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The
PulmonaryPaperDedicated to Respiratory Health CareMay/June 2016 Vol. 27, No. 3
What POC is Best for Me?
Inside:Our 2016 Annual Portable Oxygen Concentrator Guide
2 www.pulmonarypaper.org Volume 27, Number 3
Table of Contents We are hiding The Pulmonary Paper logo on our front cover. Can you find it?
Left to right: Susan Elfeld, Paul Kourtz, Joy Lynch
and Larry Strotheide agree that it’s
good to have a support network
behind you!
Features 04 | Calling Dr. Bauer
06 | Fibrosis File
08 | Ask Mark
12 | The Ryan Report
20 | Sharing the Health
30 | Respiratory News
Your Health10 | Buyer Beware with
Stem Cell Claims
23 | “Who's Your Daddy?” Quiz
24 | The Language of Dyspnea
For Fun28 | Sea Puffer Cruises:
Alaska, Canada, Hawaii or the Caribbean … Where do you want to go?
You have to have a good attitude and a
smile to deal with people that want to express
an opinion about your chronic lung disease.
Most mean well, as when you are trying to
catch your breath and are asked, “Are You
All Right?” “Do I look all right?” Be ready to
let the comments go by without any reaction
including these:
“You don’t look sick to me!” “Just wait until I walk up those flights of stairs.”
“Have you lost weight?” “Yes, trying to breathe!”
“I’m sorry.” Instead of pity, wouldn’t it be nicer if they said, “I am here for you!”
“Things will get better.” “You know a cure that the rest of us don’t?”
“How much did you smoke?” “Are you blaming me? Do they need to know this?”
“You’re so brave.” “Do I have a choice?”
“You should try oxygen water or Vitamin O or Oil of Oregano. It will make you breathe better!” “Um, No.”
“I know just how you feel.” “No you don’t, just ask me how I feel.”
“It could be worse.” “Things can get worse? Oh, good!”
Sometimes people don’t have to say any-thing – a friend or family member just being with you makes all the difference
in the world!
Things That Make You Go ‘Hmmm’
May/June 2016 www.pulmonarypaper.org 3
Ellen Glenn from Arizona enjoys a flower market in Nice, France!
“Resilience is accepting your new
reality, even if it’s less good than the one
you had before. You can fight it,
you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something
that’s good.”
Elizabeth Edwards
Editor’s Note
O ver the years, I am totally amazed at the determination people
with lung disease exhibit! We recently took a group of Sea Puffers all
the way to Europe. Lots of planning went into the trip and everyone
was excited and ready – even when our flight was delayed seven hours. We
amused ourselves in different ways and all was well.
After a great sense of accomplishment flying into Barcelona, the wheelchairs
were lined up to give us assistance to the baggage claim area. A woman
from the flight, seeing the oxygen users, made the comment, “It looks like
you all smoked the same kind of cigarette!” Seriously? Her husband was also
in a wheelchair – we didn’t blame him for it! What gives people the right to
say you brought this on yourself? If anyone has used a good comeback for
these ridiculous remarks, please let me know! It didn’t matter what she said,
after resting up, we took Europe by storm. I appreciate the stop smoking
commercials that are running on television but I disagree with the one
that says you can only go as far as your oxygen tubing. That oxygen tubing
travels very nicely!
Please read through all the articles in this issue. Mark talks about why it is not
okay to wear your oxygen only when you want to. Ryan helps you choose
the equipment that is right for you – not because it is smaller in size or on
sale. Get involved and know the Medicare and insurance regulations about
oxygen therapy – and let your elected officials know what you don’t like!
A member told us when she goes to the mall, she leaves her oxygen in the
car and goes out to it when she feels she needs to. Another has the cannula
by her and picks it up every now and then and takes a couple sniffs. People
have told us their doctor asked them if they want to be on
oxygen. Do they expect a yes answer? It wasn’t until she
landed in the hospital that using oxygen was no longer
a choice. There are people who tell us they would rather
have a shorter life without using oxygen than deal with
using it. Others fool themselves into thinking they are
being strong by refusing to put it on. Our favorite ,Flo, just
uses her lipstick when her lips start turning blue. All this
is not okay!
Make the right decisions for yourself today and don’t
let anyone make you feel like you deserved to get lung
disease. I salute you and your loved ones for your grit and
determination!
4 www.pulmonarypaper.org Volume 27, Number 3
Questions 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.
Dear Dr. Bauer,JB from Orlando, FL, writes, I often feel chills and shiver when I don’t have a cold or infection. Could this be due to the fact that I am on oxygen therapy?
Dr. Bauer explains, Circulation problems are nearly always the main cause of feeling cold all the time. The most common long-term side effect of oxygen is drying and irritation of the nasal passage due to cold, dry air passing through your airways. This can be minimized by humidifying the oxygen supply. There are a variety of moisturizing salves and sprays that can be very helpful. (Oxygen cannot explode but does enhance combustion and should not be used by open flames.)
Many patients on home oxygen ask me if there are any long-term side effects to oxygen therapy and what the proper flow rate is for oxygen delivery. Do you need oxygen just with activity, just at night while sleeping, or all of the time? Feeling short of breath may be an indicator of low oxygen, but this is not a sensitive or specific finding. You can easily check your oxygen saturation with a pulse oximeter. You will be prescribed oxygen therapy if your saturation is 88 percent
Here I am at the trail's center, just a few miles to go! A well-deserved rest stop along the trail.
In this issue, we are bringing you a former column of Dr. Bauer’s. He is currently taking a walk, a very long walk, on the Appalachian Trail, to celebrate his semi-retirement.
Follow his journey at his blog found at www.MickCtown.com and you just might find a message to Pulmonary Paper readers!
Calling Dr. Bauer …
May/June 2016 www.pulmonarypaper.org 5
or less on room air. You may be fine sitting at rest but when walking your readings may drop significantly.
A common oxygen flow rate to start out at is 2 liters per minute. I often tell my patients to adjust the flow according to their pulse oximetry readings when they are active.
A common misconception is thinking you can get addicted to oxygen. The need for oxygen depends solely on the course of your underlying lung disease. If you are fortunate to have an improve-ment in lung function with new treatments, your oxygen may be discontinued.
Dear Dr. Bauer,
AS of Tully, NY, asks, My doctor recently told me that my carbon dioxide level was high. What does this mean and should I worry about it?
Dr. Bauer replies, We know that the job of the lung is to extract oxygen from the air we breathe and deliver it to our blood. Oxygen is a vital ingredient for many of the chemical reactions that occur in our body all the time. A byproduct of these chemical reactions is carbon dioxide. Every time we exhale, our lungs are getting rid of the carbon dioxide from our body. If your lungs cannot do this task, carbon dioxide could build up in the blood – this condition is called hypercapnia. When carbon dioxide levels rise, one of the ways our body compensates is to have us breathe more deeply and rapidly. You can image that could be quite stressful for someone with COPD. An arterial blood gas will be drawn to check your carbon dioxide levels. Symptoms of mild hypercapnia might include headache, confusion and lethargy. Se-vere hypercapnia may cause unconsciousness.
It is relatively easy to treat low oxygen levels by giving you supplemental oxygen. It’s a tougher problem to get rid of excess car-bon dioxide. Treatment with BiLevel Positive Airway Pressure (BiPAP) may be necessary. Optimizing lung function with a proper program of medication, treatments and reha-bilitation is crucial for you to keep your lungs functioning as well as possible!
6 www.pulmonarypaper.org Volume 27, Number 3
Fibrosis FileInformation Sources
Dr. David Lederer is a pulmonologist from
New York City who specializes in the care
of people with pulmonary fibrosis and those
who have undergone lung transplantation.
Dr. Lederer created a blog called “Pulmonary
Fibrosis–Clearing the Air,” to help increase
awareness about the diagnosis and manage-
ment of pulmonary fibrosis. It may be found
at www.pfdoc.org
Don’t forget to check www.pulmonary
fibrosisnews.com for updated research find-
ings and treatment information. Pulmonary
Fibrosis News has reports that can easily be
understood. Recent presentations include
“Pulmonary Fibrosis Associated with Sclero-
derma: What You Need to Know” and “Is
Pulmonary Fibrosis the Same as Idiopathic
Pulmonary Fibrosis?”
Barbara, affectionately known as the Cat
Lady, is active in online support groups
for Pulmonary Fibrosis. You may see her
interview online at www.youtube.com/
watch?v=XdNvEhO0t6Y as she talks about
living with IPF for the past six years, answer-
ing many questions about how to cope with
the disease.
Pulmonary Fibrosis Foundation RegistryThe Pulmonary Fibrosis Foundation (PFF)
has established a national Patient Registry.
The PFF Patient Registry collects information
on people diagnosed with pulmonary fibrosis
who are seen at any of the PFF’s participat-
ing 40 Care Center Network sites across the
U.S. The Registry collects medical data from
people’s clinical care, CT imaging files, and
responses to questionnaires about PF symp-
toms and how PF impacts their lives. Blood
samples may also be stored.
It is a powerful tool for observing the
course of disease, understanding the effec-
tiveness of different treatments and care
practices, and comparing outcomes across
different types of people. It is observational,
which means that people’s medical care is
not changed as a result of participating – no
extra visits, and no required changes in med-
ications. For more information, please visit
www.pulmonaryfibrosis.org
News in the Fight against FibrosisVeracyte, Inc. presented new data in-
dicating that its in-development test, the
Envisia classifier, has the potential to diag-
nose idiopathic pulmonary fibrosis (IPF),
distinguishing it from other interstitial lung
diseases (ILD), and reduce the need for inva-
sive diagnostic surgeries.
Afferent Pharmaceuticals announced the
results from their study, revealing that the
company’s medication, known as AF-219,
significantly reduced cough frequency in
people with IPF.
New analyses, presented at the American
Thoracic Society 2016 Annual Conference,
further support the efficacy and safety of
nintedanib (Ofev) in treating IPF. Boehringer
Ingelheim shared a host of data at the meet-
ing, establishing nintedanib as an important
player in IPF management, regardless of
disease severity.
May/June 2016 www.pulmonarypaper.org 7
In the first large-scale study comparing
a variety of lung diseases, Yale scientists
revealed that chronic obstructive pulmonary
disease (COPD) shares a network of underly-
ing genes with idiopathic pulmonary fibrosis.
The new findings advance our understanding
of both conditions, and might possibly aid
in the development of common therapeutic
approaches.
Much information on lung disease diag-
nosis and treatment may be found at the
American Thoracic Society’s site at www.
thoracic.org/patients
If you are on Medicare or anticipate en-
rolling, you should know about the Medi-
care Rights Center which is the largest
source of Medicare information and assis-
tance in the U.S. They have a new resource
to help learn about what is covered under
the program that you can access at www.
medicareinteractive.org. You can create your
own profile and easily save and access the
information you are interested in.
For instance, did you know if you have
Medicare and use oxygen, you’ll rent oxygen
equipment from a supplier for 36 months.
After 36 months, your supplier must contin-
ue to provide oxygen equipment and related
supplies for an additional 24 months even
though the monthly rental payments will
stop. Your supplier must provide equipment
and supplies for up to a total of five years,
as long as you have a medical need for
oxygen. The supplier can’t charge you for
performing these services. If you use oxygen
To see how our friends across the pond
find support for pulmonary fibrosis and
other lung conditions, visit the British Lung
Foundation’s site at www.blf.org.uk and
click on the “Support for You” tab.
cylinders that need delivery of gaseous or
liquid oxygen contents, Medicare will con-
tinue to pay each month for the delivery of
contents after the 36-month rental period.
If your medical need continues past the
five-year period, your supplier no longer
has to continue providing your oxygen and
oxygen equipment, and you may choose to
get new equipment from any supplier. A
new 36-month payment period and five-year
supplier obligation period starts over with
the new supplier.
Medicare Rights Center Will Tell You What is Covered under the Program
8 www.pulmonarypaper.org Volume 27, Number 3
Ask Mark …
David from EFFORTS writes, My oxygen saturation (SpO2) readings stay around 92% to 94% at rest but during exercise
or activity, they drop to the mid 80s. They come back up within a minute or so. Am I hurting myself by not wearing my oxygen?
Mark tells us, This is a subject about which I’ve written much over the years. Hypoxemia – low oxygen level in the blood – begins a process that leads to inevitable, damaging complications and consequences. If supplemental oxygen is initiated, the damage to your heart and lungs can be slowed, even reversed, to some degree. In early hypox-emia, we see is a classic pattern which you so nicely described. One has a decent, even ‘normal’ oxygen saturation while at rest and often with minimal exertion. But when you increase intensity of exertion, that saturation drops below 90%. The lower your oxygen saturation level goes, the greater will be the “over time” even though your saturation quickly returns to a level above 90% saturation.
The fact that your saturation returns to an accept-able level after dropping into the 80s is of no real help. It is the ‘repeated’ dropping that does the damage. Hypoxemia causes blood pressure within the lungs to increase because low oxygen levels cause constriction of pulmonary blood vessels – called pulmonary vasoconstriction. The increase in pulmonary blood pressure puts stress and strain on the right side of the heart – that part of the ‘heart pump’ which pushes blood into and through the lungs. Normal right heart pressure is between
5 mmHg and 20 mmHg. Constricted blood vessels in your lung can cause right heart pressures to rise, reaching 50 mmHg to 60 mmHg in more severe or advanced cases. The right heart muscle is not designed to be a high-pressure pump.
Over time, the muscle that makes up the right ventricle of the heart does one of two things: it increases in mass and thickness or it stretches out which causes thinning of the muscle wall. When the right heart muscle becomes “hypertrophic” (increased in mass and thickness), it is not like building your biceps, which results in stronger arms. Rather it becomes more like a 300-pound canary trying to fly. It holds less blood because of chamber volume reduction from the
Mark Mangus, RRTEFFORTS Board
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.
May/June 2016 www.pulmonarypaper.org 9
encroaching mass (thickness). It also loses pumping strength and the ability to push blood adequately through the lungs. If the muscle thins, then it also loses its pumping strength with the same result – less blood being pumped into and through the lungs.
Ultimately the process advances until the heart and lungs develop congestive failure. Fluid leaks out of the pulmonary blood vessels into what we call the “third space”. It follows gravity to cause your ankles and legs to swell.
The lungs become like a saturated sponge. Breathing becomes more difficult. Exchang-ing oxygen and carbon dioxide becomes difficult and normal function progressively becomes impossible if continued advance-ment is allowed.
The good news? Starting oxygen early in the disease process lessens the effects by not allowing hypoxemia to occur or to occur as severely. Oxygen is the number one inter-vention that can reverse pulmonary vaso-constriction. Indeed, we have known for dec - ades that it is the only intervention in treat-ment of COPD that extends survival and im-proves function and as a result, quality of life.
My recommendation would be for you to see your pulmonologist or whoever manages your COPD and get a walk test to document your oxygen desaturation. You might also receive a recommendation to have a sleep study to determine if you desaturate during sleep. If you qualify for supplemental oxygen, you should begin using it. The longer you go with the oxygenation pattern you describe, the more you travel down that road towards inevitable lung and heart damage. Using oxy-gen sooner rather than later is key to putting the brakes on the process.
Gary M. from EFFORTS asks Mark to explain oxygen saturation readings with an oximeter, arterial blood gas, and how a heart medicine like Lopressor affects COPD.
Marks explains, Three components go into calculating your oxygen saturation percent-age when you have your arterial blood gas drawn. Your pH, carbon dioxide and oxygen partial pressures are compared and factored together to arrive at a calculated saturation of the hemoglobin. Hemoglobin in the red blood cells is responsible for transporting and delivering over 99 percent of the body’s oxygen supply. Pulse oximeters look only at the saturation without distinguishing how the other factors may affect the reading.
Lopressor is a beta blocker. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. They are medications that reduce blood pressure and treat cardiac arrhythmias. Years ago, “non-selective” beta medications we used to open up the airways caused problems by affecting all types of beta receptors. The com-bination of inhaled beta antagonists and oral beta blockers made the respiratory medica-tion less effective in improving air movement and interfered with the beta blocker’s ability to control heart arrhythmias. Because of the refinement to more ‘selective’ beta receptor antagonists, such problems are extremely rare with today’s medications. Still all beta blockers continue to carry a warning about the potential interference from beta agonists, such as Albuterol, to counteract beta blockers such as Lopressor.
Oxygen is the number one intervention that can reverse pulmonary vasoconstriction.
10 www.pulmonarypaper.org Volume 27, Number 210 www.pulmonarypaper.org Volume 27, Number 2
Buyer Beware with Stem Cell Claims!There are an estimated 100 stem cell
clinics in the United States operating on
questionable claims and with little supervi-
sion. Reporters from the Tampa Bay Times
reported on a local center known as the Lung
Institute and their involvement in stem cell
treatments. You can read the entire article at
this internet site, http://tinyurl.com/gwkn8p7
The medical director of this facility says he
can treat lung patients in the U.S. because he
is re-infusing them with their own stem cells,
a legal process under certain circumstances.
It is not approved or endorsed as a lung
disease therapy in this country. Medicare
won’t cover it. Participants must pay cash
– between $7,500 and $12,000 for a three-
day treatment, plus $4,500 for additional
“boosters” of cells extracted from their blood
or abdominal fat.
There is no clinical data showing stem cell
therapies benefit people with lung disease.
Stem cells can reproduce themselves to repair
tissues and mature into cells that perform a
specific function.
Adult stem cells can be taken from any-
one’s body. After withdrawing your blood,
a centrifuge pulls out the stem cells and they
are given back to the same person either
intravenously or inhaled via a nebulizer. No
evidence suggests stem cell therapy results in
growth of new lung tissues either in animals
or people.
The FDA in 2008 determined that the pro-
cedure in which a person’s own stem cells are
re-injected constitutes a “drug,” meaning the
clinics would be subject to the same rigorous
testing requirements that govern the pharma-
ceutical companies. The FDA later released a
narrow list of exceptions to the regulations
and the Lung Institute says it operates under
those exceptions.
The Lung Institute has not published
results or scientific studies of its treatments.
The medical director has said that about 70
percent of people report some benefit after
the treatment, such as walking to the mailbox
seems easier after having the treatment.
Congratulations to our friends at
Monaghan Medical Corporation on
receiving the Gold Award at the Medical De-
sign Excellence Awards for the Aerobika®.
The Aerobika® is an Oscillating Positive Ex-
piratory Pressure Therapy handheld device
that provides intermittent resistance, positive
pressure and oscillation (which is moving
back and forth) all at the same time. This
helps to clear mucus in the upper airways
so it can be coughed out. The device was
put to the test in a study performed at the
Robarts Research Institute, Western Uni-
versity, London, Ontario, Canada, and re-
searchers found that the study subjects had
improvements in increased mucus clearance,
decreased cough frequency and breathless-
ness, and enhanced exercise tolerance.
May/June 2016 www.pulmonarypaper.org 11
FOR DRUG-FREE,
NATURAL AIRWAY
CLEARANCE.
AEROBIKA® Oscillating
Positive Expiratory Pressure (OPEP) Therapy System
Words or phrases accompanied by ™ and ® are trademarks and registered trademarks of Monaghan Medical Corporation or an affiliate of Monaghan Medical Corporation. © 2016 Monaghan Medical Corporation. 1 Data on file
Now available through The Pulmonary Paper.
Call today, 1-800-950-3698 or visit www.pulmonarypaper.org
The AEROBIKA® OPEP is designed to aid in the loosening and removal of secretions in your lungs.
The device is lightweight, simple to use and can be carried anywhere.
It may also be used in combination with your nebulizer treatments.
The AEROBIKA® OPEP is easy to clean and dishwasher safe.
After using the AEROBIKA® device people say1:
“It was easier to raise my secretions.”
“I don’t cough as often.”
“I don’t feel so short of breath.”
“It has improved my ability to do different
activities.”
“It has made my life better.”
monaghanmed.com
12 www.pulmonarypaper.org Volume 27, Number 3
Ryan Diesem is Research Manager at Valley Inspired Products, Apple Valley, MN. Contact Ryan at rdiesem@inspiredrc.com with questions or com ments.
Ryan Diesem
The Ryan ReportHome Oxygen Guru – The HO2G Pen
2016 Portable Oxygen Concentrator Guide
Here it is, the 2016 version of our annual Portable Oxygen
Concentrator (POC) Guide. Not much needs to be added
from our previous 2015 version as there hasn’t been much
introduced in the last year.
• Over the summer of 2015, Philips Respironics introduced the
SimplyGo Mini, a pulse-only POC that can produce up to around
1000 mL/min of oxygen. Unlike the larger SimplyGo, the SimplyGo
Mini cannot provide continuous flow, and
be aware that the pulse volumes delivered
at identical settings between the SimplyGo
Mini and the SimplyGo are not the same. In
terms of oxygen production and size, the
SimplyGo Mini is most similar to the Inogen
One G3 and the FreeStyle 5. As of now, the
SimplyGo Mini has yet to be approved for air
travel by the FAA (though we do expect it will be at some point), so
keep that fact in mind when considering renting or buying this unit.
• At the beginning of 2016, Inogen updated its Inogen One G3
concentrator, adding some production volume, increasing the total
output from around 840 mL/min to around
1000 mL/min, and adding a pulse setting of
5, giving the unit a range of settings from
1 to 5. The same goes for the OxyGo POC,
which is the same exact model as the G3
but marketed under a different name. Users
interested in an Inogen One G3 or OxyGo
model should inquire whether or not the unit has 4 or 5 settings
to be sure they are getting the latest model.
May/June 2016 www.pulmonarypaper.org 13
Below is a brief list of items to keep in mind
when considering purchasing a POC.
• Size Matters. In general, the smaller the
POC, the less oxygen the device will be able
to produce. This is especially important to
keep in mind because during activity, most
oxygen users need more oxygen delivered
to them to maintain adequate saturations. If
the device cannot produce enough oxygen
to saturate the user during certain activities,
that device should not be considered
appropriate for use during those activities.
• Each POC is Different. Every model of POC
has its own perfor mance characteristics
that make it unique from other POCs.
Users should never assume that one
device will deliver the same therapy as
another. Differences in performance tend
to be wider when comparing a larger POC
to a smaller POC, but even similar sized
POC models will have oxygen production
and delivery charac teristics that should not
be ignored.
• Pulse Delivery Characteristics. All POCs
feature pulse delivery settings, and users
should know whether or not the POC
delivers its pulses via minute volume
delivery or via fixed pulse delivery. POCs
that use minute volume delivery will reduce
the pulse volume delivered per breath as the
user’s rate rises (where typically the user will
need more oxygen, not less), whereas fixed
pulse devices will not lower pulse volumes
with an increase in rate. Currently, all POCs
that do not have continuous flow capability
have minute volume delivery algorithms.
Further explanation of minute vs. fixed
pulse delivery can be found in the January-
February issue of The Pulmonary Paper.
• Added Weight. Manufacturers, when
report ing the weight specifications, typically
only state how much the unit itself plus
one battery weighs. This value ignores the
added weight of any accessories, which can
include extra batteries needed for travel,
carrying bags and carts, ac and dc power
adapters, and other items. When looking
at how much the POC weighs, be sure to
add anywhere from one to five additional
pounds depending on the amount of
accessories that will be needed for use.
• Battery Life Varies. POC battery life will be
dependent on the setting used as well as
the breath rate of the user. Users needing to
set the POC to higher pulse settings should
expect less battery life than if set at a lower
pulse setting. For POCs with continuous flow
operation, setting the unit to continuous
flow will go through the battery power
at a significantly higher rate than if set to
the same pulse setting value. Also, device
specifications for battery life are reported
in optimal (and new) conditions and will
decrease over time.
As always, feel free to contact me if you
have any questions about POCs at my email
address, rdiesem@inspiredrc.com.
14 www.pulmonarypaper.org Volume 27, Number 3
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Main Clinic Supply is a proud and loyal supporter of The Pulmonary Paper. We are
fortunate to have helped many readers with port able oxygen. We have also referred
many of our customers to a Sea Puffer Cruise! None of this would be possible without
the hard work and dedication of Celeste Belyea, publisher of The Pulmonary Paper.
Celeste works very hard to produce this paper for all of us. She does so without con-
cern of the profitability and costs to make it happen. She needs all our help to keep the
paper going for months and years to come! If you are reading this and gaining valuable
information, then please make a contribution to help Celeste help all of us into the
future!
Please pass on the paper to someone else in
need of this valuable news and information. And
ask them to help support the paper as well!
Francis FoxGeneral Manager / CEO of Main Clinic Supplywww.MainClinicSupply.com
P.S.: Take a cruise with the Sea Puffers!
Celeste and Holly are the greatest travel agents,
tour guides and respiratory therapists! When
you travel with them you get all three of these
times two!
Take it from my mother, Diana Fox, who just returned from a Mediterranean Sea
Puffer cruise. …
“Celeste and Holly just killed themselves to make sure everyonehad fun and (they) were always there when someone
needed help with their oxygen.”
Thank you, Celeste!
Call Courtney for special Pulmonary Paper member pricing!
May/June 2016 www.pulmonarypaper.org 15
960 mL/min(0.96 LPM)
1 to 5
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 64 mL
30 BPM: 32 mL
6 lbs.
2.0 hours
12,000 ft.
333 mL/min(0.33 LPM)
NoneSelectable
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 22 mL
30 BPM: 11 mL
3 lbs.
1.5 hours
10,000 ft.
AirSep AirSep AirSep Inogen Focus™ FreeStyle™ FreeStyle™ 5 One G2
PRODUCTION AND DELIVERY
Please consult with your doctor or therapist before deciding to use or purchase any of these devices.
2016 Portable Oxygen ConcentratorsINTERMITTENT FLOW (PULSE ONLY) POCS
Maximum Oxygen
Production (mL/min)
Available Settings
Pulse Delivery
Type
Maximum Delivered Pulse
Volume
Unit & Battery (Approx.)
Approx. Battery Time at Pulse
Setting 2
Max. Altitude
500 mL/min(0.5 LPM)
1 to 3
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 33 mL
30 BPM: 17 mL
4 lbs.
2.5 hours
12,000 ft.
1,260 mL/min(1.26 LPM)
1 to 6
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 84 mL
30 BPM: 42 mL
7 lbs.
4.0 hours(est.)
10,000 ft.
DOSE VOLUMES PER BREATH***2 LPM Continuous Flow: 15 BPM: 44mL 30 BPM: 22mL
4 LPM Continuous Flow: 15 BPM: 88mL 30 BPM: 44mL
6 LPM Continuous Flow: 15 BPM: 133mL 30 BPM: 66mL
WEIGHT (UNIT + STD. BATTERY); ADD UP TO 5LBS. FOR ACCESSORIES
STANDARD SINGLE BATTERY OPERATION TIMES
ALL UNITS (EXCEPT SIMPLYGO MINI) APPROVED FOR FLIGHT BY FAA
16 www.pulmonarypaper.org Volume 27, Number 3
Inogen Inova Labs Inova Labs Invacare One G3/OxyGo Activox™ Pro Activox™ 4L XPO2
PRODUCTION AND DELIVERY
INTERMITTENT FLOW (PULSE ONLY) POCS
450 mL/min(0.45 LPM)
1 to 3
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 30 mL
30 BPM: 15 mL
5 lbs.
7.3 hours
10,000 ft.
840 mL/min(0.84 LPM)
1 to 5
Minute Vol.Delivery: Dose
decreases asrate rises
15 BPM: 56 mL
30 BPM: 28 mL
6 lbs.
2.5 hours
10,000 ft.
WEIGHT (UNIT + STD. BATTERY); ADD UP TO 5LBS. FOR ACCESSORIES
STANDARD SINGLE BATTERY OPERATION TIMES
ALL UNITS (EXCEPT SIMPLYGO MINI) APPROVED FOR FLIGHT BY FAA
Maximum Oxygen
Production (mL/min)
Available Settings
Pulse Delivery
Type
Maximum Delivered Pulse
Volume
Unit & Battery (Approx.)
Approx. Battery Time at Pulse
Setting 2
Max. Altitude
Please consult with your doctor or therapist before deciding to use or purchase any of these devices.
2016 Portable Oxygen Concentrators
840 mL (0.84 LPM) (pre-2016)
1000 mL/min (1.0 LPM) (2016)
1 to 4 (pre-2016)
1 to 5 (2016)
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 56 mL/67 mL
30 BPM: 28 mL/33 mL
5 lbs.
3.0 hours(est.)
10,000 ft.
******* Approximate Continuous Flow volumes at 2, 4, and 6 LPM are provided for comparison to maximum volumes delivered by the selected POC.
480 mL/min(0.48 LPM)
1 to 4
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 56 mL
30 BPM: 16 mL
5 lbs.
8.3 hours
10,000 ft.
May/June 2016 www.pulmonarypaper.org 17
500 mL/min (0.5 LPM) EasyPulse 3
780 mL/min (0.78 LPM) EasyPulse 5
1 to 3 (EasyPulse 3)
1 to 5 (EasyPulse 5)
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 52 mL
30 BPM: 26 mL
5 lbs. to 7 lbs.
4.0 hours (EasyPulse 3)3.4 hours (EasyPulse 5)
9,000 ft.
DOSE VOLUMES PER BREATH***2 LPM Continuous Flow: 15 BPM: 44mL 30 BPM: 22mL
4 LPM Continuous Flow: 15 BPM: 88mL 30 BPM: 44mL
6 LPM Continuous Flow: 15 BPM: 133mL 30 BPM: 66mL
Precision Respironics DeVilbiss® Invacare EasyPulse 3/5 SimplyGo Mini iGo Solo2®
PRODUCTION AND DELIVERY
3,000 mL/min(3.0 LPM)
1 to 6Continuous 1 to 3 LPM
Fixed Delivery 14 mL
per setting
84 mL
19 lbs.
4.7 hours(20 BPM)
13,123 ft.
Please consult with your doctor or therapist before deciding to use or purchase any of these devices.
2016 Portable Oxygen Concentrators
1,000 mL/min(1.0 LPM)
1 to 5
Combination Fixed Delivery/
Minute Vol.Delivery
15 BPM: 55 mL
30 BPM: 33 mL
5 lbs.
4.5 hours
10,000 ft.
3,000 mL/min(3.0 LPM)
1 to 6Continuous
0.5 to 3 LPM
Minute Vol.Delivery: Dose
decreases as rate rises
15 BPM: 133 mL
30 BPM: 66 mL
20 lbs.
3.5 hours
10,000 ft.
INTERMITTENT FLOW (PULSE ONLY) POCS CONTINUOUS FLOW POCS
WEIGHT (UNIT + STD. BATTERY); ADD UP TO 5LBS. FOR ACCESSORIES
STANDARD SINGLE BATTERY OPERATION TIMES
ALL UNITS (EXCEPT SIMPLYGO MINI) APPROVED FOR FLIGHT BY FAA
18 www.pulmonarypaper.org Volume 27, Number 3
O2 Concepts Respironics™ SeQual® SeQual® Independence SimplyGo Eclipse eQuinox
PRODUCTION AND DELIVERY
2,000 mL/min(2.0 LPM)
Pulse 1 to 6Continuous
0.5 to 2 LPM
Combination Fixed/Minute
Vol. Delivery**
15 BPM: 72 mL
30 BPM: 66 mL
10 lbs.
3.0 hours(20 BPM)
10,000 ft.
3,000 mL/min(3.0 LPM)
Pulse 1 to 6*Continuous
0.5 to 3 LPM
Fixed Delivery16 mL
per setting
96 mL*
19 lbs.
5.1 hours(12 BPM)
13,123 ft.
3,000 mL/min(3.0 LPM)
Pulse 1 to 6*Continuous
0.5 to 3 LPM
Fixed Delivery16 mL
per setting
96 mL*
14 lbs.
2.75 hours(12 BPM)
13,130 ft.
WEIGHT (UNIT + STD. BATTERY); ADD UP TO 10 LBS. FOR ACCESSORIES
STANDARD SINGLE BATTERY OPERATION TIMES
ALL UNITS (EXCEPT SIMPLYGO MINI) APPROVED FOR FLIGHT BY FAA
Maximum Oxygen
Production (mL/min)
Available Settings
Pulse Delivery
Type
Maximum Delivered Pulse
Volume
Unit & Battery (Approx.)
Approx. Battery Time at Pulse
Setting 2
Max. Altitude
CONTINUOUS FLOW POCS
Please consult with your doctor or therapist before deciding to use or purchase any of these devices.
2016 Portable Oxygen Concentrators
3,000 mL/min(3.0 LPM)
Pulse 1 to 6Continuous 1 to 3 LPM
Fixed Delivery16 mL
per setting
96 mL
19 lbs.(w/2 batteries)
2.9 hours(20 BPM)****
13,123 ft.
****The Eclipse models also have pulse settings of 128, 160 and 192 mL, but have additional breath rate restrictions for use. See Eclipse manuals for more information.
****The SimplyGo has two IF delivery modes: Pulse Mode and Night Mode. Shown volumes are for Pulse Mode. Night Mode has Minute Volume Delivery.
****The Independence is packaged with (2) batteries that can be used simultaneously, doubling the reported operating time.
May/June 2016 www.pulmonarypaper.org 19
Englewood, CO 80112Toll Free 1-877-699-8439 or www.oxyview.com
Let everyone see the real you!
No more nasal cannula when you are out and about.
Oxygen therapy eyeglasses allow you to ditch the nasal cannula!
Spring into Comfort with Oxy-View Eyewear!
Great news..We are receiving our new shipment of frames in October. Be one of the first to place your order.
Call TollFree at 1-877-699-8439 or visit our website at www.oxyview.com to place your order.
Need a second pair? Ask about our second pair discount.
Talk to your doctor now about the benefits of Transtracheal Oxygen Therapy.
Live Longer! Breathe Easier! Improve Quality of Life! Even Look Better!
For information, call: 1-800-527-2667 or E-mail drscoop@tto2.com
• Improve your mobility
• Develop greater exercise capacity
• Reduce your shortness of breath
• Improve your self-image
• Save money on portable oxygen sources
• Compatible with virtually every oxygen conserving device
• Eliminate the discomfort of your nasal cannula
• Increase your longevity
You’ve suffered long enough. Ask your doctor about TTO2.
20 www.pulmonarypaper.org Volume 27, Number 3
Sharing the Health!I would like to share that if anyone is on the
medications Breo Ellipta or Spiriva, you can
get Breo Ellipta free for one year and pay no
more than $10/month for Spiriva. You may
qualify even if you have insurance.
See www.mybreo.com/COPD or call 1-888-
825-5249 and www.spiriva.com/copd/
why-spiriva/savings-and-support for more
information. You may phone 1-888-777-
1919 for additional information on Spiriva’s
program.
Kathy L., Passaic, NJEllen G. of California writes, My good
friend sent me a note that she finally got
a better understanding of what it is like to
have a chronic illness by reading an article
entitled “The Spoon Theory” by Christine
Miserandino found on the Internet at www.
butyoudontlooksick.com
I invite you to share it with your family
and friends as it may make them realize that
the activities you choose to do and the time
you may spend at these activities are not
really something over which you have total
control. Each spoon represents something
you will do that particular day – you only
have so many spoons to work with and you
decide what you will accomplish. Family
and friends will see you are making the best
choices for you!
Bronchiectasis is a lung disorder where
the bronchial tubes are permanently and
abnormally widened (dilated), causing
secretions to pool and be difficult to cough
out. This situation often results in frequent
infections. Nontuberculous mycobacteria
(NTM lung disease) refers to bacteria that
cause lung problems but not tuberculosis
and is commonly known as MAC. In an
effort to meet the needs of the bronchiec-
tasis and NTM communities, the COPD
Foundation has created the Bronchiectasis
and NTM Initiative.
BronchandNTM360social is an online
community where members can interact,
ask questions, read and comment on blog
posts, and more. You will find educational
information and research programs such
as the Bronchiectasis and NTM Research
Registry. Visit www.NTMinfo.org and
www.brinchandNTM260social.org to learn
more.
Every so often, it is a good idea to clean
your showerhead. Atypical mycobacteria has
been known to build up. It is a dangerous
bug for people with chronic respiratory
problems. Fill a plastic bag with white vine-
gar, cover the showerhead and close the bag
with a rubber band at the top, soak for an
hour. You can then shower with confidence!
May/June 2016 www.pulmonarypaper.org 21
Nina C. of California gets together with
ladies who are helping take care of loved
ones who have medical problems. They
recently discussed ways to get through dif-
ficult times.
• You need to state your feelings and
discuss them; holding them inside will
only cause more problems and stress.
The FDA has finally issued rulings that
bring electronic cigarettes, hookah pipes,
and cigars into the agency’s regulation of
tobacco products.
These products will now be subject to the
same restrictions as traditional cigarettes,
including a ban on sales to minors and re-
striction on advertising and marketing. The
FDA also gets authority over ingredients
and product design, which many have spec-
ulated, will spell the end to youth-friendly
flavors.
Calls to poison control centers resulting
from exposure to vaping liquids by young
children have increased dramatically with
the popularity of e-cigarettes. There were
comas, seizures, and even one death from
these exposures.
We can only hope regulating e-cigarettes
will be successful for the war on smoking.
Bans on smoking may have a higher success
rate on discouraging our young people to
stop smoking than imposing high taxes on
• Don’t be afraid to ask for help from
family, friends, neighbors, church
members, or if possible, hire someone if
no one is available.
• Join or establish a support group to be
able to talk to other caregivers. There
are sites on the Internet as www.care
giveraction.org and www.caregiver.org
• Take time out for you every day.
• Take one crisis at a time, don’t let things
get overwhelming.
• Plan ahead to avoid problems.
• Keep a positive attitude.
cigarettes. If they are unable to smoke inside
restaurants or bars, they are choosing not to
smoke at all.
The FDA has also teamed with Minor
League Baseball for a campaign to reduce
smokeless tobacco use, including chewing
tobacco and dip, among rural male teens.
In a study done on human cells exposed
to extracts taken from e-cigarettes, cell death
and breaks in DNA strands were found. This
is the kind of cell damage associated with the
development of cancer.
E-Cigarettes Now Regulated by the FDA!
22 www.pulmonarypaper.org Volume 27, Number 3
Sharing the Health! continued
If you are a member of Facebook, you
will want to join the Ultimate Pulmonary
Wellness group sponsored by New York’s
Dr. Noah Greenspan, Program Director of
the Pulmonary Wellness and Rehabilitation
Center, and join in some lively discus-
sions! Dr. Greenspan also has a web site
at www.pulmonarywellness.com and has
a new video presentation, “Physiology of
Exercise for the Pulmonary Patient,” that
can be seen at https://www.youtube.com/
watch?v=OhgfzLEYNVo
Our friend John Leaman of the Asthma/
Emphysema Self-Help Group and editor of
Respiratory News and Views, recently re-
ported on Dr. Greenspan’s presentation at a
recent Lung Force Expo. He lists basics that
can be changed to improve lung function.
1. Medical. People with pulmonary prob-
lems should have three physicians – an in-
ternist, a pulmonologist and a cardiologist.
The cardiologist is necessary because of the
similarity of many symptoms of lung and
heart disease.
2. Exercise. You should be exercising every
day, if only for five minutes at first, working
up to as long as you can. Start off with an aer-
obic activity and add strength and flexibility
training – all forms of exercise are beneficial.
3. Nutrition. People with lung problems
have different needs than others. You want
to limit carbohydrates because they may
increase carbon dioxide production.
4. Stress and Anxiety Management. Re-
lax! Stress will release adrenaline which will
increase your shortness of breath.
5. Prevention of Infection. Wash your
hands and try and avoid sources of infection.
I would like to share how I keep my tubing
from getting tangled up around the house!
I use two 25-foot length oxygen tubing with
a swivel connector. I hang the tubing over
a door and it really does stay straightened
out when I use it. It works with cannulas
too – I hang them from a hook and it not
only keeps them from tangling but also gets
rid of the plastic odor. Putting four bed risers
underneath the concentrator in my bedroom
keeps the air moving around it and keeps the
room cooler for me.
Jacquie T., Glendale, AZ
A report presented at the recent American
Thoracic Society conference compiled the
input of patients, family members, health-
care providers, payers, and pharmaceutical
companies to highlight the COPD patient
experience and address gaps in COPD care
delivery. The 54-page report outlines the
current state of COPD care, the economic
burden of the disease, our community’s
research and evaluation efforts, COPD-
specific care and coordination of that care,
and the assessment of quality and cost-
effectiveness. To read the entire article about
the important needs in the next decade
for people with COPD, register for a free
Lancet account at http://tinyurl.com/j3n9ryh
and access the full article at this link, http://
tinyurl.com/jaqwbcl
I bruise very easily and use a product
called Dermablend to cover the purple
blotches on my arms. You can get this in
many department stores or order it from
the Internet. It is definitely not necessary but
makes me feel better! Fran Z., El Paso, TX
8. American actor Robert Young starred
in what 1950s TV show dedicated to
fathers?
a. Make Room for Daddy
b. Leave It to Beaver
c. The Adventures of Ozzie & Harriet
d. Father Knows Best
9. Which “Make Room For Daddy” star
fathered the star of “That Girl”?
a. Jesse White
b. Ben Lessy
c. Danny Thomas
d. Desi Arnaz
10. Who is often called the “Father of
Medicine”?
a. Demosthenes
b. Hippocrates
c. Galen
11. According to the quote by Galileo,
who is the “Father of Invention”?
a. Victory
b. Shame
c. Doubt
d. Fear
12. Which father and daughter have both
won Oscars?
a. Bruce and Laura Dern
b. Gwyneth and Bruce Paltrow
c. Anjelica and John Huston
1. Who were the “Founding Fathers”?
a. the leaders of the American
Revolution
b. the signers of the Declaration of
Independence
c. the delegates to the 1787
Constitutional Convention
2. In the Roman Catholic Church, who is
the “Holy Father”?
a. God
b. Jesus
c. The Pope
3. He is known as the “Father of History”:
a. Pliny
b. Herodotus
c. Aristotle
4. In Greek myth, he is the “Father of the
Universe”:
a. Cronus
b. Uranus
c. Zeus
5. “Father Time” is also known as:
a. St. Nicholas
b. The Grim Reaper
c. Daedalus
6. Who is considered the “Father of the
Symphony”?
a. Joseph Haydn
b. Wolfgang Amadeus Mozart
c. Ludwig van Beethoven
7. Saint Nicholas, the martyr behind the
“Father Christmas” myth, is from:
a. Asia Minor
b. The Netherlands
c. England
Who’s Your Daddy? Test Your ‘Father’ Knowledge!
May/June 2016 www.pulmonarypaper.org 23
24 www.pulmonarypaper.org Volume 27, Number 3
People with cardiac problems common-ly describe their chest pain as “pres-sure,” “tightness,” “dull” or perhaps
“crushing weight.” Cardiologists use these descriptions to help them make a specific diagnosis. Unfortunately, when it comes to describing shortness of breath, things become a bit more cloudy. The medical term for shortness of breath is dyspnea (pronounced disp-nee-uh), meaning difficult breathing. Physicians from around the world have been studying something they call “the language of dyspnea.”
There are literally hundreds of causes of dyspnea. For example, over 200 different causes of interstitial lung disease (ILD) have been identified. There are cardiac causes, blood disorder causes, traumatic causes, neuromuscular causes, and even obesity can cause an increase in dyspnea. The list is very long. When you experience shortness of breath, it can be an extremely uncomfortable and even downright frightening experience. It is for this reason that the physician taking your medical history should speak the same language as you are speaking. This leads directly into the discussion of the language
Understanding Why You Are Short of Breath:
The Language of Dyspneaby John R. Goodman BS, RRT, FAARC and Mark Mangus BS, RRT, FAARC
of dyspnea. People describe their shortness of breath in a variety of ways:
I feel that my breathing is rapid. My breath does not go out all the way. My breath does not go in all the way. My breathing is shallow. My breathing requires effort. My breathing requires more work. I feel that I am smothering. I feel a hunger for more air. I feel out of breath. I cannot get enough air. My chest feels tight. My chest feels constricted. My breathing is heavy. I feel that I am breathing more.
It might be very useful to be specific when you tell your doctor under which conditions you feel your breathing is shallow, or when you feel your breathing requires more work.
It was the brilliant Dr. Julius Comroe who first began the study of dyspnea back in the mid-1960s. He described six possible causes that might explain the sensation of dyspnea that he was hearing from his pulmonary patients. In the early 80s the list was short-ened to four symptoms repres enting the basic sensations of breathing. They were tightness, excessive ventilation, excessive frequency, and breathing difficulty. Studies proved that the major pulmonary disease groups do use different descriptors to de-scribe their dyspnea. Asthmatics report differently than people with COPD, as well as those with ILD. Add in the racial and ethnic variations and you can see that what used to be a rather simple couple of
May/June 2016 www.pulmonarypaper.org 25
questions asked during a routine medical history, has become even more important as the “language” develops.
The pulmonary community has done a stellar job in making you aware of your oxygen saturation levels with the use of digital pulse oximeters. Certainly low oxy-gen saturations can make any of us short of breath. In Denver, we take our respira-tory therapy students up to the top of Mt. Evans at 14,000 feet above sea level to induce shortness of breath in these young healthy students. They stand in your shoes for an hour or so. Many people believe that whenever they get short of breath, it is most likely due to a low oxygen blood level. When they check their oximeter, they find that their saturations are either near normal or not low enough to explain their degree of dyspnea. If it isn’t a low saturation that is making you short of breath, maybe it’s the other gas involved in ventilation, the one we call the “insidious gas,” and that of course is carbon dioxide or CO2.
Mark describes of the effects of carbon dioxide on the body and how it can lead to a phenomenon called “dynamic hyper-inflation.”
When you’re exercising, or doing chores around the house, your breathing may become harder. Your respiratory rate is increasing and yet you feel like you can’t get enough air into your lungs. So you work even harder. You check your oxygen satu-ration and see that it is falling, despite your increased efforts to get more air into your lungs. You have your oxygen flow up higher and think it should be enough to help you breathe better but it’s just not helping. You wonder what is going on! You begin to use pursed-lips breathing (PLB) which seems to help some but not enough and you wish
you had started out using it. You’re left to wonder what the heck is this all about!
The answer is that a complicated set of mechanisms are at play. The signals sent to your brain are: “I can’t get enough air in.” Yet the reality is that you already have too much air in your lungs! If you were to have a sample of your blood tested, you’d see that while your oxygen level is not in the ‘text-book’ normal range, it is plenty high enough that your saturation shouldn’t be as low as you see that it is. You scratch your head wonder how can that be?
What is going on is the phenomenon we call “dynamic hyperinflation”. Looking at those words to try to understand what they mean and how they apply, we know “dy-namic” means moving or in motion. What is dynamic here is our breathing mechanics and how much air gets into our lungs.
“Hyperinflation” suggests that our lungs are over-inflated. Normally with COPD, because of weakened air sacs, we are unable to push all the air out that we have inhaled and it becomes trapped. What is so different about dynamic hyperinflation? The answer is that it results from breathing faster and faster and taking in more air with each breath than we can breathe out. Our lungs go from our usual state of hyperinflation to an even higher state of hyperinflation, as our breathing becomes more and more disturbed.
Think of a balloon that has been blown up too many times. It has lost its elasticity to the point that it can’t spring back to its smaller size – as it was when it came out of the package. It represents your lungs with emphysema. Think of blowing up that bal-loon and with each breath you blow into it, you let out only part of the air. Soon, it becomes inflated to its maximum point.
Continued on page 26
26 www.pulmonarypaper.org Volume 27, Number 3
overall breathing. The slower you breathe, the less you tend to over-inflate your lungs. PLB also facilitates splinting your airways open and especially, slowing your exhala-tion so you can empty more air out of your lungs from breath to breath.
Hopefully, you can now appreciate the utter complexity of the simple phrase “short of breath.” Maybe we should turn the tele-scope around and have the physicians ask their questions based on the known descrip-tors used by those with breathing problems. They might read like this:
1. Is your breathing shallow? 2. Do you feel the urge to breathe
more? 3. Is your chest constricted? 4. Does your breathing require effort? 5. Do you hunger for more air? 6. Do you feel out of breath? 7. Are you getting enough air? 8. Does it feel like your breath is not
getting all the way in? 9. Does your chest feel tight? 10. Are you working hard to breathe? 11. Do you feel that you are smothering
or suffocating? 14. Do you feel that your breath isn’t
getting all the way out? 15. Do you feel that your breathing is
heavy? If our list of 15 questions takes even one
minute each to ask and answer, it would take longer than an average office visit.
Now imagine that balloon is your lungs during “dynamic hyperinflation”. They reach a point that trying to breathe in more air becomes impossible because they are already filled to the maximum. Yet your brain is telling you that you need to get more air in!
What is causing the drop in your oxygen saturation is not the lack of oxygen. It is the fact that with so much stale air in your lungs that you can’t exhale, your carbon dioxide has increased. Oxygen saturation is not based only on what the oxygen level is in the blood, but a combination of the oxygen level, the blood pH (acidity or alkalinity) and carbon dioxide. If we look at all three of those levels in your blood we would see that oxygen is still relatively high, but the pH is severely decreased (acidic) and the CO2 is severely increased. That is why the saturation has dropped and what the effect of dynamic hyperinflation does to your oxygenation. There are other factors at play that contribute to the resulting disturbance in your blood gases too.
So, what are you to do about this prob-lem? Well, Pursed Lip Breathing (PLB) is a good start. It will slow down the onset and severity of dynamic hyperinflation. Depend-ing upon how well you can pace both your breathing and your activity will determine how effectively you can control and combat dynamic hyperinflation. Even then, you may find that you reach a point that you simply can’t overcome the discomfort of the process, in which case you will simply have to stop and allow yourself to recover. As you rest, your demand for more breath-ing decreases and dynamic hyperinflation subsides. Your lungs deflate back towards your resting baseline volume. The import-ant benefit of PLB in combatting dynamic hyperinflation is that it slows down your
John R. Goodman, RRT FAARC is Executive Vice Presi-dent of Tech ni cal/Profes sional Services at Transtracheal Ser-vices, Denver, CO, who says “All You Need Is Love!”
Continued from page 25
May/June 2016 www.pulmonarypaper.org 27
1. Rank the following foods for potassium content from
most to least.
Answer: While bananas are an excellent source of
potassium, with 420 milligrams, other foods have even
more: yogurt, 530 milligrams; orange juice, 500; halibut,
490; broccoli, 460. Also rich in potassium are tomatoes,
apricots, spinach, beets, prune juice, potatoes, lentils,
soybeans, nuts, and sunflower seeds. A potassium-rich
diet helps control blood pressure. The goal is 4,700
milligrams a day.
2. Which of the following contain calcium?
Answer: All of them! Figs, almonds, soybeans and collard
greens. dairy foods are the best sources (milk has 300
milligrams per cup; yogurt even more).
3. A label that lists trans fats as “0” means:
Answer: (C) It has less than 0.5 grams of trans fat per
serving. Because of a labeling loophole, a "trans fat
free" food may still contain small amounts of partially
hydrogenated oil, the source of artery-damaging trans
fats. And these small amounts can add up, especially
since standard serving sizes are often small.
4. Rank the following fast foods for their sodium,
from most to least: (A) Burger King veggie burger, a
Dunkin’Donuts corn muffin, a large Burger King choco-
late shake, McDonald’s large French fries.
5. How much fiber should you aim for every day?
Answer: 21 to 35 grams, depending on your total daily
calories. A cup of raisin bran with a banana (10 grams),
a cup of broccoli (6 grams), a pear (5 grams), a sweet
potato with skin (5 grams), and a slice of whole-wheat
bread (2 grams) get you within that range.
6. True or false? Honey, agave, and coconut sugar are
better for you than table (white) sugar.
Answer: False. Sugar is sugar, and no form of it offers
significant nutritional advantages. That goes not only
for honey, agave nectar, and coconut sugar, but for other
healthier-sounding forms of sugar, including molasses,
evaporated cane juice, and fruit juice concentrate. So the
only reason to substitute one for another is taste. Honey
is sweeter than table sugar, for example, while coconut
sugar is less sweet and has a more caramel taste.
7. To lower blood pressure, you should: Eat more fruits
and vegetables, eat dairy foods and use less salt. An
eating plan that emphasizes fruits, vegetables, and
low-fat/nonfat dairy foods (the DASH diet) has been
proven to lower blood pressure – even more so when
sodium is also reduced. No one should take a potassium
supplement or use a potassium-based salt substitute un-
less advised to by a doctor, since they can be dangerous
for many people, including those with impaired kidney
function or diabetes.
8. Which does not contain fiber?
Answer: Steak. Fiber, which improves blood sugar con-
trol, lowers cholesterol, and helps prevent constipation,
is found only in plant foods as broccoli, oatmeal, apples
and baked beans.
9. Vitamin D is found in eggs, milk, fatty fish and mush-
rooms (not in chicken). Milk is fortified with vitamin D
and is the major dietary source. To get the 800 IU to
1,000 IU a day we recommend, vitamin D supplements
are usually necessary, since it's difficult to get this much
from food.
10. Fatty fish (salmon, sardines, halibut, trout, mack erel,
tuna and eel) is a good source of protein and omega-3
fats (not vitamin C and beta carotene). Fish has about 20
grams of protein in 3 ounces, cooked, as much as meat;
fatty fish also provide omega-3 fats, which may reduce
the risk of cardiovascular disease and other disorders.
Answers to the Nutrition Quiz (by the University of California at Berkley Wellness Center from the March/April issue)
28 www.pulmonarypaper.org Volume 27, Number 3
Canada & New England 9 DAYS
Our annual trip to see the wonders of Alaska, round trip from Seattle aboard the Crown Princess. Visit Juneau, Glacier Bay, Skagway, Ketchikan and Victoria!
Alaska Inner Passage Cruise 7 DAYS
FST–
ST39
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Visit www.seapuffers.com for more information!
Join the Sea Puffers!Travel for People with Respiratory Concerns
Call Us Today! Pre-Trip: New York City See Broadway's "Beautiful", tour the city!September 22–October 1, 2016 Nine days! Explore the Royal Caribbean’s all new digital ship, Anthem of the Seas, as we sail to New England and Canada from Cape Liberty, NJ!
Join us in New York even if youare unable to cruise to Canada!
Pre-Canada & New England Cruise Package, September 19–21:Spend three nights at the Westin Hotel, Times Square, arriving September 19. Includes a four-hour tour of New York City on September 20–21, dinner at Sardis, a Broadway play in Orchestra or Front Mezzanine seats (“Beautiful: The Carole King Musical”), and transfers to the Anthem of the Seas on September 22.There are many extras included as admission to NYC attractions and shopping discounts!
The cost of this three-night vacation before the vacation is based on double occupancy.Double occupancy, $1,181/person. Triple occupancy, $967/person. Four in a room, $860/person. Single occupancy, $1,943/person.
May/June 2016 www.pulmonarypaper.org 29
JOIN THE SEA PUFFERS ON ONE OF OUR GROUP CRUISES ESCORTED BY RESPIRATORY THERAPISTS!
CALL TODAY!1-866-673-3019We make it easy to travel with oxygen! Join the Sea Puffers family for life-long friendships and support.
July 15–22, 2017 Our annual trip to see the wonders of Alaska, round trip from Seattle aboard the Ruby Princess. Visit Juneau, Glacier Bay, Skagway, Ketchikan and Victoria!
Alaska Inner Passage Cruise 7 DAYS
January 23–February 4, 2017 Enjoy relaxing days at sea before visiting Hilo on the Big Island, Honolulu on Oahu’s South Shore, Nawiliwili on the island of Kauai, the island of Maui, and Ensenada, Mexico aboard the Star Princess. Roundtrip from Los Angeles. Lots of fun and surprises in store on this vacation!
Hawaiian Island Cruise 15 DAYS
March 6–16, 2017 (11 DAYS)Experience luxury at its finest aboard Oceania’s Riviera! Roundtrip from Miami. This first class trip includes stops at St. Barts, Barbados, St. Lucia, Antigua and Tortola. There are many perks with this cruise including free gratuities, onboard credit of $150/cabin, free Internet access and for a limited time, your choice of one of the following: 4 free shore excursions, free house beverage package or an additional $400 shipboard credit!
Caribbean Hideaways Cruise
We will always get the best possible pricing for your trip – even if it is lower after you make your reservation! There are never any additional charges for arranging your oxygen and medical needs for your vacation when you book your individual or Sea Puffer trip with us!
Respiratory News
30 www.pulmonarypaper.org Volume 27, Number 3
Time to get in shape! UCLA researchers
have found people with cardiovascular dis-
ease who have high muscle mass and low fat
mass have greater survival rates than those
with other body compositions. The findings
also suggest that regardless of a person’s level
of fat mass, a higher level of muscle mass
helps reduce the risk of death.
Pharmaceutical company Boehringer
Ingelheim and Propeller Health, a provider of
digital programs for respiratory health, have
partnered to offer health tools and services
to help people living with COPD and asthma
to better manage their disease. The Propeller
sensor attaches to the Respimat inhaler and is
designed to
keep people
connected to
their caregiv-
ers and pro-
vide insights
into disease
triggers. For
more information, visit propellerhealth.com
A new study in the New England Jour-
nal of Medicine finds that smokers, who
wouldn’t typically be diagnosed with COPD,
are still showing symptoms consistent with
the diagnosis. It was found that about half
of current or former smokers experienced
respiratory symptoms similar to COPD,
as well as an increased risk for flare-ups in
their symptoms, even though their lungs
seemed to function normally according to the
spirometry test results.
Uncontrolled inflammation plays a role
in many major diseases, including cancer,
heart disease, diabetes and Alzheimer’s.
A new study by the University of Liver-
pool found diets rich in fruits and vegeta-
bles, which contain polyphenols, protect
against age-related inflammation and chronic
diseases. Polyphenols derived from onions,
red grapes, green tea and açai berries may
help reduce the risk of chronic inflammation.
Neutrophils are white blood cells that are
important for fighting infection. A type of
neutrophil behavior in the lungs of people
with COPD appears to reduce their ability
to destroy bacteria. It is hoped that detecting
this can identify those at risk of deteriora-
tion. Research might help doctors determine
which people are less likely to respond to
standard treatment and are at higher risk for
disease advancement.
The FDA has approved AstraZeneca’s
Bevespi Aerosphere (glycopyrrolate and
formoterol fumarate) for long-term main-
tenance treatment of airflow obstruction
in people with COPD. Bevespi Aerosphere
is an inhaled aerosol used twice daily in a
pressurized metered-dose inhaler.
University of Washington researchers
have developed SpiroCall, a tool that can
accurately measure lung function over a
simple phone call. With SpiroCall, you can
call a 1-800 number, blow into the phone
and use the telephone network to test your
lung function.
May/June 2016 www.pulmonarypaper.org 31
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Dedicated to Respiratory Care
Volume 27, No. 3May/June 2016
The Pulmonary Paper PO Box 877Ormond Beach, FL 32175 Phone: 800-950-3698Email: info@pulmonarypaper.orgThe Pulmonary Paper is a 501(c)(3) not-for-profit cor-poration supported by individual gifts. Your donation is tax deduc tible to the extent allowed by law. All rights to The Pulmonary Paper (ISSN 1047-9708) are reserved and contents are not to be reproduced without permission. As we cannot assume responsibility, please contact your phy-sician before changing your treat ment schedule.
The Pulmonary Paper StaffEditor . . . . . . . . . . Celeste Belyea, RRT, RN, FAARCAssociate Editor
Dominic Coppolo, RRT, AE-C, FAARCDesign . . . . . . . . . . . . . . . . . . . . . Sabach DesignMedical Director . . . . . . . . . . . .Michael Bauer, MD
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