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|Disclaimer: The information provided herein, is not intended to be of a diagnostic nature or to question treatment by your own physician. It is meant strictly as information and education based on what is disclosed in the questions submitted by our membership. Any response by Mr. Mangus, Mr. Conway, or Mr. Richter is based solely on his training and knowledge and of course might be subject to correction or difference of opinion.|
Q. I just wanted to learn about Buteyko Breath and what is opinion of this method. Dusan
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A. Theoretically it doesn't jibe with western/mainstream biophysiological theory. Yet, it has received some positive assessment in regard to completely reversible airways disease - - - the fancy name for "Asthma". I came across some information over the past year that indicated it is receiving empiric study, at present. Other than that, I know of no peer-reviewed studies that either support OR dispute its veracity.
I CAN tell you that those with consequential COPD should steer WAY clear of Buteyko, since it encourages breathing methods that promote retention of carbon dioxide, a significant problem for those with advanced COPD and disturbed pulmonary gas exchange. Regards, Mark Mangus
DLCO Pre or Post Meds
Q. On all of my PFT tests, the DLCO percentage is listed under the 'pre' medication column. Is the DLCO test usually done pre-medication, and if so, would the values and percentages possibly improve after medication? Thank You Angie
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Yes it is common practice to do the DLCO and also the lung volumes on the "pre-bronchodilator" series of measurements. While we can sometimes see a significant change in lung volumes if they are repeated after bronchodilator, it is not considered the standard to do such measurements. The DLCO 'can' change, too. But, any change would likely be small and insignificant. It is not as sensitive a measurements as are the others. In other words, if it were to change 3 %, that wouldn't translate into anything meaningful in terms of the clinical picture. Regards, Mark Mangus
Loss of Time
Q. I have no memory of my ambulance ride, nor the ER, nor x-rays or blood draws. I have some vague memory of saying bi-pap! , athough I've never been on one before. I have little memory of the 1st day (monday) in ICU, except for constant neb treatments. I remember someone saying I had staph pneumonia (MRSA) which I've had before, someone else saying respiratory distress, and, later on, acute bronchitis. Then, it was not MRSA but MSSA (don't know that one).
My concern is the lost 24 hours. My Pulmo says I wasn't unconscious, or in a coma. I just have zero memory of anything-which I'd like to know. I have applied for a copy of my records. Any comments Mark, or other Medical people? Although I was in ICU for 5 days, I was feelng well in 4 days, and, when sent to a room, did fine. What happened ???? Susan
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A. There is a phenomenon I have seen thousands of times - - - and it's been written about in the medical literature in numerous publications, as well as described in the popular literature in various ways. When someone gets severely ill, such as what you describe, their brain kind of lets their consciousness take a vacation, so to speak. You can be awake and lucid, with regard to responses and a lot of things, yet, for some sort of primal and/or instinctive (my description) reasons, you do not store memory of the time period. I saw this when working intensive care for more than 18 years. Folks would be deathly ill for some period of time. When they recovered and regained their orientation to time and place AND were 'recording/retaining memory' again, they'd have lost sometimes many days. It seems to be some sort of 'defense' mechanism - - - kind of as if the conscious realization of what's going on could be so overwhelming it could cause you to react in such a way as to be counter productive to what your body needs to do to heal. So it simply hits the "off button" on memory and lets you babble on and interact without recollection or account.
Don't worry about it. I've never seen it cause any kind of permanent consequence - - - AND - - - I've seen many hundreds of patients long after their episodes. They were just fine! Best Regards, Mark
Weight and FEV1
Q. Have any studies looked at the relationship between weight and FEV1? I mean a person like yours truely type male, 6 ft and 200 lbs age 62. I should weigh 170 or so, but now that extra FAT is in my belly and probably crowding my lungs.
I ask because I have lost about 10 lbs and my FEV1 max has increased slightly.. (I take it weekly and doing a running average for a trend). Another question on my mind is the way the medical community rates COPD by FEV1. Wouldn't a better method to be to take other phyiscal data into the rating. Example: Take the 6 or 12 minute walk time and convert thats to MET's, divide by weight and the mulitiply by FEV1 ? It certainly would give people a incentive for getting in better shape and helping themselves. Smiles Bob
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A. A couple of interesting questions you ask. I am aware of a number of studies done over quite a stretch of years that have looked at the specific relationship of weight to FEV-1. Across the breadth of them they have found that there is a positive correlation between weight and FEV-1 - - - BUT - - - NOT in the manner, or to the degree with which you suggest a potential correlation.
As best I can recall, until one has increased their weight by MORE than about 30 % over what should be ideal for them, body mass in the form of excess body fat does not tend to interfere with ventilation IN AND OF ITSELF. Conditioning has most to do with what interference additional or inadequate body mass will have upon FEV-1. If one is in poor physical condition, the impact is amplified,on both sides of the weight issue. In fact, as body weight DROPS below ideal , mortality increases as a direct correlate to weight and FEV-1. FEV-1 is found to fall as body mass drops below ideal, independent of condition. So, contrary to what you might have suspected, being too heavy has much less 'raw' impact on FEV-1 AND survival rate/duration than does not weighing enough! It is striking to see that survival drops sharply as body mass drops below 90 % of "ideal". So, in the end, even those who are significantly above ideal body mass and have COPD turn out to have a better survival rate than those who are on the light side.
Insofar as why FEV-1 alone is used to classify folks - - - and especially now, under the GOLD standard - - - is because of ALL the different individual measurements, factors and other data, FEV-1 has been shown through "decades" of extensive "worldwide" research to correlate best with 'degree of severity', in terms of symptoms AND in particular, 'survival rates', independent of many ofther factors. What you suggest, in terms of synthesis of several factors would 'actually' confound and obscure the very product you wish to produce, by interjecting exceedingly variable 'subjective' information into what is shown already to be a simple and clean single factor. The 6 or 12 minute walk test is NOT any kind of measure that would add clarity to assigning one's condition. It's veracity is dependent upon too many factors that are subjective - - - good day, bad day, more or less symptoms than usual, subject's effort, etc. The FEV-1 is already the best of all those that you mention. Putting FEV-1 into and equation and factoring in a whole bunch of subjective information would only confuse things further, not provide any better information, I'm afraid!
Insofar as the question of METS is concerned, that is good for those who know what they are and can equate them to tangible measures and practical application. For the average person they are too esoteric, IMHO and that of most others with whom I talk about it. Further, because metabolic rates are so skewed in those who have significant COPD, METS are all but impossible to calculate with any meaning. Lastly, the exercise load of which most with significant COPD are capable provide METS so low that they are not helpful in quantifying anything meaningful about what the subject did. Again, as with the multifactoral calculation to figure out how bad someone is, METS would serve to further confuse the "practical" information provided by other measures. Heart rate and blood pressure for a big part are ALSO equally confounding in many of those with advanced COPD. That is why for many of us, they are not helpful in determining to to do or not to do for and with our pulmonary disease patients.
I'm sorry to burst any bubbles, you might have had in these regards. I applaud your effort to think about these questions and to pose them with suggestions. It is when we quit thinking and asking questions that we are doomed! ! ! Keep thinking and asking, Bob! Best Regards, Mark Mangus
How Come My Emphysema Is So Different?
Q. Have been reading letters from Emphysema patients and so many have mucus > problems? I have Emphysema &am on oxygen 24/7 and take 1 nebilizer a day with Xopenex levabuterol HCI and take Spiriva once a day. I nearly ever cough and if I do-nothing has to come up?? I am wondering why my illness is so different? Please answer. Doris
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A. It is indeed related to WHETHER one has Chronic Bronchitis or Emphysema and 'how much of a mix' of the two they have.
Those who have more purely emphysema generally will not produce mucus. Those who have more purely Chronic Bronchitis will generally produce mucus. Yet, this is not the beginning and end to the case for Chronic Bronchitis. Some 'bronchitis' are what I call "dry bronchitis" - - - similar to the post that suggested there are those who produce mucus and those who don't, going so far as to label them "wet" and "dry". There are those with bronchitis who produce gobs of mucus. I refer to them as "wet bronchitis" or "fulminant" - - - a fancy term for "profuse" or "lots". These are by no means universal, medical terms, just "MY" labels from throughout the years of my practice.
Generally speaking, one who has a smoking history can be expected to have "some" degree of chronic bronchitis. While their emphysema can be severe, simply because they don't produce mucus doesn't mean they don't have Chronic Bronchitis. The ONLY SURE way to tell exactly that one has or doesn't have Chronic Bronchitis is to biopsy the bronchial tissue. Chronic Bronchitis (CB) poses classic and characteristic changes in the structure and tissues that form the bronchial tubes. If those changes are present, then the diagnosis is made.
What differentiates the mucus producers from those who don't produce mucus is the presence of - - - and number of - - - increased "goblet cells" and "mucin glands". These are the mucus factories within the airways. In S-O-M-E folks with CB the number of these structures does NOT increase as destructive changes occur on the way to clinically significant and worsening of their disease. In others, these structures proliferate at a high rate and become disproportionately abundant compared to their normal ratio/numbers. THESE are the folks who become the wet/fulminant CB'ers.
So, while you can certainly ascertain whether or not you have more emphysema than CB, according to the amount of mucus you may produce, if you've got a 'significant' smoking history (more than 20/day for more than 20 years), the only way you can truly rule out chronic bronchitis is by direct examination of the bronchial tissues (histologic examination). Regards, Mark Mangus
FEV1 Measurement Before or After
Q. When referring to the FEV1%, as we often do, is it standard to use the % predicted BEFORE medication or AFTER medication ? Which number is everyone else here using when they give their % ?? If you have a lot of reversibility - which number is used to determine true lung function, or even eligibility for SSDI ? In addition, my DLCO seems to have been taken BEFORE medications, would this number change at all AFTER medications ?? I'm sorry if this seems like a stupid question, but I truly do not know which of the two sets of numbers are used. Thank You !
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A. The FEV1 necessary to qualify for disability is < 60 %. If one can reach greater than 60 % after bronchodilation, then they wouldn't qualify UNLESS they had additional conditions or circumstances that would factor in to make the FEV1 hold less weight in the determinating equation. For instance, folks with pulmonary fibrosis can have great FEV1's but lousy oxygenation. What qualifies them is their hypoxia, not their difficulty (or lack thereof) in moving air. Generally speaking, folks who have COPD that is mild enough that their FEV1 is greater than 60 % - - - even those whose FEV1 requires bronchodilator medication to exceed 60 % - - - do not have breathing limitations that would impede their ability to function for most tasks of moderate to significant vigor.
Lastly, what is better to do than to simply state your FEV1, is to add the qualifier that the number you quote is either "before" or "after" bronchodilator. That way, no one has to guess which one you are quoting. When you run into an unqualified quote, ask the individual if the number they put forth is before or after bronchodilator medication. Regards, Mark
Do Oximeters Need Calibrating?
Q. I have been using the same pulse oxi for 5-6 years now. Do they need to be serviced/calibrated/battery changed? June-NJ
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A. They do not need to be "calibrated". As long as they are functioning with presumed or proven 'reasonable' accuracy, they do not need service. One should gently wipe the light emitter and pick-up sensors with isopropyl alcohol at intervals to keep them free of oils and dirt that can distort the signal and impose error into the measurement.
I would think that if you have a "battery-powered" model, you'd have had to change the batteries long ago and several times in a 5 - 6-year period. But, if you haven't had to change batteries in that time AND your oximeter still works, then I have to ask what brand and model of oximeter you are using before I can offer any definitive information in your particular instance. Regards, Mark
Waking Up with a Headache
Q. I have been waking up every morning this week with a headache. I am on oxygen at night at level 2. I read something somewhere or someone told me that it has something to do with my oxygen. Do you get the headaches because of to much oxygen or not enough oxygen? I want to know if I am doing something wrong. Some times at night when I have the oxygen on I take it off while I am sleeping, and then when I wake up I have a headache. So if someone could please help me with this I would appreciate it. Viola-NV
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A. You can be getting headaches from a couple of different causes related to what your gas exchange is, Most often, when folks are experiencing morning headaches, it is because their oxygen is going too low, if the reason is related to oxygen at all. While there are rare instances when folks can develop a headache from getting "too much" oxygen, the evidence and documentation on this phenomenon is very scant.
Folks can be experiencing elevated CO2, as well. High CO2 (low pH) causes the blood vessels in the brain to dilate and hold more blood. The increased pressure inside the head that results from this is what causes the headache. A combination of elevated CO2 and decreased O2 can cause the problem, as well. Frequently, these three scenarios occur when one is suffering from sleep apnea. If you snore or have 'periodic breathing' or pauses when you don't breathe that last more than 20 seconds and have not been evaluated for sleep apnea, I would advise you to seek evaluation. If you know that you DO have sleep apnea and are being treated for it - - - say with oxygen and CPAP or BiPAP - - - then you should let your doctor know, so (s)he can evaluate you and maybe adjust your therapy, if needed.
Yet another possibility that is unrelated to your lung disease can be blood pressure. You may be experiencing high blood pressure. In any case, all prospects point to calling your doctor and seeking evaluation. Your complaint is a fairly definitive one and warrants investigation. Regards, Mark
Emphysema Progression Question
Q. Could someone tell me if there is a procedure (tests) a doctor can do to tell how far Emphysema has progressed. In other words, I would like to know where I stand with this disease. All that's been done is a lung capacity test (I think that's what it's called when you blow into a machine) and X-Rays. I've been told that I have E, to use the medicine that's been given and to quit smoking. I have no idea what percentage of damage I have to my lungs. Monte Miller
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A. The Pulmonary Functions Test (where you blew into the machine and it measured what you did when you blew) is a fairly definitive test, in terms of telling how much "structural damage" you have done to your lungs. Your blood gas tests and finger oximetry can show what - - - if any, to this point - - - deficits you have developed in regards to exchanging oxygen and (indirectly/estimated) carbon dioxide. But, there is not much more you can know that those tests don't tell you. "Quantifying" one's lung disease and loss of lung function is far from being "cut 'n' dried" in mathematical and percentage terms. As you will learn as you read stories and information from our members, some have HORRIBLE "n-u-m-b-e-r-s" and yet "f-u-n-c-t-i-o-n" quite remarkably. Others have good numbers and percentages but have horrible gas exchange, which slows them down to a crawl. A lot of what determines what folks can or cannot do, with regard to function and activity often has more to do with their ability to tolerate discomfort and" keep on keepin' on", versus NOT being able to tolerate the hardship and finding themselves sitting more and more and functioning less and less AND when they DO have to exert, finding that even the least demanding tasks can become nearly impossible to do - - - at least not without horrible breathing difficulty.
So, the numbers are what YOU make of them. How you live with COPD is what YOU are able to make of it and of what function you retain and maintain. It is only loosely dependent upon measurements and percentages. You need to do as your doctor suggested and then get moving and pushing and see what the future hold for you AS IT HAPPENS. No one I've ever met has a good crystal ball to tell you what IS GOING to happen in your future. It WILL be what you make of it! Best wishes and regards, Mark
Oxygen: How High is Too High?
Q. Mark the other day I asked a question about raising my oxygen when I exercise on the treadmill well I raised it to 4 today and my sats stayed at 95-96 throughout my 35 minutes. When I had it on 3 my sats were going down to 92 at times. My question is how high is too high to raise during exercise. thank you francine, texas
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A. According to Dr. Richard Casaburi, a guru in exercise and oxygenation in folks with COPD, you can't raise it too high! He recently did a blinded and randomized study on folks who weren't considered to need oxygen and found that their performance improved by a statistically significant margin when they were given oxygen to raise or maintain their oxygen saturations at greater than 96 % during exercise. We have a lot of data that shows that folks who exercise at saturations of 88 - 92 % do a lot worse (performance and tolerance) than they do when their oxygen saturation is 92 - 96 %. When I oxygenate folks here in the clinic, I do not hesitate to boost their oxygen saturation to 96 %, especially if it allows them to go faster, farther and longer!
So, I would suggest that if you do better when your oxygen is 95 - 96 % on the 4 liters, then by all means do so, especially if it gives you wiggle room to go faster, farther and/or longer! Best Regards, Mark
Steroid Inhalers and Thrush
Q. I get constant thrush from any inhaled steroid even if I rinse. So this brings up a question that I have had for a very long time,,,,,last year I had a bronchoscopy (sp?) ... and it showed a substantial yeast growth in my lungs, voice box & esophagus. I had to take diflucan for 2 weeks to get rid of it. After finishing the medication, my lungs cleared out & breathing became much easier.
Now my question ... EVERY time I try to use inhaled steroids, I seem to get this thrush and ny breathing gets worse little by little. We can rinse our mouths, yes, but how do we keep the thrush / yeast out of our lungs ?? Wouldnt it stand to reason that if the thrush populates the mouth & esophagus, that it would also populate the lungs ? Maybe this is a stupid question, but Ive been worried about it for a very long time. I had always noticed a gradual decline in my breathing after using flovent or pulmicort - This seems to be a problem for me - and I think its related to thrush - but the docs dont believe me. I try to adhear to the doctors orders to use the steriod every day (I have a strong asthma component) .. but I am wondering if it is doing me more harm than good ?
I am now on Nystatin again, for thrush in the back of my throat, and I wonder how far the thrush has gone .... any input ? Thanks. Angie
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A. Your concerns AND questions ARE most legitimate, and far from possibly being stupid! Generally, the organism that causes thrush (Candida Albicans) does not cause pulmonary infections. HOWEVER, you say you have had a yeast infection in your lungs which cleared up with Diflucan. Whether or not the organism was Candida or another yeast, you have a specific history of yeast infections in your lungs. That alone should be reason for your doctors to be suspicious about your complaints AND ongoing difficulties, let alone trying to do more about them.
Check with your doctor and see if vitamin and mineral supplements targeting enhancement of your immune system might not be an option. How about yogurt? Have you tried a daily intake of one or two servings?
The problem facing you and your doctors is that as you relate, you have a strong asthmatic component. That 'should' be effectively kept at bay by the steroids. HOWEVER, you also relate that you feel you breathe worse with the steroids. There are those who don't respond as we'd like, or expect when they take steroids. You could ask for a PFT done while on steroids and another after two weeks off steroids. That should tell the story about whether or not you need the steroids so much that (other dilemma/consideration) that they are worth the grief they cause you. You are still faced with the question of benefit out-weighing the drawbacks and difficulties. Don't take their brush-off. Keep at them until you receive satisfactory answers and/or results. Otherwise, consider an additional opinion and seek it. Regards, Mark
Inhalers and the Heart
Q. Is it possible to weaken the heart by over-medicating with combivent via inhalers? If so, how does one know how much is too much? Thanks, Mike
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A. It is indeed *possible* to "over-use"/"over-dose" on the Albuterol component of Combivent. HOWEVER, the amount that it would take - - - FOR MOST FOLKS - - - is rather large. The 'red flag' point is usually when one is using in excess of two inhalers per month. When use approaches or exceeds three inhalers per month, then we are looking at very certain danger. That is in the neighborhood of 20 inhalations and more, per day - - - for a lot more than a few days! This is also just a general answer. For some folks, the overdose point may be lower. For others, higher. For folks with certain additional vulnerabilities and conditions, it changes even more to a lower level.
My recommendation is that if you find that your inhaler OR nebulizer isn't carrying you for more than two hours at a time, with two to four puffs then you should be on the phone with your doctor to determine additional action to take. I hope this answers your question. Best Regards, Mark Mangus
Getting Oxygen Too Fast??
Q. Is there such a think as getting the o2 to fast to make you sob? I was having trouble with the regular size hose so they gave me a smaller one (the part of the hose to your nose) Now it comes out fast and I can hear it all the time. Everyone keeps telling me I have an O2 leak! God Bless, Debbie
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A. When you take the same amount of flow you were putting through tubes of a larger size and push it through tubes of smaller size, the rate (speed) at which it comes out the tubes will necessarily increase. So, for it to 'feel' like it is coming out faster is exactly what is happening. That the increased speed, or "jet-like flow" can make you MORE short of breath is unlikely. Naturally, with it coming out faster, it WILL make more noise. It can also cause increased irritation within your nose, too, depending upon your oxygen flowrate. What was your problem with the "regular-sized hose? Regards, Mark Mangus
I only use 02 part time but find the nasal cannula thing, a nuisance, awkward and embarrassing in public. I going for a TTO, what is the hospital issue, time, etc.? If I wanted to swim, how could I block the opening ? The process seems so slick, I wonder why more people don't have it done? Your advice on this would be sincerely appreciated. Warren H.
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A. I want to caution you, Warren, the TTO is
recommended as solely a "cosmetic" maneuver. TTO, is most
often recommended for those whose oxygen requirements are high enough
that standard portable oxygen systems cannot easily accommodate their
needs. TTO allows reduction in oxygen flow AND in the case
of conservation devices, allows them to work better than they might with
a cannula as the delivery device. Unless recommendations
have changed in recent years - - - and having spent considerable time at
the TTO exhibit this past weekend at our AARC national conference, NO
recommendations were forthcoming to the effect that TTO is now
recommended solely for cosmetic reasons and considerations - - - TTO
should be reserved for those who have a specific indication and need for
Recuperation Time During 6 Minute Walk
Q. Idid the six minute walking test and
accomplished a very decent distance, according to the physiotherapist at
the Pulmonary Rehab Center..My 02 sat dropped to 89%...HOWEVER, she
clearly pointed out that the RECUPERATION time was a key factor as to
whether I needed oxygen for exertion. I recuperated within ONE MINUTE ,
back to 93% or so, on ROOM AIR..She was very happy with that and said I
did not require oxygen at this point.
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A. I have heard a lot of medical professionals talk about
"recuperation time" as if it makes a difference in whether and when one
needs to begin using supplemental oxygen. I have serious
concerns about the whole notion for a number of reasons.
O2 Use At Night and Daytime Sats
Q. My question relates to a post that said sats should stay around
93. I'm on 2L O2 during sleep, but not during 'regular' house-type
activity, but use 2L when trying to exercise at rehab or when taking
outdoor walks. My normal daytime level is usually 88-89. If
I do PLB it goes up to 91 or 92 but doesn't stay there. Before I
used O2 at night my usual daytime level was 91. So it seems to me
that by using O2 at night and having levels of 94-97, my daytime level
has dropped. Does this make sense? Also, I've heard the 'old
wives tale' that once you go on oxygen, you never go off -- but, but,
but -- I've also heard that some people need O2 for a number of months
or a year while they exercise and build up the healthy part of their
lungs. Is this actually possible? Finally, if sat starts
dropping, even with oxygen use, what then? What's happening and
how does one recover from this episode?? Yes, I'm newly diagnosed
and have ALL the questions a lot of you are bored to tears with, but
still I must ask.
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A. It is trickier to make a call on one's saturations when they
live at 5000 feet elevation AND have COPD. 88 - 89 and 90 -
92 might be good for someone - - - even with COPD - - - at that
altitude, though I'd have to yield to the person's doctor, who knows
them better. I CAN say that there is no reason to think that
because Carolyn is using oxygen at night that it would somehow make her
saturations WORSE during the day. that just doesn't follow any
kind of physiologic pattern that we see or know in pulmonary disease and
its progression. Carolyn doesn't say if she has polycythemia
or not. THAT has a bearing on potential changes and
expectations. She doesn't use her oxygen during the day with
activity, despite relating information that suggests she desaturates
sufficiently to warrant its use.
Diffusion: What Does This Mean?
Q. If my diffusion is 57, what exactly does that mean? I am really confused. Thank you.....Diana in Ohio
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A. I will assume the 57 is "57 %" and is what you possess in regards
to what you "should" possess, according to equations that predict what
your 100 % maximum would be. In diffusion, one can exchange
oxygen reasonably well until they drop below 50 %. Some
experience hypoxia (low blood oxygen levels) with a diffusion of as high
as 40 %. Others can have a diffusion that drops to 30 % and still
not exhibit hypoxia. The value is relative to the rest of
your pulmonary functions and some anatomical factors, like matching of
where air goes in your lungs to where it comes in contact with blood
flowing through your lungs. There are other factors associated
with breathing and circulation that can influence diffusion, both
positively and negatively.
Is Coughing Damaging to the Lungs
Q. When you do a lot of coughing does it do any damage to the lungs or is it just uncomfortable and exhausting.? I am on atrovent and advair the coughing is much better but not all gone yet. I go back to get checked next Friday. Thanks for any info you might have.
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A. The short answer to this question: We don't know for absolutely sure. The likely answer; probably NOT.
While in theory, a cough CAN cause damage to the lungs, it would likely happen only under the most extreme or unusual set of circumstances. AND, any damage that 'could' occur, would be expected to be restricted to the immediate moment - - - say in the form of a "pneumothorax" - - - a collapsed lung; from popping open a breach (tear) to the outside of the lung, allowing air to leak into the chest and compress the lung, rather than to a cumulative effect over years of coughing.
The lungs have very unique and effective defense mechanisms, not just from a functional standpoint, but also from a physical and mechanical standpoint, too. When we cough, many 'counter forces' are activated to keep us from 'busting a gut', so to speak. While tremendous 'amounts' of pressure are generated in the coughing (and sneezing, too!), opposing and 'splinting' forces and mechanisms keep them from doing structural harm/damage.
So, while we can't say that 'without exception', coughing doesn't contribute to emphysema, we have many reasons to believe that it indeed doesn't. Regards, Mark
Borderline Oxygen Levels and
Q. This question has probably been answered before but ...... I am facing a business trip for work requiring air flight. I am not on O2 yet, but close to borderline on needing it. I am really worried about going on a plane and what it might do to my breathing status. Haven't been on a plane in 4 years, and I was nearly as bad then. You thoughts please ? Thank You
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A. Get a walk test before going. If you drop into the upper 80's as your lowest saturation after walking more than 4 minutes, I'd say you can squeak by without having to use oxygen in flight. If you drop below the upper 80's with less than four minutes walking, then I'd say think about it hard and would recommend using it. Saturation changes any worse than those - - - you should definitely use oxygen in-flight. I can't get any more specific about or speculate any better than these limits. Regards, Mark
What % Does DLCO Become a Problem?
Q. At what % does DLCO become a problem ?? What values on a PFT determine trapping from Asthma vs E or Bronchitis? If a person has E + Asthma, and is very over weight, could their PFT values, specifically the DLCO improve ?? Thanks in Advance !!
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A. Usually at less than 30 %. It is different 'among' individuals as a factor of how bad the 'air distribution' within their lungs happens to be. If their emphysema/air-trapping is worse, they will start to have oxygenation problems at a higher DLCO than those who ventilate better. There is no 'hard-set' threshold number.
There is no way to tell exactly how much air-trapping is from each. There is no informative value in knowing the difference, either. If it were possible to know, it wouldn't have any bearing upon choices of treatments, any way.
To your last question/scenario, "anything's possible!" It certainly 'c-o-u-l-d' happen. Yet, it's one of those things that you can't know until you 'look over your shoulder' at the past. (as in 20/20 hindsight). Regards, Mark
Does Emphysema Cause Pneumonia?
Q. I have had pneumonia every year for the past 5 years since I was diagnosed with emphysema. That is how my doctor originally found out I had emphysema. This year my doctor advised me to get the flu and pneumonia injection, which I did, but I had the worst bout of pneumonia ever. Is getting pneumonia a common consequence of emphysema? Karen (Australia)
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A. The pneumonia shot covers over 20 varieties of pneumococcal pneumonia O-N-L-Y. It does NOT cover "all" pneumonias. There are M-A-N-Y other organisms NOT covered by the pneumonia shot that can give you a pneumonia. So even though you get the pneumonia shot, you can STILL suffer a bout of pneumonia. It just won't likely be causes by one of the pneumococcus strain of bacteria.
The reason the several pneumococcal pneumonias are covered and so important to cover is that THAT strain of bacteria are responsible for the greatest number of pneumonias that kill older folks, infants and those with chronic/other health problems, like COPD. Regards, Mark
Acceptable Level of Oxygen at Rest
Q. Can someone please tell me what an acceptable level is for my oxygen at rest? When I went to the doctor last week, she was not very happy because me oxygen was at 95% at rest. It is lower today to > about 92%. Is that normal? I have been coughing a lot today and cannot seem to "catch my breath".
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A. I think she is concerned about the drop compared to prior levels. The levels you quote are not troubling in and of themselves - a 92% SaO2 is quite good for a COPD patient, and a 95% is about what mine runs without COPD.
Directly to your question: An SaO2 above 90% is acceptable for a COPD patient. That is a level at which we would consider weaning you from oxygen (or lowering the amount of oxygen you are on) in a hospital.
As with so many things in medicine, the issue is not the "snapshot" number, but the trend over time. That may be what has your doctor concerned. Larry Conway, RRT
Dampness in Basement Apartment
Q. Just moved into a basement appt.which is cheap but discovered I have to use a Dehumidifier which fills with water very quickly especially when it rains. Is a wet/humid atmosphere good for my lungs Fev....44%COPD or damaging.I seem to be much more bronchial/wheezy since moving in 12 days ago. Will appreciate any advice Mark or whosoever can help. Peace ...life and breath to us all Jonathan
* * *
A. It sounds like you might be getting more than humidity. Molds and fungus like that environment, too. If the humidity alone isn't bothering you, then it could be the molds. Are you able to get the environment pretty well dried out with that de-humidifier? You might need to think of a move to a better location from the standpoint of breathing. The cheap price may be easy on your pocketbook, but hard on your breathing! Regards, Mark
Dad Not Doing Well...What Can He Do?
Q. Hi, my name is Peg, my dad is 78 yrs. old, he has emphysema, do you know of anyone that could tell me if this might be something my dad could try? He is not doing very well, I think that anything that may work would be worth a try. I would like to keep my dad for a while longer, as long as he is not struggling to stay alive. Any info would be greatly appreciated. Thanks
* * *
A. More than any magic potions or medications, the core action to survival IS "struggling" . . . struggling to move . . . struggling to breathe . . . struggling to keep on keepin' on. It is those who seek only comfort who succumb sooner to this disease AND suffer worse along the way, in so many instances! The more comfortable you try to make your father, the more you will NOT be helping him - - - strange as that may sound. By him not getting up and struggling, he is becoming weaker and actually losing strength and stamina.
As many folks here on our list can tell you, even though he may seem VERY debilitated, weak and frail, hope is not lost or absent. On the contrary, he may have a whole lot more to gain than y'all can imagine, from where you stand at this time. If it is possible, see if he can be evaluated for entry into a pulmonary rehabilitation program. They can help him get on track to really make some progress, if that is a possibility.
I'm not trying to discourage you from trying alternative treatments. But, I'd like for you to know that drugs and alternative treatments to "make him feel better" may not be indicated, or of potential benefit, much less be enough to do what you hope they can do. If you have more questions, or we can help, please post again and we'll see what we can do. Regards, Mark Mangus
Exercise: How Much, How Often
Q. Tell me, someone, what is a general rule-of-thumb for how often and how long we should be exercising? Daily for 6-hr workouts (:- } (prepping for US Open) or every 5 days for 5minutes? It has to fall somewhere in between, correct? I have somewhat advanced E, am on O2 24/7, and was diagnosed about 6-7 yrs ago. I went thru rehab but forgot exercise formula. I didn't do a lot of exercise as my work kept me hopping until retirement 6 months ago. Thanks for your response. erlyn in az
* * *
A. Studies show that a minimum of 3 days-per-week is what's
needed to achieve and maintain benefit. That considers a
fairly vigorous exercise plan of cardiovascular-targeted aerobic
exercise of at least 20 minutes and up to one hour, burning around 1000
calories. This is for "healthy" people to maintain a
reasonable baseline level of fitness. This also generally
fits the recommendations of the ACSM (American College of Sports
Medicine) This really presents a wide range, when you
think about it. But, people are different among each other
and requirements vary.
Needing Assistance Flying Overseas
Q. My wife and I would like to travel to Japan next year ,but I understand the airlines will not let you carry your own oxygen on the plane and I cant find anyone that knows how I can get oxygen refills in Japan. And all I have now is an home oxygen concentrator and the portable one's I have found on the computer are to big for me to carry.I use oxygen only at night at 2lpm.Is there anyone there that can help me.? Ed
* * *
A. Try contacting VGM and Associates (Van G. Miller)
(1-800-642-6065) They have helped many folks whom I've
referred to them for overseas oxygen services. The man
answering at this number may even be Brad Workmeister, who answered when
I called a few months back.
Getting Oxygen When Needed
Q. Can oxygen be beneficial to help breathing with a FEV1 of less than 25% even when the blood saturation is mostly over 90 %, PO2 between 54-65? Do you have some information on this? Marie from Germany
* * *
A. It most certainly CAN! Those numbers are at the
low end of clinical acceptability! In deed, here in the US,
one qualifies for government (Medicare) reimbursed oxygen when their pO2
is 55 mmHg or less. So the 54 you relate falls within our
guidelines. Also, in the report of a substantial study, in
Chest, last December, Dr. Richard Casaburi, a pulmonary specialist,
prominent for his research here in the US, found that even folks whose
saturation averaged in the low to middle 90 %'s exhibited
clinically/statistically significant improvement in exercise tolerance
and performance when given oxygen sufficient to raise their saturation
to normal (> 96 %).
Why Do We Take Steroids?
Q. I was on Advair and Spiriva. Had thrush so bad and the meds my Dr. gave me would not clear it up. Previous to Advair I was on Serevent & Qvar with a Aero-chamber. Never had any problem with thrush. (I did rinse and all that!!) Am now on Foradil & Spiriva with no steroid. What exactly is why we take steroids? My Dr. said a lot of us don't need them. I don't feel any different without them. Should I be taking some kind? I know this has been kicked around before but I'm still now clear. I live in a small Ok. town that don't have a pulmonary Dr. so rely on my GP and you for answers. Also I use my handihaler for my Foradil too. I order my Spiriva from Canada and so far have not had a bad one. Guess that shows we are all different ! I don't post often but read everything. Loved Mark's answer on the 8 minute treadmill. Tried it yesterday and sure enough I didn't get so winded. Thanks Mark. Donna Sullivan OK
* * *
A. You ask some good questions. Steroids are
prescribed for their anti-inflammatory effect - - - inflammation not
always being a component of the "narrowed airway" problem for many with
chrinic bronchitis and especially emphysema. That you don't
feel any different without the steroid on board than you do with it
indicates (anecdotally) that you don't need it.
Can You Improve Your DLCO?
Q. Is there any way to improve your DLCO readings? Other than quitting smoking, of course. Since this seems to relate to whether or not you need 02 in your life, thought I'd ask. Joy/MO
* * *
A. There is nothing you can "do" to change or improve
your DLCO. It is one of those things in COPD that is solely
based upon physical and physiological changes that, once altered, do not
return to normal. Loss of lung tissue, destroyed with the
progression of emphysema, along with the blood vessels that accompany
that tissue reduce the number of oxygen molecules that can pass through
the remaining viable tissue. Add to that any "thickening" of the
tissue between the gas-holding alveoli and the blood vessels in contact
with for exchange of gases, or from scarring and you have even more
difficulty with regard to getting oxygen molecules to pass into the
Using Helios at Night
Q. On Monday I was put on the Helios system and just love it. I now have the freedom I need to be as active as possible. My 02 prescription reads 2L at rest and 3L on exertion and sleep. Yesterday when I was in Pulmonary Rehab and they asked me what I was doing for nighttime 02, and I told them I am using the Helios. I am suppose to use 3L at night, because my levels drop. The Helios is only able to be used with the conserving device at 3L and I have no concentrator to use at night. I do hook up to the large tank so that I don't run out during the night. The 2 gals in the Pul Rehab now say I should have the overnight complete sleep study (in the hospital 2 yrs ago I had the night test ,but it was just my finger hooked to the oximeter while sleeping and it showed at that time I dropped to below 80 several times during the night). I guess what I'd like to know is just how important it is to have the complete sleep study done and do I need to have them provide for me a concentrator for overnight use? thank you, Lorraine - ND
* * *
A. When I was in home care our policy was to never set one of
our patients up with the Helios for use while sleeping without an
overnight oximetry study. This way we had documented proof that the
system worked for them. When a person sleeps they usually breathe more
shallowly than they do when they are awake. If one's breathing is too
shallow to trigger the pulse of oxygen during the night, then you won't
get anything from the Helios. That is why most Helios users (that I have
talked to anyway) have a continuous
Q. I'll hopefully be having LVRS - as soon as I can choose a surgeon. My dilemma and question is: Is it better to go with a surgeon who is said to be top-notch but has stringent rules about no smoking and prednisone for 3 months, (both of which may be a problem) or another very good surgeon (but not first choice) who will likely be more open in his qualifications? What's the deal with no prednisone? I'm hoping to decide in 2 days. My emphysema is very serious, I live with SOB all the time now. The Dr. thinks it's LVRS or nothing. Thanks for your opinion.
* * *
A. The no prednisone rule is because you'll heal better AND the
integrity of your tissues is likely to be better after three months off
steroids. Those are extremely important considerations in
success of the procedure. They could make or break survival,
so I wouldn't compromise them, were I in your shoes. The
smoking is also a concern, because if you don't quit for three months,
at least - - - solid - - - no cheating, then the likelihood of
recidivism is extremely high, especially if you really have a good
result in breathing improvement.
Target Heart Rate During Exercise
Q. I need your advice on a subject that came up today at rehab. Each of us has a different target heart rate which they tell us is determined by our resting heart rate. They have told us that our target heart rate is 30 beats higher than our resting heart rate. We are told that when we are on the treadmill we should not exercise to the point that our heart rate is higher than this. They feel that 'slower and longer' is the best way to exercise. I know that you have expressed your reasoning on this before but would you be so kind and explain again how you do it at your hospital? I was told that only the cardiac patients are urged to push themselves past their target heart rate. Thank you and God bless, Jeanette in Ohio
* * *
A. For the reason that you are confused about what it 'should'
be, is why I dislike "target heart rates" for any populations other than
cardiac rehab patients. And while I'm mentioning them, they
are set target heart rates that are NOT to be exceeded, so either you
might have misunderstood the information, or you were told wrongly about
Should Patients Have Oximeters?
Q. I can see why some Drs. do not want patients to have an oximeter. My wife consults it all the time. She shows it to me whenever it is low. That is after walking across a large room , or getting out and into the car. On her conserver she wants it on continuous feed instead of pulse because it might dip to high eighties. I don't think dips are serious, especially if it comes back to nineties shortly. Who is correct ??
* * *
A. You did not indicate how long your wife has been diagnosed or
how long she has had the pulse oximeter. It IS human nature to
focus on any new information source when either the problem or the
information source is new. Also, if she is newly diagnosed, her
concern is reasonable; she has not yet learned to be comfortable with
the feedback she gets from her own body and how to correlate that to the
readings. That will take time.
Q. I have been walking 2 miles a day in my warehouse at work. Most days I do it in segments separated with a minute or so when I feel I should stop and catch my breath. My question is this, if I get disturbed during this routine, as in having to go answer a few phone calls, and end up doing the two mile in bits and pieces throughout the day, does that diminish the value of the exercise? John in NJ
* * *
A. The simple answer is "YES!"; Spreading a 2 mile walk out over
the course of the day, done in spurts of short duration, will yield a
significantly diminished result over doing it without stopping, or even
the way you describe you do it, with short pauses along the way to catch
Is Paint Harmful?
Q. I know this might have been talked about but I'd like to get this straight about paint. Is it harmful permanently or just an irritant? The smell of paint never bothered me or at least I thought it didn't. I have severe Emphysema, but am wondering if I can still paint if I can get up the energy to do so. How about painting outdoors? Does this make a difference? Please let me know, as I am getting ready to paint the baseboards in the basement and maybe paint the fence. Thank you in advance for any advice. Mimi, Pa
* * *
A. If you don't react negatively to the odor of the paint, then "Go for it! ! !" Most paints today don't carry additives that caus harm, like those of days gone by. Stains and solvents are another thing altogether. But, latex base paints are generally safe. It's all in what your nose likes, after that. Regards, Mark
Swimming and Breathing
Q. My kids bought a swimming pool for my grandson for his birthday and put it right next to my porch since he's here 99% of the time. It one of those easy set 1 2 3 pools. Anyway, I almost drowned when I was little and have stayed clear of water over my ankles ever since but he wanted me to get in with him so I did. I LOVE IT! I don't understand it but I can stay in there for 2 or 3 hours moving the whole time and not get out of breath. I still wheeze but I feel fine. When not in the water I can't get from one room to the next without getting out of breath. I just don't want to get out and my husband was kidding about putting it in the living room this winter because he hasn't seen me laugh so much in years. I just can't get over how much better I feel in there. The first time I got out I thought I would have to go to the hospital because it hit me like a ton of bricks, couldn't get a breath but it passed. Now, I use my nebulizer before I get in, my husband brings my inhaler to me before I get out and he put a chair right next to the ladder so I can sit right away. The porch is only 20 feet away but I just can't go that far when I get out. I also noticed that I stay blue in there. My nails are blue, they say my lips are blue, my husband said my face is snow white and when I get out it looks like my legs and feet are kinda blue. Nobody else gets blue in there. I think maybe because my circulation isn't the best? Everybody worries about me when I'm in there and I don't want to worry them but I don't want to stop going in. I'm hoping somebody will know why I have tons more trouble breathing when I get out and why I get so blue and will it be ok? Thanks! Kay in West Virginia
* * *
A. It is well documented that because of buoyancy in the water
(90 % of your body mass is supported by buoyancy) that less energy is
expended to move about. ALSO, because of the density of water,
exercise is more effective, pound for pound and easier to do!
I send my most deconditioned patients into our pool when land-based
exercise is beyond their condition of the moment. The
reason why you have so much difficulty getting out and back into the
house is because you lose the buoyancy when you leave the water.
Why Do Some Need Oxygen and Some Don't?
Q. Just recently, I seem to have read of several members whose FEV1 is much higher than mine, and yet they are on supplementary oxygen 24/7 and I'm not on it at all. Could the RRTs explain why some people need to have supplementary 02 in these circumstances, please. Are there other factors that make the FEV1 reading unimportant? Ann
* * *
A. The short answer is that there are several factors that
influence whether you need supplemental oxygen at a given FEV1.
The biggest single factor is what kind of physical condition you are in
beyond your COPD. If you exercise and stay in good condition, your
body is more efficient in using whatever oxygen your lungs are able to
provide to it. This means that you can function comfortably
without supplemental oxygen (or with less supplemental oxygen than if
you were in worse physical condition).
Suddenly Falling Asleep
Q. My husband has copd, emphysema, cor pulmonale and congestive heart failure. He will suddenly fall into a deep sleep without any warning that he is sleepy. His sats are usually in the normal range for him ( 88 -92%). Is this normal for his condition?
* * *
A. Regardless of his pulmonary diagnoses, what you describe is NOT normal, nor acceptable to continue without effort to find the cause and resolve it if possible. What you call "normal for him" at 88 - 92 %, is not good, for someone who has cor pulmonale and CHF! B-e-c-a-u-s-e of his CHF and cor pulmonale, he should be allowed to drop no lower than 92 %. He should be getting more supplemental oxygen, IMHO. I would recommend asking the doctor about turning up he oxygen flow. In any case, there are folks who have a severe form of "narcolepsy", where they suddenly and without warning, drop into a deep sleep. It can be a primary problem caused by neurologic or pulmonary or a combination of factors from each system. It can be secondary to something like severe OSA (Obstructive Sleep Apnea). In any event, I would strongly suggest you consult with his doctor about this and be sure it is thoroughly investigated! Regards, Mark,
Oximeter Use While Still Smoking
Q. The number you read on an oximeter ,(any number) is supposed to be the percentage of oxygen in the blood stream. I have also heard that the number may be including other gases as well like Co2 and/or carbon monoxide or any other present gases. Is this true? If a person smokes the gas from the burning tobacco gets into the blood stream. Does this gas displace, or take up space that O2 would normally be? A person that smoked 2 packs a day may have a reading of say 95.If he were to quit smoking would that number change?...Rusty
* * *
A. Oxygen saturations measurements represent the percentage of
hemoglobin that is available to carry oxygen compared the actual amount
that it is carrying. So, a saturation of 95 % means that of
the hemoglobin's capacity to carry oxygen, it is carrying 95 % of what
it CAN carry. While the oximeter is able to detect
"oxygen", but is NOT able to distinguish between "types" of oxygen, it
picks up ALL of the oxygen that is bound to carbon as carbon dioxide
(CO2 = a VERY small percent), to carbon as "monoxide" (CO = also a
VERY small percent - - - unless you are a smoker) as well as the good
stuff - plain old bi-molecular oxygen - O2. While the
"percentage of carbon monoxide increases in an active smoker, the
saturation itself, as a measurement, is NOT affected by it. So,
when the person stops smoking, the percentage of carbon monoxide carried
on their hemoglobin drops and is replaced by bi-molecular (the good
stuff) oxygen without any change occurring in the overall saturation.
The only way you can tell the shift has occurred is to run a sample of
arterial blood through a co-oximeter, which DOES distinguish between
'types' of oxygen carried on the hemoglobin.
Is Oxygen Dangerous?
Q. I'm confused about oxygen and the different references to it regarding it being flammable. A while ago, someone said that it (ox) did not catch fire. Isn't being flammable and "catching fire" the same thing? (I guess I'm referring only to pressurized oxygen, not that which I'm right now breathing in). When one has oxygen in the home, what happens if there is a leak? Can it catch fire? How about explosive qualities? And if it can't catch fire or explode, what does flammable actually mean? What makes oxygen dangerous? I know I sound like a new student in freshman science but I never had reason to wonder about this stuff before. Any answers and/or insight into oxygen would be appreciated.
* * *
A. I know it can be confusing. Many doctors and nurses are
confused about it to some degree as well, so don't feel alone.
New Doctor Experience
Q. My new doc was seen today for the 1st time. My records were not in order...sigh.... but he found the info he needed (I hope) and looked things over and determined that I not only had E but asthma. Maybe we all do but i didn't know that. Said my numbers were not very good. Will be putting me on a new (very old med with rare side affects) to help with the asthma component. The nurse put the oximeter on my finger and the reading was 93. Usually 97 98 when at rest for me. So i asked him about that and he took it again and it was 97. Said well now that you are resting it is up. I wanted to know about exertion as i am very SOB on exertion. He said" Do you want to drag an o2 tank around??? I said no but I would if i needed it to breathe. So then he said ok we will schedule a 75 minute rest exercise test. My question is:Should I do the test? Is he giving me a CHOICE as to whether or not i will use o2. Whether I need it or not??? I am very confused about this. Can anyone like one of the docs or the RRT's shed some light as well as any members who have experience with this attitude or whatever. Thanks so much for any replies. Hugs..and yes I am frightened...Diana
* * *
A. I always figure tests are how we get information. To me the question should be: Do I NEED to drag an oxygen cylinder around?, not: Do I WANT to drag an oxygen cylinder around? Comprehensive testing will give you an honest answer to the first question, a look at some of the compact, lightweight portable systems available today will give you an answer to the second (if it needs to be answered at all). I thought the days of dragging an oxygen cylinder around were over. I find that one of the most important things I can do for some people in Pulmonary Rehab is help them see the benefits of using supplemental oxygen if they need it.
I had a lady tell me she didn't want to be restrained by using
oxygen. I asked her how often she got out other than to come to rehab
and go to the doctor, she said almost never because she was too short of
breath. When she saw how much she could do with the oxygen on in rehab
she tried it at home too. Now she is happy with her more active
lifestyle. She doesn't run marathons or anything, she does her own
grocery shopping, and goes out to lunch with her friends. Oxygen set her
free, it didn't tie her down.
Q. What if on your earlier tests there is a marked difference between the two (pre-med vs post med) maybe 15%, then maybe 2 years later they do another spirograph & there is no little difference between the two? (Pre/post) Joy
* * *
A. When one has a PFT and the 'post-bronchodilator' result represents a significant % improvement, is THEN put on medications to maintain the improvement and THEN, when re-tested later shows NO improvement, the physician needs to ask himself/herself three questions: (1) Did the patient take their bronchodilator medications too close to being tested? (2) Does the "lack of significant improvement mean medication is no effective or necessary, or does it show the medication is having the desired effect? (3) How does this test compare to the one on which the significant improvement was observed? Is it the same as the "post-bronchodilator" measurement from the earlier test? Or is it the same as the "pre-bronchodilator" measurement from the previous test? Without answering at least 'these' questions, to make the decision to stop the medication does not consider enough to support it as the best direction in which to go. These are all important facts to consider before stopping a medication that could indeed be the reason the test DOESN'T show significant change. Otherwise, you could end up right back where you began before the earlier test. AND, you could end up enduring a lot of unnecessary discomfort and suffering. Regards, Mark
Inhaled Steroids and Osteoporosis
Q. Previously I was on several breathing medicines. Two years ago I threw them all away and went on Spiriva. I am very happy with Spiriva. Now my new Doctor tells me at my first appointment I should add Advair. (not Pulmo) What do you think?? I kind of agree with him when I heard it had steroids: However I have osteoporosis so I worried. The Doctor says only oral steroids cause osteoporosis.
Concerning rehab and the procedures. I always thought it was funny how the people in charge say "don't overdo" BUT----"Push yourself" Appreciative for your informative thoughts. in EFFORTS. Don
* * *
A. The influence on osteoporosis from inhaled steroids is
significantly less than for oral steroids, by a factor of several times.
If you already have osteoporosis, you have reason to be concerned.
BUT, you probably should consider if or not the steroid helps your
breathing more than it could be hurting your osteoporosis.
If you can exercise more and more vigorously because of the added
beta-agonist and steroid, then perhaps you can override the negative
influence of the steroid. But, while I agree with your
doctor that oral steroids doses - - - being SOOO much higher
(relatively) than inhaled steroids and influencing systemically rather
than locally targeted - - - can "cause" osteoporosis, the incidence of
inhaled steroids "causing" osteoporosis is g-r-e-a-t-l-y reduced, but
nevertheless still there. If I were in your shoes, I'd
probably try Advair. If it helped significantly, I'd accept the
risk on the osteoporosis consideration. That's "my" opinion
on what "I'd" do. Take it for no more than that, please.
Exercise Pushed Too Hard?
Q. Is there an age and severity level at which a person will NOT benefit from moving a little more each day? Is it smart to allow the very severe and or aged to sit back and not exercise. Lyn
* * *
A. Essentially, there is NO age or level of severity of COPD at
which we say one shouldn't try to exercise or improve. There
is only one condition that I know of that is prohibitive to being able
to exercise or realize improvement from it. That condition
is the one where you have no pulse or respirations! Until
you are afflicted by that eternal ailment, the only thing standing
between you and improvement are your imagination or any excuses you may
have conjured up. There are doctors and others out there who
will impose their opinion on you and say you can't or shouldn't or
FEV1 Doesn't Change with Bronchodilator
Q. My FEV-1 has always been the same before and after using a bronchodilator yet nothing helps me as well as albuterol when I'm SOB. If it doesn't change my airways to improve the FEV-1, how does it improve my breathing? I've been treating copd for 24 years and it seems I have more questions about it now than ever!! Virginia n Va
* * *
A. A possibility is that it reduces your air-trapping enough that you can feel the difference there. Yet, it doesn't have to show up as an FEV-1 change to be significant. Regards, Mark