Breathe Healthy Program

COPD & Asthma
©February 2010, Premier Home Care, Inc.
www.premierhomecareinc.com
Rev 10/14
To Our Patients:
This booklet is designed to educate, assist and support you with your Chronic Obstructive Lung
Disease (COPD) or Asthma. We are confident this booklet will become a useful tool in helping you
and your family cope with your illness and the lifestyle changes you will need to make. This booklet
does not replace the advice or care plan of your physician. You should always consult with your
physician before changing and/or altering any prescriptions.
Premier Home Care, Inc., values you as a customer. We provide an extensive line of medical equipment
and services to aid you and your family with your health related needs. All of our products and services
comply with the highest of home care standards.
Our professional staff includes nurses and licensed respiratory therapists and highly trained medical
equipment technicians. We add a personal touch by communicating with you on a regular basis and we
stay in contact with your physician to ensure that you continue to adhere to your therapeutic regimen.
Our motto is simple, we provide, “Your Solution to Healing at Home.”
Premier Home Care, Inc. thanks you for the opportunity to serve your health care needs and we look
forward to working with you for many years to come.
Wishing you the best of health,
Jeff. W. Knight, CEO
Premier Home Care, Inc.
LOCATIONS AND TOLL FREE NUMBERS
ELIZABETHTOWN
1-877-313-9738
LOUISVILLE
1-888-238-8794
SCOTTSBURG
1-888-338-4601
LEXINGTON
1-888-653-2331
RICHMOND
1-888-488-0202
PIKEVILLE
1-877-274-5770
LONDON
1-800-507-1077
DISEASE MANAGEMENT CENTER
1-866-696-9902
Emergency Toll Free Number
1-888-238-8794
Table of Contents
Introduction........................................................................................................................................1
Frequently Asked Questions About COPD..................................................................................2-3
Asthma Basics..................................................................................................................................4-5
Test to Evaluate your Lungs...........................................................................................................6-8
Exercise and Good Nutrition.........................................................................................................9-10
Breathing Exercises for the COPD Patient................................................................................11-12
Tips for the Family / Caregivers of COPD Patients..................................................................13-14
Frequently Asked Question About Oxygen Therapy................................................................15-17
How to Use Your Concentrator........................................................................................................18
How to Use Your Portable Oxygen System................................................................................19-20
Going on Vacation?......................................................................................................................21-23
Supporting Websites …....................................................................................................................24
Common Patient Concerns............................................................................................................. 25
Common Equipment Problems.......................................................................................................26
Glossary of terms.........................................................................................................................27-28
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
Introduction
16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare covered item.
17. A supplier must disclose to the government any person having owndership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number, i. e. the supplier may not sell or allow another entity to use
its Medicare billing number.
Welcome to Premier Home Care, Inc, we look forward to sharing this time with you. After reading this
booklet if you have any questions, we offer a free consultation with one of our clinicians. Our
clinicians can answer any additional questions you may have about Chronic Obstructive Pulmonary
Disease (COPD) or Asthma and the therapy needed to treat it. Just give us a call. We'll be
happy to speak with you.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these
standards. A record of these complaints must be maintained at the physical facility.
If you are reading this booklet, you may have recently been diagnosed with Chronic Obstructive
Pulmonary Disease (COPD) or Asthma or perhaps a family member or someone you know has
Chronic Obstructive Pulmonary Disease (COPD) or Asthma. Then again, maybe you just want to
gain some information about a health condition that affects over 12 million Americans according to the
National Institutes of Health. Whatever your reason for reading this booklet, when you finish you
should have a better understanding of Chronic Obstructive Lung Disease (COPD) or Asthma and
what can be done to treat it.
22. All suppliers must be accredited by a SMS-approved accreditation organization in order to receive and retain a supplier
billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in
order for the supplier to receive payment for those specific products and services (except for certain exempt pharmaceuticals).
Implementation Date – October 1, 2009.
20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions take to resolve it.
21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
23. All suppliers must notify their accreditation organization when a new DMEPOS location is operned.
24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.
25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for
which they are seeking accreditation.
26. All suppliers must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). Implementation date - May 4, 2009
27. A supplier must obtain oxygen from a state-licensed oxygen supplier.
Call us toll free at 1 (888) 238-8794
28. A supplier must maintainn ordering and referring documentation consistent with provisions found in
42 C.F.R. 424.516(f).
29. DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers.
30. DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions.
9/9/2010
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Palmetto GBA
National Supplier Clearinghouse
P.O. Box 100142 * Columbia, South Carolina * 29202-3142 * (866) 238-9652
A CMS CONTRACTED INTERMEDIARY and CARRIER
30
MEDICARE DMEPOS SUPPLIER STANDARDS
DMEPOS suppliers have the option to disclose the following statement to satisfy the
requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the
beneficiary. The products and/or services provided to you by Premier Home Care, Inc. are
subject to the supplier standards contained in the Federal regulations shown at
42 Code of Federal Regulations
Section 424.57(c). These standards concern business professional and operational matters
(e.g. honoring warranties and hours of operation). The full text of thesestandards can
be obtained at
http://ecfr.gpoaccess.gov
Upon request we will furnish you a written copy of the standards.
Frequently Asked Questions About COPD
What do the letters COPD stand for and what do they mean?
• COPD stands for Chronic Obstructive Pulmonary Disease
Chronic refers to an issue that will not go away
Obstructive means partial blockage
Pulmonary referring to the lungs
Disease refers to an identified type of illness
COPD is an umbrella term for Asthma, Chronic Bronchitis and Emphysema, as well as
several other pulmonary diseases, which can cause difficulty in breathing.
What causes COPD?
The most common cause is cigarette smoking, however, other factors can cause
COPD as well. These factors include air pollution, second-hand smoke, history
of childhood respiratory infections, asthma, and heredity.
How will my COPD be treated and will treatment really help me?
Your physician will decide the best course of treatment for your condition. It may include
antibiotics for infections, systemic or inhaled steroids to control inflammation
and irritation to your airways, and bronchodilator drugs to help keep your airways
open. Your physician may also order supplemental oxygen therapy. You may be
encouraged to get regular influenza and pneumonia vaccinations and encouraged
to enroll in a pulmonary rehabilitation program to help increase your disease awareness and
physical stamina.
If you follow the program prescribed by your physician, you may greatly increase
your chances of maintaining a higher quality of life while dealing with your
diagnosis of COPD
Probable
Cause Solution
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2
What can I do to help myself?
The number one thing that a person with COPD who smokes can do is to STOP SMOKING.
Quitting smoking is the best way to slow down the progression of the disease. Also, if your physician
outlines an exercise program for you, do it. Becoming more active is one of the best ways to improve
your overall health.
When should I call my physician or EMS (911)?
You should call your physician immediately if you…
• Have shortness of breath and/or wheezing
that is rapidly getting worse
Oxygen Conserver-Regulator- A device that is attached to an oxygen tank to help control the flow of
oxygen out of the tank. A conserver will only deliver oxygen during the inspiratory portion of your
breathing, thus saving oxygen and allowing you more portability.
Peak flow- Measures how fast a person can exhale air. It is one of many lung function tests that
measure how well the lungs are working.
Pulmonary Function testing- A group of tests that measure how well the lungs take in and release air.
This type of testing is done to diagnose lung disease, find the cause of shortness of breath and to
determine the degree of lung impairment from disease and environmental contaminants that may be
work related.
Pulmonary Rehabilitation- An extensive program that helps improve the well-being of people who
have chronic breathing problems.
• Cough more deeply or more frequently.
Especially if you notice an increase in
mucus (sputum) or a change in color of
the mucus.
Pulse oximetery- A non-invasive measurement that uses infra-red light to determine the amount of
oxygen saturation in the blood. Commonly performed by placing a probe on the finger for a brief
period of time for a sample reading.
• Cough up blood.
Pursed-lip breathing- A breathing technique that helps to control shortness of breath by keeping the
airways open longer during the exhalation phase of breathing.
• Have increased swelling in your legs or
abdomen.
Vital Capacity- The maximum amount of air that can be inhaled or exhaled from the lungs in a single
breath. One of the measurements taken during a pulmonary function test.
• Have a high fever (over 100 °F).
• Develop flu-like symptoms.
• Notice that your medications are not working as well as they have been.
What other type of things can I do to keep my condition from getting worse?
You should avoid conditions that may irritate your lungs such as indoor or outdoor
air pollution, second-had smoke, smog, extreme weather conditions or high altitudes.
You should also take regular rest breaks while doing household chores and learn simple
breathing techniques to improve airflow in and out of your lungs (see section on breathing
exercises).
Good nutrition is very important in order to maintain your strength and health.
Problems with muscle weakness and weight loss are common in people with COPD. You should join
a Better Breathers support group that keeps you aware of any new developments in therapy
and drug treatments for COPD. Keep your appointments with your doctor and maintain a journal of
your daily activities to share with him/her.
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Glossary of Terms
Asthma- is a chronic disease that affects the airways. Asthma makes your lungs more sensitive to
irritants and allergens that will cause inflammation and tightening of the airways. This can result in
wheezing, tightness in your chest, coughing and shortness of breath. Asthma is treated with two (2)
kinds of medicines: quick relief (bronchodilators) and long-term control medicines (corticosteroids).
Bronchodilator- is a medicine that treats the airways by relaxing the smooth muscle around the
bronchial tubes allowing air to move easily in and out of the lungs. This type of drug is used to treat
both Asthma and COPD.
COPD- Chronic Obstructive Pulmonary Disease is a progressive lung disease that makes it hard to
breathe. The most common cause of COPD is cigarette smoking. Also known as Chronic Obstructive
Airway Disease (COAD) and Chronic Obstructive Lung Disease (COLD).
Corticosteroids - Are man-made drugs that resemble the hormone cortisol that is naturally produced in
your body. The purpose of corticosteroids is to reduce inflammation and the activity of the immune
system. Corticosteroids should not be confused with muscle building steroids that are called androgenic
or anabolic steroids.
Diaphragmatic Breathing- The act of breathing deep by the use of your diaphragm rather than your
chest wall muscles. It is also known as abdominal breathing or belly breathing. See specific
instructions on page 12.
Forced Vital Capacity (FVC)-The amount of air that can be forcefully exhaled from your lungs after
taking a single maximum deep breath. Used as a test of the movement of air out of your airways
during pulmonary function testing.
Forced Exhaled Volume at 1 second (FEV1)- The volume of air exhaled during the first second of a
forced exhalation maneuver. A value derived from the forced vital capacity in pulmonary function
testing used to evaluate the degree of impairment in COPD and obstructive lung diseases.
Forced Exhaled Volume at 1 second per Forced Vital Capacity ratio (FEV1 / FVC)- The ratio of air
exhaled during the first second to the total forced vital capacity maneuver obtained during pulmonary
function testing.. A value used to evaluate the degree of impairment in COPD and obstructive lung
diseases.
Inhaler- Also known as a metered dose inhaler is a medical device used for delivering medication to
the lungs. Medication is stored in a compressed canister that when actuated will deliver a “puff” of
medication to be inhaled.
Nebulizers- A device used to deliver medication in a mist form that is inhaled to treat disorders of the
airways.
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Asthma Basics
The Basics
According to a 2009 report by the
Center for Disease Control and
Prevention, over 16 million adults in
the United States have Asthma. Of
those diagnosed, 10.6 million
will end up visiting their local doctor or
emergency room for treatment. Asthma
patients should become educated about their
symptomatic triggers and work with their
physician in developing an Asthma
Management Plan.
In patients over age 40, it is not always
easy to differentiate between asthma and
COPD.
Inadequate treatment of airway inflammation can lead to irreversible bronchial structure changes.
Many lung disorders have both a reversible and an irreversible component. There are many
medications to manage airway inflammation and obstruction to prevent the reversible components
of lung diseases such as asthma from leading to irreversible structural changes. Despite the best of
care and medication, in severe cases of asthma, irreversible changes in the respiratory tract are not
always preventable.
Asthma Tips
• The diaphragm cannot work as well when the stomach is full. This may cause additional
shortness of breath. Eating smaller meals will help reduce this symptom. Acid reflux.
may be reduced as well.
• Double or triple your favorite recipes to keep your freezer full for times when you
do not feel like cooking.
• Do the tasks that require the most effort when you have the most energy.
• Don’t stand when you can sit.
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Asthma Medicine
Common Equipment Problems
Small volume nebulizers are devices
that hold liquid medicine. The medicine is
turned into a fine mist by a small air
compressor and inhaled into the
airways and lungs where the medicine will
quickly go to work.
Alarms
Bronchodilators are used to help relax the
muscles in the airways and ease shortness
of breath and wheezing.
Probably cause
Concentrator
not operating.
Power on. Short
beeps – long
pause.
Power cord not
plugged in. No
power to outlet.
Circuit breaker
tripped. Internal
breaker tripped.
Use oxygen from your back-up
tank until problem is resolved. ·
Insert plug into outlet.
· Use a different outlet.
· Reset breaker by pushing reset
button on concentrator.
Continuous
alarm
System failure.
Unit overheating
due to blocked air
intake.
Use oxygen from your back-up
tank until problem is resolved.
· Remove and clean cabinet
filters.
· Move oxygen concentrator at
least three inches away from
walls, draperies or furniture.
· Internal repairs needed.
Low-flow alarm
Kinked or
blocked tubing or
cannula
Use oxygen from your back-up
tank until problem is resolved. ·
Inspect for kinked, blocked, or
twisted tubing, as well as
furniture or concentrator
wheels on top of tubing.
· Correct, clean, or replace item.
Once corrected, turn the
concentrator off for 60 seconds
and then turn back on.
Rapid alarm
Flow meter set at
less than ½ LPM
· Make sure that flow meter is set
at one LPM or more.
Corticosteroids are very effective and potent anti-asthma
drugs. They help the immune system and inflammation.
Inhalers are small hand held devices that allow medications to be delivered directly to the lungs.
Oxygen Therapy is used to treat moderate, severe and extreme cases of asthma. Asthmatics using
oxygen therapy experience better sleep, increased alertness and more stamina. In emergency situations,
when oxygen levels can become abnormally low, the patient can use supplemental oxygen to
provide additional oxygen to vital organs.
Always take Medicine as prescribed, even if you are feeling better or have no noticeable symptoms.
You should always take your prescribed maintenance medicine.
Small Volume Nebulizer Maintenance
Solution
How to Clean the Medicine Cup
• Rinse after every use.
• Wash at the end of the day with warm soapy water. Rinse under running water and allow to
air dry
• Weekly: Soak in 3 part water and 1 part white distilled vinegar for 20 minutes to
disinfect. Rinse the medicine cup in clear water thoroughly and allow to air
dry on a clean towel.
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If problems persist please call Premier Home Care, Inc.
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Know Your Zones!
Peak Flow Meter
Common Patient Concerns
A peak flow meter is a hand-held device that is used to measure how well air flows out of your lungs.
Measuring your peak flow using this meter is an important part of managing your asthma symptoms.
PATIENT CONCERN
POSSIBLE CAUSE
POSSIBLE SOLUTION
Patient feels
that no oxygen
is coming from
nasal cannula
Loose
connection,
kink, or twist
in tubing,
concentrator, or
furniture on top
of tubing
· Recheck all connections.
Follow tubing from nasal
cannula to concentrator.
· Check for kinks or twists.
· Make sure that the concentrator
wheels or articles of furniture
are not sitting on top of the
tubing.
Patient not
responding to
oxygen therapy
Patient may need
medical attention
· Put nose piece in glass of
water. Bubbles prove oxygen is
making it to patient.
Nasal dryness/
burning
Lack of moisture
· Use a non-petroleum based
product such as KY Jelly. Do
not use Vaseline.
Oxygen from
tubing too warm
Filter is dirty
· Wash filters on outside of
panels of concentrator.
· Lower the room temperature.
Water in tubing
Condensation
from temperature
change
Cannula smells
Ear soreness
The peak flow meter works by measuring how fast air leaves the lungs when you exhale forcefully
after inhaling fully. Keeping track of your peak flow measurements is one way you can know if your
symptoms of asthma are in control or worsening.
Zones
•
Cannula is
adjusted too tight
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Red
Symptoms None
Small
Flare Up
Full
Attack
Peak Flow > 80% of
Personal
Best
> 50% to
80%
< 50% of
Personal
Best
Action
Add quick
relief
Meds
Call
Family Dr.
Now or
911
Continue
Daily
Meds
Your “personal best” is defined by your physician
•
· Disconnect cannula. Turn
up liter flow to highest
setting and allow water to be
blown out tubing.
· Return flow to doctor’s
prescription and elevate
tubing.
•
•
•
You are not experiencing
any breathing problems.
You do not have any
early warning signs or
asthmas symptoms
Continue to take your
medicine as prescribed
by your doctor
If prescribed, take you
inhaler before exercise.
Yellow Zone
•
•
•
•
•
•
· Loosen adjustable cannula
fitting beneath the chin.
If problems persist please call Premier Home Care, Inc.
Yellow
Green Zone
· Let cannula air out before
using.
· Open up new cannula a day or
two before using.
· Change out cannula.
New cannula
Green
•
You may be
experiencing itching in
your throat or chin
You may have a cough,
stuffy nose or sneezing
You may feel restless or
have dark circles under
your eyes
Use your rescue
medicine
Recheck your peak flow
in 20 – 30 minutes
Contact your doctor is
your peak flow does not
return to the Green Zone
or your peak flow drops
into the Yellow Zone
again in less than 4
hours.
Red Zone
•
•
•
•
•
•
•
Your chest may feel tight
or hurt
You may feel very short
of breath
You may be breathing
faster than normal
You may find it difficult
to speak
Use your rescue inhaler
or nebulizer now
Contact your physician
If you notice any
“blueness to your nail
beds or around your
mouth, call 911
If you don't own a peak flow meter, Premier Home Care, Inc. can provide you with a quality
peak flow meter once we receive a prescription from your physician.
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Test To Evaluate Your Lungs
PULSE OXIMETRY
From time to time your doctor may want to check the
level of oxygen saturation in your blood. This test is
simple and painless. A small probe with an infrared
light is placed on the end of your finger over the nail
bed. The sensor will painlessly measure the average
amount of oxygen attached to your red blood cells as
well as your heart rate. With each pulse of your heart beat
the sensor will determine an average amount of oxygen.
The device then records this average amount.
This test may be done to see if you meet the required guidelines for supplemental oxygen use on a
continuous basis or just during sleep. The physician may also request the test to determine your
response to oxygen once you begin using it. Knowing the level of oxygen in your blood helps your
doctor know if oxygen is right for you.
Supporting Websites
American Lung Association
Working to save lives through lung health
www.lungusa.org
National Heart, Lung, & Blood Institute
Global Leader in education of and prevention of diseases.
www.nhlbi.nih.gov
Global Leader for COPD Initiative
Raising awareness with health care professionals to improve prevention and treatment
www.goldcopd.org
SEAPUFFERS
Travel Cruises for Oxygen Patients
www.seapuffers.com
PULMONARY FUNCTION TEST (PFT)
Understanding the need for pulmonary
function testing can often be confusing
for patients with lung disease. Knowing
your lung values in COPD is as important
as knowing your cholesterol and blood
pressure values .
The Pulmonary Function test will help to
determine your lung function and the degree
of damage, if any to your airways. COPD
creates a chronic lung condition in which
the airways may become narrowed by
inflammation or mucus and the ability to
exhale air from your lungs becomes increasingly difficult. The basic Pulmonary Function Test is
referred to as “Spirometry”. This type of test is often the first test requested by a physician to
determine a patients lung status when difficulty breathing is present. This test is a simple painless test
that is administered by a trained, licensed clinician. It involves having the patient inhale as deeply as
possible and then exhale quickly into a mouthpiece attached to a recording device.
Airline Oxygen Council of America
Airline policies for in flight portable concentrators
www.airlineoxygencouncil.org
National Home Oxygen Patient Association
Volunteers helping to improve oxygen patient lives
www.homeoxygen.org
American Association for Respiratory Care
Promoting good lung health and rights for health care workers
www.aarc.org
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Basic Pulmonary Function Testing Terminology
Traveling by Bus
Since the policies vary by bus line, we suggest that you check with the bus operator
well in advance of your trip. Buses should be all nonsmoking by now, so if portable
oxygen is allowed, there should be no problem.
Traveling by Rail
Similarly, there are no set policies for traveling with oxygen by rail. Contact the
railroad well in advance and notify them of your oxygen needs. Check their policy
on the type of equipment you can bring on board. You will need to sit in the nonsmoking
section.
These Basic Values are Used in Evaluating COPD
Forced Vital Capacity (FVC) The amount of air that can be forcefully exhaled after the deepest
inhalation you can possibly perform. This test is measured in time increments.
Forced Expiratory Volume in 1 second (FEV1) The amount of air that can be forcefully exhaled after
a deep inhalation during the first one second of the exhaled breath.
Forced Expiratory Volume in one second / Forced Vital Capacity (FEV1/ FVC %)
The amount of exhaled air in one second seen as a percentage of the total exhaled volume after a deep
inhalation.
Vital Capacity (VC) The amount of air that can be exhaled forcefully after a deep breath without time
limitations.
Traveling By Sea
Check with the cruise line for their supplemental oxygen policy. Some ships may
be able to provide supplemental oxygen. Otherwise, you will need to bring enough
oxygen to last throughout the trip or arrange for refills at ports of call. Some companies
such as www.seapuffers.com, www.medicaltravel.org or www.cruiseholidays.com
organize cruises specially for people with COPD.
If you are taking your equipment with you or you will need help making
arrangements, please notify us at least one month in advance.
Global Initiative for Obstructive Lung Disease (GOLD)
The current standard for determining lung disease
GOLD Spirometric Criteria for COPD Severity
I. Mild COPD
* FEV1 /FVC < 70%
* FEV1 > 80% predicted
At this stage, the patient is
probably unaware that lung
function is starting to decline.
II. Moderate COPD
* FEV1 /FVC < 70%
* FEV1 < 80% predicted
Symptoms during this stage
progress with shortness of breath
developing upon exertion
III. Severe COPD
* FEV1 /FVC < 70%
* FEV1 < 50% predicted
Shortness of breath becomes
worse at this stage and COPD
flare ups are common.
IV. Very Severe COPD
* FEV1 /FVC < 70%
* FEV1 < 30% predicted
or
FEV1 < 50% predicted with
chronic respiratory failure.
Quality of life at this stage is
gravely impaired. COPD flare
ups can be life threatening.
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8
Exercise and Good Nutrition
When Traveling By Land
Exercise
COPD & Asthma make the lungs
and heart work harder to carry
oxygen to all parts of the body.
Because of this, you should control
your weight to reduce heart and
lung strain. Work with your
doctor to develop a program
of exercise that is right for you.
There are special exercises to
strengthen your chest muscles
and improve your breathing.
Aerobic exercise, such as walking
and riding a bike, are very
important for increasing your
stamina and improving your ability
to do daily activities. Strength
training for the upper body can
also produce added benefits.
There are fewer restrictions
when traveling by land,
however, you should always
speak with your doctor and
oxygen company. Let your
physician know if you will
be traveling to a region that
has different altitudes, as
it could alter your current
oxygen prescription. Notify
your oxygen company to
discuss options and make
any needed arrangements in
advance.
Have a copy of your oxygen
prescription with you at all times.
Traveling by Car
Pulmonary Rehabilitation
Pulmonary rehabilitation is a structured program that can help reduce the effects of COPD. This
organized program is usually offered in hospitals and rehabilitation centers. A team of medical
professionals, including physicians, nurses, respiratory therapists, occupational therapists,
physical therapists, mental health professionals, pharmacists, and nutritionists, will
work together to provide a program suited to your individual needs.
When traveling in a car you have the freedom to use a portable concentrator device
or your own portable tanks. Your oxygen company can help arrange oxygen refills
and find local oxygen companies for you as you travel. Be sure to travel with your
oxygen safely, making sure your tanks or device is secure and stored away from heat or
flame.
Traveling by RV
You may want to use your concentrator in your RV, trailer, or conversion van if you
have an auxiliary generator. In other vehicles, you may be able to run your concentrator
from a generator or through an inverter. If you do use your concentrator on
the road, here are some words of advice:
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9
• Secure your concentrator so it will not slide around while traveling.
• Always have a back-up oxygen cylinder close at hand.
• Turn off your engine or generator while refueling.
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Going On Vacation?
Pulmonary rehabilitation offers…
If you are taking your equipment with you or you will need help making arrangements,
please notify us one month in advance
When Traveling by Air
Traveling on an airplane with oxygen can be a very complicated, frustrating, and expensive
endeavor. Many airlines do not offer in-flight supplemental oxygen. As of May 13, 2009,
the Federal Aviation Administration (FAA) has mandated that patients be allowed to use
Portable Oxygen Concentrators in flight. Airlines DO NOT supply oxygen while you are
waiting in the airport.
If you are planning to make a trip involving air travel and you need supplemental
oxygen, we suggest that you plan well ahead.
Airlines will probably charge you for in-flight oxygen. Charges vary from airline to
airline. Any airline that offers in-flight supplemental oxygen will require a physician’s
statement of oxygen need and liter flow per minute. Contact your selected
airline at least one month in advance and ask them the following questions:
• Do you accept passengers who need supplemental oxygen?
• What do you charge for supplying oxygen during the flight?
• Do you provide a mask or cannula or should I provide my own?
• What equipment will be available on my flight?
• What is its liter flow capability?
• What do you require as far as proof of need for oxygen?
• Do you allow the use of portable oxygen concentrators in flight?
• How do I get my medical equipment through security?
Premier Home Care, Inc. has an oxygen travel program. If you are interested in
the use of an airline approved portable oxygen concentrator for travel, please
contact us at our toll free number for further details.
1 (888) 238 - 8794
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• Structured and monitored exercise training.
• Nutritional advice.
• Techniques for reducing and controlling breathing problems.
• Education on maintaining and improving heart and lung function.
• Help to quit smoking.
• Information about your disease and coping strategies.
• Emotional support.
Nutrition
Maintaining your health is impossible
without eating the right foods. Speak
with your physician or nutritionist if
you need help in planning and preparing
a healthy diet. Some people with COPD
have trouble keeping weight on. If this
is a problem for you, discuss nutritional
supplements with your physician or
nutritionist. Maintaining a healthy weight
is critical for functioning well with
COPD.
Many people with COPD find it
helpful to…
• Eat several small meals throughout the day instead of three large ones. Your stomach is
located directly under your lungs and eating a large meal can push against your diaphragm
making it harder to breathe.
• Avoid eating gas-producing foods such as apples, broccoli, brussel sprouts,
cabbage, corn, cucumbers, and carbonated beverages.
• Drink water to help keep your secretions thin and more free flowing.
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Breathing Exercises for the COPD & COPD & Asthma Patient
Breathing Better
Your physician can prescribe
medications and oxygen to
help control your COPD &
Asthma. You can also do
many things to help yourself
feel better. Using two simple
breathing techniques—
pursed-lip breathing and
diaphragmatic breathing—
can help you get more oxygen
into your lungs and help
relieve shortness of breath.
Pursed-Lip Breathing
Pursed-lip breathing helps
you exhale more completely
so that you can take in more
oxygen-enriched air when
you inhale. Use pursed-lip
breathing to control your
breathing any time you start
to feel short of breath.
Use it to prevent shortness of breath when you do things like exercising, climbing stairs, bending or
lifting. Practice these steps every day so you will know how to do them if shortness of breath occurs.
• Relax your neck and shoulder muscles. Inhale slowly through your nose for two
counts.
• Pucker your lips as if you were going to blow out a candle. Exhale slowly and
gently through your lips for four - five counts.
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Use the chart below to determine how long a full oxygen cylinder will last. Simply find
your prescribed liter flow and note the hours of oxygen in a full cylinder.
Note: The above times are estimates. Your breathing pattern and activity level will
cause variations to these times.
Estimated Usage Time Versus Flow Rate is Shown in Hours
Flow Rate
(LPM)
M-6
Cylinder
D
Cylinder
E
Cylinder
-
CF
CD
CF
CD
CF
CD
0.05
5.5
16.5
9.5
28.5
16
48
0.75
3.6
10.8
6.5
19.5
11
33
1
2.5
7.5
5
15
8
24
2
1.4
4.2
2
6
4
12
3
0.9
2.7
1.2
3.6
2.5
7.5
4
not recommended
not recommended
2
6
5
not recommended
not recommended
1.5
4.5
6
not recommended
not recommended
1
3
LPM=Liter Per Minute
CF=Continuous Flow
CD=Conserving Device (Pulse Dose)
Note: The above times are estimates. Your breathing pattern and activity level will
cause variations to these times.
Call two working days in advance for delivery of tank refills or go to your local Premier
office to drop off empty and pick up full oxygen tanks.
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How to Use Your Portable Oxygen System
Call two working days in advance for delivery of tank refills or go to your local Premier office
to drop off empty and pick up full oxygen tanks.
You will need the following equipment to prepare your portable for use:
• Oxygen Cylinder
• Regulator/Conserver
• Cylinder Wrench
• Nasal Cannula
• Transport Cart
or Pouch
1. Carefully remove the seal from the cylinder neck. There is a small washer attached
to the seal. You will need to use this washer if your regulator does not have a permanent
one already attached.
2. Notice that their are two holes located on only one side of the oxygen cylinder neck
(valve stem).
3. Place the regulator over the top of the cylinder. Align the two prongs on the regulator
with the two holes on the cylinder neck. If your regulator doesn’t have a permanent
washer, use the plastic washer provided and place it above the two prongs on
your regulator, there will be a protruding knob to help direct you.
4. Use your cylinder wrench as a lever, to tighten the handle on the regulator until it is
firmly attached.
5. Attach your cylinder wrench to the top of the cylinder. Turn the wrench slowly
counterclockwise to open the cylinder. You should see the needle on the pressure
gauge read “full” or “2000 psi – 2200 psi” at this point.
6. Adjust the flow rate by turning the flow knob clockwise until you reach your prescribed
flow rate.
7. Attach your oxygen delivery device (cannula or mask) to the flow outlet of the oxygen
regulator.
Things to Remember:
• Always exhale for a longer period of time than you inhale. This allows your lungs
to empty as much as possible.
• Exhale during the difficult part of any activity, such as when you bend, lift, or reach.
Never hold your breath.
Diaphragmatic Breathing
Diaphragmatic breathing helps prevent shortness of breath by increasing movement of
the diaphragm. Normally, the diaphragm does most of the work in breathing. When you
have COPD, your lungs may become enlarged and prevent the diaphragm from doing its job..
Relaxing your abdominal muscles as you breathe in gives your diaphragm more
space to move downward and allows more air to enter your lungs. Tightening your
abdominal muscles as you exhale will help force more air out. This can be combined with
pursed-lip breathing for a effective technique to improve your lung endurance.
• Sit upright or at a slight reclining angle that is comfortable for you. You may also lie
down in a comfortable position with your head supported and your knees bent. Relax your
neck and shoulder muscles.
• Place one hand over the center of your abdomen at the base of your breast bone and the
other on the upper chest. Exhale first through pursed lips. Next, inhale slowly through
your nose to the count of two. As you inhale you should focus on relaxing your abdominal
muscles and allowing the abdomen to move your hands outward. Your upper chest should stay
still.
•Tighten your stomach muscles and exhale through pursed lips to the count of four or five.
You should feel your stomach muscles move in as you exhale. Concentrate on making each
breath slow and deep.
Use suitable assistive devices to simplify work activities. For example, use non stick
cooking utensils to minimize the effort needed to clean them. Use electrical blender and
micro-wave oven to shorten the time of food preparation. Use a light weight vacuum cleaner
or long-handled mopping/cleaning device to avoid the need to bend down.
8. To turn your oxygen off, attach your cylinder wrench to the top of the cylinder and
turn it clockwise. Always turn your tanks completely off when not in use.
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Tips for the Family/Caregivers of
COPD & Asthma Patients
How to Use Your Oxygen Concentrator
• Plug your concentrator into a properly
grounded electrical outlet.
Remember
• Turn on your concentrator. Expect to hear
an alarm for approximately the first 5 - 10
seconds. If you hear this alarm at any
other time, your concentrator may be
malfunctioning. Refer to your owners
manual or the “Common Patient Concerns”
section of this booklet on page 25 for more
trouble shooting details.
• Be careful about using cologne or
perfume around a COPD or Asthma
patient.
• Strong scented household cleaners,
disinfectants, and air fresheners can
cause serious breathing problems
for COPD & Asthma patients.
• Adjust the flow meter to your prescribed
flow ate. Do
r not use a higher flow rate than
prescribed by your physician.
• COPD & Asthma patients should
remain in a smoke-free environment.
Please don’t allow anyone to smoke
around them.
• Air conditioning and low humidity
conditions are ideal in the summertime,
if at all possible, for COPD
& Asthma patients.
• Connect your nasal cannula with extension
tubing to the machine. You are now ready
to use your oxygen concentrator.
Oxygen Concentrator Safety
• Keep your oxygen concentrator in a cool, dry place.
• Always keep your oxygen concentrator upright.
• Do not place anything on your oxygen concentrator, especially liquids.
• Keep your oxygen concentrator away from curtains which may block air intake.
• Keep your oxygen concentrator away from closed areas to allow for adequate ventilation
(i.e., closets, cabinets).
• Do not run the power cord under carpeting or rugs.
If you want to experience what the breathing of a COPD patient feels like, try breathing
through a straw while closing off your nose with one hand. You will notice after
a few breaths that it is becoming more and more difficult to get all the air out of
your lungs before it is time to take another breath.
COPD PATIENTS DEAL WITH THIS FEELING ALL THE TIME.
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Maintenance
• Once a week remove the air intake filters from the oxygen concentrator.
• Wash the filters with mild soap and warm water to remove dust, etc.
• Squeeze the remaining water out of the filter, shake dry, and replace filter.
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Can I use electrical appliances while using oxygen?
Yes, but make sure the electrical appliances that get hot during operations are kept at
least five feet away from the oxygen system. You should never let your oxygen and
oxygen tubing get within five feet of an open flame (e.g., fireplace, cigarettes, stove,
and candles).
In times of slight distress or trouble
• DON'T PANIC.
• Keep the patient in a sitting or an upright reclining position.
Can I drive or travel while using oxygen?
Yes. When driving, secure the oxygen unit so it will not tip over. Leave a window
open slightly for ventilation so the oxygen will not accumulate in the car. You
may also travel on public transportation while using oxygen. Be sure to make reservations
early, alerting the reservations people of any special needs you may
have. This will give them time to accommodate you. We can help arrange to have
oxygen en route and at your destination. (Please see the section on Going on Vacation
Pgs. 21 - 22.)
• Keep the lighting low.
• Keep noise to a minimum.
• Don't ask them to speak any more than is absolutely necessary. Let them use
their energy to breathe.
• Keep the room temperature cool.
• Be prepared to give the patient a nebulizer treatment.
What can I do while using
oxygen?
• Make sure their oxygen cannula is properly placed and that the liter flow is
correct.
You can do anything that
you would normally do,
except for those things that
would bring you within
five feet of an open flame,
a burning cigarette, or an
electrical appliance that
sparks. Actually, you may
find that you will be able
to increase some of your
daily activities as a result
of using your oxygen.
therapy.
• Be prepared to call EMS (911) if the patient's condition worsens and make sure that
you can give precise directions to your location.
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Frequently Asked Questions About Your
Oxygen Therapy
At Premier Home Care, Inc., we want to help answer any questions you may have
about your home oxygen system. Below are some commonly asked questions about the
use of oxygen.
What is Oxygen?
Can I become addicted to oxygen?
Oxygen when properly used is not harmful or addicting. We all need oxygen to live. If your
lungs or heart are diseased and cannot supply enough oxygen to your body from normal room
air, you may need to breathe supplemental oxygen.
Do all patients with lung or heart disease require supplemental oxygen?
No, but it is estimated that over 4 million patients with lung or heart problems are
benefiting or could benefit from supplemental oxygen. This is a rather small percentage
of the estimated 60 million Americans who are currently affected by lung and/or
heart disease.
How can I tell if I’m getting enough oxygen?
Oxygen is a drug that is a
colorless, tasteless and odorless
gas that is necessary for life.
When we take a breath, we
draw air into our lungs that
contains 21% oxygen. The
oxygen passes from our lungs
into our bloodstream, where it
is carried in the red blood cells
to all the organs and tissues of
our bodies.
Low levels of oxygen in your blood will often cause your to feel short of breath, have
tightness in your chest and breathe faster than normal. In severe cases you may notice
a “blueish” skin discoloration around your lips or nail beds.
Can I turn up my oxygen if I’m having a bad day?
You might anticipate that some of the symptoms you had before using the oxygen
will start to go away as your blood’s oxygen level returns to a more normal level. The
only way to be sure that you are getting the right amount of oxygen is to have the
oxygen level in your blood measured while using the supplemental oxygen. If new
symptoms, such as headaches, confusion, increased sleepiness, etc. appear, you might
be getting too much oxygen. Contact your physician immediately.
Why do I need supplemental
oxygen?
Never change the liter flow or hours of usage without permission from
your physician
Normally oxygen passes readily from the lungs into the bloodstream and is pumped by
the heart to all parts of the body. When lung disease occurs, oxygen may not be able to
pass as readily into the bloodstream. This can cause many undesirable effects, such as
a decreased ability to exercise, difficulty breathing, fatigue, confusion, loss of memory,
etc. Breathing supplemental oxygen increases the amount of oxygen that passes into
the blood stream and that is carried to the organs and tissues. When the heart and/or
lungs are diseased, they may not be able to supply as much oxygen-enriched blood as
our bodies need.
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Will oxygen relieve my shortness of breath?
Oxygen frequently does help, but there are reasons other than lack of oxygen for shortness
of breath. In such cases, oxygen may not relieve the condition.
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