🏅Your Path to Certification
Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · COPD badge and printable certificate, recognized across the FFH Network.
Aware · Identity: Self-Advocate
You know your body and your condition. Layer 1 — Condition Literacy.
- Complete Modules 1–4 (Condition Literacy)
- Pass the "What COPD Is" quiz (≥80%)
- Identify your GOLD stage (1–4 by FEV1 % predicted) and ABE group (GOLD 2024), your CAT + mMRC + exacerbation count, your pulse-ox at rest + ambulatory, your LTOT criteria status (SpO₂ ≤88% sustained), your alpha-1 antitrypsin status, your blood eos (≥300 favors ICS + biologic eligibility for dupilumab), your smoking status + pack-years + quit-date, your pulmonary rehab participation, and your medication regimen (LAMA + LAMA-LABA + triple as indicated)
- Build your one-page numbers card + daily pulse-ox log + monthly CAT score + exacerbation log + rescue-use count + vaccination record + written COPD Action Plan with rescue albuterol + oral steroid + antibiotic at home + inhaler-technique check date + smoking status
Active · Identity: Care Team Member
You partner with your team and navigate the system. Layer 2 — Care & System Literacy.
- Complete Modules 5–7 (Self-Monitoring · When to Call vs ED · Comorbidity Awareness)
- Demonstrate teach-back on your LAMA-LABA + (ICS if Group E or ACO or eos ≥300) regimen, correct inhaler technique with spacer + rinse mouth after ICS, the absolute rule that ICS monotherapy is NOT recommended in COPD, and your "when to call vs ED" decision rule (severe dyspnea unrelieved by rescue, drowsiness/confusion, cyanosis, can't speak full sentences, pulse-ox <88% sustained, sudden chest pain — possible pneumothorax in bullous COPD)
- Complete one "great visit" prep + debrief with your PCP or Pulmonology team (especially if biologic candidate for eosinophilic COPD, or LTOT candidate, or pulm rehab candidate)
- Establish Pulmonology referral if moderate-severe (GOLD 2+); pulmonary rehabilitation enrollment (under-prescribed); Pharmacist or RT inhaler-technique check; smoking-cessation counselor or Quitline 1-800-QUIT-NOW if applicable; Cardiology if CV comorbidity (CV is #1 killer); Sleep Medicine if snoring/daytime sleepiness (OSA-COPD overlap); Behavioral Health if PHQ-9 elevated (40% prevalence); Palliative Care if moderate-severe (symptom management + ACP normalization)
- Successfully resolve one prior auth (e.g., for dupilumab for eosinophilic COPD, alpha-1 augmentation therapy if confirmed deficient phenotype), LTOT criteria documentation, manufacturer copay-program application, Veterans PACT Act claim if eligible, or insurance-navigation issue via the ALA / COPD Foundation Helplines
Certified Prepared Patient · Identity: Ambassador
You teach, mentor, fight stigma, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.
- Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
- Mentor 1 newly-diagnosed person or family via the COPD Foundation peer-mentor program + COPD360social / ALA Better Breathers Clubs, OR present at a faith-community / employer / school / community health worker / Veterans-organization education session about smoking cessation, pulm rehab, LTOT navigation, alpha-1 screening, and Veterans PACT Act eligibility
- Sign the Prepared Patient Pledge
- Complete (or refresh) your written COPD Action Plan with rescue albuterol + oral steroid (prednisone) + antibiotic at home AND distribute copies to family Ambassador + employer/HR (if relevant) + emergency contacts; Advance Care Planning conversation if moderate-severe (palliative care + healthcare proxy + code status + goals-of-care)
- Submit one advocacy action (story, World COPD Day in November outreach, spirometry-access advocacy, pulmonary-rehab-referral advocacy, LDCT screening advocacy, women + AA + Indigenous + rural underdiagnosis closure, Veterans PACT Act outreach, alpha-1 universal screening, air-quality + environmental-justice advocacy)
📋Master Pre / Post Assessment
Where You Stand — Confidence Before & After
Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when an issue can wait for clinic, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.
📈 Your Pre→Post Growth
📞Know Who to Call — PCP / Pulm First, ED for Red Flags
COPD care runs as a long arc — diagnosis, GOLD stage + ABE group, controller titration, biologic decisions (for eosinophilic COPD), LTOT decisions, pulm rehab, and (if exacerbation) acute management + post-exacerbation step-up. Most days are routine. Some bring adherence or air-quality calls. A few bring red flags. Knowing the right number to call — your PCP / Pulmonology team, your RT or Pharmacist, the ALA Lung HelpLine / COPD Foundation, or 911 / ED — saves time, dignity, and lives. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.
🚑 Go to the ED right away for any of these
Severe dyspnea unrelieved by rescue albuterol · drowsiness, confusion, agitation (hypercapnia / CO₂ retention or hypoxia) · cyanosis (blue lips, fingers, nail beds) · can't speak in full sentences ("single-word dyspnea") · pulse ox <88% sustained despite rescue (especially <85%) · severe chest pain (rule out MI, PE, pneumothorax — bullous COPD at risk for spontaneous pneumothorax) · hemoptysis (coughing blood) — substantial or recurrent · fever + new sputum production (pneumonia possible) · severe accessory muscle use, tripoding · cor pulmonale signs (peripheral edema worsening, JVD, hepatomegaly) · active suicidal intent or attempt (988 or 911/ED). When in doubt, go.
🧭 Same-day call to your bone-health team — most things are addressable in clinic, not the ED
For increasing dyspnea beyond baseline (yellow zone of Action Plan), increased sputum / color change / new sputum (start Action Plan oral steroid + antibiotic per home plan), fever, new cough or worsening, CAT trending up, missed LTOT dose if applicable, missed biologic dose if on dupilumab, peripheral edema, palpitations or new arrhythmia, inhaler-technique concerns, or medication-adherence concerns, call your [Pulm / PCP line: (555) 123-4567]. Most issues are addressable in clinic.
💬 Routine questions, refills, scheduling, peer support
Use [MyChart portal] first — most messages answered within 1 business day. For inhaler refills, spacer dispensing, biologic copay help, LTOT logistics, or inhaler-technique check, call [Pharmacy / RT: (555) 222-9050]. For peer mentoring + family support + navigation + biologic-copay help, call the ALA Lung HelpLine 1-800-LUNGUSA or COPD Foundation 1-866-731-COPD — free, real humans, M–F. For AA / Indigenous / rural / Veterans communities: COPD Foundation + ALA Better Breathers Clubs + VA PACT Act 2022 outreach. World COPD Day third Wednesday in November.
🆘 Mood crisis · suicidal thoughts → 988 (call or text)
Depression and anxiety affect ~40% of COPD patients. Mood-COPD loop is real: untreated mood worsens adherence + symptom perception + ED visits. Any thoughts of wanting to die or hurt yourself = call or text 988 (Suicide & Crisis Lifeline · free, confidential, 24/7). Active risk → 911 / ED. Veterans: 988 then press 1. Crisis Text Line: text HOME to 741741. Asking about suicide does not plant the idea. SSRIs are COPD-safe (sertraline, escitalopram); treating mood improves COPD control + adherence.
📚Condition Literacy & the 10 Prepared Patient Competencies
A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.
Advocate for Self
You speak up for your own care, plan, pain, and goals.
Care Team Member
You partner with your team — not above, not below.
Ambassador
You teach, mentor, and shape research, policy & access.
🧬 Condition Literacy Learn It · Tier 1 Aware
"I know my body and my disease." The foundation. Without this, nothing else holds.
What Osteoporosis Is
A silent bone disease — bone mineral density (BMD) and microarchitecture quality drop until ordinary loads cause a fragility fracture (wrist, spine, hip, shoulder). About 10M Americans have osteoporosis; another ~44M have osteopenia. 1 in 2 women and up to 1 in 4 men over 50 will fracture in their remaining lifetime. Highly modifiable at any age. What osteoporosis is NOT: osteoarthritis (joint cartilage disease), osteomalacia (defective mineralization), Paget's disease (focal disordered remodeling), or normal aging.
Know My Numbers & Causes
Your COPD dashboard: GOLD 1–4 by FEV1 % predicted (post-BD FEV1/FVC <0.7 = obstruction; required for diagnosis); GOLD 2024 ABE groups by symptoms (CAT or mMRC) + exacerbations. CAT ≥10 = symptomatic; track monthly. SpO₂ at rest + ambulation; LTOT criteria ≤88% sustained or PaO₂ ≤55. Blood eos ≥300/μL favors ICS + biologic eligibility (dupilumab approved 2024). Alpha-1 antitrypsin level — test at least once in every COPD patient (under-diagnosed). Smoking history + pack-years; Veterans PACT Act 2022 — Agent Orange + burn-pit eligibility. BODE index predicts mortality. Equity: women ~60% of US COPD deaths; AA + Indigenous + rural underdiagnosed.
Lifestyle Force Field — Cessation + Rehab + Vaccines
Smoking cessation = #1 disease-modifying intervention — slows FEV1 decline; Quitline 1-800-QUIT-NOW + behavioral + pharmacologic (varenicline most effective + NRT + bupropion); multiple quit attempts normal. Pulmonary rehab improves mortality + QoL — under-prescribed despite Medicare coverage; refer at GOLD 2+ or any exacerbation. Annual vaccinations: flu + COVID + RSV (60+) + pneumococcal + Tdap + shingles (50+) — viral URI is #1 exacerbation trigger. Daily exercise maintains rehab gains. Air-quality + indoor air (AirNow; smoke-free; gas-stove ventilation). Nutrition protein 1.2–1.5 g/kg/day; treat cachexia + obesity. OSA evaluation if snoring (overlap syndrome — CPAP). LDCT lung-cancer screening if eligible.
Medications + LTOT + Inhaler Technique
GOLD 2024 hierarchy: LAMA first-line for symptomatic (tiotropium, umeclidinium, glycopyrrolate); LAMA-LABA combos for Group B (Stiolto, Anoro, Bevespi, Duaklir); Triple ICS-LABA-LAMA (Trelegy, Breztri) for Group E or ACO or eos ≥300. ICS monotherapy NOT recommended in COPD (pneumonia risk). Roflumilast PDE4i for chronic bronchitis + frequent exacerbators. Chronic azithromycin for frequent exacerbators (QT + hearing monitoring). Dupilumab FDA-approved 2024 for eosinophilic COPD (eos ≥300). LTOT ≥15 hr/day prolongs survival for hypoxemia (NOTT + MRC). NIV for hypercapnia. Alpha-1 augmentation for confirmed deficient. Inhaler technique HIGH-LEVERAGE — ALWAYS spacer with MDI; rinse mouth after ICS.
🤝 Care & System Literacy Live It · Tier 2 Active
"I'm part of the team. I navigate the system." Where most preventable ED visits, decompensation crises, and frustration happen — and where this course pays off the most. Optimal utilization lives here.
Self-Monitoring — CAT, Exacerbations, Pulse-Ox, Action Plan
The numbers card travels. Daily pulse-ox ($20 home meter); sustained ≤88% = LTOT criterion (call team). Monthly CAT (≥10 = symptomatic; track trend). Exacerbation log: date, severity (mild/moderate/severe), trigger. Written COPD Action Plan with rescue albuterol + oral steroid (prednisone 40 mg × 5 days) + antibiotic at home for prompt initiation. Rescue (SABA) use / month. Smart inhalers (Propeller, Hailie). Smoking status; pulm rehab participation; LTOT compliance ≥15 hr/day. Vaccinations current. BP + A1c + lipids (CV is #1 killer). PHQ-9 + GAD-7. BODE index periodic. LDCT status. Adherence drift #1 failure mode.
When to Call vs Go to ED — COPD Red Flags
ED: severe dyspnea unrelieved by rescue; drowsiness/confusion (hypercapnia); cyanosis; can't speak full sentences; pulse-ox <88% sustained (especially <85%); severe chest pain (MI, PE, or pneumothorax — bullous COPD at risk); hemoptysis; fever + new sputum (pneumonia possible); severe accessory muscle use, tripoding; cor pulmonale signs (peripheral edema, JVD). Same-day call: Action Plan yellow zone (↑dyspnea + sputum + color change), fever, missed LTOT or biologic dose, peripheral edema, CAT trending up. Mood crisis → 988 (~40% prevalence).
Comorbidity Awareness — The COPD Ecosystem
COPD-specific Module 7. Frame: the COPD ecosystem — multi-system disease + comorbid loops. Cross-references: Cardiovascular disease — #1 cause of death in COPD (cluster cross-referenced); Sleep Apnea overlap syndrome (cluster); Asthma companion + asthma-COPD overlap (ACO; dupilumab); Depression/Anxiety ~40% prevalence (Sprint 6 cross-ref; 988; SSRIs COPD-safe); Osteoporosis chronic steroid bone loss (Sprint 9); Lung Cancer (LDCT screening 50–80 + ≥20 pack-years + quit <15 yr); Hip Fracture falls + steroids + cachexia (Sprint 9); steroid-induced diabetes; GERD; cachexia/sarcopenia; cor pulmonale; polycythemia; alpha-1 deficiency under-diagnosed; pneumothorax in bullous; pulmonary HTN; frailty. Vascular cluster (md5 7587a559b24ca8b9bab40b1756475d84) cross-referenced, NOT embedded.
📣 Advocacy & Ambassadorship Share It · Tier 3 Certified
"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.
Family, Caregiver, Care Team — Inhaler Coach + Pulm-Rehab Partner + LTOT Logistics
The long-arc partnership. Ambassador roles: inhaler-technique coach + pulmonary-rehab partner (drive to sessions; post-program maintenance) + LTOT logistics partner (portable concentrator + tank rotation + travel) + exacerbation-watch + adherence partner + quitline + cessation support (supportive non-judgmental; multiple quit attempts normal) + advance-care-planning team (palliative care normalized at moderate-severe) + family-history alpha-1 Ambassador + equity Ambassador for women + AA + Indigenous + rural + Veterans PACT Act Ambassador. Care team: PCP + Pulm + RT + Pulm Rehab + Pharmacist + Quitline + Cardiology (CV = #1 killer) + Sleep Med + BH + Dietitian + Palliative Care + Thoracic Surgery / Interventional Pulm + COPD Foundation peer + ALA + Family Ambassador. Caregiver mental health real.
Sharing — Talk to Family, Workplace, Equity Ambassador for Women + AA + Veterans
Kids/adult children: "COPD limits how much air the lungs move; the trajectory is highly modifiable." Partner: inhaler coach + rehab partner + LTOT logistics + ACP team. Family hx of alpha-1 deficiency — first-degree relatives test (one-time blood test). Equity Ambassador: women ~60% of US COPD deaths (historically underdiagnosed); AA + Indigenous + rural face spirometry/pulm rehab/LTOT/biologic access gaps. Veterans PACT Act 2022 expanded eligibility for Agent Orange + burn-pit — file the claim. ADA covers COPD; FMLA for exacerbations + pulm rehab; SSDI in severe; workers'-comp for occupational COPD. Smoking-cessation conversation: supportive non-judgmental; multiple quit attempts normal; ~15% never-smokers. COPD Foundation peer + ALA Better Breathers Clubs + World COPD Day (November).
Mastery & Graduation — Sustained Engagement, Peer Mentor, Long-Arc Identity
Sustained trajectory modification: smoking cessation sustained + medication adherence + correct inhaler technique + pulm rehab maintenance + vaccinations + daily pulse-ox + monthly CAT + Action Plan + LTOT compliance if applicable + ACP normalization + CV-risk management + LDCT if eligible. Peer mentorship via COPD Foundation peer-mentor + COPD360social + COPD360coach + ALA Better Breathers Clubs + World COPD Day (third Wednesday in November). Advocacy: spirometry-access + pulm-rehab-referral + LDCT-access + LTOT-navigation + biologic-eligibility + air-quality + alpha-1 universal screening + women + AA + Indigenous + rural underdiagnosis closure + Veterans PACT Act outreach. Advance care planning normalized. Long-arc identity: COPD is a long disease; you are a Prepared Patient for life. Earn Certified Prepared Patient · COPD.
👥My Care Team
Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for COPD — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list and surfaces the ALA Lung HelpLine + COPD Foundation + Quitline + LTOT logistics + LAMA-LABA + ICS-only-NOT-recommended rule + spacer-with-MDI + rinse-mouth-after-ICS rules + written Action Plan + alpha-1 status + Veterans PACT Act eligibility.
📖Glossary — words you'll hear
Plain-English definitions for terms doctors and labs use. Tap to expand.
COPD (Chronic Obstructive Pulmonary Disease)
GOLD staging (1–4 + ABE groups)
Spirometry + FEV1/FVC
CAT (COPD Assessment Test)
LAMA / LABA / ICS
LTOT (Long-Term Oxygen Therapy)
Alpha-1 antitrypsin deficiency
Pulmonary rehabilitation
COPD exacerbation
Cor pulmonale
Overlap syndrome (OSA + COPD)
Asthma-COPD overlap (ACO)
PACT Act 2022
🧪Screen & Lab Tutor — your FEV1, CAT, pulse-ox, alpha-1, and what your COPD workup means
Screen & Lab Tutor — your COPD workup
In COPD, the most important "labs" are your post-bronchodilator spirometry (FEV1 + FEV1/FVC), CAT score, pulse-ox at rest + ambulation, alpha-1 antitrypsin level, blood eosinophils, exacerbation history, vaccinations, LDCT eligibility. Your "normal" may differ from a friend's. Ask your team to write your personal baseline in the column on the right.
| Test / Screen | What it measures | Typical adult range | What to ask if it's off | My baseline |
|---|---|---|---|---|
| Spirometry post-BD (FEV1 + FEV1/FVC) | In-office. Obstruction if FEV1/FVC <0.7 post-bronchodilator. FEV1 % predicted = GOLD 1–4. | FEV1/FVC ≥0.7 = no obstruction; FEV1 ≥80% predicted = mild | What is my GOLD stage? Annual repeat. | [fill in] |
| CAT (COPD Assessment Test) | 8 questions, 40 points. Monthly. | <10 = low; ≥10 = symptomatic; trending up = consider step-up | What is my CAT? Trend? Should we escalate? | [fill in] |
| mMRC dyspnea scale | 0–4 scale of breathlessness. | 0 = only with strenuous exercise; 4 = too breathless to leave house | What is my mMRC grade? | [fill in] |
| Pulse-ox at rest + ambulation | Home + clinic. LTOT criteria: sustained ≤88% resting or PaO₂ ≤55 (or 56–59 + cor pulmonale/polycythemia). | >92% normal; ≤88% sustained = LTOT criterion | Do I meet LTOT criteria? ABG to confirm if borderline? | [fill in] |
| 6-min walk distance + desaturation | Functional baseline + identifies exercise-induced desaturation. | Decline over time = trajectory concern | What is my 6-min walk distance + nadir SpO₂? | [fill in] |
| Alpha-1 antitrypsin level | Single blood test. Test at least once in every COPD patient (under-diagnosed). | ≥100 mg/dL normal; lower with deficiency; confirmed by phenotype (ZZ, SZ, MZ, etc.) | Was I tested? If positive: family testing + augmentation candidate? | [fill in] |
| Blood eosinophils | CBC differential. Drives ICS use + biologic eligibility. | ≥300/μL favors ICS; biologic eligibility (dupilumab) | Am I a biologic candidate (dupilumab approved 2024 for eosinophilic COPD)? | [fill in] |
| Exacerbations / year | Moderate (oral steroid or antibiotic) + severe (hospitalized) counts. | 0 = ideal; ≥2 moderate or ≥1 severe = Group E + biologic referral | Am I in Group E? Step-up therapy + biologic-eligibility audit? | [fill in] |
| Chest CT / LDCT lung-cancer screening | LDCT for current/former smokers 50–80 + ≥20 pack-years + quit <15 yr. Medicare + most insurance cover. | Per USPSTF eligibility criteria | Am I eligible for LDCT? When is my next? | [fill in] |
| Vaccinations | Annual flu + COVID + RSV (60+) + pneumococcal + Tdap + shingles (50+). | All current | Am I current? Viral URI is #1 exacerbation trigger. | [fill in] |
| BMI + body composition | Cachexia common in advanced COPD; poor prognosis. Obesity worsens dyspnea + work of breathing. | BMI 22–30 ideal range for COPD | Am I cachectic? Obesity? Dietitian consult? | [fill in] |
| PHQ-9 + GAD-7 | Mood + anxiety screens. ~40% prevalence in COPD; treatable. | <5 minimal; ≥10 moderate; ≥15 mod-severe | Should we add a COPD-safe SSRI (sertraline, escitalopram)? AVOID amitriptyline. | [fill in] |
| BP + A1c + lipids + statin (CV-risk audit) | CV is the #1 cause of death in COPD. | Per general CV-risk guidelines | Is my CV risk being managed? Statin indicated? | [fill in] |
| Sleep study if snoring / daytime sleepiness | Identifies OSA-COPD overlap syndrome (worse prognosis; CPAP indicated). | AHI <5 normal; ≥5 OSA | Should I have a sleep study? CPAP if overlap? | [fill in] |
➕Add-On Modules & Earnable Badges
Stackable modules that match your situation. Complete one to earn an extra badge on your certificate.
🚭 Smoking-Cessation Routine
#1 disease-modifying lever. Quitline 1-800-QUIT-NOW + behavioral + pharmacologic (varenicline most effective; NRT patch+gum; bupropion). Multiple quit attempts are normal — keep trying. Family supportive non-judgmental.
🏃 Pulmonary Rehab Enrollment + Maintenance
6–12 weeks multi-disciplinary; under-prescribed despite Medicare coverage. Improves mortality + QoL + exacerbation rate. Post-program walking, gym, telerehab.
💨 Inhaler-Technique-With-Spacer Routine
Most patients use inhalers wrong. ALWAYS use spacer with MDI. Rinse mouth after ICS. Pharmacist or RT teach-back at every visit. COPD Foundation video library.
🩸 Alpha-1 Antitrypsin Testing
Single blood test in every COPD patient (under-diagnosed). If positive (ZZ or SZ): family testing + augmentation therapy consideration.
🫁 LTOT Setup + Portable Concentrator
Sustained SpO₂ ≤88% or PaO₂ ≤55 = LTOT criterion. ≥15 hr/day prolongs survival (NOTT + MRC). Portable concentrator for mobility — life-changing.
📊 Pulse-Ox At Home Tracking
$20 home meter. Daily resting + ambulatory. Sustained ≤88% = LTOT conversation. During exacerbation: <88% sustained = ED.
📋 Written COPD Action Plan
Green/yellow/red zones. Rescue albuterol + oral steroid (prednisone 40 mg × 5 days) + antibiotic at home for prompt initiation per plan. COPD Foundation + ALA templates.
💉 Annual Vaccinations
Flu (any age) + COVID + RSV (60+) + pneumococcal (PCV20 or PCV15+PPSV23) + Tdap + shingles (50+). Viral URI is #1 exacerbation trigger.
💊 LAMA-LABA + (ICS if Group E or ACO or eos ≥300)
GOLD 2024 hierarchy. LAMA first-line; LAMA-LABA for Group B; triple ICS-LABA-LAMA for Group E. ICS monotherapy NOT recommended.
💉 Dupilumab for Eosinophilic COPD (2024)
FDA-approved 2024 for COPD with eos ≥300/μL. Anti-IL-4Rα; reduces exacerbations + improves lung function. Manufacturer copay programs cover most patients.
❤️ CV-Risk Audit
CV is the #1 cause of death in COPD. BP + A1c + lipids + statin + ASA (if appropriate). Cardiology co-management in moderate-severe.
🩻 LDCT Lung-Cancer Screening
Current/former smokers 50–80 + ≥20 pack-years + quit <15 yr. Medicare + most insurance cover. Major opportunity for early cancer detection.
📓 Advance Care Planning (Palliative Care)
Normalize at moderate-severe COPD — palliative care for symptom management + ACP + caregiver support. NOT just hospice. Code status + healthcare proxy + goals-of-care.
🇺🇸 Veterans PACT Act 2022
Substantially expanded VA eligibility for Vietnam-era Agent Orange + post-9/11 burn-pit exposure. COPD now presumptive in many cases. File the claim if eligible.
🧪 In a COPD Clinical Trial?
Trials currently exploring novel biologics for COPD, alpha-1 augmentation, regenerative therapies, telerehab effectiveness. Search ClinicalTrials.gov + COPD Foundation Patient-Powered Research Network.
+ Add Your Institution's Module
Local COPD Foundation peer-mentor program, ALA Better Breathers Club, Pulmonary Rehab program, smoking-cessation clinic, Veterans-organization partnership.
🛡️Force Field Emergency Card
🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY
A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself. Pair with the BHOF Helpline (1-800-231-4222) and the post-fracture treatment-gap rescue checklist.
🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport
📘 My Health Passport PATIENT-OWNED JOURNAL
This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).
🩺Working With a Prepared Patient · COPD
Your patient is going through a structured, evidence-based course. Here's how to get the most out of every visit, slow FEV1 decline + reduce exacerbations + improve QoL, support the family Ambassador roles (inhaler-technique coach + pulmonary-rehab partner + LTOT logistics + exacerbation-watch + ACP team), and partner well across the long COPD care arc. Built on the AHRQ SHARE Approach, IOM teach-back, alignment with the GOLD 2024 report, ATS / ERS COPD guidelines, NHLBI COPD National Action Plan, NOTT + MRC LTOT trials, COPD Foundation, ALA, and the dupilumab approval for eosinophilic COPD (2024). The ALA Lung HelpLine (1-800-LUNGUSA) + COPD Foundation (1-866-731-COPD) are surfaced throughout.
The SHARE Approach — your 5-step playbook
Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).
💬Teach-Back & Risk Communication
The two highest-yield, lowest-cost SDM techniques. Use both at every visit.
🔁 Teach-Back (1–2 min)
- "Just so I know I explained it well — what would you tell your family Ambassador about how to use your inhaler correctly with a spacer? About your written COPD Action Plan (yellow zone rescue meds at home)? About when to call me vs the ED during an exacerbation (silent chest, single-word dyspnea, pulse-ox <88% sustained)?"
- Open-ended ("what" / "how"), not yes/no.
- If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
- Use it for: LAMA-LABA + (ICS if Group E or ACO or eos ≥300) regimen; inhaler technique (ALWAYS spacer with MDI; rinse mouth after ICS); written COPD Action Plan with rescue meds at home; biologic-eligibility audit (dupilumab if eos ≥300 + frequent exacerbations); LTOT criteria (SpO₂ ≤88% sustained); alpha-1 testing imperative; smoking cessation (Quitline + varenicline); pulmonary rehab (under-prescribed); Veterans PACT Act 2022; advance care planning normalized at moderate-severe.
- Document teach-back in your note — it's a quality measure and a billable element of care.
🔢 Communicating Numbers
- Use absolute risk, not relative. "15 to 20 of every 100" beats "15–20%" beats "fairly common" beats "low risk."
- Keep denominators & timeframes constant when comparing options.
- Show, don't tell: icon arrays, photographs of dyskinesia vs tremor, written summary.
- For COPD numbers: give the trend, not just the value. "Your FEV1 was 45% predicted last year, 48% now after pulmonary rehab + smoking cessation. CAT went from 22 to 14 on dupilumab. Exacerbations went from 4/year to 1. Excellent trajectory. Let's continue this regimen + check LDCT screening + advance care planning conversation."
⚠️COPD-Specific Clinical Guardrails
Diagnosis
- Post-bronchodilator spirometry with FEV1/FVC <0.7 is required for COPD diagnosis. Available in primary care + Pulmonology.
- GOLD 1–4 by FEV1 % predicted; GOLD 2024 ABE groups by symptoms (CAT or mMRC) + exacerbation history drive treatment.
- Alpha-1 antitrypsin test at least once in every COPD patient (under-diagnosed). If ZZ or SZ phenotype: family testing + augmentation therapy consideration.
- Chest CT for hemoptysis, lung-cancer screening (LDCT eligibility), atypical features, or surgical evaluation.
- Pulse oximetry at rest + ambulation; ABG if hypoxemia or hypercapnia suspected; sleep study if snoring / daytime sleepiness (OSA-COPD overlap).
- Comorbidity screening: CV disease (#1 killer), depression/anxiety (~40%), osteoporosis if chronic steroid use, GERD, OSA, lung cancer (LDCT).
Evidence-Based Treatment (GOLD 2024)
- LAMA first-line for symptomatic COPD; LAMA-LABA preferred for Group B; triple ICS-LABA-LAMA (Trelegy, Breztri) for Group E or ACO or eos ≥300.
- ICS monotherapy NOT recommended in COPD (pneumonia risk without commensurate benefit unless ACO).
- Roflumilast PDE4i for chronic bronchitis + frequent exacerbations; chronic azithromycin for frequent exacerbators (QT + hearing monitoring).
- Dupilumab FDA-approved 2024 for COPD with eosinophilic phenotype (eos ≥300) — anti-IL-4Rα; reduces exacerbations + improves lung function.
- LTOT ≥15 hr/day prolongs survival for chronic hypoxemia (SpO₂ ≤88% sustained or PaO₂ ≤55, or PaO₂ 56–59 with cor pulmonale/polycythemia) — NOTT + MRC trials foundational.
- NIV (BiPAP) for hypercapnic chronic respiratory failure (PaCO₂ ≥52).
- Pulmonary rehabilitation at GOLD 2+ symptomatic or any exacerbation — under-prescribed despite Medicare Part B coverage. Improves mortality + QoL + exacerbation rate.
- Smoking cessation is the #1 disease-modifying intervention — Quitline + varenicline (most effective) + NRT + bupropion; multiple attempts normal.
- Alpha-1 augmentation (weekly IV) for confirmed ZZ or SZ phenotype with low level.
- Surgical / interventional: LVRS, endobronchial valves (Zephyr, Spiration), bullectomy, lung transplant for end-stage.
- Advance care planning normalized at moderate-severe — palliative care for symptom management + ACP + caregiver support; NOT just hospice.
The COPD "NEVER" / "ALWAYS" List
- NEVER prescribe ICS monotherapy in COPD (pneumonia risk without benefit unless ACO).
- NEVER stop LTOT abruptly in oxygen-dependent patients.
- NEVER use chronic oral steroids if avoidable — biologic-eligibility audit if eos ≥300 + frequent exacerbations.
- ALWAYS use spacer with MDI; rinse mouth after ICS.
- ALWAYS test alpha-1 antitrypsin at least once in every COPD patient.
- ALWAYS write a written Action Plan with rescue albuterol + oral steroid + antibiotic at home.
- ALWAYS refer to pulmonary rehabilitation at GOLD 2+ symptomatic or any exacerbation.
- ALWAYS audit LTOT criteria at every visit (pulse-ox at rest + ambulation).
- ALWAYS update vaccinations (flu, COVID, RSV, pneumococcal, Tdap, shingles).
- ALWAYS check LDCT lung-cancer screening eligibility (current/former smokers 50–80 + ≥20 pack-years + quit <15 yr).
- ALWAYS audit CV risk (CV is #1 killer in COPD).
- ALWAYS audit Veterans PACT Act eligibility in eligible patients.
- ALWAYS normalize advance care planning at moderate-severe COPD.
Quality Metrics for a Prepared Patient · COPD
- FEV1 trend, CAT trend, exacerbations/year, pulmonary-rehab uptake, LTOT-criteria-met patients on therapy, alpha-1 screening rates, smoking-cessation success, vaccinations, ED visits + hospitalizations, biologic uptake in eligible eosinophilic COPD, LDCT participation.
- Specialty referrals: PCP for mild-moderate; Pulm for moderate-severe + LTOT + alpha-1 + advanced; Cardiology for CV risk; Sleep Med for overlap; BH for mood; Palliative Care normalized at moderate-severe.
- Equity tracking: outcomes by sex (women ~60% of US COPD deaths), race/ethnicity (AA disparities), rural-urban, insurance, Veterans PACT Act eligibility.
🌍Equity, Cultural Competence & Trust
COPD has structural access + outcome gaps. Women are now ~60% of US COPD deaths — historically underdiagnosed (COPD framed as "old white man's disease"); women face higher per-pack-year risk than men. AA Americans: higher COPD mortality + lower spirometry access + lower pulmonary-rehab referral + lower LTOT use + lower biologic prescribing. Indigenous + rural: spirometry access gaps; LTOT logistics + portable concentrator delivery harder; pulm rehab geographic deserts. Lower-SES: occupational + indoor biomass + tobacco exposure stacked. LGBTQ+: care-access disparities documented. Veterans: PACT Act 2022 expanded eligibility substantially; many still don't file. Alpha-1 antitrypsin deficiency is underdiagnosed across all groups. Smoking-stigma is a barrier to care; ~15% of US COPD is in never-smokers — challenge the framing. Repair starts in your office.
- Default to spirometry for all symptomatic patients regardless of sex / race / age framing.
- Track pulm-rehab uptake by sex / race / rural-urban in your panel — close the access gap.
- Audit alpha-1 testing universally (single blood test in every COPD patient).
- Match the messenger when possible: COPD Foundation peer mentors, ALA Better Breathers Clubs, community health workers.
- Use qualified medical interpreters — never family, never minor children. COPD conversations (inhaler technique, LTOT logistics, advance care planning) must be in the patient's primary language.
- Invite the family Ambassador in with patient consent — long-arc COPD care needs Ambassador partnership.
- Telehealth + telerehab close rural and equity gaps — advocate for parity coverage.
- Veterans: ask about Vietnam-era Agent Orange + post-9/11 burn-pit exposure; file PACT Act 2022 claim if eligible.
- Occupational exposures: ask about coal, silica, cadmium, agricultural, isocyanates, welding; workers'-comp navigation.
- Mood crisis resources: 988; 741741; 988 then press 1 for veterans. Depression / anxiety ~40% prevalence; SSRIs COPD-safe.
🏥Customize for Your Institution
Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.
📞 What Should Replace the When-to-Call Block
- Pulmonology on-call / triage line
- ALA Lung HelpLine 1-800-LUNGUSA M–F
- COPD Foundation 1-866-731-COPD M–F
- Quitline 1-800-QUIT-NOW
- COPD-aware pharmacy (inhaler-technique check, LTOT logistics, biologic copay programs)
- Respiratory Therapist (LTOT setup, NIV titration, inhaler technique)
- Pulmonary Rehab program
- Cardiology referral (CV is #1 killer in COPD)
- Behavioral Health referral (~40% mood prevalence)
- Palliative Care (symptom management + ACP — normalize at moderate-severe)
- VA PACT Act case manager (if veteran)
- Mood crisis: 988 (call or text) · 741741 (text HOME) · 988 then press 1 Veterans
👤 Who Is Your COPD Care Navigator?
- Name, role, photo, scheduling link.
- What teach-back / check-ins they own (LAMA-LABA + (ICS if Group E) regimen, inhaler-technique with spacer, written Action Plan distribution, alpha-1 testing audit, LTOT criteria assessment, pulmonary rehab referral, biologic-eligibility audit, advance care planning, Veterans PACT Act eligibility, caregiver wellness).
- How patients and Ambassadors reach them between visits / across transitions.
- How they handle prior-auth (dupilumab, alpha-1 augmentation, LTOT supplies, pulmonary rehab), manufacturer copay programs, VA PACT Act claim navigation.
📚 Add Your Own Modules
- Your COPD clinical trial protocols (novel biologics, alpha-1 augmentation, telerehab effectiveness, lung-volume-reduction — link to ClinicalTrials.gov + COPD Foundation Patient-Powered Research Network).
- Your pulmonary rehab program — referral pathway, schedule, outcomes tracking.
- Your LTOT supplier network + portable concentrator availability.
- Local peer support partners (COPD Foundation peer mentor + COPD360social + ALA Better Breathers Clubs + Veterans-organization partnerships).
🎨 Re-skin in 2 Lines of CSS
--inst-primary: your brand color- Replace the FFH × GOLD · ATS · ERS · ALA · COPD Foundation × [Your Institution] cobrand in the hero
- Drop in your logo PNG (white version) — same 48px height as FFH logo
📚 Evidence Base — what this course is built on
- AHRQ SHARE Approach — 5-step shared decision making framework. AHRQ Pub. 25-0005, Oct 2024.
- AHRQ Health Literacy Universal Precautions Toolkit (3rd ed.) — teach-back, plain language, accessible materials. AHRQ Pub. 23-0075, March 2024.
- GOLD · Global Initiative for COPD 2024 Report — international evidence-based guidelines; LAMA / LABA / ICS hierarchy, ABE groups, exacerbation management.
- ATS / ERS COPD Guidelines — diagnosis, severity, treatment.
- NHLBI · COPD National Action Plan — US national strategy.
- American Lung Association (ALA) — ALA Lung HelpLine 1-800-LUNGUSA; Better Breathers Clubs; LUNG FORCE advocacy.
- COPD Foundation — 1-866-731-COPD; peer-mentor program + COPD360social + COPD360coach + Patient-Powered Research Network.
- NOTT trial (NEJM 1980) — LTOT survival benefit in hypoxemic COPD.
- MRC trial (1981) — LTOT survival benefit in hypoxemic COPD.
- FDA · Dupilumab approval for COPD with eosinophilic phenotype (2024) — first biologic for COPD.
- USPSTF · Lung-cancer screening (LDCT) recommendation: current/former smokers 50–80 + ≥20 pack-years + quit <15 yr.
- CDC · Tobacco Cessation Quitline 1-800-QUIT-NOW.
- VA PACT Act 2022 — expanded eligibility for Vietnam-era Agent Orange + post-9/11 burn-pit exposure.
- SPIROMICS, COPDGene, COPD Foundation PPRN — research cohorts.
- World COPD Day third Wednesday in November; National COPD Awareness Month November.
- 988 Suicide & Crisis Lifeline — call or text 988, free, confidential, 24/7. Depression/anxiety ~40% prevalence in COPD.
- FFH Prepared Patient · Asthma course (Sprint 10 companion) — asthma-COPD overlap (ACO), shared smoking-cessation + biologic + inhaler-technique frameworks.
- FFH Prepared Patient · Depression and Anxiety courses — bidirectionally cross-referenced for the 40% mood prevalence + 988.
- FFH Prepared Patient · Osteoporosis course (Sprint 9) — cross-referenced for chronic-steroid bone loss + falls overlap.
- FFH Prepared Patient · Hip Fracture course (Sprint 9) — cross-referenced for falls + chronic steroids + cachexia + sarcopenia.
- FFH Cluster Courses (HTN / T2D / CHF / CAD / post-MI / post-stroke / Alzheimer's / MS / brain tumor / cirrhosis / CKD) — the canonical comorbidity cluster module (md5 7587a559b24ca8b9bab40b1756475d84) is CROSS-REFERENCED from this COPD course's Module 7, NOT embedded or modified. CV disease is the #1 cause of death in COPD; cluster cross-talk is critical.
- Force Field Fact Sheet · COPD — the 16-square primer (companion file). This deep course extends and operationalizes the fact sheet.
Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.