There is so much confusion when it comes to defining COPD, so let’s try to clear it up for you. According to the World Health Organization, Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms “chronic bronchitis” and “emphysema” are no longer used, but are now included within the COPD diagnosis. Other diseases that fall under the COPD “umbrella” are bronchiectasis and refractory asthma (chronic, difficult to control).
Let’s break them down:
Chronic Bronchitis causes the following changes to occur in the airways: increased mucus production, swelling and constriction of the smooth muscle that surrounds the airways.
Emphysema is a lung condition that causes the air sacs in the lungs (alveoli) to become damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.
When you exhale, the damaged alveoli don’t work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter.
Most people with emphysema also have chronic bronchitis.
Bronchiectasis(brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. It is usually the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Your airways slowly lose their ability to clear out mucus, which then builds up and creates an environment in where bacteria can grow. This leads to repeated, serious lung infections. Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.
Chronic or Refractory Asthma Another frequent component of a COPD definition is refractory asthma, meaning asthma that is nonreversible, which differs from most forms of asthma. Some forms of asthma can be nonreversible and mimic emphysema. The following chart shows the differences between asthma and COPD but it is important to note that long-untreated asthma can become a chronic condition that has caused irreversible lung damage.
This was meant to be a brief overview of chronic lung diseases only. If you are unsure of your diagnosis or need more information, please contact your physician.
When you have COPD, your body burns many more calories due to increased work of breathing. While much is made of the need to lose weight, we forget about those who are losing too much weight, muscle mass and strength. About 1 in 4 people with COPD are underweight, and this makes it more likely that their immune system won’t work properly. Eating more protein and getting more calories from nutrient-rich foods are good ways to prevent excessive weight loss. Here are some tips:
- Eat healthy fats. Because of the way fats are digested, they don’t tax the respiratory system like other foods can. Toss a salad in olive oil instead of having plain steamed veggies.
- Eggs and lean meats are full of protein. Eggs are easy to cook, which is a big benefit for those who find that cooking takes too much energy. Marinate a lean cut of meat in a vinaigrette and make a stir fry cooking with oil.
- Dairy can add calories and calcium to your diet. Add a slice of cheese to pastas, casseroles and sandwiches or add mixed powdered milk into recipes. Don’t go overboard.
- Nuts are a concentrated source of healthy fats. They add calories and have antioxidants (to fight inflammation). Toss into salads or make your own favorite snack by adding some dried fruit to a handful.
- Dessert? You Bet! Enjoy eating, even if it is a struggle at times, by allowing yourself to indulge in sweets you love. Cakes and ice cream are usually made with eggs and/or milk so you’ll be getting added protein and fats. Make sure to balance these treats with more healthful food, though.
- Milkshakes and smoothies can be a good choice as a supplement to your meals, but make sure they have protein, fiber and fat. You can find these already prepared and canned for a quick snack during the day. Look here for recipes- http://theindianspot.com/healthy-weight-gain/
Many of you who are using oxygen are finding it more and more difficult to get out while using it, mostly because the tanks don’t last you long enough to make even short trips to the store, let alone take in a movie. For some of you a portable oxygen concentrator, which takes air from the room around you and converts it into a concentrated source of oxygen may be an answer. Before you actually buy one, here are some things to consider:
- Check with your insurance to see if it is a covered item.
- Talk with your physician to determine whether you can use a pulse dose (intermittent flow-IF) or will need continuous flow (CF).
- Call your durable medical equipment company to see if they have one for you to try before you buy one or if they can rent one to you. All companies are different and have different portable concentrators that they use and supply. They should be able to help you find the most appropriate device for your circumstances.
- Check the specifications- How much does it weigh? How much does it weigh with the battery? Is there a battery included? How long will the battery last? How much will a spare battery cost? Will it provide continuous flow (CF) or only intermittent flow (IF)?
- If you are set on purchasing one on your own, do your homework. It is best to call the manufacturer directly to eliminate the possibility of getting one that isn’t appropriate for you or one that may have been used and refurbished. This is not to say that there aren’t companies out there that have a variety to choose from, provide decent service and sell both new and used, but if you want to be sure, buy directly from those making the concentrator or your DME company.
- Come to our “Breathing In The ‘Burgh” boat ride on the Gateway Clipper on Friday, June 15. Our keynote speaker will be talking about this topic and can answer your questions to prevent you from making a purchase that does not suit your needs. Call 724-772-1750 or register online.
With another tax season behind us, it’s not a bad idea to think about how you’re going to handle medical expenses on next year’s returns. The federal tax law has a 7.5% threshold for medical expenses for taxes filed in 2018 and 2019 (for 2017 and 2018 tax years). This means that you can deduct medical expenses that are higher than 7.5% of your adjusted gross income (AGI). For example, if your income is $30,000—7.5% of your income is $2,250. If your medical expenses add up to $4,000, you can then claim $1,750 ($4,000 – $2,250) on your tax return for medical expenses.
Keep in mind that it will only make sense to itemize your deductions if the total of the deductions is more than what you’d get by filing with the “standard” deduction. Taking the standard deduction is much easier so if there is only a slight difference between the two totals, the standard would be the way to go.
Starting with the 2019 tax year, the standard deduction is going to go way up, almost double what it is now. If you’ve spent a large amount on medical bills over the last year, this would be a good time to look at the numbers. This deduction is particularly important to Medicare beneficiaries who spend on average $5,680 each year on health expenses that Medicare does not cover, says the AARP.
For a complete list of medical expenses you can deduct, go to www.IRS.gov/forms and see IRS Publication 502. Here is a short list of some expenses that are included aside from the typical such as physician, dental and X-rays:
- Inpatient hospital care or residential nursing home care
- Acupuncture or inpatient alcohol or drug addiction centers
- Weight-loss program for a specific disease
- Insulin and drugs that require a prescription
- Admission and transportation to a medical conference relating to a chronic disease that you, your spouse or dependents have if necessary for medical care
- False teeth, reading or prescription glasses, hearing aids, crutches, wheelchairs
- A guide dog or other service animal to assist a visually impaired or hearing impaired person
- Electricity costs for using an oxygen concentrator (you will need a formula for this calculation)
There are many more deductions available and you will need to check for specifics, but this should at least get you thinking whether itemizing might be for you. Good luck!
Ref: The Pulmonary Paper, January/February 2018 Vol. 29, No.1
The COPD Store www.IRS.gov www.aarp.org
Exercise benefits our bodies by controlling weight, it helps us to fight certain health conditions and diseases, and it improves our energy and mood. But when you have asthma, exercise may seem impossible because while exercise is very beneficial to us, asthma that is out of control will make it more difficult to workout. It is very important to work with your doctor to control your asthma before you decide to begin an exercise regimen.
With asthma, my choice of exercise is running. I know when and how fast I can run, and when I need to pre-medicate. I do more of my road work in the fall and spring, while spending my hot summer days and cold winter days in a controlled inside environment on a treadmill.
Asthma does not have to keep you out of the game, though. There are exercises that are best if you have controlled asthma that will benefit you. It is very important to offer your body a 5-10-minute warm-up and cool down, no matter what form of exercise you choose.
Some of the following exercises could work for you:
- Walking- studies have shown that 30-60 minutes of walking at a moderate pace is one of the best cardio exercises we can do, with or without asthma. Walking 3 times a week for 12 weeks can help better control asthma and increase your exercise abilities.
- Yoga- while offering you core strengthening, yoga is great for asthma because it teaches the individual controlled breathing. One study focused on people, who after doing yoga 2.5 hours a week for 10 weeks, were able to decrease their asthma medication.
- Swimming- Allergists have said that swimming is ideal for people with asthma because you’re breathing in air that is highly humidified and often warm, and staying horizontal can sometimes help loosen mucus in the lower parts of the lungs. Don’t think you have to swim laps either—just moving around in the pool can be beneficial. However, note that chlorine used in pools can trigger asthma, so use precaution at pools with a strong chlorine smell.
In addition to these exercises, Health.com also suggests baseball, softball, volleyball, and football as good sports for asthma because of the quick bursts of play coupled with rest.
Whether you pick swimming, football or walking, working out with asthma is very important for the health of your body. So, let’s get up and get moving!
Recently I received a dreaded call—the lice call. My first-grader with beautiful, flowing, long hair was possibly exposed to someone with lice! I wasn’t sure what to do, so I headed to the local pharmacy to pick up a lice kit. I wanted to arm myself against any new little friends setting up house in my little girl’s head. After speaking with the pharmacist, I purchased the Nix, Lice treatment Creme Rinse kit.
It is extremely important to read every label of the products we use. On the side of the Nix box there is a warning stating; “Ask a doctor before use if you are allergic to ragweed. May cause breathing difficulty or an asthmatic episode.”
As someone with asthma and a ragweed allergy, I wanted a better understanding of the active ingredients in this product. So what is in Nix Crème Rinse that causes this reaction? I contacted the Nix consumer group and regulatory department and learned that the active ingredient in the product is Permethrin, a synthetic version of pyrethrin. Pyrethrin is derived from chrysanthemums, which is a direct relative to ragweed. Though it is uncommon for this synthetic version to cause an asthmatic episode, it can happen.
A study on Permethrin Crème Rinse was done by using products containing this synthetic pyrtherin. The study’s results found that 1.0-3.5 adverse events per 1,000 patients proved that this reaction is uncommon, but it is still important to watch the use of this product in someone with a ragweed allergy.
Nix consumer group actually suggested NOT using this product if an allergy exists and utilize Nix Ultra with active ingredients of Dimethicone (silicone-based polymer) and mineral oil.
After this scare, I have spoken to numerous parents regarding their treatment options, and one mother turned to the Nuvo method, which is a non-toxic option that uses Cetaphil to suffocate the lice and eggs.
Another method recommend for asthmatics is repeated wet combing with the use of a lice comb.
Lice cause a real itchy situation in homes, but it is important that during the anxiety of treatment and cleaning, you don’t forget about other underlying issues such as asthma. Whatever method you use, always be careful using products on children—especially ones with asthma and allergies. Please read your labels and don’t be afraid to ask questions.
Tuberculosis is a global epidemic, but it is preventable and curable. In 2016, 10.4 million people were sickened with tuberculosis and there were 1.7 million TB-related deaths throughout the world. In the United States, there were 9, 272 cases of TB in 2016. According to the CDC, TB was reported in all 50 states with 174 of those cases in Pennsylvania.
March 24 is annual World TB day. It marks the date in 1882 that Dr. Robert Koch announced the discovery of “Mycobacterium tuberculosis”, the bacteria that causes tuberculosis (TB). In Dr. Koch’s time, TB killed 1 out of every 7 people in the United States and Europe. Today, one-fourth of the world’s population is still infected with TB. 100 years later, March 24 was designated as a day to educate the public about the impact that TB is still having around the world.
Even though the number of people with active TB disease is declining in the United States, there are still millions that have latent TB infection (LTBI). Someone with latent tuberculosis lives with tuberculosis bacteria in their body, but is not sick and cannot transmit the disease. Sometimes, the bacteria can become active. When this happens, a person will change from having latent disease to being sick with active disease. People with active TB are contagious and can spread the infection. There are certain people who are at increased risk of converting from LTBI to active TB, and for this reason, should be treated preventatively. Treatment for LTBI has been challenging, and many people do not comply with the often lengthy regimens.
For over 100 years, Breathe Pennsylvania has been involved in the fight against tuberculosis in western Pennsylvania. In honor of World TB day, we will be offering our 5th Annual Tuberculosis Education Conference on March 22. This event is an opportunity for health care professionals involved with tuberculosis to learn from experts in the field.
For more information about this year’s conference, visit our event page: http://breathepa.org/programs/tuberculosis-educationoutreach/tuberculosis-education-conference
Asthma is a chronic, obstructive disease of the lungs and having it can increase the chances of higher severity and complications from the flu. Asthma does not make a child or adult more likely to get the flu but the infection can be more serious, even with well-controlled asthma. The reason is that asthma causes swollen and sensitive airways, and the flu will cause further inflammation that cab trigger an attack. It can also increase the chances of developing pneumonia after being sick. Per the Centers for Disease Control and Prevention (CDC), asthma is the most common condition in children hospitalized with the flu.
If you have asthma, it is very important to use precaution to prevent the flu:
- Everyone ages 6 months or older should get a flu vaccine.
- Since Pneumonia can be a serious complication in people with asthma, consider getting the Pneumococcal vaccine as well.
- Stay away from people who are sick and keep your child home from school when they are sick.
- Teach your child to catch coughs and sneezes into their elbow or a tissue.
- Wash your hands often with soap and water, especially after coughing or sneezing.
- Use hand sanitizer when proper hand washing is NOT available. Washing is best.
- Avoid touching eyes, nose and mouth.
- Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill.
- Continue to follow the asthma action plan developed by your doctor or your child’s doctor.
If sickness does develop, get treated as soon as possible (within the first 48 hours). Antiviral drugs can make the flu illness milder and relive symptoms quicker. Make sure to stay hydrated and get as much rest as possible.
Take steps to prevent the flu and remain healthy!
When you have COPD it can be a struggle just getting air in and out of your lungs. Not taking in enough calories can cause you to lose muscle mass and strength, so you need to get the most nutrition and calories in every bite. Here are a few tips to try:
- Eat more often. Small meals help because you may become too full too fast when you eat a larger meal. Being too full can also make breathing harder. To save energy, make smaller meals that are quick and easy to prepare. Try: Turkey pita with cheese and fresh avocado.
- Fatten it up. Fats help you breathe easier because they make less carbon dioxide, which may already be trapped in your lungs. Try: Peanut butter, almond butter or hummus on whole wheat bread. Use full-fat mayo or dressings for your salad or sandwich.
- Pour on the protein. Proteins help build up lost muscle mass. Try: Make a batch of hard-boiled eggs to add to meals or to eat as a quick snack.
- Get fruity. Rich in fiber, vitamins and calories, fruit is easy to find all year round. Don’t eat too much, though, because fruit can pack a lot of sugar. Try: Dried fruit has less water so mix your favorites with some nuts for a great and filling snack.
- PB&J has it all. Easy to make, cheap and healthy. Have a glass of whole milk with it!
So there you have it. Eat better, breathe easier and enjoy life!
Many parents have received a prescription for a nebulizer for their child—whether it’s a one-time occurrence for bronchiolitis or reoccurring for a chronic lung disease such as asthma. Nebulizers are used to administer aerosol breathing treatments to help open the airways. Unfortunately, concise usage and care instructions are not always given, so let’s try to clear up some of the typical questions we hear from parents:
What does albuterol do? It is a medication called a bronchodilator that helps open up tightened or constricted airways. It is fast-acting, but doesn’t usually last more than 3-6 hours. While it works to make breathing easier, one of the effects you may notice is your child being “jumpy” following a treatment. Because of this, it’s important to never use it more than every 4 hours unless directed by your physician.
What is the difference between a mask, a mouthpiece and a blowby? If your child is over 4 or 5 years old and is able to follow directions, they should be encouraged to use the mouthpiece while you watch them take every breath. He/she should breathe normally through the mouth and take a deep breath and hold it for 5-10 seconds every 10-15 breaths.An infant or child-sized mask should be used for younger children, but it comes with challenges. If your child is crying they will get little to no benefit from the therapy so it’s best to help them adjust by letting them hold the mask up to their face with no medication being used or show them a sibling or parent that is using the mask. The child also has to be sitting as upright as possible to keep the medication flowing properly in the med cup (Kit/Jet nebulizer).
Although blow-by (putting the mask or flexible tubing close to the child’s nose and mouth) has been used in the past, it is now known to be discouraged.
What is a normal respiratory rate for an infant/child?
Newborn- 6 months 30-60 breaths per minute
6-12 months 24-30 BPM
1-5 years 20-30 BPM
6 years and older 12-20 BPM
How long should a treatment last? A typical unit dose vial of medication should last about 7-10 minutes depending on the machine being used. Tap the sides of the medicine cup when it starts to sputter to bring the droplets back down from the sides. You can do this a few times to get the most medication possible.
How do I know when to give my child a treatment? If your doctor has ordered a specific time frame such as every 4-6 hours, you should follow these instructions. If ordered “as needed,” you’ll want to look for these signs:
- is your child’s breathing becoming faster and more labored?
- is her cough becoming tighter-sounding with wheezing?
- is his respiratory rate becoming faster?
- are symptoms generally increasing?
These are all signs that a treatment is necessary. There are also more severe signs such as lips and nails turning darker/bluish, and much more rapid and labored breathing such as the chest pulling inwards and use of shoulders and neck muscles when breathing. In these cases, give a treatment and call your doctor. One important thing to know is that kids compensate for a long time but then can run out of steam, so it’s important for you to be vigilant at all times. No one knows your child as well as you do.
When should I call my doctor? If symptoms are worsening even after administering breathing treatments every 4 hours, if your child isn’t eating or sleeping for over 24 hours, or if your child has a fever on and off for 2 days along with respiratory symptoms. Trust your judgement.
How do I get new nebulizer kits? The company that supplied your machine will be able to send new kits to you. Their sticker should be on the machine or check for paperwork received. If you don’t know, call your insurance provider and ask them what companies can supply these for you. Check the filter on the machine and replace as necessary. Check an instruction manual if you received one, call your equipment provider or check the manufacturer’s website for more info. Generally, if it looks discolored it will need to be replaced.
Breathe PA has an assistance program that can help you obtain a nebulizer machine if you don’t have insurance coverage.
Please visit our website for more information. In addition, you are always welcome to call us and speak with one of our clinicians.
References: Cleveland Clinic, WebMD, AARC Clinical Practices, Phillips Respironics