Promising news - Pulmonary Paper

The
PulmonaryPaper
Dedicated to Respiratory Health Care
Vol. 25, No. 1
LEARN ABOUT
DE
PULSE OXIMETRY
WHAT TO ITEMIZE
ON YOUR TAXES
DE
SEX AND COPD
DE
FLU NEWS
Life is for Loving
Life is for Sharing
Table of Contents
12 | Sex and Sensibility
Don’t let COPD interrupt
your sex life!
Medical News
08 | Ask Mark
For Fun
07 | Fibrosis File
26 | Get Yourself Back
Out There!
22 | Lung Transplant
News
Featuring
03 | Editor‘s Note
06 | Calling Dr. Bauer
16 | Sharing the Health
30 | Respiratory News
28 | SeaPuffer Cruises
Plan a vacation and leave
your cares behind you!
Family Matters
24 | Variables in Oxygen
Delivery Systems
Your Health
14 | Flu News 2014
Above all, wash your
hands. Often!
04 | Tax Time
If you itemize, don’t miss
these medical expenses.
10 | Imperfect as I Am
A poem from reader,
Trish Barron
19 | Stem Cell
Research Update
15 | Pulse Oximeter is a
Valuable Tool
Love is forever.
23 | Open Conversations
with Your Doctor
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Volume 25, Number 1
Editor’s Note
C
ouples or friends often find themselves in somewhat of a
rut, always doing the same activities and finding the routine
boring. These habits are hard to break out of and often a
small surprise, a change from the ordinary, can be exciting and very
much appreciated!
“All you need
is love.”
John Lennon
Do something unexpected and look for the smiles. Do you always
want to stay home because it is too much effort to go out? Be the
one to suggest a night at the movies or a restaurant. Look in your
local newspaper listings for festivals or displays that either of you
may have an interest in. Let the people in your life know how much
you appreciate them by doing something that might be an effort for
you because you wanted to make them happy.
We are excited about the revised format to our newsletter and
hope you will be too. A lot has changed since we published the first
issue of The Pulmonary Paper in 1988. We have to take the good
with the bad but are grateful to still be here with your generous and
continued support.
I hope you continue to be the best that you can be in 2014.
Congratulations to my youngest son Julian who
recently got engaged to Ashley!
January/February 2014
www.pulmonarypaper.org
3
Yes, Virginia, It’s …
I
f you itemize deductions on your income
tax return, you may be able to get some
of your medical expenses back that
you have paid for throughout the year.
Determine whether the allowable expenses
you paid during the year (home mortgage
interest, property and state income taxes,
charitable donations, etc.) exceed the standard deduction for your filing status. For
2013 returns, the standard deduction for
single taxpayers is $6,100 ($7,600 if you are
over 65). Married couples filing jointly have
a standard deduction of $12,200 (if both are
over 65, the deduction is $14,600).
Medical costs are deductible only after
they exceed 10 percent of your adjusted
4
gross income (AGI). So if your AGI is
$50,000, the first $5,000 of unreimbursed
medical expenses does not count. There is a
temporary exemption from January 1, 2013
to December 31, 2016, for individuals age
65 and older and their spouses. They are
allowed to deduct unreimbursed medical
care expenses that exceed 7.5 percent of their
adjusted gross income.
For the complete qualified medical expenses that you may deduct, see IRS Publication 502 (you can do an Internet search
for this). In addition to the items you would
expect are deductible (such as physician,
hospital, dental, laboratory and x-ray costs),
you also may consider the following:
www.pulmonarypaper.org
Volume 25, Number 1
• An air conditioner necessary for relief from
allergies or other respiratory problems.
• Exercise program if a doctor has recommended it as treatment for a specific condition such as non-reimbursed pulmonary
rehabilitation expenses.
• Insurance premiums for medical care
coverage.
• Lodging expenses while away from home
to receive medical care in a hospital or
medical facility.
• Medical aids, including wheelchairs, hearing aids and batteries, eyeglasses, contact
lenses, crutches and braces.
• Medical conference admission costs and
travel expenses for a chronically ill person
to learn about new medical treatments.
• Oxygen, oxygen equipment and the electricity it takes to run it.
• Smoking cessation programs (program
does not have to be recommended by a
physician).
• Transportation costs for obtaining medical
care.
• Weight loss programs, if recommended
by a doctor to treat a specific medical
condition or to cure any specific ailment
or disease.
January/February 2014
Computing the cost of electricity used:
1. Look at the label on your concentrator. It states the number of volts and
amps the concentrator uses. If not
found on the concentrator, look for
it in the manual or ask your oxygen
provider. As an example, we will use
115 volts at 4 amps. To convert to
watts (W), multiply volts and amps:
115 volts x 4 amps = 460W.
2. Next, calculate the number of kilowatt (KW) hours you use per year.
Multiply the watts your concentrator
uses by .001 KW/W to convert watts
to kilowatts. In our example, 460 W
x .001 KW/W = 0.46 KW.
3. Multiply this answer by 24 hours/
day x 365 days/year if you are a continuous user. If you do not always
have your oxygen on, multiply by
the average number of hours used per
day and then by 365 days/year. To
continue the example, 0.46 KW x 24
hours/day x 365 days/year = 4,029.6
KWH/Y. This is the kilowatt hours
you have used to run your concentrator the past year.
4. Now, multiply the above result by
the cost per kilowatt hour your electric company charges you. It may be
listed on your bill or you could call
their office. Let’s say they charge you
8 cents per kilowatt hour (prices vary
widely depending on the region in
which you live).
To finish our example, 4,029.6
KWH/Y x $0.08 = $322.27. This is
the amount of electricity you paid to
run your concentrator.
www.pulmonarypaper.org
5
Calling Dr. Bauer …
M
Dr. Michael Bauer
ost of us know friends or relatives who are being treated for
obstructive sleep apnea (OSA). During sleep, the muscles
in the back of the throat (the tongue, tonsils and soft palate)
become abnormally soft, weak and flaccid. This, in turn, blocks
the air passages repeatedly, causing a poor quality sleep and loud
snoring. CPAP is often the best friend of an OSA patient.
There is a different kind of sleep apnea called central apnea
(CA). It’s much less common, but still seen most often in patients
with heart disease such as congestive heart failure or patients with
neurologic disease such as stroke. Rather than the sudden gasps
and snorts of OSA, the breathing during sleep in CA is distinctly
different. Called Cheyne Stokes breathing, it is marked by a slow
gentle increase in breathing effort, followed by a slow decrease in
effort, followed by a complete cessation of breathing. This repeats
over and over, resulting in oscillations in oxygen levels up and
down during sleep.
The cause of CA has nothing to do with muscle weakness in
the throat. Somehow, the control centers for breathing, deep in
the brain, fail to regulate respiratory rate and depth of breathing
appropriately. Sometimes CPAP or BIPAP can be helpful, but the
best treatment is to fix the underlying disease if possible.
Happy dreams to all our Pulmonary Paper readers in 2014!
Sleep Apnea Support
• The American Sleep Apnea Association is a non-profit
Question for Dr. Bauer?
You may write to him at
The Pulmonary Paper,
PO Box 877, Ormond
Beach, FL 32175 or
by email at info@
pulmonarypaper.org.
6
organization that advocates for the interests of people
with sleep apnea.
(www.sleepapnea.org)
1-888-293-3650
• Philips Respironics
markets equipment to
treat sleep apnea, and
offers information at
www.sleepapnea.com
• ResMed, another equipment provider offers,
www.wakeuptosleep.com
www.pulmonarypaper.org
Volume 25, Number 1
Fibrosis File
T
he American Thoracic Society Foundation, Coalition for Pulmonary
Fibrosis, and the Pulmonary Fibrosis
Foundation have awarded $100,000 to
Chi Hung, MD, a Clinical Instructor at
the University of Washington, in Seattle,
WA, to support research in idiopathic pulmonary fibrosis (IPF). Dr. Hung will use
mouse models to identify cells that contribute to scarring in experimental models
of fibrosis.
A team of scientists has identified a new
way to disrupt cellular activity that causes
fibrosis and scarring. The findings, published in Nature Medicine, demonstrate
a potential new approach to treat fibrotic
diseases such as IPF. The research tries to
stop a protein, transforming growth factor (TGF), that causes the scarring in your
lung. This protein is normally present in
the body in an inactive state and must be
turned on to cause the scarring. The team
has developed compounds to prevent the
TGF beta protein from being activated.
It was not only able to prevent fibrosis;
it made fibrosis less severe even when the
treatment was started after fibrosis had
begun. The next steps are to determine
exactly how much of the compound is
needed to allow normal healing to occur
instead of fibrosis. Scientists also need to
study the best way to deliver the drug.
January/February 2014
The British Lung
Foundation is launch­­
ing a campaign to
raise the profile of idiopathic pulmonary fibrosis in that country, citing a lack of support for the 15,000
people who live with the disease in the
United Kingdom. You can raise awareness of Pulmonary Fibrosis by wearing a
bracelet from The Pulmonary Fibrosis
Foundation! To order, visit http://pff.
donorshops.com or call 1-888.733.6741.
Requested donation is $2 per bracelet.
Would you like to be notified of future studies to investigate causes and
treatments of pulmonary fibrosis? The
PF Registry is a confidential database of
individuals diagnosed with PF (and/or
their primary supporters/caregivers) who
wish to be contacted about participating in
research projects as they become available. Visit http://
pulmonaryfibrosisresearch.
org for more information.
Rare Connect (www.rareconnect.org) is
an Internet support group for people with
rare medical disorders including IPF. The
organization would like to connect medical experts and people around the world
who suffer similar symptoms so they may
learn from and support each other. From
their home page, pick IPF from the list of
their patient communities to enroll in the
online program.
www.pulmonarypaper.org
7
Ask Mark …
Mark Mangus, RRT
EFFORTS Board
Cindy is concerned about when to take Brovana, Spiriva and
Symbicort.
Mark advises, You do not need to wait between treatments when
it comes to taking Brovana and Spiriva or Symbicort and Spiriva.
You should not be taking both Brovana and Symbicort on a regular
schedule. They are both long-acting beta agonists and if both taken
over a long period of time can cause issues with your breathing, heart
and possibly your blood pressure. Please check with your physician to
review the medications that you are taking.
Jane wants to know if there is a differ­
ence between the oxygen that a
con­
centrator delivers and that
delivered from a tank.
Mark says, Medical grade com­
pressed gas oxygen in tanks is
99.9998% pure, as is oxygen in liquid
form that is distilled to medical grade
purity.
Home concentrators make oxygen that is generally between 92
percent and 96 percent pure when they are working at their optimum
levels. Concentrator systems that fill compressed gas cylinders fill
those cylinders with the same purity of gas the concentrators are
producing for home use. There is no decrease in purity for the gas
being sent to the portable cylinders.
Mark Mangus RRT,
BSRC, is a member
of the Medical Board
of EFFORTS (the
online support group,
Emphysema Foundation
For Our Right To Survive,
www.emphysema. net).
He generously donates
his time to answer
members’ questions.
8
Betty from EFFORTS takes Advair, Spiriva and albuterol regularly
and comments her heart feels like it is racing and wonders if this
is normal.
If you are experiencing a racing heart, it is most likely because you
are taking too much beta agonist medication. The beta agonists are
one of the components of albuterol and Advair. The albuterol will
make you shaky and your heart pound or race, more so than the
Advair will. The albuterol should be only for rescue, not as a regular
or maintenance medication.
www.pulmonarypaper.org
Volume 25, Number 1
Susan asks Mark if it is okay to use a rescue
albuterol inhaler and then four hours
later take a nebulizer treatment, also with
albuterol.
Mark replies, Three to four hours is an
acceptable time frame between these two
doses of albuterol. You may experience the
side effects of shakiness, trembling or a racing
or pounding heartbeat. I caution to keep in
communication with one’s doctor if symptoms
escalate or remain significant enough that
treatments are needed as often as every
three hours. If you are also taking long-acting
medications such as Symbicort and/or Spiriva
and are still symptomatic enough to require
more than one or two treatments each day,
suggests a problem and the possibility that
you are having an exacerbation.
If you take the albuterol inhaler or nebulizer
treatment, be sure to wait at least two hours
before taking the Symbicort. If you take a
nebulizer with ipratropium bromide in it,
then wait two hours to take Spiriva, as well. Any
sooner may interfere with the effectiveness of
those medications. It is important that you
know and fully understand the medications
you take – why you take the ones you do and
what each is supposed to do for you.
For those who require supplemental oxygen,
using their inhalers will not increase or
appreciably alter their oxygenation or their
saturation level. Hypoxia is the result of lack
of ability to get oxygen molecules through
the membrane between the alveoli and
the capillaries that serve them. Inhaled
medications do not affect diffusion.
How Exactly Do My Inhalant Drugs Help Me?
Albuterol is a short-acting bronchodilator that relaxes muscles in the airways and increases
air flow to the lungs.
Advair contains fluticasone, a steroid to decrease inflammation and salmeterol, a long acting
bronchodilator that relaxes muscles in the airways to improve breathing.
Brovana (arformoterol tartrate) is a long-acting bronchodilator that helps you to breathe
better for up to 12 hours at a time.
Spiriva (tiotropium bromide) is also a once-daily, long acting bronchodilator for COPD.
Symbicort contains a combination of the steroid budesonide and formoterol, a long-acting
bronchodilator.
January/February 2014
www.pulmonarypaper.org
9
Imperfect As I Am
Trish Barron
McKean, PA
The true person, you are, is within you.
God varies the appearance outside.
To focus on oneself brings much sadness.
For others see, not, what “you” see reflected,
in that mirror showing only the shell – our “earthly” side.
The mirror, in life, hangs not on your wall,
But in the reflection seen through other‘s eyes.
All those flaws we all have seen, ourselves,
so prominent, in our eyes – overlooked,
or seen as, really, quite small.
They may, instead, have seen the smile, given freely,
as you entered into any unknown location.
Or a kind word, spoken, meant from the heart.
Said in truth, without hesitation.
My mother taught me a valuable lesson,
while, I, still quite very young.
What matters most to God,
is not how beautiful you are,
But how beautiful, in heart, you become.
“One” focuses on oneself.
“One” turns the focus to others.
Imperfect, as I am,
on bended knee,
God knows and sees the real,
“so loved” perfected through
“His Grace”, me.
10
www.pulmonarypaper.org
Volume 25, Number 1
Take a
Closer Look..
Are you receiving
Your oxygen
Discretely?
Toll Free 877-699-8439
www.oxyview.com
January/February 2014
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11
Sexual intimacy and COPD
Sex and Sensibility: A Guide for a Good Sex Life
COPD affects many areas of your life;
sexuality is one of them. You may get short
of breath when you are having intimate
relations. COPD also affects your emotional
health; you may feel anxious, depressed, or
lonely. Many people with COPD (and their
partners) are nervous about having sex. By
following this advice, you can enjoy sexual
intimacy and benefit from feeling close to
your partner.
The person with COPD will eventually
experience shortness of breath during sexual intimacy. A small minority of people
with COPD can manage their shortness of
breath by using a bronchodilator before or
during sexual relations. However, for most
people with COPD, the fear of becoming
short of breath may lead to avoidance of
sexual activity or an inability to maintain
sexual arousal. The non-COPD partner
may believe that abstaining from sexual
activity is in the COPD partner’s best interest. Quite the contrary, resuming intimacy
and closeness with the partner can help to
decrease the loneliness and isolation of the
person with COPD.
• Beginning an exercise program will help
to build up the COPD person’s tolerance
to activity and in turn help to reduce
shortness of breath with activity.
• Research findings show that the effort
required for intercourse does not raise
blood pressure, heart rate and respiration rate to a level that is considered
dangerous.
• Medication specific for your lungs will
not affect your sexual drive; however, if
you are taking other medications (e.g.,
antidepressants), it is important to ask
your physician how these may interfere
with your sexual drive.
• Some changes in sexuality are not related to your lung disease but are normal
changes with aging. For instance, slower
erections and delayed orgasms are normal in middle and later life.
Some things to keep in mind about
COPD and sexuality:
• COPD does not diminish sexual ability;
it is only the frequency of sexual activity that is limited, as are all strenuous
physical activities.
• The physical effort required for sexual
intercourse is approximately equal to
that required to climb one flight of stairs
at a normal pace.
12
www.pulmonarypaper.org
Volume 25, Number 1
• Because of the physical effort required,
it is important to have adequate rests
both before and during sexual relations.
In other words plan your activity
for your best time of day and rest
at intervals during the activity if necessary.
• Clear bronchial secretions prior to
sexual activity.
• Choose sex positions that are less energy
consuming and that avoid pressure on
the chest. For instance, side-to-side position during intercourse is more comfortable and less tiring than the top-bottom
position.
• Have the able-bodied partner assume a
more active role so that the COPD partner becomes less fatigued or anxious.
• Plan to have sexual activity immediately
after using a bronchodilator.
• If you use supplemental oxygen for
activity plan to use the same amount of
oxygen during sexual relations.
• Avoid sexual activity immediately after
a heavy meal, after consuming alcohol,
in an uncomfortable room temperature
or when under emotional stress. All of
these factors will only increase your
fatigability.
• Avoid allergic elements in the environment (e.g., perfumes, hair sprays) that
may induce bronchospasm.
• Remember that simply touching, being
touched and being close to someone is
essential to help a person feel loved,
special and truly a partner in the relationship.
Information provided from The Canadian Lung
Association. Read more about Coping with
COPD at their website www.lung.ca
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January/February 2014
www.pulmonarypaper.org
13
H
WS
E
N 4
U
FL 201
ealth officials are warning this
flu season has been particularly
hard on the young and the elderly
and could last until May. Three
strains of influenza viruses – influenza A
(H3N2), 2009 influenza A (H1N1) and
influenza B viruses – have been especially
harsh in terms of the number of people
infected and the severity of symptoms.
The same H1N1 virus emerged in 2009
to cause a pandemic. They have continued
to circulate since that time, but this is the
first season that the virus has circulated at
high levels since the pandemic, according
to the Centers of Disease Control weekly
flu report. Forty states reported widespread
influenza activity at the beginning of 2014.
Of the 3,745 influenza-associated hospitalizations that have been reported this
season, 61 percent have been in people 18
to 64 years old. The same pattern of more
hospitalizations among younger people
occurred during the 2009 H1N1 pandemic,
according to the CDC.
Besides getting your flu shot, washing
your hands frequently and avoiding those
who are infected with the flu, you should
take a daily vitamin and eat a diet high in
fruits and vegetables, whole grains, nuts
and seeds which provide optimal immunity.
Also, get plenty of sleep, exercise and reduce
your stress levels.
The American College of Chest Physicians
report the high-dose vaccine stimulated significantly more protective antibodies
against all three strains
of the flu than did the
THE SP
READ
corresponding
OF THE
WASH
FLU
YOUR
HANDS
COVER
regular dose
C
STAY A OUGHS
T
vaccine.
(IF SIC HOME
K
STOP
)
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14
www.pulmonarypaper.org
Volume 25, Number 1
Reading your oxygen levels,
Pulse Oximeter is a Valuable Tool
I
n the old days, the only way to know what
your oxygen levels were, was to draw an
arterial blood sample, an invasive procedure.
(Invasive means entry into the body by cutting or by inserting an instrument.) In 1935,
a German physician developed the first ear
oxygen saturation meter. Pulse oximetry
was developed in 1972 and introduced for
commercial distribution in 1981. Originally,
it was used in the operating room to monitor
oxygen levels. Its use expanded to the recovery room, intensive care units, neonatal
nurseries, physician offices and eventually
to oxygen users themselves. In 2009, Nonin
Medical (the name Nonin came from noninvasive) introduced the first Bluetoothenabled oximeter, which allowed health
clinicians to be able to monitor readings
remotely.
There was quite a concern among pulmonary physicians about their patients having
their own oximeter. Many felt that people
would become obsessed with looking at
their readings and they would be overwhelmed with calls every time there was a
low measure­ment. Instead it has become a
very valuable tool to involve the oxygen user
in their own course of treatment.
The reading from your oximeter displays
the percentage of blood’s hemoglobin that
is loaded with oxygen. Normal ranges for
people without pulmonary pathology are
from 95 to 99 percent. It utilizes a processor
and a pair of small light-emitting diodes.
Oxygenated hemoglobin absorbs more
infrared light and allows more red light to
pass through. The reading is a result of the
January/February 2014
processor calculating the
ratios of
the light
absorbed.
There are
several things that
can affect your readings:
• Low blood pressure can make it difficult
for the sensor to pick up the blood flow.
• Cold hands can cause the pulse oximeter
to give inaccurate readings.
• If you have anemia – low hemoglobin –
your readings will be affected.
• Methemoglobin is a form of hemoglobin
that does not carry oxygen. You normally have 1% to 2% in this form. Higher
levels would cause a pulse oximeter to
have a reading of around 85 percent
regardless of the actual oxygen saturation level. Higher percentages can be
genetic or caused by exposure to certain
chemicals and medications.
• A pulse oximeter cannot distinguish the
differences between carbon monoxide
and oxygen on the hemoglobin molecule.
If 20 percent of hemoglobin has carbon
monoxide and 75 percent has oxygen,
the reading would be 95 percent. False
readings will result in people with smoke
inhalation, carbon monoxide poisoning,
and heavy cigarette smoking.
• Nail polish, especially purple or black
polish, will make readings difficult.
• Bright light in the room that you
are using the oximeter can affect
readings.
www.pulmonarypaper.org
15
Sharing the Health!
The Pulmonary Wellness & Rehabilitation Center in Manhattan will host live
webinars that bring the experience of a
Better Breathers Club meeting to those
who do not have the opportunity to attend a support group. “Better Breathers
Clubs are meetings where people with
COPD and other lung diseases can come
to not only learn more about how to
manage their disease but offer and receive
support from others who are experiencing
similar challenges,” says program director
Dr. Greenspan. Upcoming meetings that
will be available as live online webinars
are:
• February 26: Breathe Deep!
Your Absolute Best Breathing
Techniques Ever
Valerie McLeod RRT of Flint, MI, encourages her Pulmonary Rehabilitation participants with inspirational quotes such as:
Life isn’t about waiting for the storm to
pass, it’s learning to dance in the rain!
There comes a time in your life, when
you walk away from
the drama and the
people who create it.
You surround
yourself with people
who make you laugh.
Forget the bad and
focus on the good.
Love the people who
treat you right.
Life is too short to be anything
but happy.
16
• March 19: Make it Work!
Maximizing Your Pulmonary
Medications Now
• April 23: Move It! Move It!
Exercise and Pulmonary Disease
All of these events will take place
at 6 p.m. at the Pulmonary Wellness
& Rehabilitation Center, located at 22
West 38th Street, New York City, on the
second floor. Those who want to participate online should visit www.Pulmonary
Wellness.com and click on ‘webinar’ to
register. It is suggested you log in at 5:45
p.m. For more information, call 1-212921-0214 or email info@pulmonary
wellness.com. The group is sponsored by
the American Lung Association.
Receive a Free
One Year Membership
Contribute a picture or tip on how
you COPE with COPD!
Send to The Pulmonary Paper, PO
Box 877, Ormond Beach, FL 32175.
Include your name and address.
Be sure to visit www.pulmonary
paper.org and see past years of The
Pulmonary Paper.
New members will sign up and be
given a password. If current members would email us at members@
pulmonarypaper.org, we will send
you a password to access the Member
Only section.
www.pulmonarypaper.org
Volume 25, Number 1
Kandy B. of Mobridge, SD, is a COPD
Advocate from Emphysema Foundation for
Our Right To Survive (EFFORTS) at www.
emphysema.net.
Kandy was born with asthma and diagnosed with COPD fifteen years ago. She
advises when you are initially diagnosed,
the first step is to make the choice to live
with this illness. In living with something,
you accept it fully as a different lifestyle and
embrace it. Accept it as something you want
to do to improve your lifestyle and quality
of life. Choosing a healthy diet, pulmonary
rehab, getting your flu and pneumonia
shots, taking your medications, using your
oxygen and keeping a good attitude that you
are making the right choices also are keys
to handling this illness.
public comment (oxygen, cold weather
masks, inhalers) and being concerned (often
excessively) about contact with cold or flu
germs. Accept it.
Living with COPD can mean crying
easily, angering easily, becoming frustrated
and impatient because I can’t do the things
I used to do. There is a lot of anxiety and
panic living with COPD. Accept it.
Living with COPD is very restrictive.
Accept it. It means having to avoid strong
odors, smoke, flowers, perfumes, cleaning
agents, paints, solvents, vehicle exhaust,
shaving lotion, bath powders and incense.
I also have to avoid temperature extremes
or wind, crowds, molds and dusty places
because they make me short of breath.
Living with COPD can mean having
difficulty walking up stairs or inclines, not
walking very far, being unable to rush and
tiring easily especially if things last too long,
being unable to tolerate tight clothing and
the inability to talk for any length of time.
Accept it.
Living with COPD can mean coughing in
public, which attracts attention and embarrasses me, having to use or wear devices or
equipment, or take medication which invites
January/February 2014
www.pulmonarypaper.org
17
Sharing the Health! continued
I would like to get something off my
chest! I am so tired of people asking me
if I smoked when they notice that I am
using oxygen and basically shrugging their
shoulders as if to say what did you expect?
They can be very condescending! Many
people contracted AIDS from unprotected
sex and are not chastised for being ill.
According to the FAIR (Fair Allocations
in Research) Foundation, the National
Institute of Health spends an astronomical
$329,576 in research dollars for every AIDS
death in the United States, compared to a
measly $806 for every death from COPD.
I quit the cigarettes, which to me is the
important fact.
Christine D., Florida
For years, I fought
a battle with my
wife’s cats who insisted on chewing
holes in my oxygen
tubing! I also had a hard time trying to
keep the tubing untangled. Finally we came
up with the idea of covering the oxygen
tubing with Gardner Bender 3/8-inch Split
Flex Tubing. You can find it at home supply
stores. The cats gave up the battle and the
tubing tangles went away!
Scott Babcock, Knoxville, TN
The Cleveland Clinic wants to encourage
oxygen users to exercise within their limits.
Talk to your physician about the goals you
want to achieve and ask for his recommendations. There are enormous benefits for
you including:
• Improved circulation
• Fewer COPD symptoms
• Higher energy levels
• Healthier heart
• Increased endurance
• Lower blood pressure
• Better strength and muscle tone
• Improved flexibility and balance
• Stronger bones
• Reduced body fat and healthier weight
• Reduced levels of stress, anxiety
and depression
• Improved self image
• Improved night’s sleep
Sara A. from Tampa, FL, shares, I find
doing this simple exercise gives me a lot
more upper body strength! The push-ups
will strengthen your arms, shoulders, and
chest.
• Face a wall, standing a little farther than
arm’s length away, feet shoulder-width
apart,
• Lean your body forward and put your
palms flat against the wall at shoulder
height and shoulder-width apart,
• Slowly breathe in as you bend your
elbows and lower your upper body
toward the wall in a slow, controlled
motion. Keep your feet flat on the floor,
• Hold the position for 1 second,
• Breathe out and slowly push yourself
back until your arms are straight,
• Repeat 10 to15 times,
• Rest, then repeat 10 to 15 more times.
18
www.pulmonarypaper.org
Volume 25, Number 1
Progress in
Stem Cell Research
T
here has been progress in efforts to
develop lab-grown lungs. Scientists
from New York’s Columbia University have successfully turned human stem
cells into functional lung and airway cells
for the first time. The researchers believe it
could lead to the creation of lab-made lungs,
using a patient’s own cells. As published
in Nature Biotechnology, the researchers
developed six types of lung and airway
cells and documented evidence of basic
functionality.
Unfortunately, even successful lab-grown
cells often perform at just a fraction of the
levels of cells in a living human body. For
instance, researchers crafted a heart that
beat, but it didn’t beat with enough power
or synchronization to sustain a life. The
New York team feels any clinical application is still many years away and it will be
decades before we will have implantable
organs.
Stem cell research is taking place all over
the world. A new study in Lancet Respiratory Medicine also suggest a patient’s own
bone marrow stem cells might someday be
used to treat multi-drug-resistant tuber­
January/February 2014
culosis. The Pacific Heart, Lung & Blood
Institute in California is studying potentially groundbreaking stem cell mesothelioma
research that could dramatically change
the treatment of this disease. In India, The
EMBO Journal reports researchers reveal
that human lung cells can rejuvenate damaged cells. And in Japan, research is ongoing
to get human organs to grow inside pigs.
As a provider of regenerative medicine,
the Lung Institute, located in Tampa,
Florida, offers stem cell treatment for the
potential repair and regeneration of damaged lung tissue for those who suffer from
Chronic Obstructive Pulmonary Disease
(COPD), pulmonary fibrosis, cystic fibro­sis
and mesothelioma.
To find out more about the organization
and what they have to offer, you may call
1-855-469-5864 or visit their web site at
www.lunginstitute.com.
(The Pulmonary Paper is not affiliated with nor
endorses any medical company or facility.)
www.pulmonarypaper.org
19
[
Looking Back over the Last Fifty Years
The Surgeon General’s recent report, The Health Consequences of Smoking50 Years of Progress, confirmed smoking is responsible for killing almost half a
million Americans every year including 61% of all lung disease deaths more than
87% of those from lung cancer. The first was published on January 11, 1964.
S
ince 1959, the additional risk of lung
cancer among women smokers has increased nearly tenfold. More women than
men now die from COPD. For the first
time, the Surgeon General links smoking
to increased risk for both contracting and
dying from tuberculosis and suggests that
youth smoking may cause asthma.
The economic burden of tobacco in
the United States is staggering – as much
as $333 billion each year which includes
productivity losses and direct medical costs.
Unfortunately, a report from a coalition of
anti-smoking groups, says there are states
that spend about 200 times as much to
treat diseases related to smoking each year
as it spends on preventing smoking and
helping people quit. This is being blamed
on the aggressive strategies of the tobacco
industry to cause youth and young adults
to start smoking.
For every adult who dies prematurely
from a smoking-related cause, more than
two young people become replacement
smokers. If smoking continues at current
levels, 5.6 million American youths will die
prematurely from a smoking-related illness.
The American Lung Association is calling
for the White House to empower the FDA
to aggressively implement the Tobacco
Control Act to regulate all tobacco prod-
20
]
ucts, including e-cigarettes and cigars. They
should remove menthol cigarettes from the
marketplace completely as they have been
shown to be a greater health risk.
The U.S. would have several million fewer
smokers if graphic warning labels similar
to those introduced in Canada nearly a
decade ago were required on cigarette packs,
according to researchers. The Canadian
labels led to a 2.9 to 4.7 percent drop in
smoking rates – which would mean 5.3 to
8.6 million fewer smokers in the U.S. if the
same results were obtained. The findings
are published online in the journal Tobacco
Control. Graphic warning labels on cigarette
packages have been implemented in more
than 40 countries. There are currently about
www.pulmonarypaper.org
Volume 25, Number 1
18 percent of Americans who smoke; it is
hoped this rate will decrease to less than 10
percent within 10 years.
The tobacco industry challenged the
FDA’s requirement for graphic warning
labels, and a U.S. Court of Appeals ruled
that the federal agency lacked evidence that
graphic warning images would reduce the
number of Americans who smoke.
Congress should also significantly increase the federal tobacco tax and close
tobacco tax loopholes so that all tobacco
products are taxed at equivalent rates.
The cost of a pack of Marlboro cigarettes
in New York City (where you now have to
be 21 years old to purchase them and where
the mayor has included e-cigarettes in its
ban from public places) were approximately
$14.50 compared to the state of Kentucky
where the same brand would cost you $5.
Eric Lawson, an actor who played the
Marlboro Man in cigarette ads during the
1970s passed away of COPD – at least the
fifth Marlboro Man to pass away from such
circumstances.
January/February 2014
Every day, more than 3,200 of our young
people smoke their first cigarette. The CDC
is also concerned about other forms of
nicotine use. Electronic cigarettes, hookahs
and dissoluble tobacco were all more popular in 2012 than the year before, perhaps
because they are seen as “safer” than conventional cigarettes. High schoolers have
also taken up cigar smoking. The fact is
cigars and hookah tobacco are addictive
and deadly.
Hookahs are water
pipes that are used to
smoke specially-made
tobacco that comes in
different flavors, such
as apple, mint, cherry,
chocolate, coconut, lic­orice,
cappuccino and watermelon. Hookah
smok­ing is typically done in groups, with
the same mouthpiece passed from person
to person. Because of the way a hookah is
used, smokers may absorb more of the toxic
substances also found in cigarette smoke
than cigarette smokers do.
The U.S. Surgeon General has said one
in 13 children could see their lives shortened by smoking unless the nation takes
more aggressive action to end the tobacco
epidemic. The 2014 report added more
disease states to the list caused by smoking.
In addition to lung and heart disease, we
now know Type 2 diabetes, rheumatoid
arthri­­
tis, erectile dysfunction, macular
degeneration, birth defects as cleft palate
and cleft lip, and liver and colorectal cancer
are smoking related illnesses. We can’t wait
another 50 years!
www.pulmonarypaper.org
21
Lung Transplant News
P
romising news for those waiting for
a lung transplant! Dr. Thomas Egan,
from The University of North Carolina at
Chapel Hill, is using the fact that lungs live
on for an hour or more after a person passes away to boost lung transplants. The air
left inside the lungs keeps them from deteriorating right away as other organs do.
People who are registered organ donors
and pass away outside of a hospital, do not
get their wish of helping others fulfilled, as
we do not have a system to recover their
organs quickly enough. Only 2 to 3 percent of people die in circumstances that
lets them be organ donors.
If a person dies whose license shows
they are an organ donor, medical workers
can pump air into their lungs (within an
hour of death) and the lungs can be recovered and tested for transplant.
United Network
for Organ Sharing
(UNOS) is the private,
non-profit organization that manages the
nation’s organ transplant system. If you
visit their website at www.unos.org, you
will be able to see how many people are
currently on the waiting list for transplants
as well as a wealth of information and
support.
Want to live longer? Look better?
Breathe easier and improve your quality of life?
What are you waiting for?
Talk to your doctor about the Benefits of
Transtracheal Oxygen Therapy:







Improved mobility
Greater exercise capacity
Reduced shortness of breath
Improved self-image
Longer lasting portable
oxygen sources
Eliminates discomfort of the
nasal cannula
Improved survival compared to the
nasal cannula
Haven’t you suffered long enough?
For information call:
800-527-2667 or e-mail [email protected]
Ask your doctor about TTO2
22
www.pulmonarypaper.org
Volume 25, Number 1
For more effective treatment of your COPD,
Initiate An Open Conversation with Your Doctor
A
ccording to a study by the National Insti­
tutes of Health, patients
and their doctors need to have
open conversations to more effectively treat
COPD. Interestingly, current smokers are
82 percent more likely to talk with their
doctors about their symptoms than former
smokers.
The American Lung Association offers a
COPD Management Tool that will help you
talk to your physician about your current
state of health. You may access this on the
Internet by visiting www.lungusa.org and
putting COPD Management Tool in the top
left search box.
Dr. Oz Recommends These Tips:
1. Make a list of your concerns. If you get
interrupted – which is a likely – having
a list of the topics you want to discuss
will remind you to return to your most
important points.
2. Don’t spare the details. More than
80 percent of health problems can be
diagnosed by the information that you
provide to your doctor – so be specific.
If you have belly pain, for example, be
prepared to pinpoint whether it is piercing or throbbing, how severe it is on a
scale of 1 to 10, when it occurs and how
often, and what makes it better or
worse.
3. Ask the tough questions. If your doctor
suggests a new medication, why is it
better than the drug you are currently
January/February 2014
taking? If she advises that you get a
diagnostic procedure, are there any less
invasive alternatives?
4. Don’t tweak the truth. Some of the
most common white lies we hear: (falsely) swearing that you don’t smoke or
drink, that you are eating a healthy
diet, and that you are following doctor’s
instructions. Some researchers estimate
that as many as half of all patients
tell their doctor they are taking their
medication as prescribed, when in fact
they are not.
5. Insist on understanding. Less than 2
percent of doctors ask their patients
whether they understand what is being
discussed. Don’t be afraid to interrupt
and say, “I’m confused – can you
explain that in layman’s terms?” If it
helps to take notes or tape-record the
conversation, do so. One study showed
that after the visit was over, on average,
older patients forgot more than 75
percent of what their doctor had said.
www.pulmonarypaper.org
23
Intermittent Flow Devices
Many Variables Exist in Oxygen Delivery Systems
W
e are all familiar with continuous
flow oxygen – you set the dial to
a liter flow setting and oxygen is
perpetually delivered to the user at that set
flow rate. It’s a pretty basic concept, which
has helped continuous flow oxygen delivery
remain a “gold standard” in oxygen therapy.
Intermittent flow oxygen delivery systems
were introduced in the 1980s as a way to
maximize oxygen availability – by delivering
oxygen to the user during inhalation only.
Delivered oxygen was no longer wasted
during exhalation so storage tanks and portable devices were able to provide oxygen
for a longer period of time before the device
or tank needed refilling. Manufacturers
were also able to create smaller and lighter
products to help the user remain active and
ambulatory without needing to haul around
large concentrators or storage bottles.
However, with this introduction of inter­
mittent flow systems, new variables in the
delivery of oxygen were introduced that
impacted therapy outcomes. This article will
explore and explain some of these variables
to help you understand some of the impor­
tant characteristics of intermittent flow
oxygen delivery.
Intermittent flow oxygen delivery – often
referred to as “pulse flow”, “pulse dose”, or
some other variation containing the word
“pulse”– requires the oxygen system to be
able to sense the user’s inhalation, deliver a
volume of oxygen within the user’s inhalation phase, and turn off oxygen delivery so
that oxygen does not get delivered during
exhalation. Portable oxygen concentrators
(POCs), battery powered conservers and
liquid oxygen systems use electronic compo24
nents to achieve all three outcomes. Other
non-electric devices use control valves to
meter the oxygen delivered the inhalation.
Sensitivity Trigger to User’s Inhalation
One performance variable introduced
by intermittent flow systems was triggering
sensitivity, or the ability of the device to
sense the user’s inhalation and then respond
by turning on the flow of oxygen. The more
sensitive a device, the earlier that oxygen
can be delivered. If the device is too sensitive, the unit may “auto-trigger”, delivering
oxygen at an inappropriate time. If a device
is not sensitive enough, oxygen may not be
delivered at all!
Once the user has started inhaling, an adequately sensitive device will be able to trigger
oxygen delivery very quickly, ensuring that
the pulse of oxygen gets to the user while
they are still in the first part of their inhale
cycle. Shallow breathing, such as when the
user is sleeping, may result in the pulse of
oxygen being delivered late in the inhalation
phase, or not at all. This is one reason why
when considering sleeping with an intermittent flow device, it is recommended to have
an overnight oximetry study while on the
device before purchasing or using the device
long term.
Volume of Pulse Effects Oxygen Delivery
Another performance variable introduced
by intermittent flow systems were pulse
waveform characteristics – or the shape and
volume of the pulses. Each intermittent flow
system has a unique way of delivering its
volume of oxygen. For example, one system
set to “4” may deliver a pulse at a very high
flow rate, like 12 LPM, for a very short time,
www.pulmonarypaper.org
Volume 25, Number 1
like 200 milliseconds (ms). This results in a
pulse volume of 40 milliliters (mL). Another
system also set to “4” may deliver its pulse
volume at 5 LPM for 600 ms, totaling 50 mL
of oxygen delivered. So on two devices set to
the same numerical setting, we have oxygen
pulses delivered at different flow rates, for
different lengths, resulting in different pulse
volumes delivered.
Pulse volumes directly impact the user’s
inspired oxygen (FiO2), and SpO2 (oxygen
saturation). Some systems, when set to a specific setting, deliver the same pulse volume
regardless of how fast the user is breathing.
These are considered fixed-pulse devices.
Other systems, when set to a specific setting,
reduce the pulse volume delivered as the
user breathes faster. These are considered
minute-volume devices. There are a small
number of products even feature both types
of delivery methods!
Considering the number of intermittent
flow oxygen systems currently available,
and that each one has its own unique
pulse flow characteristics, the variability
in performance by these systems is huge. It
is no wonder some users of pulse systems
are able to use one device but not another.
Unfortunately this also leads to some people
discrediting pulse flow delivery altogether,
“Well, I tried Device X and it didn’t work,
so I must not be able to use pulse flow.” This
isn’t accurate at all, since it may just be that
that particular device isn’t able to meet the
user’s needs, whereas another system might
have the ability to oxygenate that user at all
of their activity levels.
The Timing is Important Too
One other performance variable introduced by intermittent flow systems is when
the pulse delivery is stopped by the device.
January/February 2014
When a pulse volume of oxygen is delivered, the timing of the pulse is important.
Delivering the pulse within the first part
of inhalation in imperative, as any oxygen
delivered in the later half may not reach the
user’s lungs. This is why oxygen pulses are
often delivered within 200–600 ms, though
some devices may have settings with delivery
times lasting much longer.
Electronic intermittent flow systems are
programmed to stop delivery after a certain
amount of time has passed. Most pneumatic
devices require the user to exhale against the
oxygen flow before turning off flow delivery.
In both cases, when flow delivery is stopped
is ultimately dependent on the product’s
design characteristics. At faster breath rates,
or in cases where the pulse is triggered later
in inhalation, flow may be stopped well
after the user had begun exhaling, meaning
that some or all of the delivered oxygen has
been wasted.
Learn the Pros and Cons of Systems
There are many pros and some cons to
intermittent flow delivery systems. At their
best, they allow the user to have a lightweight, long-lasting oxygen system at their
side, giving them freedom and mobility that
stationary concentrators and large tanks
cannot provide. At their worst, the user
is unable to stay oxygenated and ends up
with an expensive paperweight. Look for
another system that could meet your needs.
As always education is important, and in the
current oxygen environment where common
misconceptions still exist among many folks
working with oxygen equipment, you must
be your own advocate in learning about
what systems may be beneficial for you.
Ryan Diesem is Research Manager at Valley
Inspired Products, Apple Valley, MN. Contact
Ryan at [email protected] with questions.
www.pulmonarypaper.org
25
Get Yourself Back Out There. People Are Waiting to Meet You!
W
hen we are on a Sea Puffer cruise, the
respiratory therapists bring oxygen
equipment for travelers to see and try out.
One recently unnamed passenger was short
of breath while walking. She had told her
physician she would rather not use oxygen.
Her oxygen saturations showed she would
benefit. When given a portable oxygen concentrator to use, she exclaimed “Wow, I can
walk and breathe at the same time!”
Jim Nelson from Arizona (affectionately
known as Uncle Jim on the EFFORTS website) received a lung transplant and no longer
needs to use oxygen. He is still very involved
in helping others cope with living with lung
disease. One of the main complaints he hears
26
all the time is that people do not want to be
seen in public using their oxygen. He has
suggestions for them.
1) Plan a trip to a favorite restaurant, a
mall, a big-box store or to a theater. Set
a date for your excursion, and enlist a
caregiver, family member or friend to
go with you.
2) Be sure to plan ahead. Gather enough
oxygen to last the trip plus some. If
you are using a portable concentrator,
put a spare oxygen tank and regulator
in the car, just in case. Make sure that
you have your inhalers and any other
medication you need to take.
www.pulmonarypaper.org
Volume 25, Number 1
3) Find something nice to wear – something that you like, something that you
think makes you look good.
4) When the big day comes, face it with
anticipation. You are actually going to
go out and do something! You are going to act like a normal human person,
rather than a victim.
5) When you reach your destination, park
as close as you can to the entrance.
There is no use in wasting your energy
trudging across 40 acres of parking
lot. If you have a handicapped sticker
on your car, use it. If not, have your
companion drop you off at the door.
6) Walk into the store, restaurant or
theater like you own the place! Keep
your head up and walk proudly. If
someone catches your eye, SMILE at
them! Maintain an appearance of happiness, contentment. If nothing else,
it will make people wonder what you
have been up to!
7) Keep track of how many people stare
at you. Remember, these are the same
people who will stare at someone in a
wheelchair or who is wearing a cast.
That first time, you will be very sensitive to those stares. If you find that
a lot of people stare at you, or turn
away with looks of disgust, or say
really outlandish things like, “You are
obviously going to die soon, can I have
your coat?” Our little experiment will
then have failed. You probably should
consider going back home and going
back into hiding.
January/February 2014
8) On the other hand, if you find that the
stares are few and totally harmless, that
most people ignore you completely,
that a few people are actually nice to
you, then maybe, just maybe, you might
want to try it again!
9) If you choose to try this, and I pray that
you will, my hope is that you will get
over your reluctance to be seen with
your cannula, be able to relax and start
to live like real people, rather than like
a hermit!
10) Let me be the first to welcome you to
your new life!
I
nstead of dreading the
thought of people noticing you, why not go
the opposite way and embrace it! We know
many people who dress up their oxygen
tanks like animals for every holiday. Who
doesn’t want a little bling on their portable
oxygen concentrator? We have seen sparkles
of all colors, bumper stickers and pictures of
grandchildren.
Make it fun to go out!
A new product called Oxy
Couture can be seen at www.
oxycouture.org. This organization will make a wrap for your cannula
– maybe even in your favorite team colors or
logo! This can be a real conversation starter!
If you would still prefer people not notice
your oxygen, call 1-877-699-8439 or visit
www.oxyview.com to order your pair of
OxyView glasses!
www.pulmonarypaper.org
27
OH, THE PLACES YOU’LL GO! 28
EASTERN CARIBBEAN
MEDITERRANEAN
Spring Break on the Holland
America’s Westerdam! Leave
March 8–15, 2014 for the Eastern
Caribbean from Fort Lauderdale.
Cruise the Mediterranean on Royal
Caribbean’s Liberty of the Seas!
Leave from Barcelona, May 25–
June 1, 2014 for this exciting
seven-day vacation.
www.pulmonarypaper.org
Volume 25, Number 1
PLAN YOUR WORRY-FREE VACATION.
CALL TODAY!
Join the Sea Puffers on one of our
group cruises escorted by respiratory
therapists!
Call 1-866-673-3019 to also arrange
your own cruise or tour!
Visit www.seapuffers.com for more information!
AND THE PEOPLE YOU’LL MEET!
ALASKA
SOUTHERN CARIBBEAN
Experience Fall in style! Board
RCI’s Jewel of the Seas, roundtrip
from San Juan, Puerto Rico, sailing
Member
October 18–25, 2014.
FST–ST39068
Our annual trip to Alaska is on the
Grand Princess, sailing from Seattle
on July 20 through July 27, 2014.
January/February 2014
www.pulmonarypaper.org
29
Respiratory News
T
o keep up on the latest pulmonary
news, click on the link on the home
page of www.pulmonarypaper.org.
In patients with moderate-to-very-severe
respiratory impairment, regular treatment
to keep airways open with one or more
long-acting bronchodilators (as Foradil
or Serevent) or long-acting anticholinergic
agent (as Spiriva or Pressair) is recommended. A growing body of evidence shows that
taking both type of drugs is more effective
than either drug class alone in managing
stable COPD to improve lung function,
symptoms and health status.
The FDA has approved Glaxo Smith
Kline’s (GSK) umeclidinium bromide/
vilanterol (trade name Anoro Ellipta) as a
convenient dry powder combination anti­
cholinergic/long-acting beta2-adrenergic
agonist.
Last May, the FDA also
approved GSK’s fluticasone furoate/vilanterol dry
powder combo inhaler for
COPD sold as Breo Ellipta.
Researchers at the University of Alberta,
Edmonton, Canada, studied nearly 7,000
elderly patients with COPD for a period of
three years. They found those taking inhaled
corticosteroids (as Flovent, Pulmicort and
Qvar) for their condition on discharge from
hospitals were approximately 25 percent less
likely to die from any cause than those who
did not take them.
30
Researchers at the Veterans’ Administration Medical Center in Atlanta, GA, found
men with lung disease have a five-fold
increased risk of osteoporosis, a condition
where your bones become more fragile
and more likely to fracture. Calcium and
Vitamin D supplements are recommended
to help with this increased risk.
On the horizon, London scientists have
developed a new drug (RPL554) that could
treat COPD and asthma in two ways at
once, according to research published in The
Lancet Respiratory Medicine. RPL554 has
the potential to both reverse the narrowing
of the airways and reduce inflammation
quicker and with fewer side effects than
current therapies. Further studies are
planned.
The American College of Allergy, Asthma
& Immunology reports 26 million Americans have asthma, a number that is increasing every year. Asthma is responsible
for 4,000 deaths and an economic cost
of $20.7 billion annually. According to a
study presented at a recent medical meeting,
asthma visits can be reduced by 55 percent when inhalers contain a simple dose
counter. Dose counters on rescue inhalers
display the amount of medication remaining
in the device, but they are not standard for
all meter dose inhalers. Dose counters help
patients know if they are getting enough
medication and warn if the inhaler is nearing empty, both of which can help reduce
asthma attacks.
www.pulmonarypaper.org
Volume 25, Number 1
The
PulmonaryPaper
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The Pulmonary Paper is a 501 (c)(3) not-for-profit corporation and supported by individual contributions.
Your donation is tax deduct­ible to the extent allowed by law.
The
PulmonaryPaper
Dedicated to Respiratory Care
The Pulmonary Paper Staff
Editor . . . . Celeste Belyea, RN, RRT, AE-C, FAARC
Volume 25, No. 1
Associate Editor
Dominic Coppolo, RRT, AE-C, FAARC
January/February 2014
Design. . . . . . . . . . . . . . . . . . . . . Sabach Design
The Pulmonary Paper
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The Pulmonary Paper is a membership publication. It is published six times a year for those
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January/February 2014
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