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Bob Penhallow,RCP, Licensed Respiratory Care Practitioner
These are the questions and answers from our original forum. Our new forum contains the newest question. Look through them, your answer may be here.
I have asthma, but I wonder if I might have a mild case of COPD. Sometimes I have the same symptoms as COPD. Is this possible? Please e-mail me back concerning my questions. Thank you. Pinky Pinky, Bob P here, Linda's Resident Respiratory Therapist. Asthma "symptoms" are very prevalent with people that have adult lung disease (COPD). Your airways may be very reactive to many stimuli like pollen, smoke, perfumes, etc, and they may cause the airways to shutdown and you may wheeze and such. U may have what I call "legitimate" asthma or But to know exactly what u have, it is IMPERATIVE that U have a COMPLETE Pulmonary Function Test, and I can't stress this enough. Talk to your doctor about this and about your exact diagnosis. Have him or her review the results with U and don't take no for an answer! Knowledge is everything! Hope this helped and come back to let me know how things went. BobP
Is this right? If you have alveoli that are hyperinflasted you can't get 02 in. If you have Emphysema you can't get the c02 out. Are both these copd? Is the treatment the same? How do you find out which one you have? Does it make any difference? Thank you.
The whole thing about emphysema is that air can get in but can't get out, like a one-way valve, it's the airway that does this, and this is why PLB is so very important to do, for intra-bronchial pressure (think of u holding a hose
and watering your garden, a steady stream of water is coming out. Now u squeeze the end so only a trickle is coming out. What do U feel from the hose
in back of the hand that is squeezing? The hose is bulging, right! Well, your airways act the same way with PLB.) Anyway, the alveoli keep getting bigger
and bigger and weaker and weaker and finally tear apart. Remember a group of alveoli share a common wall so it deteriorates until the whole thing is one big giant nothing. Also when air gets into an aveolus there may not be any circulatory mechanism for the O2 to be transported. Like a dried up river
bed. The reverse can happen also. This is called a V/Q mismatch. The V is for ventilation and the Q (both with a dot over them) is for circulation. But I
want to tell U that there may be parts of your alveolar architecture that are OK alveoli, just not being used, ( it's like use it or lose it, for a while anyway) like when people have thoracic or abdominal surgery. Some alveoli are not used due to inadequate breathing volume so they become basically dormant, this is called atelectasis and can be remedied to a certain extent with increased activity and breathing exercises, especially with a device they call an Incentive Spirometer. This is a device with a ball or cylinder that when U breathe in deeper the ball, or whatever will go up thereby encouraging U to breathe deeper. But U have to be careful not to over do this. Lastly, yes people with emphysema, cannot get CO2 out, and this is the problem that I mentioned above. But if U remember and are compliant with pursed lips breathing, this problem can be abated to some degree. Only problem is that U have to remember to it whenever U need it and not to pant and this is tough! Hope I helped, BobP
Is cramping of the feet and hands do to any medication we might be taking for COPD? Also the dry skin. Is this a sign of old age or COPD? I am 68 have had LVRS but still on o2. Thanks again. Peg
Bob P here, Linda's resident respiratory therapist here. Peg's question. There is a slight possibility of muscle cramps due to albuterol, which is just one of the side effects of this drug. Also prednisone and the inhaled equivalents; azmacort, aerobid, flovent, vanceril, etc have as side effects, muscle WEAKNESS. But she should, under her doctors care and guidance, check her potassium level (have an "electrolyte" panel done, it's a simple blood test), this can cause muscle cramps; and she should be drinking, as much water, (64 oz. or MORE), ALL DAY, as she can or as her doctor has allowed and this is VERY important to do everyday without fail! This will nourish the whole body and keep it hydrated. And as a side bar, ask her to use ONLY water soluble hand lotion like Keri, and not Vaseline Intensive Care, types. The water soluble type will absorb into the skin before evaporating unlike the Vaseline types, which main ingredients are wax & petroleum. Your friend , Bob Penhallow, RCP, resident respiratory therapist
NEW INFORMATION: Bob P here, Linda's resident respiratory therapist here. This just out! A new bronchodilator is on the market and I think U all should know, if U dont already! Its called, LEVALBUTEROL, brand name Xopenex (say: Zo-pen-ex) from Sepracor, INC. It is a Beta2-adrenergic, like albuterol (Ventolin, Proventil and their generics from Warrick,et al). But it only contains the R-isomer (isomers - those chemical substances that have the same molecular formula but have different chemical and physical properties). Albuterol has BOTH the R & S isomers. It is the R- isomer that is the one that is responsible for the bronchodilation of the smooth muscles of the airways, the S- isomer does not bind to the Beta2 adenoreceptors. I know this may be "gobbly gook" to some, but just sit back and enjoy and learn.
The indications for this drug are for REVERSIBLE bronchospasm in moderate asthma and COPD! Yes, it is very similar to albuterol but may be tolerated
better. Please consult your physician! It is available in unit dose vials of 3 ml(cc), containing, 0.63 mg levalbuterol & normal saline. The recommended dosage is three times a day (TID) every 6-8 hrs., by nebulizer only, at the time of this notice. Yes, that means, no metered dose inhaler, yet! It is for patients, 12 yrs old and older! Please consult your MD for adverse effects, but they are very similar to albuterol.
By the way, for those of U that use a nebulizer unit (like Pulmoaide, etc) U might try getting the PARI LC Jet nebulizer unit to use with your compressor
unit! These are covered by Medicare now, and last for 6 months. They are SO superior to other nebulizers and do such a tremendous job. It may take a little, to a lot longer to get through a "treatment," but they nebulize every little particle, so that U get the treatment that U deserve, and NEED!
Again I am glad to give U this info, but as always, please consult your physician as to this drug and nebulizer! OK? Bob Penhallow, RCP, resident respiratory therapist
Dear Synthy, Bob P here. Just thought of a couple of things. First, u are 49y/o, right? When U see your physician, ask him to test U for Alpha 1 -Antitrypsin (AAT). This is the genetic form of emphysema. Now I dont want U to get alarmed at ALL! It is just a simple blood test and will tell U a lot. If its negative then U know THAT, if it is positive, then there is treatment for this. U just need to know and rule this out. The hallmark is your age, especially if U have had a breathing problem for most of your 40's. It is the lack of a protein, Alpha 1-Proteinase Inhibitor (that guards against the elastase enzyme, (which likes to destroy good lung tissue, thinking it is guarding against those enemies that attack your lungs). The process of knowing about your lung situation, as I have said many times, is a strong offense! Knowing all that U can about your lungs is strengh! To know is to understand what to expect and reslove! To be able to talk to your MD in a knowledgeable way! To know what he/she is saying to U and what to ask! But I beg of U, NOT to get worried at all! OK? Some MDs are reluctant to order this test, because they seem to think it is so "out there" that it is not necessary. AAT affects 1 in 46 emphysematic patients! If U are one, U need to know, period. So just ask your MD to order this. Insist! Second, have U heard of the drug, Zyban? Its a drug that has been an anti-anxiety, anti-depressive under the name of Wellbutrin (generic: bupropion HCL). Well when people had been taking this drug for anxiety disorders and smoked, they found that those people stopped smoking. So they did some studies and it seems that there is something about this certain drug, as opposed to others in this catagory, such as Xanax, BusPar, Ativan, Valium, that has an effect to cause people to NOT have the urge to smoke or at least lessen the urge! It has been used with my smoke cessation program pts. for a year now and it is so very successful that I recommend everyone serious to stop smoking to ask their MD to prescribe! Some MDs are again reluctant to prescribe because they think that anti-depressants reduce the "drive" to breathe well. This is not entirely true, if dosed properly! It is a safe drug, if U look at the side effects and don't necessarily look to the "seizure disorder" one. Of course if U have a history of seizures then this drug is NOT for U! But in the last year, not ONE person has complained of anything but occasional insomnia and mild other side-effects that do not affect their lives in anyway! It can be used in conjuntion with the nicotine patch, inhaler and gum! It seems to work, so ask your MD about this also. Go with health in your life and peace in your heart! Bob Penhallow, RCP, resident respiratory therapist
How can I not smoke when I go into a panic situation?
Dear Synthy, Bob P here. Why do u smoke to begin with? Most likely to reward yourself, something to do with your hands, it physically "calms" u down, etc. All of these things can be done by doing something else! When U feel panic or depression, just take a walk or do something else to delay the urge! And DO IT! Dont wait. Just leave and walk outside a little! Remember something. The urge for a cigarette WILL go away, whether U have a cigarette or not! If someone tied U to a chair, (and I am not advocating this for real..LOL) u would have an urge in probably 7-10 mins and if no cigarettes where available to u, the urge would just pass! Think about all the cigarettes in the day that U smoke that U really didn't like, but U did it out of habit. Yes, nicotine is a most highly addictive substance and it is THE toughest of all substances to "kick"! But just try to take a walk, change your habits that are connected to smoking, ie: talking on the phone, driving, having your morning coffee, cocktails at nite,etc, do some other exercise, just divert yourself in some way! Get a kids coloring book and place it by the phone and when u get a call,just start coloring or doodle! It does take diligence and constant vigilance! Just take it one step at a time! Just knowing when and WHY u light up, and taking a sec to realize what U are doing to your lungs is a big step to quiting. But first try to do what I said when u feel panic! Just leave the scene! One of the best things to do, and U can do this anywhere and anytime, is Pursed Lips breathing. Just take in a moderately deep breath through your nose, and exhaling through pursed lips (this is puckering your lips like U would to whistle) and make the exhalation at least twice as long as U inhaled! Practice this! If u have trouble with this, get a candle, light it and sit in front of it at least an arms length away and do the pursed lips breathing toward the candle and make the candle light flicker but not go out! This prcedure is not only a good substitute for smoking but is good for your lungs, and one of the best relaxation techniques known to man! Just practice, practice! Just try some of these Synthy. That is all U can do, is just TRY, and u will be taking one of the biggest steps of your life and FOR your life! Hope I helped in some way! Hope i helped in some way. Go with health in your life and peace in your heart! Bob Penhallow, RCP, resident respiratory therapist
My doctor said I have this stuff. I'm 49. He said to test me he has to lock me in a box. I am very clastrophobic I haven't made an appointment yet because even the thought of getting locked in a box sends me into a panic, isn't there something else he can do? Synthy
Dear Synthy, Bob P here, the resident Respiratory Therapist for this site. I feel your pain! What they want to do is a complete Pulmonary Function Test. This will tell u and your MD what exactly is going on with your lungs! It is THE most important test U could have, if U have a lung problem! The "box" is an enclosure that should have windows all over the place, and an intercom so U can communicate with the therapist that is administering the test! It only takes a few minutes in the "box" and the therapist should comfort U all the time! Its really not THAT bad, but the results are SO,SO important to your knowledge of your lung situation, that U should do it!!! It shouldn't be all that bad. It sounds soooooo bad when they tell U over the phone but the reality is not that bad! Its over before U know it! The therapist should calm U down and tell him/her about your fears beforehand! OK? They will certainly comfort U! But DO the test! It is SO important for U to do that I cant say this enough! At least try! OK? Come back to me and tell me your experience!
If your MD told U that U will be in a "box", without explaination, he should be scolded by U! This is so rediculous of him/her to tell U this, in that way!! It IS not that bad of a test! Yes it is vigorous, but U will do so fine with it! I am so sorry that many MDs do not have the "tact" to let U know exactly what to expect that it makes me SO mad! They have a responsiblity to your health and explainations are part of it! U must demand this respect from your MD! And get a COPY of the results and discuss with him/her! I hope U will do this test and again,let the therapist know about your fears before U do the test! He/She will do whatever it takes to make U comfortable! If not, let me know, and I will complain to the organization that I belong to! Go with peace, friend! Hope i helped in some way. Go with health in your life and peace in your heart! Bob Penhallow, RCP, resident respiratory therapist
My stepson met a woman with a trachael catheter and she told him that she loved it. Does any one know anything about it? Bob, what do you think about a trachael catheter instead of a nasal cannula? Maintenance? Comfort? Satsifaction? Jim
Bob Penhallow here for Jim! What they are talking about is called a Trans-Tracheal Oxygen Catheter (TTOT) for short. I have assisted in this surgical procedure many, many times and it is such a great procedure for those that need it! It is the placing of a very small catheter, about 4 1/2 (11cm) inchs long or so, that is surgically placed beneath your "adams apple". The procedure is so painless that an arterial blood gas out of your arm is more painful! A tiny incision is made at a point around there and procedure starts. It is too compicated to tell now, but the end result is that U have a tiny catheter that almost touchs your carina,that part of your respiratory "tree" where your main bronchial tubes divide to the two lungs! This way Oxygen is transported to the lungs without having to go through the nose and trachea. This is what they call "dead space" because it does not provide respiration (the exchange of O2 in your body and the waste gas, CO2, which U exhale). Hope I not getting too technical, if be, talk to me later, OK? So there is more O2 going to the parts of your lungs that need it most! The catheter is eventually in place for as long as U want it! And yes it needs to be cleaned daily, by putting saline (salt water) into the catheter and "brushing" it with a stylet that is provided. No big deal, I can assure U! The only thing that has been a problem as I can see, is a sore throat for awhile and mucus plugs that may attach to the catheter. This latter problem can be remedied by flushing more saline down the catheter. No big deal! The attractive thing about the TTOT is that there is NO nasal cannula that corrodes your nose and ears and no one can see it, really! Just the O2 device that U have, I would hope that would be on a liquid O2 system!
Now the person that could benefit from TTOT? This is the person that NEEDS O2 ALL THE TIME! In most respects, that I am experienced with, this means those individuals that have what they call restrictive lung disease (read: asbestosis, or basically those that have had working relationships with chemicals, fumes, and other toxic gases, etc that have caused a lung disease, that have been diagnosed) but those that have COPD and are on continuous oxygen, and NEED it for ALL activities, can SO benefit from this procedure, if they are willing to be complient to the cleaning and general care regime! I am not going to minimalize the extent of the care that is necessary for the care of this catheter, it is to be a constant vigilance, but those that have to use O2 all the time can find peace in the comfort of this little catheter. Its a decision that U must make with your loved ones and your physcian and he/she should be able to give U more info and a video tape about the procedure. If U are interested and do not get any response, I can give U an address where U can get more info! Please do not think this procedure is permanent! It is NOT! It takes a few weeks to have a "mature" track ( that is that the "hole" in your neck heals) and alot of patience and responsible caring for it. But U can say, at any period, that this is NOT what I want and the tiny opening in your throat will heal and thats that! It IS so worth it if U fall into those outlined situations! But U NEED to be SO informed! Your MD should or could be able to provide U with this info! If U have a problem with anything, come back and talk to me! I will make sure U have the info U need, Jim! OK? I know I have rambled on here, but this is a subject that I think I have to address to the general public of people with restrictive lung disease and those with COPD anyway. Good question and I hope that I gave some help. Come back and tell us your experience!
Go with health and peace of heart, Jim Bob Penhallow, RCP
I have a problem. I can't swallow most pills and large capsules. If I try I regurgitate. I am taking Orasone, combivent and flovent, and have problems finding normal vitamines and now I've been told to take some kind of calcium for osteoporosis. Any suggestions? Is it necessary because of my age or my meds? Dotty
Hi! Bob P here, the Resident Respiratory Therapist for this site, for U! I have come across your problem with my patients for some years now! Especially for people that have to a theophyline product like Theodur, et al. These are tough pills to swallow for anyone! If the product is a "capsule" take a teaspoon or tablespoon of applesauce, open the capsule and mix the two! If the capsule or tablet is a time released type, try to swallow it with lots of water, before, during and after. For the regular type of tablets that are too large, crush them and do the same with applesauce or a small amount of orange juice or apple juice. Mix well and drink all! U could also, with tablets only, cut them in half and take them separately! But do not lose count of what your prescription says.
As far as vitamins are concerned, I believe that a simple, all around, one a day type of vitamin is something we should all take after we reach 40 y/o. There are so many that are good and I wouldn't quite get into the "fads" of vitamins today! OK! Calcium on the other hand is a good one to augment what your body can not replenish as it did once. Follow your physcians advice on this! And dont think that milk gives U calcium! IT DOES NOT! Those ads for milk are BS! Milk does not cause mucus to form, but it makes it SO difficult to cough up! Remember. milk is a protein and it takes time to break down in your stomach, as does mucus, so do your stomach a favor and go with the calcium supplement! Your body will love U for it! I think I will write something about milk products later! This milk does a body good, crap has got to be addressed. Sorry I digress, Dotty! When we get older and again, especially when someone is on many pulmonary meds, as prednisone, and others, we have to replenish our calcium input!
Hope I helped in some way, Dotty!
I bid U good health and peace of heart! Bob Penhallow, RCP, resident respiratory therapist
I am 52, female, married, diagnosed with COPD a little over 2 years ago. Smoked for 20 years, not heavy. Live in area of frequent brush and forest fires. Let me know of any more info you want. I was not given any extensive testing so I don't have much to give you the last time I was checked with an oximeter was over 2 years ago and it was around 85-90 at rest, much lower with exercise. My doctor doesn't think I need pul rehap, nor does he think an oximeter is required. He just gave me Prednisone (5 MG a day, Combivent 2 puffs every 4 Hrs, and Flovent 2 puffs twice a day. Last fall he cut my Prednisone to 10 MG max per week. I got some Rehab at home after I got out of the hospital. (My insurance company is still fighting the bill after over two years) My grandfather had emph. and died from it even thought he never smoked. I live at approx 5000 ft, rural area. Have only a concentrator. Large allergy problem in the rural agricultural area that I live. No place I can really work out in a very small house, can't afford a treadmill or other equip. Lost the little toning I had during winter. What can I do? Sun May
Hi! Bob P here, the Resident Respiratory Therapist for this site, for U! Your MD is an ___ if I may say that! He and many physicians do not want to deal with their COPD pts. Now I am certainly generalizing here! There are many MDS that truly CARE for their pts. But I have come to realize that so many do not! They just want to get U "off their backs" so to speak, so U don't bother them all the time. U have to realize that living with a lung disease is a very demanding thing! A lot of MDs are so prone to order a Prednisone type drug just so U will breath better and not complain to much! But that type of drug is SO destructive to your body in general that that is really not the way to treat someone with COPD! All the time. There are situations that dictate this treatment, but the total treatment should be more tailored to YOUR particular situation and that takes an attentive MD. U DO NEED PULMONARY REHABILITATION if U have a DX of COPD and it is available in your area (if U need a listing for the closest Rehab service in your area, just email me (Linda has a connection for me) or give your state and city to this site, and I will relay the closest Rehab in your area) Your oxygen saturation worries me...did U say between 85-90% Are U sure? This is not good, if this is true! And remember that it will go down, greatly with ANY exercise! U NEED to tell your MD that U want an Ambulation Study (write these things down,OK). This determines your need for O2 at rest and with any exercise! U NEED to have a PFT (Pulmonary Function Test) this will tell exactly what kind of lung disease U have and to what extent! An ABG (Arterial Blood Gas) is necessary to determine your blood oxygen and carbon dioxide,etc, levels! U NEED to know this stuff, and U HAVE THE RIGHT to know this info! Just demand that your MD do these things so u are in the know about what is happening to U! I would do this ASAP!!!! Call for an appointment! Get this done! U said that U have a history of smoking but "not heavy"! Smoking is smoking! Period! Damage occurs and there's nothing U can do about that fact. Don't be in denial! OK? I am also concerned with your environmental situation! U said about brush fires and such! These are big considerations to your problem, maybe! Never the less. U need to know the info I have outlined for U and take care of it ASAP! PLEASE! Just know that U have all the rights to all this info and u need to pursue this until it is done! MDs are NOT Gods, ANYMORE! It is incumbent upon all of us to demand respect, and to get info that we can understand from our physicians!Go with health my dear! Bob Penhallow, RCP, resident respiratory therapist
In response to a message that was left about how asthma is similar to COPD!
Well, in the old days, asthma was considered part of the trifecta of COPD, that being; asthma, bronchitis, and emphysema. Now research has deemed asthma as a disease that is to be studied and treated, alone! COPD, in most centers, is considered; chronic bronchitis and emphysema, only. Most research that is being done about lung disease, today, is asthma oriented. This is good because it has brought such drugs as; Serevent, Flovent, Accolate, Singular, Tilade, Intal, et al, to be brought to the front of adult COPD treatment. And they could be of help to you. Please consult your MD!
Asthma is a disease, that as I studied it, many moons ago, consists of many things, and the one that is so imposed, is that of genetics. That you receive the asthma "gene" from a relative. It is an inflammatory (swelling airways) disease, with constriction of the smooth muscles of the airways. It is triggered by many outside and internal causes. Indoor and outdoor pollution, stress, pollens, weeds, receptors in the airway themselves, and others. What I have a problem with, is those that get a dx of asthma when they are 60 years old and have NO family history (hx) of asthma, at all, but have a smoking hx of 2-3 packs/day for 30-40 yrs, or have an environmental or working hx of being around toxic chemicals, fumes, etc. These are red flags that may determine a more involved disease process, that needs to be addressed! Asthma is a nice word to describe someone's lung disease. But if in fact that is not the case, that person is in deep water in the long run! You all need to get a COMPLETE Pulmonary Function Test to determine the true nature of your lung disease! This test, alone, can tell this! And I might remind you to ALWAYS get a copy of this test from your MD! You have that right! Have him or her explain it to you!
BUT...in adult lung disease (COPD) there is a situation called Reactive Airways Disease (RAD) that mimics the affects of asthma inflammation and constriction of the airways. They react to certain things in the atmosphere and internally, just like asthma, but, do to damage to the airways from smoking or exposure to chemicals, fumes, etc. They may be treated like asthma with the medications available. This is not to say that the meds will work, but it may be helpful to talk to your MD about these treatments. It help. Most of the above meds I have mentioned do not have severe side-effects, so it may be worth it to try them if your MD concurs! ASK! I so don't want people to be led down the path of thinking that their disease is a, so to speak, "nice" one, like asthma, (do you all know what I mean)?, when in fact, you have emphysema or fibrosis or others! You owe it to yourself to know the truth about your body! To gain knowledge about your particular disease is the best gift you can give yourself for a quality of life that YOU CAN HAVE! You just have to be receptive, responsive and responsible with what is going on with your care and treatment, in every way!
Go with peace in your heart and health in your life, Bob Penhallow, RCP, resident respiratory therapist
Most mornings it takes me 2 to three hours to get going and then it's SLOW AND SLUGGISH, I Don't Call it Shortness of Air... I Call IT FATIGUE... I ake 20MG of Accolate and 500MG OF Relafen, twice daily... MY Cough is under control... my FATIGUE is something else..
FATIGUE My name is Bob P and am the resident respiratory therapist on this site! No I am not an MD, but I am licensed by the state of CA to treat,advise and instruct people who have lung disease. This has been my vocation for the last 30 yrs. I am an instructor in Pulmonary Rehabilitation and have been for the last 12-13 yrs., this my 2nd attempt to send this message and the 1st one was very long! I will try to make this short and to the point! You have not given me much info about U! Your age, dx (diagnosis), or other meds that U are taking! I need to know this to advise! But the fact that U are taking Accolate indcates, primarily that U have "asthma". Accolate is a leucotrine inhibitor, I know that is a lot to chew on but listen. In your airway, U have "receptor" sites of many kinds and the leucotrienes are those that monitor,so to speak, the tendancy of the "smooth" muscles of your airways to constrict, therefore U have a problem breathing, your airways are tightening! Accolate inhibits this active to happen so hopefully your airways will stay open for the duration of the drug. 20 mg is the accepted dosage of Accolate and is also being used with patients with COPD who have "asthma" like symptoms, wheezing, airway "tightness",etc. Your fatigue could be to many things, but discuss with your MD as your exact dx so U know if U have any other lung disease. Knowledge is POWER!! If U know what is wrong then U can start a proper treatment pattern. If not U are lost in the woods without a scout! You have the right to know everything that is done to U by your MDS and medical records and I highly recommend that U get all the tests and whatnot from your MDS. If U have not gotten a PFT (pulmonary function test) and make it a "complete" PFT, then do so ASAP. Just tell your MD that U want one! PERIOD! this will tell U just what your lung situation is. And it is very accurate not only with what U have but also to what extent! Hope I helped, come back and talk some time ....I will be here as I can be....
Your friend , Bob Penhallow, RCP, resident respiratory therapist
Disclaimer: The purpose of this World Wide Web site is to provide information, consul and companionship. I am an individual with a respiratory illness, not a medical doctor. Medical advice should be obtained ONLY from your licensed physician. None of the information or links at this site are warranted for accuracy, reliability, timeliness, completeness, or anything else; read, research and consult with your licensed physician for medical advice. Please do this for yourself and important to me.
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