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Recent Questions for the RT
Note: The bi-weekly cut-off day is Wednesday evening. If your questions are received "after" that day, they will appear in the following week's postings.
Q: Can Oxygen Be Considered a Heroic Measure?
Editor's Note: Due to the complexity of this question, the response is in two parts. The first is from Tracy, the RRT, the second portion is from Chris Wigley; a COPD patient currently on oxygen.
Hi,
I need advice here. My mother has had COPD for over 5 years and has been
rescued from lung infections over 6 times. She also has congestive heart
failure. She is 86 and in an assisted living apartment. She had another
infection this past week and the ER doctor this time prescribed cortisone,
an antibiotic orally and water pills for the excess water around her heart
and sent her home after 2 hours of her arrival. The problem is she is also
on asthma pumps and hasn't really needed home oxygen. Each time she comes
out of hospital she uses the home oxygen for a short while then when she
starts feeling stronger she ditches the oxygen. Regular testing by the
community health nurse indicates near normal oxygen levels.
This week though she keeps along with the usual cognition difficulties she
keeps pulling off the oxygen. She truly hates it but I know she has rallied
before with it. She earlier signed a paper that indicated she didn't want
heroic measures. Does fighting with her to keep the oxygen tube on become
heroic measures if the person won't keep it on?
Her assisted living orderlies aren't required to keep checking on her
oxygen. This puts it on my shoulders to keep running by her apartment and
checking.
Please advise,
Lynn (the poster's name has been
changed for confidentiality reasons)
A secondary "add on" to the above.....
"I
understand that you are not DRS. This is more an ethical problem than a
medical. Her sats are only ok this time with the oxygen on. Every time she
takes off the oxygen she drops to 80 but upon reconnecting she jumps to 90
in ten minutes.
Thank you again, Lynn"
A. From Tracy, the RRT
Hello Lynn,
Your mother seems to have several issues taking place at the same time which
make things a little complicated as far as determining the reasons for her
treatments that her physician(s) have prescribed; COPD, asthma (?) and
congestive heart failure.
Since the ER physician did not prescribe antibiotics for the most recent issue
[only a steroid (cortisone) and a diuretic (water pill)] either your mother had
a viral infection (which cannot be treated with antibiotics) or she did not
actually have an infection. Without knowing more about the details it is
difficult to know the reasoning behind the medications.
I am not clear by what you mean by an asthma pump so I cannot comment on this.
Home oxygen can be prescribed for several reasons, primarily a lower oxygen
level on a continuous basis or for some people after they have had a medical
problem that needs time to recover and then the oxygen may not be required after
that time. It is possible that you mother only requires the oxygen for periods
of time following an infection (exacerbation) or heart problem. The oxygen was
most likely prescribed by her family physician or respirologist so this is the
person that can more easily answer your questions. Since oxygen is considered a
drug and requires a prescription before if it administered-there should be clear
guidelines for its use for your mother. If there is a home care company that
looks after the equipment they may also be able to guide you further although
this may be through the assisted living facility that you mother lives in.
Since your mother's oxygen level drops to the 80s without the oxygen she most
likely requires the oxygen on a continuous basis. You should definitely speak
with her family doctor (or prescribing physician) to discuss how the issue of
her removing the oxygen should be handled. Since you have no one at her bedside
on a continuous basis perhaps she will require one-on-one care to look after
this issue.
It has been my experience that oxygen is not considered a heroic measure in the
hospital setting; heroic measures usually involve CPR. defibrillation,
ventilator assisted breathing and certain medications to try and start the heart
again during a cardiac arrest. The definition of heroic may vary from person to
person and often times there are very specific parameters written down for a
specific person. The paper your mother signed before should have more details as
to what is considered heroic measures. Perhaps you can ask to see this paper
and this may help you out.
I hope that I have given you a little guidance in this complicated matter.
Tracy
A. To Lynn From C. Wigley, COPD Patient & Oxygen User
To me there are two different problems here.
The first, and maybe the most important, is the "ethical/emotional" problem.
To put it bluntly - maybe her mother no longer desires to keep on living and
certainly not by doing things that make her life MORE miserable. This is a
very hard thing for any child to accept, especially for a loving daughter
who does not want to let go. I was in this position when my 84 year old
father (who was a doctor) had pneumonia after years of living with
unremitting pain. One of the last things he said to me referred to
"Pneumonia - the "old man's friend." Nobody should interfere
with another's wishes in this area (I am not talking about acute and curable
depression here!).
So it boils down to this. If using the oxygen can be made comfortable enough
that it makes life better for her mother then it is good. Unfortunately, all
too often people are given only "basic" equipment. To go thought life with a
fifty foot leash tying you to a noisy machine making your room hot, where
every time you turn around you trip on the leash which tries to rip your
ears off and they are already sore from the leash rubbing on them, and the
leash is stuck up you nose and sticking into the tender bleeding flesh
inside the nose......
I could go on, but I am sure you get the point.
The
ONLY way to get people to use oxygen all the time is to make it as
comfortable and convenient as possible.
Make sure the cannula is as soft and pliable as possible - I will only use a
"soft hose" cannula www.softhose.com any
they start to get uncomfortable
after three weeks or so.
Use a short cannula and clip it to clothes so that it doesn't catch on every
doorknob you pass.
Keep the hose so that you don't/can't trip on it.
Have a quiet concentrator and have it in another room, or better yet use
liquid oxygen.
Use a lightweight portable that goes with you.....
........with the right equipment and sensibly handled it can make all the
difference in the world between barely existing and being able to go out and
about and enjoy life. I have been using oxygen for sleeping and any but the most
mild activity for the past five years. I get out and about without really
thinking (apart from sensible planning) about the oxygen. I have done a lot of
house renovation, and the same for a little houseboat, gone to crowded
automobile exhibitions and outdoor sports events and flown cross-country several
times, run a local COPD support group (as well as assist a little with COPD
Canada Patient Network!). I could have done none of these without the oxygen,
but I have taken the trouble to learn about what is available and to use what
works well for me.
And lastly there is pulmonary rehab.............
I hope this may be of some help.
Chris
Q. Youth & COPD
Can youth get COPD?
Rebecca
A.
Hello Rebecca,
The majority of people who are diagnosed with COPD have a history of smoking and
are over 40 years of age.
Tracy
Q. Oxygen Saturation/Desaturation When Flying
Hi Tracy. As you well know an educated consumer is your best customer, but this disease is so different in each person. As an example. I have a lot of asthma with my COPD, and if I get an infection or exacerbation, I seem to be able to bounce back. I have talked with my fellow sufferers, and many who have a larger portion of emphysema, do not bounce back. When ill, I get winded walking up the stairs. Now, I DO NOT GET OUT OF BREATH. Many have said that regardless of their Meds they ALWAYS get short of breath when climbing stairs. I do not need my rescue medication at all now, and I am 2 minutes away on the treadmill from equaling my best time of 35 minutes. Sometimes it is like I have no disease at all. Other times it is very evident. My question is. My 02 saturation at rest is between 94-98, on a consistent basis. I will be flying in Sept, and do not use 02. Based on the numbers I gave you , how much would one De-saturate by flying. Thanks Tracy Philip
A
Hello Philip,
I cannot say for sure if you will desaturate during the flight but it is
possible that your oxygen will remain the same as your usual due to the
pressurization of the cabin. Your saturations are usually 94-98% and this is a
fairly normal range while resting. In my experience as a respiratory therapist
only those who are usually on supplemental oxygen would require oxygen during a
flight.
Be sure to discuss the trip with your physician who will be able to give you
more details using your current background and respiratory status.
Have a safe and great trip!
Tracy
Q./Comment Nasal Spray & Oxygen Saturation
Hi Tracy. I just noticed an interesting thing. Because I
have asthma
with my COPD, my nose gets plugged. Today it was slightly plugged so I
bought a nasal spray and tried it. Do you know that it improved my 02
saturation by 2-3 points. If I walk up the stairs my saturation is 91.
With the nasal spray it was 93. At rest I am about 94-96. Now I can
reach 98. There seems to be more benefits then just clearing the nose.
Thought I would pass this on to you. Regards Philip
A.
Hello Philip,
In my experience as a respiratory therapist I have not heard of nasal
spray improving oxygen saturations. If your nose was quite congested,
the spray may allow air to more easily enter your nose but I do not know
of any reason that it would improve your oxygen saturation.
I am glad that you are having improvements in your oxygen saturations
and I thank you for the comment!
Tracy
Q. How much Ventolin?
Hello Tracy; I read your column a lot. My wife and I really
appreciate it. Many times you've answered stuff we've thought about. Now I have
a question. How much or how safe is ventolin? Sometimes 2 puffs isn't enough
to get me breathing right and I have to take more in the hot weather. Other
than it I only take atrovent every 6 hours. thank you
Chuck
Editor's Note: Albuterol • Ventolin • Proventil • Salbutamol
(Different names; same medicines)
for additional cross references of Med
Names/Equivalent
Q. Walking & Oxygen Saturation Levels- How Do I Know?
Tracy; My FEV 1 is 37% but I get on quite well. I'm not on oxygen and I walk every day almost. Unfortunately I don't own (can't afford) a pulse oximeter. If I'm walking, how can I tell if my o2 levels are lower than they should be. I want to push myself even if I get winded but I don't know how much or how long is safe. Any suggestions would be appreciated. Marsha
Q. After medical setbacks, will an FEV1 return to what it was?
Hi Tracy. I was diagnosed with copd about 8 years ago ( QUIT SMOKING AT SAME TIME), and I have a lot of asthma with my copd. To give you some idea of how much asthma, when I was first diagnosed my FEV1 was 25% of predicted. My second spiromoter test was 38% of predicted and the most up to date test ( 4 Months Ago ), it was 48% of predicted. My question is this. I have had bronchitis since Jan of this year and the cough won't go away. I had no bronchitis for the last 18 month previous. In April, I got influenza A and that was like being hit by a truck,( Another setback , and now in June I got a secondary infection and I am on my last days of levequin. Now with all these infections and illnesses would it be asking to much to get back to where I was before I got all this stuff. I am slowing working my way back on the treadmill, and before I got sick I did my 6 minute walk, and managed 496 meters. I am on singulair now and it seems to make a big difference. Your thoughts. Thanks Philip.
Q. Improvement in Lung Function
I've had COPD for many years and have been in an exercise program at our hospital for one year. I also exercise at home. My lung function is FEV o.34. Can that improve with more time and exercise ? I must admit I only quit smoking 4 months ago - this time for good.Heidi
Q. Swimming Pools & Chlorine
Is the chlorine used in indoor swimming pools;
where the smell can be
more concentrated and strong, be harmful to people with a lung
disorder? Cleo
A.
Hello
Cleo,
Chlorine exposure can be a possible cause of COPD although the
frequency and level of exposure is not well documented. For those with
lung diseases exposure to chlorine at local swimming pools may irritate
the lungs and cause constriction and other symptoms depending on the
person and their sensitivity to chlorine. Some people react more
strongly to certain irritants (such as chlorine) than others so they may
not be able to be around pools, etc where others may not be bothered by
them at all.
Tracy
Q. Qualifying for Home Oxygen
For oxygen to be prescribed what is the usual sustained
number or
level that a person has to be at? Also; how is a person tested for this
to see what their level is during the day and the night?
Thank You Gus
A.
Hello Gus,
Requirements for home oxygen differ from province to province and I
can speak for Nova Scotia only. In this province a person must have 2
blood tests done at least a day apart (arterial blood gases). The
oxygen level must be below 55 mmHG while at rest in these tests in order
to be qualified for funding for home oxygen. Most testing for home
oxygen is done by the arterial blood gas but certain situations require a
less invasive measurement (the oximeter)
People who have a lower level of oxygen while exerting themselves may
also qualify. The oxygen measured with the clip on the finger
(oximeter) has to be 80% or lower. There are oximeters used to test
oxygen levels at night (the same clip on your finger). These tests can
be ordered by a physician if warranted.
Tracy
Q. How long can a person be on a ventilator
before they can't
come off. My mom has been intubated (through the throat) for 4 weeks now. She
has severe COPD and she developed pneumonia. She's now getting better but she
can only t piece (sp?) for 4 or 5 minutes at a time.
Thank You, Fisk
A. Hello Fisk -thank you for the question!
Q. COPD & Exercise
Hi Tracy - nice to see you back. My question I have uncomplicated COPD -moderate stage. How hard should I push when it comes to exercising? Also; does the same scale apply when it comes to walk for me as it does for healthy people. The one that goes 220, minus your age, times 70 or 80% - is your targeted heart rate. Thank You.
Heather
Unfortunately, I cannot advise you on your exercise regime due to safety reasons. Any exercise regime should be done in consultation with your family physician or respirologist.
Tracy
Q. What does an RRT do?
I've only ever been and treated for COPD by my family Dr.
He has me on ventolin and atrovent. Please don't laugh when I ask this but
what does a RRT actually do? I've seen and read others talking about
respiratory thereapists but what is it they do?
Sonja
Q: How to Use a Spacer Properly
I saw this question on one of the forums. I don't know if
anyone has asked it of you yet but in case they haven't.
A lady had said that if you use a spacer when taking your puffers, she had been
told (when she took her PFt tests ) that you're suppose to put the mouthpiece in
your mouth further than your lips so that your teeth are on it.
I use an aero chamber myself but have only put it inside my lips.
Which method is the right way? Thank you, Lynn
Q. If no change after Ventolin on Spiro test, will it still work as an Rescue Puffer
Hi Tracy;
I've never had to use my emergency puffer for my copd, I guess my meds are
working great! I don't have any asthma with it and my spirometry test showed
that the ventolin doesn't make much difference in my test numbers. My
Question....does that mean the ventolin won't do me any good if I'm ever in a
situation when I can't breathe? Thanks, Angie
A. Hi Angie,
If you have trouble breathing and decide to take your ventolin (as
prescribed by your physician) you may feel relief of breathlessness even though
this may not always coincide with improvements with spirometry. The
improvement in symptoms is what counts!
Tracy
Q. Reversible Component w/o Asthma?
Hi Tracy; In the absence of asthma for a
person with COPD, and they say there's a certain percentage of a reversible
component; how can that be?
Thank You, Lou
Q. CO2 Retention
Hello Tracy. My question is about CO2 retention. Many people I've talked to with emphysema retain CO2 but so far that hasn't been a big problem for me yet. Do or will all emphysema sufferers suffer from this to the point of being severe? Thank You
Todd
A. Hello Todd,
Not all people with emphysema and/or COPD have CO2 retention. Oftentimes, the CO2 levels remain normal until advancement of the disease when it may become elevated. During an exacerbation (increase in symptoms which may be seen with pneumonia, etc.) CO2 levels may temporarily increase but return to previous levels once the exacerbation has been treated.
Tracy
Q. Will lung function decrease if on Oxygen
Hi Tracy,
I have been put on 02 supplementation for exertion and sleep; but I don't need
it if I'm just watching TV or getting up to make a cup of tea etc. However, I'm
concerned in that I've noticed my sats when not on 02 don't seem to be rising
back to my normal 95. Admittedly, I do not feel out of breath and breathing
somehow seems easier but I had understood that using 02 would not change my
overall lung function. I have heard tales of "lazy breathing" etc but they said
they were disproven. It is great that I can now get 02 for exercise only here in
Ontario and it does feel great when I use it but I am worried that my overall
function will decrease and I will find myself on it 24/7 before I would have.
Please send me your advice. Many thanks.
Shelley
A. Dear Shelley;
Q. Not Acknowledging Seriousness of the Disease & Still Smoking
My husband, who is only 37, was diagnosed with COPD in August 2005. He is a smoker and has tried to quit many times since being diagnosed, however he always starts again. Lately he is waking up with serious coughing fits in the middle of the night or will come to a sitting position and seems to be choking....this scares me to death....he seems to be numb to this fact. How can I make him understand the seriousness of his disease? Are there any pictures or stories that I can obtain to show him in black and white that he needs to stop smoking??
A. Dear Jennifer,
Your husband may be waking up coughing due to phlegm that he would normally
clear (if awake). This phlegm may be irritating his breathing such that he
needs to cough at night to try and clear it. Perhaps using a second pillow may
help with this to elevate his head and try to avoid the coughing/choking.
Since your husband has tried to quit many times in the past it shows
that he does know that it would be in his best interest to do so but it
is a very difficult thing to do for many people. Has he tried a smoking
cessation program (sometimes given through the Lung Association or Heart and
Stroke)? He may benefit from using some of the gums, medictions,etc. that are
on the market these days to help with the cravings. This is something that he
can speak with his family doctor about-to see what options are locally available
to him.
I should point out too that for a lot of people quitting does not happen the
first time but after several attempts it can just work. So, your husband is not
on his own in this regard and should be commended for trying in the past and
encouraged to try again when he is ready. If he is not mentally ready to quit
he may not be successful-this takes time and hopefully some of the following
information will help.
If you go to the Heart and Stroke Foundation website;
www.heartandstroke.ca (search
'smoking' and you will find many articles that have facts about the damage of
smoking to your heart such as "Priceless reasons for quitting smoking" among
others) or the Canadian Lung Association website:
www.lung.ca where there is information on
quitting smoking on the home page that will lead you to many information pages.
You can also look under Lung Diseases on the home page and find COPD. There you
will find plenty of information that may help. These are wonderful resources
that I think will help you and your husband.
As far as pictures a search on google.ca under images will lead you to pictures
of smokers lungs but I am not sure if this is what you
want/need. Please give me a few more details of what you would like (if you
don't find them on the above-mentioned sites) and I will try to help you.
Tracy
Q. Oxygen Need with Severe COPD? Lack of Answers
I have very severe COPD (last FEV1 33%) and am 52. Yesterday I had my first 6 min walk to see if I need 02. On room air my resting sat was 93 and during the initial walk I desaturated to the low 80s. I was then tested at 1.5, 3 & 4 lpm. At 4 lpm, I was able to do the test without any SOB and my sats stayed at 88 or above. My resting sat still only reached 95%. However, when I returned to my respirologist, he said that 02 can only be prescribed if my resting sat is 88%. I corrected him and told him about 02 supplementation for exercise an sleep and he eventually called the RT to confirm. Now I am waiting for another test that from what I understand will be the same except that ABGs will be drawn. Please explain what is going on? Why do they get 02 in the States for exercise and yet we are restricted or unable. What should I expect from this new test? Isn't 4 lpm high for someone who has never been on 02. I've been diagnosed since 1991. I'm very confused, again scared and feeling left out in the dark. I want to keep going. I am very physical and have kept that up but I'm worried about the strain on my other organs. One thing that he mentioned and I'm not quite sure what he meant, was that on room air only I walked at 69% predicted. I was just terminated from my job for being off ill and am now applying for LTD from my insurance company and CPP. I realize there are a lot of questions here and perhaps you may want to respond to my email only. I have no one else to ask and now my respirologist is being very closed - just wants me to follow his direction but doesn't want to answer questions and there's no use trying to find another doctor here in Ontario. Its impossible to even get a GP these days. Thanks Shelley
Q. Headaches & Dizziness with COPD?
I was diagnosed with COPD as well as Asthma a couple of years ago. At that time I was in the process of getting my disability because of complications from multiple surgeries and a left leg amputation. The Dr I was seeing then for my COPD wrote a letter for me and I have a copy of it. He told them that most of my levels predicted for a man my age were below 50%. Now this was about 2 years ago. I had been going to place called Carolina Allergy and Asthma. This is the Dr that has watched over me for about two years. My Primary Physician finally put me on Oxygen for 24 hours a day due to my oxygen levels dropping upon much of any exertion. He had me put the clip thing on my finger and we walked around the hallways as the nurse walked beside me and watched the meter. It did not take long for my level to drop to 88. Whe it got there, she said that is all we need to qualify you for Oxygen. Iam on Medicare. So I have been on the oxygen since January. I still have periods where I get really lightheaded and feel like I may pass out. I have also started with headaches at times. The last time I went to the allergy Dr. He begged me to get into see a Pulmonary Specialist. So I have to go see him in a few weeks. Do you think my numbers have even gotten worse by him begging me to get to a pulmonary Dr? I got an oximeter, and even on oxygen therapy it shows around 90 most of the time even at rest. Have you heard of the dizziness and headaches like that with the COPD? I get really scared at times, and I fear one day I will die fighting for every last breath. Do most folks get the dizziness and the headaches with COPD? I HAD A nUCLEAR sTRESS tEST AND THE HEART SEEMS TO BE ALRIGHT FOR NOW. Don
A Hello Don,
Q, Weather & COPD
My husband (77yrs) has acute COPD. He is on oxygen and
takes Oxese and Spiriva which seem to keep him going okay. We have checked with
his respirologist and he is not a candidate for lung reduction nor transplant.
He often has very bad breathing days and other days not so bad and even good for
him. (like most people with this disease).
question is...does the changes in barometric pressure have anything to do with
this. It seems whenever there is a change in the weather...he feels the affect.
Whether cold to warm, sunny to cloudy, still to windy.
Lori
Hi,
I was diagnosed with mild COPD on april 4th... quit smoking four days later
(after having the habit for 25 years)... and wanted to know if what I've been
told is true: "that due to the fact that it is in the beginning stages;
quitting smoking should stop it from progressing any further"... I should note
that whether or not this is true, I still intend to stick with being "smoke
free" ... even though going "cold turkey" actually proved physically
painful... but, as upset by this news as i have been, I guess I'm looking for
any hope that there may be.... despite that bad habit, i had maintained a
fairly healthy level of activity for years... so this comes as quite a
shock. Jennifer
A Hi Jennifer,
Congratulations on quitting the smoking habit! I am sure that this was a very difficult thing for you to do but it is the best thing that you could have done for your lung (and overall) health!
Smoking cessation is the most effective way to reduce the risk for developing COPD in the first place and it has been proven that this is the only way to stop the progression of COPD. (This information has been taken from the Canadian Respiratory Society Recommendations for the Management of COPD).
Q. When to Take Meds/Sequence
Hello,
I have chronic bronchitis and COPD, I take spiriva, salbutamol and advair. In what sequence should I be taking them and is there a waiting period in between inhalers.
Thank you, Maggie
A. Hi Maggie,
You should always start with your salbutamol and wait 30 sec-1 minute between puffs. If you have the time you can wait 15 minutes after your salbutamol to take your Spiriva but most people are not able to spend that much time taking their medications. Otherwise, take your spiriva a minute or 2 after the salbutamol. Your Advair can be taken last, a minute or so after the Spriva. If you have more than 1 inhalation of Advair-wait 30 sec-1 minute in between each.
I should also mention that if you are using salbutamol and /or Advair as an MDI you should definitely be using a spacing device in order to get optimal distribution of these medications in your lungs! Ask your physician or pharmacist about a spacing device if you do not currently use one.
Q. Reaction to Meds and Info on Zermaira
Spiriva and Fordial cause my esophagus to swell. The only thing I have is Albuterol and Pulmicort updrafts.
I have tried about everything out there. can you help?
(Updrafts are used with an air pump, to use the vials of albuterol and pulmicort in a nebulizer. )
What do you know about Zermaira? used for emphysema. Thank you Alan
A Hello Alan,
I believe that by ‘updrafts’ you mean aerosolized therapy using an air compressor to deliver your inhaled medications via a facemask.
Your family doctor has prescribed a short acting (reliever) medication along with a steroid (maintenance) medication for you. Since you are allergic to certain medications such as Spiriva (maintenance) and Foradil (maintenance) your family doctor is somewhat limited in what can be prescribed for you.
Zemaira is a new treatment for people who have a hereditary condition which can lead to emphysema, COPD, asthma and other respiratory disorders. This medication is not for all people with emphysema and COPD. You should speak to your physician to see if there is a possibility you may benefit from this medication. A screening blood test is required to see if you have this hereditary condition known as Alpha-1 Antitrypsin Deficiency, or Alpha-1
Hi Tracy. I have been on a rehab program with Westpark Hospital, and was doing great, and almost ready for discharge. I have copd with a high component of asthma, and I was doing my exercises faithfully until I got a sinus infection that has hung on for the last 2-3 weeks, and I have not exercised due to the illness. Before the illness I was doing 30 minutes treadmill with speed 2.5 and incline 2.5. I was also doing my home exercises. Now that I have been away from the exercises, I feel that I have deconditioned, and it is almost like starting over. How long will it take to get back to where I was before this sinus infection? Also would exercising 3-4 times a week be enough. My thanks, Philip
Is there anything a person can work on at home to help reduce the air trapping? Thank You. Tim
A Hi Tim,
(Note: Added by the Webmistress : Also here at the COPD Canada site under Breathing Distress)
Tracy, I have a couple of comments on some of your answers, which for the
most part I find very good, just a couple of exceptions :
You said " and it (the oximeter) meant to be used by someone trained in
using this equipment."
Currently Dr. Thomas Petty (renowned pulmonologist) is stressing every
patient should have an oximeter. He has written a booklet and it can be
obtained free by patients
or "Titrate when you migrate" Tom speaks
You also mention a patient shouldn't worry about CO2 from a gas range...I am not sure on this except for my personal experience, but
In Neil Schacter MD book he recommends using gas stove with a window cracked open for fresh air intake. I poo pood this until last winter we were constantly heating pots of water on our gas range, to add to the dry humidity in Denver CO. I was having lot s of coughing...and remembered that passage in the book. We stopped the gas stove being used for heating/humidifying and all discomfort stopped. The stove is functioning properly.
I don't hesitate to get near it to cook...just watch proximity of plastic tubing...but if prolonged stove top cooking...I use exhaust fan on low, now.
Thanks for your great Q & A site.
Roxlyn
My husband further explained that even a properly adjusted gas stove emits NITROGEN OXIDES which are IRRITANTS and not desirable.
CO2 if in large quantities (not likely but possible) can be suffocating.
roxlyn
Q: Lung Function/Which Numbers Are Usually Used
Q. Bronchial Thermoplasty & Seretide
Do you think bronchial thermoplasty can help COPD'ers.
Is seretide available in Canada yet and can a prescription be had for this from
my physician??
At present I am on Advair and Spiriva.
Thanks Tracy......Barry
Q. Switching from Albuterol to Xopenex in Nebulizer
I am a 63 y.o. male, I've been on Albuterol for my nebulizer, and I wanted to switch to Xopenex. My pharmacy send the unmixed kind and my question is , can I just use it and not dilute it with anything. I think that's what they did the last time I was hospitalized. What if I added the undiluted Xopenex to the diluted Albuterol ? Would that work?
Thanks for any info. Tommy
Q. Exercising AFTER Rehab
Is there a limit to how far a patient can push themselves AFTER pulmonary rehab...assuming they do not have other serious health issues, that they do monitor their sats with an oximeter, and that they have worked up to walking 30-60 minutes without stopping to rest?
A. Hi Roxlyn,
I think that you should follow the program that you used during pulmonary rehabilitation unless you have had specific guidance from your family doctor and / or physiotherapist who you saw in the program. It may be possible to push your self but you definitely need to get guidance before you change the routine that you were started on.
Q Exacerbations- Infections & Disease Progression
Hi Tracy
Hope you don't mind but this is like 3 questions.
When you have an exacerbation or flare up is it always due to an infection? I
guess I mean is it possible to have a flare up without having an infection and
if so how can I avoid it? Also do the flare ups get worse (in frequency or
severity)as the disease progresses?
Thank you very
much , Marcus
A. Hi Marcus,
COPD flare-ups (exacerbations) are most commonly caused by an infection in the lungs (such as bronchitis or pneumonia). Air pollutants can also cause an exacerbation but many times the reason for the exacerbation cannot be determined. Some are thought to be caused by problems with the heart, exposure to chemicals, or allergic reactions.
Exacerbations usually involve an increase in shortness of breath, sputum production (and or a change in its color), breathing rate and cough and may worsen as the disease progresses.
In order to try and avoid exacerbations you should avoid any triggers that you know affect your breathing (i.e. air pollutants, places where there may be strong cleaners in use or perfumes, etc.). Washing your hands frequently (especially during cold and flu season) may be beneficial in trying to avoid infections. Your doctor can help you with more information on avoidance of exacerbations specific to you.
Q. Oxygen & Exercise
Thanks Dennis
Q. Oximetry Accuracy & Smoking
How accurate is an oximeter if/when a person still smokes a bit? I've heard some say it's still pretty accurate within a few points. Also how many hours of not smoking would it have to be for an accurate reading?
Thank You
Marsha
Q. Xanaz & Anxiety
My question is I take Xanax 0.25 mg twice daily for my
anxiety and it
does help somewhat. While in the hospital they were giving me 1 mg of
xanax, I was thinking about asking my Doctor about raising my dosage to
1 mg twice daily, what do you think? Tommy
A.
Hi Tommy,
Since Xanax is an anti-anxiety medication, it is not something
that I
can comment on with any authority. Anti-anxiety medications are
appropriate for some people with lung disease but any alterations to
your dose, etc will have to be determined by your family doctor and or
respirologist.
Tracy
Q. Chronic Respiratory Failure
What does Chronic Respiratory Failure mean if a person has
severe COPD?
Mark
A. Hi Mark,
Respiratory failure can take place when someone has a problem with gas exchange
(oxygen and carbon dioxide) in the lungs. When we breathe in air, our body
takes in oxygen and gets rid of carbon dioxide with every breath. If we have a
problem with this exchange of gases, it can be called respiratory failure and
either the carbon dioxide or oxygen
components can be affected; the oxygen level can be lower than normal
and the carbon dioxide level can be higher than normal. Respiratory
failure can be either acute or chronic.
Chronic respiratory failure takes place over several days to months
whereas acute respiratory takes place over a relatively short period of
time. Each can be caused from any number or breathing problems ( lung
diseases, muscle weakness, medication overdoses, etc). Acute respiratory failure
usually requires hospital treatment but chronic respiratory failure can usually
be treated at home with oxygen and management of the disease involved.
Please let me know, and I hope that this helps!
Tracy
Q. Strengthening of Lungs
Tracy; is there such a thing as strengthening or building
your lungs?
Also; I've read about harmonica playing for c.o.p.d as well as a new
device called a Breather which supposedly optimizes lung power. Please
don't tell me to talk to my Doctor; he doesn't know much about c.o.p.d
treatments and rehab isn't an option for me here in Nfld. Thank You
Natasha
A. Hi Natasha,
There are several breathing techniques that can help to improve
breathing capacity. Although you do not have access to pulmonary
rehabilitation , you should still be able to get some expert advise in
this area. Physiotherapists are a integral part of pulmonary
rehabilitation and are able to teach many different overall body
strengthening exercises and breathing techniques to help with your
breathing capacity.
Even though you feel that your family doctor does not know about many
COPD treatments you can ask to have a physiotherapy consult and perhaps spend
some time with a physiotherapist to learn how to improve your breathing.
Also, you can contact your local Lung Association and get some advise
from them. They may be able to help you find resources in your area and they
also have instructions for breathing techniques on their site.
This can help to get you started!
http://www.nf.lung.ca/
http://www.lung.ca/diseases-maladies/copd-mpoc/breathing-respiration/index_e.php
I found a little information on the "Breather' but not very much. I
have seen similar devices used for people with breathing problems but
not this specific device. Again, the physiotherapist would be a great
resource for a device like this since they would likely see more types
than I have in the past.
Tracy
Q. Low Oxygen Saturation & Organ Damage
How long can a person maintain an oxygen saturation level in the 80's before damage is done to their organs?
Debby
A. Hi Debby,
For people with healthy lungs, oxygen saturations (pulse oxymeter readings) are usually in the mid-high 90’s. As we age, our lungs age as well and do not perform as efficiently as they may have at one time and this may lower our pulse oxymeter readings. Some people with chronic lung diseases may have lower readings since their body has gradually gotten used to having less oxygen (due to lung damage). How long a person can maintain a level in the 80’s before damage is done to their organs is completely individual to the person’s past history and current illness.
Rehab
Ctr - Toronto
I would like to help you with some information on respiratory
rehab centre. I live in Toronto, Ontario. Westpark Healthcare Centre, address 82
Buttonwood Avenue Toronto, Ontario M6M-2J5 web site
www.westpark.org. Their program is
number one in rehab for COPD. It is run by Doctor Goldstien. Passing on helpful
information to you from some one who likes to help others with COPD.
Ron
A. Hi Ron,
Thank you very much for sending out information on the pulmonary rehabilitation program in your area. I hope that you enjoy your time in the program and learn about how you can make adjustments to your daily routine to help improve your quality of life!
Q. COPD Meds....which Order?
Hi Tracy.
I am in a respiratory rehab program at Westpark Healthcare Centre. I have learned a new way of taking medications for my c.o.p.d I have severe emphysema. When people take there med in the morning; I take my Advair 500 first. I then wait for 30 minutes, then I take my Spiriva. All the people have tried this and found breathing much better for them. I would like to pass this information to other people who have c.o.p.d this information needs to be investigated; very helpful. I was asked to be involved with groups because my age is 56. I am considered a baby in the group. My goal is to try and help others. I love to get involved with copd and make people aware of this. I am from Toronto Ontario. We need to wake up people who smoke to this copd. I have learned people do not know of copd; We need to wake up society. I am amazed at how many family doctors know nothing on copd.
A. Hi Ron,
Some people may take their medications in a specific order and may also take a break in between medications to optimize distribution of medications in the lungs. The order in which to take your medications should involve you family doctor and / or pharmacist and will depend on which medications you are currently taking.
It sounds like you are learning a lot about emphysema and COPD at your pulmonary rehabilitation program. Keep up the good work!
Q. Thrush & COPD Medicines
Tracy I hope you can point me in the right direction. My mouth is so sore from thrush which I'm sure is caused from my COPD medicines. Is there anything I can buy over the counter to get rid of it?
Tracy
A. Hi Tracy,
Oral thrush is a fungal infection in the mouth which shows up as white or yellow sores on the tongue. These sores may be painful and may bleed if rubbed or scraped.
If you are taking inhaled steroids (Flovent®, Advair®, Pulmicort®, Symbicort®) there are 2 ways to help prevent thrush; 1) always use a spacing device with your inhaled MDI’s and 2) always gargle and rinse your mouth after taking inhaled steroid medications.
Antifungal medications are commonly prescribed for oral thrush. These medications can come in lozenges, tablets or as a mouth rinse.
There are non-prescription treatments that are commonly used for oral thrush, gentian violet is one of them although you should consult your family doctor before starting to take this (or any other herbal supplement) to make sure that it does not interfere with other medications that you may be taking. Your pharmacist may be able to help you with finding non-prescription treatments for this problem.
Part 2 of A Question by Marge on Arthritis & Wheezing
Q.
OxyArms
Dear Tracy;
I'm interested to know what you think about the OxyArm vs the old nasal cannula.
The reason I ask is that the nasal one dries out my nose really bad but my
concern is whether I'd still get enough oxygen using the OxyArm since it's so
open. thanks Pete
A. Hi Pete,
The OxyArm is a device that looks similar to a headphone with a
mouthpiece that has tubing that comes from on oxygen source
(concentrator or tank) and directs oxygen towards the nose and mouth. Some
people may feel that this device is more comfortable than nasal cannula since it
does not sit directly in the nose (this may be less irritating to the nose). I
have not seen the Oxyarm in clinical use, only on the internet. The company
claims that you will get the same amount of oxygen with it as you would with
nasal cannula. I was unable to find clinical studies that supported this claim
but a lot of reviews from people that currently use it-supported that it gave
them adequate flow compared with nasal cannula. Perhaps you can ask your home
oxygen provider if they have any information on this device since I am not very
familiar with it.
Q. Arthritis Pain & Wheezing
I have bad arthritis, I'm 67 with severe but stable COPD.
(For the
past year) Every once in awhile I'll wake myself wheezing. I use to be
that way all the time until I got on Symbicort. I've noticed that it
only seems to happen when my arthritis is acting up. Do you think it
can be casued from the pain since I don't have any current infection or
breathing problems at other times; other than having COPD.
Marge
A.
HI Marge,
I am not aware of any direct relationship between arthritis
pain and
wheezing. I will try to find some more information for you and post it
later on this week.
Interpreting Spirometry Numbers
Sandi; please forward your test result numbers.
Q. Exercises to Strengthen Back/Shoulders
Can you suggest any particular exercises to help strengthen my back or point me in the right direction. I have severe COPD and I'm noticing that my shoulders are starting to slouch forward. thanks, Ted
A. Hi Ted;
A physiotherapist would be the best health care professional to suggest exercise to strengthen your back muscles. Leaning forward on a table may make it easier for you to exhale (which you may currently be doing). If you are, this leaning forward may make you feel as though you are slouching.
You can ask your physician if there is a pulmonary rehabilitation program in your area that you can be referred to. Pulmonary rehabilitation programs are found in many cities across Canada. That being said, there is definitely a need for more programs across the country as more people are diagnosed with the disease. These programs educate people with COPD (and other breathing disorders) about their disease, how to recognize and control their symptoms, and exercises to help improve their quality of life.
If there is no program in your area perhaps your family physician or Respirologist can guide you further. Since you say that you have severe COPD you should definitely speak with your physician before trying any new exercises for your own safety.
Q. Low Oxygen Sat Levels But No COPD
My hubby has COPD. He also has a finger pulse oximeter which he uses occasionally. Recently I used it a few times to check my own oxygen levels...I was feeling lightheaded. On and off over the past couple of days it's read 92 or 94. What can cause drops like that in a healthy person? Thank You
Ruthie
A. Hi Ruthie,
A pulse oximeter is a devise that is primarily used in the hospital environment although it is used in the home setting as well. It is a measurement of the oxygen traveling through your blood and is measured using a small clip on your finger. With proper training, this reading can give health care professionals added information about a person's breathing status. Keep in mind that readings can be affected by many factors such as nail polish, cold fingers, etc. and it meant to be used by someone trained in using this equipment. For healthy individuals-readings are usually in the high 90's.
As we age, our lungs age as well and do not perform as efficiently as they may have at one time and this may lower our pulse oximeter readings. Without knowing your age or medical history it is difficult to assess why your readings may be a little lower than usual although 92-94% is not necessarily low. If you are feeling lightheaded-you should speak to your family physician and get his or her opinion about why this may be taking place.
Q. CO2 and CO - Relationship to COPD
Tracy -- What is the relationship to COPD of both CO2 and CO. Is one much worse than the other or are they about the same effect? I'm referring primarily to gas ranges and ovens...when enough burners are on and the windows are closed, I have to leave the area as I have great difficulty breathing and at times my nails take on a blue tint. Thanks, Vic
A. Hi
Vic; CO2 (carbon dioxide) is a product of the body's normal metabolism and we
all have it! The CO2 level may be increased for people with COPD due to lung
damage. The body attempts to compensate for this increase in CO2.
CO (carbon monoxide) is not normally produced in the body like CO2. CO is
produced when certain fuels are burned (natural gas, propane,
kerosene, wood, oil, etc.). We inhale CO every day in small amounts but
it is not usually harmful to us unless inhaled in larger amounts.
If your gas range is working properly-it should not produce enough CO to
affect your breathing. NEVER use a gas range to heat your home as this
is very dangerous! It is possible that the heat from the stove may have
an affect on your breathing but you should definitely speak with your
family doctor or respirologist about this and the blue tinge (cyanosis)
that you notice on your fingers. He or she can further investigate the
reason for your shortness of breath and cyanosis.
Q. Asthma, Emphysema, Isocyantes
A. Hello Ron; This is a very difficult question to answer since some of your symptoms of asthma and emphysema may be similar. It is possible that exposure to isocyantes may worsen your symptoms of emphysema but this would be difficult to determine.
Q. Peak Flow Meter & COPD
Thanks, Mike
A Mike;
Yes, you can have a normal peak flow measurement with COPD. A peak flow
meter measures the fastest flow of air from your lungs when you blow out.
This measurement is useful for people with asthma to help
manage their disease.
The most important measurement for COPD is the FEV1 (forced expired
volume in 1 second). This measurement is taken during a breathing test
called spirometry. Most people with COPD have a reduced FEV1 measurement
for their age, height and weight.
Q.&n