• We Get Mail!
  • Please remember that a newsletter is limited to general information. Only your physician can accurately diagnose and treat you.
  • Pulmonary Fibrosis
  • Gary writes: "I have pulmonary fibrosis. About 3 weeks ago my breathing became very shallow and I was having trouble sleeping. I went to emergency and was told that my problem could be caused by an infection. I was put on antibiotics for 10 days. They put me on oxygen while I was in emergency and my oxygen level went from 94% to 97%. They later took an arterial blood sample and found it to be 94%. At no time was I given a stress test. Do I need oxygen at home?"
  • Usually you have to have an oxygen saturation of less than 89% with exercise to be eligible for home oxygen. With pulmonary fibrosis oxygen levels may be quite adequate at rest, as yours were, but drop substantially with exercise. This is especially true if you have a pulmonary infection. If you are still having unusual shortness of breath with exercise you might ask your physician about testing your oxygen level during a 6-minute walk, even though they were normal at rest. Do remember that shortness of breath does not necessarily indicate the need for oxygen.
  • Gary also asks: "In one of the articles on your web site they discussed the use of Tiotropium for COPD. Does it help pulmonary fibrosis? What is the difference between pulmonary fibrosis and COPD?"
  • Unfortunately, tiotroprium bromide (Spiriva) has not been shown to be effective with pulmonary fibrosis.
  • COPD stands for chronic obstructive pulmonary disease, which usually includes emphysema, chronic bronchitis, and some severe chronic asthma. Pulmonary fibrosis is a restrictive disease. We'll go into this in greater detail at a later date since it is a question we often have and is of interest to many people. I'm glad you asked! Keep reading the Second Wind for information.

  • Oxy-glasses
  • Ann asks, "What are Oxy-glasses?"
  • Good question since we neglected to explain this in our last newsletter. Oxy-glasses are glasses with hollow frames and earpieces though which you can thread oxygen tubing. The small amount of tubing that shows around the glass frame allows oxygen into the nares of the nose and is barely visible. Your eyeglass prescription can be used, or sunglasses, or plain glass if you don't need magnification. Dr. Petty often uses oxy-glasses during lectures and the audience not in the know is surprised to learn that he is actually receiving oxygen.

  • Normal Oxygen Level
  • Shirley was wondering what a normal oxygen level should be in a 53 year old white male. Her husband just got diagnosed with COPD and his level was 90. She is very concerned.
  • That answer is a little more complicated than you might expect. It depends on the altitude where your test was taken and if it was done with an oximeter (a device clipped to the ear or finger) rather than an arterial blood gas (with blood drawn from the wrist). It also makes a difference if he was sitting at rest for 20 minutes before the test or if it was taken at the end of a period of exercise. There are other factors that can affect the accuracy of an oximetry reading, the most common of which are the circulation of blood to the finger with the oximeter, or smoking before the test. The carbon monoxide in the smoke combines with the oxygen in the blood. This results in an oximeter reading that falsely overestimates the amount of oxygen carried in the blood. It is also important to know if this was a routine test or taken while he was ill with a lung infection, such as pneumonia.
  • All that being taken into consideration, the normal oxygen saturation of a person at sea level would be about 95-98% saturation, so his reading may be somewhat low (though not apparently low enough to require chronic oxygen therapy) . There are many things that can be done to help your husband improve his oxygenation. The physician will probably give him inhalers to open up his airways. An infection will be treated with antibiotics. If he is very overweight it prevents the lungs from expanding properly and loosing weight will help. If he has chronic bronchitis it can be helped with various medications and cough control techniques. In pulmonary rehab classes we find a dramatic decrease in sputum production as patients increase their daily activity level.
  • If his oxygen saturation was taken at rest, it may be repeated and taken after a six-minute walk. Oxygen is not prescribed until the saturation is down to 88%, and occasionally 89%. If he has acute infection saturation will be checked again when he has fully recovered, usually about 3 months. As you can see there are many things to be considered. I'd urge you to ask your physician about a referral to a pulmonary rehab program if there are any in your area. They will help both of you understand his condition and get started on an exercise-reconditioning program. Our web site also has a lot of helpful information. Don't forget to check the archived newsletters. There is a lot that can be done to help your husband improve! It is wonderful that he has your support and encouragement!

  • Resistance Devices
  • Dan asks: Is there any merit to devices to which you can set a resistance to exhalation or exhalation and inhalation (i.e. Powerbreath, PowerLung, Expand a Lung). I'm pretty fit and am breathing fairly well except when I have a bronchial flare-up. I've been doing PLB with good results though I was probably blowing too hard judging from your information and the exercise book I just received by Vijal Sharma, Ph.D. (he says blow out like your cooling soup in a spoon or causing a candle flame to flicker). It seems logical that lungs and diaphragm and other muscles would be strengthened if they had to work against greater resistance. I've simulated the action of the above devices by using the flexible end of my nebulizer and breathing in and out while partially blocking the end. Might it be doing some good?
  • As you may know, the medical professionals in our Foundation are especially interested in breathing techniques and have been involved in research about its effectiveness. We had a lot of fun with some of the studies we did with pursed lip breathing. Much research has been done on resistive breathing devices and exercises which might strengthen the diagram. They seem helpful for people confined to bed or with serious physical limitations. It doesn't sound as if you are in that category. Most research indicates it probably would be of limited value for someone like you. To explain, it is sort of like telling your mailman to walk 30 minutes three times a week when he gets off work. It isn't going to hurt him, it may help a little, but it is not of great value. (Unless he is sitting in a truck all day!)
  • You are right not to concentrate on breathing out too hard. It can actually lower the oxygen level of your blood if you do it too forcefully. But please don't worry about it since it is nothing you would do without a great deal of concentration. Besides, it would make you light headed! Congratulations on continuing to exercise. It is one of the best things you can do to improve your health.