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PulmonaryPaperDedicated to Respiratory Health CareMarch/April 2014 Vol. 25, No. 2

Inside:

Spring Cleaning Tips DE Save Your Energy

Oxygen Delivery Facts You Need to Know

Featuring 03 | Editor‘s Note

08 | Calling Dr. Bauer

09 | Fibrosis File

10 | Ask Mark

16 | Sharing the Health

30 | Respiratory News

Spring Things12 | Breathing … Rehab Style.

14 | Exercising with lung disease

21 | April Is Sarcoidosis Awareness Month

22 | Spring Cleaning

Your Health04 | Oxygen Q & A

07 | Reducing Stress

20 | Small Changes to Save Energy

24 | Oxygen Purity vs Oxygen Concentration

27 | CVS Drops Cigarette Sales to Public

For Fun28 | SeaPuffer Cruises Plan a vacation and leave your cares behind you!On the Cover: (L-r), Joyce, Ann and Joan, affectionately known as ‘The Golden Girls’, prove they still have it!

Marge and Gerry Gregory from The Villages, FL, celebrate 50 years!

www.pulmonarypaper.org Volume 25, Number 2

Table of Contents

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March/April 2014 www.pulmonarypaper.org 3

Editor’s Note

Hopefully when you read this, the very long, very cold winter weather will be over and Spring will be around the corner. Time to have fun! It’s okay to be silly, sometimes even more

than every now and then! On a recent Sea Puffers trip, people who normally go about their daily business coping with lung disease, got to let loose a little and some were amazed at themselves! Others were so used to it, everyone on the entire ship knew their name by the time we left. Step out of your comfort zone. Have fun by taking up a new hobby or activity and surround yourself with those who have a positive attitude and energy. Laugh a lot this Spring!

For over 25 years, we have been looking for ways to make your life with lung disease a little easier. With many new technologies available, we are working on determining your needs to develop specific tools that will support and motivate you to achieve your optimum state of health. I would truly appreciate your time and effort to complete the survey we have enclosed (also available online at www.pulmonarypaper.org). Everyone who responds by June 1, 2014, will be eligible to win an Apple iPad Air and a Nonin Onyx Vantage pulse oximeter! Now that’s fun!

“Fun is good.”

Dr. Seuss

Q What are the differences between indus-

trial and medical grade oxygen?

AThe vast majority of oxygen manufac-

tured and delivered in the United States

is USP-graded oxygen, meaning it is suit-

able for human consumption. This includes

industrial oxygen used in applications like

welding, and oxygen for use in aviation and

research. Regardless of the intended use of

the oxygen, each of these cylinders contains

at least 99.0% pure oxygen, the minimum

percentage allowed to be qualified as USP

oxygen. Any oxygen tank that does not have

“USP” on it should not be considered safe

for human use.

So why is there a distinction in grades?

Since each grade of USP oxygen is suitable

for breathing by humans, the differences

aren’t as much in the contents of the oxy-

gen tank as they are in the tracking of the

processes used to fill the tanks.

Oxygen is labeled as a drug and is regu-

lated by the FDA. Part of the requirements

set for medical oxygen involves tracking the

source and filling process for each tank of

oxygen. The cylinder is assigned a number

that helps track where and how the cylinder

was filled. Medical oxygen tanks, when re-

filled, are first vacuumed to remove any con-

taminants – rust, for example – that might

have accumulated in the tank. Then tanks

are refilled, the process is recorded for the

FDA, and the cylinder is shipped on its way.

Further tracking occurs by the home care

Oxygen Q&Aprovider before and after the tank makes its

way to the user’s household.

Industrial/welding oxygen cylinders do

not need to get vacuumed before refilling,

though this process may be completed any-

way. Research grade oxygen cylinders are

filled with 99.999% pure oxygen and thus

contain the purest form of oxygen available,

though you will likely not see this type of

oxy gen outside of lab settings. Aviation

grade oxygen is dehydrated to a point where

the low temperatures found at high altitudes

will have less likelihood of freezing any

water vapor present in the oxygen line that

could block flow.

So there are some differences in the

grades of oxygen cylinders,

yet as long as the oxy gen

cylinder is labeled USP

(and you trust where

it came from), you can

consider it to be safe for

human consumption. This

doesn’t mean I recommend

you supply yourself with

any USP-labeled oxygen.

On the contrary, with

medical grade oxygen –

a prescription drug, you

are assured the oxygen

in the cylinder meets

FDA requirements and is

traceable should there be an issue with its

delivery.4 www.pulmonarypaper.org Volume 25, Number 2

Q I am going to be traveling and have

oxygen needs greater than 3 Liters per

Minute (LPM). Is it safe to use the oxymizer

at a setting of 3 on a continuous-flow Por-

table Oxygen Concentrator (POC) during

flight or in the car?

A Yes. However, there are some things

you will need to consider before

determining if this is a viable option

for you.

For those who do not know, the oxy mizer

is a reservoir-style nasal cannula that can be

used with continuous flow oxygen. (Note:

You should never use the oxymizer on

devices operating in pulse-flow modes.) You

wear the device like a regular nasal cannula,

except the oxymizer has a large, approxi-

mately 20 mL, reservoir to store an extra

volume of oxygen as you are exhaling.

The oxymizer comes in a mustache or

pendant style (see photo). When you

breathe in, this extra volume is inhaled

along with the usual amount of con tinuous

flow oxygen, increasing the FiO2% (the

fractional amount of oxygen inspired in

that breath) in the air you breathe. (Please

see further explanation of this topic on page

24.) Using an oxymizer can help lower the

continuous flow you need to maintain your

oxygen saturation levels. Some high flow

users who use portable tanks can lower their

flow by as much as 2LPM.

With traveling, however, some other

issues need to be taken into consideration.

Current Continuous Flow (CF) POCs have

a maximum continuous flow setting of 3.

Using an oxymizer for the cannula can only

add approximately 20 mL of oxygen to the

inhaled volume, which limits the benefit

the product can provide. Anyone routinely

need ing 6 LPM or higher will likely not be

able to oxygenate with a POC at a setting

of 3 continuous and oxymizer cannula only.

Another possibility to get adequate flow

for your needs is to have two POCs linked

together to get up to a continuous flow of

6 and also use the oxymizer. This can cause

issues with portability and battery life.

It would work best when both POCs are

plugged into an electrical outlet.

CF POCs operating on battery power (as

would be required for flying) will deplete


Continued on page 6

Continuous Flow (CF) POCs Currently Available DeVilbiss Invacare Oxlife Respironics™ SeQual® SeQual® iGo Solo2® Independence SimplyGo Eclipse 5 eQuinox

6 www.pulmonarypaper.org Volume 25, Number 2

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Continued from page 5

their batteries’ charge significantly faster

than they would if operating in pulse mode.

At a setting of 3, CF POCs are lucky to get

an hour of operating time from one battery.

This means that long flights would require

several batteries – the FAA requires that you

carry enough batteries to last 1.5 times the

duration of the flight. Batteries can weigh 1

to 2 pounds each, so carrying several could

be an additional burden.

Also, keep in mind that the maximum

pulse settings on all current CF POCs range

from 84 mL to 96 mL, which are capable of

oxygenating those of you with needs in the

4 LPM to 6 LPM range, assuming you can

tolerate pulse flow delivery. Battery life

at these settings would be increased too,

compared to using a continuous flow of 3.

Additionally, the SeQual Eclipse 3 and 5

models (and the upcoming Equinox model)

have pulse settings of 128 mL, 160 mL and

192 mL, which have the potential to oxy-

genate those with needs in the 7 LPM to 9

LPM range, but have breath rate limits that

may make it difficult to remain oxygenated

at active breath rates.

Ryan Diesem is Research Manager at Valley Inspired Products, Apple Valley, MN. Contact Ryan at [email protected] with questions or comments.

Our annual review of Portable Oxygen

Con centrators will be in our next issue. Ryan

will compile all the latest facts

about units so you can com-

pare which one would best

suit your needs. There will

be a new player, the Sequal®

eQuinox from Caire, which is

the next generation of the Sequal® Eclipse. It

is being marketed as smaller and quieter than

the latest version of the Eclipse with a front

loading battery, but it still does not produce

higher than a continuous setting of 3.

When Helen from New Hampshire was

diagnosed with emphysema, she was given a

prescription for oxygen and an explanation

of how to use it. There was no explanation

of emphysema, she was only told she now

had to live with it since there is no cure.

Helen went into a depression, giving up

on any kind of future. With the help of her

husband, they began to find information

about living with lung disease and entered

a pulmonary rehabilitation program.

Helen thinks that there is a real need to

provide hope to a newly diagnosed person

with COPD, “It will be less frightening and

you will know it can be an acceptable way of

life with a real and satisfying future. It will

avoid the depression and panic I first felt!”

To Reduce StressChange how you see things. It isn’t the

stressful situation that causes the problem;

it’s your reaction and attitude to the

situation.

Organize your life. Eliminate unnecessary

activities. Do the most important and most

difficult tasks first.

Assess your skills. Are you utilizing all

your strengths?

Calm your sense of urgency. You are

not running a race but living a life. You

have only now to improve the quality of

the moment.

Pace yourself! Remember the fable of the

tortoise and the hare? It makes better sense

to pace yourself and keep going slowly,

rather than push through activities and have

to stop often to recover from shortness of

breath. Patience, persistence and pacing are

the keys to winning the race!

Escape for a while. We all need time

out to renew ourselves and gain a new

perspective.

Don’t try to be a “super person”. Give

the best of your effort and ability and

don’t feel guilty if you do not achieve the

impossible.

Consider a change in your diet. If you

use a lot of caffeine, sugar or have poor

nutrition in general, those can elevate your

level of tension.

Do something physical. Exercise

increases the level of endorphins in the

body, calms the mind and reduces tension.

Relax! Stress can leave you feeling

exhausted. Design your own personal stress

reduction plan – ever have a massage?

Beware of self-absorption. Consider how

often you use words like I, me or mine.

Consider yourself part of a team – whether

it be of family, friends or neighbors.

Keep it light! A man complained to his

physician that he woke up every night

screaming from one of two dreams. First

he would dream that he was a tepee, the

next he would dream he was a wigwam.

The doctor’s diagnosis? Relax … You are

just too ‘tense’!

Coping with COPD and

Reducing the Stress of a Chronic Illness



Dr. Michael Bauer

Calling Dr. Bauer …

Several readers have asked about the benefits of one “brand” of inhaler compared to another. We have a poster in each of

our clinic rooms that shows all of the inhalers on the market. This helps our patients tell us exactly what they are using at home. It’s hard to keep up, since every year or so there seems to be a new inhaler on the market.

International and national lung societies have published many guidelines for proper inhaler use. The broad outlines include when to use short acting bronchodilators (like albuterol), long acting bronchodilators, and/or inhaled steroids. Dosage strengths and frequency of use can be prescribed according to accepted standards of care.

The most variable aspect of inhaler use is the different delivery systems. The oldest inhaler is the classic “metered dose inhaler” or MDI that we puff once or twice into our mouth (or even better into a spacer). This delivers a small dose of a liquid aerosol. The other main delivery system is called a “dry powdered inhaler”. There are many versions of these inhalers. Some twist, some click and some twirl before each dose.

Several different drug companies/brands may all deliver the same medication. ProAir, Ventolin and Proventil are all the exact same albuterol medication! Often, the choice of inhaler boils down to patient preference. Proper technique is critical for adequate drug delivery to the lung. Some patients do better clicking and inhaling rather than squeezing and puffing. These days, some brands of the same medication are covered by an insurance company that may decline coverage of the same medication from a different drug company.

If it sounds confusing, it’s because it is! Most important is to use an inhaler you are comfortable with and that can reliably deliver the medication deep into your lungs! Your pulmonary doctor and respiratory therapist should be a good resource for further questions.

Question for Dr. Bauer? You may write to him at The Pulmonary Paper, PO Box 877, Ormond Beach, FL 32175 or by email at [email protected].


We have been following pharmaceuti-

cal company InterMune and its bat-

tle to get pirfenidone approved in the United

States. The drug has been available to

treat idiopathic pulmonary fibrosis (IPF) in

Europe, Canada, Japan, South Korea,

China, India, Argentina and Mexico where

it is known as

Esbriet. In a sur-

prise move in May 2010, the U.S. Food and

Drug Administration (FDA) denied approval

of pirfenidone, citing the lack of data to

prove its effectiveness in treating IPF and

asked for further clinical trials.

The results of the Phase 3 ASCEND trial

showed that after a year of treatment, 16.5

percent of patients in the pirfenidone group

experienced disease progression, around

half the level of those using a placebo. The

study also showed that 22.7 percent of

patients getting the drug experienced no

decline in lung function, more than double

the 9.7 percent seen among those taking the

placebo. Pirfenidone had a favorable safety

profile and was generally well tolerated.

InterMune will now resubmit its application

for approval of the drug to the FDA before

the end of the year.

Another pharmaceutical company, Boeh-

ringer Ingelheim, is also developing a drug,

Nintedanib (BIBF 1120), for treating IPF

and the company is expected to present data

from a late-stage trial of the drug sometime

this year. If the FDA approves the drug,

never a given, the earliest Americans will be

able to benefit is mid-2015.

Teresa Barnes,

VP, Patient Out-

reach & Program

Sup port for the Co-

alition for Pulmo-

nary Fibrosis, tells

us the organization’s

Daughters of PF

program launched

a campaign called

A Daughter’s Love.

Women all over the world are joining

in by posting a photo of their loved one

on social media inside a heart and telling

their stories about why they are a member

of Daughters of PF and how they want to

increase awareness of the disease. The group

has hundreds of women, most of whom have

lost a parent to PF, but a growing number

are joining who are wives, sisters, moms

and other family members of patients past

or present. Any woman whose life has been

affected by Pulmonary Fibrosis is invited

to join this group by visiting www.coali-

tionforpf.org or calling 1-888-222-8541,

Extension 702. The Daughters also have a

Facebook page.

Below is the Daughter’s Love heart Teresa

made in tribute to her father, Hollis Richard-

son, who succumbed to Pulmonary Fibrosis.

Fibrosis File

Teresa Barnes met up with Senator Mark Kirk from Illinois (who lost his father to PF) while she was in Washington raising awareness of Pulmonary Fibrosis.


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.

Ask Mark …

Brian from COPD Canada (www.copdcanada.ca) asks Mark if there are recommendations for indoor environments or air filter use for people with COPD. Mark advises, Indoor air quality is an ongoing and difficult issue that affects folks very individually. Where one lives, the local and immediate pollutants, allergens and weather seem to contribute much to the difficulties and resolutions that end up being effective. There is no blanket recommendation for what folks should do with regard to conditioning the air within the home, aside from restricting smoking of any kind and being careful with cooking smoke and odors, etc.

Generally, it is always recommended that during the winter, you should try to keep the humidity of indoor air higher than the weather will usually supply. Around 40% seems to be a good level. But, most folks don’t have suitable equipment to measure humidity. So, comfort has to be the litmus. On cold days, steamy windows indicate that the humidity is usually at least 40%, if not higher.

Some folks find it helpful to use an air filter of some sort, whether a HEPA placed in a central air/heat unit or a free-standing device. But, adequately filtering the large volume of air within one’s home is a daunting and difficult task. One can spend considerable money for less than a stellar return. Also, with many air filters producing ozone as a by-product, it can be a challenge to find a device that will not add that pollutant to the environment and counter efforts to improve air quality. So I make no recommendations in that regard.


JW asks if Mark if he could explain the association between COPD and anemia. He has low iron despite taking an iron pill daily and eating spinach and iron rich foods. Mark says, Anemia is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. The nor mal range for RBC levels is 4.4–5.9 mil/uL (millions per cubic millimeter) for men and 3.8–5.2 for women. Hemoglobin (Hgb) is the protein in your red blood cells that carries oxy-gen. A normal reading for men is 13–18 g/dl (grams per deciliter); for women, 12–15 g/dl. When you take your oximetry reading, it is read as a percent, which is the percent the hemoglobin is saturated with oxygen.

Hemoglobin carries 97% of our oxygen, and when we have anemia with a deficit of 10% or more, getting sufficient quantities of oxygen to the tissues becomes a challenge – one that increases the more severe one’s anemia is. Folks with anemia have a precarious relation-ship with regard to oxygenation. Your physi-cian may determine either a blood transfusion or medication to stimulate the bone marrow to produce more RBC or Hgb is in order.

Bottom line: Many people have low levels of red blood cells and hemoglobin and do just fine. The more advanced one’s COPD, especially if oxygen supplementation is required, the more consideration must be given to anemia and its consequences. Red meat is a good source of iron, enzymes and vitamins that help with anemia even more than supplements. Also eat foods that provide plenty of vitamin C, which helps your body better absorb the iron. Those who are anemic should be very sure to discuss their concerns with their doctor and get an

ade quate explan a tion that they are doing what can be done to either remedy the con-dition or keep the anemia stable and exerting the least negative influence possible.

Fred asks why after four months of using the Advair discus inhaler as prescribed, it burns his lungs when he inhales it. He takes it at night because that’s when a phlegm problem forces him to sleep just about sitting up.Mark replies, It certainly is possible that Advair is not the right medicine for you. But, in taking it only at night you are not taking it as you should. It is supposed to be taken twice a day and as close to 12 hours apart as possible. It is not sup posed to be taken for “phlegm control” though it should help reduce phlegm over time. There is a possibility that part of your difficulty with it is because of the once-a-day dosing pattern.Ask your doctor if you can try Symbicort and about taking Spiriva, another very COPD-specific med that could help with phlegm.

Iron Rich Foods to Add to Your Diet• Red meat• Egg yolks• Dark, leafy greens • (spinach, collards)• Dried fruit (prunes, • raisins)

• Iron-enriched • cereals and grains

• Mollusks (oysters, clams, • scallops)

• Turkey or chicken giblets• Beans, lentils, chick peas, • soybeans

• Liver• Artichokes


Love stories are like that …A heart fluttersSmiles brighten

And songs speakOf “taking one’s breath away.”

A sure sign of true love

And long marriagesAnd love storiesBringing hope

Of life’s happy endings

COPD is not quite like that …Oxygen tanks and hoses

Scar tissue, damaged lungsAnd respiratory therapists speak

Of how “to breathe better”

Pause, relax and breathe …Think of favorite places

Calm the inner selfPrioritize how to spend one’s energy

And breathe, breathe, breathe …

The secret lies in the methodThe technique of releasing CO2Making room for more oxygenAnd the strangle hold of COPD

Begins to lose its grasp …

Modern technology is wonderfulProviding those of usThe proof we seek:

A concrete oxygen saturation percentageOn the magic finger oximeter

No longer is there a doubtClearly the red blood cells

Are or are not carrying sufficient oxygenTo our internal organs

A job they must do to sustain life

Enter “pursed lip breathing”…Smell the roses and blow some

beautiful bubblesTake a deep breath in through the nose

Slowly exhale through the pursed lipsAnd lo, those wonderful life-saving

bubbles can appear.

Who hasn’t loved a bottle of bubbles?Hours of childhood play can be had

Trying for perfection:The biggest bubble, blown with patience,

That would float ever so long before bursting …

Perhaps, therein is the clue:

Childhood wonder and childhood patience –

No “instant skill” at pursed lip breathingNo “instant acceptance” of even doing it

But trying nevertheless …

Life is really a series of “nows”And appreciating each moment

As we live it.When once we sang,

“You take my breath away”Today may be a day for a new song

The verses are unique to each of us

The diseases that brought us this song, our own

But the chorus remains the same:“Purse your lips, blow the bubbles

And find fulfilling breath for life today.”

Thank you, dear respiratory therapists, at Pulmonary Rehab for being so patient and kind and helping even us “willful

children” to learn this new way

to breathe for a better life.

Breathing … Rehab Style

Louise JonesReading, PA


Closer Look..Take a

Toll Free 877-699-8439

www.oxyview.com

Are you receiving

Your oxygen

Discretely?


People often wonder why they are less

short of breath after they begin an

exercise program. Shortness of breath during

activity isn’t a matter of air supply as much

as the blood supply to the muscles. When

you exercise, the heart pumps more blood

and the lungs take in more air to meet the

muscles’ increased oxygen demands. The

carbon dioxide given off by the working

cells also has to be removed.

Getting Fit Feels Good!During an unaccustomed increase in

activity, the heart and lungs temporarily

can’t deliver enough oxygen to the muscles.

The muscles then burn carbohydrates

anaerobically (meaning without oxygen) and

produce lactic acid – which is what causes

the “feel the burn” sensation. More carbon

dioxide is produced and you breathe faster

to expel it. The result is shortness of breath.

If you stay with your exercise program,

you will become fit and will accumulate less

lactic acid at a given level because you have

raised the threshold! That means you have

raised the capacity of your heart and blood

vessels to deliver oxygen to your muscles.

Your training also enhances the ability of

muscle fibers to use oxygen.

Your breathing will improve over time

when you continue your exercise routine.

When you start, your breathing will

probably be quick and shallow. The more

you train, the more efficient your breathing

becomes. You will find a deeper rhythm

that suits your activity. Not only will your

breathing improve, exercise can lower your

blood pressure, improve the way your body

metabolizes fats and lower your cholesterol.

Diabetic patients may metabolize glucose

better and be able to lower the amount of

insulin needed. Your resting heart rate may

also be decreased.

Best Exercises to Do with COPD Try adding some of these to your daily

activities! The universal exercise of walking

always works and can be more enjoyable

with a friend – the two or four-legged kind.

Even if it is for just five or 10 minutes a

day at a slow pace, you will feel a sense of

accomplishment. Try and add a little bit

more time each day.

Getting out in the garden this spring not

only keeps you active but you can see some

beautiful results!

Strengthening Exercises With these strengthening exercises, try

doing them ten times. Work yourself up to

resting afterwards and then trying ten more.

Arm curls: Arm curls

usually done with

dumbbells or weights

in the gym, but can

also be done at

home with cans

of food for the

weights. They

will strengthen

your arm

muscles and

make carrying items

easier.

Moving to Improve Fitness Levels

Exercising with Lung Disease


Forward arm raises: Hold the small

weights at your side with your palms facing

in and lift them straight up in front of you.

Calf raises: Stand behind a chair, using

it for balance, and lift yourself onto your

toes. As you get stronger, try lifting yourself

on one leg.

Leg extensions: Sit down and extend

your leg straight out until it’s parallel with

the floor.

Water aerobics: If you have access to a

pool at home or at a center, exercising in a

pool will be easier on your joints.

Tai chi: The gentle movements of tai chi

tone muscles and help you relax. Seek a class

or a video to learn the moves.

Biking: Pedal at your own pace. Some

people start on a stationary bicycle using just

one leg and letting the other one rest. Once

you have built up your strength, challenge

yourself to go just a little bit longer.

Activities to Engage Your Mind!Join a book club or potluck supper

group. It’s an easy way to socialize with friends without all the work usually involved.

.

Write a long letter or call an old friend or classmate that you have lost touch with over the years.

.

Take a class in a subject that has always interested you. Gourmet cooking, interior design, a foreign language, writing, the possibilities are endless.

.

Take up a new hobby..

Do something thoughtful for someone else. Make a casserole for a friend, send a batch of cookies to a college student or neighbor.

.

Tour your city like you were a visiting tourist. You just may learn things you never knew before! Contact your local Visitors Bureau for ideas, then set out for a new adventure.

.

Consider adopting a pet from a local shelter. If you would be able to care for an animal, you not only will be able to save their life but bring joy and companionship into your home.

Sharing the Health!


Joy Recla of Jacksonville, FL, recom-

mends using probiotics to avoid thrush – an

infection of your mouth that can be caused

by oral steroids as Advair. (This is in addi-

tion to the important “rinse and spit’ rule of

rinsing your mouth and spitting after using

the inhaler!)

Probiotics or “good bacteria” are live

microorganisms, similar to those found in

the human intestines. Using probiotics may

make it harder for bacteria that cause illness

to grow in your system. They are found in

yogurt that lists “live and active cultures”

on the label.

Jean S. of Massachusetts uses a straw to

drink all liquids – coffee, tea, soups, even

oatmeal, and think she saves a lot of energy

doing it! Jean thinks it is very important to

keep a sense of humor as we go about our

lives with lung disease and hopes to give a

smile to everyone she meets.

Living in Florida, I have a grapefruit tree

in my back yard and can walk out in the

morning and have my pick. I have been told

not to drink grapefruit juice at all since I am

taking medications. My neighbor told me the

grapefruit reacts with many drugs so that I

do not get the effects that the drugs are sup-

posed to give me. My physician confirmed

that drinking one glass of grapefruit juice in

the morning could still cause the interaction

with absorbing the medication up to 24

hours! Sadly, I have had to give away my

crop but got smiles from my neighbor!

Bill K., Ormond Beach, FL

Editor’s note: The NIH Senior Health

web site offers a great explanation of how

medications work in the body at http://

nihseniorhealth.gov/takingmedicines/drugs

inthebody/01.html

Do we have a potential new spokesperson? Leonard Nimoy,

Star Trek’s super smart Dr. Spock, recently revealed he has

COPD. Now 83 years old, he says lung problems have been

slowing him down. Leonard very wisely stopped smoking

30 years ago.

Live long and prosper, Dr. Spock!


My grandchildren are teaching me the

ways of the Internet, cell phones and con-

necting with others. At first, I resisted and

now couldn’t be more thrilled! I don’t feel

so isolated any more.

In case you haven’t found www.Etsy.com

it is a great place for unique items to perk

you up. If you search for

oxygen, you will find

an oxygen tank lamp,

many different

styles of covers

for your portable

tanks and a card

with an oxygen

tank that says

‘Thanks for the

8

OOxygen15.999

Jim Nelson’s article in our last issue about

being reluctant to be seen in public with oxy-

gen generated a lot of comments! Burt Bacher

of Peoria, AZ, has a solution that has worked

for him, “Simply stare right back and smile!

Gets them every time!”

Burt tells us he was having coffee with two

friends from his pulmonary rehab program

who were both using oxygen via cannulas

that were partially hidden by their goatees.

A mom came in with her seven- or eight-

year-old in tow. Seeing us sitting there with

our cannulas, she obviously was thrilled that

she could provide a real life lesson in health

habits for her daughter. The mom says, “See,

Mary, look at what hap-

pens to you when you

smoke.” The little girl

replied, “Yes, Mommy, I

see that when you smoke

you get a beard!” Keep

smiling!

You can find asthma and allergy friendly

products and services at www.aafa.org/

certified, the Asthma and Allergy Founda-

tion of America’s website.

The certified catego-

ries are air cleaning de-

vices, bedding, cleaning

products, flooring, vacu-

um cleaners, paints, toys,

washing machines, AC/

furnace filters. Profes-

sional carpet steam cleaning services are

also listed on the website.

Fresh Air!’ How about making your tank

into a horse or a dog?

A t-shirt with the

oxygen symbol from

the periodic table

of elements says

‘Can’t Live with-

out You!’ Another

one says, ‘I Am in My Element!’

Search for ‘Breathe’ and you will have a

lot of fun seeing how you can put a light side

on chronic lung disease!

Donna B.

Honeoye Falls, NY

Anyone using Metamucil knows it can

produce bloating and gas, which makes

breathing very difficult. I use psylium cap-

sules from the health food store that seem to

work better. When I eat foods that cause gas,

I use a product called Beano that also helps.

Lisa H., Phoenix, AZ

Sharing the Health! continued


Lois from Minnesota doesn’t go anywhere

in her house without her trusty reach ex-

tender to pick up items on the floor or on

high shelves that she can’t reach. She

also uses a set of sliders underneath her

furniture to easily move the pieces when

cleaning.

I was having a problem with getting an

irritation in my throat and being unable to

stop coughing. Hard candy in my pocket

has saved me more than once. I also bought

a travel size bottle of mouthwash and fill it

with water when I go out. It is not heavy to

carry and the small drink is often enough to

quiet the cough. K. Everson, Iowa

Ilsa from Connecticut thinks when she

starts her day, running cold water over a

washcloth and putting it up to her eyes is a

great way to wake up. But when her nasal

passages and sinuses get stuffy, she puts a

very warm washcloth on her face and nose

to relieve the congestion.

Margo Harris from Washington has a

list of positive changes and she intends to

accomplish at least one item on it every day

this Spring!

Ask for Help

Do It Differently

Commit to Commit

Compliment Somebody

Extend Myself

Forgive Myself and Others

Use My Helping Hand

Laugh Out Loud

Learn Something New

Look Within

Visit Mother Nature

Relax

Sing a Song

Share A Secret

Thank Someone

Write My Life Story

Most of us have been on prednisone

during our course of treatment for lung dis-

ease. It makes our skin thin and very easy to

tear and we end up with purple blotches on

our arms and legs. Rubbing the area with a

moisturizing lotion as soon as possible after

bumping it, makes the bruise goes away

sooner. C.B., New Mexico

I have hints for the men who cope with

COPD! I organize all my respiratory medica-

tions and needs in a tackle box that I decorate

with stickers from my favorite sports team.

A urinal at my bedside helps save steps

during the night to the bathroom.

I use an electric shaver instead of foam and

a razor. I do not use oxygen.

We throw our toothbrushes away at the

beginning of each month and if one of us has

any kind of infection.

My shirts all button down the front. Trying

to get pullovers on takes my breath away.

Play out the hand you’ve been dealt the best

you know how. I have seen a small pair turn

out to be a pretty good hand!

Lou W., York, PA


Try and Relax!The JAMA Internal Medicine published

a review that found meditation may be as

effective as taking anti-depressants in

helping to reduce anxiety, depression and

pain. Meditation is focusing 100% of your

attention in one area. It takes practice

to clear your mind of your worries and

concerns. It will also be a good time to do

your pursed lip breathing!

• Sit in a comfortable position in a quiet

room. Don’t lie down.

• Systematically tense and relax your dif-

ferent muscle groups. Each time, feel the

tension and then enjoy the relaxation, the

light feeling and return of blood flow to

the muscles. If one part of your body is

still tense, repeat the process.

• While you are contracting your mus-

cles, slowly count one one-thousand, two

one-thousand, three one-thousand to your-

self and relax for a slightly longer count.

Pursed lip breathing would be ideal!

• Start by making a fist with each hand to

your count and then relax.

• Bend the arm at the elbow and tense your

upper arm on each side.

• Grasp each shoulder with the opposite

hand and pull, and you will feel the tension

in your lower arms.

• With your feet flat on the floor, push your

toes away and the top of your feet will

tense up.

• If you curl your toes upward, you’ll pro-

duce tension in the front of the shin.

• Squeeze the buttocks together.

• Push the abdomen out as your breathe in.

• Arch your back and put your shoulders

back, this will produce tension in your

back.

• Contract your abdominal muscles.

• Bite down with your teeth, clenching the

jaw and then allow the mouth to fall open.

• Push your tongue on the roof of your

mouth.

• Wrinkle your forehead and nose.

• Grimace, pulling your lips back and tight-

ening your mouth.

• Feel as though you are floating on a cloud

and think of your own secret word that

means “calm” to you. Repeat it in your

mind.

Ahhhhhhhhh! Feels great, doesn’t it!


• Excess humidity can make it tougher to

breathe, use warm water rather than

hot, leave the bathroom door open, turn

on exhaust fans and open a window if

possible.

• Raising your arms takes a lot of ener-

gy! If washing your hair is difficult,

ask someone to do it for you. Use a

long-handled brush or sponge for your

back and feet.

• Use your oxygen in the tub or shower –

drape the tube over the shower rod or

side of the tub.

• Dry off by wearing a long terry cloth

robe and blotting rather than rubbing

with a towel.

• Installing grab bars, not only in the

shower but also near the toilet, can give

support when you rise. A raised toilet

seat helps too.

Grooming

• Ladies that have a simple hairstyle won’t

have to raise their arms for a lot of blow

drying and styling.

• Sit in front of the mirror when shaving

or applying makeup.

• Avoid products that are aerosolized or

heavily scented. Perfumes and colognes

may also make it more difficult for you

to breathe.

Small Changes Can Help A Lot!Even though COPD can not be cured

today, you can make life style changes that

will stabilize and slow the progression of

your disease. Vlady Rosenbaum of COPD

Alert (www.copdalert.com) shares ways to

conserve energy when you have lung disease.

Bathing

• People find a pump soap dispenser or

“soap on a rope” makes life easier when

showering. Instead of standing in the

shower, use a bath stool. A towel over

the chair will keep water from bouncing

and the soap dispenser from slipping off.

• Turn around and face away from the

water source and it will reduce breath-

ing discomfort. A hand-held shower

extension eliminates the water overhead

altogether.

• Keep a water squeegee inside the shower.

Before you get out, use it on the glass

door if you have one. This keeps water

from accumulating and turning into

mold.

• Have safety strips put on the floor of

your tub or shower to prevent falls.


Dressing

• Keep your clothes in drawers and closets

that don’t re quire you to bend or reach.

• Plan ahead and lay out tomorrow’s

clothes the night before.

• Avoid tight-fitting clothing that can make

breathing difficult. Men can wear sus-

penders instead of belts, and women can

wear undershirts or camisoles instead of

regular bras.

• Stay away from tight socks or stockings

that can restrict circulation.

• Wear slip-on shoes instead of those you

tie. A 12 to 18 inch shoehorn can also

make it easier to put shoes on.

• Sit while dressing. Put underwear inside

your pants and pull both on together.

• When you wash clothes, if you have

someone raise the washer and dryer on

an 18-inch platform, it will save you

from bending over to take the clothes

out. They are easily made and also

available for purchase where you buy

your appliances.

Sarcoidosis is a disease of inflammation

and fibrosis (scarring) that can affect almost

any organ in the body, the lungs are the

most frequently involved. The scarring and

inflammation associated with sarcoidosis

may involve other organs including the skin,

eyes, heart, kidneys, and occasionally, the

nervous system.

The cause of sarcoidosis is unknown, but it

is felt to result from alterations in the body’s

immune system which defends you against

harmful substances. Normally inflammation

occurs during the response of fighting off the

substance and afterwards, the inflammation

should go away. When it doesn’t, the cells

may form in clumps called granulomas and it

is this scarring that causes the trouble. They

may cause you to wheeze and cough, be short

of breath, feel tired or many people can be

entirely without symptoms!

Sarcoidosis is not a form of cancer and

is not caused by smoking. It seems to occur

most frequently in persons between the ages

of 20 and 40 years. Genetics may play a

April is Sarcoidosis Awareness Monthfactor. The disease is more common in Af-

rican Americans and Northern Euro peans.

Approximately one million individuals

worldwide have sarcoidosis.

Sarcoidosis is often detected by abnormal

chest x-ray that may show enlarged lymph

glands within the lung. Fortunately, the ma-

jority of patients with sarcoidosis have quite

limited disease and spontaneous remissions

occur in many. Only a small portion of peo-

ple develop progressive scarring with loss

of lung function and other organ damage.

Prednisone is often the main medication used

in treatment.

Find more information about sarcoidosis

through these organizations:

Foundation for Sarcoidosis Researchwww.stopsarcoidosis.org1-866-358-5477

Bernie Mac Foundationwww.berniemacfoundation.org 1-312-291-4493

Sarcoid Networking Associationwww.sarcoidosisnetwork.org1- 541-905-2092


Spring is the time of the year to open up

the windows and let the fresh air in.

It is the time to clean up accumulated

clutter and donate things we don’t use

or want anymore. You will feel so good

afterwards! We have gathered tips to make

the task a little easier.

Around the HouseTake your bronchodilators before you

start and wear your oxygen. The tasks

do not have to be done in one day – pace

yourself. Don’t start something right after

a big meal – your digestive system will be

using oxygen!

Gather supplies in an easy-to-carry basket

so that you won’t have to keep going back

and forth to the storage closet to get things.

If you have two floors in your house,

duplicate the basket of supplies and keep

one on each level.

You might want to wear a simple dust

mask if an area is very dusty.

Aerosols used for cleaning may be irrita-

ting to your lungs. Using one teaspoon of

liquid soap and one teaspoon of baking soda

in one quart of water might also save you

money. A damp cloth might work and you

can also purchase microfiber cloths which

pick up the dust without releasing it into the

air like a dry rag would. When you are done,

toss them in the washer and dryer to clean.

Change the filters on your air conditioners

and vents throughout the house.

Purchase a vacuum with a HEPA-filtered

or micro-filtration system. Walk with the

vacuum cleaner rather than pushing it with

your arms.

My dustbuster is great for quick picks up

rather than dragging the vacuum out. I also

use it to vacuum the filters on my oxygen

concentrator, rather than washing, drying

and reinstalling them.

Don’t forget to clean the blades of your

ceiling fans and baseboards often with warm

soapy water. Use long-handled tools so that

you won’t have to stretch and reach.

When you have to pick something up

that is heavy, use your legs to crouch down

instead of bending over as you do when you

tie your shoes. Keep the object close to your

body when rising back up.

Let the sun shine in!

Spring Cleaning with Lung Disease


Cellphones, your computer mouse and

keyboard, and the television remote should

be cleaned often.

Around the KitchenKitchen cloths, sponges, faucets and

your bathtub and shower walls have been

identified as the places in your home that

have the most germs. If you warm white

vinegar in the microwave, spray it on the

surfaces and let sit for five minutes, it will

help get rid of the dirt.

Use a pump soap dispenser at the sinks

instead of a soap dish to eliminate messy

cleanup.

Plants Gather Dust TooIndoor plants such as peace lilies, spider

plants, Boston ferns, weeping figs and

philodendrons may act as air purifiers and

will add color to your home. Dust them

periodically too.

Basements Get Water DamageWhen you get to the basement, look for

any water damage from leaks to get them

dried out and repaired. If you find any mold,

use hydrogen peroxide, white vinegar or a

chlorine bleach solution while wearing your

mask. A dehumidifier will prevent excessive

humidity (no more than 50 per cent relative

humidity in summer and 30 per cent in

winter). You can measure humidity with a

hygrometer, available at home supply stores.

Time to Reorganize TooSpring is a good time to reorganize as well

as clean. Move your most used items in your

closets and kitchen cabinets so that they

are easily reached, between your waist and

shoulder levels, so that you won’t have to

reach or bend over. You may need to hang

shelves. Your bathroom items will be easily

accessible if you put them in a basket on

the counter. Have someone help rearrange

your furniture so that you won’t have to

crisscross around the room.

You may have had your comfy chair

for many years but is it good for your

breathing? Are you slouched in it? If so,

you may not be allowing your diaphragm

to expand. Does it have lumbar support for

your lower back?

And Readjust an OutlookDoes your attitude need a little refreshing

this spring? A lady diagnosed with COPD

did not want to admit it. She recently agreed

to use her oxygen and included her family

in her decision-making saying, “We are all

in this together.”

She didn’t want to be seen in a wheelchair,

even though it would make life easier if her

daughter pushed her around the mall instead

of walking at a slow pace and stopping

often. Remember Marge’s Rule, “Swallow

Your Pride and Take the Ride!” You will be

able to visit a lot more stores and not be so

short of breath doing it if you do!


Oxygen users find themselves

confused between the

“purity” of oxygen and

the “concentration” of

oxygen. The terms are

often used interchangeably.

If we use the decade of the 1960s as

the beginning of our timeline for bringing

oxygen into the home, we have somewhere

around 50 years of home oxygen experience.

The majority of patients of that era were

most certainly on cylinder oxygen, as the

oxygen concentrator and liquid oxygen were

still a decade or more away from widespread

acceptance. Oxygen cylinders for home use

were big, heavy and difficult to store, but

they did provide oxygen that was rated at

99.99% pure. Even the earliest liquid oxy-

gen systems provided at least 99.0% pure

oxygen at the outlet. This was determined

to be “medical grade” oxygen. Early oxygen

prescriptions were almost certainly written

for 2 L/min (liters per minute) with little

vari a tion. A rare pulmonary pioneer (like

Dr. Tom Petty) might have instructed a

patient to increase the flow rate by 1 L/min

with activity, but generally you were on

2 L/min under all conditions for as long as

you were on oxygen.

This was due in large part to the belief

you would knock out your drive to breathe

if you turned up your oxygen. We have since

debunked much of this theory, at least in how

prevalent or dangerous it really is. Another

thing that is easy to overlook is there was

simply no affordable finger pulse oximeters

available at that time. Today you can get

them at very reasonable prices. All oxygen

users can now carefully titrate their oxygen

flow rates to keep them well saturated

under conditions of both rest and activity.

A routine order from your pulmonogist will

have your oxygen company do an overnight

oximetry study to

monitor your

oxygen satura-

tion while you

sleep. In many cases

a patient is sur prised to

learn that they actually need

more oxygen at night while they are

do ing absolutely nothing, than they do when

they are up and around during the day!

Percentage of Oxygen DeliveredLet’s review liter flow of oxygen and the

actual percentage of oxygen that is delivered

to the lungs. For a very long time now,

pulmonary clinicians have been following

this guideline – for every one liter of oxygen

per minute via nasal cannula, there is about

a 4% increase in the amount of oxygen

getting down to the lungs. Remembering

that room air has 21% oxygen, it is simple

math to continue up the scale as follows:

1 Liter per Minute equals 25% oxygen.

2 Liters per Minute equals 29% oxygen.





(These numbers are not exact, but they are close

enough for purposes of this discussion.)

What is the difference?

Oxygen Purity versus Oxygen Concentrationby John R. Goodman


Flows above 6 L/min via standard nasal

cannula with just a bubble humidifier are

pretty difficult for most patients to tolerate

24 hours per day. At this point either an

expensive heated humidification system

needs to be considered, or perhaps the

patient is advised to wear a simple oxygen

mask. As underlying lung disease progresses

and higher flow rates become necessary,

many patients consider transtracheal oxygen

for its improved comfort and efficiency.

These percentages are actually fractions,

the medical abbreviation is FiO2, where

the (F) stands for fraction the (i) stands

for inspired and the O2 is for oxygen.

Altogether we get the fraction of inspired

oxygen. The numbers listed above assume

that the source oxygen was of medical grade

or 99%+ pure.

So why does the FiO2 which starts

out at near 100% at the cylinder outflow

connection, drop all the way down to

around 30% at 2 L/min by nasal cannula?

Simply picture yourself with your nasal

cannula set at 2 L/min, taking in a simple

breath and exhaling normally. This is called

your Tidal Volume and al though it differs

widely based on sex, age, and height, we can

give a range of 350 cc to 500 cc per breath.

So even though you may have 99%+ oxygen

flowing out of the prongs of your nasal

cannula, you are diluting it with several

hundred ccs of room air that contain just

21% oxygen with every breath.

Other Factors Affecting FiO2There are other factors such as your

respiratory rate, and the difference in the

time it takes to inhale and exhale, and the

amount of space taken up by your mouth,

nose and throat. But when we take all the

variables into effect, the net result is a very

substantial decrease in your FiO2. As long

as the liter flow you are using keeps your

saturation in the normal range, you are

good to go.

When the very first concentrators were

intro duced to the market, they were very

big, very noisy, used a great deal of

electri city, usually couldn’t generate

any more oxygen than 3 L/min, and

could not generate the 99.9% “pure” oxygen

like oxygen cylinders and liquid oxygen

systems produced.

About this time the

term “purity” began to

be used to describe the

amount of oxygen that

could be manufactured

or generated by this new

revolutionary technology.

This purity figure was

usually somewhere be-

tween 90% and 95%.

Continued on page 26


Purity and Liter FlowPurity has always been inversely related

to liter flow. That is, as liter flow went up,

oxygen purity (or the FiO2) dropped. The

question is what is the clinically acceptable

lower limit to purity? The answer is we

don’t know! Some of the very latest models

of portable oxygen concentrators (POCs)

have been extensively studied. Depending

on the variables, the purity of at least one

current POC was down around 87% with

the range being 87% to 96%. The general

opinion seems to be that it is not clinically

significant. I say it only has to be clinically

significant to you. Clearly we need to study

this scenario in detail.

What Does This All Mean? This means that what might work

acceptably for one oxygen user, might not

even be close for another. And to bring this

full circle, you can see where pulmonologists

and respiratory therapists like myself put

so much emphasis on using your pulse

oximeters so that you are not just adequately

oxygenated to a saturation of somewhere

a little north of 90%, but saturated to

whatever saturation is normal for where

you live, work and play. This could be in

the 96% to 98% range at or near sea level

to between 94% to 97% in Denver or other

cities at altitude. No one knows your body

better than you, especially regarding your

oxygen therapy.

One Size Doesn’t Fit AllOne thing we know for sure, there is no

such thing as “one size fits all” when it comes

to oxygen therapy at home. It took many,

many years of trial and error before this

important observation came to be accepted

by the pulmonary community at large. Ask

questions, get on the treadmill whenever

you can, pay attention to nutrition, check

into local pulmonary rehab programs. Take

control of the things you can control, but

don’t ever let your lung disease control you!

John R. Goodman BS RRT is Executive Vice President of Technical /Professional Services at Transtracheal Services, Denver, CO, who says “All You Need Is Love!”

Continued from page 25

With both personal and pro fessional experience with

liv ing with oxygen and lung disease, John has

a way of making a wide variety of complicated topics

understandable to all!

To order The Hypoxic Club, which is dedicated to

John’s niece Litta pictured on the cover, please send $15

(includes all shipping and handling charges) to:

John Goodman, TransTracheal Oxygen Systems14 Inverness Dr. East, Suite H-100, Englewood, CO 80112


Want to live longer? Look better? Breathe easier and improve your quality of life?

What are you waiting for?

Talk to your doctor about the Benefits of Transtracheal Oxygen Therapy:

Improved mobility Greater exercise capacity Reduced shortness of breath Improved self-image Longer lasting portable

oxygen sources Eliminates discomfort of the

nasal cannula Improved survival compared to the

nasal cannula

Haven’t you suffered long enough?

Ask your doctor about TTO2

For information call:

800-527-2667 or e-mail [email protected]

Congratulations to CVS Pharmacies who

made the bold decision to stop selling

cigarettes to the public, giving up millions

in revenue. Wanting to be seen

as a source to go to for your

healthcare needs, it certainly did

not make sense to sell a known

cancer causing product.

We went into another drug store soon

after the announcement, that had placed

stop smoking brochures near the front

door. It doesn’t exactly have the same effect!

Many State Attorneys General are asking

other large pharmacy chains, as Wal-Mart,

Walgreens, Rite-Aid, Safeway and Kroger, to

stop selling tobacco products at their stores.

We can only hope they follow the leader.

CVS No Longer Selling Cigarettes to PublicWe have all heard of second hand smoke

that people around a smoker are subjected to

inhale. Harvard Medical School Researchers

have identified what they call “third hand

smoke” – toxic particulate matter left behind

after a cigarette is smoked. It can be found

on your clothes, hair, furniture, rugs and any

place in the vicinity of the smoker.

Third hand smoke is of particular danger

to infants who

may crawl on

the rugs

and bury

their face

in your

hair or

clothes.


PLAN YOUR WORRY-FREE VACATION.

CALL TODAY!

OH, THE PLACES YOU’LL GO!AND THE PEOPLE YOU’LL MEET!

Join the Sea Puffers on one of our group cruises escorted by respiratory therapists!

Call 1-866-673-3019 to also arrange

your own cruise or tour!

Visit www.seapuffers.com for more information!


FST–

ST39

068 Member

Our annual trip to Alaska is on the Grand Princess, sailing from Seattle on July 20–27, 2014.

ALASKA

Enjoy 10 days of Spring on the Legend of the Seas, leaving round trip from Fort Lauderdale on March 20, 2015.

SOUTHERN CARIBBEANTake an incredible 14-day journey round trip from Amsterdam, leaving May 20, 2015, on Holland’s small ship, ms Prinsendam.

KIEL CANAL & BALTIC

Experience Fall in style! Board RCI’s Jewel of the Seas, round trip from San Juan, Puerto Rico, sailing October 18–25, 2014.

SOUTHERN CARIBBEAN

OH, THE PLACES YOU’LL GO!AND THE PEOPLE YOU’LL MEET!

Start the New Year right with a 7-day cruise on the Grand Princess, round trip from Los Angeles January 17, 2015.

MEXICAN RIVIERA

Additional 2015 Cruises include: July–Alaska Cruise/Tour of Denali National Park

September–California Coastal Cruise

October–Panama Canal

Watch for details!

2014 CRUISES

2015 CRUISES


Respiratory NewsTo keep up on the latest pulmonary

news, click on the link on the home

page of www.pulmonarypaper.org.

Stay active! A

Spanish study shows

people with COPD

who decreased their

activities or did not exer-

cise at all were associated

with a subsequent increase

in hospitalizations for exac-

erbation (worsening) of their

disease. The results were re-

ported online in Respirology.

The associations were indepen-

dent of age, lung function and

prior hospitalizations for exacer-

bations. Researchers suggest that

small changes in physical activity

habits could significantly improve

important outcomes.

Research has revealed COPD increases

risk for mild cognitive impairment (MCI), a

stepping stone to dementia. A recent Mayo

Clinic study found that people with COPD

are twice as likely to develop MCI that in-

cludes memory loss. MCI is a stage between

normal cognitive aging and dementia. Like

COPD itself, if you can identify risk factors

early on and find interventions, the cognitive

loss can be delayed.

The antioxidant supplement N-acetylcys-

teine, used to treat an overdose of acetamin-

ophen (Tylenol), breaks up thick secretions

as Assist, Mucomyst or Mucosil. It is sold

as a nutritional supplement to protect the

liver and was found to cut acute exac-

erbations of COPD by 22 percent in the

Chinese PANTHEON trial.

A vaccine that has been used against

childhood infections, Prevnar 13 from

Pfizer, Inc., has been found to prevent

pneumonia outside of hospitals in people

age 65 and older. A very large 85,000-

patient study called CAPiTA, showed

that Prevnar 13 prevented infections of

Streptococcus pneumonia. The FDA esti-

mates 300,000 adults aged 50 and older

are hospitalized every year because of

pneumococcal pneumonia.

New treatments for emphysema and

chronic bronchitis are a step closer thanks

to research that pinpoints why existing drugs

are ineffective. Scientists in Edinburgh, Scot-

land, have found that glucocorticoid drugs

(as prednisone) can be ineffective because,

at inflammation sites, there is not enough

oxygen for the drugs to function efficiently.

Treatments that are less reliant on oxygen

supply are therefore more likely to be effec-

tive, researchers said.

Make sure you let your primary doctor

know all the medications that you are tak-

ing, even if another physician ordered them!

Researchers in Connecticut and Oregon

found that 22.6 percent of study participants

received at least one medication that could

worsen a coexisting condition.

March/April 2014 www.pulmonarypaper.org

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The

PulmonaryPaperDedicated to Respiratory Health Care

Dedicated to Respiratory Care

Volume 25, No. 2

March/April 2014

The Pulmonary Paper PO Box 877Ormond Beach, FL 32175 Phone: 800-950-3698Email: [email protected]

The Pulmonary Paper is a 501(c)(3) not-for-profit corporation 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 physician before changing your treat ment schedule.

The Pulmonary Paper StaffEditor . . . . Celeste Belyea, RN, RRT, AE-C, FAARC

Associate EditorDominic Coppolo, RRT, AE-C, FAARC

Design . . . . . . . . . . . . . . . . . . . . . Sabach Design

Medical Director . . . . . . . . . . Michael Bauer, MD

The Pulmonary Paper is a membership publica-tion. It is published six times a year for those with breathing problems and health profession-als. The editor encourages readers to submit information about programs, equipment, tips or services.

Phone: 800-950-3698 • Fax: 386-673-7501www.pulmonarypaper.org

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