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The

PulmonaryPaperDedicated to Respiratory Health CareMay/June 2014 Vol. 25, No. 3

Inside:

What Portable Oxygen

Concentrator is right

for you?

DEOur annual POC review

is here along with articles to help you

make the right

choice!

Featuring 03 | Editor‘s Note

04 | Calling Dr. Bauer

16 | Ask Mark

18 | Fibrosis File

20 | Sharing the Health

30 | Respiratory News

Oxygen Things11 | Portable Oxygen Concentrator Chart and Checklist

15 | Fourth Annual POC Comparison

Your Health05 | Lung Force Unites Women in Fight Against Lung Cancer

10 | Write Your Congressman!

23 | Smoking Alarm

24 | Alpha-1 Antitrypsin Deficiency

26 | e-Smoking Gains Ground

For Fun28 | SeaPuffer Cruises Plan a vacation and leave your cares behind you!

Calling couples! Let us know how you cope with lung problems. Send us a photo!

www.pulmonarypaper.org Volume 25, Number 3

Table of Contents

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GiGi Bill

OxyView wearer GiGi and husband Bill Stoodley from California never let lung disease come between them!

We are hiding The Pulmonary Paper logo on our front covers. Can you find it?

May/June 2014 www.pulmonarypaper.org 3

Editor’s Note

D ecisions, Decisions, Decisions! How do you know you are making the right one? The only thing you can do is gather as much information and opinions as you can

about the subject. A member called one day and asked why you would choose one Portable Oxygen Concentrator (POC) over another. The answer is that only you can decide which one would best fit your needs and lifestyle! Do you travel away from home frequently? You may want one with one both continuous and pulse dose capabilities. Many times people purchase a POC based on size but, unfortunately, the smallest or lightest one may not be adequate for their oxygen needs.

If you are looking to purchase or rent a POC, we hope you will find this issue valuable to understand the differences of those on the market today. Please get involved in your care and don’t accept an oxygen concentrator that does not allow you to maintain your lifestyle.

We have had a tremendous response to our request to complete the survey we enclosed with our last issue – thank you so much for your support. We truly appreciate everyone taking the time to fill out the questionnaire to help determine how best we can serve your needs in the future. For those who would like to participate, the survey is available at www. pulmonarypaper.org/survey. The winner of an Apple iPad Air and Nonin oximeter will be announced in our next issue.

“In a moment of decision, the best thing you can do is the right thing to do. The worst thing you can do is nothing.”

Theodore Roosevelt

This is my husband Mark – one of the best decisions I have made in my life!

4 www.pulmonarypaper.org Volume 25, Number 3

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].

Dr. Michael Bauer

Calling Dr. Bauer …

My patients often share with me their frustrations dealing with insurance companies and home care companies. I’d

like to share with you some of my frustrations, which, I suspect are quite the same.

In some ways, writing prescriptions has become a lot easier for me. I used to hand write 10 to 20 prescriptions every day. Now, almost all of this is done online using my hospital electronic record software. The hard part now is when I click “send”, I frequently get a message saying “this drug is not the preferred drug on the patient’s insurance plan”. This often means you, the patient, will have to pay more unless we all can agree on an alternative that “is covered”.

Albuterol is probably the most common inhaler I prescribe. Some of you like Proventil, some like Ventolin and some like ProAir. They are all albuterol, but some insurance carriers will only cover one or two of these brands. Cost is usually the deciding factor for insurance carriers. Multiply this by the scores of other types of inhalers out there, and it can be quite a challenge for all of us! Within reason, I try to help my patients get what they want. With the incredible high cost of many inhalers, sometimes we are left with little choice.

Certification and recertification for oxygen is the other high-volume paperwork chore doctors make sure we have completed for you. Regulations seem to keep changing regarding frequency of documentation and medical qualifying criteria. These are regulations that are driven by federal Medicare standards. Remember, an oxygen saturation of 88% or less is usually re-quired for you to continue to receive insurance coverage for your concentrator and portable systems.

CPAP users also know there is a “smart card” computer chip in their machine telling us exactly how often and how long the machines are being used. Medicare wants an average of at least 4 hours every night for a month-long time period.

Let’s keep trying to work together to keep our blood pressure and heartburn under control!

Do you have a

complaint or bad

experience with

changes in your

oxygen service and

equipment?

If you don’t voice

your concerns, the

people that will

be able to change

the situation will

never know.

Call the COPD

Information Line

at 1-866-316-

2673 for advice

on sharing your

concerns.


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When American women were asked to

name a cancer that is top-of-mind, only one

percent named lung cancer. The truth is,

every eight minutes, lung cancer kills a

woman in our country. What are the lead-

ing causes of cancer death among women?

Number one is lung cancer at 38%, number

two is breast cancer at 22%.

The American Lung Association has

launched Lung Force to rally and unite wom-

en in the fight against lung cancer and for

lung health. Their partner, CVS Caremark

who made the bold move to remove tobacco

from their CVS/pharmacy stores, want this

new initiative to make lung cancer in women

a public health priority, drive policy change

and increase research funding.

Lung cancer is a disease that has per-

sonally affected actress Valerie Harper and

country music star, Kellie Pickler. Their

experiences motivated them to join LUNG

FORCE. In 2009, Harper was diagnosed

Lung Cancer is Number One Killer of Women

with non-small cell lung cancer. Her mother

died of lung cancer and like Valerie, never

smoked. When she was 15, Pickler lost her

grandmother to lung cancer just one day

after she was diagnosed. Picker shared, “Not

only was she a loving, strong and gracious

person, she was also the woman that I called

‘Mom.’ I support Lung Force in hopes that

others won’t have to lose such amazing

women in their lives.”

Visit LUNGFORCE.org to raise your

voice, share your story and take action.

Turquoise is the color to wear to support

the cause!


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 …

Sharon from New Mexico was recently hospitalized with a pneumothorax and asks Mark to explain what caused it.Mark explains, A quick review of how the lungs work might help unde rstand how a pneumothorax may occur, as well as what must be done to correct it and reduce chances of its happening again.

The pleural space is a cavity between the lung’s outer surface and the inside of the chest wall – usually filled with about 5 ml of serous fluid that acts as a lubricant to let the lung and chest wall slideagainst each other without friction as you breathe. Thereare two pleural mem branes, the visceral pleura which covers and encloses the lung, and the parietal pleura, the membrane attached to the inside of the chest wall. If you’ve ever had pleurisy, you learned how important it is for there to be no friction between the two pleural membranes. Pleurisy is inflammation of those membranes and results in friction as the two membranes rub against each other with pain on every breath you take!

A pneumothorax is the collection of air or gas in the pleural space, sometimes caused by a hole that has developed in your lung. People with emphysema have weakened air sacs called blebs. In some cases, a collapsed lung occurs without any cause. This is called a spon-taneous pneumothorax.

The immediate treatment is to evacuate the air, usually done by inserting a chest tube or, in an emergency, placing a catheter or large needle into the space and pulling the air out with a large syringe. Once the air is evacuated, the lung re-expands under most circumstances. Suction put to the chest tube continues to evacuate air as it continues to leak into the pleural space through the hole in the lung. Given time for the hole to close and heal, the chest

Pleuralspace


tube keeps the lung expanded while that healing takes place. It can take as little as a day or two or even more than a week. If the pneumothorax does not resolve with simply waiting for healing and supporting with chest tube evacuation of the air, then another procedure may be considered.

For persistent leaks, a surgical procedure to close the leak once and for all and to sig nifi-cantly reduce the chances for recurrence is performed. That procedure is often done through the existing chest tube. It is called a pleurodesis which involves injection of a talc or the antibiotic tetracycline, into the pleural space. They are very caustic to the two pleural membranes, causing them to become inflamed and to ‘weep’ blood and fluids in response to the caustic attack. The two pleural layers then heal together, becoming one, effectively obliterating the pleural space. Once healed, even if other blebs might try to burst and leak air outside the lung, the pleural space is no longer able to be breached, or can only be breached for very small areas that are rarely clinically consequential. Pneumothorax in young folks is a surprisingly frequent occurrence, especially in tall, thin teen agers. They usually go on to lead normal lives without pulmonary consequences.

Subcutaneous emphysema is air that dis-sects its way between tissues and spreads

throughout the body, usually from areas closest to the lungs moving away from them. While a scary thing, most often it is a nuisance and cosmetic problem. The cause needs to be resolved and time will allow reabsorption of the free air. There is nothing one can do to prevent fu-ture recurrence of pneumothorax. If it is in the cards, it is in the cards. Having bullous emphy-sema sets one up for the possibility.

Healthy alveoli

Stretched anddamaged alveoli


Fibrosis FilePeople suffering from idiopathic pulmo-

nary fibrosis (IPF) will soon have treat-

ment options! InterMune, Inc. has

initiated the Expand-

ed Access Program

(EAP) for the in-

vestigational drug,

pirfenidone. Pirfeni-

done is currently

under review by the FDA

to determine if it should

be approved in the United

States to treat IPF.

The EAP will be conducted under a

treatment protocol limited to enrollment of

IPF patients in the U.S. who meet specific

medical criteria and will be enrolled after

being assessed by a physician who specializes

in treating IPF and whose hospital or clinic

center is participating in the EAP, meeting

specific eli gibility requirements. This means

that not all physicians can provide access

to pirfenidone through the EAP and not all

patients who seek pirfenidone will be able

to get access to it through EAP.

InterMune decided to pursue this type

of EAP for pirfenidone now that their

Phase 3 clinical trials have been completed.

The duration of the program will be up

to 18 months from the initiation or until

InterMune has a decision from the FDA

regarding approval of pirfenidone.

As of May 2014, there are 15 sites

accepting patients for enrollment in the

pirfenidone EAP, 80 centers are expected by

September of this year. There is no cost to

you for the medication received through

the EAP. Costs for diagnostic tests to

determine eligibility or routine

medical treatment will need

to be covered by your

health insurer.

To learn if an

ap proved center is with -

in your reach, call InterMune

Medical Informa tion at 1-888-486-

6411. This number will be answered

24 hours a day. You will be given the

number of the nearest participating location,

and be told you are in the inclusion/exclu-

sion criteria to the study.

Information about other current studies

involving the drug that are currently

recruiting may be found at www.clinical

trials.gov and search ing for ‘pirfenidone’.

You may also visit the Coalition for

Pulmonary Fibrosis web site at www.

coalitionforpf.org for information.

InterMune has also launched two educa-

tional websites – www.KNOWIPFNOW.

com for patients and caregivers, and www.

IPFRALLY.com for health care providers.

Both offer pod casts and videos by several

interstitial lung disease experts. Sites include

downloadable materials to better understand

and live with IPF.

The good news continued when Boeh-

ringer Ingelheim announced the results of

its Phase 3 INPULSIS™ trials which showed


the oral medication, Nintedanib, slowed the

progression of IPF. The effect the drug had

on preventing exacerbations was less certain.

The results were published online in the New

England Journal of Medicine.

Over 1,000 people with IPF were involved

in the study and the scientists plan on further

studies to determine its effectiveness.

Unfortunately, the PANTHER-IPF

trial showed a third medication, N-acetyl-

cysteine used on its own, had no impact

on outcomes in idiopathic pulmonary

fibrosis.

PF Affects Horses, Dogs and CatsActress Anjelica Huston’s words greeted

researchers from around the globe when

they met recently to better understand

Pulmonary Fibrosis (PF). The lung disease

is killing horses, including thoroughbred

horses, and other domestic animals, just

as it is claiming an increasing number of

human lives. The scientists are hoping the

animals will hold a key to finding desper-

ately needed treatments faster for both.

The Fibrosis Across Species meeting, in

Louisville, KY, discussed comparative re-

search – or research that compares human

disease to similar diseases in animals. It

has been used successfully in the treatment

of bladder, prostate, bone and other forms

of cancer.

“We are concerned about the growing

incidence and prevalence of pulmonary

fibrosis and realize that research done the

customary way has limitations,” said Dr.

Jesse Roman, a human pulmonary fibrosis

researcher and chair of medicine at the

Uni versity of Louisville. “Studying animals,

in particular horses and dogs, may allow

us to better understand the underlying

causes of this lung disease and how to best

tackle finding life-saving treatments for all

affected species.” There is a comparative

research division at the National Cancer

Institute.

In addition to horses, the disease is also

known to affect cats and dogs, especially

terrier breeds of dog like the West High-

land White Terrier. As we know, there

are no approved drugs for this disease in

the U.S.


Established by the Medicare Modernization Act of 2003 (P.L. 108-173), the Competitive Bidding

Program helps Medicare set payment rates for DMEPOS items and services. Studies from the

Department of Health and Human Services’ Office of the Inspector General and the Government

Accountability Office have shown Medicare’s current fee schedule payments were outdated and

too high. Unfortunately, taxpayers and Medicare beneficiaries bear the burden of paying these

inflated costs.

The Competitive Bidding Program replaces the current fee schedule amounts with competitively

bid prices. The first phase of the program was launched on January 1, 2011. In the nine areas where

competitive bidding was implemented, the program saved $202 million, a reduction of 42 percent

in costs. As the program expands, it could save an estimated $42.8 billion in taxpayer dollars.

As the Centers for Medicare and Medicaid Services continues forward with the Competitive

Bidding Program, we will continue to monitor the implementation of these programs and their

outcomes to ensure that beneficiaries have access to the medical supplies they need.

I wrote to my congressman about the

hardships people who use oxygen have

had to endure with competitive bidding and

asked for change. This is what I received:

I told him beneficiaries do not have access

to the medical supplies they need. A lady

in Minnesota was told she would have to

stay home more because her liquid oxygen

delivery was being reduced to once a month.

A man in North Carolina on high liter flows

was denied liquid oxygen all together. A lady

in Florida was told if she wanted portable

tanks, she would have to come to the office

to get them, even though she doesn’t drive.

A man in Colorado was told he could only

have eight tanks, even though he needed ten

to travel with. A national oxygen company

told a lady in California she would have to

pay triple the normal rate to rent a portable

oxygen concentrator because she was going

on a flight out of the country.

Please continue to contact your elected

officials. Mine obviously does not understand

the true situation. Many oxygen supply

companies that submitted low proposals

are finding out that it is hard to stay in busi-

ness. A lady who was expecting an oxygen

delivery was told that her new supplier did

not have enough tanks to go around!

Write your Congressman


This issue marks the fourth year

the Pulmonary Paper is publishing

its portable oxygen concentrator

(POC) chart. This year, we’re adding a

checklist of important questions to ask

before purchasing, renting or simply using

a POC.

POCs are seeing even wider acceptance

among oxygen users, home medical equip-

ment dealers and clinicians in the field.

Manufacturers have responded – POC avail-

ability is at an all-time high, with a majority

of current POC models being released within

the last five years. However, throughout

the home respiratory care spectrum there

remain many mis conceptions relating to

the performance capabilities and limitations

of POCs.

Perhaps the most important factor to

consider regarding POCs is that one size

does not fit all. Each POC has limited

oxygen production ability and, generally,

the smaller and lighter the POC is, the

smaller its production capacity is, meaning

it will meet fewer users’ needs than the

larger POCs. Since most oxygen users would

naturally prefer a smaller, lighter device,

manufacturers have made a con scious trade-

off in performance ability that allows for

the POC to be as little and lightweight as

possible while sacrificing oxy gen production

capacity, thereby limiting the total number

of users that could adequately oxygenate

on the device in some or all of their daily

activities.

The smallest available POC weighs

around 3 pounds and produces around

333 mL of oxygen per minute, or 0.33 LPM,

and can only deliver its oxygen in pulse

form while the user is inhaling. It features

no adjustable pulse flow settings, and as the

user breathes faster, the pulse flow volume

delivered actually decreases. Nevertheless,

since this POC is the smallest POC available,

it has clear appeal to a wide range of users,

even though some of them may not know

that the device may not be able to keep them

adequately oxygenated during some or all

of their daily activities.

At the other end of the spectrum, there

are several larger POCs available that can

produce 3000 mL of oxygen per minute, or

3.0 LPM. These units can provide oxygen

at both continuous flow settings and a wide

variety of pulse flow settings, making them

viable options for a wide range of oxygen

users. Yet these POCs can weigh anywhere

from 12 to 20 pounds, and this is before

Portable Oxygen Concentrators:

The Chart and the Checklist

Continued on page 12


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]

adding the weight of the various accessories

that come with the POC. To many users,

that is just too much size and weight to

routinely carry with them no matter how

well the POC can oxygenate them.

Unfortunately, despite the variety of

small- and large-form POCs available, POC

options for oxygen users with high flow

needs is still limited. Users with needs in

the 4 LPM to 6 LPM continuous flow range

may find they can oxygenate well in some

or all of their daily activities on some of

the larger POCs set to their higher pulse

Perhaps the most important

factor to consider

regarding POCs is that

one size does not fit all.

settings. However, those with needs greater

than 6 LPM may not be able to routinely use

any of the POCs currently available, though

there may be some select applications and

scenarios where one of these larger POCs

could be an option for use.

Following is a checklist of questions

anyone considering use of a POC should

take with them when deciding what POC

to buy or use. These questions cover what

we feel are some of the most important

factors to think about when determining

what POCs are options for the user, but this

is not meant to be an exhaustive list. The

more these questions are asked, the more

manufacturers and dealers will need to be

clear on the answers. For now, don’t expect

to get immediate answers to all of them, but

do try and find out as much information as

you can before making a decision.

Continued from page 11


Q What is the oxygen production capac

ity of the POC?

Oxygen production capacity tells you

how much oxygen the POC is capable

of producing per minute. Smaller POC

units tend to produce less oxygen per

minute than larger units, and will meet

a smaller range of user needs than their

larger counterparts.

Oxygen production is typically given

in milliliters (mL) per minute. 1000 mL/

min = 1 LPM.

Q Is the POC continuous flow capable?

Not all POCs can provide con-

tinuous flow oxygen. Many of the

smaller POCs are pulse-only devices,

meaning that all oxygen volumes are

delivered via pulses as the user breathes

in. Pulse delivery of oxygen has

fundamentally different characteristics

compared to con tinuous flow oxygen

deliv ery, so do not assume pulse settings

have liter flow equivalency (e.g., 2 pulse

setting ≠ 2 LPM). Use of a pulse-only

POC during sleep is not recommended

unless the user has completed an overnight

study with the device showing that

they stayed oxygenated throughout the

night.

Q What is the range of pulse settings

available – and continuous flow

settings if applicable, and what are the

associated pulse volumes at resting and

active breathing rates?

For example, a POC with settings of

1, 2, and 3 may deliver:

1 = 16 mL @ 15 BPM 8 mL @ 30 BPM

2 = 32 mL @ 15 BPM 16 mL @ 30 BPM

3 = 48 mL @ 15 BPM 24 mL @ 30 BPM

Pulse settings on POCs will vary from

device to device – one POC model set

to “2” pulse delivery will not be the

same on another POC model set to “2”.

Additionally, some POCs reduce the pulse

volume deliv ered at a setting as the user’s

breath rate goes up (aka, minute volume

delivery), whereas others keep the pulse

volume the same no matter the rate of

breathing (aka, fixed pulse delivery). Some

units combine both! Know that on minute

volume delivery POCs and some fixed

pulse POCs, you may need to increase

the pulse setting when you are active to

maintain adequate oxygenation.

Q What is the POC’s typical battery life

for each pulse setting at resting and

active breath rates? What are the battery

run times for continuous flow settings, if

available?

Battery life can be dependent on a

variety of factors. For example, a POC

with settings of 1, 2 or 3 may operate from

a full battery charge for:

1 = 4 hrs @ 15 BPM 3 hrs @ 30 BPM

2 = 3.5 hrs @ 15 BPM 2.5 hrs @ 30 BPM

3 = 2.5 hrs @ 15 BPM 1.5 hrs @ 30 BPM

Continuous flow opera tion, when

available, will go through battery power

much faster than a setting in pulse

operation. In pulse delivery, the setting

selection and the user’s breath rate are

significant factors in determining battery

life. Knowing how long each battery will

Continued on page 14


last in the conditions it will be used in can

help to determine how long the user can

be away from a power source or will need

to swap in a freshly charged battery. Per

FAA regulations, traveling with a POC

requires bringing enough battery power

to last the user 1.5 times the duration of

the flight.

Q Is the device limited when being pow

ered by the DC power supply?

Some users find out too late that they

can’t use the device as they normally

would when using DC power. DC power

is provided through fixtures like car

adapters, and most POCs come with a

DC supply for travel purposes.

However, some POCs have limits on

their functionality when operating from

DC power. These limits may include non-

operation at higher flow and pulse settings

and/or the inability to charge the battery

while the device is in use.

Q How much does the POC unit weigh,

with and without all of the included

acces sories?

Manufacturers often will only report

what the unit plus one battery weighs,

which ignores the weight that is added

when toting a wheeled cart, AC/DC pow-

er supplies, extra batteries and other

accessories.

Carrying all of these addi tional pieces

can significantly add to the total weight

of the POC, which can make a difference

to those who may have trouble lifting and

maneuvering the equipment.

Q What is the manufacturer’s warranty

on the POC? If the POC needs repair

(under warranty or not under warranty),

will a substitute POC be supplied while it

is in for service?

If you are buying a POC new, be aware

that the warranty will typically cover the

unit, but not the battery, which will have

its own warranty terms. While the repair

cost may be covered, users who return a

POC for warranty service may be asked

to pay for shipping costs. Some, but not

all, dealers will provide a backup unit

while the defective POC is in for repair. If

a POC is bought used, the manufacturer’s

warranty may not be honored, so check

to see if the seller offers any warranty

guarantees.

The POC comparison chart compiles

information from manufacturer specifica-

tions, device manuals and manufacturer-

supplied material found in the American

Association of Home Respiratory Care’s

A Guide to Portable Oxygen Concen

trators, which can be downloaded for free

at https://www.aarc.org/resources/oxygen_

resources/portable_oxygen_concentrators_

guide.pdf. Please note that some POCs

previously included have been discontinued

and are no longer listed. Every effort has

been made to present the most accurate and

up-to-date infor mation in this comparison

chart – if you no-

tice an error please

contact Ryan

Diesem at rdiesem

@inspiredrc.com.

Continued from page 13


1,000 mL/min(1.0 LPM)

1 to 5

Minute Vol.Delivery: Dose

decreases as rate rises

15 BPM: 66 mL

30 BPM: 33 mL

6 lbs.

2.0 hours

12,000 ft.

333 mL/min(0.33 LPM)

NoneSelectable



15 BPM: 22 mL

30 BPM: 11 mL

3 lbs.

1.5 hours

10,000 ft.

AirSep AirSep AirSep Inogen Focus™ FreeStyle™ 3 FreeStyle™ 5 One G2

PRODUCTION AND DELIVERY

Please consult with your doctor or therapist before deciding to use or purchase any of these devices.

2014 Portable Oxygen ConcentratorsINTERMITTENT FLOW (PULSE ONLY) POCS

Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type

Maximum Delivered Pulse

Volume

Unit & Battery (Approx.)

Approx. Battery Time at Pulse

Setting 2

Max. Altitude

500 mL/min(0.5 LPM)

1 to 3



15 BPM: 33 mL

30 BPM: 17 mL

4 lbs.

2.5 hours

12,000 ft.

1,260 mL/min(1.26 LPM)

1 to 6



15 BPM: 60 mL

30 BPM: 30 mL

7 lbs.

4.0 hours(est.)

10,000 ft.

DOSE VOLUMES PER BREATH***2 LPM Continuous Flow: 15 BPM: 44mL 30 BPM: 22mL

4 LPM Continuous Flow: 15 BPM: 88mL 30 BPM: 44mL


WEIGHT (UNIT + STD. BATTERY); ADD UP TO 5LBS. FOR ACCESSORIES

STANDARD SINGLE BATTERY OPERATION TIMES

ALL UNITS APPROVED FOR FLIGHT BY FAA

High Flow


1 to 5



15 BPM: 56 mL

30 BPM: 28 mL

6 lbs.

2.5 hours

10,000 ft.


Inogen Inova Labs Invacare Oxus One G3 Activox™ XPO2 POC


INTERMITTENT FLOW (PULSE ONLY) POCS


1 to 3



15 BPM: 30 mL

30 BPM: 15 mL

5 lbs.

4.0 hours

10,000 ft.


1 to 5

Fixed Delivery8.5 mL

per setting

43 mL

10 lbs.

3.0 hours

8,000 ft.




Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type


Volume



Setting 2

Max. Altitude


2014 Portable Oxygen Concentrators


1 to 4



15 BPM: 56 mL

30 BPM: 28 mL

5 lbs.

3.0 hours(est.)

10,000 ft.

****Approximate Continuous Flow volumes at 2, 4, and 6 LPM are provided for comparison to maximum volumes delivered by the selected POC.

DOSE VOLUMES PER BREATH***2 LPM Continuous Flow: 15 BPM: 44mL 30 BPM: 22mL



Precision DeVilbiss® Invacare EasyPulse iGo Solo2®


3,000 mL/min(3.0 LPM)

1 to 6Continuous 1 to 3 LPM

Fixed Delivery 14 mL

per setting

84 mL

19 lbs.

4.7 hours(20 BPM)

13,123 ft.





Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type


Volume



Setting 2

Max. Altitude




1 to 5



15 BPM: 52 mL

30 BPM: 26 mL

7 lbs.

3.2 hours(est.)

9,000 ft.

3,000 mL/min(3.0 LPM)

1 to 6Continuous

0.5 to 3 LPM



15 BPM: 133 mL

30 BPM: 66 mL

20 lbs.

3.5 hours

10,000 ft.

INTERMITTENT FLOW (PULSE ONLY) POCS CONTINUOUS FLOW POCS

O2 Concepts Respironics™ SeQual® SeQual® OxLife Independence SimplyGo Eclipse 3/5 eQuinox


2,000 mL/min(2.0 LPM)

Pulse 1 to 6Continuous

0.5 to 2 LPM

Combination Fixed/Minute

Vol. Delivery**

15 BPM: 72 mL

30 BPM: 66 mL

10 lbs.

3.0 hours(20 BPM)

10,000 ft.

3,000 mL/min(3.0 LPM)

Pulse 1 to 6*Continuous

0.5 to 3 LPM

Fixed Delivery16 mL

per setting

96 mL*

19 lbs.

5.1 hours(12 BPM)

13,123 ft.


3,000 mL/min(3.0 LPM)

Pulse 1 to 6*Continuous

0.5 to 3 LPM

Fixed Delivery16 mL

per setting

96 mL*

14 lbs.

2.75 hours(12 BPM)

13,130 ft.

WEIGHT (UNIT + STD. BATTERY); ADD UP TO 10 LBS. FOR ACCESSORIES



Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type


Volume



Setting 2

Max. Altitude

CONTINUOUS FLOW POCS



3,000 mL/min(3.0 LPM)

Pulse 1 to 6Continuous 1 to 3 LPM

Fixed Delivery16 mL

per setting

96 mL

19 lbs.(w/2 batteries)

2.9 hours****(20 BPM)

13,123 ft.

****The Eclipse models also have pulse settings of 128, 160 and 192mL, but have additional breath rate restrictions for use. See Eclipse 3 manual for more information.

****The SimplyGo has two IF delivery modes: Pulse Mode and Night Mode. Shown volumes are for Pulse Mode. Night Mode has Minute Volume Delivery.

****The Independence is packaged with (2) batteries that can be used simultaneously, doubling the reported operating time.


Closer Look..Take a

Toll Free 877-699-8439

www.oxyview.com

Are you receiving

Your oxygen

Discretely?

20 www.pulmonarypaper.org Volume 25, Number 220 www.pulmonarypaper.org Volume 25, Number 3

Sharing the Health!My oxygen supplier no longer carries

these EZ-wrap ear protectors for me and I

relied on them to prevent sore ears. (They

slip over the cannula

tubing that goes around

my ears.) I found them

online at Amazon.com

from a company that

sells 50 pairs for $50,

that includes shipping. Maybe you can find

friends in your pulmonary rehab or Better

Breather support group to go in on them

with you!

Christie B., Colorado

Get friendly with your oxygen! A lady

from EFFORTS reports her husband has

named his “Jose” (hose-ay). They like to

try and find the humor in moments if they

can – it helps! He has two 25-foot lengths of

tubing with a connector between them that

rotates as he moves about. It really lessens

the tangling.

A Recipe for Joy

Put a smile

on your face.

A pedometer on

your waist.

Take a walk in

the mall

And stand tai chi tall!

Try a senior citizens’ center

for discussion groups.

Chair yoga to Zumba classes

Few fogies around!

A college, university or

other institute nearby?

Check it out!

Try a new fruit or veggie recipe lately?

Volunteer this year!

Judy Denkel, lucky to live in Reno, NV

The Proair (Al

buterol) inhaler

has a propellant

that may cause the

inhaler to become

plugged up if not

properly cleaned.

Visit www.proairhfa.com and click on

ProAir HFA Videos to learn proper clean-

ing techniques.

I clean my cannulas with hand sanitizer.

There is a new brand, Clean Smart, that does

not contain alcohol.

I hate the marks that the

cannula leaves on my cheeks.

Before bed, I move the sides

up level with my eyes. The

marks are barely visible when

I wake up. Hope these tips

help my fellow oxygen users!

Chris Gilfillan, Bloomington, MN

Sharon Miles of Loma Linda points out

that the word ‘Impossible’ becomes ‘I’m

Possible’ with a little rework!

March/April 2014 www.pulmonarypaper.org 21May/June 2014 www.pulmonarypaper.org 21

I think you will enjoy this! When I

went to church yesterday, a new priest

was standing at the door to introduce

himself and as he approached me, he

was really laughing. He said, “When I

saw you coming from the parking lot,

I saw you pulling this and all I could

think was why is this woman bringing

her vacuum cleaner to church? Now I

realize it is just your oxygen!”

So people who think the public is

staring at them because they wear

oxygen may have to clear up the

confusion!

I know he will always remember me,

so there is a plus!

Jeri M.

Minnesota

Ladies with emphysema often have

an increased chest diameter from hyper-

expanded lungs. This can make wearing a

bra very uncomfortable! Elaine from Canada

found extender hooks that can be purchased

in the notions de-

partment of fabric

stores. Some wom-

en have told us they

buy bras in a bigger

size than normal.

A camisole may be

your answer or if you need more support, a

sports bra may give you the support but be

flexible at the same time.

The Genie bra, available online at www.

geniebra.com, has been used by many ladies

with COPD. We have heard from some that

have deducted the purchase cost of having

to buy specials undergarments on their tax

return along with medical and therapy costs!

Russell from New Jersey loves his Vest®

Airway Clearance System! He has had

COPD for over ten years and was always

battling congestion, mucus and respiratory

infections that kept him on a lot of antibi-

otics and steroids and also in and out of the

hospital.

Since he has been using the Vest, his life

has improved tenfold! He is doing things

that he hasn’t done in years and is now able

to clear his secretions without medication.

For more information, visit the website,

www.thevest.com.


Carmen Parent from Bangor, Maine was

annoyed with her cannula always getting in

her way. They now get along much better

since she slips it over her head and lets it

hang down her back while still resting on

her ears. Carmen also uses a small clothes

pin to attach it to her shirt!

I was annoyed with the “little

black bags” that I was given to

carry my oxygen canisters, so I

started making my own in colorful,

sometimes seasonal fabrics. I don’t

have a pattern, I just measure the

tanks. The bags are very sturdy be-

cause I use webbing for the handle

and it goes around the entire bag.

They have interfacing/interlining

in between the outer layer and the

lining and a pocket outside to carry

the tank key. I have dressy ones and

ones made from old jeans. They can

be made large enough to carry your

wallet, Kleenex, emergency inhaler

or whatever you want. It only takes

a quarter yard of fabric and 1-1/2

yards of webbing (or you can cut

up a garment you no longer want).

Appliqués can be ironed on or but-

tons added. If you don’t sew, get

with someone who does and ask

them to help you.

Hope Lee, Clinton, MD

Sharing the Health! continuedRose Sladek

who has been on

oxygen therapy for

two years writes us

with this tip. Every

once in a while, she

would get water

coming through the cannula and dripping

out her nose – very unpleasant! She talked

to her supplier and he gave her a water trap

that worked great. It fits between the tubing

and the end of her cannula so the excess

water drips into the trap.

She empties and washes it as needed. It

works in Florida where she spends the win-

ter and in northern Ohio where she spends

the summer.

Hope it helps others!

Beverly Campbell of Dillsboro, IN, agrees!

Being forced to change from her liquid ox-

ygen to a home fill concentrator was very

difficult. She found a problem with water in

her tubing, even when using the water trap

her supplier provided her. If she disconnects

the tubing and connects it to her nebulizer

for a few minutes, it quickly blows the

water out!

A respiratory therapist gave me advice

that made my morning routine much easi-

er. When I take a shower, it is okay to use

my oxygen – I just throw the tubing over

the shower rod to keep it out of the way.

She also told me to turn down the heat. I

had always liked taking hot showers, along

with leaving the bathroom door open, but

taking a cooler shower makes me less short

of breath! Vicky M., Ormond Beach, FL


Yes, I’m Airhead Dan, the O2 man,

wanting to help you make a stand

against the evils of smoking

to this end, I am not joking!

When you smoke,

your Lungs sound an alarm.

This warns you about all the harm.

Save me, Save me, they will say.

Somebody douse that butt,

Save the day!

Soon your lungs are turning black.

Then you get that nagging hack.

Very soon, no oxygen will flow.

Off to the coroner you will go.

He’ll wrap you up in a big white sheet

then put you under six feet deep.

So bury that cigarette instead

We don’t want you to end up dead!

Just say no!

Dan Lyle, the O2 Man

Smoking Alarm

A Great “Small” TownThe Villages in central Florida, is not

just a retirement community with approx-

i mately 50,000 homes, but was ranked

as the number one, fastest growing small

town in the United States in 2012 by Forbes

magazine. They have an active Better

Breath er group called the AirHeads that

meets twice a month.

Dan also wanted you to keep your

wits sharp by figuring out what these

abbre viated terms mean! (As an example,

“26 L of the A” would be “26 Letters of

the Alphabet”.) Answers next issue!

1) 88 P K 2) 7 W of the A W 3) 1001 A N 4) 12 S of the Z 5) 54 C in a D (with the J) 6) 9 P in the S S 7) 60 S in a M 8) 13 S on the A F 9) 32 D F at which W F 10) 18 H on a G C 11) 90 D in a R A 12) 200 D for P G in M 13) 8 S on a S S 14) 3 B M ( S H T R ) 15) 4 Q in a G 16) 24 H in a D 17) 5 D in a Z C 18) 1000 W that a P is W 19) 29 D in F in a L Y 20) 2 S Y O

“TransTrachealOxygenUser” Sally Dover and “NotUsingAnythingbutanECylinder” Dan Lyle


It has been 50 years since the discovery

of the genetic abnormality of Alpha-1

Antitrypsin Deficiency, also known as

Alpha-1. It is a hereditary condition that is

passed on through generations that could

result in emphysema in adults and/or liv-

er disease in infants, children and adults.

A lack of a protein in the blood called

alpha-1 antitrypsin (AAT) that is mainly

produced by the liver is the problem. The

main function of AAT is to protect the lungs

from inflammation caused by infection and

inhaled irritants as tobacco smoke. When

AAT is missing and a person starts smoking,

they develop lung disease at a much earlier

age than cigarette smokers who have normal

levels of AAT.

Alpha-1 Education DayWe had the opportunity to attend a local

Alpha-1 Education Day sponsored by the

Alpha-1 Association and the Alpha-1 Foun-

dation. The event was a wealth of infor-

mation and support for those who have

been diagnosed with this genetic form of

emphysema. It is strongly recommended

that everyone who has been diagnosed with

COPD be tested for Alpha-1.

It is estimated that 3% of the people di-

agnosed with COPD, actually have AAT.

Testing is simple through a blood test or

mouth swab.

Free Testing Kits to Florida ResidentsThe Alpha-1 Foundation offers a free

Alpha-1 test kit for residents of the state

of Florida. You can get yours by calling

1-877-228-7321, extension 250. Call the ge-

netic counseling program at 1-800-785-3177

to find answers on testing results. Others

may receive an application for a free,

confidential test kit provided by the Alpha-1

Coded Testing Study – an Alpha-1 Founda-

tion-supported program run by the Medical

University of South Carolina. Contact the

MUSC at 1-877-886-2383 or email alpha

[email protected].

Listening to the participants, you could

hear “I am a MZ” or “I am a ZZ.” For each

trait a person has, as hair or eye color, there

are two genes – one from each parent. Nor-

mal alpha-1 genes are called M. The most

common types of abnormal alpha-1 genes

are S and Z. A person who does not have

Alpha-1 will be a MM.

The Z version of the gene produces very lit-

tle alpha-1 antitrypsin. Individuals with two

Z genes in each cell are likely to have Alpha-1

Antitrypsin Deficiency. If two parents have

the MZ combination of genes, with children

getting one version of the gene from each

parent, on average, one child in four children

will have Alpha-1 Antitrypsin Deficiency, and

three in four will have at least one Z version

of the gene.

Hereditary Condition Related to Emphysema

Alpha-1 Antitrypsin Deficiency


Treatment TherapiesAugmentation therapy is a treatment used

only for people who have AAT-related lung

diseases that involves getting infusions of the

AAT protein. The infusions raise the level of

the protein in your blood and lungs. Also

treatment with inhaled alpha-1 antitrypsin

is now being studied.

Patient Resources AboundThe Alpha-1 Foundation and Alpha-1

Association are merging into one organiza-

tion and a third called Alpha Net may soon

join the group. Call the Patient Information

Hotline at 1-800-245-6809 with any ques-

tions you may have.

The Peer Guide Program can give you

insight into what to expect as only one who

has personal experience can know. If you are

newly diagnosed and would like to speak to

someone who has been dealing with Alpha-1

symptoms and how it has affected their life,

call 1-877-346-3212.

You can access more than 200 past pre-

sentations given at all of the Education Days

and annual national conferences held for the

past eight years! Visit www.alpha1.org and

look for e-education under the education tab.

The Insurance and Reimbursement Referral

Hotline at 1-855-351-6610 is available to pro-

vide referral assistance with medical insurance

and reimbursement issues. The Associa tion’s

Private Health Insurance Toolkit can be found

under the Resources tab at www.alpha1.org.

The pharmaceutical companies that mar-

ket the medications also have education and

support programs for those diagnosed with

Alpha-1 Emphysema.

• www.aatmosphere.com (Baxter)

• www.cslcarez.com

• (Zemaira by CSL Behring)

• www.prolastin.com

• (Prolastin-C by Grifols)

Diet Choices Make a DifferenceAlina Zhukovskaya, a certified holistic

health coach, recently advised people with

Alpha-1 on food choices that may make them

feel better!

Alina warns burgers, fries and carbonated

beverages take a lot of energy to digest and

may cause inflammation. Choose foods that

are easy to digest and give your lungs energy

and support. You want to get the most nu-

trition out of the least volume of food. Fruits

and vegetables are a great choice. When you

juice your foods, you have a head start on

digestion and energy levels. The following

foods may benefit you:

• Avocados and sweet potatoes: Reduce

blood pressure and bloating.

• Cucumbers: Reduce bloating and hydrate

the body.

• Dark leafy greens: Purify blood and

strengthen the lungs.

• Radishes: Reduce mucus and relieve con-

gestion by clearing the sinuses.

• Tomatoes: Contain lycopene and support

heart health. Lycopene may block cancer

cell growth.

• Grapes: Help reduce mucus and bloating.

• Sesame seeds: High in calcium and support

strong bones.


Ecigarettes were first developed in

China and introduced to the U.S.

market in 2007. When they appeared,

it was thought they could help people stop

smoking. Now we know it might not be

such a good idea! According to a study con-

ducted by the University of California, San

Diego, vapor from e-cigarettes makes the

untreatable MRSA superbug more poisonous

and weakens the body’s ability to fight the

multi-antibiotic resistant bug. E-cigarettes

strengthened the bacteria.

Vaporizing Nicotine ‘Solution’The Associated Press has presented a

series of excellent articles concerning the

dangers and potential regulation of e-

cigarettes. The battery-powered devices are

actually vaporizers, made of plastic or metal,

that heat a liquid nicotine solution creating

vapor that users inhale or “vape.” Some e-cigs

are disposable, while some are designed to

be reused with cartridges or tanks that fans

of the product call e-juice. Many come with

a tiny light on the tip that glows.

The ingredient in the liquid is nicotine, wa-

ter, glycerol, propylene glycol and flavorings.

Propylene glycol is a thick fluid some times

used in antifreeze but also used a food

ingredient.

Users say e-cigarettes address both the

addictive and behavioral aspects of smok-

ing. Smokers get their nicotine without the

thousands of chemicals found in regular

cigarettes while getting to puff and exhale

something that looks like smoke without the

ash, odor or tar.

Scientists’ research, as to their safety and

whether they help you quit smoking all

together, is inconclusive. The federal gov-

ernment is adding millions of dollars into

independent and company studies to deter-

mine the health risks.

Skyrocketing Usage since 2006The e-cigarette industry has skyrocketed

from thousands of users in 2006 to several

million worldwide. Sales have been estimated

at $2 billion last year. There are now more

than 200 brands. Many manufacturers are

staying with tobacco and menthol flavors

but others are selling candy-like flavors like

cherry and strawberry that could attract

children to the product. Because of this, our

FDA wants to ban sales to minors and require

approval for new prod-

ucts and health warning

labels on the products.

The FDA would like

to extend its authority

to regulate cigars, hoo-

kahs, nicotine gels, pipe

tobacco and dissolvable

tobacco products. The

E-Cigarette Use Gaining Ground


Information from the CDC (Centers for

Disease Control in Atlanta) told us on

May 2, 2014, the first U.S. case of Middle

East Respiratory Syndrome or MERS was

confirmed in a traveler from Saudi Arabia

to Indiana, via London and Chicago. The

patient is a healthcare worker who lives and

works in Saudi Arabia. He was isolated in a

hospital during the course of illness and later

discharged, having fully recovered. A second

U.S.-imported case of MERS was confirmed

in a traveler who also came to the U.S. from

Saudi Arabia. This patient is also a healthcare

worker who traveled from Saudi Arabia to

Orlando. The MERS situation in the U.S.

represents a very low risk to the general pub-

lic in this country. The CDC and other public

health partners continue to investigate and

respond to the changing situation to prevent

the spread of MERS.

FDA first announced its plans to regulate

e-cigarettes in April 2011 and many groups,

such as the Campaign for Tobacco-Free

Kids, are frustrated by the delay. A 2013

study published by the Centers for Disease

Control and Prevention, showed e-cigarette

use among American middle and high school

students doubled during 2011–2012. Gov-

ernment representatives worry if the regula-

tions are too strict, they will have the deadly

effect of causing people to turn to regular

cigarettes.

The first human lung transplant was

performed on June 11, 1963. The patient,

identified later as convicted murderer,

survived for 18 days after the single lung

was transplanted.

We have come a long way since then.

The world’s first living donor lung trans-

plant was successfully completed at Kyoto

University Hospital in Japan. The entire left

lung of a female patient with a diffuse lung

disease was removed, and replaced by the

lower lobe of her husband’s right lung. The

patient in her 40s had a type of idiopathic

interstitial pneumonitis, which causes respi-

ratory distress due to the hardening of lung

tissue as in Idiopathic Pulmonary Fibrosis.

The recipient is steadily recovering and her

husband has returned to work.

For further information on lung trans-

plantation you may visit the Second Wind

Lung Transplant Association, comprised

of people who have gathered information

to help those seeking a transplant and sup-

porting those that have had one. They may

be found on the Internet at www.2ndwind.

org or you may call their information help

line at 1-888-855-9463.

2014 CRUISES


FST–

ST39

068 Member

PLAN YOUR WORRY-FREE VACATION.

CALL TODAY!

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

ALASKAINNER PASSAGE

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

Still time to

join us!

2015 CRUISES

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!


Enjoy 10 days of Spring on Holland America’s Noordam, leaving round trip from Fort Lauderdale on March 20–30, 2015.

Oxygen Guru Ryan Diesem will be our guest speaker!

SOUTHERN CARIBBEAN

Take an incredible 14day journey round trip from Amsterdam, leaving May 20–June 3, 2015. A once in a life time trip aboard Holland America’s small ship Prinsendam.

KIEL CANAL & BALTIC

Start the New Year right with a 7day cruise on the Grand Princess, round trip from Los Angeles January 17–24, 2015.

MEXICAN RIVIERA


Respiratory NewsTo keep up on the latest pulmonary

news, click on the link on the home

page of www.pulmonarypaper.org.

A recent article in the respiratory therapy

journal, Respiratory Care, showed giving

the recommended dose of Guaifenesin had

no measurable effect on sputum volume or

properties and is unlikely to be help you

raise or thin secretions when used to treat

acute respiratory tract infections. Guaifene-

sin is sold under the trade names: Mucinex,

Robitussin, Liqufruta, QTussin, Guiatuss,

MucaPlex and Bronchoril.

Another reason to get moving! California

researchers found exercise might help reduce

the risk of hospital re-admission in people

with COPD.

Too many platelets in your blood is

known as thrombocytosis. It was found in

12% of COPD patients admitted for exac-

erbations and was associated with elevated

mortality rates.

The online journal, Thorax, reports low-

dose aspirin (80 to 100 mg/day) might be a

reasonable strategy during and after acute

exacerbations.

Sharpen those pencils for crossword puz-

zles or get out the Scrabble game! The online

journal, JAMA Neurology, reports seniors

with COPD have an increased risk of de-

veloping mental decline, especially thinking

problems, without apparent memory loss.

The study involved more than 1,400 adults.

An FDA advisory panel recommend-

ed Montelukast (Singulair) should not

be allowed as an over-the-counter help

for hay fever and other upper respiratory

allergy symptoms. Among the side effects

are agitation, aggressive behavior, anxiety,

depression, hallucinations, insomnia, irrita-

bility and suicidal thoughts. If people could

buy Singulair without a prescription, the

potential for inappropriate and potentially

dangerous use is high.

Canada has become the first country to

approve umeclidinium monotherapy (Incruse

Ellipta by GlaxoSmithKline) for COPD. In-

cruse Ellipta contains 62.5μg umeclidinium

delivered with the company’s Ellipta dry

powder inhaler. Used once daily, the drug is

indicated for long-term maintenance bron-

chodilator treatment of airflow obstruction.

Keep cool this summer! A study from

researchers at Johns Hopkins found COPD

patients who were exposed to warm tem-

pera tures had greater disease-related

morbidity, including an increase in symp-

toms, a rise in the use of rescue medications

and a decline in lung function.

A new study presented at the ATS Con-

ference has shown a direct link between

eating fish, fruit and dairy products and

improved lung function among those with

COPD. Conducted by researchers in the U.S.

and Europe, the study specifically looked

at lung function within 24 hours of eating

grapefruit, bananas, fish and cheese.

May/June 2014 www.pulmonarypaper.org

Would you or a friend like to receive our newsletter every other month? Complete and mail this form or visit our website today! www.pulmonarypaper.org

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I I

The

PulmonaryPaperDedicated to Respiratory Health Care

Dedicated to Respiratory Care

Volume 25, No. 3

May/June 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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arePO

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