygen in a hot car or direct sunlight.
8 JUL 2019 Pace yourself with outdoor activities during hot weather. Always have your rescue inhaler on hand and drink plenty of fluids.
9 AUUST 2019 STOP SMOKIN if you haven't aleady and try to avoid being around others who may still smoke. If you are using oxygen, stay away from any open flames.
10 SEPTEMBE 2019 Don t forget to get your FLU SHOT this month and check to see if you re up to date with PNEUMOVAX as well.
11 OCTOBE 2019 With the leaves falling, mold and mildew levels are rising so close those windows!
12 NOVEMBE 2019 Pace yourself during the holidays. Let your family help you with food preparation and decorating.
13 DECEMBE 2019 Family time is such a blessing, but ask them not to visit if they aren't feeling well to avoid catching a cold. If you do get sick, make sure to finish all prescribed medications.
14 Type Primary Care Physician: Pulmonologist: Cardiologist: Other Important Physician: Other Important Physician: Other Important Physician: Pharmacy: Local Hospital: Local E: Home Health Agency: Other: Other: Name eference Sheet Phone Numbers American Lung Association Website Phone LUNUSA ( ) What they do: egistered nurses, respiratory therapists, certified tobacco treatment specialists and counselors make up our helpline staff. They are ready to assist with your lung health questions. et detailed and accurate information about lung cancer, asthma, COPD, quitting tobacco and multiple other lung health topics Medications List
COPD Zone Tool & Action Plan
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