Bronchiectasis Basics Airway Wall Eople with Bronchiectasis Have a Con Pstant Battle with Raising Secretions

Live Longer! Breathe Easier! Improve Quality of Life! Even Look Better! Talk to your doctor now about the benefits of Transtracheal Oxygen Therapy! • Improved mobility • Greater exercise capacity • Reduced shortness of breath • Improved self-image • Longer lasting portable oxygen sources • Eliminated discomfort of the nasal cannula • Improved survival compared to the nasal cannula You’ve suffered long enough. Ask your doctor about TTO2! For information call: 1-800-527-2667 or e-mail [email protected]

www.pulmonarypaper.org Volume 25, Number 6 Editor’s Note

artha from Virginia recently wrote saying, “I know I should exercise and have made it my number one Mresolution.” We hope you achieve your goal, Martha! The three things on our goal list are to educate, empower and encourage you to continue to enjoy life despite obstacles that you may have to overcome.

Bob McCoy RRT of Valley Inspired Oxygen in Apple Valley, MN, put things into perspective recently when he talked about people’s reluctance to wear oxygen at an American Association of Respira tory Care meeting. When a person who needs glasses puts them on, he is no different than a person who has 20-20 vision naturally. Glasses level the playing field and put everyone on the same “There is no footing. remedy for love but to Time equals tissue – the sooner you give your body the oxygen love more.” supply it needs, the less tissue damage there will be. Why do Henry David Thoreau health professionals and insurance companies wait until the point where your oxygen is very low to say, “Okay, now we are going to prescribe oxygen for you”? What if that happened with your vision? You would have to wait until you are walking into walls before they would say, “Okay, let’s order some glasses for you”.

Being educated about your respiratory condition and treatment plan options empowers you. You are the one in control of your team. It is up to you to be a good leader in 2015 and beyond!

Leaders also are known to have a softer side. Remember the romance. There is always time for romance – no matter how small the ges ture. The impact of letting someone know you care can be huge. Our cover couple Joy and Fran Lynch from Edmonds, WA, live the romance every day! Hard work pays off! My son, Ben, recently earned his MBA from the University of Tennessee and his family couldn’t be prouder!

January/February 2015 www.pulmonarypaper.org 3 Calling Dr. Bauer …

s we start the new year, I would like to share some of the guidance I give my patients about when to call and what to Ado in case of an emergency. At the end of every clinic visit, I tell them to call me if they have any new breathing concerns.

Dr. Michael Bauer I am contacted when there is more shortness of breath than usual or if they are experiencing chest discomfort. The first questions I ask are: “What does your sputum look like? Are you coughing up more amounts than normal? Is it dark colored or bloody? Do you have a temperature?” More and more, patients have portable oximeters at home to measure oxygen saturation. A marked reduction in oxygen levels can be concerning. Answers to these questions help us decide if an antibiotic should be prescribed over the phone. Some of my “informed” patients will be given a prescription to be kept on hand at home in case they can’t get a hold of me or for an emergency. I always encourage them to call first if at all possible. It’s too easy to take an antibiotic too often these days. Overuse of prescrip tions can result in resistant infections. I’m less inclined to recommend antibiotics if there is no concurrent fever. Many of my patients are on chronic steroid inhalers and/ or oral prednisone. I try to discuss a plan in clinic for increasing the dose of inhalers when breathing symptoms become worse. A burst and taper of prednisone is often helpful, but again, I really like my patients to call before we mutually make this decision. Most patients with chronic lung disease know when they can manage problems at home. I know most of my patients well enough Question for Dr. Bauer? that when I get the call, “Dr. Bauer, I really need to see you soon,” You may write to him at The Pulmonary Paper, I make room for a clinic visit. On the other hand, when you can’t speak PO Box 877, Ormond in full sentences, if chest pain is severe and saturations are dropping Beach, FL 32175 or by email at info@ quickly, it’s time to come to the emergency room! pulmonarypaper.org.

4 www.pulmonarypaper.org Volume 26, Number 1 ] Robert Frost Robert

Call Toll Free (877) Free 699-8439 Call Toll or visit www.oxyview.com took the Road Less took Traveled? “Two roads diverged in a woods, “Two Oxygen Therapy and I – I took the one less traveled by, traveled less theand one I – took for the 21st Century the 21st for Oxy-View OxygenOxy-View Therapy Eyeglass Frames And that has made all the difference.” [

Isn’t it time you it Isn’t

January/February 2015 www.pulmonarypaper.org 5 The Ryan Report

his issue’s article is going to be a little bit different than the norm. In November 2014, I had the opportunity to visit Tokyo, TJapan, on a work-related trip, and I felt some readers may be interested in the experience. For those that do not know, I work for a small company, Valley Ryan Diesem Inspired Products (VIP), based in Apple Valley, MN. Among other services, we are known as an independent testing house for a wide variety of products in home respiratory care. Home oxygen systems, ventilators, CPAP machines, CPAP masks … you name it, we’ve probably tested it at some point. Recently we were invited to visit the facilities of one of our clients in Japan. We have worked with this group for several years, and the relationship has proven to be mutually beneficial. And while several of their staff have visited and worked with us at our facility, we had not yet been able to make the journey across the Pacific. When a chance to give a presentation on a variety of topics related to home respiratory care and equipment was given to us, we had to jump on it.

In Japan, home oxygen therapy has only been available since the Ryan Diesem is Research mid -1980s, and the number of Japanese citizens on home oxygen Manager at Valley currently is around 150,000 (compared that to over 800,000 home Inspired Products, Apple Valley, MN. Contact Ryan oxygen users in the U.S.). Like the U.S. home oxygen market, the at rdiesem@inspiredrc. majority of Japanese oxygen users have a stationary concentrator in com with questions or the home. Tighter noise regulations mean Japanese concentrators comments. tend to be quieter than their U.S. counterparts, but the trade-off may be increased size and weight. For those with portable systems, most Japanese oxygen users are given cylinders with continuous or pulse regulators. Home fill devices are not allowed in Japanese homes, so cylinder deliveries are needed when tank supply is low. There are a handful of portable oxygen con centrators (POCs) and liquid oxygen (LOX) options available, but they are not yet widely used.

6 www.pulmonarypaper.org Volume 26, Number 1 benefit to the home care dealer than it was to the oxygen user.

With the advent of Portable Oxygen Con centrators (POCs), which manufacture their own oxygen, savings ratio is no longer the buzz term it once was, at least in the U.S. In Japan, however, savings ratio is still a big selling point for devices with pulse oxygen delivery. A majority of the pulse devices available in Japan feature a minute volume delivery algorithm (i.e., the volume of oxygen delivered per breath decreases as the user’s Ryan Diesem, left, with Bob McCoy, Managing Director of Valley Inspired Products breath rate increases) which will give a higher oxygen savings ratio. Using data and For our visit to Japan, we were asked to information we have collected over the years, present information on the numerous I tried to impress upon those listening that changes occurring in the U.S. healthcare oxygenation capability should trump savings system as well as the current equipment ratio when marketing OCDs. landscape. I was given the lecture floor to There is nothing wrong with a device that discuss the wide variety of home oxygen utilizes a minute volume delivery method, equipment and the benefits and limitations but showing that the device can sufficiently of each type of system. In a later meeting, one oxygenate the user is more important in the topic of particular interest was the concept of long run than promoting its savings ratio. “savings ratio”. Savings ratio refers to the amount of In the end, our presentations and insight oxygen “saved” when using an oxygen were well received. With home oxygen ther conserving (a.k.a., pulse delivery) device apy still a relatively new segment of Japanese compared to continuous flow. For example, home healthcare, research, testing, and using an oxygen conserving device (OCD) information sharing are valued as important promoted as having a 4:1 savings ratio means components in ensuring the Japanese home that the oxygen cylinder the OCD is operating oxygen market has a diverse knowledge base from will last the user four times as long on from which to draw. pulse flow versus continuous flow at the same setting. As pulse delivery systems became There are certainly circumstances unique to more popular, savings ratio became a key the Japanese healthcare system that are not marketing term. Unfortunately, savings ratio present elsewhere, but in the end the goal is is based purely on mathematics, and does not the same – to make sure that home oxygen take into account real life factors that happen users and their caregivers are provided the with each individual. Use of a device with a right tools and equipment to maintain their higher savings ratio was certainly more of a health and way of life.

January/February 2015 www.pulmonarypaper.org 7 Ask Mark …

Nina from EFFORTS is wondering why she seems to get another infection as soon as she stops taking antibiotics! Mark explains, We have to consider that recurring infections may not be separate or new infections nor are they likely to be necessarily bacterial in nature. Antibiotics are effective only against bacteria Mark Mangus, RRT EFFORTS Board and those bacteria that are vulnerable to a given antibiotic agent. Viruses are not in the least susceptible to the effects of antibiotics. Estimates of viruses causing increased mucus production and inflammation, rank high among those with chronic infections. Many people with COPD have a relative increase in the bacterial counts within their lungs. When they take antibiotics, those counts are reduced, resulting in a decrease in inflammation and mucus production. It gives the illusion that you had an infection, which the antibiotic was effective to wipe it out and it is credited with the reduction in symptoms and improvement you feel when taking the antibiotic. In reality, if the infection is caused by a virus, and while your symptoms may be reduced while taking an antibiotic, it doesn’t mean that you have overcome the infection. Indeed, when the antibiotic is finished, the virus continues to cause trouble and is now accompanied by the increased influence of the return of your bacterial count to what it was before you took the antibiotic. Many studies have been done looking at question of the overuse of antibiotics. The common use of antibiotics to treat symptoms, without having confirmed that any given bacteria is causing the infection, may be leading to bacterial resistance to many of those antibiotics. Doctors and patients are in a damned-if-you-do and Mark Mangus RRT, damnedf -i -you-don’t position with regard on how to treat your BSRC, is a member symptoms not knowing if bacteria or virus is causing them. The of the Medical Board of EFFORTS (the option to play it safe and treat with antibiotics is often exercised. online support group, Emphysema Foundation When you use oral steroids, you will feel a big improvement in your For Our Right To Survive, symptoms. When you finish taking them, you return to your baseline www.emphysema. net). level of symptoms. Too often, folks fail to consider that at baseline, He generously donates his time to answer they have a certain amount of mucus production. They have a certain members’ questions. level of breathing difficulty. They have a certain level of exertional

8 www.pulmonarypaper.org Volume 26, Number 1 breathing difficulties. When they return to Mark has received many questions about that baseline, too often, the tendency is to what order and when to take inhaled bron think they’ve gotten worse again, or they’re chodilators. getting sick again. The tendency is to go Mark explains, There seems to be a bit of back up on steroid doses. confusion about inhaled medications – types, Too often, people continue on steroids short or long acting, etc. Let me offer the because they simply cannot tolerate – or following: condition themselves to tolerate – the Albuterol and Atrovent are both “short-act return to what was their previous baseline ing” medications, Duo Neb is Albuterol and level of symptoms. The steroid and Atrovent in combination as one solution. You antibiotic merry-go-rounds are similar can and should take Albuterol and Atrovent to each other. It is easy to fall into their at the same time/one after another. They traps. Consider your own situation very work best when taken very close to each other carefully before you simply go back to or together. another course of antibiotics or increase your Salmeterol and Formoterol, also found in steroids. Advair and Symbicort, are long-acting medi cations. They are the stronger, longer-lasting Geb from Arizona recently asked for infor cousins to Albuterol. mation about the medication Tudorza. Spiriva is another long-acting medication Mark says, Tudorza, a long-acting anti and is the stronger longer -lasting cousin to cholinergic, is taken twice-daily. Inhaled Atrovent. anticholinergic medications are specific as If you take Albuterol, you should wait at maintenance drugs that improve airflow and least 2 hours before taking Symbicort/ symptom control of COPD. Advair so that the albuterol won’t react They are also very safe to use, except for with Salmeterol/Formoterol, reducing their those with narrow-angle glaucoma. Urinary effectiveness. If you take Atrovent, wait at retention has been reported as a side effect least 2 hours before taking Spiriva. for some folks, as well, though the incidence It is best to take Formoterol/Salmeterol and is rare. Spiriva ‘together’, rather than spaced an hour It acts likes Spiriva which is only taken once a or more apart. The best action is obtained day – because of this, some people prefer to when they are taken close together, since take the Spiriva. one drug complements the other, resulting in a better overall effect.

January/February 2015 www.pulmonarypaper.org 9 Fibrosis File The Pulmonary Fibrosis Foundation up to date by selecting “Other” as the (www.pulmonaryfibrosis.org) has an Inter Health Care Provider Type, “1” as the net Patient Support Community called total number of Current IPF Patients, Inspire. It is a great place where people and “Other” when they ask my Practice can share helpful tips and their concerns at Setting. www.inspire.com. • A poll among the group who has Among the postings: tried the new medications, ESBRIET • I still love to cook and having just (pirfenidone) and OFEV (nintedanib), gone through the holidays, I thought I reveals the majority of people who would share a few tips. I have a couple have tried these report some nausea of office chairs placed in my kitchen, and loose bowel movements when first along with a little low table so I can sit started. The dosage is reduced while when I’m prepping meals. The chairs they get used to the drug and most are let me zoom around from one side of able to go back to the recommended the kitchen to the other, chop and dice dosage. at my preferred height, and get into • People who are looking to participate cupboards and the dishwasher while in clinical trials for potential treatments conserving my energy. for IPF should go to www.clinicaltrials. • It can be a nightmare chopping onions gov. Search for interstitial pulmonary with my cannula on. I wear a pair of fibrosis or IPF and enter the state in silly glasses and other than trying not which you reside in the search box. to giggle, have not had a problem since! Select “include only open studies” to receive a list of those that are actively recruiting people. Then click on a study title and scroll down until you see “Contacts and Locations” for a list of study locations and contact informa tion. • A doctor who specializes in pulmo nary fibrosis recommended this web Exercise and IPF Talk site (www.pilotforipf.org), it is geared Listen to Dr. Noah Greenspan’s talk toward healthcare professionals, but I from the Weill Cornell Living Center on IPF know there are many of us who seek Patient Education Day where he discusses out more information and knowledge exercising with IPF (idiopathic pulmonary about our disease. There are webinars fibrosis). you can watch and a lot of information Go to at www.youtube.com/watch?v= in the FAQ section. I signed up to stay ncDB9gQ9g_k

10 www.pulmonarypaper.org Volume 26, Number 1 immune system by protecting the body against outside invaders, such as infections. All leukocytes are born in the bone marrow, and then turn into one of five different types of cells based on the molecules they contact. Their physical appearance and their func tion distinguishes them from one another.

The investigators found several subtypes of leukocyte that, when measured at the begin ning of the study, predicted later more severe IPF outcomes. Specifically, leukocytes in an “inflammatory” or activated state pre dicted poorer outcomes.

Although these markers could indicate progression, and may point toward immune therapies for treating IPF, the scientists he recent edition of the Journal of cautioned that more research is needed TCardioPulmonary Rehabilitation and before being able to measure these markers Prevention reports on CardioRespiratory to predict progression of the disease in an Function before and after Aerobic Exercise individual. Training in Patients with Interstitial Lung Disease. The training lasted for ten weeks The Mayo clinic describes interstitial and consisted of treadmill walking for 30 to lung disease as a large group of disor 45 minutes, three times a week. Significant ders, most of which cause progressive clinical improvements were found after scarring of lung tissue. The scarring training relating to more efficient oxygen associated with interstitial lung dis uptake by the muscles of the participants. ease eventually affects your ability It has long been believed that a muscle that to breathe and get enough oxygen is toned and in shape, takes less oxygen to into your bloodstream. Different types move than one that is not. include • Idiopathic and Familial Pulmonary Researchers have found that specific types Fibrosis of white blood cells (leukocytes) might be • Sarcoidosis used to predict the disease progression of • Hypersensitivity Pneumonitis IPF. The study appeared in the December • Bronchiolitis Obliterans 22 issue of Frontiers in Medicine. • Lymphangioleiomyomatosis Leukocytes are found throughout the • Connective tissue or autoimmune body and play an important role in the disease -related Pulmonary Fibrosis

January/February 2015 www.pulmonarypaper.org 11 It’s Important to Maintain Weight with COPD People with chronic lung disease often Besides eating six to eight small meals find it difficult to eat and as a result will a day, they try to conserve energy while begin to lose weight. The act of breathing boosting calories. They keep nutritious will normally use about 100 calories a foods such as fresh fruits and vegetables day. For those with chronic obstruc and nuts for snacking. Nuts are a con tive lung disease, the calorie usage centrated source of healthy fats, and goes up to about 430 to 720 cal they really boost one’s calories. They ories a day as you try and take are also packed with antioxidants, in oxygen and get rid of your which have lots of heart-healthy carbon dioxide. If you con benefits and fight inflammation. tinue to lose weight, your Try spreading peanut butter on muscles will become inef toast or bagels, tossing nuts fective and you will be into salads or a stir fry. come more susceptible Eating more protein to infection. and getting more calo Many have found ries, while keeping an eating more fre eye on nutrition, is a quent, smaller good way to fight meals through weight loss. out the day Eating a lean rather than protein is very three larger important for meals, has your muscles made the and immune biggest difference. Also, don’t rush and be system. Food texture may be an issue. It’s sure to wear your oxygen. harder to digest a steak than it is some light er meats, beans or other sources of protein. Jim and Mary Nelson told their EFFORTS Healthy fats such as mono-unsaturated (Emphysema Foundation for Our Right to fats in canola oil, avocados and nuts are Survive at www.emphysema.net) friends heart healthy and provide extra calories. how they changed their way of eating to Because of the way fat is digested, high-fat help Jim maintain his weight. foods do not tax the respiratory system like Bending over when preparing meals digestion of other foods can. Try marinat restricts breathing and they suggest you keep ing meats in an olive oil-based vinaigrette. things at a handy height. Cook more food Protein in eggs can be very helpful in adding than you need and freeze the rest. For safety bulk to the diet of someone with COPD. reasons, move your oxygen tubing from Cheese is a concentrated source of calories front to back while cooking. Keep it as sim but dairy fat isn’t the best thing for your ple as using paper plates to reduce cleanup. arteries.

12 www.pulmonarypaper.org Volume 26, Number 1 Stay hydrated but you may want to drink grapefruits, bananas and cheese seemed to less during your meals to avoid bloating have better lung function. A Mediterra Fried foods can cause bloating. nean-style diet with fresh fruits, vegetables, Ice cream, puddings, custards and cakes grains, lean protein and olive oil would be made with eggs are a great way to bulk up good to follow. on fat and protein. Add cheese to sandwich Mary recommends the U.S. Department es, pastas, and casseroles or mix dried milk of Agriculture’s ChooseMyPlate Web powder into recipes. site (www.choosemyplate.gov) as a good A recent study found that people with resource for learning how to balance COPD who ate more of four foods – fish, meals.

Mark Mangus’s Famous Shake Recipe Pasta and Chicken Salad to Maintain Weight (from the COPD International website 1 Package Instant Breakfast mix at www.copd-international.com) 6 oz. Whole milk 2 Chicken breasts, skin on, grilled or 4 oz. High-fat ice cream lightly sautéed 2 tbsp. Vegetable oil (Do not use olive 4 oz. (dry) Pasta shapes, boiled al dente, oil, it won’t taste good!) drained and cooled Blend above ingredients. You may add 2 Ribs celery, finely diced flavor by using the chocolate, vanilla or ½ Sweet pepper, finely diced strawberry Instant Breakfast and by adding ½ Sweet onion (purple or Vidalia type), ice cream, jelly, jam or syrup. You may also finely diced add fruit as desired. 1 tsp. Dry basil leaves ¼ tsp. Dry oregano leaves This shake provides a total of 875 cal ¼ cup Pumpkin seeds ories plus any additional additives. Sip on ½ tsp. Coarse-ground pepper it throughout the day as a supplement to ½ cup Extra-virgin olive oil regular meals. While it packs most daily 3 tbsp. Lemon juice or rice vinegar vitamins needed, it doesn’t contain all of 1 Clove garlic, mashed them. Lactose intolerant folks can substitute Several lettuce leaves nondairy ingredients which will decrease Remove and discard the chicken skin, the calorie count. Adding more oil will add cube the meat into bite-size pieces and add 125 calories per teaspoon, though it is not to the pasta. Add the celery, pepper, onion, recommended to go above 2 tablespoons. herbs, and seeds, and mix thoroughly. Combine oil, lemon juice and garlic in a small bowl, whisking into an emulsion, then drizzle over the mixed salad. Serve on bed of lettuce with sprinkling of pepper. About 4 servings.

January/February 2015 www.pulmonarypaper.org 13 ® Oscillating Positive Expiratory Pressure Therapy System

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14 www.pulmonarypaper.org Volume 26, Number 1 Keep Secretions Moving Widened Scarred and airway thickened Bronchiectasis Basics airway wall eople with bronchiectasis have a con Pstant battle with raising secretions. Bron chiectasis (pronounced bronch-e-EK-ta-sis) is a lung condition where the airways be Mucus come distorted instead of being straight and smooth. It is very difficult to cough out the mucus. As a result, secretions pool which can often cause bacteria to grow with a resultant infection. The initial lung damage that leads to Examples of lung infections that can lead bronchiectasis often begins in childhood. to bronchiectasis include: severe pneumonia, Symptoms may not occur until months or Whooping cough or measles (uncommon even years after you start having repeated in the United States due to vaccination), lung infections. It may be caused during the tuberculosis and fungal infections. development of the lungs before birth. Conditions that damage the airways Bronchiectasis usually is due to a medical raising the risk of lung infections include: condition that injures the airway walls or cystic fibrosis; immunodeficiency disorders prevents the airways from clearing mucus. and allergic bronchopulmonary aspergillosis Early diagnosis and treatment of bron which is an allergic reaction to a fungus chiectasis are important. The sooner your called aspergillus which causes swelling in doctor starts treating bronchiectasis and the airways. Also damaging are disorders any underlying conditions, the better your that affect cilia function, such as primary chances of preventing further lung damage. ciliary dyskinesia. Cilia are small, hair-like Continued on page 16

The Aerobika® is a Great Success! Previously only given to people when in the hos pital, the Aerobika® has proven of great benefit in the daily regime of many people with COPD! PF of Las Vegas said she was amazed at how quickly she saw results! CP of Missouri uses it twice a day and no longer is fearful of her cough! At this time, Medicare does not reimburse for the cost ($79.95 plus $5.95 shipping). You may order by using the form on page 31, by calling 1-800-950- 3698 or by visiting our website at www.pulmonary paper.org.

January/February 2015 www.pulmonarypaper.org 15 Continued from page 15 structures lining the airways that beat upwards to help clear mucus. Chronic pulmonary aspiration is a condition in which you inhale substances into your lungs and inflame the airways. Connective tissue diseases, such as rheumatoid arthritis and Crohn’s disease, along with immuno deficiency and allergic disorders, may also cause the airways to become distorted so secretions become difficult to raise. The most common signs and symptoms of bronchiectasis are a daily cough that occurs over months or years with produc to treat bronchiectasis. Drinking plenty of tion of large amounts of sputum, shortness fluid, especially water, helps prevent airway of breath and wheezing; chest pain and mucus from becoming thick and sticky. clubbing (the flesh under your fingernails Chest physical therapy (clapping on the and toenails gets thicker). chest to loosen secretions) can be done To find out whether you have bronchiec manually, with a mechanical percussor or tasis, your doctor may recommend a chest an inflatable therapy vest that uses high- CT scan, blood tests and a sputum culture frequency air waves to force mucus toward which will show the presence of bacteria; your upper airways so you can cough it lung function tests to show how much lung up. Oscillating positive expiratory pressure damage you have; tests for cystic fibrosis therapy, using a small hand held device as and a bronchoscopy may be done where the Aerobika®, has you breathe out through a flexible tube with a light on the end is a restriction which causes vibrations that inserted through your nose or mouth into dislodge the mucus. your airways to provide a video image of Wash your hands often and of course get your airways. your pneumonia and annual flu vaccination. Bronchiectasis often is treated with med Try to be as physically active, it can help icines, hydration and therapy to raise secre loosen mucus. People who have chronic lung tions. Your doctor may recommend surgery diseases are more prone to depression, anx if the bronchiectasis is isolated to a section iety and other emotional problems. Talking of lung or you have a lot of bleeding. The to a professional counselor can help. If goals of treatment are to treat any under you’re very depressed, your doctor may lying conditions and lung infections, to recommend medicines or other treatments keep airways clear of mucus and to prevent that can improve your quality of life. complications. Support from family and friends also can Your doctor may prescribe antibiot help relieve stress and anxiety. Let your ics, bronchodilators, expectorants, or loved ones know how you feel and what mucus-thinning medicines as acetylcysteine they can do to help you.

16 www.pulmonarypaper.org Volume 26, Number 1 Own the best! Order Online: Store.MainClinicSupply.com Order by Phone: 1-800-775-0942 CUSTOMER SERVICE 24 HOURS A DAY, 7 DAYS A WEEK

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January/February 2015 www.pulmonarypaper.org 17 Sharing the Health! COPD8 USA was held two years ago in Joy Lynch of Edmonds, WA, (also on our Chicago and proved to be a wonderful mix cover this issue) wants you to know about of health professionals and people with OraCoat’s XyliMelts. Her Spiriva causes chronic lung disease working together. uncomfortable dry mouth and this product COPD9 USA will be held at the Hyatt provides relief. XyliMelts are long-lasting, Regency O’Hare Chicago on June 5–6. oral adhering discs that relieve dry mouth and increase saliva, even while sleeping.

Joy also finds when she has to walk up an in A program on the first day is specifically cline, she turns designed for those coping with COPD. Our around and favorite presenters will be there. walks back If you are interested in attending, please wards. She says let us know as there may be scholarships it is much easi available for registration or you can register er, she gets less at www.copdconferencesusa.org. short of breath and has a lot of smiles and quizzical looks thrown her way!

Recently, friends helped a member with dress up ideas for her oxygen tank (she calls it Airielle) on the day of her son’s wedding! It was suggested she make a cloth bag with a draw string at the top and slip her tank in it. The material could match her dress and the tank wouldn’t clank against the My son recently sent me this picture he metal of the cart. found of a lady on oxygen receiving her Another idea was to have diploma and I wanted to share it with you. I a tux made for it! have it taped to my bathroom mirror so I can see it every morning when I start my day! Ruth Vinall, Florida

18 www.pulmonarypaper.org Volume 26, Number 1 I have a Sequal Eclipse that is getting older. an hour and 30 minutes, even though it was My oxygen provider gave me some advice fully charged. It has lost some of its capacity about batteries that I thought The Pulmo- to hold the charge. When it gets as low as nary Paper readers may benefit 80% of the original, the battery is from. often unreliable and will not hold The best way to store an Eclipse its charge. battery is not fully charged, but Calibration consists of com when it is approximately 40% to pletely draining and recharging 50% charged. Keep it in a cool, dry location. the battery cartridge and will ensure that a The battery can sit unused for up to 12 full battery charge lasts as long as it should. months and still hold the 50% charge. Run your Eclipse on battery power only. Since people use their batteries more often Allow it to completely discharge until the than others, it is difficult to predict the life of alarms stop sounding. Plug power cords the battery. It should last through 500 cycles into your Eclipse and charging should begin of being fully charged and discharged. automatically. When the panel shows the When you got your new battery, say it battery is 100% charged, you know your lasted for two hours on your continuous liter calibration has been successful. flow of 2. Now you notice it only lasts for F. Barnes, DeLand, FL

e have been highlighting a couple in each issue that has Wstayed together though sickness and health! Since it is Valentine’s Day, we thought we would highlight two couples!

Above: Pat and Dave Frazer recently traded their home in the Northeast for one in Las Vegas and have lots of new adventures ahead!

Right: Roses and candy for Nancy Ehemann from her husband Fred. That is one romantic California couple!

January/February 2015 www.pulmonarypaper.org 19 Sharing the Health! continued

Approaching Your Resolutions Gloria Wright of Fort Myers, FL recent One of the most common New Year’s ly let us know how she has found inner resolution is to stop smoking. peace. After months of soul searching, she Financial incentives by your health insur determined – ance companies and workplaces to get you If you can start the day without caffeine, to stop smoking have been very effective. If you can always be cheerful, ignoring Imperial Tobacco Group, the world’s third aches and pains, largest cigarette maker, is moving into the If you can resist complaining and boring caffeine habit as more people kick the deadly people with your troubles, smoking habit. They are launching a melt- If you can eat the same food every day and in-your-mouth strip designed to give an be grateful for it, energy boost in seconds. The product, called If you can understand when your loved Reon, comes in flavors such as “grapefruit ones are too busy to give you any time, & zing” and “black currant & fresh.” For If you can take criticism and blame with now it is only sold in Manchester, England out resentment, and online. If you can conquer tension without med ical help, Pay Yourself! If you can relax without alcohol, We like the reward method. For every day If you can sleep without the aid of drugs, you don’t smoke, put the money you would … then you are probably the family dog have spent on cigarettes aside – say $5 per because this is too hard for me! day. If you make it through the first day, buy yourself something you would never spend the money on, like a magazine about a hobby or activity you like. The longer you don’t smoke, the more money you will have for your rewards! Don’t spend it on a bill or on anyone else – this is only for you. At the end of the month, you will have $150. That Getting more exercise is also high on the can buy a decent toy! resolution list. Justin Daniels of Indiana set a very lofty goal for himself – he is intent on running a marathon in each of the 50 states. His dad was diagnosed with COPD in 2011 and Justin is running to bring awareness of the disease to Americans.

And remember – all you have to do is start where you stand!

20 www.pulmonarypaper.org Volume 26, Number 1 ow many of these heart-felt Great News! questions can you answer? Boehringer Ingelheim Pharmaceuticals, H Inc. announced today that Spiriva® Re 1) Nirvana’s first single fromIn Utero spimat® (tiotropium bromide) Inhalation 2) The subject of this Huey Lewis song is Spray is now available by prescription still beating in Cleveland, Detroit and through retail pharmacies several other cities across the United States. 3) Acute myocardial infarction The Spiriva® HandiHaler® 4) Memoir and film from Mariane powder which is the num Pearl, widow of the slain journalist ber one branded prescrip Daniel Pearl tion medication for COPD 5) The more common and colorful name maintenance in the United for the U.S. Badge of Military Merit States, will continue to be 6) 1990 Film by David Lynch available. 7) Role-playing game developed by BI will offer a savings Square Enix card that will allow those 8) 2009 film starring Jeff Bridges for eligible to get Spiriva Respimat for as low which he won an Oscar as $10, depending on their insurance pro 9) The farm belt region of the U.S. vider. The savings card is available at www. 10) Joseph Conrad novella set in Africa spiriva.com and can be activated at most 11) Beatles 1967 album and song pharmacies. 12) Billy Ray Cyrus’s 1992 hit song 13) Lewis Carroll character who apparent ly is quite the fan of decapitation 14) Tom Petty’s backing band 15) He succeeded Henry II as king of England 16) 1843 Edgar Allan Poe short story Congratulations to oxygen user 17) British TV police drama series set in extraordinaire Edna Fiore! Edna was 1960s Yorkshire honored by the American Association 18) Over-sized piano duet from the movie for Respiratory Care (AARC) at their Big annual meeting last December for her 19) Take some Zantac to treat this symp never-ending work to raise awareness tom of gastroesophageal reflux disease of COPD. 20) Elvis’ first number one single Edna was given the prestigious 21) Spaceship in The Hitchhiker’s Guide honor of becoming an honorary mem to the Galaxy, also a Neil Young song ber of the organization. The AARC is 22) Tony Bennett’s signature song the professional organization of respi Answers will appear in our next issue! ratory therapists.

January/February 2015 www.pulmonarypaper.org 21 Tax Time Again Do You Itemize Your Deductions? If you itemize deductions on your income The standard deduction rises to $6,200 for tax return, you may be able to get some of single taxpayers and married taxpayers filing your medical expenses back that you have separately ($7,600 if you are over 65). The paid for throughout the year. Determine standard deduction is $12,400 for married whether the allowable expenses you paid couples filing jointly (if both are over 65, the during the year (home mortgage interest, deduction is $13,600). property and state income taxes, charitable donations, etc.) exceed the standard deduc Medical costs are deductible only after tion for your filing status. they exceed 10 percent of your AGI. So if your AGI is $50,000, the first $5,000 of If you and your spouse are both under age unreimbursed medical expenses does not 65, on your 2014 tax return that you will file count. There is a temporary exemption from in 2015, you can deduct only the amount of January 1, 2013 to December 31, 2016, for your unreimbursed, allowable medical and individuals age 65 and older and their spous dental expenses that is more than 10 percent es. They are allowed to deduct unreimbursed of your adjusted gross income (AGI). medical care expenses that exceed 7.5 per If you or your spouse is 65 or over, you cent of their adjusted gross income. For the are temporarily exempt from this year’s $50,000 year income, the deductions would increase. The exemption applies to any tax start after $3,750 has been paid. year beginning after December 31, 2012, and ending before January 1, 2017, if you or your For the complete qualified medical expens spouse attained age 65 during or before the es that you may deduct, see IRS Publication tax year. You will use the 7.5 percent thresh 502 (you can do an Internet search for this). old of your adjusted gross income In addition to the items you would expect are

22 www.pulmonarypaper.org Volume 26, Number 1 Computing the cost of electricity used: deductible (such as 1. Look at the label on your concentra physician, hospital, tor. It states the number of volts and dental, laboratory amps the concentrator uses. If not and x-ray costs), you found on the concentrator, look for also may consider the it in the manual or ask your oxygen following: provider. As an example, we will use • An air condition 115 volts at 4 amps. To convert to er necessary for re watts (W), multiply volts and amps: lief from allergies 115 volts x 4 amps = 460W. or other respiratory 2. Next, calculate the number of kilo problems. watt (KW) hours you use per year. • Exercise program if Multiply the watts your concentra a doctor has recom tor uses by .001 KW/W to convert mended it as treat watts to kilowatts. In our example, ment for a specific condition such as 460 W x .001 KW/W = 0.46 KW. non-reimbursed pulmonary rehabilita 3. Multiply this answer by 24 hours/ tion expenses. day x 365 days/year if you are a con • Insurance premiums for medical care tinuous user. If you do not always coverage. have your oxygen on, multiply by • Lodging expenses while away from home the average number of hours used to receive medical care in a hospital or per day and then by 365 days/year. medical facility. To continue the example, 0.46 KW • Medical aids, including wheelchairs, x 24 hours/day x 365 days/year = hearing aids and batteries, eyeglasses, 4,029.6 KWH/Y. This is the kilo contact lenses, crutches and braces. watt hours you have used to run • Medical conference admission costs and your concentrator the past year. travel expenses for a chronically ill 4. Now, multiply the above result by person to learn about new medical the cost per kilowatt hour your elec treatments. tric company charges you. It may be • Oxygen, oxygen equipment and the listed on your bill or you could call electricity it takes to run it. their office. Let’s say they charge • Smoking cessation programs (program you 8 cents per kilowatt hour (prices does not have to be recommended by a will vary widely depending on the physician). region in which you live). • Transportation costs for obtaining med To finish our example: ical care. 4,029.6 KWH/Y x $0.08 = $322.27. • Weight loss programs, if recommended This is the amount of electricity you paid by a doctor to treat a specific medical to run your concentrator. condition or to cure any specific ailment or disease.

January/February 2015 www.pulmonarypaper.org 23 Great News Effective January 1, 2015, the payment rate for hospital outpatient pulmonary reha bilitation programs for Medicare beneficia ries who meet the guidelines for moderate, severe and very severe COPD will be $52.35. This is a substantial increase over 2013 and 2014 which saw rates hover between $39 and $37, respectively. Many programs have had to close over the last several years as good as walking on a treadmill? Canadian because there simply wasn’t enough fund researchers conducted a study reported in ing to keep them open. Thank you to the Clinical Respiratory Journal that showed powers that be for realizing the importance no significant differences between the two of pulmonary rehabilitation! exercise periods. People did, however, ex perience a 2.33% higher oxygen saturation Attending a Pulmonary Rehabilitation reading following the Wii intervention when Program and returning weekly to exercise compared with the treadmill intervention. is one of the best things you can do to beat lung disease. A recent study in the medical The Timed Up and Go (TUG) Test is journal CHEST showed getting family done with a stopwatch and a chair to assess members or a friend involved in your pul your mobility and balance. You may use a monary rehabilitation program could benefit walking aid if needed. Sit back in a standard everyone! Investigators compared outcomes arm chair and identify a point 10 feet away for people who participated in pulmonary on the floor. The person with the stopwatch rehab alone and those who participated with will say Go and begin timing. You stand up a family member. The 12-week program from the chair, walk at a normal pace, turn, consisted of exercise training three times walk back and sit down when the timing a week and once weekly psychosocial sup ends. An older adult who takes 12 seconds port and education. Peoples in both groups or longer to complete the TUG is at high experienced significant improvements in risk for falling. In a recent study, significant exercise tolerance, functional balance, knee improvements were seen before and after extensors strength and health-related quality pulmonary rehabilitation. of life, but persons and family members who participated together saw significantly great Why don’t people participate in a pulmo er improvements in family coping. Family nary rehab program? Lack of interest was members reported greater changes in sexual cited by 39% of the respondents. Other rea relationships and psychological distress. sons included being too ill, frail or disabled; being too busy; distance or travel issues; Video games are just not for kids any commitment issues; comorbidities; and lack more! Could playing Nintendo Wii be just of social support.

24 www.pulmonarypaper.org Volume 26, Number 1 Flu News Vaccination Recommended for Everyone In January, the Centers for Disease Con but some protection is better than none. They trol and Prevention (CDC) reported flu- believe if they could pick the vaccine strains related hospitalizations of the elder later in the year instead of in February, there ly are the highest since government offi would have been more evidence to choose cials started tracking these the viruses they believe will numbers nine years ago. be dominant in the upcom Almost 200 out of every ing year. 100,000 people who are 65 and older have been hospi In December, the U.S. talized with the flu. That’s Food and Drug Adminis roughly 86,000 people. tration approved Rapivab Unfortunately, the 2015 (peramivir) to treat influenza vaccine has proven to be only infection in adults. 23% effective. This vaccine’s Rapivab is administered as formula does not contain the virus H2N2 a single intravenous (IV) dose. It is intended which has been predominantly circulating. for people 18 years and older who have acute In the best flu season, the vaccine has been uncomplicated influenza and have shown 50% to 60% effective. Hopefully, we have symptoms of flu for no more than two days. reached the peak of the flu season and the A common side effect of Rapivab is diarrhea. infection rate will continue to decrease. Rare but serious side effects include seri Despite the limited protection provided ous skin or hypersensitivity reactions. by this season’s influenza vaccine, the CDC repeated its recommendation for vaccination Similar drugs to treat flu include osel of everyone aged 6 months and older. By tamivir (Tamiflu) administered orally, and early November 2014, only 40% of eligible zanamivir (Relenza) which is inhaled. Older people in the United States had received this antiviral drugs for flu, amantadine and season’s influenza vaccine. rimantadine, are no longer recommended by Experts compare influenza vaccination the CDC because circulating influenza strains with wearing a seatbelt in a car: It may not are resistant to these drugs. protect from high-speed crashes all the time,

The 2004 to 2011 National Health support occupations followed by food Interview Survey data for working adults 40 preparation to 70 years old was analyzed to estimate the and serving- prevalence of COPD by major occupational related groups. The estimated overall COPD preva occupations. lence was 4.2%. The odds of getting COPD were highest among workers in health care

January/February 2015 www.pulmonarypaper.org 25 Test for Radon Gas in Your Home The U.S. Environmental Protection Agen- cy (USEPA) provides valuable information on the dangers of radon in your home. Radon is an odorless, tasteless and invisi ble gas produced by the decay of naturally occurring uranium in soil and water. It is a form of ionizing radiation and a proven carcinogen. Every January is designated as Radon Awareness Month and is a good time to check your home for this danger.

Exposure to radon causes lung cancer in non-smokers and smokers alike. Lung cancer now surpasses breast cancer as the number one cause of death among women. A smoker who is also exposed to radon has The National Radon Program Services at a much higher risk of lung cancer. Radon is Kansas State University offers discounted the number one cause of lung cancer among test kits available to purchase online. Go to non-smokers, according to EPA estimates. http://sosradon.org/test-kits. Short-term test Secondhand smoke is the third leading cause. kits (3 to 4 days) are $15, which includes all costs. Long-term test kits (3 to 12 months) Radon is found in the indoor air of build are $25. Once completed, you can use the ings of all kinds. The average radon concen test’s serial number to access your results at tration in the indoor air of American homes www.radon.com. You can also find the test is about 1.3 pCi/L (picocuries per liter). A kits at home improvement stores. pCi is a measure of the rate of radioactive Sources of Radon decay of radon. EPA recommends that Americans consider fixing their homes when the radon level is between 2 and 4 pCi/L.

Most indoor radon comes into your home from the soil or rock beneath it. Radon and other gases rise through the soil and get trapped under the building, building up pressure. They enter your home through 69.3% Soil around house cracks and cavities in floors and walls, 18.5% Well water around sump pumps and drains, joints in 9.2% Outdoor air construction materials and gaps around 2.5% Building materials pipes and wires. 0.5% Public water supplies

26 www.pulmonarypaper.org Volume 26, Number 1 What Do You Do for Fun? We had over 1,400 responses to our in- options open to you online either through depth survey last year and thank all who Facebook or individual organizations. It is participated. We asked what our members very important that you do not become iso did for fun and the games they liked to play. lated because of your chronic lung problems. • Almost half of you love Solitaire – either There are many lines of communication online or the old fashioned way! open to you – please know that you are not • Fourteen percent play Bridge and other alone! card games. • Scrabble and Word with Friends are the Answers to our Christmas pop culture favorite of eleven percent. quiz from our last issue: • Candy Crush dominated the online 1. What were the names of the Three gaming choice. Wise Men? Answer: Caspar, Balth- • Bunko is a favorite of neighbor ladies. azar and Melchior • Nine percent play Mahjong which in 2. What is the best-selling Christmas re trigued us as we didn’t realize it was so cording of all-time? Answer: White popular! The game is played with a set Christmas of 144 tiles based on Chinese characters 3. How many sides does a snowflake and symbols. have? Answer: Six 4. ‘Good King Wenceslas looked out on the Feast of Stephen’. When is the ‘Feast of Stephen’? Answer: December 26 5. If you received all of the gifts listed in “The Twelve Days of Christmas” song how many presents would you get? Answer: 364 6. What is a Christmas Cracker? An- swer: A hollow tube traditionally Invite your friends in or meet at a commu from England filled with a surprise nity center for your favorite game! Make it 7. From what were the first artificial a weekly, or bi-weekly event. Sometimes, it trees made? Answer: Goose feathers only takes a phone call to organize a simple 8. What country lays claim to Christ minimal cost activity that can bring much mas Island? Answer: Australia laughter and friendship to your life! . 9 What state was last to declare Christ We asked if you agreed with the statement, mas a holiday in 1907? Answer: “Connecting with other people with COPD Oklahoma through an online social network will help 10. Traditionally, where does “Xmas” me manage my own lung disease.” Seventy- come from? Answer: X is the Greek five percent did agree. There are many symbol of Christ

January/February 2015 www.pulmonarypaper.org 27 2015Sea Puffer Group Cruises

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Respiratory News Authors evaluated the efficacy of a monitor people with COPD for their blood 12 -week oral treatment with azithromy oxygen saturation and other key vital signs. cin in adults with bronchiectasis. They The recorded measurements will be auto concluded that 12-week administration matically transferred to your personal file. of azithromycin produces significant The company also wants to encourage reductions in sputum volume, health status physical activity and adherence to treat and stabilization of lung function val ment and nutrition to better self-manage ues. Sputum volume reduction and the your condition. Based in England, they improvement of quality of life were sus hope to have the product available by the tained for 12 weeks after cessation of end of 2015. azithromycin. Maintenance treatment with azithromycin also significantly decreased A new review entitled “Standards of Suit the exacerbation (flare up) rate compared ability for the Management of Chronic Ob with placebo. structive Respiratory Diseases” was recently published in the journal Multidisciplinary Bronchodilators form the mainstay of Respiratory Medicine. treatment for COPD. When symptoms COPD is the third cause of mortality are not adequately controlled with one worldwide and leads to significant health, bronchodilator, addition of another bron social and economic burdens. Clinicians chodilator is recommended. Authors have and patients commonly disregard early recently developed a combination of tiotro symptoms of COPD because they consider pium (Spiriva) and formoterol (Foradil) in them to be a result of smoking instead of a single pressurized metered dose inhaler. important signs of a beginning disease The aim of this study was to compare the that becomes irreversible, progressive and bronchodilator effects of a single dose of severely disabling. The diagnosis typically 18 mcg of tiotropium versus a single dose only occurs when the disease reaches its of a combination of 18 mcg tiotropium later stages. plus 12 mcg formoterol administered via a Topics discussed were spirometry as a pMDI in subjects with moderate-to-severe critically important tool for COPD man COPD. The combination produced a faster agement; the essential role of blood gas and superior bronchodilator response than results for long-term oxygen therapy; and tiotropium alone over a period of 24 hours. the demand for interventions to decrease the acute exacerbation rates. Smoking cessation Aseptika Limited recently announced it was found to be insufficiently implemented. is boosting development of a medical smart The researchers conclude in their review watch called BuddyWOTCHT (Walking, that a standardized management for COPD Oxygenation, Temperature, Chronicle and is a public health concern that still needs Heartrate). It is designed to constantly more debate.

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The PulmonaryPaper Dedicated to Respiratory Care As we cannot assume responsibility, please contact your physician before changing your treatment Volume 26, No. 1 schedule. January/February 2015 The Pulmonary Paper Staff The Pulmonary Paper Editor . . . . . Celeste Belyea, RRT, RN, FAARC PO Box 877 Associate Editor Ormond Beach, FL 32175 Dominic Coppolo, RRT, AE-C, FAARC Phone: 800-950-3698 Design...... Sabach Design Email: [email protected] Medical Director ...... Michael Bauer, MD

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Bronchiectasis Basics Airway Wall Eople with Bronchiectasis Have a Con­ Pstant Battle with Raising Secretions

Bronchiectasis Basics Airway Wall Eople with Bronchiectasis Have a Con Pstant Battle with Raising Secretions