Friday’s COPD Newsletter From COPD Support, Inc.

newspaper12
Volume 10, Issue 06
January 8, 2010
Joan Costello, Editor

BACK TO BASICS - PULMONARY REHAB

By Michael Gibbons. An analysis of how CMA plans to implement pulmonary rehabilitation coverage. It is a move in the right direction - just not far enough. That is one early reaction as the dust settles on the long-awaited edict by officials at the Centers for Medicare & Medicaid Services on how they intend to pay for outpatient pulmonary rehabilitation services. We also heard the opinion that this new reimbursement ruling could make it even harder for PR programs to stay afloat.

Medicare’s new national coverage determination (NCD) for PR, which took effect Jan. 1, will change the way PR providers do business. CMS defined PR as “monitored exercise” but referred to the CPT code for unmonitored cardiac rehab. “That’s a flaw in their methodology. It does not compute to say we will use unmonitored cardiac rehab for monitored PR.”

“We’ve always had the same components to rehab - six-minute walk, instructions for proper MDI use, breathing retraining, secretion management clearance, oxygen use - but now they have bundled them under one code, including the psychosocial assessment,” said Trina Limberg, BS, RRT, program director of PR at University of California, San Diego, Medical Center. “All those things take so much time. They are all indirect costs of PR.” Figuring out how many minutes each component of a PR service will take, and how many full-time equivalents you will need to deliver those services, will pose many challenges to PR managers beginning in 2010, she said.

CMS agreed to include patients with “very severe COPD” under the national coverage umbrella along with patients with moderate disease. Giving PR professionals the ability to intervene early at stage II COPD is a “tremendous opportunity we’ve never had before.” It remains to be seen if “local Medicare intermediaries will still decide whether or not to cover patients with lung conditions other than COPD.”

“Medicare pays for lung transplants, the majority of whom are restrictive or pulmonary hypertension patients. PR is necessary in their care. How can Medicare exclude these patients? It’s discriminating… Prior to this rule, patients with idiopathic pulmonary fibrosis awaiting a lung transplant could get PR. In states without a local Medicare policy, what’s going to happen to them?”

Two moves by CMS officials met with wide approval: First, they expanded PR coverage from a maximum of 36 sessions up to 72 sessions - but, again, only at the discretion of local Medicare intermediaries. After reviewing historical claims data, CMS officials set a median reimbursement fee for outpatient PR at $50. That is up from their initial proposal of $15. With the ability to bill for two sessions per day, the total daily reimbursement per patient comes to $100. Even so, that $50 figure leaves many rehab specialists incredulous.
http://respiratory-care-sleep-medicine.advanceweb.com/Editorial/Content/Editorial.aspx?CC=213359

ALSO IN THIS ISSUE

-FACTORS THROUGH LIFE AFFECT MIDDLE AGE LUNG FUNCTION
-MOBILE OXYGEN SUPPLY GIVES PATIENTS FREEDOM
-COLD WEATHER TIPS FROM CAROLYN/MI
-MORE COLD WEATHER TIPS
-TO AVOID BREATHING DIFFICULTIES LEARN TO MANAGE YOUR RESPONSE TO WEATHER CONDITIONS
-WHERE TO LIVE
-HOW WEATHER CAN AFFECT YOUR COPD
-LA RESIDENT? SHARE YOUR COPD STORY
-COPD-SUPPORT’S BIRTHDAY MAVEN WRITTEN UP IN LOCAL PAPER
-SPECIAL POST-NEW YEAR WARNING FOR COPD PATIENTS
-THREE COPD VIDEOS
-LETS GET FIT
-MISCELLANEOUS

~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
SOURCES: News items summarized in The COPD-NEWS are taken from secondary sources believed to be reliable. However, the COPD Family of Services does not verify their accuracy.
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<

FACTORS THROUGH LIFE AFFECT MIDDLE AGE LUNG FUNCTION

By Nancy Walsh, Contributing Writer, MedPage Today: Lung function in middle age is influenced by multiple factors, including childhood respiratory infections, birth weight, and lifetime amount of cigarette smoking. Change in lung function between youth and middle age is influenced by physical, medical, and demographic factors acting throughout life, analysis of data from a nested case-control study showed.

“Unfavorable influences in childhood can adversely affect later respiratory health, with childhood asthma, respiratory tract infections, and low birth weight all associated with reduced lung function in adulthood.” However, it has been unclear whether these influences are limited to early life, or whether later factors also contribute to accelerated respiratory decline in middle age. Data from the prospective Newcastle Thousand Families Study, which included 1,142 children born in 1947, provided an “unusual opportunity” to examine pulmonary function over a period of 35 years.

The finding that severe respiratory illness during childhood is associated with later reduced lung function is consistent with most previous studies, whereas the association of birth weight and lung function in adolescence and adulthood agrees with only some other studies, according to the researchers. “Our finding that birth weight influenced the progress of FEV1 between ages 14 and 49 to 51 years suggests that some of this effect may be determined by events later in life.”

Mechanisms that also could help account for the association between birth weight and pulmonary function include lower maximal function and accelerated decline.

Another noteworthy finding was a large difference between women and men in change in FEV1 between ages 14 and 50 years, according to the authors. Compared with men, the average FEV1 in women declined by 35.4% after age 14, which may be explained by the fact that girls typically reach their peak FEV1 at a younger age, with boys generally having a large amount of growth remaining at age 14.
http://tinyurl.com/ydufg96

MOBILE OXYGEN SUPPLY GIVES PATIENTS FREEDOM

Nearly 1 million people in the United States require oxygen therapy 24 hours a day. Oxygen for long-term use comes in several different systems. At home, most patients use liquid and compressed gas systems, which involve large tanks. Smaller, more portable tanks can be used for a few hours outside the home. Oxygen is typically delivered through a two-pronged nasal tube, or cannula, but this method can be highly wasteful of oxygen. Other options include reservoir cannulas, which store oxygen in a small chamber when it is breathed out, and trans-tracheal catheters, which deliver oxygen directly into the trachea.

While oxygen therapy through a nasal cannula has been used successfully for decades…A new supplemental oxygen system delivers oxygen directly through the trachea rather than through the nostrils. Research shows the system, called trans-tracheal oxygen therapy (TTOT), allows patients to be more active. This is because delivery through the trachea avoids the “dead space” of the nose, mouth and upper part of the trachea. The system also reduces oxygen flow requirements by 30 to 50 percent. That means oxygen sources last about twice as long as traditional oxygen therapy. A major benefit for patients is improved self confidence, since they can wear the catheter on a necklace or hidden with a scarf and tubes are hidden under clothing.

To implant the TTOT system, surgeons make an incision in the neck and place a stent in. The next morning, the stent is removed and a catheter replaces it. Because this method of oxygen delivery requires surgery, there is a risk of bleeding in the neck and infection. There is also a risk of mucus buildup on the implanted catheter. Patients may experience pain shortly after the procedure. Patients who require a high amount of oxygen may not be candidates for TTOT since the catheter used to deliver oxygen is small. Forwarded by Elena/IL
http://abclocal.go.com/wls/story?section=news/health&id=7203859

Editor’s note: About 10 years ago there was a lot of experimentation done with TTO’s. For some reason they did not become widely accepted. It will be interesting to see what has been developed recently.

Medscape background on TTO
http://www.medscape.com/viewarticle/455720_19

~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
MEDICAL DECISIONS. Your physician should be consulted on all medical decisions. New procedures or drugs should not be started or stopped without such consultation. While we believe that our accumulated experience has value, and a unique perspective, you must accept it for what it is…the work of COPD patients. We vigorously encourage individuals with COPD to take an active part in the management of their disease. They do this through education and by sharing information and thoughts with their primary physician and pulmonologist. However, medical decisions are based on complex medical principles and should be left to the medical practitioner who has been trained to diagnose and advise.
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<

COLD WEATHER TIPS FROM CAROLYN/MI

Posted on the COPD List.

What can we do to help protect ourselves during this cold time of year? There are several ways to meet the cold cause we sure can’t beat it!

…if at all possible do not overheat your house. I can’t say what is overheated and what is comfortable for you, but if you get yourself too warm before going out you will have more trouble fighting off the cold.

Layer your clothing, even inside. Wear a t-shirt over or under a long sleeved shirt and have a sweat shirt, sweater or flannel shirt around. Make sure you layer yourself as you go out as well. If you are going to a store or the Doctor’s be sure to undo and/or remove your coat while inside. It may be a hassle but if you don’t you will feel twice as cold once you are outside again.

Hats are a must along with gloves. Gloves, boots or at least warm shoes and socks are also very important during this time of year. For people with chronic illness, suppressed immune systems and possibly poor circulation frost bite is a very real concern, so please cover up.

I personally breathe better in cold weather until it gets down to around zero and the wind is blowing. I wrap a scarf loosely around my neck and cover mouth and nose, again this is loosely. I also inhale through my nose and that will help warm the air a bit before it hits the lungs. You do have to try to get a scarf that is fairly lint free. You can also wear a surgical mask to help cut the wind. Another thing that is out there is the nose turtle or mouse. Depends on what part of the country you are from, as to what they are called. Skiers wear them. You put them over you head kind of like a turtle neck sweater and then pull it up over mouth and nose and there are holes for your to breathe through. Personally I felt like I was going to suffocate with one on.

Now here is a biggie especially if you are new to O2. Remember to try and keep your O2 hose inside your coat. They get cold and brittle fast! When I was using O2 in the winter I wanted to keep my green portables warm as well. Cold O2 is not always comfortable. We had one lady at rehab that knitted portable warmers for her different sized tanks to help keep them warm.

And last but not least, your car. If at all possible try to warm your car up before you actually have to leave. If this is not possible, remember to keep your heater fan off until your engine is actually warm enough to give you heat.

All of this goes for you in the Southern states as well. Maybe your temps are not hovering around zero but it is much colder for longer then you are used to. You can modify the above to fit your circumstances but remember if you are used to 70 and it is 43 well Baby it’s cold.

MORE COLD WEATHER TIPS

Shirlee/MI: I’ve found the key to wearing the Skier’s hat without feeling like you are going to suffocate, is to find one that is large enough, and also a looser knit than probably skiers like to wear. Mine happens to be bright orange for hunters, but it works well. Has a lot of stretch in it.

I do find, however, that having to wear so many layers of clothing and heavier coats, boots, etc. makes it extremely difficult for me to breathe. And it just wears me out. So I try to avoid going out when it is really cold if I can possibly avoid it.

Dick/MO: For me, the problem with wearing all those layers is that simply putting them on makes me SOB and I need to sit down and recover before I can pick up my O2 bottle and head out. That means that mostly, I stay in during extreme cold weather.

Penny/PA: And, Dick, just like when we were kids, as soon as you get all that stuff on, you’ve got to go to the bathroom!

Dick/MO: That’s a good comment and leads into another suggestion that I picked up from a friend recovering from prostate cancer. I don’t have a real incontinence problem but when you get SOB and your O2 sats get low, your body assigns blood flow and O2 to areas it considers important. The important areas are your heart, brain and other vital organs. Bladder control is not considered important at all. For safety sake I never leave home now without an incontinence pad in place. They’re rarely needed but on those rare times it’s very good to have. They’re available at Wal-Mart, Target, Walgreen and many other large stores. They’re also available from www.amazon.com is you would feel uncomfortable about going through a local checkout with them.

John/MPLS: Last summer sitting in the grocery parking lot, I noticed how most of the women were dressed, particularly no socks and floppies for shoes. I realized I was an old stick-in-the-mud putting on socks and shoes so I started to go out wearing just the clothes I had on at home - including bare feet in moccasins. That, and other simpler clothing decisions, sure has made my going out easier. This fall and winter I put on just a down vest to go out - very simple to put on and no weight. No cold weather problem - my car is parked in an underground garage so my outside exposure is only from the car into the store and back. It wasn’t till last week when it was zero with a 10 mph wind and my arms could get cold, that I put on a jacket with sleeves.

As long as I cannot go for walks outside anymore and don’t need to wait for buses, etc, I might as well take advantage of the situation and not fuss with putting on layers, hats, gloves, scarves, etc. As with everything with this COPD, we are all different.

TO AVOID BREATHING DIFFICULTIES LEARN TO MANAGE YOUR RESPONSE TO WEATHER CONDITIONS

Most COPD patients learn to recognize the environmental conditions that trigger breathing difficulties. Two of the most common environmental triggers are the weather and air pollution. You can learn to adjust your schedule and how you prepare for the weather if you need to be out of your home.

Weather: People with COPD may have reactions to changes in the weather, and these reactions are quite individual. Some have more trouble with cold weather, others with warm. Some may prefer some humidity in the air, others need dry air. Often the best approach when faced with extreme cold or high levels of pollution is to stay at home if possible.

In most cases, breathing cold air causes the most difficulty for people with COPD, because it narrows their airways and restricts air flow into the lungs.

- In colder weather, wear a scarf over your mouth and nose, or pull a turtleneck over your nose.

- Wear a cold-weather mask, made of comfortable, soft sponge and available at many drugstores or medical supply stores.

- Breathe in through your nose rather than your mouth when you are outdoors. This helps filter, warm, and humidify the air before it enters your lungs.

- Use your bronchodilator about 30 minutes before going outside to open up constricted airways.

http://www.associatedcontent.com/article/1813920/steps_to_managing_outdoor_triggers.html?cat=12

WHERE TO LIVE

I am home again with largynitis. Thought it was over last month but no, it has raised its ugly head. Its really cold in NYC right now. I was just wondering if you all could pick the place place to live year round with COPD, where would it be? In terms of weather conditions and facilities, as the only consideration.
Peggy/NYC

I live in the Phoenix area, and I find it ideal. I stay in a lot when it’s really hot. This time of year is perfect. It’s going to get to 71 today, and has been in that range all week. I feel for you all in the deep freeze, but am glad I’m not sharing it.
Janet/AZ

Three years ago I was able to make a trip to Las Vegas in November. Temperature averaged 70 degrees It took me several days to realize ..GOSH I can breathe, it’s the low humidity I guess. Still long to revisit wonder if it would still work. Yes, we are all different….I would rather the cold than heat.
Carolyn/CT.

HOW WEATHER CAN AFFECT YOUR COPD

Weather and temperature changes can trigger COPD symptoms. Here’s what you can do by Krisha McCoy. Medically reviewed by Cynthia Haines, MD. Weather changes are one of many factors that can trigger your COPD symptoms. Symptoms of COPD, which include shortness of breath, cough, and phlegm production, tend to get worse for some COPD patients when the air is very cold and when it is hot and humid. “Weather extremes are not good,” says Barry Make, MD, co-director of the COPD program at National Jewish Health. Dr. Make says that he has noticed that temperatures below freezing or above 90 degrees Fahrenheit tend to cause COPD symptoms to flare up.

COPD and Weather: When It’s Cold and Windy

Cold air and strong winds are known to be triggers for the worsening of COPD symptoms. “If [COPD patients] go out [when] it is windy and they have to walk against the wind, there is more resistance, and that can be a problem,” says Make. And frigid temperatures can fatigue COPD patients. “COPD patients just feel like they are more tired after they’ve been in the cold,” he says. If cold and windy climates bother you, try loosely wearing a scarf or face mask over your nose and mouth, and breathe through your nose on wintry days. The scarf, or muffler, and breathing through your nose warms the air before it enters your lungs, which can help prevent the worsening of your symptoms.

Should You Move?

Seasonal exacerbations of COPD symptoms can be so bad that people will move across the country in an effort to deal with the problem. “One of the most common questions we get [from COPD patients] is what part of the country [is best] to live in because of the weather,” says Make. He says that in the past, physicians commonly recommended moving to the western United States, where the air is less humid. But he says that it is now known that the COPD-weather connection is very individualized, and that what works for one person might not work for the next. “It is variable from person to person,” says Make. “Some people prefer more humidity and some less.” It is usually not necessary to move when you have COPD, but if you live in a climate with extreme weather changes and moving is an option for you, talk with your doctor. Make strongly recommends a trial run before you relocate.”If people are going to think about moving somewhere for the weather,” he says, “be there for all of the seasons of the year.” That way you will know if the move will provide year-round improvement of your symptoms.
http://www.everydayhealth.com/copd/weather-can-affect-copd.aspx

Editor’s note: If you need to go out in your car alone, make sure you have an emergency kit with you. A cell phone, disposable hand warmers. An old blanket. A couple of candy bars, a few flares, a shovel, bottled water…You may not need any of it, but will feel much better if you have it. I bought my grandsons emergency packs of hand warmers for shoveling their driveways and perhaps having to change a tire or push a car out of a rut in the snow.

~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
COMMERCIAL FREE: We do not accept any paid advertising. Any corporations, products, medicines (prescription or non) mentioned in this newsletter are for informational purposes only and not to be construed as an endorsement or condemnation of same.
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<

LA RESIDENT? SHARE YOUR COPD STORY

The TV Show, The Doctor’s is looking for folks in the LA area with COPD or have been recently diagnosed with it. Please contact them and share your story!
http://www.thedoctorstv.com/main/tell_us_form/860

Editor’s Note: That is Los Angeles, not Lower Alabama as a friend suggested.

COPD-SUPPORT’S BIRTHDAY MAVEN WRITTEN UP IN LOCAL PAPER

Music sings of the evils of smoking-By Laurie Gordon Vernon — Barbara “Bunny” Music has lived some life. She hitched from New York City to Woodstock in 1969 and got a ride back to Greenwich Village in a limo with a rock star. Later, when desktop publishing came along and put her occupation as a typesetter out to pasture, she spent time living on the streets of New York. But then thanks to a friend in the real estate business, she worked her way up to being an agent on the Upper West Side. “I’ve done a lot and I’ve seen a lot,” said the 65-year-old, but I can’t go anywhere without Oscar.” Music has COPD and “Oscar” is what she named her oxygen tank. After smoking for 44 years, she contracted COPD, a lung condition that includes emphysema and chronic bronchitis. She started smoking at a young age because “everyone did it back then.”
http://www.strausnews.com/articles/2009/12/31/advertiser_news/news/5.txt

SPECIAL POST-NEW YEAR WARNING FOR COPD PATIENTS

Hospital admissions for COPD tend to peak in the first week of the New Year. Why? High stress, easily spread coughs and colds and the cold winter weather are the culprits behind exacerbation of lung problems. COPD may account for one in eight hospital admissions during the cold winter months. Here is a list of precautions COPD patients are urged to take:

-Pay close attention to weather alerts and stay indoors when the weather is bad.

-Avoid crowds and keep away from people who are sick.

-Practice frequent hand washing and hand hygiene.

-Notify your doctor at the first sign of COPD exacerbation.

-Practice stress relieving measures.

http://copd.about.com/b/2010/01/04/special-post-new-year-warning-for-copd-patients.htm

THREE COPD VIDEOS

What is Bronchiectasis?

Sufferers of bronchiectasis have abnormally enlarged airways because of persistent inflammation or infection. Symptoms include constant cough, phlegm, and mucus. Learn more about bronchiectasis.
http://video.about.com/copd/Bronchiectasis.htm

What Is Emphysema?

…a respiratory disease caused by toxic vapors like cigarette smoke. Learn more about this disease and its effects.
http://video.about.com/copd/Emphysema.htm

Causes and Types of COPD

More information at:
http://video.about.com/copd/COPD.htm

LETS GET FIT

…is getting ready to start a new team for List subscribers who may want to join the Lets Get Fit Program. LetsGetFit is about exercising to help ourselves breathe better and to increase strength and endurance. We have small groups of exercisers who email each other daily to report their exercise efforts and to share information, encouragement and support, but we do not tell our members what exercises to do. All members must rely on their medical advisors for guidance.

We hope to start the Newbee team in a couple of weeks. There are also several existing teams that need new members and they are waiting for you! Izzy K will be your leader and Bruce Petro will assist her. Contact izzykuehl@yahoo.com or petrojman@aol.com for more information and/or sign up.
http://lgf.copd-support.info/

Editor’s note: A basic requirement to join is that you are a current subscriber to one of our COPD-Support lists.

~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
JOIN US? Subscription to this Newsletter is free and we hope that it serves your needs. For more Newsletter information, go to:
http://copd-support.com/signup-news.html

The Newsletter, like all other endeavors of the Family of COPD Support Programs, is provided to you by COPD-Support, Inc. a non-profit member organization with IRS designation 501(c)(3). If you would like to be involved and help us provide these programs to the individuals who benefit from them, please consider joining us as a member. Further information is available at:
http://copd-support.com/membership.html
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<