the paper pulmonarypulmonaryperformance.com/ppsepoctfinal.pdf · 2012-06-09 · the safety profile...

Dedicated to Respiratory Health Care www.pulmonarypaper.org • Volume 21, Number 5

PaperThePulmonary

September/October 2010

COPD hasMany Hats!Also inside:

Calling Dr. Bauer

Sharing the Health

COPD hasMany Hats!Also inside:

Calling Dr. Bauer

Sharing the Health

contentsFlu Season InformationWho should get a flu shot?

Looking to the FutureParticipants needed in study

Words of InspirationFrom EFFORTSVice President, Ann Lornie

Calling Dr. Bauer …What is pseudomonas?

Ask Mark …Exercising and PAH & more!

Fibrosis FileSTX-100 for IPFgets Oprhan Drug Status

Sharing the Health

Traveling NewsNew TSA Regulation!

Get Up & Go2 Cruises

Taking Aerosol Meds Correctly

Innovative Photo Project & COPD

Respiratory News

Dedicated to Respiratory Care

Volume 21, No. 5September/October 2010

On the cover: Hilde Hanson ofLakeland, Florida, doesn’t takeCOPD sitting down!

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.

“I look to the future becausethat’s where I'm going to spend the rest of my life.”

– George Burns

PaperThePulmonary

My son Julian has a key chain that says, “Has anyone seen mypotential?” After graduating with a degree in film, he hasstruggled to find permanent employment in his field. So he istrying to adapt, bend, fit in, change, conform, reconcile andacclimate to his situation. We believe it is all in the attitude!You may have to realistically change your goals about where

you want to be throughout your life. There is no reason to thinkabout what you no longer can do, and every reason to think aboutwhat you can do! The holidays will soon be here –I know every one of you can makea difference to someone else!

www.pulmonarypaper.org Volume 21, Number 5

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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

Our cover girl, HildeHanson, is on the go!Somehow she makes time torun the web site she beganon alternative treatmentsfor COPD, http://Livingwith-COPD.org.

It is now recommended for all people six months andolder to receive an annual influenza vaccination. Thisis a new and expanded recommendation for this sea-

son. In February 2010, CDC’s Advisory Committee onImmunization Practices voted in favor of “universal”influenza vaccination in the United States to protect asmany people as possible against the flu. Manufacturersproject that there will be ample supplies of vaccine andthat most vaccine will be distributed by November 2010.

Will I have to get two flu vaccines this season?No. Only one flu vaccine is being made this year and

most people will only need to get vaccinated once. Thereis one exception to this: CDC recommends that childrenaged 6 months through 8 years of age who have neverreceived a seasonal flu vaccine get two doses of vaccinespaced at least four weeks apart.

Which viruses does the vaccine protect against?The flu vaccine is updated every year to combat the flu

viruses that research indicates are most likely to causeillness during the upcoming season. The 2010–2011 fluvaccine is being made in the same way as seasonalvaccines have been made for decades. It will protectagainst the 2009 H1N1 virus that caused so much illnesslast season, and two other influenza viruses (an H3N2virus and an influenza B virus). About 2 weeks aftervaccination, antibodies that provide protection againstinfluenza virus infection develop in the body.

Even people that got vaccinated with the 2009 H1N1vaccine or last year’s seasonal vaccine need to be vacci-nated with the flu seasonal vaccine this year. This season’svaccine provides protection against other influenzastrains that were not in either the seasonal or the 2009H1N1 vaccine last season and besides, immunity froma vaccine gotten last year may decline over time.

Is there a new type of vaccine availablefor seniors who are 65 years or older?

Yes. Fluzone High-Dose, a new influenza vaccinemanufactured by Sanofi Pasteur Inc., is designed specif-ically for people 65 years and older. Fluzone and FluzoneHigh-Dose are both injectable influenza vaccines toprotect people from influenza – made up of the three flu

strains most likely to cause illness for that particular fluseason. Fluzone High-Dose vaccines contain four timesthe amount of antigen (the part of the vaccine thatprompts the body to make antibodies) contained in reg-ular flu shots. The additional antigen is intended to cre-ate a stronger immune response (more antibodies) in theperson getting the vaccine. The High-Dose vaccinationwill be covered under Medicare.

Why is a higher dose vaccine availablefor adults 65 and older?

Human immune defenses become weaker with age,which places older people at greater risk of severe illnessfrom influenza. Also, aging decreases the body’s abilityto have a good immune response after getting influenzavaccine. A higher dose of antigen in the vaccine issupposed to give older people a better immune responseand therefore better protection against flu. Data fromclinical trials comparing Fluzone to Fluzone High-Doseamong persons aged 65 years or older indicate that astronger immune response occurs after vaccination withFluzone High-Dose. Whether or not the improvedimmune response leads to greater protection againstinfluenza disease after vaccination is not yet known. Anongoing study designed to determine the effectiveness ofFluzone High-Dose in preventing illness from influenzacompared to Fluzone is expected to be completed in 2012.

Is Fluzone High-Dose safe?The safety profile of Fluzone High-Dose vaccine is

similar to that of regular flu vaccines, although adverseevents (which are also reported after regular flu vaccines)were reported more frequently after vaccination withFluzone High-Dose. The most common adverse eventsexperienced during clinical studies were mild andtemporary and included pain, redness and swelling at theinjection site and headache, muscle aches, fever andmalaise. Most people had minimal or no adverse eventsafter receiving the Fluzone High-Dose vaccine.

The Centers for Disease Control and Prevention (CDC) has the facts on the 2010–2011 flu season.

Who Should Get a Flu Vaccine This Season?

September/October 2010 www.pulmonarypaper.org 3

4 www.pulmonarypaper.org Volume 21, Number 5

Seeing into the FutureResearchers at the Wake Forest Institute for

Regenerative Health in Winston-Salem, NC, have beenusing human cells to growmuscles, blood vessels,skin, and amazingly,a complete urinarybladder. A bladder isthe first lab-generatedhuman organ to beimplanted in more thantwo dozen children andyoung adults. The scientistsoptimistically hope to inject healthy cells into diseased lungs,livers and hearts, prompting these to regenerate.

Dr. James Kiley serves as the Director of the Division ofLung Diseases at the National Heart, Lung and BloodInstitute. In the future, he hopes to have the answer of whysome smokers develop chronic lung disease whileothers do not. To date, the COPDGene® Study hasenrolled over 8,500 participants – with enrollmentincreasing steadily each week. The study hopes to reach theirrecruitment goal of 10,000 by the end of 2010. Forinformation on participating, visit www.copdgene.org orcall the contact person of one of the 21 clinical studycenters listed here:

University of Alabama, Birmingham, ALContact: Don Davis, [email protected]

Los Angeles Biomedical Research Institute,Torrance, CAContact: Carmen Lopez-Garcia, [email protected]

University of California at San Diego, CAContact: Amanda Alvarez, [email protected]

National Jewish Health, Denver, COContact: Christina Schnell, [email protected]

Morehouse School of Medicine, Atlanta, GAContact: Jolita Wainwright, [email protected]

University of Iowa, Iowa City, IAContact: Kim Sprenger, [email protected]

Johns Hopkins University, Baltimore, MDContact: Teresa Concordia, [email protected]

Brigham and Women’s Hospital, Boston, MAContact: Grace Brown, [email protected]

Fallon Clinic, Worcester, MAContact: Diane Kirk, [email protected]

University of Michigan, Ann Arbor, MIContact: Candace Flaherty, [email protected]

Ann Arbor VA Medical Center, Ann Arbor, MIContact: Lisa McCloskey, [email protected]

HealthPartners Research Foundation,Minneapolis, MNContact: Natalie Woodruff, [email protected]

University of Minnesota, Minneapolis, MNContact: Cheryl Stibbe, [email protected]

Minneapolis VA Medical Center, Minneapolis, MNContact: Doris Stuber, [email protected]

Columbia University Medical Center, NY, NYContact: Adina Lemeshow, [email protected]

Duke University, Durham, NCContact: Kim Hamilton, [email protected]

Temple University, Philadelphia, PAContact: Gretel Ortiz, [email protected]

University of Pittsburgh Pittsburgh, PAContact: Patty Tomko, [email protected]

Baylor College of Medicine, Houston, TXContact: Laura Bertrand, [email protected]

Houston VA Medical Center, Houston, TXContact: Dorothy Williams, [email protected]

University of Texas Health Sciences Centerat San Antonio, San Antonio, TXContact: Nita Zaragoza, [email protected]


Words of InspirationEFFORT’s (Emphysema Foundation For Our Right

To Survive – www.emphysema.net) Vice President,Ann Lornie, has rewritten the words to Johnny Nash’sI Can See Clearly Now to support her fellow members!

I can breathe clearly now, the phlegm has goneThere are no blockages now in my wayGone is the loneliness I dwelt uponIt’s gonna be a bright (bright), bright (bright)Sun shiny day!

I can breathe clearly now, my meds are rightI threw the ones that didn’t work awayI’m sleeping better now, all through the nightIt’s gonna be a bright (bright), bright (bright)Sun shiny day!

Ears to the ground, we hear no more sad sighsAnd all around, nothin’ but glad cries!

Now that I exercise, my life is goodI can move round and walk a good long wayThe group is the rainbow I’ve been waiting forIt’s gonna be a bright (bright), bright (bright)Sun shiny day!

We can breathe freely now to our surpriseC O P D will be just historyFor which all our thanks will go to EFFORTS guysAnd we will have bright (bright), bright (bright)Sun shiny days!

How to improve life with chronic lung disease:

4Focus on yourself. Take an hour out of every day to check off the things on the list below.Be your own Pulmonary Rehabber for 60 minutes!

4Treat yourself with respect.

4Are you eating healthy and working on achieving your optimum weight?

4Are you working with your medical team to ensure you are on the best medication for you?

4Are you getting good quality sleep? If you have problems in this area, do not ignore them. Seek informationand help so that the situation can be improved.

4Are you exercising daily to improve your muscle tone and your heart rate? Don’t just end your workoutwith a ‘that will do’ face, but with an endorphin-filled grin! The more you do, the more you can achieve.

4Don’t forget strength training! Muscle tissue, strength and bone density decline over the years. Strengthtraining is the most effective way to slow and possibly reverse much of this decline.

Clockwise: Ann stairsteppin’ al fresco; happywalking because she can! and, showing off her muscles!


Calling Dr. Bauer …

Dr. Michael Bauer

Dear Dr. Bauer,My aunt is continually coming down with a pseudomonas infection. Could

you explain what this is? Thank you. Roberta from Maine

Pseudomonas is the name of a bacteria that can occasionally causepneumonia but more often results in a low-grade infection or chronicinflammation in the lung. This common bacteria is an infrequent cause ofpneumonia in healthy individuals.

Adults who have chronic scarring in their lungs may be more susceptible topseudomonas infection. Bronchiectasis is a condition in the lung that resultsin chronic dilation and scarring of the larger bronchial airways. This isprobably the most common setting where we see pseudomonas infection. Inchildren and teens, pseudomonas infection is frequently seen in those with adiagnosis of cystic fibrosis. This microbe seems to like lung scars and once itgets a hold on these areas, it can be very difficult to eradicate. Patients oftenhave to come to some kind of a balance with this bacteria, letting it grow veryslowly in the lung but still resulting in a minimal amount of toleratedsymptoms. Rotating a different antibiotic each month or sometimes takingantibiotics by inhaled nebulized solution can be very effective in controllingpseudomonas. Intravenous antibiotics are usually reserved for severe infectionsor true pneumonia.

Fortunately, pseudomonas is rarely transmitted from individual toindividual by coughing. A diagnosis of pseudomonas usually requires asample of mucus to culture in the laboratory.

Question for Dr. Bauer? You may write to him at The Pulmonary Paper, PO Box877, Ormond Beach, FL 32175 or by email at [email protected].

Pulse Oximetry at a low discount price!

Call for special pricing forPulmonary Paper members.


Alex from Minneapolis, MN, asksMark about exercising when youhave pulmonary hypertension (PAH).

Mark explains, of paramountimportance is to maintain adequateoxygenation while exercising. If notmaintained relatively high, breath-lessness and anxiety will rule, bring-ing those who suffer them to theirknees. If you are not able to keep yoursaturation greater than 94% whileexercising, this could be the reasonyou are struggling. If you don’t havea pulse oximeter to measure youroxygen saturation, then you have noway of knowing what your saturationis running and that is likely the keyproblem.

Folks with significant PAH requirevery high amounts of oxygen to keepthem adequately saturated, either inhigh enough flow at fixed concentra-tions (high-flow Venturi mask, likeI use in my clinic) or high concentra-tion masks with more than the usuallyrecommended flow (as a non-rebreather mask). So if you find thatyou’re not saturating well enough andfind that your oxygen systemresources can’t get you there, you needto find a place where you can get theneeded oxygen in the right amount.

To humidify or not to humidify?That is the question!

Mark advises, while evidencesuggests that not a whole lot ofhumidity/moisture is added to oxygenas it passes through water in ahumidifier, nevertheless “some”moisture is indeed added. On thedownside, humidifiers are a site ofcontamination and potential prolif-eration of bacteria that can causerespiratory infections. They are alsoa site for leaks when not assembledproperly and tightly.

Just because humidifiers can be asource of problems doesn’t make itgood practice to simply not use them.As my friend and colleague, JohnGoodman RRT advises, use ofhumidifiers is a must for Trans-Tracheal Oxygen users, regardless ofhow little moisture they may beconstrued to add. We know that notusing them results in complicationsthat are not seen when they are used.Regardless of how much they add,it is nevertheless a critical amount!Care in keeping humidifiers cleanand changing them out at regularintervals is the solution to avoidingpotential problems.

Humidity in the air has virtuallynothing to do with whether or not thedryness of oxygen flowing acrossyour mucus membranes will causeirritation, bleeding and potentialinfection. Use of a humidifier shouldnever be tied to the question ofatmospheric humidity.

Penny from EFFORTS asks whatthe difference is between Perforomistand Brovana and is one preferred?

Mark replies, Perforomist is For-moterol. Brovana is Arformoterol.They are similar except that Brovanais the Formoterol molecule that hasbeen “split in half, lengthwise” and isonly the active half. Formoterol hasthe two halves together, one of whichdoes not cause the desired action.Some would argue that in theory,Brovana is better. Clinically, it variesamong individuals. The only way toknow is for an individual to use eachfor a period of time and see if they cantell a difference. For many, they won’tnotice a thing.

Linda was wondering if Daxas®

will replace a steroid, is it in a classby itself? Do users overseas take asteroid inhaler in addition to Daxas®?

Mark tells us Daxas® roflumilast hasbeen approved in the E.U. for themaintenance treatment of severeCOPD in patients with chronicbronchitis and a history of frequentexacerbations. It will be used as anadd-on to bronchodilator treatment.It is not intended to replace anycomponent of the inhaled medicationscurrently used. It is intended to serveas yet a fourth prong in the classes ofdrugs used to treat COPD, particularlychronic bronchitis. Phosphodiesteraseinhibitors help reduce an irritant thatis responsible for causing inflamma-tion. Some folks may find that they cando just as well without their inhaledsteroid if Daxas® is effective for them.Others may benefit from the action ofDaxas®, but still need their steroid.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.

Ask Mark …

Mark Mangus, RRTEFFORTS Board


We Need Your Participation!If you have been diagnosed with pulmonary fibrosis

(PF), the Coalition for Pulmonary Fibrosis (CPF) urgesyou to consider being involved in clinical trials. Progresscan only be made in PF by studying promising therapiesand having ample patient participation in clinical trials.There is a full listing of trials on the CPF website atwww.coalitionforpf.org/cpf_research_ clinical.php. TheNational Institutes of Health (NIH) is conductingclinical trials as part of a multi-study protocol known asIPFnet (www.ipfnet.org). The new clinical trials aretesting drugs that block pathways considered key for thedevelopment of tissue fibrosis yet have, until now,never been adequately tested for their effectiveness in PF.

The first trial, named PANTHER, will evaluatethe effectiveness of anti-oxidants. An earlier studysuggested a promising role for anti-oxidants in PF.PANTHER has been adequately designed to test whethersteroids and related drugs are helpful. The PANTHER-IPF: Prednisone, Azathioprine, and N-Acetylcysteine isa study that evaluates the effectiveness of N-acetylcysteine alone and in combination with prednisone andazathioprine at preventing the loss of lung function. Thistrial is available to all people with IPF diagnosed inthe last 48 months between 35–85 years of age withmoderate disease who meet study-specific enrollmentcriteria.

“Many PF patients are treated with these types of drugs,yet the usefulness of steroids remains in question.PANTHER will answer this question once and for all, butonly if patient enrollment goals are met,” said JesseRoman, professor and chair of the Department ofMedicine at University of Louisville and chair of theEducation Committee in the IPFnet. “It is critical that PFpatients participate in this study so that we begin toobtain answers that might lead to effective and safetreatments. Patients are crucial for the success of thisresearch.”

The second trial is called ACE. The ACE trial willexplore the effectiveness of blood thinners in treating PF.The use of Coumadin and related drugs is common inpatients with vascular disorders, but they have not beentested extensively in the setting of PF, even thoughanimal studies and small clinical studies suggest it may

Orphan Drug Status GrantedIn early September, the FDA granted orphan drug

status to STX-100, an investigational, humanizedmonoclonal antibody used in the treatment ofidiopathic pulmonary fibrosis (IPF).

STX-100 targets a key pathway in the initiation andprogression of pulmonary fibrosis, according tomanufacturer Stromedix Inc. There are currently noFDA-approved treatments for IPF.

The drug works by targeting integrin vß6.Stromedix, which has completed a phase 1 clinicaltrial of STX-100, is currently planning to initiate aphase 2 clinical trial for IPF and chronic allograftnephropathy patients in 2011.

IPF Pirfenidone Treatment One Step CloserIntermune Inc., is hoping to make pirfenidone

available to treat IPF. Steps are being taken after theFDA recommended further research be done on thedrug before they give their approval. An additionalphase 3 study to demonstrate the efficacy ofpirfenidone in IPF prior to marketing approval hasbeen requested.

Intermune reports, “On March 23, 2010, ourapplication to the European Medicines Agencyseeking approval of pirfenidone for the treatment ofIPF in adults was validated. Validation indicates thatthe application is complete and that the review processhas begun. We anticipate submitting our responsesto their questions sometime during the fourthquarter of 2010 and stand by our previous guidanceof a decision regarding approvability of pirfenidonein the European Union during the first half of2011.”

Fibrosis File


State Investigator Institution Contact Information

Alabama Joao de Andrade, MD University of Alabama Tonja Meadowsat Birmingham 205-934-7630

California Joseph Lynch, MD University of California Eileen Callahanat Los Angeles 310-794-8595

Talmadge King, MD University of California Renee Jeffreyat San Francisco 415-476-5034

Colorado Kevin Brown, MD National Jewish Health Todd Dubois303-398-1621

Connecticut Danielle Antin-Ozerkis, MD Yale University Jean EstromSchool of Medicine 203-785-7324

Florida Marilyn Glassberg, MD University of Miami, Emmanuelle SimonetMiller School of Medicine 305-243-3728

Illinois Imre Noth, MD University of Chicago Cathy Brown773-834-7085

Kentucky Jesse Roman, MD University of Louisville Tamra Perez502-852-1358

Louisiana Joseph Lasky, MD Tulane University Sandy Ditta504-988-4040

Michigan Fernando Martinez, MD University of Michigan Debra Dahlgren734-936-8917

Minnesota Jay Ryu, MD Mayo Clinic Susan Walsh507-293-0367

Missouri Neil Ettinger, MD Saint Luke’s Hospital Sue Merli314-576-4501

New York Michael Kallay, MD Highland Hospital/University of Elizabeth LydaRochester Medical Center 585-233-4358

Robert Kaner, MD Weill Cornell Medical Center of Vanessa MonroyCornell University 646-962-5568

North Carolina Lake Morrison, MD Duke University Medical Center Terri Haram919-668-4562

Ohio Jeffrey Chapman, MD Cleveland Clinic Foundation Susan Lubell216-445-5872

Pennsylvania Milton Rossman, MD University of Pennsylvania Susan Metzger215-662-3115

South Carolina Steven Sahn, MD Medical University Kimberly Argabrightof South Carolina 843-792-3168

Tennessee James Loyd, MD Vanderbilt University Wendi MasonMedical Center 615-343-7068

Texas John Fitzgerald, MD University of Texas Barbi EstesSouthwestern Medical Center 214-648-6729

Utah Mary Beth Scholand, MD University of Utah Laurie BrewsterLung Health Research Center 801-581-5811

Washington Ganesh Raghu, MD University of Washington Carolyn Spada206-598-4967

be beneficial. The ACE trial is available to all people withIPF between 35–80 years of age, regardless of time ofdiagnosis, who meet study-specific enrollment criteria.

To learn more information about the IPFnet trials,contact one of these clinical sites:

I found a great site on the Internet to get tips on howto live with COPD at the Breathe Easy Arizona Coalition’swww.breatheeasyaz.org. They even have “How To”videos! Dana Afshari, FL

I found a company that sells oxygen holders for yourtwo-wheeled walker and/or wheelchair. It is calledComfort Solutions – their number is 1-315-472-8077 andcan be found on the internet at www.to2te.com Theholders can store “E”, “D”, “M6/B” and “M9/C”cylinders as well as portable liquid oxygen units.

Karen Sherrier, FL

What do you say when you see people staring at youroxygen? Need a comeback when they make a commentabout it? Oxygen users have used the following linesrecently:

“I am Buzz Lightyear’s mother!”“It’s one of the first iPods – when it was thought that

sound was better delivered up the nostrils.”“I got this on eBay. It was hideously expensive, but

apparently there are very few retro cell phones around.”“I’m a balloon.”“It has a wireless connection to my PC. Email is trans-

mitted directly to my brain via the nostrils. I reply bythinking and send with a little snort.”

Our favorite remains the child who amazingly told alady using pulse dose, “I can hear your nose running!”

I use a concentrator at home with 50 feet of tubing.We recently brought home a kitten from the HumaneSociety. She is a real joy at home except when she isbiting holes through my tubing. The bitters in aproduct called YUK did nothing to deter her andstayed on my hands forever! Finally, we foundcorrugated split black plastic tubing at Ace Hardware.It is used to cover electrical wires. Now the kitten mayjump at the tubing as it moves through the house but shedoes not bite it! Carole Beran, Elkhorn, NE

The Amerian Lung Association’s “My Fighting for AirCommunity” is a simple, immediate way for friends,family, colleagues and neighbors to assist loved ones inneed at http://lungusa.lotsahelpinghands.com. It is an easy-to-use private group calendar, specifically designed fororganizing helpers, where everyone can pitch in with mealsdelivery, rides and other tasks necessary for life to runsmoothly during a crisis. Additionly, helpful resources areprovided on symptoms, causes and treatment options forvarious lung diseases, as well as contact information tolocal American Lung Associations and the Lung HelpLine(1-800-548-8252).

Lori Palermo of Love Your Lungs, Breathe For Life,would like you to sign an online petition to help raiseawareness of COPD through our very own stamp fromthe U.S. Post Office. Please visit www.thepetitionsite.com/takeaction/761/710/249/ to show your support!

Medicare had covered tobacco counseling only forthose diagnosed with a tobacco-related disease or show-ing signs of such a disease. Medicare beneficiaries will nowhave expanded coverage of tobacco cessation counseling.Under the new coverage, any smoker covered byMedicare will be able to receive tobacco cessation coun-seling from a qualified physician or other practitioner.

Lyn Cole of Littleton, CO, and a network of otherTransTracheal Oxygen (TTO2) users, would like tooffer their help to people who have recently received theircatheters for this form of oxygen therapy. If you havequestions, simply send them to [email protected] she will forwardyour inquiries or com-ments to the group,which includes healthprofessionals.

Since Nick Jones,right, of The Villages,FL, got his TTO2catheter, he now callshimself a “Necker”!

Sharing the HealthReceive a Free One Year Membership

Contribute a picture or tip on how you COPE withCOPD! Send to The Pulmonary Paper, PO Box 877,Ormond Beach, FL 32175. Include your name/address.



Paul Thompson began making his own cannulas yearsago when he thought the ones his aunt was wearing weretoo uncomfortable for her. Oxygen users have enjoyedthe soft hoses and other innovative products Paul andhis wife Chris have produced, which are available atwww.softhose.com.

Paul and Chris are now experimenting with differentcolored cannulas and tubing. Are you going to an affairand want to match your formal black dress or tuxedo?You may want a black cannula or a red one for theChristmas holidays. Someone recently requested fleshcolored supplies. For more information, [email protected] or call the Thompsons inCalifornia at 1-858-748-5677.

With cooler weather approaching, smokers need to becareful of exposure to wood smoke, either from homeheating, cooking or from the outside environment. Arecent study in the American Journal of Respiratory andCritical Care Medicine found exposure to wood smokeputs smokers at a higher risk to develop COPD thatincludes DNA changes.

As the cold weatherapproaches, don’t forget aboutNancy Pearsall’s Breath Warm-ers! They are made of soft,comfortable polar fleece withadjustable Velcro closures to

protect you against the cold air.BreathWarmers™ are available for $15.95 plus

$2.95 for shipping. For further information call 1-810-653-8006, visit www.breathwarmers.com, or writeBreathWarmers™, P.O. Box 121, Davison, MI 48423.

Say What?Ron Sveden, 75, of Brewster, MA, was astonished to

discover that what he thought was a tumor growing inhis lung was actually a plant that had sprouted from aninhaled pea. It was about half an inch long.

The doctors told him he must have eaten a pea that“went down the wrong way,” and the moist andwarm conditions in the lung were just right forit to sprout and grow. He underwent surgeryto remove the pea, and is now home.

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When you make your airline or other travel reservations,make sure your name matches exactly what is on thegovernment-issued ID that you are going to use foridentification. The Transportation Security Administration(TSA) has announced that it will require full name(middle name too if on your passport or driver’s license),date of birth and gender for all passengers traveling onor after November 1, 2010, regardless of when thereservation was booked.

Invacare’s Solo2 portable oxygen concentrator hasreceived FAA approval for use during flight. This meansyou now have 11 choices of portable oxygen available toyou. As always, be sure to check your airline’s specific rulesand regulations well before your trip is scheduled.American and United Airlines are still supplying oxygento their passengers in addition to allowing portableoxygen concentrators to be used onboard.

The AARP recommends quick exercises while travelingto keep your energy levels up. When in the car for manyhours, make sure the driver’s seat is at a 90 degree angleto prevent the head from tilting forward and that every-one has plenty of leg room. You should not sit on yourwallet since it could irritate your sciatic nerve.

Take frequent breaks to stretch. While standing, raiseyour arms above your head, clasping your fingers together.Look up at your hands, holding this pose for 20 seconds,then relax.

Also try to place your right foot on a bench or step thatis at knee height, as in a lunge position. Place both hands,palms down on your right knee, keeping your left legstraight. Lean in slightly and hold this position for 20seconds and then repeat with the other leg.

Finally, sit near the edge of abench and extend one leg in frontof you, toes pointed up. Bendforward slightly at the hip, keep-ing your back straight, untilyou feel a slight stretch in yourhamstrings. Try to hold your legup for 20 seconds and then try it with your other leg.

The concept of altitude affecting your breathing whenyou travel by air is a difficult one to understand. Thepressure in an airplane’s cabin is the same as if you wereat 5,000 to 8,000 feet above sea level. To give you someperspective, the people in Denver – the Mile High City –live at an altitude of 5,280 feet. The population ofWinter Park, CO, is about 1,000 people when it is not skiseason – they live at an altitude of about 9,000 feet.

When you go up in elevation – as on a flight – thepressure becomes less and less oxygen is available tosupply energy to your body.

According to the Aerospace Medical Society, “Half thecabin air is fresh air drawn in via the engines with theother half recirculated from the cabin. The recirculatedair is ducted through a HEPA air filter before beingreintroduced into the cabin. There is a total air change(filtered/recirculated plus outside air) every 2 to 3 minutes.

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7-Day Cruise: Roundtrip from Ft. Lauderdale

The Western Caribbean!March 13, 2011Aboard Holland America’s Nieuw AmsterdamDay PortMarch 13 Ft. LauderdaleMarch 14 Half Moon Cay, BahamasMarch 15 Grand Turks, Turks and CaicosMarch 16 Cruising at seaMarch 17 Georgetown, Cayman IslandsMarch 18 CostaMaya, MexicoMarch 19 Cruising at seaMarch 20 Ft. Lauderdale

Price per person based on double occupancy. Inside Cabin from $799;Ocean View Cabin from $849; Balcony Cabin from $1,099; Mini-Suite/Suite from $1,699. Government taxes and fees are $74.78/person. Single and Third/FourthPerson Occupancy available. Adeposit of $350 is due within 5days of making your reservation.Final payment is due Dec. 28,2010. A passport is required!

Join the Airheads fromThe Villages, FL!

10-Day Cruise: Roundtrip from Ft. Lauderdale

The Panama Canal!April 4, 2011 Aboard the Coral PrincessDay PortApril 4 Ft. LauderdaleApril 5 Cruising at seaApril 6 Cruising at seaApril 7 ArubaApril 8 Cartagena, ColombiaApril 9 Panama Canal, PanamaApril 10 Limon, Costa RicaApril 11 Cruising at seaApril 12 Ocho Rios, JamaicaApril 13 Cruising at seaApril 14 Ft. Lauderdale

Price per person based on double occupancy. Inside Cabin from $1,299;Ocean View Cabin from $1,499; Balcony Cabin from $1,899; Mini-Suite/Suite from $2,189. Government taxes and fees are $223.48/person. Single and Third/FourthPerson Occupancy available. Adeposit of 20% is due within 5days of making your reservation.Final payment is due Jan. 19,2011. A passport is required!

11-Night Cruise: Roundtrip from Copenhagen, Denmark

Scandinavia & Russia!June 4, 2011 Aboard the Emerald Princess

Day PortJune 4 Copenhagen, DenmarkJune 5 Oslo, NorwayJune 6 Aarhus, DenmarkJune 7 Berlin, GermanyJune 8 Cruising at seaJune 9 Tallinn, EstoniaJune 10 St. Petersburg, RussiaJune 11 St.Petersburg, RussiaJune 12 Helsinki, FinlandJune 13 Stockholm, SwedenJune 14 Cruising at seaJune 15 Copenhagen, Denmark

Price per person based on double occupancy. Inside Cabin from$1,590; Ocean ViewCabin from $2,190; Balcony Cabin from $2,690;Mini-Suite/Suite from $3,390.Government taxes and fees are$151.57/ person. Single andThird/Fourth Person Occupancyavailable. A deposit of 20% is duewithin 5 days of making yourreservation. Final payment is dueMarch 21, 2011. A passport is required!

8-Day Cruise: Roundtrip from Seattle, Washington

Alaska’s Tracy Arm FjordJuly 1–8, 2011 Aboard Celebrity’s InfinityDay PortJuly 1 Seattle, WashingtonJuly 2 Cruising at seaJuly 3 Ketchikan, AlaskaJuly 4 Tracy Arm Fjord & Juneau, AlaskaJuly 5 Skagway & Inside PassageJuly 6 Cruising at seaJuly 7 Victoria, British ColumbiaJuly 8 Seattle, Washington

Price per person based on double occupancy. Inside Cabin from $935;Ocean View Cabin from $1,135; Balcony Cabin from $1,665; Mini-Suite/Suite from $2,499. Government Taxes and Fees are $159.38/person. Single and Third Person Occupancy available. A deposit of 20%is due within 5 days of makingyour reservation. Final payment isdue April 17, 2011.

Get Up and Go2featuring

Sea Puffers Cruises

We take the worry out oftraveling with oxygen!

Visit www.seapuffers.com or call 1-866-673-3019 to join the fun! FST: ST36334

You will always the lowest possible price availableat time of booking with Get Up & Go2! Each person will

receive shipboard credit as well as other surprises!

Become a fan or ‘Like’ ourGet Up and Go2 featuringSea Puffer Cruises Facebookpage! You’ll be able to keep upon our latest news, includingdaily blogs during our trips! º

Call to book your individual trip or join us on our upcoming group cruises!


A recent article in the Journal of Asthma and AllergyEducators talked about common mistakes made whentaking aerosol medications. Unfortunately, each deviceuses a different technique of inhaling. When usedincorrectly, you could receive less than optimummedication delivery. It is all about the particle size whenyou take breathing treatments. Too large particles willdeposit in your throat and never make it to your lungs;too small will stay suspended and be exhaled.

Nebulizers –You should take your treatmentwith slow, regular breathingthrough your mouth.Frequently holding yourbreath at an end of aninspiration ensures theaerosol particles are depositedin your lung. Be especially careful ofkeeping the nebulizer clean. Any germs on the equip-ment may go directly into your lungs.

Dry Powder Inhalers (DPIs) –When using medications such as the Spiriva Handihaler,Advair Diskus or Foradil Aerosolizer, instead ofbreathing in slowly on the DPI, you should breathe infast and deep to get the most benefit. Be sure to take themedication in the chamber of a discus before trying to

advance it or it may becomeclogged. With the Handihalerand Aerosolizer, you shouldpuncture the capsule only once.If done multiple times, you mayend with pieces of the capsulein your lungs. You should notbreathe into a DPI as the moisture may collect and affectthe medication. Remember to rinse your mouthafterwards to avoid any infections.

Valved-Holding Chambers –With spacers used with your metered dose inhaler(MDI), remember to prime your inhaler according tothe manufacturer’s instructions. You should use onlyone puff of medication at a time. Many people depressthe inhaler twice and then take two breaths. If you waittoo long before takingthe breath after youhave activated theinhaler, you willget less medicationto your lungs. Breathe in slowly and hold your breathfor ten seconds.

Please read the manufacturers cleaning and disinfectingdirections on all the devices. It is critical that they bekept clean!


Taking Aerosol Medications Correctly

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

Sequal’s EclipseSmallestcontinuousflow POC. 3LPMcontinuousand 6LPMpulse

Respironic’sEverGoBest battery life,8 hours at 2LPM6LPM pulse

Respironic’sEverflo™ Quiet withOxygen Purity IndicatorSmall form, 30 lb.stationary unit ($799delivered). Great for afteryour Medicare rental!

Invacare®XPO2™Lightest POC at6 lbs.! 5LPM pulse

Rx Stat Respiratory will match or beat anyone’s prices on oxygen equipment!

Rx Stat will beat anyone’s priceon a new portable concentrator.

We also rent POCs for travel:$395 for first 10 days, $295 for each

additional 10 days–includes shipping!

And we buy and sellused portable concentrators.

Call for availability!

See demos of POCson YouTube.com,search “Rx Stat”


Our Lives, Our Air is the COPD Foundation’s inno-vative “phase two” of its Faces of COPD program. Thiscivilian photography project encourages individualswith COPD to become involved in changing the stereo-types that come with a COPD diagnosis. Our Lives, OurAir will be a new form of a documentary designed to raiseawareness of COPD and its prevention and treatment.

In order to represent the magnitude of the COPDepidemic, the project is planned to be large in scale,engaging approximately 200 citizen photographers.Each individual will use the camera to tell their story,photograph their life and share their unique experiencesof living with COPD.

Our Lives, Our Air will result in a traveling photo-graphy exhibition, as well as a book and educationaloutreach programs, that will reach millions worldwide.Photographs produced through this project will becarefully edited by world renowned photographers,Taj Forer and Joel Sternfeld.

The final photographs will poignantly and respectfully

represent the realities of COPD in various geographicregions in the United States and the world with beautyand power. It is clear that powerful, visual educationalprograms and messages have an impact.

Our Lives, Our Air will provide a significant visualprogram that will re-define the face of COPD and sharestories of the global epidemic. With increased awarenessleading to increased testing and education, COPD willaffect fewer people and those affected will have the mosteffective medical care possible to improve their overallquality of life. Our Lives, Our Air has the potential toimpact generations of men, women and children acrossthe globe.

For more information about Our Lives, Our Air andhow to participate, visit www.ourlivesourair.org.

Faces of COPD is also a program of the COPDFoundation. The people who are sharing their stories areinformed, educated and empowered and want to sharetheir COPD story with you at www.shareyourcopdstory.com.

Innovative Project Encourages Change to Stereotypes of COPD

Dedicated to Respiratory Health Care

PaperPO Box 877, Ormond Beach, FL 32175-0877

ThePulmonary Non-ProfitOrganizationUS Postage

PAIDDaytona Beach, FL

Permit #275

Respiratory NewsA clinical study comparing Sprivia in the Handihaler

and in the Respimat is now recruiting participants. It issponsored by Boehringer Ingelheim Pharmaceuticals – theclinicaltrials.gov identifier is NCT01126437.

Because it requires control of breathing and posture,singing lessons can improve quality of life measuresand decrease anxiety in COPD patients, according to astudy in the August 2010 issue of BMC PulmonaryMedicine. After a 6-week course of twice weekly singingclasses were added to usual care, 81% of attendeesindicated a “marked physical difference” after theirattending the sessions.

Budesonide and Formoterol (medications which makeup Symbicort) resulted in a significant improvement inendurance time one hour after the last morning dose ina 1-week treatment period versus Formoterol andplacebo. This study demonstrates, for the first time, thebenefit of inhaled corticosteroids in addition to long-acting beta(2)-agonists on exercise tolerance in peoplewith COPD.

Pulmonary arterial hypertension (PAH), high bloodpressure in the lungs, currently has few treatment options.It is caused by excessive growth of cells in the wall of thelung blood vessels, which puts pressure on the right ven-tricle of the heart and may lead to heart failure. Researchersat the University of Alberta have found that this excessivecell growth can be reversed by targeting the mitochondriaof the cell, which control cell metabolism. The use ofdichloroacetate (DCA) or Trimetazidine (TMZ),mitochondria-targeted drugs, helped eliminate the excessivecells and reverse pulmonary hypertension in an animalmodel. Clinical trials are expected to be the next step.

Handihaler Respimat

the paper pulmonarypulmonaryperformance.com/ppsepoctfinal.pdf · 2012-06-09 · the safety profile...

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