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Resources Centers for Disease Control and Prevention (CDC). 2018. "COPD Costs." infographics/copd-costs.html. Centers for Disease Control and Prevention (CDC). 2019a. "Basics About COPD: Chronic Obstructive Pulmonary Disease (COPD)." Centers for Disease Control and Prevention (CDC). 2019b. "Data and Statistics: Chronic Obstructive Pulmonary Disease (COPD)." Cruz-Montecinos, Carlos et al. 2017. "The Immediate Effect of Soft Tissue Manual Therapy Intervention on Lung Function in Severe Chronic Obstructive Pulmonary Disease." International Journal of Chronic Obstructive Pulmonary Disease 12 (February 21, 2017): 691– 96. Editorial Team. 2016. "Were You Tested for Alpha-1 Deficiency?", living/alpha-1-deficiency. Mosenifar, Zab et al. 2019. "Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology." overview. National Institutes of Health (NIH). 2019. "NIH Fact Sheets: Chronic Obstructive Pulmonary Disease (COPD)." Polastri, Massimiliano et al. "Manual Massage Therapy for Patients with COPD: A Scoping Review." Medicina 55, no. 5 (May 2019): 151, Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 35 al., 2017). This report includes a detailed description of the massage therapy protocol. Compared to measures taken before the session, researchers found that one 30-minute massage treatment appeared to improve inspiratory capacity and led to a significant increase in oxygen levels in the blood. A weakness of this project, however, is that they did not take similar measures in a control or comparison group. Clearly, we need more data, but even this minimal amount of research suggests that massage therapy could be helpful for this population—if appropriate accommodations can be made. ACCOMMODATIONS For clients with COPD, it is extremely important to offer a massage therapy environment that is as free as possible from airborne irritants. This can include scents from candles, essential oils, the fabric softener in your sheets, and your previous client's perfume. The scent of cigarette smoke can be especially irritating. It is also important to keep in mind that people with impaired lung function have a much higher risk of contracting respiratory infections compared to the rest of the population. What might be the end of a mild cold for one person may quickly become life-threatening pneumonia for the next. To manage this risk, we must be diligent about hygienic practices, including cleaning all the surfaces clients may touch—remembering doorknobs, light switches, and bathroom fixtures—before we work with a person who has COPD. Another accommodation clients with COPD may need is in positioning. It is often uncomfortable for people with this condition to lie flat, and pressure on the sternum from a massage chair can feel oppressive. Breast recesses may help some clients. Having the option to offer a reclining surface so that their torso is at a roughly 45-degree angle (sometimes called Fowler's position) is appreciated by many. And finally, if the client's priority is to lessen some of the symptoms related to COPD, we would do well to focus on primary and secondary respiratory muscles, as well as other muscles that may become hypertonic with a lot of tension around the chest, shoulders, and neck. Some practitioners may also offer percussion and/or vibration over the chest in an effort to help support the cough reflex and the movement of sputum out of the lungs, but it is critical to be aware that steroidal anti-inflammatories can compromise bone density, so this must be done with the greatest care. Do you have any clients who have COPD? What do they look for in a massage session, and how do you know you are providing it? Because COPD is so common, and because massage therapy may have substantial benefits to offer, this is a topic that would benefit greatly from case reports written by massage therapists in the field— that's you. Will you add to our knowledge about massage therapy for COPD? Author's note: I had conversations with several people to help me prepare this article. Their input is incorporated throughout, and I thank them for their generosity. Contributors include: • VSM—massage therapist whose husband died of emphysema in 2013; she now specializes in working with patients with advanced COPD • MM—person with bullous emphysema • AA—massage therapy educator who has COPD along with a complex autoimmune condition • TB—massage therapist with COPD Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at, now in its sixth edition, which is used in massage schools worldwide. Werner is available at or PATHOLOGY PERSPECTIVES

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