The predominant debilitating symptom in patients with chronic obstructive pulmonary disease (COPD) is shortness of breath. Self-efficacy theory has been used in a case study approach to begin examining the expectations of a patient with COPD who attended a pulmonary education program. Mr. M. was selected for the case study because his condition typifies many of the problems encountered by patients with COPD. Mr. M.'s self-confidence in managing his breathing difficulty was measured by using the COPD Self-Efficacy Scale (CSES) before an educational program began and again 1 month and 6 months after the program. The CSES measures patients' confidence in their ability to manage or avoid breathing difficulty in a variety of situations. Mr. M.'s scores on the CSES improved in most areas. Incorporating programs to increase patients' self-efficacy may have implications for rehabilitation nurses who help patients with COPD manage their breathing difficulty.