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Asthma

5 Common Myths Associated with Asthma 

Asthma is a chronic condition that affects the airways in the lungs. Among children, asthma is a common condition however it affects people of all ages ranging from infants to the elderly.

While there are many things that can cause asthma such as genetics, environmental factors, and occupational exposures,  sometimes the exact cause cannot be determined. If you or someone you know has recently been diagnosed with asthma, it can be overwhelming.

Your healthcare provider can provide you with some great resources, and while the internet is a great source of information, take caution regarding some common myths associated with asthma. Read on to learn the truth to these common myths.

Myth #1: Asthmatics Should Avoid Exercise.

While many asthmatics experience exercise induced asthma, it does not mean that it should be avoided all together. This, in fact, is a myth. It is important to assess your individual risk factors and determine if your asthma is well controlled with an asthma-action plan. If your asthma is well controlled, you may enjoy activities such as a brisk walk, leisure biking, swimming, and hiking. Avoid exercising outdoors in colder weather months to avoid an asthma flare-up.

Myth #2: Asthmas Goes Away after Childhood.

While some children will experience asthma only in the early years of life, asthma does not just go away. A common misconception, but, in fact, a myth. A clear answer to this myth would be that, for some children, asthma can go into a hibernation state and never return. This is due to a person’s lungs growing and maturing and the lungs becoming less affected by triggers. Its important to know that while your asthma may not ever truly go away, your attacks can be well controlled if you are aware of your triggers.

Myth #3: No One Dies from Asthma.

This is alarmingly false. According to the World Health Organization (WHO), in 2016 there were 417,918 deaths globally due to asthma. Asthma is one of the major noncommunicable diseases, this means that asthma is not transmissible directly from one person to another. While asthma can be controlled with medication, it can cause deaths. It is important to seek treatment and not allow your symptoms to get worse. Ensure you continue your medications and asthma action plan set by your healthcare provider.

Myth #4 All You Need is Albuterol.

Albuterol sulfate is a common bronchodilator, which works by relaxing the muscles in the lungs, and makes it easier to breathe. The truth is albuterol is not the only medication available to treat asthma. Also, everyone with asthma does not take the same medication. Asthma can be treated with two types or medications: a quick-relief and long-term controller. A quick relief will control the symptoms of an asthma flare-up. A long-term medication will work by helping you have fewer and milder flare-ups.

Myth #5: Asthma is Easy to Diagnose and Treat.

The truth is asthma can be difficult to diagnose. The reason being that asthma mimics other diseases and often there are similar symptoms, making it difficult to make the diagnosis. Asthma is underdiagnosed and undertreated which creates a substantial health burden globally and to individuals and their families. If you suffer from asthma, and you have a long family history of asthma, it may be easier to diagnose. For some, a series of test may be needed to make the diagnosis.

Takeaway

Asthma is estimated to have affected more than 339 million people in 2016 according to WHO. It is a common condition, and it is important to have facts and understand the misconceptions and myths associated with it. Asthma can be treated and controlled so that a person can enjoy their day-to-day life!

Sources:

https://www.cdc.gov/asthma/faqs.htm

https://www.nhlbi.nih.gov/health-topics/asthma

https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

https://www.who.int/news-room/fact-sheets/detail/asthma

What Exactly is Respiratory Therapy?

Respiratory therapy involves caring for patients with chronic breathing problems and lung issues. Factors that cause respiratory problems such as lung cancer, pneumonia, and chronic obstructive pulmonary disease (COPD) are often treated by respiratory therapy interventions. The American Thoracic Society states that the most common diseases needing respiratory therapy include severe asthma, COPD, interstitial or fibrotic lung diseases, pneumonia, lung cancer, lung infections, and bronchiolitis.

Respiratory therapy can also help improve the breathing of premature babies. According to the March of Dimes, 1 in 10 babies born in the U.S. is born prematurely. Many of these premature babies will need assistance breathing well into the first months of life, and some will require respiratory therapy even after they leave the intensive care unit and go home.

respiratory therapy

What is Respiratory Therapy?

Who performs Respiratory Therapy?

A respiratory therapist (RT) specializes in treating patients who require respiratory therapy. They work as part of a team to help diagnose lung and breathing problems and help people improve their respiratory health and day-to-day lung function. RTs’ must have a broad knowledge of how the body works, specifically the lungs, and are part of a medical team that diagnoses and treats patients.

Where do Respiratory Therapist Work?

They work in a variety of settings. They commonly work in hospital settings, including the emergency room, the intensive care unit, and the newborn or pediatric intensive care unit. Respiratory Therapists work with patients of all ages, ranging from premature infants with underdeveloped lungs to elderly patients with advanced heart and lung issues.

Outside of the hospital setting, respiratory therapists also work in pulmonary rehabilitation clinics and manage pulmonary rehabilitation centers. With the evolving pandemic and the rise in patients recovering from the Coronavirus, they may find themselves working in specialized clinics to treat Covid-19 ‘long haulers’. An RT can also work in doctors’ offices, sleep disorder clinics, and long-term care facilities. Careers in teaching, patient education, and roles within the medical devices industry are also new areas where respiratory therapists work.

What duties do Respiratory Therapist Perform?

Along with having extensive knowledge of the cardiopulmonary system, respiratory therapists must be experts in the machines and devices used to administer respiratory care treatments. This encompasses a variety of responsibilities.

Some responsibilities of respiratory therapists include:
  • Managing life support mechanical ventilation systems
  • Administering aerosol breathing treatments
  • Monitoring equipment related to cardiopulmonary therapy
  • Analyzing blood samples to determine levels of oxygen and other gases
  • Evaluating patients for the need for supplemental oxygen

Takeaway

During the last week of October, Respiratory Therapists are celebrated and acknowledged for their dedication to patient care, promoting respiratory health, and being a vital part of the healthcare community.

Seven Steps to Help You Quit Smoking Cigarettes

Smoking is not only a physical addiction, but also a psychological habit. The temporary high that smokers get from tobacco is extremely addictive.

Smoking severely damages your lungs, specifically your alveoli which are tiny sacs found within the lungs. Smoking is the #1 cause of chronic obstructive pulmonary disease (COPD). According to American Lung Association, over 16.4 million people are diagnosed with COPD, yet millions more have COPD without being aware of it. Smokers also have a greater chance of getting cancer, especially in the lungs.

Quit Smoking

Based on information collected from the US Department of Health and Human Services, cigarette smoking is responsible for over 480,000 fatalities in the United States every year. Over 41,000 of these deaths are caused by exposure to secondhand smoke. To put these statistics in perspective, that is 1 in 5 deaths yearly, or 1,300 deaths per day. According to the New England Journal of Medicine, smokers’ lifespans are typically 10 years shorter than nonsmokers. Below are helpful steps to quit smoking.

Step 1: Realize Why You’re Quitting

This reason is usually health related, and quitting smoking will help you live a healthier and longer life. Another reason might be stopping for your loved ones. Living to see your kids or grandchildren grow up is a great motivator to extend your lifespan by quitting smoking. Whatever your reason may be, quitting will give you more time to do the things you love, and will eliminate the anxiety that comes with wondering when you will get to smoke next. You will look better, smell better, and most importantly feel better after quitting.

Step 2: Tell Others

Sharing that you are planning to quit smoking with your loved ones will give you the encouragement and support you need to stop. They will be able to hold you accountable for you dedication to quitting and can be constant reminders of your reason to quit.

Step 3: Get Rid of Cigarettes and Paraphernalia

Dispose of all cigarettes, ashtrays, lighters, or anything that reminds you of smoking. Not having easy access to cigarettes would cost you a trip to the store to buy another pack, and will remind you of your reason for quitting.

Step 4: Consider Alternatives

Nicotine replacement therapy (NRT) is a safe and efficient way to help smokers with nicotine withdrawal. NRT gives you the nicotine that your body is craving in a form other than a cigarette. Cigarettes contain thousands of chemicals when inhaled, including toxic ones found in rat poison and nail polish remover. Although nicotine is an addictive chemical, just taking in nicotine is much safer than smoking cigarettes. The more cigarettes you smoked per day, the higher dose of nicotine you will need starting out.

There are many options when it comes to NRT, and one of the most common is a nicotine patch. There are also other options such as gum, inhalers, nasal spray and lozenges. Some NRT is available over-the-counter, but others you need a prescription for. The goal of NRT is to gradually decrease your dose until you can get off nicotine altogether.

Other types of NRT can be prescribed in pill form as well. These do not contain any nicotine, but they work by cutting cravings and block nicotine receptors in your brain. Talk to your doctor to determine which quitting aid is best for you.

Joining a support group can be very helpful to connect with others that are struggling with the same problems. Support groups can either be online or in person.

Nicotine addiction rehabilitation centers are also available if you feel that you will not be able to quit on your own. These rehab centers offer full-time help along with other people who are going through the same thing as you. There are multiple options available, such as outpatient and residential programs.

Step 5: Keep Busy

You may be irritable, anxious and experience headaches for a few days after quitting suddenly, so keep this in mind if you are around others. Use this time to grow as a person by trying new things, picking up new hobbies and filling your time with activities. This will keep your mind occupied on things other than the need to smoke. Below is a list of ideas to keep yourself entertained.

  • Cook or bake
  • Shoot photography
  • Birdwatch
  • Exercise
  • Call a friend or family member
  • Adopt a pet
  • Try a new food or restaurant
  • Read a book, write or paint
  • Garden
  • Take a class to learn something new

Remember that half of quitting smoking is the psychological aspect.

Step 6: Know and Avoid Your Triggers

Realize what triggers you to smoke a cigarette. Triggers can range from smelling cigarette smoke to finishing a meal, but everyone has different triggers. Avoid the triggers when you can, but it’s a given that not all will be avoidable. For example, if your routine was to wake up and smoke with a morning cup of coffee, go to a coffee shop instead of making your own. This way you won’t be tempted because you can’t smoke inside.

What To Do if You’re Triggered

If you’re thinking about getting more cigarettes, go to a public indoor place such as the mall or a museum where smoking is prohibited instead. This will shift your focus off cigarettes for the time being.

If it’s the feel of the cigarette in your mouth that you are craving, have some gum or mints on hand to fight this urge and keep your mouth busy. Having a glass of water around at all times can be beneficial to drink since your body was used to the motion of moving your hand to your mouth and back.

Step 7: Reap the Benefits

By not smoking anymore, you are saving money which you can use to treat yourself for your hard work. You are also improving your quality of life by having more energy to perform your daily acts of living.

Quitting now will prevent any more damage from being done to your body. Even if you have been smoking for 40 years, you will be able to gain a great portion of your health back.

The American Cancer Society suggests that not smoking for just 12 hours will return your carbon monoxide levels to normal. Around 3 months after, circulation improves, and you will have better lung function. Anytime between 1 and 9 months after quitting, your shortness of breath will decrease along with your coughing. After a year, you will cut your risk of heart disease in half. The longer you go without smoking, the more benefits will come, such as lowering your risk of cancers and diseases.

We wish you the best of luck on your journey to quitting. It may not be easy, but quitting smoking is a great accomplishment and something to be extremely proud of. You are doing this to set yourself up for a healthier lifestyle, and taking this initiative shows how strong of a person you are.

 

Sources:

https://www.addictionsandrecovery.org/quit-smoking/how-to-quit-smoking-plan.htm

https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd#:~:text=COPD%20is%20the%20third%20leading,disease%20without%20even%20knowing%20it.

https://www.cancer.org/healthy/stay-away-from-tobacco/benefits-of-quitting-smoking-over-time.html

https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

https://www.nejm.org/doi/full/10.1056/NEJMsa1211128

https://www.rehabs.com/getting-help-for-nicotine-addiction/

 

 

Risk Factors of COPD Among Women

Historically, men have been perceived to have a higher prevalence of chronic obstructive pulmonary disease (COPD) as compared to women, however, studies now show that more women are diagnosed with COPD and their mortality rates are higher. There is evidence of susceptibility among women of the risk factors associated with COPD.

The World Health Organization (WHO) in conjunction with the Global Burden of Disease (GBD), reports a prevalence of 251 million cases of COPD as of 2016. In 2015, it was estimated that 3.17 million deaths, accounting for 5% of global deaths, were caused by COPD. This is something that WHO had not predicted to occur until the year 2030.

As we know, COPD is a progressive respiratory condition that causes various limitations for breathing.

  • Pathophysiological changes involve inflammation in the lungs, narrowing of the airways, and damage to the lung parenchyma
  • The most common risk factors associated with the development of COPD include smoking, exposure to secondhand smoke, air pollution as well as occupational dust and fumes that are inhaled
  • WHO estimates that 25% of deaths attributed to COPD involve low- and middle-income countries and correlate to the increased exposure of household air pollution
  • Women who are exposed to high levels of indoor smoke and are twice as likely to develop COPD as compared to women that use cleaner fuels and technologies

While the diagnosis and treatment of men or women with COPD are the same, the risk factors are not consistent among both sexes. The associated risk factors among women that will be discussed include smoking status, associated comorbidities, occupational exposure, as well as anatomical and biological differences.

Smoking Status

As we know, tobacco smoke is the main cause of COPD in the United States and smoking is the leading cause of preventable death. According to information available from the Centers for Disease Control (CDC) and the U.S. Department of Health and Human Services (HHS) cigarette smoke causes about one of every five deaths annually, or 1,300 deaths every day. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, of which 201,773 deaths are among women.

The use of tobacco among women has steadily increased over the years, with a dramatic increase in use since the 1950s. During this time, it was more socially acceptable for women to smoke, and the tobacco industry targeted women in their marketing campaigns by promoting sex appeal, independence, and style. Decades later, tobacco companies continued their strategies by marketing cigarettes with slogans that included phrases such as “It’s a woman thing” or “You’ve come a long way, baby.” Some companies even suggesting that reaching for a cigarette was better than reaching for food and over-indulging, aligning with their campaigns that smoking made you more appealing and stylish. The effects of advertising are attributed to the rise in smoking among women in that era and their shift in use explains why consumption levels remain higher in places such as France, as compared to other countries.

Associated Comorbidities

COPD is typically associated with accompanying comorbidities and includes more organ systems than just our lungs. A recent publication in the respiratory care journal shares data researchers gathered regarding comorbidities among COPD patients and their associated healthcare use. The study included a total of 70,274 COPD subjects, women made up 58.2% of the total COPD subjects. Fifteen comorbidities were identified and the most prevalent diagnosed were hypertension accounting for 47.6%, high cholesterol at 29%, and allergies accounting for 34.2%. Women were found to have at least one or more comorbidities, 51.2% of the subjects studied, and had three times as many diagnosed comorbidities than their male counterparts.

In a 2016 review, Barnes discusses sex differences in COPD and notes that women with severe COPD have a higher risk of hospitalization and death from respiratory failure and associated comorbidities. For those women that have developed COPD due to smoking, their risk of dying from coronary heart disease as compared to other middle-aged nonsmokers’ women is five times higher.

Often, comorbidities in COPD patients go undiagnosed and therefore lead to failure in treatment for their needs. More standardized protocols should be developed by organizations with a goal to provide useful management of patients with COPD and comorbidities so that those healthcare providers caring for these patients provide the right care.

Occupational Exposure

Occupational and biomass exposure is another common risk factor for COPD. Workplace exposures can include things such as dust, fumes, gases, and secondhand smoke. Presently, some three billion people use biomass or solid fuel as energy sources to heat and light their homes, and to cook. In developing countries, women often are exposed to these risks as they spend most of their time in the home and do most of the cooking leaving them disproportionately exposed to larger amounts of biomass irritants.

It has been studied that a lower a person’s socioeconomic status, the higher their risk of poor health. This statistic includes women and children who live in severely impoverished countries and have the greatest exposure to air pollutants. In a 2006 WHO review on energy and health, women who cook with solid fuels have an equivalence of smoking two packs of cigarettes a day. To put it in perspective, a 1-year old girl can accumulate a two-pack year smoking history without ever having been exposed to tobacco smoke.

Women now work in similar jobs as do men, taking on careers in factories and chemical plants, working as farmers, mechanic shops, and in the hospitality industry. All these job fields along with others risk their health through exposure to harmful toxins that can in time lead to the development of COPD.

Anatomical and Biological Differences

Recent studies have also discussed the anatomical differences among men and women and how that is factored into the development of COPD. Various authors have compared lung sizes via different radiological tests and proven that men’s lungs are bigger. According to Aryal et al.,  women are more susceptible to developing COPD due to the size difference of their airways. Their airways are relatively smaller than those of males in comparison to their respective lung volumes.  Therefore, the level of tobacco smoke may be increasingly concentrated per unit of small airway surface. However, no difference in size has been observed in the number of alveoli per unit area, the number of alveoli per unit area volume, individual lung units, and alveolar dimensions. Collectively, more studies should investigate the specific differences in lung size as it relates to tobacco particle disposition and inhaled irritants.

Tobacco smoke contains more than 4,000 chemicals, the smoke inhaled into the lungs is then absorbed and metabolized throughout the body. The process involves a multistep approach but what is important to note about it is that cytochromes p450 (CYP) are what differentiates COPD between men and women. CYP is important in the clearance and breakdown of various compounds, irritants from inhaled tobacco being one of them. In fact. According to a 2016 publication by Hardin, female smokers have increased lung expression of CYP enzymes compared with male smokers. This evidence explains why estrogen levels in women have also been linked to the development of COPD. Estrogen may regulate CYP expression, specifically the estrogen receptor Era, which is more prevalent in women. This information collectively suggests female hormones may hasten the metabolism of tobacco smoke, via the CYP pathways, and accelerate the metabolism of nicotine.

Closing Thoughts

While the number of COPD-related deaths has fallen over the years, the number of diagnosed cases is rising. In the UK, COPD cases continue to rise as the population ages. The long-term effects of smoking are also likely to increase the present burden of COPD on healthcare systems. This presents challenges for both patients and the healthcare systems, not just in the U.S. and UK, but worldwide. It is imperative that we understand the underlying differences between men and women as it relates to COPD.  We should continue to work towards improving the diagnosis, treatments, and monitoring of COPD in women. Reducing the stigma surrounding COPD, raising awareness about various risk factors, and tailoring smoking cessation programs to women can help flatten the curve of this incurable disease.

 

Resources:

Aryal, S., Diaz-Guzman, E., & Mannino, D. M. (2014). Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. International journal of chronic obstructive pulmonary disease, 9, 1145–1154. https://doi.org/10.2147/COPD.S54476

CDC – Data and Statistics – Chronic Obstructive Pulmonary Disease (COPD). (2018, June 05). Retrieved September 22, 2020, from https://www.cdc.gov/copd/data.html

Barnes PJ. Sex Differences in Chronic Obstructive Pulmonary Disease Mechanisms. Am J Respir Crit Care Med. 2016 Apr 15;193(8):813-4. DOI: 10.1164/rccm.201512-2379ED. PMID: 27082528.

Han, MeiLan. (2020). Chronic Obstructive Pulmonary Disease in Women: A Biologically Focused Review with a Systematic Search Strategy. International Journal of Chronic Obstructive Pulmonary Disease. Volume 15. 711-721. 10.2147/COPD.S237228.

Hardin M, Foreman M, Dransfield MT, et al. Sex-specific features of emphysema among current and former smokers with COPD. Eur Respir J. 2016;47(1):104-112.

Quaderi, S. A., & Hurst, J. R. (2018). The unmet global burden of COPD. Global health, epidemiology, and genomics, 3, e4. https://doi.org/10.1017/gheg.2018.1

Soriano JB, Maier WC, Egger P, et al. Recent trends in physician-diagnosed COPD in women and men in the UKThorax 2000;55:789-794.

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Accessed September 22, 2020.

World Health Organization (WHO). Chronic obstructive pulmonary disease (COPD). http://www.who.int/respiratory/copd/en/. Accessed September 20, 2020

Balanced Diet & Nutritional Tips for Lung Health

If you suffer from chronic obstructive pulmonary disease (COPD) or other respiratory health conditions, you may notice that eating certain foods may affect your breathing. Consuming a balanced diet with the right mix of nutrients can make breathing easier. Below are some general nutritional tips on foods that can help you.

Healthy food choices

Healthy Foods

How Does My Diet Relate to My Breathing?

Metabolism is the body’s process of changing food to fuel. Oxygen and food are the raw materials of the process, and energy and carbon dioxide are the finished products.

When our bodies metabolize simple carbohydrates, such as a slice of cake, we use more energy and therefore use up more oxygen. That process can leave us short of breath. Eating a diet with fewer simple carbohydrates and more healthy fats can help you breathe easier.

Nutritional Tips

The American Lung Association is a great resource for lung health & disease management. Some of their recommended guidelines for a balanced diet include:

  • Eat Complex Carbohydrates– such as whole-grain bread and pasta, vegetables, and beans
  • Limit Simple Carbohydrates– such as candy, cake, and soft drinks
  • Limit Foods that cause Bloating– foods such as legumes, cause gas and bloating making breathing difficult
  • Increase your Fiber– aim to eat 20-30 grams of fiber from foods such as nuts, seeds, or oatmeal
  • Eat High Protein Foods– such as grass-fed meats, eggs, milk, and fish such as salmon
  • Consume Healthy Fats– avocados, coconut and coconut oil, olives and olive oil, and cheese are great choices
  • Limit Saturated Fat- foods cooked in lard, vegetable oils, or fried foods should be avoided
  • Consider a Multivitamin– adding calcium and vitamin D could benefit COPD patients who take steroids
  • Limit Your Sodium– foods with too much sodium may cause swelling and increased blood pressure
  • Stay Hydrated– remember to drink 6-8 glasses (8 fl oz each) of water throughout your day and limit caffeine
  • Eat Smaller Meals– this helps the muscle under your lungs move freely and lets your lungs expand easily

Weigh In

Weighing yourself on a regular basis can help you and your health care provider keep track of how your diet is going. Various health complications could result from being underweight or overweight. When your body is well-nourished, it is better equipped to handle infections and respond to treatments.

The Takeaway

It is important to monitor your diet to ensure you are getting the right mixture of nutrients for your overall health, especially if you suffer from COPD. Keep in mind that the ideal diet will vary depending on a person’s weight and lifestyle and each person’s needs are different. Always talk to your health care provider or a registered dietitian nutritionist to help you get started with a balanced diet.

Pulse Oximetry and its Importance in COVID-19

Patients with conditions such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and various cardiac conditions have utilized pulse oximeters as tools in monitoring their supplemental oxygen use. Pulse oximeters have become essential diagnostic tools because of ease of use, portability, and applicability in a wide range of clinical settings. In the face of the current pandemic, pulse oximeters have gained popularity with patients and physicians alike. Could early pulse oximetry monitoring be utilized in COVID-19?

Globally as of today,  09/23/2020, there are now approximately 31,375,325 confirmed cases of COVID-19 according to the World Health Organization (WHO). Since the outbreak, there have been roughly 749,069 cases in Texas with a significant spike in cases just days ago on 09/21 of 9,853. That is the most significant jump in new daily cases since mid-July when cases climbed to 14,916 on 07/17/2020.  While the number of daily new cases is trending down, we should remain cautious and continue to wear masks, social distance, and avoid large gatherings when possible.

When oxygen levels are low, the organs in our body receive less oxygen which can negatively impact their bodily function. Knowing baseline oxygen saturation levels at rest and with activity can help trend changes among various health conditions. In the presence of COVID-19, monitoring pulse oximetry levels can help monitor oxygenation and warn of impending or silent hypoxemia. While only a few independent studies have assessed the performance of pocket oximeters and smartphone-based systems, future studies could be performed to determine their accuracy.

Pulse Oximeter

Pulse Oximeter monitoring SpO2 and heart rate.

Common Questions regarding Pulse Oximeters:

What is a Pulse Oximeter?

A pulse oximeter is a small, battery-powered device that is used to measure how much oxygen your blood is carrying. The blood oxygen level measured with an oximeter is called your oxygen saturation level (SpO2) and is displayed as a percentage. The device works by sending two wavelengths of light into the finger through the nail bed and measures what is absorbed by the blood. It can also calculate your pulse and that is displayed as beats per minute (bpm).

How are Pulse Oximeters used?

A pulse oximeter comes as a small unit with a built-in finger/toe clip. All you must do is place your finger inside the pulse oximeter. The pulse oximeter delivers a calculated value and will display it once the reading stabilizes. It is normal for the value to fluctuate so do not worry if you see it changing constantly. Remember to keep working batteries in your oximeter to limit interruptions in your monitoring.

What is a Normal Oxygen Saturation Level?

The American Thoracic Society (ATS) recommends you ask your health care provider what oxygen saturation level they want you to maintain. ATS suggests most people need an oxygen saturation level of at least 89% to keep their cells healthy. COPD patients are advised to maintain a pulse oximetry level between 88-92%. Normal oxygen saturation levels run between 95% and 100%. Medical professionals should be consulted if a patient with suspected or confirmed COVID-19 has SpO2 ≤90%. Having a pulse oximeter will allow you to monitor your blood oxygen level, know if you are within your recommended range, and whether you need to increase your supplemental oxygen level.

How Accurate is a Pulse Oximeter?

The oxygen level from a pulse oximeter is reasonably accurate. Most oximeters give a reading 2% over or 2% under what your saturation would be if obtained by arterial blood. A pulse oximeter may also be less accurate with very low oxygen saturation levels (below 80%).

Factors affecting accuracy to read include:

  • Dark-colored nail polish
  • Cold fingers or poor circulation
  • Tremor or movement
  • Too much pressure on the probe
  • Low blood pressure

Closing Thoughts

For patients and health professionals alike, it will be imperative to be vigilant in the use of new technology advances, such as the way consumer tech companies are marketing health capabilities and promoting pulse oximetry monitoring among their devices. What they can do and what they can reliably do may in fact be two separate things. The use of these devices could potentially threaten and jeopardize a person’s health if the user relies on its accuracy to dictate when they seek medical care. Recently, Brian Clark, a pulmonologist and professor at the Yale University School of Medicine was featured in an article in the Washington Post speaking on the topic of emerging tech companies diving into the medical space. He commented, “I agree with you that it is a dangerous trend for technology companies to release medical devices that don’t meet FDA standards and claim that they are not medical devices”. Dr. Clark also adds, “But the more concerning and potentially dangerous scenario is when the devices provide false reassurance and people don’t seek health care when they really need it”.

Patients suffering from respiratory health conditions will continue to use pulse oximetry monitoring devices for the unforeseeable future. Hand-held pulse oximeters have become a common assessment tool and according to various studies, have been useful as diagnostic tools for the assessment of COPD. They can be used during both stable phase and exacerbations, as well as confirming the need for oxygen therapy.

Worldwide, people are looking to health monitors for any clue that they may have COVID-19, the illness caused by the novel coronavirus. For regular supplemental oxygen users that notice oxygen levels trending low, it will be important to speak with your healthcare provider or respiratory therapist as to when to increase or decrease your oxygen level based on pulse oximetry readings. Regardless of preexisting conditions, monitoring yourself for COVID-19, or recovering from recent hospital admission, its important to seek immediate medical attention if you notice significant changes in your oxygen levels. If you are caring for a patient with COVID-19 and their SpO2 ≤90%, refer to their primary care provider for further evaluation and possible treatment.

Sources:
  1. Adler JN, Hughes LA, Vivilecchia R, Camargo CA Jr.Effect of skin pigmentation on pulse oximetry accuracy in the emergency department. Acad Emerg Med1998596570
  2. Fowler, G. (2020). Washington Post [Editorial]. Https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/. Retrieved September 23, 2020, from https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/
  3. Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc. 2020 Sep;17(9):1040-1046. DOI: 10.1513/AnnalsATS.202005-418FR. PMID: 32521167; PMCID: PMC7462317.
  4. Lipnick, Michael S. MD*; Feiner, John R. MD*; Au, Paul BS*; Bernstein, Michael BS†; Bickler, Philip E. MD, Ph.D.* The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications, Anesthesia & Analgesia: August 2016 – Volume 123 – Issue 2 – p 338-345 DOI: 10.1213/ANE.0000000000001300
  5. WHO Coronavirus Disease (COVID-19) Dashboard. (n.d.). Retrieved September 23, 2020, from https://covid19.who.int/

5 Tips to Control Your COPD Symptoms This Fall

Happy Fall! As the weather begins to get colder, breathing can become more difficult. The dry air you are exposed to in the winter can cause flare-ups, also called exacerbations, if you have chronic obstructive pulmonary disease (COPD). Luckily, there are steps that can be taken to reduce the chances of flare-ups and take on the colder months this fall.

Limit your time outdoors.

Being outside in cold and harsh wind can increase your chance of catching a cold, and colds are even worse when you are suffering from COPD.

Patients with COPD

Controlling your COPD this Fall

Practice nasal breathing.

When air travels through the nose, it has time to warm up and humidify before moving to the lungs. Mouth breathing does not have this warming effect, and it results in cold, dry air entering your lungs. To make breathing through your nose easier, be sure to regularly moisturize your nostrils with spray or gel, which is available over the counter at any drug store.

Keep your home at a comfortable temperature.

Dr. Bohdan Pichurk, a Pulmonary physician at Cleveland Clinic in Ohio, recommends keeping your thermostat between 68 and 72 degrees Fahrenheit. A humidifier set at 45 to 50 percent can help reduce your nasal dryness. Adding moisture into the air helps the colder air you breathe not be so dry.

Cover your face with a scarf or blanket when you are exposed to cold, dry air.

This will help warm the air as it enters your body. If you are on oxygen, keeping your portable oxygen concentrator under your coat or warm clothing will help the cannula warm up, allowing the air that enters your body to be warmer and less harsh.

Be mindful of fires.

The fumes from indoor fireplaces or outdoor fires can further irritate your lungs, causing your symptoms to worsen.

Be sure to follow your prescribed medications as directed.

Doctors may alter your medications with extreme weather changes. Taking your medications when you’re supposed to will help your symptoms from worsening.

 

These small and mindful tips will help cold you conquer the cold weather this season. Belluscura wishes you a happy and healthy fall!

 

Sources:

https://www.everydayhealth.com/hs/chronic-obstructive-pulmonary-disease/copd-triggers-in-your-house/

https://www.health.harvard.edu/staying-healthy/7-strategies-to-fight-winter-breathing-problems

Respiratory Health Among First Responders

This year marks the 19th Anniversary of the September 11th attacks of 2001. Immediate deaths involved those at the World Trade Center (WTC) in New York City (NYC), the Pentagon, and the passengers on board the four aircrafts, which included Shanksville, Pennsylvania, and Arlington County, Virginia. Of the 2,977 lives lost that day, 343 firefighters and 71 law enforcement officers perished. As the day approaches, we pause to remember the victims, the families, and survivors affected by this horrific event.

New York City Firefighters

Firefighters work at the site of the World Trade Center terrorist attack in New York City on September 11, 2001.
Photo: Mark Lennihan/Associated Press

With specific regard to the WTC and ground zero, the information provided by the NYC Commissioners office states that the rescue and recovery clean-up of the 1.8 million tons of wreckage took 9 months to complete. Firefighters, Emergency Medical Technician (EMT), law enforcement officers, and volunteers joined in the effort to recover and rebuild, putting their respiratory health at risk in the process.

Firefighters are regularly at an increased risk of developing respiratory conditions due to occupational exposures. In fact, researchers have found an increased prevalence of chronic obstructive pulmonary disease (COPD) among nonsmoking workers. According to the Centers for Disease Control and Prevention (CDC), nonsmokers account for an estimated 26 -53% of COPD cases attributed to occupational exposures. Inhalation of occupational elements can lead to short- and long-term effects on the respiratory system. During the “knockdown” phase, firefighters are actively fighting the fire. During the “overhaul” phase, firefighters have extinguished the fire, and embers and smoldering flames have subsided. Consequently,  both lead to exposure to toxins and respiratory irritants such as sulfur dioxide, aldehydes, and hydrogen chloride.

The World Trade Center Health Program was implemented to manage the ongoing health effects of the 9/11 attacks. As of December 2017, the program has reported asthma, COPD, various cancers, and gastroesophageal reflux disease (GERD) to be the most common conditions they treat. Air pollution experts suggest that along with pulverized building materials and electronic equipment, first responders were also inhaling things such as burning jet fuel, plastics, metal, and fiberglass. Under normal circumstances, firefighters are not exposed to this magnitude of inhaled pollutants.

The events of 9/11 highlight the essential need for firefighters to use self-contained breathing apparatus (SCBA). The use of an SCBA can prevent or slow the progression of developing respiratory conditions such as asthma and COPD, prevent inhalation of pulmonary irritants, and reduce the risk of smoke inhalation injuries. The significance of COPD among firefighters is like that of a problem in developing countries where household air pollution is a concern. According to the World Health Organization (WHO), 25% of deaths attributed to COPD involve low- and middle-income countries and are due to the exposure to household air pollution. Women who are exposed to high levels of indoor smoke and are twice as likely to develop COPD as compared to women that use cleaner fuels and technologies.

Lung disease among firefighters is studied routinely. Schermer TR, et al. set out to compare occupational exposures, use of respiratory protective devices, and their association with health-related quality of life among metropolitan firefighters. A cross-sectional cohort analysis of the South Australian metropolitan fire-fighter was performed. The questionnaire involved 570 participants and analyzed respiratory symptoms, medical conditions, occupational tasks and exposures, and the consistency of respiratory protection. Of the results reported, 91% of firefighters that participated reported relevant occupational exposures in the last year. Asthma accounted for 4% and COPD for 7% as a diagnosis based on criteria answered in the questionnaire. Firefighters with asthma reported they had been sick due to occupational exposures twice as often as those with COPD, emphysema, or chronic bronchitis.

Our medical textbooks teach us that asthma and COPD are two distinct disorders however there is increasing evidence that many patients may have features of both, now referred to as Asthma-COPD overlap (ACO).  Asthma is classified by having intermittent symptoms early on and has an effective response to inhaled medication therapy. COPD however is generally is associated with a late-onset, a patient typically has a slow progression of symptoms, poor response to inhaled therapy, and often associated with long-term smoking. COPD patients are prescribed long term oxygen therapy (LTOT) manage their symptoms whereas most asthma patients are not. Patients with ACO have a decline in the quality of life and higher mortality compared with patients who have either isolated-COPD or isolated asthma.

Firefighters at ground zero after the attacks at the World Trade Center

Firefighters at ground zero in New York City shortly after the attacks on the World Trade Center (WTC). September 11, 2001.

In a similar 2016 study by Aldrich TK et al., lung function trajectories in WTC firefighters over the course of 13 years were observed. Information was collected from 10,641 WTC-exposed NYC firefighters. Significant findings revealed that on average, firefighters lost 10% of their lung function after 9/11, and >10% developed new obstructive airway disease. The data also revealed that there was a little recovery in lung function over a span of the first 6 years. First responders, those arriving at ground zero the morning of 9/11 had a significant pulmonary function test (PFT) results, having an FEV1 < lower limit of normal as compared to those that arrived toward the end of the day. Of those studied, Aldrich et al. did separate the subjects into never smokers, current smokers, and previous smokers. Current smokers had existing lung function damage, but the significance of the findings is that 65% of the firefighters never smoked yet make up the 10% of those who have a new diagnosis of obstructive disease. Smoking cessation plays a significant role in any patient population however extremely imperative in the firefighter population. While the damage caused by the WTC exposure is immutable, focusing on improving PFT metrics can monitor the progression of the long-term respiratory conditions.

The National Institute for Occupational Safety and Health (NIOSH) is a federal agency and organization that conducts research and makes recommendations to prevent work-related injuries and illnesses. According to NIOSH, mortality from lung cancer, heart disease, and COPD are three diseases traditionally associated with firefighting. Based on previous research collected, current smokers may tend to overlook signs and symptoms of COPD which could lead to delay in care and treatment of lung damage. As with our current COVID-19 pandemic, great importance is placed on the use of personal protective equipment (PPE). NIOSH Respiratory Protection Week is September 8-11, 2020. Their focus for the last 101 years has been to compile resources and determine proper respiratory protection and maximize the availability of respiratory protection in addition to designing innovative respirators.  

The International Association of Fire Fighters (IAFF) is another key organization among firefighters. Information provided by the IAFF suggests that depending on when a diagnosis is made of COPD and how aggressively firefighters can change exposures and behaviors, further decline in lung function can be decreased with appropriate PPE. As mentioned before from what we know with the events of the 9/11 attacks, the use of SCBA equipment by firefighters can slow the progression of respiratory diseases by preventing inhalation of pulmonary irritants and reduce the risk of smoke inhalation injuries. Beyond that, specific attention to the consistent use of respiratory protection devices in employees who have underlying chronic respiratory conditions is equally important.

Among the common respiratory conditions firefighters face, cancer is among the highest diagnosed within the profession. In 2010, NIOSH published a study that included nearly 30,000 firefighters who were employed from 1950 – 2009. Findings suggested that compared to U.S. population rates, firefighters had a 9% increase in cancer diagnosis and a 14% increase in cancer-related deaths. This information is consistent with a cancer diagnosis that has been trended from the WTC Health Program. Each year more firefighters have lost their life due to various types of cancer, linked back to the exposure of the 9/11 attacks.

The dedication and bravery the multitude of first responders from 9/11 and all firefighters today exhibit should never be forgotten. Integrity, respect, and compassion are qualities these men and women display daily all while risking their lives and health. Let us pause to commemorate the lives of those we lost that day and join in the effort to bring safety awareness to this vulnerable population who is at increased risk of developing respiratory health issues and fatal conditions.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289858/

https://www.sciencedirect.com/science/article/abs/pii/S0091743511003616

http://postprint.nivel.nl/PPpp6792.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686342/

https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

https://www.cdc.gov/niosh/index.htm

https://www.iaff.org/asthma-copd/