COPD & Asthma. Rev 10/14. February 2010, Premier Home Care, Inc.

Transcription

1 COPD & Asthma Rev 10/14 February 2010, Premier Home Care, Inc.

2 To Our Patients: This booklet is designed to educate, assist and support you with your Chronic Obstructive Lung Disease (COPD) or Asthma. We are confident this booklet will become a useful tool in helping you and your family cope with your illness and the lifestyle changes you will need to make. This booklet does not replace the advice or care plan of your physician. You should always consult with your physician before changing and/or altering any prescriptions. Premier Home Care, Inc., values you as a customer. We provide an extensive line of medical equipment and services to aid you and your family with your health related needs. All of our products and services comply with the highest of home care standards. Our professional staff includes nurses and licensed respiratory therapists and highly trained medical equipment technicians. We add a personal touch by communicating with you on a regular basis and we stay in contact with your physician to ensure that you continue to adhere to your therapeutic regimen. Our motto is simple, we provide, Your Solution to Healing at Home. Premier Home Care, Inc. thanks you for the opportunity to serve your health care needs and we look forward to working with you for many years to come. Wishing you the best of health, LOCATIONS AND TOLL FREE NUMBERS ELIZABETHTOWN LOUISVILLE SCOTTSBURG LEXINGTON RICHMOND PIKEVILLE Jeff. W. Knight, CEO Premier Home Care, Inc. LONDON DISEASE MANAGEMENT CENTER Emergency Toll Free Number

3 Table of Contents Introduction...1 Frequently Asked Questions About COPD Asthma Basics Test to Evaluate your Lungs Exercise and Good Nutrition Breathing Exercises for the COPD Patient Tips for the Family / Caregivers of COPD Patients Frequently Asked Question About Oxygen Therapy How to Use Your Concentrator...18 How to Use Your Portable Oxygen System Going on Vacation? Supporting Websites...24 Common Patient Concerns Common Equipment Problems...26 Glossary of terms

4 Introduction 15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries. 16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare covered item. 17. A supplier must disclose to the government any person having owndership, financial, or control interest in the supplier. 18. A supplier must not convey or reassign a supplier number, i. e. the supplier may not sell or allow another entity to use its Medicare billing number. Welcome to Premier Home Care, Inc, we look forward to sharing this time with you. After reading this booklet if you have any questions, we offer a free consultation with one of our clinicians. Our clinicians can answer any additional questions you may have about Chronic Obstructive Pulmonary Disease (COPD) or Asthma and the therapy needed to treat it. Just give us a call. We'll be happy to speak with you. If you are reading this booklet, you may have recently been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) or Asthma or perhaps a family member or someone you know has Chronic Obstructive Pulmonary Disease (COPD) or Asthma. Then again, maybe you just want to gain some information about a health condition that affects over 12 million Americans according to the National Institutes of Health. Whatever your reason for reading this booklet, when you finish you should have a better understanding of Chronic Obstructive Lung Disease (COPD) or Asthma and what can be done to treat it. 19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility. 20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions take to resolve it. 21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations. 22. All suppliers must be accredited by a SMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment for those specific products and services (except for certain exempt pharmaceuticals). Implementation Date October 1, All suppliers must notify their accreditation organization when a new DMEPOS location is operned. 24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare. 25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation. 26. All suppliers must meet the surety bond requirements specified in 42 C.F.R (c). Implementation date - May 4, A supplier must obtain oxygen from a state-licensed oxygen supplier. Call us toll free at 1 (888) A supplier must maintainn ordering and referring documentation consistent with provisions found in 42 C.F.R (f). 29. DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers. 30. DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions. 9/9/2010 Palmetto GBA National Supplier Clearinghouse P.O. Box * Columbia, South Carolina * * (866) A CMS CONTRACTED INTERMEDIARY and CARRIER

5 MEDICARE DMEPOS SUPPLIER STANDARDS DMEPOS suppliers have the option to disclose the following statement to satisfy the requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary. The products and/or services provided to you by Premier Home Care, Inc. are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section (c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of thesestandards can be obtained at Upon request we will furnish you a written copy of the standards. Frequently Asked Questions About COPD What do the letters COPD stand for and what do they mean? COPD stands for Chronic Obstructive Pulmonary Disease Chronic refers to an issue that will not go away Obstructive means partial blockage Pulmonary referring to the lungs Disease refers to an identified type of illness COPD is an umbrella term for Asthma, Chronic Bronchitis and Emphysema, as well as several other pulmonary diseases, which can cause difficulty in breathing. What causes COPD? The most common cause is cigarette smoking, however, other factors can cause COPD as well. These factors include air pollution, second-hand smoke, history of childhood respiratory infections, asthma, and heredity. How will my COPD be treated and will treatment really help me? Your physician will decide the best course of treatment for your condition. It may include antibiotics for infections, systemic or inhaled steroids to control inflammation and irritation to your airways, and bronchodilator drugs to help keep your airways open. Your physician may also order supplemental oxygen therapy. You may be encouraged to get regular influenza and pneumonia vaccinations and encouraged to enroll in a pulmonary rehabilitation program to help increase your disease awareness and physical stamina. If you follow the program prescribed by your physician, you may greatly increase your chances of maintaining a higher quality of life while dealing with your diagnosis of COPD Probable Cause Solution

6 What can I do to help myself? The number one thing that a person with COPD who smokes can do is to STOP SMOKING. Quitting smoking is the best way to slow down the progression of the disease. Also, if your physician outlines an exercise program for you, do it. Becoming more active is one of the best ways to improve your overall health. When should I call my physician or EMS (911)? You should call your physician immediately if you Have shortness of breath and/or wheezing that is rapidly getting worse Cough more deeply or more frequently. Especially if you notice an increase in mucus (sputum) or a change in color of the mucus. Cough up blood. Have increased swelling in your legs or abdomen. Have a high fever (over 100 F). Oxygen Conserver-Regulator- A device that is attached to an oxygen tank to help control the flow of oxygen out of the tank. A conserver will only deliver oxygen during the inspiratory portion of your breathing, thus saving oxygen and allowing you more portability. Peak flow- Measures how fast a person can exhale air. It is one of many lung function tests that measure how well the lungs are working. Pulmonary Function testing- A group of tests that measure how well the lungs take in and release air. This type of testing is done to diagnose lung disease, find the cause of shortness of breath and to determine the degree of lung impairment from disease and environmental contaminants that may be work related. Pulmonary Rehabilitation- An extensive program that helps improve the well-being of people who have chronic breathing problems. Pulse oximetery- A non-invasive measurement that uses infra-red light to determine the amount of oxygen saturation in the blood. Commonly performed by placing a probe on the finger for a brief period of time for a sample reading. Pursed-lip breathing- A breathing technique that helps to control shortness of breath by keeping the airways open longer during the exhalation phase of breathing. Vital Capacity- The maximum amount of air that can be inhaled or exhaled from the lungs in a single breath. One of the measurements taken during a pulmonary function test. Develop flu-like symptoms. Notice that your medications are not working as well as they have been. What other type of things can I do to keep my condition from getting worse? You should avoid conditions that may irritate your lungs such as indoor or outdoor air pollution, second-had smoke, smog, extreme weather conditions or high altitudes. You should also take regular rest breaks while doing household chores and learn simple breathing techniques to improve airflow in and out of your lungs (see section on breathing exercises). Good nutrition is very important in order to maintain your strength and health. Problems with muscle weakness and weight loss are common in people with COPD. You should join a Better Breathers support group that keeps you aware of any new developments in therapy and drug treatments for COPD. Keep your appointments with your doctor and maintain a journal of your daily activities to share with him/her. 3 2t

7 Glossary of Terms Asthma- is a chronic disease that affects the airways. Asthma makes your lungs more sensitive to irritants and allergens that will cause inflammation and tightening of the airways. This can result in wheezing, tightness in your chest, coughing and shortness of breath. Asthma is treated with two (2) kinds of medicines: quick relief (bronchodilators) and long-term control medicines (corticosteroids). Bronchodilator- is a medicine that treats the airways by relaxing the smooth muscle around the bronchial tubes allowing air to move easily in and out of the lungs. This type of drug is used to treat both Asthma and COPD. COPD- Chronic Obstructive Pulmonary Disease is a progressive lung disease that makes it hard to breathe. The most common cause of COPD is cigarette smoking. Also known as Chronic Obstructive Airway Disease (COAD) and Chronic Obstructive Lung Disease (COLD). Corticosteroids - Are man-made drugs that resemble the hormone cortisol that is naturally produced in your body. The purpose of corticosteroids is to reduce inflammation and the activity of the immune system. Corticosteroids should not be confused with muscle building steroids that are called androgenic or anabolic steroids. Diaphragmatic Breathing- The act of breathing deep by the use of your diaphragm rather than your chest wall muscles. It is also known as abdominal breathing or belly breathing. See specific instructions on page 12. Forced Vital Capacity (FVC)-The amount of air that can be forcefully exhaled from your lungs after taking a single maximum deep breath. Used as a test of the movement of air out of your airways during pulmonary function testing. Forced Exhaled Volume at 1 second (FEV 1 )- The volume of air exhaled during the first second of a forced exhalation maneuver. A value derived from the forced vital capacity in pulmonary function testing used to evaluate the degree of impairment in COPD and obstructive lung diseases. Forced Exhaled Volume at 1 second per Forced Vital Capacity ratio (FEV 1 / FVC)- The ratio of air exhaled during the first second to the total forced vital capacity maneuver obtained during pulmonary function testing.. A value used to evaluate the degree of impairment in COPD and obstructive lung diseases. Inhaler- Also known as a metered dose inhaler is a medical device used for delivering medication to the lungs. Medication is stored in a compressed canister that when actuated will deliver a puff of medication to be inhaled. Nebulizers- A device used to deliver medication in a mist form that is inhaled to treat disorders of the airways. Asthma Basics The Basics According to a 2009 report by the Center for Disease Control and Prevention, over 16 million adults in the United States have Asthma. Of those diagnosed, 10.6 million will end up visiting their local doctor or emergency room for treatment. Asthma patients should become educated about their symptomatic triggers and work with their physician in developing an Asthma Management Plan. In patients over age 40, it is not always easy to differentiate between asthma and COPD. Inadequate treatment of airway inflammation can lead to irreversible bronchial structure changes. Many lung disorders have both a reversible and an irreversible component. There are many medications to manage airway inflammation and obstruction to prevent the reversible components of lung diseases such as asthma from leading to irreversible structural changes. Despite the best of care and medication, in severe cases of asthma, irreversible changes in the respiratory tract are not always preventable. Asthma Tips The diaphragm cannot work as well when the stomach is full. This may cause additional shortness of breath. Eating smaller meals will help reduce this symptom. Acid reflux. may be reduced as well. Double or triple your favorite recipes to keep your freezer full for times when you do not feel like cooking. Do the tasks that require the most effort when you have the most energy. Don t stand when you can sit

8 Asthma Medicine Small volume nebulizers are devices that hold liquid medicine. The medicine is turned into a fine mist by a small air compressor and inhaled into the airways and lungs where the medicine will quickly go to work. Bronchodilators are used to help relax the muscles in the airways and ease shortness of breath and wheezing. Corticosteroids are very effective and potent anti-asthma drugs. They help the immune system and inflammation. Inhalers are small hand held devices that allow medications to be delivered directly to the lungs. Common Equipment Problems Concentrator not operating. Power on. Short beeps long pause. Continuous alarm Alarms Probably cause Solution Power cord not plugged in. No power to outlet. Circuit breaker tripped. Internal breaker tripped. System failure. Unit overheating due to blocked air intake. Use oxygen from your back-up tank until problem is resolved. Insert plug into outlet. Use a different outlet. Reset breaker by pushing reset button on concentrator. Use oxygen from your back-up tank until problem is resolved. Remove and clean cabinet filters. Move oxygen concentrator at least three inches away from walls, draperies or furniture. Internal repairs needed. Oxygen Therapy is used to treat moderate, severe and extreme cases of asthma. Asthmatics using oxygen therapy experience better sleep, increased alertness and more stamina. In emergency situations, when oxygen levels can become abnormally low, the patient can use supplemental oxygen to provide additional oxygen to vital organs. Always take Medicine as prescribed, even if you are feeling better or have no noticeable symptoms. You should always take your prescribed maintenance medicine. Low-flow alarm Kinked or blocked tubing or cannula Use oxygen from your back-up tank until problem is resolved. Inspect for kinked, blocked, or twisted tubing, as well as furniture or concentrator wheels on top of tubing. Correct, clean, or replace item. Once corrected, turn the concentrator off for 60 seconds and then turn back on. Small Volume Nebulizer Maintenance Rapid alarm Flow meter set at less than ½ LPM Make sure that flow meter is set at one LPM or more. How to Clean the Medicine Cup Rinse after every use. Wash at the end of the day with warm soapy water. Rinse under running water and allow to air dry Weekly: Soak in 3 part water and 1 part white distilled vinegar for 20 minutes to disinfect. Rinse the medicine cup in clear water thoroughly and allow to air dry on a clean towel If problems persist please call Premier Home Care, Inc. 26

9 Common Patient Concerns PATIENT CONCERN POSSIBLE CAUSE POSSIBLE SOLUTION Patient feels that no oxygen is coming from nasal cannula Patient not responding to oxygen therapy Nasal dryness/ burning Oxygen from tubing too warm Water in tubing Loose connection, kink, or twist in tubing, concentrator, or furniture on top of tubing Patient may need medical attention Lack of moisture Filter is dirty Condensation from temperature change 25 Recheck all connections. Follow tubing from nasal cannula to concentrator. Check for kinks or twists. Make sure that the concentrator wheels or articles of furniture are not sitting on top of the tubing. Put nose piece in glass of water. Bubbles prove oxygen is making it to patient. Use a non-petroleum based product such as KY Jelly. Do not use Vaseline. Wash filters on outside of panels of concentrator. Lower the room temperature. Disconnect cannula. Turn up liter flow to highest setting and allow water to be blown out tubing. Return flow to doctor s prescription and elevate tubing. Cannula smells New cannula Let cannula air out before using. Open up new cannula a day or two before using. Change out cannula. Ear soreness Cannula is adjusted too tight Loosen adjustable cannula fitting beneath the chin. If problems persist please call Premier Home Care, Inc. 25 Know Your Zones! Peak Flow Meter A peak flow meter is a hand-held device that is used to measure how well air flows out of your lungs. Measuring your peak flow using this meter is an important part of managing your asthma symptoms. The peak flow meter works by measuring how fast air leaves the lungs when you exhale forcefully after inhaling fully. Keeping track of your peak flow measurements is one way you can know if your symptoms of asthma are in control or worsening. Zones Green Yellow Red Symptoms None Small Flare Up Peak Flow > 80% of Personal Best Action Continue Daily Meds > 50% to 80% Add quick relief Meds Your personal best is defined by your physician 6 Full Attack < 50% of Personal Best Call Family Dr. Now or 911 Green Zone Yellow Zone Red Zone You are not experiencing any breathing problems. You do not have any early warning signs or asthmas symptoms Continue to take your medicine as prescribed by your doctor If prescribed, take you inhaler before exercise. You may be experiencing itching in your throat or chin You may have a cough, stuffy nose or sneezing You may feel restless or have dark circles under your eyes Use your rescue medicine Recheck your peak flow in minutes Contact your doctor is your peak flow does not return to the Green Zone or your peak flow drops into the Yellow Zone again in less than 4 hours. Your chest may feel tight or hurt You may feel very short of breath You may be breathing faster than normal You may find it difficult to speak Use your rescue inhaler or nebulizer now Contact your physician If you notice any blueness to your nail beds or around your mouth, call 911 If you don't own a peak flow meter, Premier Home Care, Inc. can provide you with a quality peak flow meter once we receive a prescription from your physician. 6

10 Test To Evaluate Your Lungs PULSE OXIMETRY From time to time your doctor may want to check the level of oxygen saturation in your blood. This test is simple and painless. A small probe with an infrared light is placed on the end of your finger over the nail bed. The sensor will painlessly measure the average amount of oxygen attached to your red blood cells as well as your heart rate. With each pulse of your heart beat the sensor will determine an average amount of oxygen. The device then records this average amount. This test may be done to see if you meet the required guidelines for supplemental oxygen use on a continuous basis or just during sleep. The physician may also request the test to determine your response to oxygen once you begin using it. Knowing the level of oxygen in your blood helps your doctor know if oxygen is right for you. PULMONARY FUNCTION TEST (PFT) Understanding the need for pulmonary function testing can often be confusing for patients with lung disease. Knowing your lung values in COPD is as important as knowing your cholesterol and blood pressure values. The Pulmonary Function test will help to determine your lung function and the degree of damage, if any to your airways. COPD creates a chronic lung condition in which the airways may become narrowed by inflammation or mucus and the ability to exhale air from your lungs becomes increasingly difficult. The basic Pulmonary Function Test is referred to as Spirometry. This type of test is often the first test requested by a physician to determine a patients lung status when difficulty breathing is present. This test is a simple painless test that is administered by a trained, licensed clinician. It involves having the patient inhale as deeply as possible and then exhale quickly into a mouthpiece attached to a recording device. Supporting Websites American Lung Association Working to save lives through lung health National Heart, Lung, & Blood Institute Global Leader in education of and prevention of diseases. Global Leader for COPD Initiative Raising awareness with health care professionals to improve prevention and treatment SEAPUFFERS Travel Cruises for Oxygen Patients Airline Oxygen Council of America Airline policies for in flight portable concentrators National Home Oxygen Patient Association Volunteers helping to improve oxygen patient lives American Association for Respiratory Care Promoting good lung health and rights for health care workers

11 Traveling by Bus Since the policies vary by bus line, we suggest that you check with the bus operator well in advance of your trip. Buses should be all nonsmoking by now, so if portable oxygen is allowed, there should be no problem. Traveling by Rail Similarly, there are no set policies for traveling with oxygen by rail. Contact the railroad well in advance and notify them of your oxygen needs. Check their policy on the type of equipment you can bring on board. You will need to sit in the nonsmoking section. Traveling By Sea Check with the cruise line for their supplemental oxygen policy. Some ships may be able to provide supplemental oxygen. Otherwise, you will need to bring enough oxygen to last throughout the trip or arrange for refills at ports of call. Some companies such as or organize cruises specially for people with COPD. If you are taking your equipment with you or you will need help making arrangements, please notify us at least one month in advance. Basic Pulmonary Function Testing Terminology These Basic Values are Used in Evaluating COPD Forced Vital Capacity (FVC) The amount of air that can be forcefully exhaled after the deepest inhalation you can possibly perform. This test is measured in time increments. Forced Expiratory Volume in 1 second (FEV 1 ) The amount of air that can be forcefully exhaled after a deep inhalation during the first one second of the exhaled breath. Forced Expiratory Volume in one second / Forced Vital Capacity (FEV 1 / FVC %) The amount of exhaled air in one second seen as a percentage of the total exhaled volume after a deep inhalation. Vital Capacity (VC) The amount of air that can be exhaled forcefully after a deep breath without time limitations. Global Initiative for Obstructive Lung Disease (GOLD) The current standard for determining lung disease GOLD Spirometric Criteria for COPD Severity I. Mild COPD * FEV 1 /FVC < 70% * FEV 1 > 80% predicted II. Moderate COPD * FEV 1 /FVC < 70% * FEV 1 < 80% predicted III. Severe COPD * FEV 1 /FVC < 70% * FEV 1 < 50% predicted IV. Very Severe COPD * FEV 1 /FVC < 70% * FEV 1 < 30% predicted or FEV 1 < 50% predicted with chronic respiratory failure. At this stage, the patient is probably unaware that lung function is starting to decline. Symptoms during this stage progress with shortness of breath developing upon exertion Shortness of breath becomes worse at this stage and COPD flare ups are common. Quality of life at this stage is gravely impaired. COPD flare ups can be life threatening

12 Exercise and Good Nutrition Exercise COPD & Asthma make the lungs and heart work harder to carry oxygen to all parts of the body. Because of this, you should control your weight to reduce heart and lung strain. Work with your doctor to develop a program of exercise that is right for you. There are special exercises to strengthen your chest muscles and improve your breathing. Aerobic exercise, such as walking and riding a bike, are very important for increasing your stamina and improving your ability to do daily activities. Strength training for the upper body can also produce added benefits. When Traveling By Land There are fewer restrictions when traveling by land, however, you should always speak with your doctor and oxygen company. Let your physician know if you will be traveling to a region that has different altitudes, as it could alter your current oxygen prescription. Notify your oxygen company to discuss options and make any needed arrangements in advance. Have a copy of your oxygen prescription with you at all times. Traveling by Car Pulmonary Rehabilitation Pulmonary rehabilitation is a structured program that can help reduce the effects of COPD. This organized program is usually offered in hospitals and rehabilitation centers. A team of medical professionals, including physicians, nurses, respiratory therapists, occupational therapists, physical therapists, mental health professionals, pharmacists, and nutritionists, will work together to provide a program suited to your individual needs. 9 When traveling in a car you have the freedom to use a portable concentrator device or your own portable tanks. Your oxygen company can help arrange oxygen refills and find local oxygen companies for you as you travel. Be sure to travel with your oxygen safely, making sure your tanks or device is secure and stored away from heat or flame. Traveling by RV You may want to use your concentrator in your RV, trailer, or conversion van if you have an auxiliary generator. In other vehicles, you may be able to run your concentrator from a generator or through an inverter. If you do use your concentrator on the road, here are some words of advice: Secure your concentrator so it will not slide around while traveling. Always have a back-up oxygen cylinder close at hand. Turn off your engine or generator while refueling

13 Going On Vacation? If you are taking your equipment with you or you will need help making arrangements, please notify us one month in advance When Traveling by Air Traveling on an airplane with oxygen can be a very complicated, frustrating, and expensive endeavor. Many airlines do not offer in-flight supplemental oxygen. As of May 13, 2009, the Federal Aviation Administration (FAA) has mandated that patients be allowed to use Portable Oxygen Concentrators in flight. Airlines DO NOT supply oxygen while you are waiting in the airport. If you are planning to make a trip involving air travel and you need supplemental oxygen, we suggest that you plan well ahead. Airlines will probably charge you for in-flight oxygen. Charges vary from airline to airline. Any airline that offers in-flight supplemental oxygen will require a physician s statement of oxygen need and liter flow per minute. Contact your selected airline at least one month in advance and ask them the following questions: Do you accept passengers who need supplemental oxygen? What do you charge for supplying oxygen during the flight? Do you provide a mask or cannula or should I provide my own? What equipment will be available on my flight? What is its liter flow capability? What do you require as far as proof of need for oxygen? Do you allow the use of portable oxygen concentrators in flight? How do I get my medical equipment through security? Premier Home Care, Inc. has an oxygen travel program. If you are interested in the use of an airline approved portable oxygen concentrator for travel, please contact us at our toll free number for further details. 1 (888) Pulmonary rehabilitation offers Nutrition Structured and monitored exercise training. Nutritional advice. Techniques for reducing and controlling breathing problems. Education on maintaining and improving heart and lung function. Help to quit smoking. Information about your disease and coping strategies. Emotional support. Maintaining your health is impossible without eating the right foods. Speak with your physician or nutritionist if you need help in planning and preparing a healthy diet. Some people with COPD have trouble keeping weight on. If this is a problem for you, discuss nutritional supplements with your physician or nutritionist. Maintaining a healthy weight is critical for functioning well with COPD. Many people with COPD find it helpful to Eat several small meals throughout the day instead of three large ones. Your stomach is located directly under your lungs and eating a large meal can push against your diaphragm making it harder to breathe. Avoid eating gas-producing foods such as apples, broccoli, brussel sprouts, cabbage, corn, cucumbers, and carbonated beverages. Drink water to help keep your secretions thin and more free flowing

14 Breathing Exercises for the COPD & - COPD & Asthma Patient Breathing Better Your physician can prescribe medications and oxygen to help control your COPD & Asthma. You can also do many things to help yourself feel better. Using two simple breathing techniques pursed-lip breathing and diaphragmatic breathing can help you get more oxygen into your lungs and help relieve shortness of breath. Pursed-Lip Breathing Pursed-lip breathing helps you exhale more completely so that you can take in more oxygen-enriched air when you inhale. Use pursed-lip breathing to control your breathing any time you start to feel short of breath. Use it to prevent shortness of breath when you do things like exercising, climbing stairs, bending or lifting. Practice these steps every day so you will know how to do them if shortness of breath occurs. Relax your neck and shoulder muscles. Inhale slowly through your nose for two counts. Pucker your lips as if you were going to blow out a candle. Exhale slowly and gently through your lips for four - five counts. Flow Rate (LPM) Use the chart below to determine how long a full oxygen cylinder will last. Simply find your prescribed liter flow and note the hours of oxygen in a full cylinder. Note: The above times are estimates. Your breathing pattern and activity level will cause variations to these times. Estimated Usage Time Versus Flow Rate is Shown in Hours M-6 Cylinder D Cylinder E Cylinder - CF CD CF CD CF CD not recommended not recommended not recommended not recommended not recommended not recommended 1 3 LPM=Liter Per Minute CF=Continuous Flow CD=Conserving Device (Pulse Dose) Note: The above times are estimates. Your breathing pattern and activity level will cause variations to these times. Call two working days in advance for delivery of tank refills or go to your local Premier office to drop off empty and pick up full oxygen tanks

15 How to Use Your Portable Oxygen System Call two working days in advance for delivery of tank refills or go to your local Premier office to drop off empty and pick up full oxygen tanks. You will need the following equipment to prepare your portable for use: Oxygen Cylinder Regulator/Conserver Cylinder Wrench Nasal Cannula Transport Cart or Pouch 1. Carefully remove the seal from the cylinder neck. There is a small washer attached to the seal. You will need to use this washer if your regulator does not have a permanent one already attached. 2. Notice that their are two holes located on only one side of the oxygen cylinder neck (valve stem). 3. Place the regulator over the top of the cylinder. Align the two prongs on the regulator with the two holes on the cylinder neck. If your regulator doesn t have a permanent washer, use the plastic washer provided and place it above the two prongs on your regulator, there will be a protruding knob to help direct you. 4. Use your cylinder wrench as a lever, to tighten the handle on the regulator until it is firmly attached. 5. Attach your cylinder wrench to the top of the cylinder. Turn the wrench slowly counterclockwise to open the cylinder. You should see the needle on the pressure gauge read full or 2000 psi 2200 psi at this point. 6. Adjust the flow rate by turning the flow knob clockwise until you reach your prescribed flow rate. 7. Attach your oxygen delivery device (cannula or mask) to the flow outlet of the oxygen regulator. Things to Remember: Always exhale for a longer period of time than you inhale. This allows your lungs to empty as much as possible. Exhale during the difficult part of any activity, such as when you bend, lift, or reach. Never hold your breath. Diaphragmatic Breathing Diaphragmatic breathing helps prevent shortness of breath by increasing movement of the diaphragm. Normally, the diaphragm does most of the work in breathing. When you have COPD, your lungs may become enlarged and prevent the diaphragm from doing its job.. Relaxing your abdominal muscles as you breathe in gives your diaphragm more space to move downward and allows more air to enter your lungs. Tightening your abdominal muscles as you exhale will help force more air out. This can be combined with pursed-lip breathing for a effective technique to improve your lung endurance. Sit upright or at a slight reclining angle that is comfortable for you. You may also lie down in a comfortable position with your head supported and your knees bent. Relax your neck and shoulder muscles. Place one hand over the center of your abdomen at the base of your breast bone and the other on the upper chest. Exhale first through pursed lips. Next, inhale slowly through your nose to the count of two. As you inhale you should focus on relaxing your abdominal muscles and allowing the abdomen to move your hands outward. Your upper chest should stay still. Tighten your stomach muscles and exhale through pursed lips to the count of four or five. You should feel your stomach muscles move in as you exhale. Concentrate on making each breath slow and deep. Use suitable assistive devices to simplify work activities. For example, use non stick cooking utensils to minimize the effort needed to clean them. Use electrical blender and micro-wave oven to shorten the time of food preparation. Use a light weight vacuum cleaner or long-handled mopping/cleaning device to avoid the need to bend down. 8. To turn your oxygen off, attach your cylinder wrench to the top of the cylinder and turn it clockwise. Always turn your tanks completely off when not in use

16 Tips for the Family/Caregivers of COPD & Asthma Patients Remember Be careful about using cologne or perfume around a COPD or Asthma patient. Strong scented household cleaners, disinfectants, and air fresheners can cause serious breathing problems for COPD & Asthma patients. COPD & Asthma patients should remain in a smoke-free environment. Please don t allow anyone to smoke around them. Air conditioning and low humidity conditions are ideal in the summertime, if at all possible, for COPD & Asthma patients. How to Use Your Oxygen Concentrator Oxygen Concentrator Safety Plug your concentrator into a properly grounded electrical outlet. Turn on your concentrator. Expect to hear an alarm for approximately the first 5-10 seconds. If you hear this alarm at any other time, your concentrator may be malfunctioning. Refer to your owners manual or the Common Patient Concerns section of this booklet on page 25 for more trouble shooting details. Adjust the flow meter to your prescribed flow ate. Do r not use a higher flow rate than prescribed by your physician. Connect your nasal cannula with extension tubing to the machine. You are now ready to use your oxygen concentrator. Keep your oxygen concentrator in a cool, dry place. Always keep your oxygen concentrator upright. Do not place anything on your oxygen concentrator, especially liquids. Keep your oxygen concentrator away from curtains which may block air intake. Keep your oxygen concentrator away from closed areas to allow for adequate ventilation (i.e., closets, cabinets). Do not run the power cord under carpeting or rugs. If you want to experience what the breathing of a COPD patient feels like, try breathing through a straw while closing off your nose with one hand. You will notice after a few breaths that it is becoming more and more difficult to get all the air out of your lungs before it is time to take another breath. COPD PATIENTS DEAL WITH THIS FEELING ALL THE TIME. Maintenance Once a week remove the air intake filters from the oxygen concentrator. Wash the filters with mild soap and warm water to remove dust, etc. Squeeze the remaining water out of the filter, shake dry, and replace filter

17 Can I use electrical appliances while using oxygen? Yes, but make sure the electrical appliances that get hot during operations are kept at least five feet away from the oxygen system. You should never let your oxygen and oxygen tubing get within five feet of an open flame (e.g., fireplace, cigarettes, stove, and candles). Can I drive or travel while using oxygen? Yes. When driving, secure the oxygen unit so it will not tip over. Leave a window open slightly for ventilation so the oxygen will not accumulate in the car. You may also travel on public transportation while using oxygen. Be sure to make reservations early, alerting the reservations people of any special needs you may have. This will give them time to accommodate you. We can help arrange to have oxygen en route and at your destination. (Please see the section on Going on Vacation Pgs ) What can I do while using oxygen? You can do anything that you would normally do, except for those things that would bring you within five feet of an open flame, a burning cigarette, or an electrical appliance that sparks. Actually, you may find that you will be able to increase some of your daily activities as a result of using your oxygen. therapy. In times of slight distress or trouble DON'T PANIC. Keep the patient in a sitting or an upright reclining position. Keep the lighting low. Keep noise to a minimum. Don't ask them to speak any more than is absolutely necessary. Let them use their energy to breathe. Keep the room temperature cool. Be prepared to give the patient a nebulizer treatment. Make sure their oxygen cannula is properly placed and that the liter flow is correct. Be prepared to call EMS (911) if the patient's condition worsens and make sure that you can give precise directions to your location

18 Frequently Asked Questions About Your Oxygen Therapy At Premier Home Care, Inc., we want to help answer any questions you may have about your home oxygen system. Below are some commonly asked questions about the use of oxygen. What is Oxygen? Can I become addicted to oxygen? Oxygen when properly used is not harmful or addicting. We all need oxygen to live. If your lungs or heart are diseased and cannot supply enough oxygen to your body from normal room air, you may need to breathe supplemental oxygen. Do all patients with lung or heart disease require supplemental oxygen? No, but it is estimated that over 4 million patients with lung or heart problems are benefiting or could benefit from supplemental oxygen. This is a rather small percentage of the estimated 60 million Americans who are currently affected by lung and/or heart disease. Oxygen is a drug that is a colorless, tasteless and odorless gas that is necessary for life. When we take a breath, we draw air into our lungs that contains 21% oxygen. The oxygen passes from our lungs into our bloodstream, where it is carried in the red blood cells to all the organs and tissues of our bodies. How can I tell if I m getting enough oxygen? Low levels of oxygen in your blood will often cause your to feel short of breath, have tightness in your chest and breathe faster than normal. In severe cases you may notice a blueish skin discoloration around your lips or nail beds. Can I turn up my oxygen if I m having a bad day? You might anticipate that some of the symptoms you had before using the oxygen will start to go away as your blood s oxygen level returns to a more normal level. The only way to be sure that you are getting the right amount of oxygen is to have the oxygen level in your blood measured while using the supplemental oxygen. If new symptoms, such as headaches, confusion, increased sleepiness, etc. appear, you might be getting too much oxygen. Contact your physician immediately. Why do I need supplemental oxygen? Normally oxygen passes readily from the lungs into the bloodstream and is pumped by the heart to all parts of the body. When lung disease occurs, oxygen may not be able to pass as readily into the bloodstream. This can cause many undesirable effects, such as a decreased ability to exercise, difficulty breathing, fatigue, confusion, loss of memory, etc. Breathing supplemental oxygen increases the amount of oxygen that passes into the blood stream and that is carried to the organs and tissues. When the heart and/or lungs are diseased, they may not be able to supply as much oxygen-enriched blood as our bodies need. Never change the liter flow or hours of usage without permission from your physician Will oxygen relieve my shortness of breath? Oxygen frequently does help, but there are reasons other than lack of oxygen for shortness of breath. In such cases, oxygen may not relieve the condition