the pulmonarypaper€¦ · o or oil of oregano. it will make you . breathe better!” “um, no.”...

The

PulmonaryPaperDedicated to Respiratory Health CareMay/June 2016 Vol. 27, No. 3

What POC is Best for Me?

Inside:Our 2016 Annual Portable Oxygen Concentrator Guide

2 www.pulmonarypaper.org Volume 27, Number 3

Table of Contents We are hiding The Pulmonary Paper logo on our front cover. Can you find it?

Left to right: Susan Elfeld, Paul Kourtz, Joy Lynch

and Larry Strotheide agree that it’s

good to have a support network

behind you!

Features 04 | Calling Dr. Bauer

06 | Fibrosis File

08 | Ask Mark

12 | The Ryan Report

20 | Sharing the Health

30 | Respiratory News

Your Health10 | Buyer Beware with

Stem Cell Claims

23 | “Who's Your Daddy?” Quiz

24 | The Language of Dyspnea

For Fun28 | Sea Puffer Cruises:

Alaska, Canada, Hawaii or the Caribbean … Where do you want to go?

You have to have a good attitude and a

smile to deal with people that want to express

an opinion about your chronic lung disease.

Most mean well, as when you are trying to

catch your breath and are asked, “Are You

All Right?” “Do I look all right?” Be ready to

let the comments go by without any reaction

including these:

“You don’t look sick to me!” “Just wait until I walk up those flights of stairs.”

“Have you lost weight?” “Yes, trying to breathe!”

“I’m sorry.” Instead of pity, wouldn’t it be nicer if they said, “I am here for you!”

“Things will get better.” “You know a cure that the rest of us don’t?”

“How much did you smoke?” “Are you blaming me? Do they need to know this?”

“You’re so brave.” “Do I have a choice?”

“You should try oxygen water or Vitamin O or Oil of Oregano. It will make you breathe better!” “Um, No.”

“I know just how you feel.” “No you don’t, just ask me how I feel.”

“It could be worse.” “Things can get worse? Oh, good!”

Sometimes people don’t have to say any-thing – a friend or family member just being with you makes all the difference

in the world!

Things That Make You Go ‘Hmmm’

May/June 2016 www.pulmonarypaper.org 3

Ellen Glenn from Arizona enjoys a flower market in Nice, France!

“Resilience is accepting your new

reality, even if it’s less good than the one

you had before. You can fight it,

you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something

that’s good.”

Elizabeth Edwards

Editor’s Note

O ver the years, I am totally amazed at the determination people

with lung disease exhibit! We recently took a group of Sea Puffers all

the way to Europe. Lots of planning went into the trip and everyone

was excited and ready – even when our flight was delayed seven hours. We

amused ourselves in different ways and all was well.

After a great sense of accomplishment flying into Barcelona, the wheelchairs

were lined up to give us assistance to the baggage claim area. A woman

from the flight, seeing the oxygen users, made the comment, “It looks like

you all smoked the same kind of cigarette!” Seriously? Her husband was also

in a wheelchair – we didn’t blame him for it! What gives people the right to

say you brought this on yourself? If anyone has used a good comeback for

these ridiculous remarks, please let me know! It didn’t matter what she said,

after resting up, we took Europe by storm. I appreciate the stop smoking

commercials that are running on television but I disagree with the one

that says you can only go as far as your oxygen tubing. That oxygen tubing

travels very nicely!

Please read through all the articles in this issue. Mark talks about why it is not

okay to wear your oxygen only when you want to. Ryan helps you choose

the equipment that is right for you – not because it is smaller in size or on

sale. Get involved and know the Medicare and insurance regulations about

oxygen therapy – and let your elected officials know what you don’t like!

A member told us when she goes to the mall, she leaves her oxygen in the

car and goes out to it when she feels she needs to. Another has the cannula

by her and picks it up every now and then and takes a couple sniffs. People

have told us their doctor asked them if they want to be on

oxygen. Do they expect a yes answer? It wasn’t until she

landed in the hospital that using oxygen was no longer

a choice. There are people who tell us they would rather

have a shorter life without using oxygen than deal with

using it. Others fool themselves into thinking they are

being strong by refusing to put it on. Our favorite ,Flo, just

uses her lipstick when her lips start turning blue. All this

is not okay!

Make the right decisions for yourself today and don’t

let anyone make you feel like you deserved to get lung

disease. I salute you and your loved ones for your grit and

determination!


Questions 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].

Dear Dr. Bauer,JB from Orlando, FL, writes, I often feel chills and shiver when I don’t have a cold or infection. Could this be due to the fact that I am on oxygen therapy?

Dr. Bauer explains, Circulation problems are nearly always the main cause of feeling cold all the time. The most common long-term side effect of oxygen is drying and irritation of the nasal passage due to cold, dry air passing through your airways. This can be minimized by humidifying the oxygen supply. There are a variety of moisturizing salves and sprays that can be very helpful. (Oxygen cannot explode but does enhance combustion and should not be used by open flames.)

Many patients on home oxygen ask me if there are any long-term side effects to oxygen therapy and what the proper flow rate is for oxygen delivery. Do you need oxygen just with activity, just at night while sleeping, or all of the time? Feeling short of breath may be an indicator of low oxygen, but this is not a sensitive or specific finding. You can easily check your oxygen saturation with a pulse oximeter. You will be prescribed oxygen therapy if your saturation is 88 percent

Here I am at the trail's center, just a few miles to go! A well-deserved rest stop along the trail.

In this issue, we are bringing you a former column of Dr. Bauer’s. He is currently taking a walk, a very long walk, on the Appalachian Trail, to celebrate his semi-retirement.

Follow his journey at his blog found at www.MickCtown.com and you just might find a message to Pulmonary Paper readers!

Calling Dr. Bauer …


or less on room air. You may be fine sitting at rest but when walking your readings may drop significantly.

A common oxygen flow rate to start out at is 2 liters per minute. I often tell my patients to adjust the flow according to their pulse oximetry readings when they are active.

A common misconception is thinking you can get addicted to oxygen. The need for oxygen depends solely on the course of your underlying lung disease. If you are fortunate to have an improve-ment in lung function with new treatments, your oxygen may be discontinued.

Dear Dr. Bauer,

AS of Tully, NY, asks, My doctor recently told me that my carbon dioxide level was high. What does this mean and should I worry about it?

Dr. Bauer replies, We know that the job of the lung is to extract oxygen from the air we breathe and deliver it to our blood. Oxygen is a vital ingredient for many of the chemical reactions that occur in our body all the time. A byproduct of these chemical reactions is carbon dioxide. Every time we exhale, our lungs are getting rid of the carbon dioxide from our body. If your lungs cannot do this task, carbon dioxide could build up in the blood – this condition is called hypercapnia. When carbon dioxide levels rise, one of the ways our body compensates is to have us breathe more deeply and rapidly. You can image that could be quite stressful for someone with COPD. An arterial blood gas will be drawn to check your carbon dioxide levels. Symptoms of mild hypercapnia might include headache, confusion and lethargy. Se-vere hypercapnia may cause unconsciousness.

It is relatively easy to treat low oxygen levels by giving you supplemental oxygen. It’s a tougher problem to get rid of excess car-bon dioxide. Treatment with BiLevel Positive Airway Pressure (BiPAP) may be necessary. Optimizing lung function with a proper program of medication, treatments and reha-bilitation is crucial for you to keep your lungs functioning as well as possible!


Fibrosis FileInformation Sources

Dr. David Lederer is a pulmonologist from

New York City who specializes in the care

of people with pulmonary fibrosis and those

who have undergone lung transplantation.

Dr. Lederer created a blog called “Pulmonary

Fibrosis–Clearing the Air,” to help increase

awareness about the diagnosis and manage-

ment of pulmonary fibrosis. It may be found

at www.pfdoc.org

Don’t forget to check www.pulmonary

fibrosisnews.com for updated research find-

ings and treatment information. Pulmonary

Fibrosis News has reports that can easily be

understood. Recent presentations include

“Pulmonary Fibrosis Associated with Sclero-

derma: What You Need to Know” and “Is

Pulmonary Fibrosis the Same as Idiopathic

Pulmonary Fibrosis?”

Barbara, affectionately known as the Cat

Lady, is active in online support groups

for Pulmonary Fibrosis. You may see her

interview online at www.youtube.com/

watch?v=XdNvEhO0t6Y as she talks about

living with IPF for the past six years, answer-

ing many questions about how to cope with

the disease.

Pulmonary Fibrosis Foundation RegistryThe Pulmonary Fibrosis Foundation (PFF)

has established a national Patient Registry.

The PFF Patient Registry collects information

on people diagnosed with pulmonary fibrosis

who are seen at any of the PFF’s participat-

ing 40 Care Center Network sites across the

U.S. The Registry collects medical data from

people’s clinical care, CT imaging files, and

responses to questionnaires about PF symp-

toms and how PF impacts their lives. Blood

samples may also be stored.

It is a powerful tool for observing the

course of disease, understanding the effec-

tiveness of different treatments and care

practices, and comparing outcomes across

different types of people. It is observational,

which means that people’s medical care is

not changed as a result of participating – no

extra visits, and no required changes in med-

ications. For more information, please visit

www.pulmonaryfibrosis.org

News in the Fight against FibrosisVeracyte, Inc. presented new data in-

dicating that its in-development test, the

Envisia classifier, has the potential to diag-

nose idiopathic pulmonary fibrosis (IPF),

distinguishing it from other interstitial lung

diseases (ILD), and reduce the need for inva-

sive diagnostic surgeries.

Afferent Pharmaceuticals announced the

results from their study, revealing that the

company’s medication, known as AF-219,

significantly reduced cough frequency in

people with IPF.

New analyses, presented at the American

Thoracic Society 2016 Annual Conference,

further support the efficacy and safety of

nintedanib (Ofev) in treating IPF. Boehringer

Ingelheim shared a host of data at the meet-

ing, establishing nintedanib as an important

player in IPF management, regardless of

disease severity.


In the first large-scale study comparing

a variety of lung diseases, Yale scientists

revealed that chronic obstructive pulmonary

disease (COPD) shares a network of underly-

ing genes with idiopathic pulmonary fibrosis.

The new findings advance our understanding

of both conditions, and might possibly aid

in the development of common therapeutic

approaches.

Much information on lung disease diag-

nosis and treatment may be found at the

American Thoracic Society’s site at www.

thoracic.org/patients

If you are on Medicare or anticipate en-

rolling, you should know about the Medi-

care Rights Center which is the largest

source of Medicare information and assis-

tance in the U.S. They have a new resource

to help learn about what is covered under

the program that you can access at www.

medicareinteractive.org. You can create your

own profile and easily save and access the

information you are interested in.

For instance, did you know if you have

Medicare and use oxygen, you’ll rent oxygen

equipment from a supplier for 36 months.

After 36 months, your supplier must contin-

ue to provide oxygen equipment and related

supplies for an additional 24 months even

though the monthly rental payments will

stop. Your supplier must provide equipment

and supplies for up to a total of five years,

as long as you have a medical need for

oxygen. The supplier can’t charge you for

performing these services. If you use oxygen

To see how our friends across the pond

find support for pulmonary fibrosis and

other lung conditions, visit the British Lung

Foundation’s site at www.blf.org.uk and

click on the “Support for You” tab.

cylinders that need delivery of gaseous or

liquid oxygen contents, Medicare will con-

tinue to pay each month for the delivery of

contents after the 36-month rental period.

If your medical need continues past the

five-year period, your supplier no longer

has to continue providing your oxygen and

oxygen equipment, and you may choose to

get new equipment from any supplier. A

new 36-month payment period and five-year

supplier obligation period starts over with

the new supplier.

Medicare Rights Center Will Tell You What is Covered under the Program


Ask Mark …

David from EFFORTS writes, My oxygen saturation (SpO2) readings stay around 92% to 94% at rest but during exercise

or activity, they drop to the mid 80s. They come back up within a minute or so. Am I hurting myself by not wearing my oxygen?

Mark tells us, This is a subject about which I’ve written much over the years. Hypoxemia – low oxygen level in the blood – begins a process that leads to inevitable, damaging complications and consequences. If supplemental oxygen is initiated, the damage to your heart and lungs can be slowed, even reversed, to some degree. In early hypox-emia, we see is a classic pattern which you so nicely described. One has a decent, even ‘normal’ oxygen saturation while at rest and often with minimal exertion. But when you increase intensity of exertion, that saturation drops below 90%. The lower your oxygen saturation level goes, the greater will be the “over time” even though your saturation quickly returns to a level above 90% saturation.

The fact that your saturation returns to an accept-able level after dropping into the 80s is of no real help. It is the ‘repeated’ dropping that does the damage. Hypoxemia causes blood pressure within the lungs to increase because low oxygen levels cause constriction of pulmonary blood vessels – called pulmonary vasoconstriction. The increase in pulmonary blood pressure puts stress and strain on the right side of the heart – that part of the ‘heart pump’ which pushes blood into and through the lungs. Normal right heart pressure is between

5 mmHg and 20 mmHg. Constricted blood vessels in your lung can cause right heart pressures to rise, reaching 50 mmHg to 60 mmHg in more severe or advanced cases. The right heart muscle is not designed to be a high-pressure pump.

Over time, the muscle that makes up the right ventricle of the heart does one of two things: it increases in mass and thickness or it stretches out which causes thinning of the muscle wall. When the right heart muscle becomes “hypertrophic” (increased in mass and thickness), it is not like building your biceps, which results in stronger arms. Rather it becomes more like a 300-pound canary trying to fly. It holds less blood because of chamber volume reduction from the

Mark Mangus, RRTEFFORTS Board

Mark Mangus RRT, BSRC, is a member of the Medical Board of EFFORTS (the online support group, Emphysema Foundation For Our Right To Survive, www.emphysema. net). He generously donates his time to answer members’ questions.


encroaching mass (thickness). It also loses pumping strength and the ability to push blood adequately through the lungs. If the muscle thins, then it also loses its pumping strength with the same result – less blood being pumped into and through the lungs.

Ultimately the process advances until the heart and lungs develop congestive failure. Fluid leaks out of the pulmonary blood vessels into what we call the “third space”. It follows gravity to cause your ankles and legs to swell.

The lungs become like a saturated sponge. Breathing becomes more difficult. Exchang-ing oxygen and carbon dioxide becomes difficult and normal function progressively becomes impossible if continued advance-ment is allowed.

The good news? Starting oxygen early in the disease process lessens the effects by not allowing hypoxemia to occur or to occur as severely. Oxygen is the number one inter-vention that can reverse pulmonary vaso-constriction. Indeed, we have known for dec - ades that it is the only intervention in treat-ment of COPD that extends survival and im-proves function and as a result, quality of life.

My recommendation would be for you to see your pulmonologist or whoever manages your COPD and get a walk test to document your oxygen desaturation. You might also receive a recommendation to have a sleep study to determine if you desaturate during sleep. If you qualify for supplemental oxygen, you should begin using it. The longer you go with the oxygenation pattern you describe, the more you travel down that road towards inevitable lung and heart damage. Using oxy-gen sooner rather than later is key to putting the brakes on the process.

Gary M. from EFFORTS asks Mark to explain oxygen saturation readings with an oximeter, arterial blood gas, and how a heart medicine like Lopressor affects COPD.

Marks explains, Three components go into calculating your oxygen saturation percent-age when you have your arterial blood gas drawn. Your pH, carbon dioxide and oxygen partial pressures are compared and factored together to arrive at a calculated saturation of the hemoglobin. Hemoglobin in the red blood cells is responsible for transporting and delivering over 99 percent of the body’s oxygen supply. Pulse oximeters look only at the saturation without distinguishing how the other factors may affect the reading.

Lopressor is a beta blocker. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. They are medications that reduce blood pressure and treat cardiac arrhythmias. Years ago, “non-selective” beta medications we used to open up the airways caused problems by affecting all types of beta receptors. The com-bination of inhaled beta antagonists and oral beta blockers made the respiratory medica-tion less effective in improving air movement and interfered with the beta blocker’s ability to control heart arrhythmias. Because of the refinement to more ‘selective’ beta receptor antagonists, such problems are extremely rare with today’s medications. Still all beta blockers continue to carry a warning about the potential interference from beta agonists, such as Albuterol, to counteract beta blockers such as Lopressor.

Oxygen is the number one intervention that can reverse pulmonary vasoconstriction.

10 www.pulmonarypaper.org Volume 27, Number 210 www.pulmonarypaper.org Volume 27, Number 2

Buyer Beware with Stem Cell Claims!There are an estimated 100 stem cell

clinics in the United States operating on

questionable claims and with little supervi-

sion. Reporters from the Tampa Bay Times

reported on a local center known as the Lung

Institute and their involvement in stem cell

treatments. You can read the entire article at

this internet site, http://tinyurl.com/gwkn8p7

The medical director of this facility says he

can treat lung patients in the U.S. because he

is re-infusing them with their own stem cells,

a legal process under certain circumstances.

It is not approved or endorsed as a lung

disease therapy in this country. Medicare

won’t cover it. Participants must pay cash

– between $7,500 and $12,000 for a three-

day treatment, plus $4,500 for additional

“boosters” of cells extracted from their blood

or abdominal fat.

There is no clinical data showing stem cell

therapies benefit people with lung disease.

Stem cells can reproduce themselves to repair

tissues and mature into cells that perform a

specific function.

Adult stem cells can be taken from any-

one’s body. After withdrawing your blood,

a centrifuge pulls out the stem cells and they

are given back to the same person either

intravenously or inhaled via a nebulizer. No

evidence suggests stem cell therapy results in

growth of new lung tissues either in animals

or people.

The FDA in 2008 determined that the pro-

cedure in which a person’s own stem cells are

re-injected constitutes a “drug,” meaning the

clinics would be subject to the same rigorous

testing requirements that govern the pharma-

ceutical companies. The FDA later released a

narrow list of exceptions to the regulations

and the Lung Institute says it operates under

those exceptions.

The Lung Institute has not published

results or scientific studies of its treatments.

The medical director has said that about 70

percent of people report some benefit after

the treatment, such as walking to the mailbox

seems easier after having the treatment.

Congratulations to our friends at

Monaghan Medical Corporation on

receiving the Gold Award at the Medical De-

sign Excellence Awards for the Aerobika®.

The Aerobika® is an Oscillating Positive Ex-

piratory Pressure Therapy handheld device

that provides intermittent resistance, positive

pressure and oscillation (which is moving

back and forth) all at the same time. This

helps to clear mucus in the upper airways

so it can be coughed out. The device was

put to the test in a study performed at the

Robarts Research Institute, Western Uni-

versity, London, Ontario, Canada, and re-

searchers found that the study subjects had

improvements in increased mucus clearance,

decreased cough frequency and breathless-

ness, and enhanced exercise tolerance.


FOR DRUG-FREE,

NATURAL AIRWAY

CLEARANCE.

AEROBIKA® Oscillating

Positive Expiratory Pressure (OPEP) Therapy System

Words or phrases accompanied by ™ and ® are trademarks and registered trademarks of Monaghan Medical Corporation or an affiliate of Monaghan Medical Corporation. © 2016 Monaghan Medical Corporation. 1 Data on file

Now available through The Pulmonary Paper.

Call today, 1-800-950-3698 or visit www.pulmonarypaper.org

The AEROBIKA® OPEP is designed to aid in the loosening and removal of secretions in your lungs.

The device is lightweight, simple to use and can be carried anywhere.

It may also be used in combination with your nebulizer treatments.

The AEROBIKA® OPEP is easy to clean and dishwasher safe.

After using the AEROBIKA® device people say1:

“It was easier to raise my secretions.”

“I don’t cough as often.”

“I don’t feel so short of breath.”

“It has improved my ability to do different

activities.”

“It has made my life better.”

monaghanmed.com


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

Ryan Diesem

The Ryan ReportHome Oxygen Guru – The HO2G Pen

2016 Portable Oxygen Concentrator Guide

Here it is, the 2016 version of our annual Portable Oxygen

Concentrator (POC) Guide. Not much needs to be added

from our previous 2015 version as there hasn’t been much

introduced in the last year.

• Over the summer of 2015, Philips Respironics introduced the

SimplyGo Mini, a pulse-only POC that can produce up to around

1000 mL/min of oxygen. Unlike the larger SimplyGo, the SimplyGo

Mini cannot provide continuous flow, and

be aware that the pulse volumes delivered

at identical settings between the SimplyGo

Mini and the SimplyGo are not the same. In

terms of oxygen production and size, the

SimplyGo Mini is most similar to the Inogen

One G3 and the FreeStyle 5. As of now, the

SimplyGo Mini has yet to be approved for air

travel by the FAA (though we do expect it will be at some point), so

keep that fact in mind when considering renting or buying this unit.

• At the beginning of 2016, Inogen updated its Inogen One G3

concentrator, adding some production volume, increasing the total

output from around 840 mL/min to around

1000 mL/min, and adding a pulse setting of

5, giving the unit a range of settings from

1 to 5. The same goes for the OxyGo POC,

which is the same exact model as the G3

but marketed under a different name. Users

interested in an Inogen One G3 or OxyGo

model should inquire whether or not the unit has 4 or 5 settings

to be sure they are getting the latest model.


Below is a brief list of items to keep in mind

when considering purchasing a POC.

• Size Matters. In general, the smaller the

POC, the less oxygen the device will be able

to produce. This is especially important to

keep in mind because during activity, most

oxygen users need more oxygen delivered

to them to maintain adequate saturations. If

the device cannot produce enough oxygen

to saturate the user during certain activities,

that device should not be considered

appropriate for use during those activities.

• Each POC is Different. Every model of POC

has its own perfor mance characteristics

that make it unique from other POCs.

Users should never assume that one

device will deliver the same therapy as

another. Differences in performance tend

to be wider when comparing a larger POC

to a smaller POC, but even similar sized

POC models will have oxygen production

and delivery charac teristics that should not

be ignored.

• Pulse Delivery Characteristics. All POCs

feature pulse delivery settings, and users

should know whether or not the POC

delivers its pulses via minute volume

delivery or via fixed pulse delivery. POCs

that use minute volume delivery will reduce

the pulse volume delivered per breath as the

user’s rate rises (where typically the user will

need more oxygen, not less), whereas fixed

pulse devices will not lower pulse volumes

with an increase in rate. Currently, all POCs

that do not have continuous flow capability

have minute volume delivery algorithms.

Further explanation of minute vs. fixed

pulse delivery can be found in the January-

February issue of The Pulmonary Paper.

• Added Weight. Manufacturers, when

report ing the weight specifications, typically

only state how much the unit itself plus

one battery weighs. This value ignores the

added weight of any accessories, which can

include extra batteries needed for travel,

carrying bags and carts, ac and dc power

adapters, and other items. When looking

at how much the POC weighs, be sure to

add anywhere from one to five additional

pounds depending on the amount of

accessories that will be needed for use.

• Battery Life Varies. POC battery life will be

dependent on the setting used as well as

the breath rate of the user. Users needing to

set the POC to higher pulse settings should

expect less battery life than if set at a lower

pulse setting. For POCs with continuous flow

operation, setting the unit to continuous

flow will go through the battery power

at a significantly higher rate than if set to

the same pulse setting value. Also, device

specifications for battery life are reported

in optimal (and new) conditions and will

decrease over time.

As always, feel free to contact me if you

have any questions about POCs at my email

address, [email protected].


{Order Online: Store.MainClinicSupply.comOrder by Phone: 1-800-775-0942

Own the best!

• New 2016 Model Inogen G3 • 1 to 5 Enhanced Portable Concentrator

• Inogen GS-100 Constant Flow • Concentrator with Travel Case included, • with free overnight delivery

Ultimate Freedom Package!

Main Clinic Supply is a proud and loyal supporter of The Pulmonary Paper. We are

fortunate to have helped many readers with port able oxygen. We have also referred

many of our customers to a Sea Puffer Cruise! None of this would be possible without

the hard work and dedication of Celeste Belyea, publisher of The Pulmonary Paper.

Celeste works very hard to produce this paper for all of us. She does so without con-

cern of the profitability and costs to make it happen. She needs all our help to keep the

paper going for months and years to come! If you are reading this and gaining valuable

information, then please make a contribution to help Celeste help all of us into the

future!

Please pass on the paper to someone else in

need of this valuable news and information. And

ask them to help support the paper as well!

Francis FoxGeneral Manager / CEO of Main Clinic Supplywww.MainClinicSupply.com

P.S.: Take a cruise with the Sea Puffers!

Celeste and Holly are the greatest travel agents,

tour guides and respiratory therapists! When

you travel with them you get all three of these

times two!

Take it from my mother, Diana Fox, who just returned from a Mediterranean Sea

Puffer cruise. …

“Celeste and Holly just killed themselves to make sure everyonehad fun and (they) were always there when someone

needed help with their oxygen.”

Thank you, Celeste!

Call Courtney for special Pulmonary Paper member pricing!


960 mL/min(0.96 LPM)

1 to 5

Minute Vol.Delivery: Dose

decreases as rate rises

15 BPM: 64 mL

30 BPM: 32 mL

6 lbs.

2.0 hours

12,000 ft.


NoneSelectable



15 BPM: 22 mL

30 BPM: 11 mL

3 lbs.

1.5 hours

10,000 ft.

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

PRODUCTION AND DELIVERY

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

2016 Portable Oxygen ConcentratorsINTERMITTENT FLOW (PULSE ONLY) POCS

Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type

Maximum Delivered Pulse

Volume

Unit & Battery (Approx.)

Approx. Battery Time at Pulse

Setting 2

Max. Altitude

500 mL/min(0.5 LPM)

1 to 3



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: 84 mL

30 BPM: 42 mL

7 lbs.

4.0 hours(est.)

10,000 ft.

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

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


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

STANDARD SINGLE BATTERY OPERATION TIMES

ALL UNITS (EXCEPT SIMPLYGO MINI) APPROVED FOR FLIGHT BY FAA


Inogen Inova Labs Inova Labs Invacare One G3/OxyGo Activox™ Pro Activox™ 4L XPO2


INTERMITTENT FLOW (PULSE ONLY) POCS


1 to 3



15 BPM: 30 mL

30 BPM: 15 mL

5 lbs.

7.3 hours

10,000 ft.


1 to 5


decreases asrate rises

15 BPM: 56 mL

30 BPM: 28 mL

6 lbs.

2.5 hours

10,000 ft.




Maximum Oxygen

Production (mL/min)

Available Settings

Pulse Delivery

Type


Volume



Setting 2

Max. Altitude


2016 Portable Oxygen Concentrators

840 mL (0.84 LPM) (pre-2016)

1000 mL/min (1.0 LPM) (2016)

1 to 4 (pre-2016)

1 to 5 (2016)



15 BPM: 56 mL/67 mL

30 BPM: 28 mL/33 mL

5 lbs.

3.0 hours(est.)

10,000 ft.

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


1 to 4



15 BPM: 56 mL

30 BPM: 16 mL

5 lbs.

8.3 hours

10,000 ft.


500 mL/min (0.5 LPM) EasyPulse 3

780 mL/min (0.78 LPM) EasyPulse 5

1 to 3 (EasyPulse 3)

1 to 5 (EasyPulse 5)



15 BPM: 52 mL

30 BPM: 26 mL

5 lbs. to 7 lbs.

4.0 hours (EasyPulse 3)3.4 hours (EasyPulse 5)

9,000 ft.

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



Precision Respironics DeVilbiss® Invacare EasyPulse 3/5 SimplyGo Mini 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.



1,000 mL/min(1.0 LPM)

1 to 5

Combination Fixed Delivery/

Minute Vol.Delivery

15 BPM: 55 mL

30 BPM: 33 mL

5 lbs.

4.5 hours

10,000 ft.

3,000 mL/min(3.0 LPM)

1 to 6Continuous

0.5 to 3 LPM



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® Independence SimplyGo Eclipse 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 192 mL, but have additional breath rate restrictions for use. See Eclipse manuals for more information.

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

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


Englewood, CO 80112Toll Free 1-877-699-8439 or www.oxyview.com

Let everyone see the real you!

No more nasal cannula when you are out and about.

Oxygen therapy eyeglasses allow you to ditch the nasal cannula!

Spring into Comfort with Oxy-View Eyewear!

Great news..We are receiving our new shipment of frames in October. Be one of the first to place your order.

Call TollFree at 1-877-699-8439 or visit our website at www.oxyview.com to place your order.

Need a second pair? Ask about our second pair discount.

Talk to your doctor now about the benefits of Transtracheal Oxygen Therapy.

Live Longer! Breathe Easier! Improve Quality of Life! Even Look Better!

For information, call: 1-800-527-2667 or E-mail [email protected]

• Improve your mobility

• Develop greater exercise capacity

• Reduce your shortness of breath

• Improve your self-image

• Save money on portable oxygen sources

• Compatible with virtually every oxygen conserving device

• Eliminate the discomfort of your nasal cannula

• Increase your longevity

You’ve suffered long enough. Ask your doctor about TTO2.


Sharing the Health!I would like to share that if anyone is on the

medications Breo Ellipta or Spiriva, you can

get Breo Ellipta free for one year and pay no

more than $10/month for Spiriva. You may

qualify even if you have insurance.

See www.mybreo.com/COPD or call 1-888-

825-5249 and www.spiriva.com/copd/

why-spiriva/savings-and-support for more

information. You may phone 1-888-777-

1919 for additional information on Spiriva’s

program.

Kathy L., Passaic, NJEllen G. of California writes, My good

friend sent me a note that she finally got

a better understanding of what it is like to

have a chronic illness by reading an article

entitled “The Spoon Theory” by Christine

Miserandino found on the Internet at www.

butyoudontlooksick.com

I invite you to share it with your family

and friends as it may make them realize that

the activities you choose to do and the time

you may spend at these activities are not

really something over which you have total

control. Each spoon represents something

you will do that particular day – you only

have so many spoons to work with and you

decide what you will accomplish. Family

and friends will see you are making the best

choices for you!

Bronchiectasis is a lung disorder where

the bronchial tubes are permanently and

abnormally widened (dilated), causing

secretions to pool and be difficult to cough

out. This situation often results in frequent

infections. Nontuberculous mycobacteria

(NTM lung disease) refers to bacteria that

cause lung problems but not tuberculosis

and is commonly known as MAC. In an

effort to meet the needs of the bronchiec-

tasis and NTM communities, the COPD

Foundation has created the Bronchiectasis

and NTM Initiative.

BronchandNTM360social is an online

community where members can interact,

ask questions, read and comment on blog

posts, and more. You will find educational

information and research programs such

as the Bronchiectasis and NTM Research

Registry. Visit www.NTMinfo.org and

www.brinchandNTM260social.org to learn

more.

Every so often, it is a good idea to clean

your showerhead. Atypical mycobacteria has

been known to build up. It is a dangerous

bug for people with chronic respiratory

problems. Fill a plastic bag with white vine-

gar, cover the showerhead and close the bag

with a rubber band at the top, soak for an

hour. You can then shower with confidence!


Nina C. of California gets together with

ladies who are helping take care of loved

ones who have medical problems. They

recently discussed ways to get through dif-

ficult times.

• You need to state your feelings and

discuss them; holding them inside will

only cause more problems and stress.

The FDA has finally issued rulings that

bring electronic cigarettes, hookah pipes,

and cigars into the agency’s regulation of

tobacco products.

These products will now be subject to the

same restrictions as traditional cigarettes,

including a ban on sales to minors and re-

striction on advertising and marketing. The

FDA also gets authority over ingredients

and product design, which many have spec-

ulated, will spell the end to youth-friendly

flavors.

Calls to poison control centers resulting

from exposure to vaping liquids by young

children have increased dramatically with

the popularity of e-cigarettes. There were

comas, seizures, and even one death from

these exposures.

We can only hope regulating e-cigarettes

will be successful for the war on smoking.

Bans on smoking may have a higher success

rate on discouraging our young people to

stop smoking than imposing high taxes on

• Don’t be afraid to ask for help from

family, friends, neighbors, church

members, or if possible, hire someone if

no one is available.

• Join or establish a support group to be

able to talk to other caregivers. There

are sites on the Internet as www.care

giveraction.org and www.caregiver.org

• Take time out for you every day.

• Take one crisis at a time, don’t let things

get overwhelming.

• Plan ahead to avoid problems.

• Keep a positive attitude.

cigarettes. If they are unable to smoke inside

restaurants or bars, they are choosing not to

smoke at all.

The FDA has also teamed with Minor

League Baseball for a campaign to reduce

smokeless tobacco use, including chewing

tobacco and dip, among rural male teens.

In a study done on human cells exposed

to extracts taken from e-cigarettes, cell death

and breaks in DNA strands were found. This

is the kind of cell damage associated with the

development of cancer.

E-Cigarettes Now Regulated by the FDA!


Sharing the Health! continued

If you are a member of Facebook, you

will want to join the Ultimate Pulmonary

Wellness group sponsored by New York’s

Dr. Noah Greenspan, Program Director of

the Pulmonary Wellness and Rehabilitation

Center, and join in some lively discus-

sions! Dr. Greenspan also has a web site

at www.pulmonarywellness.com and has

a new video presentation, “Physiology of

Exercise for the Pulmonary Patient,” that

can be seen at https://www.youtube.com/

watch?v=OhgfzLEYNVo

Our friend John Leaman of the Asthma/

Emphysema Self-Help Group and editor of

Respiratory News and Views, recently re-

ported on Dr. Greenspan’s presentation at a

recent Lung Force Expo. He lists basics that

can be changed to improve lung function.

1. Medical. People with pulmonary prob-

lems should have three physicians – an in-

ternist, a pulmonologist and a cardiologist.

The cardiologist is necessary because of the

similarity of many symptoms of lung and

heart disease.

2. Exercise. You should be exercising every

day, if only for five minutes at first, working

up to as long as you can. Start off with an aer-

obic activity and add strength and flexibility

training – all forms of exercise are beneficial.

3. Nutrition. People with lung problems

have different needs than others. You want

to limit carbohydrates because they may

increase carbon dioxide production.

4. Stress and Anxiety Management. Re-

lax! Stress will release adrenaline which will

increase your shortness of breath.

5. Prevention of Infection. Wash your

hands and try and avoid sources of infection.

I would like to share how I keep my tubing

from getting tangled up around the house!

I use two 25-foot length oxygen tubing with

a swivel connector. I hang the tubing over

a door and it really does stay straightened

out when I use it. It works with cannulas

too – I hang them from a hook and it not

only keeps them from tangling but also gets

rid of the plastic odor. Putting four bed risers

underneath the concentrator in my bedroom

keeps the air moving around it and keeps the

room cooler for me.

Jacquie T., Glendale, AZ

A report presented at the recent American

Thoracic Society conference compiled the

input of patients, family members, health-

care providers, payers, and pharmaceutical

companies to highlight the COPD patient

experience and address gaps in COPD care

delivery. The 54-page report outlines the

current state of COPD care, the economic

burden of the disease, our community’s

research and evaluation efforts, COPD-

specific care and coordination of that care,

and the assessment of quality and cost-

effectiveness. To read the entire article about

the important needs in the next decade

for people with COPD, register for a free

Lancet account at http://tinyurl.com/j3n9ryh

and access the full article at this link, http://

tinyurl.com/jaqwbcl

I bruise very easily and use a product

called Dermablend to cover the purple

blotches on my arms. You can get this in

many department stores or order it from

the Internet. It is definitely not necessary but

makes me feel better! Fran Z., El Paso, TX

8. American actor Robert Young starred

in what 1950s TV show dedicated to

fathers?

a. Make Room for Daddy

b. Leave It to Beaver

c. The Adventures of Ozzie & Harriet

d. Father Knows Best

9. Which “Make Room For Daddy” star

fathered the star of “That Girl”?

a. Jesse White

b. Ben Lessy

c. Danny Thomas

d. Desi Arnaz

10. Who is often called the “Father of

Medicine”?

a. Demosthenes

b. Hippocrates

c. Galen

11. According to the quote by Galileo,

who is the “Father of Invention”?

a. Victory

b. Shame

c. Doubt

d. Fear

12. Which father and daughter have both

won Oscars?

a. Bruce and Laura Dern

b. Gwyneth and Bruce Paltrow

c. Anjelica and John Huston

1. Who were the “Founding Fathers”?

a. the leaders of the American

Revolution

b. the signers of the Declaration of

Independence

c. the delegates to the 1787

Constitutional Convention

2. In the Roman Catholic Church, who is

the “Holy Father”?

a. God

b. Jesus

c. The Pope

3. He is known as the “Father of History”:

a. Pliny

b. Herodotus

c. Aristotle

4. In Greek myth, he is the “Father of the

Universe”:

a. Cronus

b. Uranus

c. Zeus

5. “Father Time” is also known as:

a. St. Nicholas

b. The Grim Reaper

c. Daedalus

6. Who is considered the “Father of the

Symphony”?

a. Joseph Haydn

b. Wolfgang Amadeus Mozart

c. Ludwig van Beethoven

7. Saint Nicholas, the martyr behind the

“Father Christmas” myth, is from:

a. Asia Minor

b. The Netherlands

c. England

Who’s Your Daddy? Test Your ‘Father’ Knowledge!



People with cardiac problems common-ly describe their chest pain as “pres-sure,” “tightness,” “dull” or perhaps

“crushing weight.” Cardiologists use these descriptions to help them make a specific diagnosis. Unfortunately, when it comes to describing shortness of breath, things become a bit more cloudy. The medical term for shortness of breath is dyspnea (pronounced disp-nee-uh), meaning difficult breathing. Physicians from around the world have been studying something they call “the language of dyspnea.”

There are literally hundreds of causes of dyspnea. For example, over 200 different causes of interstitial lung disease (ILD) have been identified. There are cardiac causes, blood disorder causes, traumatic causes, neuromuscular causes, and even obesity can cause an increase in dyspnea. The list is very long. When you experience shortness of breath, it can be an extremely uncomfortable and even downright frightening experience. It is for this reason that the physician taking your medical history should speak the same language as you are speaking. This leads directly into the discussion of the language

Understanding Why You Are Short of Breath:

The Language of Dyspneaby John R. Goodman BS, RRT, FAARC and Mark Mangus BS, RRT, FAARC

of dyspnea. People describe their shortness of breath in a variety of ways:

I feel that my breathing is rapid. My breath does not go out all the way. My breath does not go in all the way. My breathing is shallow. My breathing requires effort. My breathing requires more work. I feel that I am smothering. I feel a hunger for more air. I feel out of breath. I cannot get enough air. My chest feels tight. My chest feels constricted. My breathing is heavy. I feel that I am breathing more.

It might be very useful to be specific when you tell your doctor under which conditions you feel your breathing is shallow, or when you feel your breathing requires more work.

It was the brilliant Dr. Julius Comroe who first began the study of dyspnea back in the mid-1960s. He described six possible causes that might explain the sensation of dyspnea that he was hearing from his pulmonary patients. In the early 80s the list was short-ened to four symptoms repres enting the basic sensations of breathing. They were tightness, excessive ventilation, excessive frequency, and breathing difficulty. Studies proved that the major pulmonary disease groups do use different descriptors to de-scribe their dyspnea. Asthmatics report differently than people with COPD, as well as those with ILD. Add in the racial and ethnic variations and you can see that what used to be a rather simple couple of


questions asked during a routine medical history, has become even more important as the “language” develops.

The pulmonary community has done a stellar job in making you aware of your oxygen saturation levels with the use of digital pulse oximeters. Certainly low oxy-gen saturations can make any of us short of breath. In Denver, we take our respira-tory therapy students up to the top of Mt. Evans at 14,000 feet above sea level to induce shortness of breath in these young healthy students. They stand in your shoes for an hour or so. Many people believe that whenever they get short of breath, it is most likely due to a low oxygen blood level. When they check their oximeter, they find that their saturations are either near normal or not low enough to explain their degree of dyspnea. If it isn’t a low saturation that is making you short of breath, maybe it’s the other gas involved in ventilation, the one we call the “insidious gas,” and that of course is carbon dioxide or CO2.

Mark describes of the effects of carbon dioxide on the body and how it can lead to a phenomenon called “dynamic hyper-inflation.”

When you’re exercising, or doing chores around the house, your breathing may become harder. Your respiratory rate is increasing and yet you feel like you can’t get enough air into your lungs. So you work even harder. You check your oxygen satu-ration and see that it is falling, despite your increased efforts to get more air into your lungs. You have your oxygen flow up higher and think it should be enough to help you breathe better but it’s just not helping. You wonder what is going on! You begin to use pursed-lips breathing (PLB) which seems to help some but not enough and you wish

you had started out using it. You’re left to wonder what the heck is this all about!

The answer is that a complicated set of mechanisms are at play. The signals sent to your brain are: “I can’t get enough air in.” Yet the reality is that you already have too much air in your lungs! If you were to have a sample of your blood tested, you’d see that while your oxygen level is not in the ‘text-book’ normal range, it is plenty high enough that your saturation shouldn’t be as low as you see that it is. You scratch your head wonder how can that be?

What is going on is the phenomenon we call “dynamic hyperinflation”. Looking at those words to try to understand what they mean and how they apply, we know “dy-namic” means moving or in motion. What is dynamic here is our breathing mechanics and how much air gets into our lungs.

“Hyperinflation” suggests that our lungs are over-inflated. Normally with COPD, because of weakened air sacs, we are unable to push all the air out that we have inhaled and it becomes trapped. What is so different about dynamic hyperinflation? The answer is that it results from breathing faster and faster and taking in more air with each breath than we can breathe out. Our lungs go from our usual state of hyperinflation to an even higher state of hyperinflation, as our breathing becomes more and more disturbed.

Think of a balloon that has been blown up too many times. It has lost its elasticity to the point that it can’t spring back to its smaller size – as it was when it came out of the package. It represents your lungs with emphysema. Think of blowing up that bal-loon and with each breath you blow into it, you let out only part of the air. Soon, it becomes inflated to its maximum point.

Continued on page 26


overall breathing. The slower you breathe, the less you tend to over-inflate your lungs. PLB also facilitates splinting your airways open and especially, slowing your exhala-tion so you can empty more air out of your lungs from breath to breath.

Hopefully, you can now appreciate the utter complexity of the simple phrase “short of breath.” Maybe we should turn the tele-scope around and have the physicians ask their questions based on the known descrip-tors used by those with breathing problems. They might read like this:

1. Is your breathing shallow? 2. Do you feel the urge to breathe

more? 3. Is your chest constricted? 4. Does your breathing require effort? 5. Do you hunger for more air? 6. Do you feel out of breath? 7. Are you getting enough air? 8. Does it feel like your breath is not

getting all the way in? 9. Does your chest feel tight? 10. Are you working hard to breathe? 11. Do you feel that you are smothering

or suffocating? 14. Do you feel that your breath isn’t

getting all the way out? 15. Do you feel that your breathing is

heavy? If our list of 15 questions takes even one

minute each to ask and answer, it would take longer than an average office visit.

Now imagine that balloon is your lungs during “dynamic hyperinflation”. They reach a point that trying to breathe in more air becomes impossible because they are already filled to the maximum. Yet your brain is telling you that you need to get more air in!

What is causing the drop in your oxygen saturation is not the lack of oxygen. It is the fact that with so much stale air in your lungs that you can’t exhale, your carbon dioxide has increased. Oxygen saturation is not based only on what the oxygen level is in the blood, but a combination of the oxygen level, the blood pH (acidity or alkalinity) and carbon dioxide. If we look at all three of those levels in your blood we would see that oxygen is still relatively high, but the pH is severely decreased (acidic) and the CO2 is severely increased. That is why the saturation has dropped and what the effect of dynamic hyperinflation does to your oxygenation. There are other factors at play that contribute to the resulting disturbance in your blood gases too.

So, what are you to do about this prob-lem? Well, Pursed Lip Breathing (PLB) is a good start. It will slow down the onset and severity of dynamic hyperinflation. Depend-ing upon how well you can pace both your breathing and your activity will determine how effectively you can control and combat dynamic hyperinflation. Even then, you may find that you reach a point that you simply can’t overcome the discomfort of the process, in which case you will simply have to stop and allow yourself to recover. As you rest, your demand for more breath-ing decreases and dynamic hyperinflation subsides. Your lungs deflate back towards your resting baseline volume. The import-ant benefit of PLB in combatting dynamic hyperinflation is that it slows down your

John R. Goodman, RRT FAARC is Executive Vice Presi-dent of Tech ni cal/Profes sional Services at Transtracheal Ser-vices, Denver, CO, who says “All You Need Is Love!”

Continued from page 25


1. Rank the following foods for potassium content from

most to least.

Answer: While bananas are an excellent source of

potassium, with 420 milligrams, other foods have even

more: yogurt, 530 milligrams; orange juice, 500; halibut,

490; broccoli, 460. Also rich in potassium are tomatoes,

apricots, spinach, beets, prune juice, potatoes, lentils,

soybeans, nuts, and sunflower seeds. A potassium-rich

diet helps control blood pressure. The goal is 4,700

milligrams a day.

2. Which of the following contain calcium?

Answer: All of them! Figs, almonds, soybeans and collard

greens. dairy foods are the best sources (milk has 300

milligrams per cup; yogurt even more).

3. A label that lists trans fats as “0” means:

Answer: (C) It has less than 0.5 grams of trans fat per

serving. Because of a labeling loophole, a "trans fat

free" food may still contain small amounts of partially

hydrogenated oil, the source of artery-damaging trans

fats. And these small amounts can add up, especially

since standard serving sizes are often small.

4. Rank the following fast foods for their sodium,

from most to least: (A) Burger King veggie burger, a

Dunkin’Donuts corn muffin, a large Burger King choco-

late shake, McDonald’s large French fries.

5. How much fiber should you aim for every day?

Answer: 21 to 35 grams, depending on your total daily

calories. A cup of raisin bran with a banana (10 grams),

a cup of broccoli (6 grams), a pear (5 grams), a sweet

potato with skin (5 grams), and a slice of whole-wheat

bread (2 grams) get you within that range.

6. True or false? Honey, agave, and coconut sugar are

better for you than table (white) sugar.

Answer: False. Sugar is sugar, and no form of it offers

significant nutritional advantages. That goes not only

for honey, agave nectar, and coconut sugar, but for other

healthier-sounding forms of sugar, including molasses,

evaporated cane juice, and fruit juice concentrate. So the

only reason to substitute one for another is taste. Honey

is sweeter than table sugar, for example, while coconut

sugar is less sweet and has a more caramel taste.

7. To lower blood pressure, you should: Eat more fruits

and vegetables, eat dairy foods and use less salt. An

eating plan that emphasizes fruits, vegetables, and

low-fat/nonfat dairy foods (the DASH diet) has been

proven to lower blood pressure – even more so when

sodium is also reduced. No one should take a potassium

supplement or use a potassium-based salt substitute un-

less advised to by a doctor, since they can be dangerous

for many people, including those with impaired kidney

function or diabetes.

8. Which does not contain fiber?

Answer: Steak. Fiber, which improves blood sugar con-

trol, lowers cholesterol, and helps prevent constipation,

is found only in plant foods as broccoli, oatmeal, apples

and baked beans.

9. Vitamin D is found in eggs, milk, fatty fish and mush-

rooms (not in chicken). Milk is fortified with vitamin D

and is the major dietary source. To get the 800 IU to

1,000 IU a day we recommend, vitamin D supplements

are usually necessary, since it's difficult to get this much

from food.

10. Fatty fish (salmon, sardines, halibut, trout, mack erel,

tuna and eel) is a good source of protein and omega-3

fats (not vitamin C and beta carotene). Fish has about 20

grams of protein in 3 ounces, cooked, as much as meat;

fatty fish also provide omega-3 fats, which may reduce

the risk of cardiovascular disease and other disorders.

Answers to the Nutrition Quiz (by the University of California at Berkley Wellness Center from the March/April issue)


Canada & New England 9 DAYS

Our annual trip to see the wonders of Alaska, round trip from Seattle aboard the Crown Princess. Visit Juneau, Glacier Bay, Skagway, Ketchikan and Victoria!

Alaska Inner Passage Cruise 7 DAYS

FST–

ST39

068

Member

Visit www.seapuffers.com for more information!

Join the Sea Puffers!Travel for People with Respiratory Concerns

Call Us Today! Pre-Trip: New York City See Broadway's "Beautiful", tour the city!September 22–October 1, 2016 Nine days! Explore the Royal Caribbean’s all new digital ship, Anthem of the Seas, as we sail to New England and Canada from Cape Liberty, NJ!

Join us in New York even if youare unable to cruise to Canada!

Pre-Canada & New England Cruise Package, September 19–21:Spend three nights at the Westin Hotel, Times Square, arriving September 19. Includes a four-hour tour of New York City on September 20–21, dinner at Sardis, a Broadway play in Orchestra or Front Mezzanine seats (“Beautiful: The Carole King Musical”), and transfers to the Anthem of the Seas on September 22.There are many extras included as admission to NYC attractions and shopping discounts!

The cost of this three-night vacation before the vacation is based on double occupancy.Double occupancy, $1,181/person. Triple occupancy, $967/person. Four in a room, $860/person. Single occupancy, $1,943/person.


JOIN THE SEA PUFFERS ON ONE OF OUR GROUP CRUISES ESCORTED BY RESPIRATORY THERAPISTS!

CALL TODAY!1-866-673-3019We make it easy to travel with oxygen! Join the Sea Puffers family for life-long friendships and support.

July 15–22, 2017 Our annual trip to see the wonders of Alaska, round trip from Seattle aboard the Ruby Princess. Visit Juneau, Glacier Bay, Skagway, Ketchikan and Victoria!

Alaska Inner Passage Cruise 7 DAYS

January 23–February 4, 2017 Enjoy relaxing days at sea before visiting Hilo on the Big Island, Honolulu on Oahu’s South Shore, Nawiliwili on the island of Kauai, the island of Maui, and Ensenada, Mexico aboard the Star Princess. Roundtrip from Los Angeles. Lots of fun and surprises in store on this vacation!

Hawaiian Island Cruise 15 DAYS

March 6–16, 2017 (11 DAYS)Experience luxury at its finest aboard Oceania’s Riviera! Roundtrip from Miami. This first class trip includes stops at St. Barts, Barbados, St. Lucia, Antigua and Tortola. There are many perks with this cruise including free gratuities, onboard credit of $150/cabin, free Internet access and for a limited time, your choice of one of the following: 4 free shore excursions, free house beverage package or an additional $400 shipboard credit!

Caribbean Hideaways Cruise

We will always get the best possible pricing for your trip – even if it is lower after you make your reservation! There are never any additional charges for arranging your oxygen and medical needs for your vacation when you book your individual or Sea Puffer trip with us!

Respiratory News


Time to get in shape! UCLA researchers

have found people with cardiovascular dis-

ease who have high muscle mass and low fat

mass have greater survival rates than those

with other body compositions. The findings

also suggest that regardless of a person’s level

of fat mass, a higher level of muscle mass

helps reduce the risk of death.

Pharmaceutical company Boehringer

Ingelheim and Propeller Health, a provider of

digital programs for respiratory health, have

partnered to offer health tools and services

to help people living with COPD and asthma

to better manage their disease. The Propeller

sensor attaches to the Respimat inhaler and is

designed to

keep people

connected to

their caregiv-

ers and pro-

vide insights

into disease

triggers. For

more information, visit propellerhealth.com

A new study in the New England Jour-

nal of Medicine finds that smokers, who

wouldn’t typically be diagnosed with COPD,

are still showing symptoms consistent with

the diagnosis. It was found that about half

of current or former smokers experienced

respiratory symptoms similar to COPD,

as well as an increased risk for flare-ups in

their symptoms, even though their lungs

seemed to function normally according to the

spirometry test results.

Uncontrolled inflammation plays a role

in many major diseases, including cancer,

heart disease, diabetes and Alzheimer’s.

A new study by the University of Liver-

pool found diets rich in fruits and vegeta-

bles, which contain polyphenols, protect

against age-related inflammation and chronic

diseases. Polyphenols derived from onions,

red grapes, green tea and açai berries may

help reduce the risk of chronic inflammation.

Neutrophils are white blood cells that are

important for fighting infection. A type of

neutrophil behavior in the lungs of people

with COPD appears to reduce their ability

to destroy bacteria. It is hoped that detecting

this can identify those at risk of deteriora-

tion. Research might help doctors determine

which people are less likely to respond to

standard treatment and are at higher risk for

disease advancement.

The FDA has approved AstraZeneca’s

Bevespi Aerosphere (glycopyrrolate and

formoterol fumarate) for long-term main-

tenance treatment of airflow obstruction

in people with COPD. Bevespi Aerosphere

is an inhaled aerosol used twice daily in a

pressurized metered-dose inhaler.

University of Washington researchers

have developed SpiroCall, a tool that can

accurately measure lung function over a

simple phone call. With SpiroCall, you can

call a 1-800 number, blow into the phone

and use the telephone network to test your

lung function.


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Respiratory Diagnosis

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