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Recent Questions for the RT
as it relates to COPD -
Mark Mangus, Sr. BSRC, RRT, RPFT, FAARC
Note: The
weekly cut-off day is Wednesday evening. If your questions are received "after" that
day, they will appear in the following week's postings. Questions and answers are usually
uploaded to this page by Sunday evening.
Previous Questions and answers of RRT Tracy Cushing,
covering 2008 and 2009, have been
archived alphabetically.
Do YOU Have a Question for Mark?
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Q. Low Oxygen, Been On Meds... No Relief .....Allergies?
Posted March 7, 2010 I need to
know what I should do next.
I had a bad bout of pneumonia beginning of December. Two doses of anti's by
intravenous. Went for a follow-up xray in January and Dr. said something
still there but didn't want to do anything just yet. Oxygen level okay.
Beginning of February eyes and sinuses burning and nose plugged. After a
few days eyes and sinuses cleared up but nose was running a lot.
That's all gone now. What I'm left with is SOB and low to mid 80's for
oxygen. Went to doctor and took 5 days Prednisone & 7 days Avelox. Just
finished Avelox and no improvement for SOB or oxygen.
On the top of my list of allergies is mould...snow, leaf and household.
Lower down on my list is pets and tree pollen Take Singulair daily since
last Spring. We had dogs ..then didn't for 3 yrs....now got a yorkshire
terrier. Supposedly the most hypo-allergenic. I bath her frequently. We
also discovered a roof leak and suspect mould in the walls.
My question: Does it sound like allergies to the dog or mould could be
causing the SOB and oxygen problem? or : did this last exacerbation cause
it?
Will nebbing something work better than the Symbicort and Spiriva I am on
now.
If this is allergy related I can do something about it...hoping nebbing will
help. I would like the last resort to be oxygen.
What should I try ..or get the doctor to try..next? Thank you.
Sandra
A. Hi Sandra,
Allergies, in
and of themselves should NOT cause hypoxia unless you have severe breathing
difficulties with them, like asthma that won’t improve despite inhaled
bronchodilator and treatment with oral corticosteroids.
You could ask
about Albuterol and Ipratropium Bromide for nebbing in between Symbicort and
Spiriva, or for Albuterol by itself, since some feel you shouldn’t take
Ipratropium Bromide AND Spiriva at the same time (There’s no harm in it.
The question is potential effectiveness AND interference between one and
the other.)
If I were
your doctor and you were noting consistent pulse oximetry measurements that
were less than 88 %, I’d want to do a blood gas to verify the accuracy AND
to do it under those conditions during which you have observed the
decrease. In other words, if you are desaturating (dropping your oxygen
level) during walking, then you should walk for a few minutes and then
IMMEDIATELY have the blood sample drawn for the blood gas before you have
been stopped for more than 15 to 20 seconds. A resting blood gas when your
resting saturation is 96 % will tell you nothing about what it drops to when
you’re active. So, the conditions and timing of the blood test are
CRITICAL!
Beyond that,
you haven’t given any information to make it possible to tell you more.
The other information you included is not pertinent or helpful to the
primary question and issue as those things shouldn’t cause hypoxia.
So, my best
recommendation at this point is to ask for a blood gas under the conditions
you have observed desaturation IF the desaturation persists until you can
get seen by your doctor.
If the blood
gas confirms hypoxia, supplemental oxygen is the only intervention you can
expect to correct the hypoxia.
Best Regards,
Mark
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Q. Marijuana Smoking vs Regular Cigarette Smoking
Posted
Feb 28th/2010
Dear Mr.
Mangus: My boyfriend is newly diagnosed and is having huge denial about the
whole situation. He has quit cigarette smoking but refuses to give up
marijuana. What are your thoughts on pot and lungs? Thanks so much.
Deborah
A. Dear
Deborah,
The evidence suggest strongly
that smoking marijuana - - - and any similar plant substance, for that
matter - - - produces irritation that, if produced often enough can result
in chronic inflammation and ‘metaplastic changes’ (fancy term for changes in
cell type) in the airways and chronic disease similar to tobacco smoking.
Sometimes folks will think that they are not likely to get hurt because the
additives and chemicals with which tobacco is treated are not there. Yet,
pot from various sources tests positive for herbicides and insecticides that
can do a number on your lungs. Since you don’t know from where the product
comes, the kind and degree of danger is not ascertainable. Mexico, a place
from which a significant amount of product is grown and supplied allows use
of insecticides long-banned in the USA. Folks sometimes reason that since
they don’t smoke as much pot or smoke it as often as they would cigarettes
that they don’t get as much exposure and therefore the risk is reduced. We
don’t know that to be the case. Evidence is pretty good that
that is not a good or valid
rationale.
The bottom
line is to continue smoking marijuana is simply a role of the dice with
respect to potential consequences. When one has been diagnosed with COPD,
their chances on that dice roll are increased toward the losing side. You
didn’t say how old your boyfriend is or how his COPD has been diagnosed or
how bad it is, much less how much pot he is smoking. And severity of
disease, current age and how much smoking IS a relevant factor in estimating
risk, at this point. If he has had a PFT, and his FEV-1 is reduced to less
than 90 %, he is on a slippery slope, though he could cruise a long time
without facing consequences. But, as COPD progresses slowly over many years
before reaching clinical significance AND because the consequences onset
years down the road, he simply can’t assume that he will be unscathed by
continuing to smoke the pot.
In the end,
you can only stress ‘your’ feelings and concerns. If he decides that your
concerns are valid enough to change his behavior, he will make that choice.
If not, then you are faced with the choice to stick with him or . . . well,
you know. If he continues to smoke the pot, he would do well to monitor his
pulmonary function so that he can see his rate of decline/progression of the
obstruction and disease.
Best Wishes,
Mark
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Q. Hand Sanitizer vs Soap
Posted Feb. 28th, 2010
Hi Mark;
I
know this isn't along the lines of a question for an RT BUT; I've gotta ask.
There's been a lot of stuff lately on hand sanitizers and it not being good
because of germs, just like antibiotic overuse, (the bugs) can get immune to
it. BUT; if soap kills germs, though I don't really know how; and hand
sanitizer does the same thing.... Does that mean we shouldn't be using it
(hand sanitizer)?
Many Thanks, Joel
A.
Hi Joel
The active
ingredient in had sanitizers today is mostly Isopropyl alcohol. There are
anti-bacterial substances put into some sanitizers, but their value,
effectiveness and influence in promoting resistance in bacteria is not the
issue that antibacterial substances in soaps is because of the alcohol
content. Alcohol inhibits life and growth of many microbes. They cannot
adjust to it because of the chemistry of it all. So, hand sanitizers are a
good thing when used appropriately.
When all is said and done good hand washing with soap and water and
especially the running water and friction of rubbing your hands is still the
staple means to cleanse them. Hand sanitizers are a good step-in when
washing is impractical or not possible. But, they are a ‘bridge’ to the
hand-washing action. AND< above all, hand washing is STILL established as
the single most effective means to prevent spread of disease-causing germs
and infection.
Best
Regards,
Mark
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Q. PFT Report - Non Smoker
Posted Feb 28th, 2010
In my Pulmonary Function test
the report says"Some difficulty in patient cooperation with FRC was noted-
what are they referring to, as I was cooperating - they rattle it off
and do not give you time to think what they are saying?
another one says " spirometery
shows mild expiratory obstruction- large airways normal - small reduced to
54 per cent consistent with small amount of obstruction- can you explain
this to me in laymen's words- what would cause this obstruction, I was not
a smoker, my husband did, I never worked in dusty buildings or factories.
I would appreciate your
input.
Additional Information was supplied:
"the
only numbers that are on this reported that was dictated by the Pulmonary
that Dr. that reads the tests from the function test are it says "small
airways flow is reduced to 54% predicted consistent with a small amount of
obstruction. There is no convincing change following bronchodilator. Maximum
voluntary ventilation is mildly reduced at 76% predicted. consistent with a
very mild loss of lung reserve, not explainable by the normal FEVI/
After my daughter read it, she thought I misinterpreted it, as on the one
test I did have to cough - so that test had to be over and he said it was
O.K. -- I think this is why it said " some difficulty in patient
cooperation with FRC was noted"-one reason I was having all this checked
as in Nov. I had a light case of the HINI or whatever it is called and this
cough developed and has hung on. That is O.K. My husband smoked , and I
guess the second hand smoke is as bad as if I had smoked."
A.
Hi Sandy,
Don’t take
the comments as criticism. When we do PFT’s we must characterize the
patient’s effort and ”cooperation” with performing the tests. PFT’s are
extremely “effort-dependent”. Poor effort - - - whether it be because of
bad coaching from the tester, subject weakness or illness or simply a bad
day for the test subject, or even something like willful interference in
attempts to obtain a valid test MUST be noted on the test form so that
interpretation can take those factors into account. Otherwise you could be
made to look sicker or healthier than you really are.
So, in
looking at your notes, there was a problem in your being able to fully
cooperate with the maneuver to measure your FRC. That test requires a
breath hold and stillness for several seconds AND the ability to take in a
breathe that is at least a minimum amount. You may not have been able to
take in such a deep breath OR to hold it for the full duration needed. If
that was the case, then the measurement would be ‘off’ from expected or
normal. The physician would need to know that the deviation from normal was
clouded by the effort/cooperation difficulty. The bottom line you need to
understand is that the tester was NOT complaining about negative behavior or
attitude on your part. He/she was simply explaining that you were unable to
cooperate fully to give the best measurement and result on that test, so
it’s results may be suspect.
Your mid to
small airways flows are reduced by a little under half. That usually
suggests some kind of obstructive defect, though it doesn’t characterize
it. If you are not at risk for the ‘usual’ COPD issues, then you ‘could’
have a bit of asthma. You don’t report other aspects of your PFT, so I
don’t know if you were tested pre- and post-bronchodilator nor what response
you might have had. In any case, you can have a bit of reactive airways
problem or asthma for many reasons without having a smoking history or other
known reasons or causes. And unless other key elements of your PFT are out
of normal range by a significant amount, then you don’t appear to have too
much of a problem
I’ll close
with an encouragement for you to get with your doctor and put your questions
and concerns to him/her. With the complete test results in hand, he/she can
answer ALL your questions.
Best
Regards,
Mark |
Q. Mucinex for Thinning Mucus
Posted Feb. 14th, 2010
Part 1
Hi Mark
As usual the horse got out of the barn before I closed the door. LOL It
was suggested that I try Mucinex to help ease my getting rid of my phlegm.
I did and now I'm not so sure I should have. Am I leaving anything
behind?
I did try the
Mucinex. Actually I'm still taking it. (600mg twice a day) My
sputum is now not as "sticky"/thick as it was and I have an easier
time coughing it up. However, now I'm wondering if I'm getting rid
of it all. I suppose the question you would be able to answer is:
Have you heard of Mucinex being prescribed to COPD patients before?
If not, is there any reason I shouldn't take it?
Thx Bob
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A. Hi Bob;
Let me answer
once for both questions posted. Mucinex (Guaifenesin) is potassium Iodide,
a drug which favors pulling water into the mucus via/through the tissues
that line the bronchial tubes. It seems to be doing what you want, Bob, in
that it has made the mucus easier to cough up. One never knows if they are
“getting all the mucus up” when they cough. But, that is really a moot
point, in many respects because mucus is produced and secreted in response
to irritation and the airways’ need to ‘flush’ or ‘cleanse’ themselves of
dirt and other debris that can be found within the airways. So, the process
is dynamic. It is ongoing. And it is necessary, too! So, your quest is to
keep coughing and clearing what mucus accumulated within your airways as
best as you can from moment to moment. The Mucinex is good to help keep it
looser and more mobile.
Now, some
would suggest that you need to drink lots of water to help thin that mucus.
Every bit of empiric evidence I’ve ever seen suggests that all drinking the
extra water ever does is increase one’s urine output. BUT, there seems to
be something in the act of drinking - - - especially hot fluids and also
with a sipping technique - - - that helps to raise the mucus at those
times. So, you certainly might try drinking ‘some’ fluids to see if it
helps. The reason I bring up fluid intake is because many folks have
problems with fluid retention and salt management. And if they are
encouraged to drink excessive amounts of fluid to try to help thin and/or
mobilize mucus, they can compromise their fluid management efforts and
actually cause increased fluid retention. That can all go towards increased
breathing difficulties and worsened heart function, while also thwarting the
action of diuretics, if those are being taken for fluid management, as well.
Lastly,
Mucinex is a commonly prescribed medication to help with mucus clearance and
management. So, you are in the mainstream taking it for the purpose you are
taking it.
Best
Regards,
Mark |
| Q.
Diaphragmatic Breathing Vs Stomach Breathing
Posted Feb 14th, 2010 Hello
Mark and Thank you for accepting questions.
My question is.... What's the difference between diaphragmatic breathing and
stomach or belly breathing? Or is there a difference? For me my chest is all
the same and flat!
Thanks, Fran
A. Hi Fran,
There is no
difference between diaphragmatic breathing and “belly” breathing, also
called abdominal breathing, per se, at least not in theory. But in
actuality, between the three terms, it is the term “diaphragmatic breathing”
that is the most incorrect simply because there is NOT ONE BREATH taken by
ANYONE that is not generated by the ‘diaphragm’. AND, try as anyone might,
we have no ability to specifically control movement of the diaphragm in any
direct or deliberate way. The diaphragm is a muscle that works on autonomic
nerve signals. And all the fancy breathing techniques that have been
devised and written about for decades are just so much malarkey when it
comes to ‘actually’ influencing the movement of the diaphragm during
breathing.!
We can
enhance effectiveness of our breathing using abdominal muscle maneuvers that
pull on the diaphragm and pull work away from the upper chest respiratory
accessory muscles. That is a GOOD thing to do since those respiratory
accessory muscles require up to many times the energy to help enhance
ventilation while only producing that help with about 40 % efficiency!
(Respiratory Accessory muscles of which I speak are those found in the neck,
shoulders, upper chest and upper back, among which are included the scalenes,
sternocleidomastoid, trapezius and pectorals.) So, we work harder for less
return when we shift breathing work AWAY from the abdominal muscles toward
the chest/respiratory accessory muscles.
If you try to
use the “diaphragmatic” breathing techniques most commonly found in
publications, you will find that you have great difficulty in properly using
your abdominal muscles to enhance your breathing. That is because most
techniques recommend placing a weight of some sort on your belly, below your
ribs, but above your navel. To properly utilize your abdominal muscles, you
must pull them DOWN toward your knees. That exerts a piston-like action on
the diaphragm, pulling it down and filling the lungs through
‘displacement’. Indeed, several studies found that traditional techniques
of “diaphragmatic breathing” using weights placed midway on the abdomen
while the subject lays recumbent or partially recumbent results in
paradoxical movement of the diaphragm and exhalation when inhalation is
desired and vice-versa. It is not automatic. BUT, it can happen without
the subject being aware of the opposite movements occurring. As such, some
sources de-recommend the technique.
I have always
advocated practicing abdominal breathing while standing upright and leaning
against something that will support your weight. One foot is place forward
and just rests upon the floor below a bended knee while the foot farthest
behind you supports your weight below a straight and stiffened knee. Next,
you bring your arms up and cross them above your shoulders. You then place
your forehead into your crossed arms and squeeze your shoulders into your
ears. This action ‘locks out’ the major accessory muscles and frees the
abdominal muscles (the belly, as a whole) to do the work to breathe. As you
inhale, your belly drops toward the floor. As you exhale, you pull your
belly up into your chest to help compress your lungs for the emptying. Of
course, you do pursed lips breathing when you exhale. (The folks on the
EFFORTS list call this the “tripod” position.)
Some helpful
activities to promote belly/abdominal breathing are blowing bubbles,
inflating balloons, playing the harmonica, singing. You get the idea . .
. Anything that makes you work your belly - - - the lower abdominal
muscles - - - will enhance movement of the diaphragm. The single most
common “complaint” I get from folks whom I teach abdominal breathing to is
that they feel like they’re not working hard enough to breathe when they do
it correctly. I laugh, because if you DO do it correctly, then you
SHOULDN’T do much work at all. And it certainly should NOT be as much work
as you do with the traditional techniques of “diaphragmatic breathing”
Best Regards,
Mark
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| Q.
Oxygen Drop and Breathing Muscles
Posted February 7th, 2010 Two
questions for you Mark if you don't mind.
Out of curiosity I've measured my oxygen (with a pulse ox) when I go into one of
my coughing episodes and it drops by about 5 (at least) points. It generally
returns within a few minutes afterwards but is that normal for COPDer's?
And; I find my abdominal muscles get quite sore some days from breathing. Guess
I tend to use my stomach more than my shoulders or upper chest. I know that
breathing with the lower muscles is good but.....should i be trying to learn to
use my chest more? (I was a singer in my younger days; breathing from my
abdomen comes naturally)
Thank You, Carla
A. Hi Carla;
Measurement of
oximetry DURING violent maximal exertion as occurs with coughing jags is fraught
with inaccuracy. You have movement to contend with. You have circulation
changes that occur rapidly in succession during the coughing. AND, you have the
‘potential’ for desaturation. Without having the opportunity to observe your
measurements as they occur, I wouldn’t be able to tell you if they are even
valid/accurate. After that, a five “point” drop, (I assume you mean “percentage
points”) tells me nothing helpful without knowing from what it starts and to
where it drops. A five point drop from 99 or 100 % to 94 or 95 % is not a
problem, under any circumstances. But, a drop from 90 % to 85 % is another
story - - - AND is NOT a good thing. If you are dropping from 82 % to 77 %
that’s REALLY a problem and a danger! So, you see, I can’t tell you what the
significance of your observation is, though I’ve given you some idea with my
examples to be able to ascertain for yourself if you have a problem or not. If
it takes as much as 5 minutes for your saturation to return to normal, then you
have further problems that suggest you need oxygen therapy or a higher dose of
oxygen, IF those drops are from a starting point of 93% or less.
Sore or not, you
are breathing correctly when you use your abdominal (lower abdominal) muscles to
generate the greatest portion of effort to breathe. Use of chest muscles
(accessory breathing muscles) is a VERY bad idea! We try to discourage folks
from deliberately trying to use their chest muscles to support breathing. Those
muscles eat up a ton of energy without returning near as much as abdominal
muscles in terms of ventilation per unit of work. There are times when I’ve
encountered folks (medical professionals) who counsel and coach use of upper
chest and accessory muscles. Besides jumping into action to help them realize
the error of their thinking and understanding, I try to have them practice and
gain a feeling for abdominal breathing - - - and NOT by using the commonly
recommended “diaphragmatic breathing retraining methods”, which are very counter
productive for a LOT of folks and can actually lead to worse use of the ‘wrong
set of muscles’ to generate breathing effort. We like to use harmonicas,
singing and other similar activities that cause the person to have to use
abdominal breathing as exercises to enhance mastery and control of exhalation.
As a singer, you
have likely learned the BEST way to breathe. Stick with it. And be SURE to use
pursed Lips Breathing when you exhale. That can go a long way to reduce your
breathing work and ultimately your soreness.
Best Wishes,
Mark
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| Q.
Ventolin Before or After Spiriva or Symbicort?
Posted January 30, 2010 I was told by my doctor before taking my spiriva
and symbicort, to take 2 puffs of ventolin 5 mins thus opening the airways so
that the spiriva and symbicort will work better. However, somewhere else, I
read that by taking the ventolin before, if clears the airways so that the
spiriva and symbicort have nothing to adhere to. Could you please tell me how
you would recommend taking my ventolin?
Bonnie
A. Hi Bonnie,
While controversy
continues to some degree and I am at the forefront of pushing for sensible and
evidence-based change, your doctor echoes instructions that are trumpeted by
many health care professionals. Regardless of how many promote doing as he has
recommended, it is plainly contrary to every bit of evidence available AND is
without one shred of evidence to support its practice.
If you take
Ventolin before taking your Symbicort, you will block the effect of the
“long-acting, beta-agonist” (LABA) medication in the Symbicort, because they
BOTH occupy the same receptor sites within your airways. Ventolin is a
“short-acting, beta-agonist” (SABA), lasting only up to 6 hours. When the
Ventolin gets there first, it ties up the sites so the Symbicort’s LABA has no
sites to bind with. By the time the sites are again freed up, the Symbicort’s
LABA has long since been shed from the lungs. So, the bottom line is by taking
the Ventolin first, you negate the potential benefit and effect of the Symbicort
LABA.
You should take the Symbicort by itself FIRST. If after 30 minutes, you feel
you really need more, THEN take the Ventolin. What I think you’ll find is that
the Symbicort by itself, is plenty and all you need. In that case, your
Ventolin becomes strictly a back-up/supplemental medication if and when you ever
need a ‘pick-me-up between Symbicort doses. Also, Never take the Ventolin
within TWO HOURS before you are due to take the Symbicort.
Best Regards
Mark
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| Q. Who Should Own A
Finger Pulse Oximeter? Posted January 24th/10 Should everyone purchase an oximeter after being diagnosed
with moderate approaching severe copd. There is no pulmonary rehab available in
my area. I am short of breath when exercising very little and I currently take
Spiriva, Advair twice a day and Albuterol when needed.
Jacquie
A. Hi Jacquie,
A pulse oximeter is only of
use to someone whose oxygen level in their blood fluctuates such that there’s a
danger it will drop too low, putting them at risk for attendant complications.
If someone has mild COPD, they usually do not have a problem with oxygenation.
The best way to know when you should acquire a pulse oximeter is when it is
first detected that your oxygen level drops to around 90 % or less. You should
have your doctor (Pulmonary doctor, most likely) measure your oxygen with a
pulse oximeter in his/her office - - - especially while you’re walking around,
NON-STOP, for AT LEAST two minutes. A measurement done while you are sitting
quietly and comfortably at rest is NOT suitable to detect “exertional hypoxia”
(low oxygen level during exertion). Before you exhibit signs of “desaturation”
(drops in your oxygen level) there is no advantage to having and/or using an
oximeter.
Best Regards,
Mark
__________________________________________________________________________________________
Q. Cooking Fumes Posted
January 24th/10
I can't stand smell of food
cooking; cuts my air off so then I get a anxiety attack and it is no fun;
Thank you, Jim
A.
Hi Jim,
I’m not sure what your ‘question’ is, as
everything you said is in the form of a statement. So let me make some general
observations and statements along with imparting a few suggestions to hopefully
help the situation. Different foods and methods of cooking will have different
effects on breathing for those who have advanced COPD. First, to suffer as you
describe, Jim, one usually has a very reduced FEV-1 (measurement from your
pulmonary function test). Frying foods can be especially difficult. But,
boiling pungent foods like broccoli or kidneys, for instance, can assault your
nostrils and literally take your breath away. So, using caution to begin with
is of utmost importance. Provide the best ventilation and source of fresh air
possible within the limits of the design of your kitchen. Use you stove fume
vent to pull odors out of the air as they rise from your cookware. Avoid
breathing the air near pungent foods, especially if you know they have a
negative affect upon you.
If you use oxygen, be sure you are using enough
to keep your saturation as high as possible to minimize low oxygen symptoms. 95
% and more is not unreasonable. Be careful to use the oxygen safely around the
active stove/oven. If you use a rescue or ‘short-acting inhaler, try taking a
couple of puffs from that before you begin cooking.
Best Wishes
Mark
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| Q. Dr.
Dismisses Rehab (Posted
January17th, 2010) Hi Mark,
Thank you so much for being a part of this board, your help is so very much
appreciated.
Mark I have asked my Pulmo about rehab, and he said it will not do any thing
for me, what do you think? He said I am severe, and i only have my left lung,
and have COPD/ASTHMA/ E I should also mention I am very active, do all my own
housework and shopping and cleaning, I get very SOBA, but I try my best.
Thank you in advance.
Sincerely Linndie
A. Hi Linndie,
I would opine that it is presumptuous of anyone to summarily dismiss the notion
that pulmonary rehab would or would not do any good for anyone based upon their
having severe COPD. While I argue at times about the uselessness of spending
our Medicare Dollars on rehab for someone who has no rehab potential, much less
desire to regain lost, but retrievable function AND I am leery of just how early
we can justify intervening with pulmonary rehab on a person who has no symptoms
or demonstrable need for significant disease management, I still have to remain
reserved as there is much to be learned to avoid complications and to slow
progression. In folks who are extremely debilitated, BUT who are enthusiastic
about regaining function AND are willing and able to tolerate the discomfort
along the way, I say: “Go for it!” I have witnessed some incredible results in
folks on whom I’d have bet upon failure. Those are times when I am MOST happy
to have been wrong! I have also learned over 20 years at this that it is a
treacherous path to tread when trying to make predictions without having “the
writing on the wall.”
You sound like you’re fairly robust despite your deficits. So, on the one hand
there might not be much in the way of conditioning that you could gain. Yet, if
you do not now have an aerobic fitness program, then you are missing a key
component that could improve your breathing, muscle function and oxygen
utilization as well as carbon dioxide production. More efficiently functioning
muscles produce less carbon dioxide. That reduces demand on the lungs to
ventilate in order to clear carbon dioxide. And that translates to potential
improvement in breathing work and anxiety. So, Pulmonary Rehab could be the
catalyst to get you started on a walking program. Doing your household chores
and similar daily work is good. BUT, it’s NOT exercise. You need “sustained,
repetitive motion over a continuous period of time” to constitute the kind of
aerobic exercise that will give you the conditioning to allow you to continue to
do those daily activities without out avoidable difficulties.
You say you only have your left lung. Am I to surmise that you had your right
lung surgically removed? If so, you need to be mindful of one thing that
SOOOOooo many physicians fail to consider. Your pulmonary functions
measurements will ALWAYS be only half of what is predicted - - - even if they’re
normal. The best you can achieve would be around 50 % of everything except for
airflow measurements. If you have asthma, airflow measurements will be
reduced. But, FEV1 and lung volume measurements MUST be interpreted against the
knowledge that only one lung is being measured. Finally, if indeed you have
only your left lung and no right lung, your COPD may not be the main cause of
your difficulty breathing. Simply having only one lung limits your maximum
exercise and exertion intensity levels. That is because you only have at best,
½ the reserve you would if you had two lungs.
Ultimately, your doctor should At least allow you the opportunity to go be
evaluated and even give pulmonary rehabilitation a try. If you find it is not
helpful, then you can always say you gave it a shot. But, to summarily shun it
does NOT seem to me to be in YOUR best interest. What’s your doctor got to lose
by letting you stick your toe in and test the water?
Best Wishes,
Mark
__________________________________________________________________________________________
Q.
SOB (Shortness of Breath) "after" Exertion
(Posted January17th, 2010)
I have a short little upgrade from my driveway to
my house, and then about 5 steps to climb. I am breathing fine until I get in
the house when I become extremely SOB to the point of gasping for air. I plb
the whole walk, and of course when I'm trying to get my breath back. Why am I
not SOB during the walk but am when I stop? Thanks!
Sue
A.
Hi
Sue,
You ask a good question that is often asked by folks. The simple answer is “lag
time”. But, there’s more to it. When you begin the trek, you are breathing
slower and easier. As you go on during the trek, even though you are doing
pursed lips breathing (PLB), you are developing an unavoidable problem that is
related to the anatomical changes within your lungs as the result of your COPD.
That problem is “dynamic hyperinflation”. It is, in simple terms “breath
stacking that occurs when you progressively breather more air INTO your lungs
than you breathe OUT of them as you walk along and especially when you climb
those stairs. By the time you reach the end of the trek, you have pushed your
lung volume to a level that is much higher than when you are comfortable and at
rest. In doing so, you also reduce your “inspiratory capacity”, making it such
that you have less room to work with to pull in each succeeding breath. That
invokes continued efforts from you to increase ventilation which is increasingly
less possible. During this time as well, your CO2 is increasing in in the air
within your lungs. More importantly, your pH (the reflection of the acidity or
alkalinity of your arterial blood) decreases commensurately with the increase in
CO2. This invokes even MORE stimulus for you to try to increase ventilation.
Since you have a reduced capacity to further increase ventilation because of the
over-distended state of hyperinflation that results during “dynamic
hyperinflation”, your only recourse is to increase your anxiety level. So, when
you finish the climb and get into your house, these factors are all affecting
you at their peak of influence. You stop the activity and continue to PLB.
And, because you are no longer making the greater demands for ventilation on
your lungs as you were during the trek, you begin to “unload” those
hyperinflated lungs, returning them to their “resting volume”. At the lower
state of hyperinflation, you are able to return to more effective and
comfortable ventilation as you return to expelling more air during exhalation
than when during the activity AND you return to a lower respiratory rate.
When I teach more effective ways to breathe to my folks in pulmonary rehab, I
stress that just because their legs and body have physically ceased activities
like you describe, doe NOT mean their work to control their breathing has
stopped. I tell them that they must continue to be deliberate and controlled
and try to increase the effectiveness of their breathing for up to several
minutes after they stop, as just as it takes a couple of minutes to develop, it
also takes a couple of minutes to resolve. Dynamic hyperinflation may sound
like a difficult and abstract phenomenon to understand. But, it really is
fairly simple. And it is essentially part and parcel what is responsible for
the breathing difficulties folks experience as their COPD advances. The lower
your FEV-1 is, the more subject you are to Dynamic Hyperinflation, especially as
the demand of the physical activity you engage in increase.
Best Wishes,
Mark
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