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.

Obstructive Sleep Apnea: Fact or Fiction?

Lately, it seems that Obstructive Sleep Apnea (OSA) has been receiving more attention than ever before. It made the the list as a probable contributor to the death of Star War’s star Carrie Fisher. Recently, NFL Star Ryan Jensen spoke to the media about how his diagnosis of OSA saved his life and career.  So, what’s the fuss over OSA?  By now, most everyone has at least heard of OSA, but there are still many misconceptions about this condition.  Read below to see if you can tell fact from fiction.

Only middle-age, overweight men suffer from obstructive sleep apnea

Fiction:  While older and heavier men create the “classic” profile of an OSA patient, younger and healthy men can be diagnosed with OSA.  Besides Ryan Jensen, Tony Dorsett and Shaquille O’Neill are other athletes living obstructive sleep apnea.  Weight is only one risk factor for OSA.  People of normal weight and thin people can also suffer from OSA.  Tongue size or jaw, nose, and airway anatomy can also cause airflow to become blocked during sleep. There is also sometimes a heredity component to OSA.

Obstructive sleep apnea is often missed as a diagnosis in women

Fact: While OSA is more common in men, women are also susceptible. However, more women than men remain undiagnosed.   In some cases, obstructive sleep apnea is overlooked as a potential diagnosis for women because women don’t often fit the “classic” profile. Women also tend to complain of different symptoms.  A recent UCLA study explains that while men often report snoring and fatigue, women often complain of depression, anxiety or fatigue.  Actresses Amy Poehler and Roseanne Barr are two female celebrities who have OSA.

Obstructive sleep apnea can lead to other serious health conditions

Fact: Untreated OSA has been connected to many other very serious health conditions such as high blood pressure (hypertension), diabetes, stroke and heart disease. Some research shows that up to 1/3 of people who have high blood pressure also have obstructive sleep apnea.  High blood pressure and sleep apnea have both been linked to an increased risk of heart attack and stroke.  OSA has also been linked to diabetes and obesity.

A CPAP machine is the only treatment option for obstructive sleep apnea

Fiction: It is true that positive pressure therapy is the most effective treatment for severe obstructive sleep apnea, but oral devices are becoming a more common option for patients that cannot tolerate CPAP therapy.  Oral appliances work by either holding your tongue in position or sliding your jaw forward when you sleep. Surgical Interventions may also be an option, depending on the cause of your sleep apnea. Ultimately, you and your doctor need to work together to find the treatment option that works for you.

 

Help Students With Asthma Have a Successful School Year

At the start of each school year we are consumed with medical paperwork—physical forms, immunization forms, medication forms and emergency contact forms. They come in the mail or are sent home with the student. It’s easy to place them on a stack with great intentions to complete and send back, but then school starts and before you know it, they are forgotten. But they really are important, why?

Working directly with school nurses as an asthma educator I can’t tell you the countless times there is a need to treat a student with asthma but there are no forms and the proper medication has not been sent in. These students range from those who occasionally present at the nurse’s office with a mild asthma attack, as well as those who have constant breathing issues and spend a majority of the school year seeking help from the school nurse. Keep in mind however, that a mild attack can turn into a major one if the proper medication and action plan is not in place and followed.

The state of Pennsylvania law states (Act 187):

 In order to ensure that a child has his or her asthma medication immediately available when an asthma attack occurs, Pennsylvania schools are required to develop a written policy that allows school aged children to carry (possess) and use (self-administer) their asthma medication. 

It is important to talk with your school nurse about your child’s asthma management before school begins or shortly thereafter. Schools have written policy and procedure that includes asthma action plans that can be completed by both parent and physician. Practice with your child proper inhaler/spacer technique and talk about the purpose of each medication. There’s a good chance your school nurse will require your child to demonstrate they are ready and equipped to self-carry.

If you are not sure what the difference is between short-acting bronchodilators and controlling medication, then consider a conversation with your pharmacist and invite your student to be part of the meeting and ask questions. Short-acting medications reverse asthma symptoms in 3-5 minutes,   easily allowing the child to return back to class to finish the day. Not having access to the inhaler can turn an easy fix to a 911 call, causing the attack to worsen. Now the student is in an ambulance and looking at a possible hospital stay and you are being pulled away from work.

Asthma is one of the top reasons for absenteeism in school settings. A simple fix is to work with both your asthma doctor, school nurse, and student to create an asthma action plan that covers medication use and what to do if an attack occurs. To help you get started, contact Breathe Pennsylvania at 1-800-220-1990 or www.breathepa.org and talk with our Certified Asthma Educators.

Asthma Training Opportunity for Early Learning Practitioners

Breathe Pennsylvania would like to invite our Early Learning Practitioners to contact our Certified Asthma Educators, Jeannie and Jessica, to host or participate in a fun, interactive asthma training.

This 3-hour asthma training has been approved by the Southwest Regional Keys.

The interactive training provides education and case studies that will help practitioners better understand chronic asthma, prevent or respond appropriately to an asthma attack, deliver support utilizing recommended management tools, and be active partners in accessing community resources.

There is no prior asthma knowledge or experience required.

CBK Code: K7 C2- Breathe Pennsylvania will manage the event through PAKeys.

Cost: The center can register 3 staff members for free. All others:

  • 3 hours of instruction costs $14 per person
  • No classes available on Sunday

For more information, contact Jeannie Simms at 412-855-4594 or jsimms@breathepa.org for Allegheny, Armstrong, Fayette, Indiana and Westmoreland counties. Contact Jessica Schuman at 724-900-1115 or jschuman@breathepa.org for Beaver, Butler, Greene, Lawrence and Washington counties.

 

Halloween: Protecting your kids with asthma and allergies

In our house the excitement of the first day of school is quickly fading and Halloween costume ideas are beginning. Rainbow Kitty, Rainbow unicorn…Rainbow unicorn kitty! There are so many options!

Halloween is a really fun time of year for kids. Ghosts, goblins and spooky sounds are around every corner, but one of the spookiest things about Halloween is how asthma and allergies can creep up on us. Consider the following:

TREATS

The merriment and excitement of holidays can cause asthma and allergies to fall to the wayside. In school, the kids’ holiday parties are regulated by the school’s food policies to protect children with allergies, but the same kids who are protected behind a school’s doors are trick or treating in your neighborhood, too.

With the abundance of peanut/food allergies, Food Allergy Research and Education (FARE) created the Teal Pumpkin Project. This initiative is to raise awareness of food allergies and to promote inclusion of all Trick-or-Treaters during the Halloween season. Here’s how it works:

You look for homes that have a teal colored pumpkin or a teal colored sign on their doorstep. These homes offer non-food, allergy friendly choices for your child.

If you want your home to be a Teal home you can visit the FARE website at www.foodallergy.org/education-awareness/teal-pumpkin-project to print out signs and get ideas on allergy friendly treats like glow bracelets, pencils, bubbles and mini note pads. Just be aware, items like moldable clay still contain ingredients like wheat, which is a known allergen.

Still want to hand out candy, too?No problem! FARE’s website offers a printable teal sign that says CANDY or a PRIZE and the child can choose. Make sure that non-food items and candy are placed in different containers to reduce cross contamination.

COSTUMES

Some costumes, masks and makeup could contain latex, which is an asthma trigger. It is very important that you read the labels on these items. Area towns offer about a two-hour Trick or Treating time. A child with asthma could have a prolonged exposure to this latex during this time, causing an attack.

Sometimes we borrow costumes, and I know if you borrow one from me, it’s going to come out of a plastic container in my basement. Though I try my best to protect my costumes, they may have dust or mold on them. Be sure to inspect old costumes and give them a proper washing to remove dust or dust mites. If a costume is moldy, it is best to throw it away.

OUTINGS

Another thing to consider is popular October outings. As we gear up to Halloween night, we visit pumpkin patches, enjoy hay rides and creep through haunted houses.

These are elements that can trigger an asthma attack. Children with asthma need to prepared for mold or allergies on hay that they are sitting on during a ride. Running through haunted houses, being scared and fog machines can all be asthma triggers, too. Moments of anxiety or fear can trigger a physical change in the lungs initiating a need for an inhaler. It is important that a child carries their short acting inhaler with them during these fun Halloween moments.

Finally, here in Pennsylvania, we have the most unpredictable weather. I remember everything from warm October nights to it snowing while I was handing out candy. The change in weather can cause a child with asthma to have a difficult time breathing. Cold temperatures can cause the airways to react and trigger an attack. It is important to have your child cover their nose and mouth with a scarf if the weather becomes cold while trick-or-treating outside.

Halloween is fun, and should be fun for everyone. You can still be scared and hunt for the perfect pumpkin without putting your asthma and allergies at risk. Think ahead and be prepared to make your Halloween the spookiest—but not in a bad way. .

 

Does Your Child’s Snoring Keep you Up at Night?

When most of us picture the loud snorer, it’s likely the classic profile of an overweight, middle-age man sleeping soundly on his back, breathing through his mouth. This is also the image many people associate with obstructive sleep apnea. Now, imagine that same loud snoring coming from your adorable cherub-like child. Could this also be obstructive sleep apnea?

Although recent data indicates that as many as 1 in 5 adults may suffer from obstructive sleep apnea, it is estimated that this condition also affects about 3% of the pediatric population. While snoring and excess weight are universal risk factors for OSA, there are some risk factors and symptoms that are more common in children.

Tonsils and adenoids are made up of lymph tissue and are located in the upper airway (the back of the throat). Tonsils and Adenoids play a role in helping to fight infection, and in young children, they often become enlarged and interfere with breathing.

At night time, the combination of relaxed throat muscles and enlarged tonsils and adenoids may narrow the airway, making it difficult for the child to breathe air from the nose and mouth into the lungs. Air that does move through the narrowed airway causes snoring sounds. If the airway becomes completely blocked, the child may experience episodes of apneas (not breathing). The child’s brain will stop the apneas and the child may choke or gasp as breathing starts again. Each time this happens, the child partially awakens and sleep is disturbed. In addition, apneas cause oxygen levels to drop in the blood, which if untreated, may lead to other health conditions later in life.

Children who are experiencing obstructive sleep apnea may have the following symptoms:
• Hyperextension of the neck during sleep – this position makes it easier for the child to breathe when the airway is narrowed or blocked
• Mouth breathing – if enlarged adenoids are blocking the back of the nose, the child may be able to breathe only through their mouth
• Restless sleep
• Irritability during the day
• Difficulty awakening in the morning or from naps
• Daytime hyperactivity, from poor quality sleep

In addition to the immediate effects of poor quality sleep, research in the field of pediatric obstructive sleep apnea suggests untreated OSA may also be linked to slow growth, ADHD and bedwetting.

If you think your snoring child could be suffering from obstructive sleep apnea, you should talk to your doctor about having your child evaluated.