the paper pulmonary2017/07/10 · july/august 2012 5 continuedonpage6 procedure is available from...

Do What MakesYou Happy!Also inside:TransTracheal Oxygen, Part 2Minute Volume Delivery ExplainedHigh Flow Users Are Grounded!

PaperThePulmonary

July/August 2012

Do What MakesYou Happy!Also inside:TransTracheal Oxygen, Part 2Minute Volume Delivery ExplainedHigh Flow Users Are Grounded!

Dedicated to Respiratory Health Care www.pulmonarypaper.org • Volume 23, Number 4

When Adrienne, my daughter, was growing up, she had a poster in herroom entitled Rules of Life. The first rule on the list was: Marry

the right person – this one decision willdetermine 90% of your happiness ormisery. This past June, we know she gotthat one right when she married JacksonPrentice. Our family happiness remains atan all time high since their wedding day!

Other Rules of Life included: Become themost positive and enthusiastic person youknow. Be forgiving of yourself and others.Be bold and courageous – when you lookback on your life, you’ll regret the thingsyou didn’t do, more than the things youdid. And my favorite, Don’t do anythingthat wouldn’t makeyour Mom proud!

I hope you arehappy, no matter whatyour situation may be.

contents

It is very important to generate a good attitude, a good heart, asmuch as possible. From this, happiness in both the short term and thelong term for both yourself and others will come. – Dalai Lama

3

4

7

9

10

Sharing the Health

Travel News

Get Up & Go2 CruisesTake a stress-free vacation

with the SeaPuffers!

News Items

Respiratory News

111213

1416

Portable OxygenMinute Volume Delivery defined

TransTracheal Oxygen DeliveryPart 2

Fibrosis FileFG-3019 granted orphan

drug designation

Calling Dr. Bauer …Personal thoughts

Ask Mark …Medication questions answered

Dedicated to Respiratory Care

Volume 23, No. 4July/August 2012

On the cover: Ann Ottati and Colinenjoy happy times while on vacationin the Baltic!

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

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

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

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

PaperThePulmonary

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

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

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

www.pulmonarypaper.org Volume 23, Number 4

Photosby

DanielP

ullenPhotography

Above, Adrienneand Jackson

At left, from leftto right: Macy(8 years), Miller(6 years) and TayteBelyea (7 years)

Continuous flow oxygen delivery (CFO), while stilla very common oxygen therapy option, is not avery efficient form of oxygen therapy. Oxygen

delivered during exhalation is mostly wasted, sent into theair around you without ever reaching your lungs. Incases where your oxygen supply comes from a cylinder orliquid reservoir, not only is CFO wasteful, its use islimited by the amount of gas available to you. I am suremany of you reading this have been concerned about youroxygen supply at one time or another. It is not uncommon.

Portable oxygen systems utilize pulse oxygen deliveryinstead of CFO to conserve oxygen while theoreticallymaximizing the potential for therapeutic benefit.A majority of portable oxygen systems – from liquidportables to conserver regulators to portable oxygenconcentrators (POCs) – use pulse oxygen delivery mech-anisms to help you stay oxygenated and ambulatorywhile at the same time trying to make efficient use of youroxygen supply.

Many portable oxygen systems have fixed pulse deliv-ery mechanisms, meaning that when the device is dialedto a particular setting, there is a very specific amount ofoxygen delivered, no matter how fast you are breathing.A device with fixed pulse delivery set to “3” delivers a 25mL bolus of oxygen per breath and will deliver that 25mL regardless of whether you are breathing at 10 breathsper minute (BPM) or 30 BPM. Some pneumatic devices(typically those without electronic components) mayadd some “tail flow” oxygen that can change the totaldelivered volume, but the bolus volume will not change.

However, there are many devices that utilize a pulse

oxygen deliverymethod calledminute volume delivery. Youmay be able to deduce that the term ‘minute volumedelivery’ is derived from the volume of oxygen that isdelivered over a one minute period, and you would beright. A minute volume pulse delivery device dialed to aparticular pulse setting will deliver the same amount ofoxygen per minute, instead of per breath like a fixed pulsedelivery device does. As a result, the oxygen volumedelivered per breath will vary depending on your breathrate. Breathe slower, and youwill get a larger dose; breathefaster and, even though you haven’t changed the setting,you will get a smaller dose. A minute volume device setto “5” that delivers 50 mL of oxygen at a resting rateof 15 BPM may only deliver 25 mL at an active rate of30 BPM.

Minute volume delivery is actually similar to CFOdelivery – with CFO set to a liter flow, the faster youbreathe, the less oxygen you get per breath. It is for thisreason that many of you have separate resting andexercise oxygen prescriptions and/or need to turn up youroxygenwhen you exercise with CFO. Portable systems thatutilize a minute volume delivery method are able tomimic CFO delivery characteristics while also beingable to conserve oxygen gas supply. Some portableoxygen systems that utilize minute volume delivery includeproducts like the EasyPulse 5 conserver (which has alsobeen fitted to some HomeFill cylinders), the Inogen One(G1/G2) and XPO2 portable concentrators, and theEasyMate liquid portable.

If you are using a minute volume delivery device, it isimportant you understand the nature of minute volumedelivery and that, if you leave the setting unchanged, youactually get less oxygen per breath at active breath ratesthan you do at resting breath rates. I do find it likely thatthere are readers out there who do not know what typeof delivery mechanism – fixed pulse or minute volume –their portable system uses. Ihighly recommend that if you donot know how your systemdelivers its oxygen dose that youask your provider or consult themanufacturer.

Ryan Diesem is Research Manager atValley Inspired Products. PulmonaryPaper thanks him for this very compre-hensive article.

July/August 2012 www.pulmonarypaper.org 3

Terms Defined:Continuous flow oxygen delivery (CFO): Oxygen

delivered during exhalation is mostly wasted, sent intothe air without ever reaching your lungs.

Fixed pulse delivery: Dialed to a particular setting,a very specific amount of oxygen delivered, nomatter how fast you are breathing.

Minute volume delivery: Dialed to a particularpulse setting, the device will deliver the same amountof oxygen per minute. The volume delivered perbreath will vary depending on your breath rate.Breathing slower yields a larger dose; breathing faster(and at the same setting), yields a smaller dose.

Portable Oxygen: Understanding Minute Volume Delivery

Ryan Diesem

Continuing with our TransTracheal OxygenTherapy (TTOT) article from the May/June issue of thePulmonary Paper, author John Goodman discusses thenext three phases and goals of the SCOOP program.

As the author mentioned in our last issue,TTOT achieves the best results when usedearly in the progression of chronic respiratorydisease. It is not meant for everyone but is a

viable choice to consider. Among the most difficultpatients seeking transtracheal oxygen are those with highoxygen flow rates or end-stage disease. The steps of theTTOT procedure are explained in this article and requirea team of doctors, nurses and respiratory therapists.

The Transtracheal Procedure and StentingPhase 2

The primary goals of Phase 2 include the following:• The creation of a quality tract that is:• In the tracheal midline.• Not through cartilage.• Not through the cricothyroid membrane.• Insure stability and well being of the patient on theday of the procedure, and during the following week.

The standard insertion procedure utilizes a ModifiedSeldinger Technique (MST). That is, making a smallopening into the trachea utilizing a needle, wire guide andtissue dilator. It is normally done as an outpatientprocedure. By definition, inpatients are not usuallystable enough to tolerate the procedure and, unless thereare some very unusual circumstances, the procedureshould be postponed until the patient is stable enough tobe done on an outpatient basis.

The procedure should be scheduled early in the day andearly in the week. With the patient sitting in an ENT typechair, using just local anesthesia, the neck is prepped, anda small vertical incision (1 centimeter) is made in thepre-selected site. A needle is passed through the incisionand into the trachea. A wire guide is passed through theneedle and the needle is removed. A smooth tissue typedilator is passed over the wire, and the tissues aregently stretched for about one minute. The dilator isremoved and a “stenting device” is passed over the wireguide into the trachea. The wire guide is removed and the

stent is sutured to the neck with two sutures. The patienthas a chest x-ray to confirm proper position, is monitoredfor approximately one hour, and discharged home withspecific instructions for tract site care, and what to do ifproblems arise. An appointment is made for the next weekwhen the stent will be removed and a functioningSCOOP catheter is inserted.

Alternatively, a procedure called Fast Tract® wasdeveloped as an alternative to the conventional ModifiedSeldinger Technique. It is a surgical procedure that mustbe done in the operating room by a qualified surgeon. FastTract® utilizes conscious sedation anesthesia, and ananesthesiologist must therefore be in attendance. Theprocedure takes approximately 45 minutes and thepatient spends the night in the hospital.

In this procedure the surgeon, while exposing thetrachea, creates skin flaps, and then surgically createsa tract by taking the skin flaps down to the exposedanterior tracheal wall. There are a number ofadvantages to the Fast Tract® procedure. Transtrachealoxygen may be initiated the very next day instead of oneweek as in the Seldinger technique. Also, the normal 6to 8 week period of time necessary for the creation of afully healed tract is reduced to 10 to 14 days, significantlyreducing complications. Additionally, the likelihood of“losing the tract” is virtually eliminated. The decisionregarding which of the two procedures is best for apatient depends on a number of variables, and varies frompatient to patient. The final decision should be made bythe patient and his or her physician. A complete line ofinstructional, educational videos, and other supportivematerials to support the patient undergoing the Fast Tract®

Part 2: TransTracheal Oxygen Delivery

4 www.pulmonarypaper.org Volume 23, Number 4

EditorialCorrection

Carolyn Denny,a TTO patient since1999, was incorrectlyidentified as Melita,the author’s niecein the previousissue.


Continued on page 6

procedure is available from Transtracheal Systems(www.tto2.com).

Transtracheal Oxygen with an Immature TractPhase 3

The goals of Phase 3 include:• Initiate transtracheal oxygen.• Avoid or treat tract problems.• Avoid or treat mucus problems.• Educate and support patient.Whether the procedure was done using the

Modified Seldinger Technique or Fast Tract® approach,transtracheal oxygen is initiated in Phase 3. The stent thatwas placed during the procedure can now be removedover a wire guide, and a functioningSCOOP catheter inserted into thetract. Phase 3 normally lasts 6 to 8weeks with the MST and about twoweeks with the Fast Tract® procedure.During this time the patient cleans thecatheter in place with saline and acleaning rod. This is normally donetwice per day, but can be increased or

decreased as determined by clinical observation. Thepatient is taught how to properly clean the catheter bya respiratory therapist or nurse.

Patients are educated regarding the development ofmucus problems, how to recognize them, and what to doif suspected. Mucus problems are largely preventable andin all cases are easy to treat if brought to the attentionof designated personnel. An occasional tract problemmayalso develop during Phase 3. These are usually easy toidentify and treat. Most treatments involve antibioticadministration and review of cleaning techniques.Approximately 95% of Seldinger-created tracts arefully mature (healed) by 6 weeks. An occasional patientmay require one or two more weeks before tract

Want to live longer? Look better?Breathe easier and improve your quality of life?

What are you waiting for?Talk to your doctor about thebenefits of SCOOPTranstrachealOxygenTherapy:

• Improved mobility• Greater exercise capacity• Reduced shortness of breath• Improved self-image• Longer lasting portable oxygen

sources• Eliminates discomfort of the nasal

cannula• Improved survival compared to the nasal cannula

Haven’t you suffered long enough?Ask your doctor about SCOOP

For more information call:800-527-2667 or email [email protected]

… transtracheal oxygen, used clinically for well over 15years, … has clearly demonstrated and documentedbenefits over standard nasal prongs – including betterpatient compliance, oxygen conservation, and improvedcomfort and overall quality of life.

maturity is achieved. Patients move from Phase 3 to Phase4 when their tract is fully mature.

Phase 3 is the most challenging of the four phasesbecause minor complications are most likely to developat this time. A skilled transtracheal team can anticipatemost of these problems and either prevent them or treatthem safely and routinely as they occur.

Transtracheal Oxygen with a Mature TractPhase 4

The goals of Phase 4 include:• Assess tract maturity.• Customize cleaning protocols.• Determine which catheter to continue with.Phase 4 begins 6 to 8 weeks after the MST procedure,

and approximately 14 days after the Fast Tract® proce-dure. The maturity of the transtracheal tract may nowbe determined to see if the tract is healed enough topermit catheter removal and reinsertion.

A tract is deemed mature when the SCOOP cathetercan be easily removed and reinserted by the patient. Thisdetermination is made by a clinician, first over a wireguide and then just the catheter alone. Patients shoulddemonstrate proficiency at catheter removal andreinsertion before being allowed to go home from this firstvisit of Phase 4. Assessing tract maturity is much lessproblematic with the Fast Tract® technique than theModified Seldinger Technique, as much more tissue isremoved, and the stoma opening is quite a bit larger thanthe tract created by the Modified Seldinger approach.

The first week of Phase 4 is a trial period. If for anyreason difficulty is encountered with catheter removal orreinsertion, the SCOOP catheter is reinserted and thepatient continues Phase 3 for an additional 1 to 2 weeks.

Tract maturity can be reassessed by the patient’sphysician at that time. Catheter cleaning is customizedfor all patients during Phase 4 to meet individualclinical needs.

Reimbursement for transtracheal oxygen therapy hasalways been limited. There are well-established codes forthe physician performing transtracheal procedures.Centers for Medicare & Medicaid Services (CMS) hasdetermined that replacement catheters are to beincluded in the monthly oxygen allowable for supplies.

It would literally take an act of Congress to change thecurrent lack of reimbursement, and no change in thissituation is expected in the near future.

Please check out our website at www.tto2.comfor a much more detailed description of transtrachealoxygen therapy.

Advanced Applications of SCOOPTranstracheal Therapy

Recent medical research has discovered new applica-tions for SCOOP catheters and transtracheal therapy.Transtracheal High Flow (TTHF) is the delivery ofhigher than normal flows of a heated and humidifiedblend of air and oxygen that is administered through aSCOOP catheter. These high flows (6 to 15 liters perminute) may help rest the respiratory muscles in afashion similar to non-invasive positive pressureventilation (NPPV). TTHF eliminates the problemsoften associated with positive pressure ventilationdelivered by a tight fitting face mask. In other casesTTHF may be used to expedite the weaning of patientsfrommechanical ventilation. Finally, TTHFmay assumean important role in the treatment of obstructive sleepapnea patients who are non-compliant with conventionaltherapies (i.e., CPAP, BiPAP, etc.).

Physicians, hospital-based andhome care respiratory therapists ornurses seeking training videos, re-source information, or other sup-portive materials can call Cus-tomer Service or theTechnical Service Division atTranstracheal Systems, Inc. Acustomer service representative orrespiratory therapist will assistyou with your request. The toll freenumber is (800)-527-2667.

For additional information, visit www.tto2.com, call 1-800-527-2667,or write Transtracheal Systems, Inc., 14 Inverness Drive, SuiteH-100, Englewood, CO 80112-5608.

Continued from page 5 (TTOT)


John Goodman

Love is all you need!John Lennon

…TTHFmay assume an important rolein the treatment of obstructive sleepapnea patients …

FDA Grants FG-3019 Orphan Drug DesignationFibroGen, Inc. announced FG-3019, a human antibody

against connective tissue growth factor, has beengranted orphan drug designation by the FDA for thetreatment of Idiopathic Pulmonary Fibrosis (IPF).

Orphan drug designation is generally granted todrugs or biologics intended for treatment of rare diseasesand disorders, i.e., those affecting fewer than 200,000people in the U.S. This designation conveys specialincentives to the sponsor, including tax credit for fiftypercent of the cost of clinical trials, prescription drug userfee waiver and seven years of U.S. market exclusivity forthe drug or biologic upon FDA approval.

FG-3019 was developed to inhibit the activity of aprotein that plays a key role in fibrosis. More than adecade of research conducted by FibroGen and others hasestablished the critical role of the growth factor as afinal common pathway in chronic fibrotic diseases.Persistent and excessive scarring leads to organdysfunction and failure.

FibroGen is currently conducting an open-label Phase2 study of FG-3019 in patients with IPF as well as twoother clinical studies in different diseases.

Clinical Trials AvailableThe Coalition for Pulmonary Fibrosis maintains a

listing of current Clinical Trials having to do with find-ing relief and a cure for pulmonary fibrosis at http://coalitionforpf.org/cpf_research_clinical.php. No treat-ments or cures can be discovered without these trials.

The ASCEND trial is designed to assess the efficacy andsafety of the use of pirfenidone in patients withIdiopathic Pulmonary Fibrosis (IPF). If you areinterested in being involved in the ASCEND trial, informyour physician and contact InterMune Medical Infor-mation at 1-888-486-6411. ASCEND is a large clinicaltrial currently enrolling patients in the U.S., Mexico,Australia, New Zealand and select South Americancountries.

Eligible patients will receive either pirfenidone orplacebo for 52 weeks. Patients who complete the entire52-week study period will be offered the opportunity to

continue taking pirfenidone treatment (or to switch fromplacebo to pirfenidone) as part of an open-label rolloverstudy. Patients may also be offered participation in therollover study if they are able to follow their dosingregimen during the initial clinical trial.

Clinical trials must set specific criteria for patient en-rollment. The main requirements of the ASCEND trial are:• The diagnosis of IPF (definite or probable)must have been

made within 4 years (48 months) of study randomiza-tion – the time at which patients will be randomlyassigned to receive either pirfenidone or placebo.

• At the time of study randomization, the patient mustbe between 40 and 80 years of age.

• Lung function, measured by a test of the ability toexhale (forced vital capacity, or FVC) must fallwithin a specific range (50% to 90%).

• Another measure of lung function, called carbonmonoxide diffusing capacity (DLCO), must bewithin the range of 30% to 90%.

• The patient must be able to walk at least 150 meters(about 500 feet) within 6 minutes.

In order to produce scientifically meaningful results,the ASCEND trial cannot admit all people with IPF.Patients with any of the following criteria are noteligible to participate in the ASCEND trial:• At the time of study randomization, the patient iseither expecting to receive a lung transplant withinone year or, for patients in the United States, is on alung transplant waiting list.

• The interstitial lung disease has a known explanation.• There is a history of asthma or chronic obstructivepulmonary disease.

• The patient has an active infection.• The patient is already receiving ongoing IPF treatmentsuch as an investigational therapy, immunosuppres-sant, or a cytokine modulating agent.

• Within the past 6 months, the patient has had unstableor deteriorating cardiac disease or a pulmonarydisease other than IPF.

• History of unstable or deteriorating cardiac orpulmonary disease (other than IPF) within theprevious 6 months.

If you would like more detailed information aboutthe ASCEND trial, please go to www.ascendtrial.com,or call InterMune Medical Information at 1-888-486-6411.

Fibrosis File



Pulmonary Paper Readers you are cordially Invited to this exclusive Oxy-View Offer.

Oxy-View Oxygen Therapy Eyeglass Frames

Any frame just $179.95 plus Free Shipping (Free shipping in the contiguous United States via standard ground UPS

use offer code PP2012 when ordering)

Call Today Toll Free 877-699-8439 or Visit us at www.oxyview.com


My motherr e c e n t l y

passed away after along chronic illness.I was fortunate tohave my parents

living in the same town as I do.Momalso received her medical care in thehospital where I work day to day.Although she did not have lungdisease, I thought I might sharesome “advice” with my readersabout terminal care in patients withchronic illness.

MyMomwas not on hospice careuntil the final week of her life. Shedid have many medical problems forthe last year or so – that she and allof us knew were only going toprogress. In this light, she clearly setout some guidelines for her familyand her doctors relating to levels ofmedical care. She did not want to beon dialysis (kidney machine) or amechanical ventilator. She hadseveral surgeries the past few years.This year, she made it clear to all ofus, that she wanted no furtheroperations, no matter what. Thesewere difficult discussions for us as afamily to have at times, but veryimportant none the less.

When the ambulance came toher home after a serious fall to takeher to the hospital, the EMT crewsaw her medical MOLST (MedicalOrders for Life Sustaining Treat-ment) form taped to the refrigeratorand knew that initiating CPR wasnot the thing to do. The doctors andnurses in the ED also knew thatcomfort for their patient, ratherthan blood tests, IVs, x-rays …, wasthe main treatment goal.

Keeping a written, updatedmedication list at home is important.Tape it to the refrigerator. In anemergency, you can show it to theEMT ambulance crew and also takeit with the patient to the ED for thestaff to really know what medica-tions are being taken, rather thanrely on a computer record that mayor may not be up to date.

It certainly is stressful for both pa-tient and family when illness isserious and prognosis is poor andespecially when pain control is anongoing issue. We all want compe-tent and compassionate care forour loved ones.

From a doctor’s perspective,I also know that hospital personnelcan be stressed and understaffedthese days. My advice is that whenpatients and family are courteousand understanding to the medicalstaff, this kindness is returnedtenfold. Nurses, therapists, doctorsall try their best.

Question for Dr. Bauer? You maywrite to him at The Pulmonary Paper,PO Box 877, Ormond Beach, FL32175 or by email at [email protected].

Calling Dr. Bauer …

Dr. Michael Bauer

Joan Bauer

Mark has been answering lots ofquestions about medications lately!

QI use Spiriva and Foradil buthave been reading about Inda-

caterol. Could I add this to mymedications or would it conflict withthe two I am taking?

AIndacaterol and Foradil arethe same class of long-acting

bronchodilators. You would need totake one or the other – not both.

QI takeMucinex. Can you tell mehow NAC compares to it?

ANAC and Mucinex both willloosenmucus, making it easier to

raise and expel. NAC as a “nutritionalsupplement” form is an over the

counter item. It comes in a gelatinecapsule and in powder form with theusual dose being 1200 mg/day. Re-member to take1000mg of vitamin Cfor each 600 mg NAC, to counteractyour risk for developing kidney stones.Remember that you need to take1000mg of vitamin C for each 600 to1200 mg of NAC you take, to coun-teract your risk for developing kidneystones from salt-metabolites of NAC.

QMy doctor gave my husbandsamples of Daliresp but the

side effects seemed a little scary. Hewas told to use his QVAR 2 puffs,3 times a day and was also given aprescription for Singulair. Healready uses Foradil and Spirivawith an Albuterol rescue inhaler. Isthis appropriate?

ADaliresp affects each individualdifferently. The good thing is

that if undesirable side effects occur,stopping the drug will stop the effectsquickly, so there is no lasting conse-quence to taking it on a trial basis.

Time will tell if taking Singulair willhelp. When you try more than onenew drug at a time, you are left withthe question of whether or not anyeffect – good or bad – is the result ofa ‘combination’ effect, or which drugis producing the positive or negativeeffect. It is always a better idea tointroduce drugs one at a time, so

better evaluation of their individualeffect can be accomplished.

It is usually not dangerous to useQVAR, an inhaled steroid, more thanthe standard recommended twicedaily dosage. In Europe, many patientsare managed with inhaled steroidsalone, rather than oral prednisone,where they often use 4 to 8 doses perday. Keep in mind that the higher theinhaled dose, the more likely the sideeffects. With inhaled steroids – evenin larger doses – the side effects are stillmuch less than with most oral doses.

QDoes having COPD ever makeyou feel flushed or hot?

AIt is not unusual for folks withsevere breathing symptoms to

‘feel hot’. A well-documented obser-vation in those with COPD is theirpreference for moving air – often a fanaimed toward their face – and theircomplaint of being too hot withoutthat moving air. Assure that roomtemperature (if controllable with airconditioning) is not above 80 degrees,if even that high. I seriously doubtbeing hot has anything to do withelectrolyte imbalance.

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

Albuterol: Short-acting, used for quickrelief of bronchospasm in COPD,asthma. (Known as a rescue inhaler.)Beclomethasone Dipropionate: A po-tent glucocorticoid steroid. As a QVARinhaler, used to prevent inflammation,asthma attacks.Formoterol: Long-acting, used in man-agement of asthma, COPD. Marketedin four forms: 1) dry-powder inhaler, 2)metered-dose inhaler, 3) oral tablet, and4) inhalation solution. (Trade namesinclude Foradil, Perforomist.)

Guaifenesin: Over the counter expec-torant, assists in bringing up phlegm.Sold as pills, syrups under many brandnames as single-ingredient formulas orincluded in many cough remedies.(Mucinex, Robitussin DAC, Primatene,Robitussin AC, DayQuil)Indacaterol: Ultra-long-acting beta-adrenoceptor agonist. Approved bythe FDA under the trade nameArcapta Neohaler, July 2011. Takenonce a day as a dry powder inhaler.

N-acetylcysteine (NAC): Primarily amucolytic agent dissolving bondswithin secretions to make easier to raiseand expel.Roflumilast: Orally administered fortreatment of inflammatory conditionsof the lungs such as asthma, COPD.(Daxas, Daliresp)Tiotropium Bromide: Long-acting, 24-hour, anticholinergic bronchodilator.Keeps airways open, used in the man-agement of COPD. (Capsules for in-halation are known as Spiriva.)

Ask Mark …

Mark Mangus, RRTEFFORTS Board

Quick

lyDefined


I use a home concentrator with 25 feet of tubing thatallows me to get conveniently to most of my small two-story house. However, the tubing kinks. It flexes, it curlsand snarls and tries to trip me. It simply would notuncurl until I laid out a new tube on my hot, hot drive-way and left it there for a couple of hours with the endscovered to ensure dirt did not enter the tubing. Thatstraightened it out beautifully and it now lies withouta kink or snarl!

Anne Glasner, Appleton, WI

Jay from Texas recommends www.softhose.com.Their hoses lie flat and don’t knot up or twist. Thenormal lengths are 25 and 50 feet, but if you email theowners at [email protected] or call them at1-858-748-5677, I am sure they can make up specificlength hoses for you. They are nice people and veryaccommodating.

Medline’s unique “relaxed” low memory tubing alsohelps prevent kinking. Violet relaxed tubing providesgreater visual contrast. The 7-foot latex-free tubing isavailable from www.preciousarrows.com at a cost of75 cents each with discounts available for ten or more.Put ‘67515’ in the search box to find the tubing listing.You may also phone 1-877-423-7796.

There are several programs that can help you savemoney on Medicare premiums, drug costs, and/or basicliving expenses. COPDNewsoftheDay.com lists them attheir site: http://tinyurl.com/d7jwh4l.

James Patterson became acare giver to his wife on NewYear’s Day 2005, after she washospitalized with complicationsfrom COPD. His “best advice”for new care givers, “Be patientand be in it for the long haul. Getas much information as possibleand know that people are there to support you.” ReadJames’s story and possibly add one of your own athttp://tinyurl.com/c8743sj.

To find a pulmonary rehabilitation group in your state,here are three sources of listings:1) http: / /www.copd-international .com/copd

advocate/support.html2) http://www.emphysema.net/rehab-support/

support/support.asp3) http://tinyurl.com/c8kdzoz

Recently I tried out Captive Technologies’ TidyTubing. It works great for a single-person office settingor workbench so I could move around and not gettangled up.

I also use it in the car which enables me to get out atthe gas station without having to bring my oxygen

supply with me. And itworks while doingchores around thehouse from my utilityvehicle.

But since the TidyTubing itself does notlay flat, I have hadother people tripover it!

Hon. Ivan MoscripWhitney Point, NY


Receive a Free One Year MembershipContribute a picture or tip on how you COPE with

COPD! Send to The Pulmonary Paper, PO Box 877,Ormond Beach, FL 32175. Include your name/address.

Sharing the Health

Grounded!Oxygen users that require over 3LPM continuous flow:

your flying days on planes based in the U.S. may now beover. American Airlines announced it

would no longer supply oxygen totheir passengers.

Quoting from their website,“American Airlines makesevery effort to accommodate itscustomers who require supple-mental oxygen inflight. Effective

July 23, 2012, American will con-tinue to assist customers who wish to

bring a POC on board, however, due to decreased demandand increased supplier costs, American will no longeraccept inflight medical oxygen.”

“American will honor all existing oxygen bookings. Allnewmedical oxygen reservations booked July 10 throughJuly 23, must have travel completed by Aug. 23, 2012.”

The airlines will accept POCs brought on board by theirtravelers, but there is not a POC on the market today thathas the capability of continuous flows greater than 3LPM.This is sure to cause hardship for supplemental oxygenusers in the future.

Driving with ArthritisOne of our members shared these tips she found make

her life a little easier.I bought a swivel seat for my car – it allows me to get

in and out without using somuch energy. I also put a cush-ioned cover aroundmy steering wheel which makes it eas-ier to turn. A friend of mine uses sports gloves to drive.

My son made my car keys bigger bywrapping tape around them – it is

not so hard to grip them now. Ifyou can afford it, get a car withleather seats – they are easi-er to slide on than cloth! Awide angle mirror allows meto see more without a lot ofmovement on my part.

The Transportation Security Administration (TSA)supplies the following information regarding bring-

ing portable oxygen aboard an airplane. Supplementalpersonal medical oxygen and other respiratory relatedequipment and devices are permitted through thescreening checkpoint once they have undergone screen-ing. Any respiratory equipment that cannot be clearedduring the inspection process will not be permittedbeyond the screening checkpoint.

Persons using oxygen:• Should inform the Security Officer if your oxygensupply or other respiratory-related equipment cannotbe safely disconnected.

• Only you can disconnect yourself to allow for youroxygen canister/system to be x-rayed.

• Check with your doctor prior to coming to the check-point to ensure disconnection can be done safely.

• If your doctor has indicated that you cannot bedisconnected or if you are concerned, ask theSecurity Officer for an alternateinspection process while youremain connected to youroxygen source.

• Infants will remain con-nected to their apneamonitors throughoutthe screening process.Apnea monitors will bescreened while remain-ing connected to the infant.

• Oxygen equipment will eitherundergo x-ray screening (only disconnected oxygenequipment) or physical inspection, and explosive tracedetection inspection.

Oxygen suppliers or persons carrying oxygen supply:• An oxygen supplier or personal assistant mayaccompany you to the gate or meet you at the gateonce they have obtained a valid gate pass from theappropriate aircraft operator.

• Persons carrying his/her supply must have a validboarding pass or valid gate pass to proceed throughthe security checkpoint.

• Oxygen being carried by the supplier or person willeither undergo x-ray screening and/or explosivetrace detection sampling.


Travel News

We Take the Worry Out ofTraveling with Oxygen!

FST: ST36334

Member

Join the Sea Puffers on one of our tripsescorted by respiratory therapists or

call us at 1-866-673-3019 to arrange yourcruise, and oxygen and mobility needs foran individual vacation!

Visit www.seapuffers.com for details!Discounts

available for PulmonaryRehabilitation and Better

Breather groups!

2012 CruisesOctober 13–20Canada & New EnglandMarvel at Fall’s beauty on this 7-daydiscovery cruise from Montreal,Canada, returning to Boston, MA,on Holland America’s Veendam

2013 CruisesJanuary 19–February 2HawaiiFifteen-day vacation to Hawaii on theSapphire Princess, roundtrip Los Angeles

March 3–10Western CaribbeanSeven-day Western Caribbean Cruiseon Holland America’s Ryndam,roundtrip Tampa

May 13–24British IslesEleven-day British Isles holiday onCelebrity’s Infinity, roundtrip Harwich

July 20–27Alaska AdventureSeven-day Alaska Adventure onHolland America’s Westerdam,roundtrip Seattle

October 13–24Panama Canal VoyageEleven-day Panama Canal Voyageon the Coral Princess, roundtripFort Lauderdale


The COPD Foundation Needs You!Become a COPD Captain in Your State!

State Advocacy Captains are volunteers with COPD,care givers, friends and family members or healthcareproviders who have been trained by the COPDFoundation to serve as peer leaders. Captains promote

the importance of becoming an advocate,mentor fellow community members look-ing for advocacy information in theirstate, and participate in online and

in-person activities.Captains spread COPD aware-

ness and encourage advocacythroughout their states. TheCOPD Foundation provides

training on COPD public policyissues, Civics 101, the COPD Action

Center, contacting elected officials, and advocate man-agement. As captains you are on the front lines ofadvocacy and legislative change.

They are the go-to people for all COPD advocates intheir states and serve as one of the Foundation’s primarycontacts for advocacy activities including:• Helping new advocates• Attending Capital Awareness Days• Attending District lobby days• Participating in legislative campaigns• Training others to be successful COPD advocates• Talking about advocacy at a local support group orpulmonary rehab

State captains will be trained throughout 2012 andare needed in all 50 states. Contact Aimee Bulthuis at866-731-2673 ext. 459 for more information.

Caring Voice Coalition: Help Accessing Health CareOur friend, Pam Harris, established Caring Voice

Coalition in 2003 to assist those with rare, chronic orlife-threatening illnesses to get access to health care.Caring Voice Coalitionalso provides insuranceeducation and counselingplus patient support pro-grams for insured or underinsured patients. Their non-profit organization has case managers, pharmacists,attorneys, grief counselors, accountants and others tooffer their assistance.

If you have Emphysema caused by Alpha One Anti-trypsin Deficiency, Pulmonary Fibrosis or PulmonaryHypertension, visit the web site at www.caringvoice.orgor call the patient line at 1-888-267-1440 to discover howthey can help!

Should You Use Expired Prescription Drugs?Robert Shmerling, MD, from Beth Israel Deaconess

Medical Center, recently discussed expiration dates onprescriptionmedications in a column onwww.intelihealth.com. In 1985 and the early 1990s, the military gathereda stockpile of medications worth more than a billion dol-lars that were close to (or had exceeded) their expirationdates. The drugs were extensively tested with supervisionby the FDA. The medications were found to be still goodnearly three years past their expiration dates.

Keep in mind that these tests of drug stability were donein the mid-1980s and early 1990s. It is likely that newermedications have not been tested. Some drugs did fail thestability test. Liquid antibiotics, nitroglycerin and insulinshowed signs of physical decay. It’s probably best not touse them past their manufacturer’s expiration dates. TheEpiPen® (injections of adrenaline for severe allergic reac-tions) also held up poorly past expiration dates.

It’s probably fine to take an allergy medication that’s amonth past its expiration date. But there is some risk intaking a heart rhythmmedication that, if ineffective, couldlead to an unstable and dangerous heart problem. Med-ications kept in a cool, dry place are likely to last longerthan those kept in a hot, damp place.

Flushing unwanted medication down the toilet may getthem into the drinking water supply. Put the medicationsin a sealed container mixed with coffee grounds, mud orother material to discourage someone from ingesting them.Remove any identifying information on the pill bottles orcontainers before throwing them in the trash.

Smoking NewsNASCAR recently announced a smoking ban at the

Daytona International Speedway grandstands. Smokerswill have to light up in designated smoking areas, andcould be asked to leave if found smoking in the stands.The speedway is the last sporting venue in Florida toenact a smoking ban in its primary seating areas.NASCAR, a sport historically known for its ties to thetobacco industry, has made agreat effort to promote healthyliving by making COPD itsofficial health initiativeand partnering with theDRIVE4COPD campaign.



Annual Donation o Check here if renewal

• Individual with lung problems:

o $25 o $50 o Other ___________

• Health Professional: o $50 (1 copy/issue/year)

o $250 (25 copies/issue/year)

o $400 (50 copies/issue/year)

o Check (Payable to: The Pulmonary Paper)

o VISA o AMEX o MasterCard o Discover

Card No.:

Exp. Date:

Signature:

Name

Address

City State Zip

Phone

Email

Respiratory Diagnosis

Please fill out this form and mail back to The Pulmonary Paperat the address below with your donation information. 8/1/12

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

The Pulmonary Paper, PO Box 877, Ormond Beach, FL 32175-0877 • 1-800-950-3698 • Fax 386-673-7501 • www.pulmonarypaper.org

The Pulmonary Paper is a 501 (c)(3) not-for-profit corporation and supported by individual contributions.Your donation is tax deductible to the extent allowed by law.

PaperThePulmonary

� ��

Rx Stat sells every brand ofportable oxygen concentrator.If you find a better price,

we will beat it! Guaranteed.

Rentals:POCs, $395 for 10 days.

Free shipping!Pulse Oximeters, $69.

Free shipping!

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

Our 15th Year in Business! Call Rx Stat Respiratory for details. 1.888.648.7250

AirSep® Focus: 2-Pound Portable Oxygen Concentrator!• Lightest oxygen

concentrator ever• Medicare covered• Only 2 Lbs.• 2 LPM pulse flow• Small and sleek design• Runs on rechargeable

batteries• AC and DC

power also• Never needs a refill

Dedicated to Respiratory Health Care

PaperPO Box 877, Ormond Beach, FL 32175-0877

ThePulmonary Non-ProfitOrganizationUS Postage

PAIDDaytona Beach, FL

Permit #275

Respiratory NewsThe AeriSeal Emphysematous Lung Sealant System

might someday help treat advanced emphysema that doesnot respond to medical therapy. Israeli studies tell us a liq-uid foam sealant is delivered endoscopically to the diseasedportions of the lung to collapse that part of the lung. Theresult is more chest space for healthier tissue to function.

The New England Journal of Medicine reports peoplewith COPDmay benefit greatly from a three-times-a-weekdose of an antibiotic. Azithromycin – taken on Monday,Wednesday and Friday – has the potential to eliminateone-third of the severe exacerbations each year amongthose with COPD. Researchers warned that this protocolmay not be suitable for everyone, such as those who alsohave heart disease. Adverse consequences are possible withyear-long use (e.g., hearing loss, antibiotic resistance andheart rhythm disturbances).

Researchers at Boston Children’s Hospital have designedtiny, gas-filled microparticles that can be injecteddirectly into the bloodstream to quickly oxygenate the

blood when the lungs are completely incapacitated. Aninfusion of these microparticles into animals with lowblood oxygen levels restored saturation to near-normal levels, within seconds. When the trachea wascompletely blocked, the infusion kept the animals alive for15 minutes without a single breath, and reduced theincidence of cardiac arrest and organ injury. In emergencysituations, this technique could give more time foremergency clinicians to safely establish an airway.

Australian scientists have paved the way for animal-human transplants in as little as five years, after keepingpig lungs alive and functioning with human blood. Thisis a significant advance compared to experiments that havebeen performed over the past 20 years. Previous attemptsto combine unmodified pig lungs and human blood end-ed abruptly two years ago when blood clots began form-ing almost immediately, causing the organs to become soblocked no blood could pass through. But when thegenetically modified lungs were used, the results were over-whelming, fueling hopes of clinical trials in five to 10 years.

the paper pulmonary2017/07/10 · july/august 2012 5 continuedonpage6 procedure is available from...

Documents