About World TB Day

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

How the Flu Impacts a Child With Asthma

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!

Eating Well to Breathe Better

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!

My Doctor Ordered a Nebulizer for My Child—Now What?

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 often should I clean the nebulizer kit? Every day. Click here for more information on how to clean your nebulizer. You can also learn more by watching an educational videoon our YouTube channel.

How often should I clean the nebulizer kit? Every day. Click here for more information on how to clean your nebulizer. You can also learn more by watching an educational videoon our YouTube channel.

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

Sleep Apnea Can Affect Your Heart Health

The month of February is often associated with love, Valentines and hearts, but there’s a reason beyond Valentine’s Day that February is the month of hearts. For 50 years, American Heart Month has been observed during the month of February. The campaign is aimed at increasing awareness of heart disease, the number 1 cause of death in our country.

According to millionhearts.hhs.gov, approximately 1.5 million heart attacks and strokes happen in the United States each year. While anyone can develop heart disease, people with high blood pressure, high cholesterol and those who smoke are at higher risk. Knowing and modifying your risk factors can lower your risk of becoming a statistic. Regular exercise, healthy eating and not smoking are all great ways to improve your heart health, but did you know that there is also a strong link between heart health and sleep?

Undiagnosed or untreated obstructive sleep apnea (OSA) has been shown to be a major cause of high blood pressure, which is risk factor for both heart attacks and strokes. Research shows that up to 50% of people with OSA also have high blood pressure. Obstructive sleep apnea is also often associated with obesity, which is another risk factor for heart disease.

How does obstructive sleep apnea cause heart problems?  When you suffer from OSA, you stop breathing many times during the night, which causes your oxygen levels fall. When this happens repeatedly, your brain sends messages to your body to “tighten up” the blood vessels so that an increased flow of oxygen can be delivered to your heart and brain. This reaction causes your blood pressure to unnaturally increase during sleep. Unfortunately, this increase in blood pressure can sometimes continue during the day. People with untreated obstructive sleep apnea can also develop atrial fibrillation (an irregular heart beat) and heart failure.

Fortunately, obstructive sleep apnea is a risk factor for heart disease that you CAN control. If you want to learn more about symptoms of obstructive sleep apnea, diagnosis or treatment options, you should make an appointment with your doctor. You can also visit www.breathepa.org for more information.

Happy Heart Month!

Medicare Coverage for Oxygen

Many people whose physicians have ordered oxygen for home use are confused as to what Medicare will and will not pay for and for how long. The following may clear this up a bit:

Durable Medical Equipment (DME) is covered by Medicare Part B. This coverage will pay 80% of the allowable rental amount— which varies by region— and the Medicare recipient pays 20% plus any Part B deductibles. The amount paid by Medicare covers not only the equipment, but any supplies needed such as nasal cannulas, bubble humidifiers or filters.

As to the equipment itself (concentrator, gas or liquid tanks), Medicare will pay your provider monthly for 36 months. After that time your supplier must continue to provide maintenance and service for the next 24 months at no extra charge to you. After that time (5 years total) you may choose a new provider or keep your current company and the 36-month rental period begins again.

Because Pennsylvania is subject to the Competitive Bidding Program you must rent your equipment from a DME supplier that is contracted with Medicare. Unfortunately, this limits your choices if you are not happy with the company you have. To find out which providers in your area are contracted with Medicare go to: www.medicare.gov/supplierdirectory. You will have to choose from a list the equipment you are inquiring about, enter your zip code and a list will be provided for you.

Stay Healthy This Flu Season

The 2017-18 flu season is in full swing, and flu activity is currently widespread in most of the United States. Here are a few facts to keep in mind as you aim to stay healthy:

  • The “stomach flu” and influenza are not the same thing. The flu is a lung disease that also can cause nausea, vomiting and diarrhea, but those symptoms are more common in children. What we refer to as stomach flu is an intestinal disease that is caused by bacteria or viruses other than influenza virus.
  • Flu vaccines cannot give you the flu.
  • Influenza is caused by a particular virus (A, B, or C), rendering antibiotics ineffective. It is spread when infected droplets enter your nose or mouth—that can happen when you breathe (especially when someone who is sick sneezes or coughs around you), when you kiss someone who is sick, or when you touch something with the virus and proceed to touch your face/mouth. Wearing a facemask helps prevent the spread of these germs.
  • The Centers for Disease Control and Prevention (CDC) reports that a flu vaccine is the most effective way of protecting against the flu. This is especially important for those suffering from chronic diseases such as asthma, heart disease, chronic lung disease, and kidney and liver disease, to name a few, because the flu can make these conditions worse.
  • The following groups are considered by the CDC to be at high risk for developing flu-related complications:
    • Children younger than 5 but especially younger than the age of 2.
    • Adults 65 and older
    • Pregnant women
    • Residents of long-term care facilities
  • The dosage of the flu shot for those 65 and older contains 4 times the antigen as the regular flu shot, creating a stronger immune response. This high-dose vaccine has been available for use in the U.S. since 2009. New for 2016-17 was the adjuvant flu vaccine (modifies the immune response to give a higher amount of antibodies so less of a foreign material needs to be injected)
  • Antiviral medications such as Tamiflu are only effective if used within the first 2 days of onset and are only available with a prescription.
  • If you begin experiencing shortness of breath while fighting the flu, see your doctor right away as it may be a sign of pneumonia. This is especially important for those suffering from chronic lung diseases.
  • Keep in mind that the cold weather masks provided by Breathe PA only warm the air you breathe. They are not a filter from allergens, smoke, molds or infectious particles.

Link: www.cdc.gov/flu/about/index.html

A Christmas Tip List for Living with Obstructive Sleep Apnea

With the holidays rapidly approaching, our minds and bodies are racing to get through an endless to-do list, with proper sleep sometimes being sacrificed in the process. For everyone, the lack of sleep can lead to fatigue and lack of concentration, and it can leave us more susceptible to the holiday blues. For those who live with obstructive sleep apnea, there can be additional problems and worries.

If you are already struggling with CPAP therapy and getting a good night’s sleep, the frustration can be worse this time of year. The following tips to common problems may help make your holiday season merrier:

  • Are marks from your headgear leaving you self-conscious for your holiday parties? Many manufacturers make CPAP headgear mask covers/pads for less than $10 that can be placed over your straps, minimizing those morning marks.
  • Does your mask leave the bridge of your nose or face sore? Maybe you should consider CPAP mask liners. You can find disposable and reusable ones for full face or nasal masks. Not only do some wearers like them to alleviate marks and pressure points, but liners can also help to create a better seal and alleviate leaks for some CPAP wearers.
  • Do you have problems with water (rain-out) in your CPAP tubing? Rain-out is caused by condensation. If you have a heated humidifier and non-heated tubing, the process of air cooling as it moves through the tubing will leave water. This problem can be worse in the winter, when the room temperature is much cooler than the temperature of the air coming out of your CPAP.  Heated tubing will keep the air warmer minimize this problem. Alternatively, some people may look for “CPAP hose covers.” These covers fit over your CPAP hose warm the air as it flows from the machine to the mask.
    • Even though your humidifier should always be positioned lower than your head, there are companies that make “hose lifts”. This is a gadget that positions your CPAP tubing higher so that the rain-out falls back into the humidifier instead of into your mask. Hose lifts also suspends your tubing overhead, keeping the hose from tugging on the mask you sleep.

A few final thoughts:

  • Alcohol can worsen obstructive sleep apnea. If you choose to imbibe over the holidays, try not to do so within four hours of bedtime.
  • CPAP only works when you wear it. With the stress of the holidays, it may be tempting to skip packing your unit for overnight travel. Even if it is only for one night, it’s important to bring your CPAP and wear it where ever your holiday travels take you.

The information provided here is not intended to replace the advice of your medical team. Always talk to your physician, sleep clinic or home medical equipment provider about any problems you are having.  Often times, a simple remedy is right around the corner.  Happy Holidays!

Tips for Holiday Travel with Oxygen & Other Respiratory Devices

The holiday season is rapidly approaching and if you’re planning to travel with oxygen or other mechanical devices you use on a regular basis such as a ventilator, nebulizer or Cpap/BiPap, it’s best to plan ahead to prevent unforeseen problems.

Keep these things in mind:

  • Don’t forget your power cord! If your device can use a car charger bring that, too.
  • Get in the habit of bringing extra supplies and all attachments, even on short trips. Pack spare nasal cannulas, Cpap filters and masks, spare batteries and nebulizer kits.
  • Fully charge battery of your device before leaving the house. If you can, plug in your device when you arrive at your destination or when an outlet is available.
  • Buy or rent an extra battery for longer trips away from home.
  • Get a car charger if possible. They come in very handy.
  • If you’re flying, check with the airline to make sure they allow your device on board.
  • Consider an oxymizer or conserving device to lessen the amount of oxygen you need to use. You will need to be tested to make sure your saturation stays up while using these devices.
  • For trips away from home, know the name and location of the closest DME company that will agree to provide service should you need their help. Your home DME company will be able to help you make the right contacts.

Happy Holidays and safe travels!

Ventless Fireplaces Can Affect Your Asthma

Ventless fireplaces (duct-free fireplaces and room-venting fireplaces), are a type of residential gas-heating device.  Ventless fireplaces are preferred because they burn at nearly 100% efficiency, release far less harmful gasses than most other portable heating alternatives, and their installation is restricted little by architectural constraints. But did you know they could cause an asthma flare up?

When homeowners ask me how to make their homes friendlier to those with lung disease, I do not recommend installing a ventless fireplace. Part of the reason is because the installation of ventless fireplaces involves making a technical judgement about the “tightness” or insulation of a home or room. If the home is very well insulated, manufacturers require additional venting connections to outdoor spaces. This begs the question, “why have supplemental heating if you have to bring in exterior (cold) air?”

These units usually burn natural gas. The byproducts of natural gas are carbon dioxide and water vapor.Carbon dioxide is an odorless, invisible and potentially lethal poisonous gas. Any time these gasses are burned something must be done with their byproducts.  In a traditional heating unit these byproducts are dispelled out of a flu or vent.

Why then are these gasses not vented in “ventless” units? First, they burn such a small amount of gas that any buildup of Co2 will usually “leak” naturally out of a home.  Second, all units have a safety device known as an Oxygen Depletion Sensing device (ODS) that shuts off the unit when carbon dioxide levels get too high.

Asthma sufferers are sensitive to humidity, and low levels of carbon dioxide, even when it is nowhere near a poisonous level.  Adding one of these units may exacerbate ones asthma, and the potential asthma of any visitor.  This is important to think about since these units are often used heavily during the holidays when families get together

If you’re looking to install a fireplace into your home, there are many types to consider. Make sure to research your options and if they will have any impact on your health.