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Scene 1 - portrait of James smoking

James is 65 and was recently diagnosed with moderate Chronic Obstructive Pulmonary Disease (COPD) after presenting to his GP with a persistent productive cough worse in the morning. He had noticed he was getting breathless on stairs and when out walking with his grandson Jack in the park. He looks after his grandson 3 times a week since retiring last year. He has started to limit the time they spend at the park as he feels breathless and he gets fatigued more quickly. Jack, being four years old, is full of energy and wants to stay longer.

James smokes 15 cigarettes a day and has done since his mid teens. His primary concern was lung cancer having lost a friend to this illness just a few months ago. His chest x-ray was clear but spirometry testing confirmed a diagnosis of COPD.

Scene 2 - portrait of James with Polly (practice nurse in uniform)

James’ practice nurse Polly started him on inhaled medication of long acting and short acting bronchodilators to relieve symptoms. So far inhalers have been helping his breathlessness and cough but he wants to know what else he can do to slow the progression of his disease and get fitter again.

In discussions with Polly, James decides he will try two goals to start with.

To stop smoking - Goal 1 To get back to walking with Jack in the park as they used to do - Goal 2

  • Goal 1: Smoking cessation. James has attempted to stop before on his own but was unsuccessful. Polly uses the readiness ruler to establish James self scores. Readiness ruler (Score 9) and confidence (Score 7). They discuss the benefits of quitting smoking and some facts and myths.
  • Goal 2: SMART goals.