the paper pulmonary

OK to Kayakwith Oxygen!Also inside:Pulmonary Hypertension: Part 2Calling Dr. BauerSharing the Health

OK to Kayakwith Oxygen!Also inside:Pulmonary Hypertension: Part 2Calling Dr. BauerSharing the Health

Dedicated to Respiratory Health Care www.pulmonarypaper.org • Volume 22, Number 5

PaperThePulmonary

September/October 2011

My friend Kerry, who lives inWashington, DC, borrowed

her husband’s car and was stoppedat a red light last month when thecar began shaking and actingstrange. Imagine her surprise whenher son told her an earthquake wasthe cause! Hurricane Irene causedmuch destruction to the OuterBanks, leaving my future son-in-law wondering if his family’s homewas still standing. My brother-in-law in Binghamton, NY, sawthe building where he workssubmerged under water. Does itseem like Mother Nature is tryingto tell us something?

If you have been through scaryweather situations this year, pleaselet us know how you dealt with alack of electricity and otherhardships. Hope you all stay safeand the weather patterns calmdown!

For the first few years on oxygen, I spenta lot of time thinking of all the thingsI couldn’t do. I finally changed that attitude!My husband and I went on a Segway tourand I loved it so much, we decided to buyone. Now I can go with him when he rideshis bike.

Kayaking at a lake works well with liquidoxygen in a backpack. (I found it still worksshould the oxygen happen to fall in the lake!)My next challenge is to figure out how to gosnorkeling.

My Oxy-View™ glasses make me feelmuch more confident too. Now people talkto me, not my cannula! – Pam Combs

contents

“Weather forecast for tonight: dark.” – George Carlin

www.pulmonarypaper.org Volume 22, Number 5

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Sharing the Health

Traveling NewsNo smoking on cruise ships

Get Up & Go2 CruisesForget the worry of travelingwith oxygen! Join us on astress-free vacation!

Did You Hear?Seasonal exacerbations;Asthma news

Respiratory NewsRecent study results

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Pulmonary HypertensionConclusion of two-part article

Calling Dr. Bauer …When are antibioticsnecessary?

POC CareKeep it working long and well!

Ask Mark …Nebulizer use; FEV1 andexercise; and more!

Fibrosis FileNew awareness launch;How to get moving!

Dedicated to Respiratory Care

Volume 22, No. 5September/October 2011

On the cover: Oxygen user PamCombs of Minnesota now tries to doany activity she wants! (At lower left,see Pam on her Segway.)

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

The Pulmonary Paper is a 501(c)(3)not-for-profit corporation supportedby individual gifts. Your donation istax deductible to the extent allowedby law.

All rights to The Pulmonary Paper(ISSN 1047-9708) are reserved andcontents are not to be reproducedwithout permission.

As we cannot assume responsibility,please contact your physician beforechanging your treatment schedule.

PaperThePulmonary

The Pulmonary Paper StaffEditorCeleste Belyea, RN, RRT, AE-CAssociate EditorDominic Coppolo, RRT, AE-CMedical DirectorMichael Bauer, MD

The Pulmonary Paper is a member-ship publication. It is published sixtimes a year for those with breathingproblems and health professionals.The editor encourages readers tosubmit information about programs,equipment, tips or services.

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

September/October 2011 www.pulmonarypaper.org 3

This 2-part article was written to give you a betterunderstanding of Pulmonary Hypertension and how itdevelops in patients with chronic lung disease.

Part 2: Pulmonary Hypertension (PH) Defined

Your pressures will help dictate your treatmentplan. For some patients, certain medicationsknown to directly lower the pressure in the lungs

may be given. For some patients blood thinners may beprescribed. In others, calcium channel blocking agents mayimprove symptoms. Ultimately, for some patients withvery severe PH, a lung transplant may be the only hope.

And There Is Hope!The vast majority of PH in patients with COPD are in

the mild to moderate category. Severe PH is seen in lessthan 5% of patients with COPD. Currently, there is noclinical test or examination finding that accuratelyidentifies PH in patients with COPD. All of the treatmentoptions mentioned are used to treat a particularcomponent of PH. There is one therapy however that hasbeen shown to decrease, and even reverse, the progres-sion of PH in many patients. What is this therapy? It’sas plain as the nose on your face or at least the nasal can-nula in that nose. Long term oxygen therapy works atreversing the very problem we described in Part 1 of thisarticle (The Pulmonary Paper, July/August 2011).Remember, the very small pulmonary arteries constrictdue to the body compensating for low blood oxygenlevels. By administering supplemental oxygen to patientswith PH, we can begin to reverse the mechanismresponsible for all that follows. Not only can oxygentherapy slow down or even reverse the progression of PH,oxygen has been shown to be the only drug (yes, I saiddrug) ever scientifically proven to increase survival! Thatmeans if you wear your oxygen as prescribed by yourdoctor, you will live longer than patients who either can’tor won’t wear their oxygen.The Centers for Medicare and Medicaid Services

(CMMS) estimates that there are roughly 1.2 millionpatients who (should) use oxygen 24 hours a day at home.By far the most common device for administeringoxygen is the nasal cannula. The nasal cannula is simple

and inexpensive, but it is also very uncomfortable andinefficient.So in reality, the problem with oxygen therapy is

somewhat complex. We know beyond any shadow of adoubt about the survival benefits of oxygen therapy,especially when combined with an organized exerciseprogram such as Pulmonary Rehabilitation programs.Neuropsychiatric function is also improved with oxygentherapy. When I am teaching new patients about thebenefits of oxygen therapy, I will usually tell them thatoxygen itself is not life support … but it sure as hell issupporting life!

A Quick ReviewA quick review of where this little discussion has

taken us is in order before we can move on. The storyof PH goes something like this. Lung disease (or someother entity) causes a chronic low blood oxygen scenario(hypoxemia) to develop. Through a variety of compen-satory mechanisms, the body attempts to “fix” theproblem by constricting the small blood vessels in thelungs and perhaps causes changes in the viscosity(thickness) of the blood by producing and releasing morered blood cells into the blood. The combined effectcauses the right side of the heart to have to work

Part 2: First you tell me I have lung disease …

Now You Tell Me I Have Pulmonary Hypertension!by John R. Goodman, BS RRT

continued on page 4

Left: This 26-year-oldpatient (the author’sniece) had PPH andreceived two differentlung transplants in aneight-year period.

harder and harder. If leftuntreated, this can lead toright ventricular hyper-trophy (enlargement),and finally right heartfailure.

Depending on thespecific cause of thehypoxemia, a widevariety of drugs with differentactions may be prescribed. Ultimately if the PH is severeand persistent enough, a lung transplant may be the onlytreatment left to the patient. Of all the “drugs” that mightbe prescribed by the doctor, the most important isundoubtably oxygen. But, oxygen delivered via standardnasal cannula is difficult to wear on a 24/7 basis asordered by the physician. A reasonable question there-fore would be: Are there other delivery devices foroxygen therapy? And the answer is, of course there are.Please remember the end-point we all seek as cliniciansis true compliance with the oxygen prescription. Theoriginal plastic nasal cannula was patented in 1956,although some primitive cannulas were available asearly as the 1930s. Oxygen masks have been availablesince before the turn of the century.

But This Is 2011!Certainly oxygen delivery devices have improved and

evolved over the past half century, haven’t they?We knowthe nose hasn’t changed in the past 55 years, and thereare just so many ways you can skin a cat. Over this timeperiod a pretty good number of new generation nasalcannulas have been introduced to the market. Differenttypes of plastics, better anatomic designs, lighter weights,different colors and a number of devices such as theOxyArm, have been introduced to patients in an attemptto improve comfort and compliance.

But the very bottom line is that with all the best effortsof the oxygen industry, compliance with oxygen via nasalcannula is still sub-optimal. Very classic studies oncompliance have proven that the vast majority of patientswho are on oxygen 24/7 are only willing or able to weartheir nasal cannula for about 18 hours per day. In effect,losing the benefits of their therapy for six or so hours perday. Is there a way to insure 24 hour per day compliance?Probably not with conventional non-invasive oxygen

delivery devices. If however, you can make a patienteither more comfortable, or less self-conscious aboutgoing out in public wearing their oxygen, you should beable to improve compliance, and as an extra bonus,improve quality of life by getting patients out of the houseand into the mainstream of life again.

Combining Oxygen and EyeglassesWe have already discussed the discomforts associated

with the use of a nasal cannula. Much of this due is tothe fact that the cannula must be worn with the prongsin the nose, and the tubing draped, lariat-style, over theears. Now imagine you also must wear glasses to see, readand just get around in general. Wearing both glasses anda nasal cannula at the same time is very uncomfortablefor patients. In fact, we knowmany patients will take theirnasal cannula off to give their nose and ears a rest.

A few years ago, an ingenious new method ofdelivering oxygen was developed that found a way tocombine the dual necessities of needing to wear oxygenwith needing to wear glasses. This product is calledOxy-View™ eyeglass wear. The frames of the glasses arehollow. Oxygen up to 5 liters per minute can flow throughthe frame and into the nose via two small, discreet prongsor “J-hooks.” Your oxygen tubing is usually connectedfrom behind your head, so it can be almost completelycamouflaged.

Finally, we can briefly discuss the most efficientmethod for oxygen delivery, transtracheal oxygen

continued from page 3

Above right: Oxy-View™glasses allow this patientmore mobility, signifi-cantly improving herquality of life.

Above left: Alice from NY says, “Since I have been wearingmy Oxy-View™ glasses, friends and family think I’vestopped using oxygen because the cannula line across myface and under my chin is gone. They are so comfortableI forget I have it on.”

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therapy (TTOT).TTOT involves theinsertion of avery small flexiblecatheter directly intothe windpipe ortrachea.

There are many,many benefits asso-ciated with TTOT.

You may want to talk to your pulmonologist to see if itmay be a good option for you. You can visit the websiteat www.tto2.com for more information too.Remember oxygen is a drug. It is almost certainly the

most important drug you are taking. It will be one of themost important therapies your doctor employs to treatpulmonary hypertension should it develop. Many bogusoxygen therapies can be found on line. An educatedpatient is an empowered patient!

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

For more information, please visit www.phassociation.org or call the PHA Toll Free Patient-to-Patient Support Line, 1-800-748-7274.

PAH Medication Assistance ProgramTracleer® (bosentan) is used in people with

pulmonary arterial hypertension to improve theirexercise ability and to decrease worsening of theircondition. Its maker, Actelion, is sponsoring the TracleerPatient Coupon Program – to help you pay no more than$10 per month for Tracleer. The company is contribut-ing up to $10,000 annually for every person who uses thedrug. For more information, visit www.tracleer.com onthe Internet.You would not be eligible for their program if your

prescription is paid for by the government (Medicare,Medicaid, VA, Tricare or Indian Health Services) or if youlive inMassachusetts, Puerto Rico or where it is prohibitedby law.


Many readers have asked Dr. Bauer about the need for antibioticsroutinely when breathing symptoms become worse.Most all practitioners would support the notion that antibiotics are being

vastly over-prescribed. There are many reasons for this. Patient expectationsare a major factor. Advertizing by the big drug companies may also play arole. The fact is, antibiotics do work and are in fact, very effective in improvingsymptoms and certainly can prevent progression to pneumonia andhospital admission. You may ask, “What then is the problem?”The first problem is that antibiotics are very expensive and a very

significant percentage of patients will get better just as quick without theiruse. It’s felt that about one-third to one-half of all infections are due toviruses, and antibiotics will have no effect on these pathogens.The second problem is a growing concern about antibiotic resistance.

Amoxicillin was prescribed routinely twenty years ago. It was used so oftenthat routine microbes such as pneumococcus and hemophilus are no longersusceptible. If we don’t become more selective in our prescribing habits, tenyears from now none of our current antibiotics will be effective.Lastly, all antibiotics have side effects. Some may be life threatening. Why

take the risk unless they are really necessary?So how do we decide when you need a course of Z-pack or Levo?

Accepted guidelines currently recommend that at least two of three criteriabe met. These include symptoms of increased shortness of breath, increasedpurulence (change from clear mucus to green color) and/or increasedamount of mucus production. Most doctors would also support the notionof a lower “threshold” for patients with severe underlying disease comparedto those with no or very mild lung disease.The best management involves a dialogue with the patient and his doctor

as well as close follow-up. I hope this is helpful advice!

Question for Dr. Bauer? You may write to him at The Pulmonary Paper, PO Box877, Ormond Beach, FL 32175 or by email at [email protected].

Flu Season NewsThis season’s flu vaccine will

contain the same three strainsincluded in last year’s immuniza-tion. Six manufacturers aremaking the vaccine so thereshould be no shortage!The Centers for Diseases Con-

trol advises the annual protectionfor those 6 months and older –especially for those with chronicrespiratory problems.Please protect yourself!

Calling Dr. Bauer …

Dr. Michael Bauer

Pulse Oximetry at a low discount price!

Call for special pricing forPulmonary Paper members.


When you use your POC frequently (Jeri Mondlochof Minnesota just turned hers in with 10,000

hours on it!), you should be aware of how to keep itworking properly. Themanufacturer of the Sequal Eclipseprovides the following tips to keep your unit in topworking condition.

Sequal Eclipse UsageThe Sequal Eclipse is designed to be both a station-

ary and portable concentrator. Its ability to produce bothpulse and continuous flow and to run from multiplepower sources makes it suitable to meet more needs thansimply portability and travel. It can be used at home orovernight by patients who require 0.5 to 3.0 LPMcontinuous flow.However, there are recommendations when caring for

Eclipse units that are either left in stock by a provideror not in use by the patient for a prolonged period oftime. At a minimum, all Eclipse units should be runcontinuously for at least two hours every monthregardless of whether the concentrator is in use or not.This may be achieved either by running it for one hourevery two weeks or by running it for two hours oncemonthly. This will help to ensure that all of its parts willoperate properly when it returns to service.As a suggestion, this monthly run-time would be a

convenient opportunity to calibrate the Eclipse powercartridge. Power cartridge calibration should also bepreformed once monthly and consists of completelydraining and re-charging the cartridge.

Cleaning Your EclipseIt is recommended that a mild solution or detergent

and water be used to clean the Eclipse cabinet,control panel, and power supplies (AC, DC, powercartridge). Follow these steps to clean the Eclipseand/or power supplies:

1) Turn off the Eclipse and disconnect the AC or DCpower supply.

2) Dampen a cloth or sponge with water.3) Spray or wet the cloth/sponge with the mild

solution of detergent and water. Do not spray anyliquids directly onto any components of the Eclipseor its power supplies.

4) Wipe down the cabinet, control panel, and powersupplies with the cloth/sponge.

To disinfect the Eclipse, repeat steps 3–4 using Lysol®

Brand II disinfectant or another disinfectant withequivalent ingredients.To clean the inside of the unit, use a small

vacuum cleaner or brush to remove any accumulationof dust or debris.

Cleaning the Eclipse Air Inlet FilterThe air inlet filter in the back of the Eclipse provides

the initial filtration of the air that is drawn into theconcentrator.To ensure that it filters appropriately, it must be cleaned

once weekly using the following procedure:1) Remove the filter from the back of the Eclipse.2) Wash the filter in warm water using a mild

detergent solution.3) Rinse the filter thoroughly and squeeze out the

excess water.4) Allow the filter to air dry thoroughly.

The filter should be completely dry before it is insertedinto the concentrator. Introducing moisture into thesystem can cause improper operation or damage to theunit. It is recommended that the Eclipse not beoperated for more than 30 minutes without an inletfilter installed. It may take more than 30 minutes tofully dry the filter. For this reason, it is recommended thatpatients are provided with two air intake filters so theycan be rotated during cleaning.This filter should also be replaced annually as part of

preventative maintenance.

Portable Oxygen Concentrator Care


Lois from Pennsylvania just beganusing a nebulizer with Albuterol. Shecomplains it is noisy, uncomfortableand a bother to clean. Since she reg-ularly uses Spiriva and Advair andso far feels no benefit from thenebulizer treatments, would herphysician change the medication?

Mark answers, Albuterol is oftenused as a “rescue” medication forthose who are using Advair. Albuterolcontains the same kind of medicationas is in the Advair. The difference isthat the one in the Advair is “long-acting” while the version in Albuterolis “short-acting”. The short-actingAlbuterol may interfere with theaction of the long-acting version in theAdvair, if taken before or withintwo hours of taking the Advair. Theresult is decreased effectiveness of theAdvair and an increased need forAlbuterol.Check with your physician to see

if you were meant to use the nebulizeron an as-neededbasis rather thanas a regularlyscheduled med-ication in addi-tion to yourAdvair.

Yves asks if your FEV1 can beimproved with exercise. (FEV1 orForced Expiratory Volume in onesecond, is a measurement of howmuch air you can forcefully exhale inone second. The reading is used toclassify how severe your lungdisease is.)

Mark says, When there isn’t anunderlying acute illness or significantde-conditioning that would preventyou from giving a maximum effort,FEV1 is a “fixed” factor owing to“physical” changes in the “struc-ture” of the lungs. Unless you changethe “structure” (by receiving a lungtransplant, volume reduction sur-gery or have a bronchial stent place-ment), you cannot change your FEV1.As most everyone who has

succeeded with an exercise orpulmonary rehab program withsignificant improvement in physicalcondition will attest – you can mostcertainly and significantly improveyour breathing while still at thesame FEV1.

Kathleen from Georgia worriesabout belly fat. Does any particularkind of exercise or specific diethelp? Or it is just an inevitable partof COPD and all of the manymedications we take?

Mark reports, Sadly there are noquick fixes available.We can’t be surethe increase in your body fat is due toCOPD. You should begin withcalculating your percentage of bodyfat, using one of the many toolsfound online. If you are significant-ly above 22% to 25% then maybeyou do have too much visceral fat.I would further modify the

assessment by asking you to grab your‘tummy’ flesh and shake or pinch tosee: Is it loose, can you pinch an inchand more? Is it hard with little sup-

pleness beyond 1/4 to 1/2 inch? Soft,supple and loose indicates predomi-nance of subcutaneous fat – which liesjust under the skin and is easiest to getrid of. Hard indicates predominanceof visceral fat – which is around yourinternal organs. The lungs as theyexpand with trapped air do encroachon the abdomen and cause changesrelated to compression and displace-ment of abdominal contents.You can counteract that loss of

tone and reduce the paunch withisometric or active exercises thatwork the abdominal muscles. Sit-upshave been a popular means in pastyears. Crunches seem in greaterfavor these days. Laying on the flooror a bed, lifting your straight-held legswhile also raising your shouldersand holding for increasing durationis a good isometric exercise that canyield great results over time. But it isa very difficult exercise to do!Calorie control, period, rather thanany fad diet is likely to yield resultsif you need to lose pounds. Keepportion control in mind at mealtimes.

Mark Mangus RRT, BSRC, is a member ofthe Medical Board of EFFORTS (the onlinesupport group, Emphysema Foundation ForOur Right To Survive, www.emphysema.net). He generously donates his time toanswer members’ questions.

Ask Mark …

Mark Mangus, RRTEFFORTS Board

The TwoKinds

of BodyFat

Subcuta-neousFat(undertheskin)

Visceral Fat(around the internal organs)

Partnership Launches National Awareness EffortsThe American Thoracic Society and the Coalition for

Pulmonary Fibrosis (CPF) have partnered to raise aware-ness and move legislation on Capitol Hill. Two weeks ofnational awareness efforts were held in September. Thepartners have also launched a special webpage formedical professionals as well as for patients, families andcaregivers or anyone else who wants to learn more aboutpulmonary fibrosis at http://tinyurl.com/4xkbtbg.“It is an exciting time in Idiopathic Pulmonary

Fibrosis (IPF) research,” said Dr. Andrew Tager, whoselaboratory investigates IPF at the Massachusetts GeneralHospital. “Lung researchers have recently identifiedmany of the molecules that contribute to the progressionof fibrosis in IPF. Pharmaceutical companies have begunto develop new drugs targeting these molecules, some ofwhich are already entering into clinical trials.”

Study Shows Positive ResultsA recent article in Respiratory Care discussed The

Benefits of Pulmonary Rehabilitation in IPF, a progres-sive lung disease that has no effective drug therapy. Astudy was conducted at National Jewish Health inDenver to see if participation in a six-week program ofteaching, behavior modification techniques, lung diseaseeducation and counseling would improve fatigue,anxiety, depression, sleep and quality of life for those withIPF. The results were positive! After graduation from theprogram, members significantly improved their fatigue.Further studies will be done to assess if these programs,originally set up for the person with COPD, should befurther adapted for those with IPF.


Fibrosis File

Amember of the Coalition for Pulmonary Fibrosis paidthe cost of this billboard to raise awareness of PulmonaryFibrosis in Sioux City, Iowa! Now that’s what we callgetting involved!

What Can You Do with 15 Minutes A Day?Many people do not have access to a pulmonary

rehabilitation program. An important key to success ishaving the confidencethat you can do it! If youhave a friend that will joinin, you can tell them thatdoing just 15 minutes ofmoderate exercise a daymay add three years totheir life!The National Insti-

tute on Aging suppliesan Everyday Guide toExercise & Physical Activity. You may adapt theexercises to your capabilities, and it would be a good placeto start! You will be able to set goals, make an exerciseand physical activity plan, and then talk with yourdoctor about your plan. The guide also has photos anddetailed exercise instructions, worksheets to help you trackyour progress, and tips on eating a healthy diet. TheInstitute also provides the video, ‘Go4Life EverydayExercises.’ You may order from the NIA InformationCenter at http://tinyurl.com/k3k2z or call 1-800-222-2225for more information.Exercise has been consistently shown to improve your

mood. So fight depression – get moving!

Getting Involved!

EdI have both emphysema and asthma and use supple-

mental oxygen on 2–3 LPM at rest and at least 5 LPM onexertion. When I develop a really stressful attack of

shortness of breath, I find usingmy little blue “Breather” helpsme remedy my condition fasterthan doing pursed lip breathing.I was given this device through

my pulmonary rehabilitationprogram and instructed to use it daily to facilitatediaphragmatic breathing. It also helps to clear my airwaysand I feel it exercises my entire respiratory system. I wouldrecommend it to everyone with breathing problems!It is available for purchase on the Internet at www.

Amazon.com or www.BlaiseMedical.com (1-888-497-3579) for approximately $30.

John Dean, Lake Wales, FL

MarthaOliver of Louisville, KY, learned of a new drugbeing developed by Appelis Pharmaceuticals, a companyin her area, that is designed to block inflammation thatoccurs in COPD and asthma. The drug is in its earlystages of development with animal testing set tobegin soon.

What do people do with their used oxygen tubing?Throw them into the landfill? Not if I can help it! As agardener, I’ve found that they are great for tying up droopyplants especially my heavily laden tomato plants. I’ve justpassed along a bagful to a gardener friend who was verygrateful. How do other oxygen users avoid the landfilland use these tubes? I’ve found that whenyou tie a square knot in them, it stays andthey never wear out. Let’s have acontest to get folks to writein to say what they dowith their used tubing!We could encourageothers to keep themout of the land fill!

Anne Glasner,Appleton WI

Oxygen Tips from Our MembersKatherine F. of Prior Lake, MN, writes that she keeps

her oxygen tubing off the floor by using single hooksplaced strategically in her home.

Morris Levinson of Oceanside, CA had a problem ofchafing of his ears from wearing a cannula. His oxygencompany supplied E-ZWraps from Salter Labs that solvedthe problem! If your home care supplier does not havea supply, you may order them fromwww.directhomemedical.com(currently $1.50 a pair, shipping is$5.50, so you would be wise toorder several sets) or by calling1-888-505-0212.

When I switch from my concentrator to my portableoxygen, I place the cannula in a zip lock bag to keep itclean and dust free!

Hyla Glover, Oklahoma City, OK

I have found oxygen swivel adaptorshelp keep my tubing from twisting.They are available with male/female ends and alsomale/male ends at www.Amazon.com.

Gail Angel, PA

I have found a cane that has a canvas seat to be veryhelpful. It folds open and closed. When I’m walking andget tired, I open the seat and take a little rest, then canmore comfortably continue. I purchased mine throughmail order for about $25. It has a weight limit of 250pounds. (We found Internet sites that carry these atwww.foldingsticks.com, 1-800-962-5003 and also atwww.footsmart.com, 1-800-707-9928.)

Barbara Seighman, Monongahela, PA

Sharing the HealthReceive a Free One Year Membership

Contribute a picture or tip on how you COPE withCOPD! Send to The Pulmonary Paper, PO Box 877,Ormond Beach, FL 32175. Include your name/address.


Most who read this wonderful newsletter are suffer-ing from some type of lung ailment, many are onsupplemental oxygen with not much hope of everreally getting any better. I have emphysema. It is very easyto have an attitude problem of “poor me” but, we do nothave to have that attitude if we do not want to. It helpsme to think about today, not yesterday, not tomorrow,just today. As I think about today, my attitude needs tobe one of gratitude just for one more day. As theexpression goes “I am still on the right side of the grass.”So then, the next question needs to be, who did we givethanks to, who are we grateful to? My answer is God.By faith I believe He is the one who has given me anotherday. I believe He is saying to me, ‘Brian, I have given youanother day, what are you going to do with it, are yougoing to make it count?’Do not focus on what you cannot do and yes, there are

a lot of things we cannot do anymore, but focus on whatyou can do and yes, there are still a lot things we can do.Life is not totally over for us, although at times it mayseem so. God says ‘I love you, I do not promise a life freefrom ailments, trials and tribulations, but I can help youget through them, trust Me.’

Brian Hall, Cohasset, CA

I know my limitations.I walk.I do community service for special needs.I socialize.

Ethel Cordaro, Revere, MA

Don’t forget to sign up to attend the National COPDConference which will be held at the Crystal GatewayMarriott in Arlington, VA, on December 2 and 3, 2011.Information can be found at http://uscopdcoalition.org/p-46.

Hey! There’s An App for That Too!Do you use oxygen in cylinders and wonder how long

you have until your supply runs out?Well, there is an appfor that!If you have an iPhone or Android phone, visit

www.respondo2.com/durationapp.html to downloadO2 to Go, free of charge. You will enter the regulator orconserver you are using, liter flow, size of your cylinderand how much oxygen is now in the tank. It isprovided by Responsive Respiratory Inc.

If you are flying to your destination and using aportable oxygen concentrator (POC) and want to be surethere is enough room under the seat in front of you toplace your POC, check out this site intended for smalldog users who are flying with a pet: www.dogjaunt.com/guides/airplane-under-seat-measurements.You can see how much space will be available to you.For more tips, Lyn Cole maintains a blog for oxygenusers at www.wellsphere.com/roxlyn/92052/posts.

New Cigarette Packaging BeginsFor the first time in 25 years, new changes to cigarette

warning labels debuted in September. By the end ofOctober, cigarette manufacturers will no longer be ableto sell their products without these graphic color warn-ings. These changes are required by the 2009 TobaccoControl Act and are being carried out by the FDA. Theimages are not expected to have immediate effects but inthe long term might have an impact on people decidingto stop smoking. Today we have 27 states in the U.S. thathave lax or no lawsbanning smoking inthe workplace andpublic places.Researchers have

found that if these27 states adoptedcomp r eh en s i v esmoking bans, morethan one millionadults would stopsmoking, nearly400,000 childrenwould never startand smoking-relateddeaths would fall by624,000.


… Are You Awake Yet?

Gene Hately of Florida is watched over a by a trusted friend.


Cruise Ships and Smoking PoliciesSmart cruise lines have realized that stricter policies are

needed when it comes to allowing smoking on their ships.We salute those that totally prohibit cigarette smokingin the cabins – balcony or not!Azamara, Celebrity, MSC, Oceania and Regent Cruise

Lines now prohibit smoking in all guest cabins. RoyalCaribbean allows smoking on your balcony but not inthe stateroom. Princess Cruises will prohibit smoking inpassenger staterooms and balconies for all voyagesdeparting after January 15, 2012.Starting December 1, 2011, smoking will be prohib-

ited in all Carnival Cruise Line’s guest staterooms.Guests in balcony cabins will be permitted to smokecigarettes and cigars on their stateroom balconies. Spastaterooms will continue to remain entirely smoke-free,including on the balconies.Starting January 2012, Holland America and Nor-

wegian Cruise Lines will no longer allow smoking incabins but will allow smoking on room balconies.

Traveling News

Would you like to have The Pulmonary Paper emailed toyou? Send a request to [email protected].

1-888-648-7250www.rxstat.net

Sequal’s EclipseSmallestcontinuous

flow POC. 3LPMcontinuousand 6LPMpulse

Respironic’sEverGoBest battery life,8 hours at 2LPM6LPM pulse

Respironic’sEverflo™ Quiet withOxygen Purity IndicatorSmall form, 30 lb.stationary unit ($799delivered). Great for afteryour Medicare rental!

Invacare® XPO2™Lightest POC at6 lbs.! 5LPM pulse

Rx Stat Respiratory will match or beat anyone’s prices on oxygen equipment!

Rx Stat will beat anyone’s priceon a new portable concentrator.

We also rent POCs for travel:$395 for first 10 days, $295 for eachadditional 10 days–includes shipping!

And we buy and sellused portable concentrators.

Call for availability!

See demos of POCson YouTube.com,search “Rx Stat”

Centers for Disease Control (CDC) Reports Risein Asthma Cases in U.S.The CDC reports asthma cases in the U.S. have risen

12.3% since 2001, and nearly one in 12 Americans arediagnosed with the disease. Officials say they do notunderstand why more people are getting asthma,especially when fewer Americans are smoking and thenation is taking steps to decrease air pollution. Thegovernment’s top priority is getting people to bettermanage their symptoms.African-American children have the highest rate of

asthma at 17.6%. Most asthma sufferers can eliminatetheir symptoms if they take prescription drugs such asinhaled corticosteroids, and if they can “modify theirenvironment to reduce or eliminate exposure to allergensand irritants,” the CDC said.

Researchers found that medicine called leukotrienereceptor antagonists (as “Singulair’ [montelukast]and ‘Accolate’ [zafirlukast]) managed asthma assuccessfully as steroid inhalers. Adherence to treatmentwas vastly improved when patients were given theonce-a-day drug.

The Global Asthma Report 2011 shows the tools tomanage asthma exist but are not reaching many of the235 million people affected.


DateChange

Join us on a stress-free vacation!January 8, 2012: Royal Caribbean Mariner of the SeasRelax on a 7-day cruise to the Western Caribbean from Galveston, TX

March 7, 2012: Emerald PrincessLuxuriate on a 10-day Southern Caribbean cruise from Fort Lauderdale, FL

April 15, 2012: Carnival PrideSee the Cherry Blossoms in DC!Warm up on a 7-day Caribbean cruise from Baltimore, MD

May 4, 2012: Holland America’s EurodamRevel in this 7-day Mediterranean Glamour cruise from Rome, Italy

August 4, 2012: Holland America’s WesterdamSee Alaska on this 7-day Alaskan Explorer cruise from Seattle, WA

October 13, 2012: Holland America’s VeendamMarvel at Fall’s beauty on a 7-day Canada & New England Discoverycruise from Montreal, Canada, returning to Boston, MAFST: ST36334

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HomeLox Unit• Makes liquid oxygen from room air.• Is extremely simple to use.• Ends your wait for adelivery truck.

• And the GoLox portabledevice is small (the size ofa large apple!), lightweight(just 3.8 lbs. filled),and lasts 10 hoursat a setting of 2.

Exasperating Exacerbations!A majority of patients with COPD who develop a

rhinovirus infection (most common cause of a cold)develop a secondary bacterial infection, suggesting thatearly antiviral therapy might be very beneficial.The American College of Chest Physicians reports a

daily dose of the antibiotic Azithromycin reduced thefrequencies of exacerbations and improved the quality oflife for those with COPD.Some 56% of exacerbations have a sudden onset,

whereas 44% have a gradual onset. Recovery time wasshorter for the sudden onset – 11 versus 13 days. It mightnot surprise you that exacerbations severe enough to betreated are twice as frequent in winter as in summer.

New Alternative Oxygen Therapy on the MarketTheHomeLox home liquid oxygen generation and stor-

age unit with a GoLox portable device is easy-to-use. Itshands-free, clean-fill process reduces the freezing and overor under filling typically found in traditional systems.

Three Steps to Making Liquid Oxygen at HomeStep 1: Concentrate Using a compressor and the same

sieve bed material found in the EverFlo™ stationaryoxygen concentrator, HomeLox collects room air andconverts it into prescription-grade oxygen.

Step 2: Refrigerate/Store The oxygen is then cooledto -279°F using a refrigerant and technology typicallyfound in industrial and household applications. The chilledoxygen is converted into a liquid and then stored.

Step 3: Refill When it’s time to refill the portableGoLox, place the unit on top of HomeLox, lock the unit,and pull the filling lever. This hands-free process addressesthe difficulties found with traditional liquid systems thatrequire the use of one or both hands to fill. When full,filling stops automatically.Visit http://tinyurl.com/3nlvc9o for the HomeLox video.


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Respiratory NewsA Belgian study published in the Journal of Respira-

tory and Critical Care Medicine found high doses ofVitamin D taken during pulmonary rehabilitationbrought significant improvements in those with COPD.

SpirometricsThe National Heart, Lung and Blood Institute is spon-

soring a seven year study to explore subsets of ChronicObstructive Pulmonary Disease (COPD ). They would liketo enroll 3,000 participants to have testing thatincludes pulmonary functions, blood drawn, six-minutewalk test and a CT scan at four different times over a threeyear period. Each participant will be paid $200 per visit.To be eligible, youmust be between 40 and 80 years old.

Six clinical sites are currently accepting participants:Columbia University Medical Center, 212-305-5097University of California at Los Angeles, 310-794-9107University of California San Francisco, 415-476-3370University of Utah, 801-581-5864University of Michigan, 734-754-7388Wake Forest University, 336-713-8553

LAM or lymphangioleimyomatosis is a rare lungdisease that affects women in their mid-30s and 40s.Muscle-like cells grow and destroy normal lung tissue.A medication called Sirolimus, currently used to preventrejection after a transplant, has been found to suppresscell growth in LAM by blocking an overactive protein.

Researchers believe that they have isolated human lungstem cells from unused donor lungs for the first time.Identical cells were also found in lung tissue specimensfrom nine cases of fetal death. When the stem cells weretransplanted into the damaged lungs of mice, they becamestructurally and functionally integrated into the organsand created human bronchioles, alveoli and pulmonaryvessels within 14 days. The findings appeared in theNewEngland Journal of Medicine.

Researchers at RMIT University in Australia areinvestigating whether ginseng can improve quality of lifeand lung function for patients with COPD.

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