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Previous (Archived from 2009)  Questions & Answers  of the Respiratory Therapist (Tracy Cushing) 

Alphabetically Arranged




After an Infection

Back & Shoulders - Strengthening


Exercise After an Illness

Exercise After an Infection

Exercise After Rehab

Help on Exercise-Info

How Hard

Improving Lung Function

Rehab at Home

Why Exercise?


Inhaler Medicines


How Much Ventolin

Inhaler Info

Inhalers Prescriptions

Smells/Cooking Odours

Spacers - Using Correctly

Spiriva and Atrovent Timing

Spiriva with Other Meds

Switching from Albuterol to Xopenex in Nebuliser



MISC. (COPD Questions)

Air Trapping/Reducing

Asthma, Emphysema & Isocynates

Bronchial Thermoplasty & Seretide

CO2 Retention

Emphysema & Isocynates

Exacerbations & Disease Progression


Headaches & Dizziness

Hyperinflated Lungs & Bras

Loss of Voice & Hoarseness

Lung Strengthening

Newly Diagnosed

Peak Flow Meter


Reaction to Meds& Info on Zemaira

RRT's - Their Role

Sexual Dysfunction & Meds

Should I Be Tested?

Swimming Pools & Chlorine

Waking During the Night


Xanax & Anxiety

Youth & COPD




Coughing Mucus for Months

Phlegm and Dairy Products




Flow Increase

If on Oxygen Will Lung Function Decrease

Is Oxygen an Heroic Measure

Nasal irritation

95% Oxygen Saturation but Short of Breath


Oxygen & Exercise

Oxygen & Humidity

Oxygen Desaturation When Flying

Oxygen Use vs Non Use

Qualifying for Home Oxygen

Reserve/Retain - Build Up


Oxygen Saturation


CO2 and CO - Relationship to COPD

Exercise and SpO2

Low Oxygen/Cognitive Impairment

Low Oxygen/Organ Damage

Low Oxygen Saturation But no COPD

Nasal Spray and Oxygen Saturation

Severe COPD - Oxygen Need

Walking & Oxygen Saturation


PFT (Pulmonary Function Test) and Spirometry


ERV Question

FEV 1 After Medical Setback

FEV 1 % - One Lung

Normal PFT but Reduced Oxygen Diffusion

PFT's and End Stage

Relevancy of FEV Numbers

Smoking & PFT's

Understanding PFTs

Ventolin - No Change in Numbers

Which Numbers are Used

Why Should I Know My Numbers




Moderate Marijuana Smoking

Oximetry Accuracy If Still Smoking

Quitting Smoking/Disease Progression

Smoking & Work Environments

Still Smoking




Anesthesia and COPD

Chronic Respiratory Failure

Ventilators - How Long?






 Q's & Answers from Tracy Cushing, RRT


Q. Exercise & SpO2  (Posted Dec. 27/09)   


I have COPD and cannot exercise hard enough to maintain my previous fitness.  I have been exercising only to the point where my blood O2 stays above 90%.  If I continue this for long periods e.g.. 3 hours, will this have a adverse effect on lung tissue?

Thank you


A.  Hello Ken,
I want to clarify that the 90% oxygen level that you speak of is not a blood level per say-it is an estimate of your oxygen level.  It is not exact and varies depending on a number of factors; cold fingers, certain blood levels, nail polish, etc.  The oxygen saturation level is oftentimes lower for people with COPD and this number will vary from person to person and may differ depending on activity.. Some people have lower levels and this is normal for them, others may only have a lower number with exercise.  Please speak to your doctor about what a safe level is for you when at rest and exercise. 
If you oxygen levels remain low for extended periods of time there can be damage to your body but this is different for everyone and I am not comfortable being any more specific in this response.
Physical activity is very important for lung and overall health so congratulations on keeping at it!!

(Note:  For a very good explanation on SpO2, please visit Konica Minolta Sensing, Inc)



Q. Restoring Exercise Level After a Flare Up or Break From Routine  (Posted Dec. 20th/09) 

Hi Tracy. Just curious as to why people with COPD do not respond well to getting back to an exercise program after a long layoff, or illness. I had some very bad back problems which kept me away from the gym for over 6 weeks. After feeling better I decided to go back to the treadmill, and I found that my usual 30 minutes has been cut down to 15. Also I noticed that my heart rate actually went up during the cool down rather then coming down. Is this a common thing?? Don't get me wrong. It was not a dramatic increase , perhaps 5 beats, but say my heart rate after the 15 minutes was 112 it would rise to 116 during cool down.

I could not believe that over the time it took me to build myself up, it only took a few weeks to tear down all that previous effort. How do I get back to where I was before my back problems? Thanks Philip

A. Hello Philip,
6 weeks is a relatively long time to be away from an activity and it takes the body time to regain back the exercise tolerance it had before the break.  Generally, the arms and legs get deconditioned more easily for people with COPD because it takes more energy and oxygen to move these large muscle groups.  This may require a faster breathing rate in order to acquire this needed which may lead to breathlessness.  In time, as you continue to exercise, the muscles may not require as much oxygen to perform (because your muscles become more toned) which may make it less difficult to use them and hopefully less breathlessness.
Keep at your exercise  and you will hopefully get back to where you were before your back problems.  Try not to push yourself too hard to avoid injury or exerting yourself so much that you get away from it again.  Slow and steady wins the race!
Your heart rate may continue to increase for a short time once you stop exercising since your body is still working hard to get what it needs from your heart and lungs.  Remember, it takes time to warm up the body before exercise and this is also true of the cool down-it doesn't happen instantly.
Good luck!



Q.  Inhaler - To Avoid ER Trips (Posted Dec. 20/09)  

Hello,  when I get a  cough it lasts more than one month before I get the courage to go the doctor.  He gives me an inhaler from the ER.  The inhaler I use daily for the next 2 months before it gets empty  and I usually get the cough twice a year.  This is only my second inhaler;  my sister has asthma as  well as my brother.  The inhaler is the only thing that I use;( I only get twice a year)  Should I keep getting my prescription renewed? This happened in July of this year.  I  get to see the  doctor twice a year.   When I went into the ER for the cough they gave me a neb treatment and prescription for inhaler. 
My Question: Should I keep getting the inhaler refilled to avoid the trip to the doctors ?

Thank You

A. Hello Eric,
I would suggest that you talk to your family doctor in depth about your breathing problems during your next visit.  You can ask him/her about what inhalers are best for you on a regular basis.  Perhaps you should see your doctor more regurlarly until your breathing problems are in better control so that you can avoid ending up in the emergency department.
When you start to get sick, I would strongly suggest not waiting a month before visiting a health professional about your breathing problems. The sooner you get treated, the less difficult it will be to treat your flare-up. Getting regular prescriptions for your inhalers does not take your doctor or health professional out of the equation; you should rely on them to help you with your breathing as he/she is the expert at keeping you healthy.



Q.  Phlegm & Dairy Products  (Posted Dec. 13/09) 

I have advanced COPD, and am underweight.  In trying to fend off the side effects of prednisone and  bone issues, I try to add milk etc to my diet.  I find this changes the phlegm consistency.  Is milk and other dairy products a beneficial part of my daily diet, or does it cause other problems.  Thanks Sheri

A. Hello Sheri,

 Canada's Food Guide suggests 2 servings of milk for those between the ages of 10-50 years and 3 servings for those over 51 years of age.  This can be in the form of milk, soy beverages, yogurt, and cheese to name a few. Serving size varies but here are some examples: a serving of milk/soy beverage is 1 cup (250 mls), yogurt 3/4 cup (175 grams) and cheese 1 1/2 ounces (50 grams). 
Although I do not know of any reason why milk would affect your phlegm I would suggest trying other foods/beverages in the Milk and Alternatives category to see if you still notice these changes.  As well, in order to try and increase your daily caloric intake try to eat snacks during the day instead of large meals.  For example, combining half and apple with some cheese or peanut butter, a small container of yogurt and a few grapes or a muffin and a glass of juice.
Eating a well balanced diet can improve energy levels, improve physical capacity and improve quality of life!
Check out this website for valuable information on Canada's Food Guide:



Q. PFT's & End Stage (posted Nov 29th, 2009) 

I don't understand my PFT's and what exactly is end stage emphysema?


A. . Hello Fred,
There is a great section  on   this website on the left hand side under BREATHING TESTS that helps to explain PFT results.  Try that and let me know if you still have questions.
End stage emphysema implies that a person's emphysema has progressed to a point that they become breathless with very mild activity and most likely cannot perform their usual daily activity without great effort. It also implies that all feasible medical treatments have been discussed with the person and their family; breathing medications, home oxygen, etc.  
Keep in mind that this disease affects people differently; some people with poor spirometry results may be quite active and have a great quality of life and others may have better results but be inactive, and not have as good a good quality of life.  It is different for each person.



Q. Oxygen Desaturation when Flying (posted November 21, 2009)    

Hi Tracy. I am going away for the Month of March, and I noticed that when on the plane, I  desaturated to about 87 when going to the men's room. When sitting down it goes back up to about 93-94.

Do some people who DO NOT use 02 on the ground sometimes need it only for flying ??? Some told me it would be rare but your input would be helpful.  Also to raise saturation when flying does pursed lip breathing always work?

Many thanks Philip

A. Hello Philip,
Although airplane cabins are pressurized there are still changes in pressure that can affect people with breathing problems..  The drop in your oxygen going to the washroom is likely due to the exertion of doing so in addition to the increased pressure.  The return to normal goes along with being back in your seat and at rest again.
I have not known of people only having supplemental oxygen for a flight but assume that-with a valid prescription-the arrangement can be made with the airline. Arrangements may have to be made with a respiratory home care company depending on the airline and whether or not they provide the oxygen in flight or if you have to bring your own. This will vary with airlines.
I suggest you check discuss your concerns with you family doctor or specialist.  Perhaps they will have had a similar situation in the past.
Although pursed lip breathing may help to reduce your breathlessness in flight I doubt that it will improve your oxygen saturations.
Have a great flight!



 Hi Tracy. I am going away for the Month of March, and i noticed that when on the plane, i desaturated to about 87 when going to the mens room. When sitting down it goes back up to about 93-94.

Do some people who DO NOT use 02 on the ground sometimes need it only for flying ??? Some told me it would be rare but your input would be helpful.  Also to raise saturation when flying does pursed lip breathing always work?

Many thanks Philip

Q. Moderate Marijuana Smoking  Posted November 14/09 

I've had no problem quitting cigarettes since finding out about my C.O.P.D. but in my job (I work in the arts) at after show gatherings I sometimes like to smoke a little weed.  If kept to moderation and only occasionally would that be a problem?    Melody

A. Hello Melody,
There are several studies that show that smoking tobacco and marijuana greatly increase the occurrence of COPD. Other studies have found that smoking marijuana alone does not appear to lead to COPD although damage to the lungs is seen.  There are few studies that look at people who have a COPD diagnosis, have quit tobacco but smoke marijuana. 
That being said-if you have COPD and continue to introduce a chemical irritant, such as marijuana, into your lungs it will likely exacerbate symptoms of COPD.  I doubt that you will find any respiratory health professional that will indicate that it is 'OK' to smoke marijuana and not have damage to your lungs.               




Q. Help On exercise/Info   Posted Nov. 14/09 

Hi!   I live in  Ontario.  I was diagnosed with moderate  approaching severe copd in Jan. 2009.  There are no respiratory therapists here and therefore obviously no pulmonary rehabilitation clinics to go to.  What could you suggest for exercise routines.  My get up and go seems to have left me behind.  Can you suggest any books, dvds et and where to get them.  Any information will be greatly appreciated!   Jacqueline

A.  Hello Jacqueline,
Congratulations on your interest in starting an exercise routine-it is a great step to reducing breathlessness and doing your daily activities with more ease. 
If there are no pulmonary rehabilitation programs in your area you can also consult a physiotherapist to get some advice on what exercises may be best to start off with.  As well, a general suggestion would be to start walking each day.  Try to increase the distance every few days or week.  If you live in an apartment building-try walking the length of a corridor, then gradually increase this distance. Or, if you have a driveway, perhaps walk the length of it and repeat, then move on to the sidewalk as you progress.
I would also suggest calling your Lung Association, Heart and Stroke Assn as well as local community organizations that may have information on social walking programs in your area.  There may be programs already in place to encourage activity although they may not be specific to COPD-it is still a great way to be social and get some exercise. Please speak with your family doctor to make sure you can safely start a walking/exercise program.
Good luck!

Additional Note Added:  COPD Canada Patient Network will have an Exercise DVD available before the end of the year.  Please check back in December.



Q.   Normal PFT (Pulmonary Function Test) Results with Reduced Oxygen Diffusion (Posted Nov. 7th/09) 

I had a lung function test this past summer because of a dry cough that continued for about 3 months in the spring.

My doctor said all the results were normal except the oxygen diffusion was at about 80-- they said it is mildly decreased.

Just wondering your thoughts on what this could be.

I am 35 yrs. old.  I have not smoked for close to ten years.

I smoked for about 8 years.

A.   Hello Teresa,
Diffusion capacity is a measurement that is an indicator of how well the membrane that separates the lungs and the surrounding blood vessels works. It can be reduced for reasons such as interstitial lung disease (pulmonary fibrosis, asbestosis, etc.) or emphysema.
It is possible that your diffusion capacity (DLCO) value may be reduced from previous damage from smoking. Speak to your physician about this result at your next appointment and he/she may have some more information for you, knowing your full medical history.

Note for Brandon:  We are unable to contact you since no e address was supplied with your query.   We're not totally sure of the Medicare rules in the U.S.   If you would like, we, or you,  can post your query on the forum since the membership and visitors there is International.

Here's the link



Q.  Exercising Again After Illness  Posted October 31st/09 

Hi Tracy. I normally do exercise on the treadmill about 4X per week at a gym, but I have missed more then a month due to the flu. I just started going back and noticed I am a bit more short of breath, Nothing drastic, but I feel it is due to my long layoff. I am afraid of overdoing it and what would you suggest as a way of getting back to where I was before the illness? The flu made me exhausted and it lasted for weeks. All I wanted to do is sleep. What regime would you suggest. Start say at 10 Minutes and work up to the 30 I did before?? What are your thoughts. Thanks Philip

A.  Hello Phillip

First of all I am happy that you are eager to get back at your regular exercise routine after having been sick with a flu!  It shows that you appreciate the value of exercise in helping reduce your breathlessness.
Secondly, you should check with your physician to make sure he/she feels you are well enough to start back at the gym.  Assuming that you get the 'OK', I think that you should gradually start back at your program and try to increase your time or intensity as the weeks go by.  If you started a specific program to build up to where you were before the flu, you can start there and then build up in the same manner as with that  program.  I think that you will see it should come back fairly quickly since you were devoting 4 sessions a week before.
Be careful no to push yourself too hard-be aware of your breathing and symptoms and take as many breaks as you need.  You do not want to injure yourself by pushing it too far when you are first getting back at it.
Great job and keep up the good work!


Q. General Anesthetic & COPD - Impact on Disease Progression  Posted Oct 17, 2009

About 5-6 years after I quit smoking (in my early 60') I had no breathing problems. I went through a 3 year period where I had 5 operations with general anesthetic and my breathing was worse after each operation. Now, at 75, I am on oxygen 24/7 and 25 yards is a long walk. In all the years I have  been treated for COPD I have had only one nurse suggest that there could be a link between the anesthetic use and COPD. All doctors questioned give vague answers. Is there any collaboration to general anesthetic and COPD?


A.  Hello William;

I am sorry for taking so long before replying to your message.  I have been unable to find any direct information in medical literature about whether or not general anesthesia can bring on symptoms of COPD.
Putting the general ansethetic aside, as you probably know, people can smoke for many years before noting any symptoms of COPD. As well, people that quit smoking may still have symptoms of COPD years down the road.  It is possible that the timing of your symptoms and having general anesthesia is a coincidence although I have no way of knowing either way. 
I will continue to try and find a definitive answer to this question and let you know as soon as I do.



Q. 95% Oxygen Saturation but Short of Breath (SOB)  (Posted Oct. 4th, 2009)

I am trying to understand the feeling of being low in O2 saturation. I do not understand that with oxygen and a sat of 95% I can still feel short of breath. What other factor other than a low oxygen saturation can give this feeling of shortness of breath?

I am just out of hospital after a pneumonia and septic shock. I have purchased an oxymeter to check on my saturation as they did in hospital many times a day. On my release i was usually at 93% without oxygen but find now, 2 weeks later, that it usually is at 90% and sometimes lower.

Thanks, Roly

A. Hello Roly,

As you may have read in a previous answer, I am not a big fan of home oximeters (the device that gives a reading of oxygen saturation).  Here is an excerpt from an answer last year: There are many factors that need to be looked at while using this device such as  circulation, cold fingers, other factors in the blood, finger movement, etc. Readings also need to be checked to ensure that the heart rate being measured on the oximeter is the actual heart rate that the person has; this needs to be checked each time it is used.  Otherwise, the readings may not be accurate. That being said-if you have an oximeter it is likely that your physician instructed you to get this for a valid reason.
If you feel more breathless than usual, are dizzy, lightheaded, or have a bluish color to your lips and around your eyes you may have a lower oxygen level. It is very important to pay close attention to how you feel and note any changes for the worse-these may be indications of a lower oxygen level. If you are having a more difficult time doing your usual daily activities it may indicate that you body is working harder than usual.
Try not to rely on the oximeter and more on how you feel and I feel that this is a better indicator of how you are doing overall.


Q. Why Exercise With COPD?

I've been on the different COPD internet sights for awhile now; well...a few months. Everyone spouts the need to exercise!  Why? it only makes it harder to breathe! what's it gonna do for me?
Thanks..... Carl

A. Hi Carl,
The most common symptom of COPD is breathlessness.  When people get breathless they tend to not exercise which leads to deconditioning of their muscles.  This deconditioning makes it more difficult to perform usual daily activities and exercise.  The more deconditioned a person gets, the more breathless a person can become and this can continue into a cycle of inactivity and breathlessness.  The importance of activity cannot be overstated.  If a person exercises by walking for example they can keep up the strength of their muscles and reduce breathlessness.  The stronger the muscles are, the less work your body has to do in order to perform usual daily activities.  This allows a person to keep up with activities and not get caught up in the cycle of inactivity.  A pulmonary rehabilitation program is an ideal way to integrate exercise along with education on the disease if there is a program in your area.  Ask your physician if there is a program in your area.  If a program is not available talk to your physician about how to start integrating exercise into your routine-it can make a significant improvement in your quality of life!!
Good luck,



Q.  Why Do I want to Know My Numbers???

Hi Tracy......  I've a question.  Some people seem to want to know what their lung function numbers are.  Others; like me... don't.  Why would a person want to know?  The results will be the same..... the inevitable


A. Hello Jean,
Some people want to know about their lung function values are just like someone with heart disease may want to know what their cholesterol values have as much information about their disease and heath as they can..  Knowing these values can help some people understand why certain medications have been prescribed (or not) and why other recommendations have been made by their physician or health care professional.  One of my favourite sayings is knowledge is power...the more you know about your disease the more you can help yourself stay on top of your own health. 



Q.  Just Diagnosed      

A friend of mine was recently diagnosed with COPD, he does not see the serious of this.
Is there info that I can some how give him?  I have printed pages off of the C.L.A site.
He is still smoking and drinking and thinks he will be able to go back to work soon.
He has a fairly physical job that is out in the weather and includes driving himself and other people.

A. Hello Eileen;

I think that you will be able to find a lot of your answers that you seek on this website. Have a look around  and you will find lots of useful information for your friend.
I will give you a few points to pass along to him though:
The only way to slow the progression of COPD is to quit smoking.  Quitting will slow the progression of lung decline to that of a non-smoker although it will not reverse any previous lung damage.  A person has to be ready to quit so the most you can do right now is offer him information on any local programs that would be available to him.  It may take a person several attempts to finally quit and this may involve different aids; gum, patch, pills, etc.  See what is available in your community and make this available to him.  The first step is thinking about quitting and no one can force someone else to want to has to come from them. You can offer support when and if the time comes that he decided to take this step.
I hope that this helps,



Q.  The Best Inhalers  for Chronic Bronchitis/COPD & In What Order

Hi Tracy,
What are the best inhalers for chronic bronchitis/COPD,and  which inhaler should  be taken first
also how long should I wait in between each puffer ? Right now I take Symbicort,salbutamol and atrovent.



A.  Hello Maggie,
In Canada there are guidelines for the treatment for COPD.  These guidelines use a combination of a person's breathlessness and spirometry results. Medications can be prescribed in a step-wise fashion as the disease and breathlessness progresses.

Here is a summary of the suggested treatments:

Early on in the disease a short-acting anti-cholinergic (Atrovent) should be prescribed and this may be changed to a long-acting anti-cholinergic (Spiriva.) later on.  In addition, a short-acting bronchodilator (salbutamol/Ventolin) should be prescribed on an as needed basis. A long-acting bronchodilator may be added but is usually in combination with an inhaled cortisteroid (Advair or Symbicort.) A short-acting bronchodilator should always be used fro relief of breathlessness as needed.

For your prescribed medications, you should take your salbutamol (Ventolin) first, then the Atrovent, followed by the Symbicort.  If your salbutamol is an MDI you need to wait 30 sec-2 minute between puffs.  The same goes for the Atrovent.  Use a spacer device, take a slow deep breath in and then hold your breath for 10 seconds for each inhalation.  Shake well between each inhalation.  Since the Symbicort is a powder in a turbohaler you cannot shake the device once you have actuated the dose.  Take a very fast deep breath in and again hold your breath between inhalations.  Waiting 30 sec-1 minute is not necessary with this device. Make sure to rinse your mouth well after taking your medications.  You can get thrush in your mouth from the steroid in the Symbicort.
Good luck,



Q. Relevancy of FEV Numbers 

 Hi Tracy. Through a great deal of research I have found that Fev numbers mean absolutely nothing as to how an individual gets around day to day. A Friend who is an RT in Texas says that he had seen people with an fev 1 of 18% who can run circles around those who,s fev1 are a lot higher. I had an fev1 of 25% and now it is 48% due to a large portion of asthma.. Taking the correct meds for your COPD is very important. Sometimes one has to experiment with meds to find the correct combination. Fev1 does not mean much. It,s what you can do with the numbers you have that really count. 

 Regards Philip

A. Hello Phillip;

The FEV1 (forced expired volume in 1 second) is a value that is important in the assessment of obstruction and constriction in the airways. This value normally declines over time. 
In Canada there are guidelines in place for COPD treatment. As the disease progresses, so does treatment (including inhaled medications.) Disease progression is partly determined by the FEV1.
As you have noted, not all persons with similar FEV1 values have the same symptoms.  This can vary from person to person but there are many reaasons why the FEV1 is important as I have noted above.
Thank you for the note,




Q.  Understanding PFT's  

 I have had Lung Volume Reduction surgery. The one thing I don't understand is how to read my PFT,s. I feel it important to know how much of my lungs work. I have never thought of the questions until now. Do my PRT's tell me this information???


A.  Hello Fred,

Pulmonary function tests (PFT) are several breathing tests that help show the volumes of air you can breathe in and out and other specifics on your breathing.  A physician will interpret these values. These tests are done in a lab usually in a hospital setting and have rigorous standards that are applied to ensure that the best values are obtained.
The link below should help you out with a description of the individual tests.  If you have further questions please let me know.



Q. Waking During the Night   

I have recently been diagnosed with COPD. I am having great difficulty getting through the night without waking up unable to catch my breath. On average I am sleeping 3  to 4 hours a night. Is this normal and what do you suggest I do to find relief from this problem.


A. Hello Eunice

Some people that have COPD use an extra pillow or two at night to help with sleep.  When we lay down the abdomen pushes the diaphragm up into the lungs.  This may make it difficult to breathe.  Using an extra pillow may help keep the abdomen lower and not push the diaphragm up so much.
Also, if you are not sleeping due to bronchoconstriction (a tightening on your airways) you may need a dose of your short-acting bronchodilator medication (for example-salbutamol) during the night to help.  Some people find salbutamol increases their heart rate which may prevent them from sleeping but it does not affect all people the same way.
Please mention this to your family doctor or respirologist at your next visit or sooner if it gets worse.
Good luck getting some zzzzz's!




Q Smoking & PFT's - How Long Before It Leaves the System   

Hello - If someone is scheduled for a pulmonary function test and they have been smoking - how long does it take for the effects from the smoking to leave your system so it will not be detected and  they will not be  embarrassed by the fact that they have been smoking.   They have now quit, but would like to know if in fact they test you for smoking when they take these tests (I believe they do)   Any information you can give us will be appreciated. Thank you.


A.  Hello Millie,
Someone who is scheduled for pulmonary function tests (PFTs) should refrain from smoking at least 24 hours prior to the test.  PFTs will likely show evidence that a person has a smoking history due to damage that may have been caused to the lungs.  Not all people will have changes to their testing and it may depend on quantity and length of time smoked. There is no test to see if someone smokes or smoked in the past that would be performed during a PFT.
If you have quit don't be embarrassed-be proud that you have quit and keep up the good work!



Q. Should I be tested for COPD?   

I am 54, living in Vancouver BC.  As a child I almost died from Scarlet Fever and Whopping cough. Then in my 30s I was diagnosed with chronic bronchitis and asthma,  I was not a smoker but I lived with heavy smokers for 35 years.  Now I cannot tolerate any second hand smoke at all, Just a small whiff will cause me to have a sinus infection that will complicate to an respiratory infection and bronchitis and sometime pneumonia.  I also used a lot of toxic cleaners like javex and ammonia for 30 years. My mother has had surgery for lung cancer twice and respiratory illnesses has cased the death of many of my family members on my mother's side for several decades.  Lately I have had dizzy spells weakness, shortness of breath and I wake up in the night choking at times.  Do you think I should get tested for COPD>  As a baby the doctors told my parents to let me live m=with my aunt because my lungs were too sensitive to the wood store that heated the house.

AHello Phyllis,
Your childhood illnesses and exposure to second-hand smoke can definitely put you at risk for COPD.  Since you have been diagnosed with asthma at some point you have likely done spirometry (a pulmonary function/breathing test).  In order to be diagnosed with COPD spirometry is needed.  Depending on the results of this breathing test and your personal history a diagnosis of COPD may be made.  You can speak to your family physician about this test and if he/she feels it is warranted.  Spirometry is available at most hospitals (sometimes in a pulmonary function lab or respiratory therapy department) and is becoming more common in clinics since the importance of spirometry in early detection of COPD is becoming more widely known.

If you are diagnosed with COPD there may be respiratory medications that you may benefit from as well as educational opportunities for you in your area that may help with management of the disease and its symptoms.




Q. Oxygen & Humidity     

Hi,My name is Peter and I have C O P D. I am on oxygen 24/7 and I would like to ask you if adding humidity to the oxygen helps? I understand bacteria is the main concern when using the humidith bottles. The humidity in my home runs about 38 to 40 percent in winter. I am on a high flow rate and it dries my nose out bad even using the saline 8 LPM at rest and 15 LPM during activities. But I do well just keeping it on 11LPM during the day and 8 at night. When sleeping I have a 97 sat and 62 heart rate. I also have lung cancer but it was caught early and radiation did the trick for now over a year. Would it be better to buy a room humidifier and keep the humidity around 50 percent? Thank you for any help you can give me.

Please Note:  Clarification was necessary from Peter before Tracy could respond.  See below for additional information.

Thank you for the reply Tracy. I use a cannula for
delivery of the oxygen and it is liquid oxygen three big tanks. I had a exacerbation back
in September I was in the hospital eleven days,it set me back on breathing and I have
never got it back. I have had concentrators that go up to 10 L/M, but I think you get
more I mean percentage of oxygen with the liquid tanks. I meant the nasal saline spray
helps with the dryness in my nose, Ocean brand makes a gel now and it really helps. I
have a water bottle on my main air line to help add some humidity to the air. It helps
but I have heard you have to watch out for bacteria and keep it clean. I clean it
everyday with warm water and soap and rinse it really well. They say a perfect humidity
for a home is 45 percent and like I said mine runs about 35 to 40, depends on the day. Do
you think I should stick with the bottles and do you think they are safe, you know about
bacteria and C O P D or should I purchase a humidifier. I use just a plane soap to clean
the bottle not a antibacterial kind is that right to use?  My settings are 8 L/M at rest
and 15 L/M during activities, I have a breathing test in April I hope the L/M comes down.
Thank You !

Best Wishes

A.  Hello Peter,
Thank you for your questions!  I am not that familiar with high flows of oxygen such as you receive but I will try answer as best I can. 

Since you are cleaning your humidity bottle daily I think that this is adequate to decrease any risk of bacteria.  Hopefully you are using distilled water as this is usually recommended for humidity bottles used with oxygen concentrators.  Distilled water can be purchased at the grocery store or pharmacy.

You are using a nasal gel and this should be giving you the most relief for your dry nose so definitely continue with this (assuming that it is not petroleum-based since this would not be recommended for use with oxygen).

If your home is humidified with an air-exchanger you can check with the manufacturer to see what their recommendation for cleaning and maintaining a clean system to reduce the likelihood of bacteria growth.  If your home does not have an air exchanger then you may benefit from purchasing a humidifier to help with your dryness but you should definitely investigate with the company the potential for bacteria growth and their recommendations for cleaning prior to purchasing a product.  The home care company that provides your home oxygen may also be able to give you some suggestions for equipment available in your area or if they feel this would be worthwhile to pursue.  Your local lung association may be helpful in this area as well if you want to talk to them about what may be recommended in your area.

I am sorry that I do not have more experience in this area but I hope that this is helpful.




Q. Smells/Cooking Odours    

I cannot stand cooking odors.  They seem to choke me even if I hide in the bedroom.



A.  Hello Jim, 

Many people with COPD are sensitive to odors for example: perfumes, pollution, cleaning products, etc.  Since you have problems with cooking odors my suggestion would be to avoid being in the kitchen as you currently do or even go outside (if possible), keep a window open while cooking is taking place to let some of the odors vent and keep the fan on over the stove to help with ventilation.   

You can also take some of your as needed ‘rescue’ inhaler medication (i.e. salbutamol) prior to cooking or being exposed to odors which may help your breathing from worsening during these times.




Q. Low 02 & Cognitive Impairment  

Can low 02 Sats cause confusion or cognitive impairment?  A relative with COPD and CHF has frequent episodes where his sats drop to the low 70's even while on 3L of 02 - 24/7.  The concern of the family is that this person is still driving and we are worried about a possible mishap and wondering if this situation should be reported to the DR.  Any information would be greatly appreciated.

A.  Hello Emerald,

Low oxygen levels can cause confusion, disorientation and sleepiness along with many other symptoms.  The concern that you and your family have regarding your relative’s driving is definitely justified.  This should be discussed with his family physician and /or respirologist to see what options are available.  If his SpO2 readings are accurate and dropping to the 70s a higher home oxygen prescription during activity may be needed to avoid these drops.  A review of his current respiratory and cardiac medications may also be warranted to ensure that he is receiving all necessary medications for his diseases given that his oxygen drops so severely at times.

Good luck,




Q.  On Oxygen Flow Increase

Hi Tracy:
I know that I am not supposed to change the flow of oxygen without the DR's orders, but when the saturation drops to the low eighties while asleep, the only way I can recover is by increasing the LPM on the concentrator.  By the way, my subscription reads 4LPM at rest and 10 LPM when active. 

I would like to have your advise regarding low saturation readings on the oximeter and increasing the oxygen LPM, as required to keep the saturation between 90-91.

Thank you

Additional information received from Paul....

I really meant when I wake up in the middle of my sleep. 
I really have a problem with my oxygen saturation, example, I could be sitting down
reading quietly, and my sats read 91 on the oximeter, but when I simply stand up, they
drop to the low eighties, and when I start walking, they continue to drop to the
seventies.  Thanks for any advice you may give me.  By the way, my Pulmol dr. authorized me
to increase the concentrator to 10LPM when active.

A.  Hello Paul,
I would suggest that you follow your physician's prescription for using a higher flow of oxygen with exercise.  If he/she has written up to 10lpm with exercise; i.e. walking around your home, etc.  then I would suggest that you start to increase the flow shortly before you are going to ambulate.  This may prevent your saturations from dropping quite low.  Each person with lung disease and home oxygen has their own individual requirements for exercise so I cannot give you an exact flow level to maintain saturations at 90-91%. 

 A walk test can be conducted with your respirologist and this may be able to help with more precise flow ranges for your activity.  Keep in mind as well that some days are better or worse than others and that may also affect how your breathing is doing and your oxygen requirements. I would suggest that you try to become very aware of your actual symptoms of breathlessness and not rely on the oximeter so much. 

Most people do not have an oximeter in their home as you do.  An oximeter is medical equipment and should only be used (in my opinion) by a health professional. I say this because there are several factors that can affect readings, circulation, cold fingers, other factors in the blood, finger movement, etc. Readings also need to be checked to ensure that the heart rate being measured on the oximeter is the actual heart rate that the person has; this needs to be checked each time it is used.  Otherwise, the readings may not be accurate. That being said-if you have an oximeter it is likely that your physician instructed you to get this for a valid reason.

I hope that I helped answer your question Paul,




Q. Uncomfortable Bra    

Why  is wearing a bra so uncomfortable even though the size is correct?


A. Hi Helen,

It is possible that your lungs are hyperinflated (a larger than normal volume of air in your lungs due to lung damage associated with COPD/emphysema).  The restriction from your bra may make is more difficult/uncomfortable for you to take a deep breath.  You can try to wear a looser exercise bra or none at all.  There are tight fitting tank tops that can be used instead of a bra that may help you feel more comfortable. Some exercise tops have a built-in shelf bra that may benefit you as well since they are not usually as tight as a regular bra but still gives some support.




Q. Prognosis of longevity 

My father is 65 yrs old, has :
1.Advanced COPD( 7 yrs now)
2. Obesity ( 310 lbs)
3. Bad heart( Pacemaker/Defribulator since 2007)
4.Sleep apnea( 7yrs)

We were told by our GP that the longevity on average is 5 yrs.
My question is, is this true?
If it is, is my dad proving the GP wrong?

My dad's recent test results, as of Jan 19,2009 were:
Blood gas-45%
Red cell count of 175

Medications are:
O2 all day and on CPAP at night with O2,spiriva,pulmicort,pills for diabetes,heart rate,blood pressure,water retention.
Can you please give me info on the longevity of  COPD patients, I am sure that I'm not the only person wanting to know this and please don't tell me to ask the GP. Its just that we the family need and want to know, how much
time we have left. We are all not nearby.


AHello Sue,
COPD is a progressive, disabling disease that not only affects the lungs but also other organs of the body.  The rate of progression varies from person to person and there is no clear answer to your question.  

Since you say that your  father is obese he would likely benefit from weight loss (with a physician's approval) which may make his breathing less difficult along with many other positive benefits on his heart and sleep apnea.

I am sure that your father's physician gave the best estimate that he/she could do given the details that you have listed above.  When you take into account heart problems, sleep apnea, obesity and COPD this is not likely an easy estimate to make 100% accurately.

I am not a physician and there is not way that I can comment on your father's longevity; as a respiratory therapist I can comment on what my education and background permit but to do otherwise would be negligent on my part.





Q.  Oxygen & Nasal Irritation    

Hello Ms. Tracy,

My husband just been discharged from hospital yesterday and ordered to be on Oxygen 24hours a day at 4L. He does not follow it instead he lowered it to 3L and not use it most of the time. He complains that his nostrils get irritated and blood comes out. What shall I do? He has COPD.Thank you.


A.  Hello Ruth,

The constant flow of oxygen through your husband's nose is likely the cause of the nasal irritation and blood.  You can ask your home oxygen provider to set up a humidifier that will attach to the outlet of the oxygen concentrator.  This can provide some increased humidity and should help with the dryness. 

You can also ask your provider if they have or recommend a nasal gel that your husband can use (some companies provide this as part of their service).  Any gel or cream used in his nose cannot be petroleum (oil) based since oxygen supports combustion and can be a hazard.

Please remind your husband that oxygen is a drug and the if the prescription should not be altered unless ordered by your physician. Your home oxygen provider should be informed of the change from 4 to 3 liters per minute and they can speak to your physician about this issue if your husband continues to change the flow.




Q. Foods to Avoid?  

Hi Tracy,

My Mom suffers from COPD as well as having had 2/3 of one lung removed due to cancer approx 25 years ago.  She sometimes mentions that she thinks eating certain foods makes her breathing more difficult. Although she has not tracked this so we can pinpoint what she should stay away from, is there any evidence to suggest that there may be some foods that can adversely affect this condition and should be avoided? 
I appreciate your response.  Thank you!


A  .Hello Robin,
As far as I know there are no "specific foods"  to avoid for those diagnosed with COPD.  Triggers for COPD symptoms usually include some or all of the following:
indoor/outdoor pollutants (cigarette smoke, cleaning products, air pollution, gas fumes), emotions (anger, anxiety, stress), changes in temperature (hot or cold, wind, humidity) and respiratory infections.

Triggers that involve food are usually associated with asthma so it may be worthwhile for your mother to speak to her physician about this. In the meantime, I would suggest that your mother keep a food diary for a period of time and keep track of when she notices difficulty in her breathing and bring this info to her physician to discuss.


Note:  Many people with COPD have "temporary " problems  with breathing on an individual basis  (non-exacerbation ) with certain "types of food"    Here are a few you may want to check



Q. Rehab Exercises at Home?    

 Hi,  I was diagnosed with emphysema caused by domestic chemicals 12 years ago I went to the hospital for two weeks my peak flow at best was 68 but with the medication & treatment I received I seemed to bounce right back to my old self. About 9 years ago I was attending a Rehabilitation course & going to the gym, then for some reason the Emphysema started to kick back hard & 4 years ago I couldn't do the 6 minute walk test at the hospital they gave me a C T scan & found I've got an abdominal Aorta aneurysm & told me I would be unfit for surgery & I have emphysema & nothing can be done so  go home & make the most of the time you have left .My question  is I am now housebound , so are there home rehabilitation exercises I can do  to improve my mobility. On a bad day I can walk 2 or 3 meters on a good day I could make 10 or 11 meters with a lot SOB can I fight my way back .? My medication is a nebulae for Ventolin 2.5mg & Ventolin inhaler as a back up Symbicort 200/6 Oxygen 2 lt at night & when required in the day.


A.  Hello Ernie,

Do you know if there is either a cardiac or pulmonary rehabilitation program in your community? Due to your emphysema and cardiac problems a supervised exercise program would likely be the safest for you.  If you currently see respirologist ask him/her is there is a program that you can be referred to (if they feel it is appropriate given your medical history).

If there is no program in your community ask your respirologist or family physician if there is there is a physiotherapist who specializes in these areas that you can be referred to for support.

Also, you may benefit from a long acting anti-cholinergic medication such as Spiriva in addition to your current medications. 

Good luck and happy holidays!




Q. Oxygen Usage vs Non Usage     

"  ..... In the home care environment most improvement has been seen when long term supplemental oxygen is worn for 24 hours per day.  ,,,,"
This from your answer to a question last week.
So its fair for me to conclude that I should NOT remove my O2.
I'm in the habit of setting my portable supply at 'conserve' putting my cannula over my neck and behaving normally.
Only when diaphragm breathing will not restore my breathing will I revert to using my portable supply.
Also at home I remove my O2 for many reasons, like working in the kitchen.
Please correct my error(s).

A.  Hello Deets,
Many people who wear long term oxygen therapy have different requirements for how long during the day/night they use their oxygen.  As long as your prescribing physician is aware of how you are using the oxygen and he/she feels that this is appropriate for you-then you should continue as you are currently doing. You can also check with your home care company (who will have a written prescription for your oxygen usage from your physician) or your physician to ensure that you are wearing it as prescribed.




Q:  Coughing up Yellow Mucus for Months     

I am 68 and haven't smoked for over 40 years. I am on Advair, Singulair, Salbutomal (ventolin) and, lately Symbicort. My problem is the massive amounts of yellow phlegm that is coughed up. My doctor says there's nothing more he can give me and that is all part of being asthmatic. He is reluctant to give me antibiotic although I find it does work. I get the flu shot every year. I have had this latest bout of coughing up phlegm since Sept. (Embarrassing in public!)
Can you shed some light on this problem?
(Good article in today's Chronicle-Herald!)

Note to the Reader:     The Article Ken is referring to can be found at



A .Hi Ken,

You say that you have a diagnosis of asthma, not COPD but I am also and asthma educator so I will try to answer your question.

Your medications of Singulair and Salbutamol are both appropriate for asthma depending on the severity of your symptoms. Either Advair OR Symbicort are also indicated but not both (they are both combinations of 2 medications that have similar properties but are made by different pharmaceutical companies). I do not know of any instance of when people should be prescribed both Advair AND Symbicort.  A person may respond to one of these medications better than the other but that usually means that switch from one to the other only.

The symptom of large amounts of yellow sputum (since September!) is not usual for asthma and would indicate that you have an infection that requires antibiotics.  You have not said why your family doctor would prefer not to prescribe antibiotics for you but from what you have told this would be the indicated treatment.  Antibiotics are not usually a common treatment for asthma although if someone with COPD had a change in color (usually to yellow or green), thickness and/or amount of sputum along with an increase in breathlessness-an antibiotic would usually be indicated. I hope that this helps you out!

Getting your flu shot was a good thing Ken!





Q.  Loss of Voice & Hoarseness   

My husband was recently diagnosed with COPD.  We are still in the learning mode of this disease.
He had a gastroscopy Oct. 1st and at that time his voice was fine.  A few days after, his voice started to go very hoarse to the point he could only whisper.  He's been seen by an ear, nose and throat specialist who says he never has seen this before.  He saw blood clots on each side of the throat.  All  5 doctors have said his voice will return.  It barely did (very faintly) for a couple of days and again went to a bare whisper.  Originally he was coughing up a lot of phlegm.  However, the past 3 days he has not.  His cough sounds very dry (even though I have him drinking a lot of water to try and keep his throat moist).
I have read about hoarseness but not totally losing your voice.
Is this (and the blood clots) anything you've heard of before?


A. Hello Lynne,

Unfortunately, I have not heard of the blood clots you mention causing hoarseness or loss of voice with your husband.  You did not mention what (if any) medications he may have recently been described for his COPD but it is possible that these may be a factor.  Some medications prescribed can cause hoarseness although I have not heard of them causing loss of voice all together.  If you husband is prescribed medications make sure that he rinses/gargles well after taking them and hopefully this may help the problem. Discuss the loss of voice with the physician who prescribed his medications to see if this may be a factor in the problem.

Good luck!


Q.  Taking Spiriva & Atrovent At the Same Time   

Hi Tracy, I just read the answer you gave someone regarding Spiriva and other meds.  You say Spiriva and Atrovent should not be taken at the same time.  I have been taking Spiriva and Atrovent (4 puffs every 4 hrs.) for over a year.  This has caused comments and a look of surprise and other doctors and respiratory therapists at my rehab. but no-one has ever told me why.  When I tried to cut back on the Atrovent to 2 puffs every 4 hrs. my O2 levels went down.  I don't get to see the specialist who prescribed this very often - every 4 or 6 months only so don't know what I should do about it.  Please advise.  Thank you


A. Hello Heidi,

As I have noted before about Spiriva there are no indications to take both Atrovent and Spiriva and I cannot say why you would be prescribed both by a specialist.  Please discuss this during your next appointment with your family doctor and prescribing specialist. I cannot suggest changes in your treatment plan, only inform you of what is used according to Canadian COPD guidelines.  

I do not see a correlation between decreasing your Atrovent and your oxygen levels (you are taking the maximum dose of this type of medication by taking 1 inhalation of Spiriva; adjusting the Atrovent dose should have no affect on your breathing).  My assumption is that there may be something else that may be affecting your oxygen levels and this should be discussed with a health care professional to try to determine the cause.




Q.  Can A Person Take Spiriva With Other Meds?   

When Spiriva first came out I tried it 2-3
times but I always seemed to get SOB early afternoon . I took
Spiriva in the morning as the GP suggested. I was also told to
take it once a day only and that I should not take any other
medication with it. Because I was SOB early PM I
stopped using it . Everybody I know who is using it think
it is great!!  I have been hearing and reading that it is now
permissible to use other medication such as Atrovent while
using Spiriva. If this is so I would give it a try again.

Your comments, please !??

A. Hello Ken,

For someone with COPD 1 inhalation of Spiriva
(tiotropium) is meant to replace 12-16 puffs of Atrovent
(ipratropium bromide).  Spiriva and Atrovent are a similar
type of medication but Spiriva lasts 24 hours, whereas
Atrovent lasts only 4-6 hours. Sprirva is usually prescribed
to be taken first thing in the morning.

If you are on Spiriva you should not be prescribed
Atrovent and vice versa.  Some people who switch to Spiriva
notice an improvement in their breathing but this may not
apply to everyone as with any medication.

 There are other medications that can be taken with
 Spiriva that your physician can prescribe depending on your
 breathing tests and how breathless you feel.  These are
 different types of medications from Spiriva/Atrovent and may
 be able to improve your breathlessness.  You can speak to
 your physician about whether or not another long-acting
 medication salmeterol (Serevent) or fomoterol (Oxeze) may be
 indicated. Some people may also benefit from taking an
 inhaled steroid medication in combination with either of
 these 2 medications (Advair or Symbicort). If you are not prescribed a short
 acting medication such as salbutamol (Ventolin) this would
 likely be of benefit as well for you to use as needed during
 the day/night for breathlessness.

The medications that I have noted are part of
standardized medication guidelines for physicians to treat
those with COPD (in Canada) but are not necessarily
appropriate for every person with COPD.


Q.  COPD Patients decondition Quicker. Why?  

Hi Tracy. Could you tell me why Copd patients decondition so very quickly if sick for a while, or they miss their exercise programs? In healthy people they seem to bounce back much more quickly then we do. Last year i had influenza "A", and it took me months of very hard work just to get back to where I was before i got sick, and I was only laid up for 2 weeks. Any thoughts??? Thanks Philip

A.  Hello Philip,
The variables with COPD are different for everyone so although you may take a longer time to recover from an infection I can't say 100% that this is true for everyone.  Because your muscles have been deconditioned in the past and your lungs do not work as effectively as those with healthy lungs-you are not likely getting as much oxygen to your muscles as your muscles need.  Oxygen is necessary for our muscles to work and if they do not get enough they may not be as effective as you would like.  For those with healthy lungs they are likely getting all of the oxygen that the body needs and this may get them back to their 'normal' faster after a setback.
The added time that it tales you to get back to your normal must be frustrating but I commend you for working hard to keep at your exercise regime!  Every time you work your muscles you are really helping your entire body and this is will help you in all of your daily activities!
Keep up the good work,


Q.  What does an ERV percentage of 34 indicate?  

A. Hi Erin;

The ERV (expiratory reserve volume) is the amount of air that a person can exhale after exhaling normally; breathe out normally and then try to push out as much more air as possible, the 'extra' air that you exhale is the ERV.  A normal value is approximately 1 litre. 
Your entire Pulmonary Function Test results would need to be interpreted (by a physician) in order to make a comment on the 34% ERV.   The % is determined using a combination of your test results and comparing them to someone of your age, height and weight.
Q.  Hi Tracy;

I hope you can answer this question for me though it may sound a bit strange.

  When I walk and if I start to cough I ultimately have to stop and catch my breath
before I can continue.  It would seem to me that the intent is to expel the CO2 so
coughing would do that. So how come I get totally out of breath and can't continue right

Thank you, Dahlia

A.  Hi Dahlia,

I think that when you start to walk you are taking deeper breaths-as we all do when we start to exert ourselves.  When we take deeper breaths we may stir up some sputum that is in our lungs.  Sometimes it takes deeper breaths to move sputum around that we may not normally notice if we are not exerting ourselves or taking deeper breaths.  Coughing is our bodies' way to try and expel sputum (or if we swallowed water the wrong way for example) and it takes more energy to cough than usual breathing.  This may be why you have to take some time after coughing before starting to walk again; it takes some time to reduce your breathlessness and get back to where you started.

Any exhaling (either normal exhaling or coughing) will expel CO2 but I do not think that this is what is causing you to cough at all.





Q:  Can Oxygen Be Considered  a Heroic Measure?


Editor's Note:  Due to the complexity of this question, the response is in two parts. The first is from Tracy, the RRT, the second portion is from Chris Wigley; a COPD patient currently on oxygen.



I need advice here. My mother has had COPD for over 5 years and has been
rescued from lung infections over 6 times. She also has congestive heart
failure. She is 86 and in an assisted living apartment. She had another
infection this past week and the ER doctor this time prescribed cortisone,
an antibiotic orally and water pills for the excess water around her heart
and sent her home after 2 hours of her arrival. The problem is she is also
on asthma pumps and hasn't really needed home oxygen. Each time she comes
out of hospital she uses the home oxygen for a short while then when she
starts feeling stronger she ditches the oxygen. Regular testing by the
community health nurse indicates near normal oxygen levels.

This week though she keeps along with the usual cognition difficulties she
keeps pulling off the oxygen. She truly hates it but I know she has rallied
before with it.  She earlier signed a paper that indicated she didn't want
heroic measures. Does fighting with her to keep the oxygen tube on become
heroic measures if the person won't keep it on?

Her assisted living orderlies aren't required to keep checking on her
oxygen. This puts it on my shoulders to keep running by her apartment and

Please advise,

Lynn (the poster's name has been changed for confidentiality reasons)

A secondary "add on" to the above.....


"I understand that you are not DRS. This is more an ethical problem than a
medical. Her sats are only ok this time with the oxygen on. Every time she
takes off the oxygen she drops to 80  but upon reconnecting she jumps to 90
in ten minutes.

Thank you again, Lynn"


A.  From Tracy, the RRT

Hello Lynn,

Your mother seems to have several issues taking place at the same time which make things a little complicated as far as determining the reasons for her treatments that her physician(s) have prescribed; COPD, asthma (?) and congestive heart failure.

Since the ER physician did not prescribe antibiotics for the most recent issue [only a steroid (cortisone) and a diuretic (water pill)] either your mother had a viral infection (which cannot be treated with antibiotics) or she did not actually have an infection. Without knowing more about the details it is difficult to know the reasoning behind the medications. 

I am not clear by what you mean by an asthma pump so I cannot comment on this.

Home oxygen can be prescribed for several reasons, primarily a lower oxygen level on a continuous basis or for some people after they have had a medical problem that needs time to recover and then the oxygen may not be required after that time.  It is possible that you mother only requires the oxygen for periods of time following an infection (exacerbation) or heart problem.  The oxygen was most likely prescribed by her family physician or respirologist so this is the person that can more easily answer your questions.  Since oxygen is considered a drug and requires a prescription before if it administered-there should be clear guidelines for its use for your mother. If there is a home care company that looks after the equipment they may also be able to guide you further although this may be through the assisted living facility that you mother lives in.


Since your mother's oxygen level drops to the 80s without the oxygen she most likely requires the oxygen on a continuous basis.  You should definitely speak with her family doctor (or prescribing physician) to discuss how the issue of her removing the oxygen should be handled.  Since you have no one at her bedside on a continuous basis perhaps she will require one-on-one care to look after this issue.

It has been my experience that oxygen is not considered a heroic measure in the hospital setting; heroic measures usually involve CPR. defibrillation, ventilator assisted breathing and certain medications to try and start the heart again during a cardiac arrest.  The definition of heroic may vary from person to person and often times there are very specific parameters written down for a specific person. The paper your mother signed before should have more details as to what is considered heroic measures.  Perhaps you can ask to see this paper and this may help you out.

I hope that I have given you a little guidance in this complicated matter.



A. To Lynn From C. Wigley, COPD Patient & Oxygen User


To me there are two different problems here.
The first, and maybe the most important, is the "ethical/emotional" problem.
To put it bluntly - maybe her mother no longer desires to keep on living and
certainly not by doing things that make her life MORE miserable. This is a
very hard thing for any child to accept, especially for a loving daughter
who does not want to let go. I was in this position when my 84 year old
father (who was a doctor) had pneumonia after years of living with
unremitting pain. One of the last things he said to me referred to
"Pneumonia - the "old man's friend."  Nobody should interfere
with another's wishes in this area (I am not talking about acute and curable
depression here!).

So it boils down to this. If using the oxygen can be made comfortable enough
that it makes life better for her mother then it is good. Unfortunately, all
too often people are given only "basic" equipment. To go thought life with a
fifty foot leash tying you to a noisy machine making your room hot, where
every time you turn around you trip on the leash which tries to rip your
ears off and they are already sore from the leash rubbing on them, and the
leash is stuck up you nose and sticking into the tender bleeding flesh
inside the nose...... 

I could go on, but I am sure you get the point.

The ONLY way to get people to use oxygen all the time is to make it as
comfortable and convenient as possible.
Make sure the cannula is as soft and pliable as possible - I will only use a
"soft hose" cannula any they start to get uncomfortable
after three weeks or so.
Use a short cannula and clip it to clothes so that it doesn't catch on every
doorknob you pass.
Keep the hose so that you don't/can't trip on it.
Have a quiet concentrator and have it in another room, or better yet use
liquid oxygen.
Use a lightweight portable that goes with you.....


........with the right equipment and sensibly handled it can make all the difference in the world between barely existing and being able to go out and about and enjoy life. I have been using oxygen for sleeping and any but the most mild activity for the past five years. I get out and about without really thinking (apart from sensible planning) about the oxygen. I have done a lot of house renovation, and the same for a little houseboat, gone to crowded automobile exhibitions and outdoor sports events and flown cross-country several times, run a local COPD support group (as well as assist a little with COPD Canada Patient Network!). I could have done none of these without the oxygen, but I have taken the trouble to learn about what is available and to use what works well for me.

And lastly there is pulmonary rehab.............

I hope this may be of some help.




Q. Youth & COPD   

Can youth get COPD?



A. Hello Rebecca,

The majority of people who are diagnosed with COPD have a history of smoking and are over 40 years of age.





Q.  Oxygen Saturation/Desaturation When Flying    

Hi Tracy. As you well know an educated consumer is your best customer, but this disease is so different in each person. As an example. I have a lot of asthma with my COPD, and if I get an infection or exacerbation, I seem to be able to bounce back. I have talked with my fellow sufferers, and many who have a larger portion of emphysema, do not bounce back. When ill, I get winded walking up the stairs. Now, I DO NOT GET OUT OF BREATH. Many have said that regardless of their Meds they ALWAYS get short of breath when climbing stairs. I do not need my rescue medication at all now, and I am 2 minutes away on the treadmill from equaling my best time of 35 minutes. Sometimes it is like I have no disease at all. Other times it is very evident. My question is. My 02 saturation at rest is between 94-98, on a consistent basis. I will be flying in Sept, and do not use 02. Based on the numbers I gave you , how much would one De-saturate by flying. Thanks Tracy Philip

A Hello Philip,
I cannot say for sure if you will desaturate during the flight but it is possible that your oxygen will remain the same as your usual due to the pressurization of the cabin. Your saturations are usually 94-98% and this is a fairly normal range while resting. In my experience as a respiratory therapist only those who are usually on supplemental oxygen would require oxygen during a flight.

Be sure to discuss the trip with your physician who will be able to give you more details using your current background and respiratory status.

Have a safe and great trip!




Q./Comment  Nasal Spray & Oxygen Saturation  

Hi Tracy. I just noticed an interesting thing. Because I have asthma
with my COPD, my nose gets plugged. Today it was slightly plugged so I
bought a nasal spray and tried it. Do you know that it improved my 02
saturation by 2-3 points. If I walk up the stairs my saturation is 91.
With the nasal spray it was 93. At rest I am about 94-96. Now I can
reach 98. There seems to be more benefits then just clearing the nose.
Thought I would pass this on to you. Regards Philip

A. Hello Philip,

In my experience as a respiratory therapist I have not heard of nasal
spray improving oxygen saturations.  If your nose was quite congested,
the spray may allow air to more easily enter your nose but I do not know
of any reason that it would improve your oxygen saturation.

I am glad that you are having improvements in your oxygen saturations
and I thank you for the comment!




Q.  How much Ventolin?   

Hello Tracy; I read your column a lot. My wife and I really appreciate it. Many times you've answered stuff we've thought about. Now I have a question.  How much or how safe is ventolin?  Sometimes 2 puffs isn't enough to get me breathing right and I have to take more in the hot weather.  Other than it I only take atrovent every 6 hours.  thank you


A.  Hello Chuck,
I am very happy to hear that you and your wife have gotten some use out of the Q and A section of the site!!
Since people react in different ways to all medications there is no set rule that I can tell you regarding a maximum dose of salbutamol (Ventolin) but I am sure that you and your physician can come up with a plan for times when you feel you are not getting the relief that you need.  It may be helpful for you to have plan of action (see later) for times when your breathing symptoms are not improved with your usual dose of breathing medications. I have been part of helping formulate these action plans with physicians and they vary from patient to patient. Usually, most people would be able to double their usual dose of salbutamol without harm (for a limited period of time) but I have to stress that this should only be done on the advise of your physician.
A plan of action can be used for people with asthma, COPD and other breathing disorders to give clear guidelines as to when to increase doses of medications and how much to take.  It can also help a person to become more aware of their breathing symptoms and to recognize when they may need more than their usual dose of medications along with knowing when to seek outside help from an educator, physician or emergency room team. 
Talk to your physician about formulating a plan of action to help get the best out of your medications when you need them the most!

Editor's Note:  Albuterol • Ventolin • Proventil • Salbutamol (Different names; same medicines)
for additional cross references of  Med Names/Equivalent



Q.  Walking & Oxygen Saturation Levels- How Do I Know? 

Tracy; My FEV 1 is 37% but I get on quite well. I'm not on oxygen and I walk every day almost. Unfortunately I don't own (can't afford) a pulse oximeter. If I'm walking, how can I tell if  my o2 levels are lower than they should be. I want to push myself even if I get winded but I don't know how much or how long is safe. Any suggestions would be appreciated. Marsha

A.  Hello Marsha,
Your question is a good one but also a difficult one to answer for me!  Your respirologist needs to be involved in this discussion since he/she can arrange to do a walking test measuring your oxygen at the same time.  This is best done in a clinic setting where you can be monitored by healthcare staff in case you need assistance. 
That being said-I do not think that it is necessary for most people to have their own oximeter-whether or not they can afford one.  You should be able to notice a change in your breathlessness and breathing rate if you are exerting yourself too much.  If you can start to pay attention (if you don't already) to how you feel doing normal activities (your breathlessness and breathing rate) and then also when you are doing activities which require more exertion.  Once you are familiar about your usual symptoms you can then become more aware of you symptoms when you are exerting yourself (such as walking). This can give you the clues you need to take a rest if you are breathing too fast and have a hard time catching your breath.  I feel that once you become more aware of how you feel it is much more important than looking at the number on the oximeter (although it is also important in many situations) but you may be the best judge of how your are doing!



Q. After medical setbacks, will an FEV1 return to what it was?  

Hi Tracy. I was diagnosed with copd about 8 years ago ( QUIT SMOKING AT SAME TIME), and I have a lot of asthma with my copd. To give you some idea of how much asthma, when I was first diagnosed my FEV1 was 25% of predicted. My second spiromoter test was 38% of predicted and the most up to date test ( 4 Months Ago ), it was 48% of predicted. My question is this. I have had bronchitis since Jan of this year and the cough won't go away. I had no bronchitis for the last 18 month previous. In April, I got influenza A and that was like being hit by a truck,( Another setback , and now in June I got a secondary infection and I am on my last days of levequin. Now with all these infections and illnesses would it be asking to much to get back to where I was before I got all this stuff. I am slowing working my way back on the treadmill, and before I got sick I did my 6 minute walk, and managed 496 meters. I am on singulair now and it seems to make a big difference. Your thoughts. Thanks Philip.

A.  Hello Philip,
For people that have COPD alone, sometimes frequent exacerbations (worsening of usual symptoms) can prevent a return to the usual 'normal'.  Since you have an asthmatic component as well as COPD you may have improvement that is not normally seen in COPD alone; you may be able to get back to where you were before January.  Singulair is a treatment for asthma -not COPD- and may help with improving your lung function and in turn help improve your symptoms. 
Getting back on the treadmill (assuming your physician has OK'ed this) is a great way to start strengthening your muscles again after (what sounds like) a rough few months.  Congratulations on the 8 years of being smoke-free and getting back to exercise-each very difficult in their own right!



Q.  Improvement in Lung Function  

I've had COPD for many years and have been in an exercise program at our hospital for one year.  I also exercise at home.  My lung function is  FEV o.34.  Can that improve with more time and exercise ?  I must admit I only quit smoking 4 months ago - this time for good.Heidi

A. Hello Heidi,
Depending on the severity of lung impairment there are recommendations for medications that may be prescribed by a physician for COPD.  Assuming that you are already receiving these medications it is unlikely that your lung function will improve. With an FEV1 of 34% recommendations include; a short acting bronchodilator [such as salbutamol (Ventolin)], long acting bronchodilators [salmeterol (Serevent)], long acting anticholinergic [tiotropium (Spiriva)], and perhaps inhaled steroids [fluticasone [Flovent]).  Some of these medications are in combination therapy and I have mentioned them.  
Exercising can help reduce breathlessness and improve quality of life.  For these reasons (and many more!) exercising is a great thing (even though your lung function will not likely improve because of it).
Quitting smoking, however, is the BEST thing that you have done to slow down the progression of COPD. Congratulations on quitting smoking AND exercising-both very positive things you are doing for yourself!



Q. Swimming Pools & Chlorine    

 Is the chlorine used in indoor swimming pools; where the smell can be
more concentrated and strong, be  harmful to people with a lung
disorder?   Cleo

A.  Hello Cleo,
  Chlorine exposure can be a possible cause of COPD although the
frequency and level of exposure is not well documented. For those with
lung diseases exposure to chlorine at local swimming pools may irritate
the lungs and cause constriction and other symptoms depending on the
person and their sensitivity to chlorine.  Some people react more
strongly to certain irritants (such as chlorine) than others so they may
not be able to be around pools, etc where others may not be bothered by
them at all.




Q. Qualifying for Home Oxygen 

For oxygen to be prescribed what is the usual sustained number or
level that a person has to be at? Also; how is a person tested for this
to see what their level is during the day and the night?
  Thank You    Gus

A.    Hello Gus,
  Requirements for home oxygen differ from province to province and I
can speak for Nova Scotia only.  In this province a person must have 2
blood tests done at least a day apart (arterial blood gases).  The
oxygen level must be below 55 mmHG while at rest in these tests in order
to be qualified for funding for home oxygen.  Most testing for home
oxygen is done by the arterial blood gas but certain situations require a
less invasive measurement (the oximeter)

  People who have a lower level of oxygen while exerting themselves may
also qualify.  The oxygen measured with the clip on the finger
(oximeter) has to be 80% or lower.  There are oximeters used to test
oxygen levels at night (the same clip on your finger).  These tests can
be ordered by a physician if warranted.





Q.   How long can a person be on a ventilator   


before they can't come off.  My mom has been intubated (through the throat) for 4 weeks now.  She has severe COPD and she developed pneumonia. She's now getting better but she can only t piece (sp?) for 4 or 5 minutes at a time.

Thank You, Fisk


A. Hello Fisk -thank you for the question! 

I will give some background information for those who are not familiar with some of the terms that you have used:
Intubation with an endotracheal tube (a plastic tube that goes from the mouth down into the throat and then into the lungs) is sometimes performed on people that cannot breathe effectively on their own.  The endotracheal tube can then be connected to a breathing machine (ventilator) to assist with breathing.  Once someone has been on a ventilator for ~ 7 days-2 weeks (depending on the circumstances) usually a tracheostomy tube (a plastic tube that is inserted through an incision made in the neck) is put in place.  A tracheostomy tube is much more comfortable since it avoids being in a person's mouth and can allow proper mouth care and in some circumstances allow a person to take some liquids or food. The tracheostomy tube can also be connected to a breathing machine if a person requires assistance with their breathing.   
It is much easier for a person to breathe on their own through a tracheostomy tube than through an endotracheal tube due to its size and length.  Picture trying to breathe through a long skinny straw (endotracheal tube) versus breathing through a short fat straw (tracheostomy tube).  The short fat straw is much easier to breathe through. 
If your mom is on a t-piece ( a piece of equipment used to deliver extra oxygen to someone with a breathing tube in place) for short periods of time it means that she is able to do all the work of breathing on her own for 4-5 minutes at a time.  I assume that she is then resting on the breathing machine in between these 4-5 minute periods. Since every person and disease process is different I am not able to give you a definitive answer to your question.  Most people gradually get stronger and can then breathe for longer periods of time on their own until they can then resume all of the work on their own.  This can be a short time for some and a much longer time for others; weeks to months.  Some people can receive assistance from the breathing machine for indefinite periods of time.  Since the period of time on a breathing machine varies so much you should speak to your mother's physician to see what he/she thinks is the short and long term plan for your mother.
I hope that this helps!  Good luck!



Q.  COPD & Exercise 

Hi Tracy - nice to see you back. My question I have uncomplicated COPD -moderate stage. How hard should I push when it comes to exercising? Also; does the same scale apply when it comes to walk for me as it does for healthy people. The one that goes 220, minus your age, times 70 or 80% - is your targeted heart rate. Thank You. 



A.  Hello Heather,

Unfortunately, I cannot advise you on your exercise regime due to safety reasons.  Any exercise regime should be done in consultation with your family physician or respirologist.




Q.  What does an RRT do?   

I've only ever been and treated for COPD by my family Dr.  He has me on ventolin and atrovent.  Please don't laugh when I ask this but what does a RRT actually do?  I've seen and read others talking about respiratory thereapists but what is it they do?

A.   A Registered Respiratory Therapist (RRT) is a health care professional that assists physicians with the diagnosis and treatment of lung disorders.  Respiratory Therapists primarily work in the hospital setting but there are many areas outside of the hospital where you can find us as well!  We work with neonatal, pediatric and adult populations.
In the hospital, we work in the intensive care units where we manage ventilators (breathing machines, sometimes called respirators on tv) and work as part of a team to treat and support patients.  We also work in the emergency rooms, general nursing units, etc. where we administer oxygen, bronchodilators and many other respiratory treatments. We are also part of the cardiac arrest and trauma teams.
RRTs can be COPD and asthma educators, anesthesia assistants in the operating room, pulmonary function technicians, sales reps, home care therapists, sleep laboratory technicians and the list goes on and on!
There are some variances of our role between each hospital and also between Canada and the US.
I hope that this gives you an idea of the role of the RRT! 



Q:  How to Use a Spacer Properly

I  saw this question on one of the forums. I don't know if anyone has asked it of you yet but in case they haven't.

A lady had said that if you use a spacer when taking your puffers, she had been told (when she took her PFt tests ) that you're suppose to put the mouthpiece in your mouth further than your lips so that your teeth are on it.

I use an aero chamber myself but have only put it inside my lips.

Which method is the right way?   Thank you,  Lynn

A.  Hello Lynn,
I instruct people to make sure that their lips are fully and tightly around the mouthpiece only, I do not ask people to make sure that their teeth are on the mouthpiece but this does not seem to be an incorrect technique.  This method will ensure that someone does not clench their teeth (clenching would obstruct the flow of air and medication going to their lungs).
I think that either technique will work fine! 
Here is a recap of proper technique:
1) shake the inhaler well before use
2) place inhaler in chamber/spacer device
3) put mouthpiece in mouth
4) depress inhaler
5) take a slow deep breath in
6) try to hold your breath for up to 10 seconds
7) breathe out normally
If a whistling sound is heard, the breath was taken in too quickly; take a slower breath in for future puffs.
For additional puffs repeat steps 1-7.



Q. If no change after Ventolin on Spiro test, will it still work as an Rescue Puffer 

Hi Tracy;
I've never had to use my emergency puffer for my copd,  I guess my meds are working great!  I don't have any asthma with it and my spirometry test showed that the ventolin doesn't make much difference in my test numbers.  My Question....does that mean the ventolin won't do me any good if I'm ever in a situation when I can't breathe? Thanks, Angie

A. Hi Angie,

If you have trouble breathing and decide to take your ventolin (as
prescribed by your physician) you may feel relief of breathlessness even though this may not always coincide with improvements with spirometry.  The improvement in symptoms is what counts!




Q.  Reversible Component w/o Asthma?

Hi Tracy;  In the absence of asthma for a person with COPD, and they say there's a certain percentage of a reversible component; how can that be?

Thank You, Lou

A.  Dear Lou,
Even in the absence of asthma, some people with COPD may have reversibility in their spirometry.  There are hypotheses as to why this may take place but I believe that this is not completely understood at this time.




Q.  CO2 Retention

Hello Tracy. My question is about CO2 retention. Many people I've talked to with emphysema retain CO2 but so far that hasn't been a big problem for me yet. Do or will all emphysema sufferers suffer from this to the point of being severe? Thank You


A.   Hello Todd,

Not all people with emphysema and/or COPD have CO2 retention.  Oftentimes, the CO2 levels remain normal until advancement of the disease when it may become elevated. During an exacerbation (increase in symptoms which may be seen with pneumonia, etc.) CO2 levels may temporarily increase but return to previous levels once the exacerbation has been treated.




Q.  Will lung function decrease if on Oxygen

Hi Tracy,
I have been put on 02 supplementation for exertion and sleep; but I don't need it if I'm just watching TV or getting up to make a cup of tea etc. However, I'm concerned in that I've noticed my sats when not on 02 don't seem to be rising back to my normal 95. Admittedly, I do not feel out of breath and breathing somehow seems easier but I had understood that using 02 would not change my overall lung function. I have heard tales of "lazy breathing" etc but they said they were disproven. It is great that I can now get 02 for exercise only here in Ontario and it does feel great when I use it but I am worried that my overall function will decrease and I will find myself on it 24/7 before I would have. Please send me your advice. Many thanks.


A.  Dear Shelley;

I have not heard specifically of 'lazy breathing' so I cannot comment on it. I can say that I have never known of home oxygen use adversely affecting lung function.  Clinical studies show that long term use of oxygen can increase survival rates for some people with COPD when prescribed for long periods of time throughout the day and night. 
It is possible that your overall lung function may be changing slightly and this may explain your decreased oxygen saturation.   Keep in mind also that oxygen saturations can vary depending on your activity, movement of the finger probe, circulation of the finger being used (i.e. cold fingers do not always pick up an appropriate reading), etc.
Since you say that you are feeling less short of breath this seems to be a very positive result of your home oxygen use.  If it enables you to do more daily activities then you will likely become physically stronger and this can help improve your quality of life.  Try to focus more on how you feel (unless indicated by your physician) and less on what the numbers say-you are a very good indicator of how you feel!  From my hospital experiences-sometimes we see people with high numbers who feel terrible and some people have low numbers and feel great!  It can be all relative to how you feel yourself.
I hope that this helps Shelley,



Q. Not Acknowledging Seriousness of the Disease & Still Smoking  

My husband, who is only 37, was diagnosed with COPD in August 2005.  He is a smoker and has tried to quit many times since being diagnosed, however he always starts again.  Lately he is waking up with serious coughing fits in the middle of the night or will come to a sitting position and seems to be choking....this scares me to death....he seems to be numb to this fact.  How can I make him understand the seriousness of his disease?  Are there any pictures or stories that I can obtain to show him in black and white that he needs to stop smoking??

A.  Dear Jennifer,

Your husband may be waking up coughing due to phlegm that he would normally clear (if awake).  This phlegm may be irritating his breathing such that he needs to cough at night to try and clear it.  Perhaps using a second pillow may help with this to elevate his head and try to avoid the coughing/choking. 

Since your husband has tried to quit many times in the past it shows
that he does know that it would be in his best interest to do so but it
is a very difficult thing to do for many people.  Has he tried a smoking cessation program (sometimes given through the Lung Association or Heart and Stroke)?  He may benefit from using some of the gums, medictions,etc. that are on the market these days to help with the cravings.  This is something that he can speak with his family doctor about-to see what options are locally available to him.

I should point out too that for a lot of people quitting does not happen the first time but after several attempts it can just work. So, your husband is not on his own in this regard and should be commended for trying in the past and encouraged to try again when he is ready.  If he is not mentally ready to quit he may not be successful-this takes time and hopefully some of the following information will help.

If you go to the Heart and Stroke Foundation website; (search 'smoking' and you will find many articles that have facts about the damage of smoking to your heart such as "Priceless reasons for quitting smoking" among others) or the Canadian Lung Association website: where there is information on quitting smoking on the home page that will lead you to many information pages.  You can also look under Lung Diseases on the home page and find COPD.  There you will find plenty of information that may help. These are wonderful resources that I think will help you and your husband.

As far as pictures a search on under images will lead you to pictures of smokers lungs but I am not sure if this is what you
want/need.  Please give me a few more details of what you would like (if you don't find them on the above-mentioned sites) and I will try to help you.




Q.  Oxygen Need with  Severe COPD?  Lack of Answers  

I have very severe COPD (last FEV1 33%) and am 52. Yesterday I had my first 6 min walk to see if I need 02. On room air my resting sat was 93 and during the initial walk I desaturated to the low 80s. I was then tested at 1.5, 3 & 4 lpm. At 4 lpm, I was able to do the test without any SOB and my sats stayed at 88 or above. My resting sat still only reached 95%. However, when I returned to my respirologist, he said that 02 can only be prescribed if my resting sat is 88%. I corrected him and told him about 02 supplementation for exercise an sleep and he eventually called the RT to confirm. Now I am waiting for another test that from what I understand will be the same except that ABGs will be drawn. Please explain what is going on? Why do they get 02 in the States for exercise and yet we are restricted or unable. What should I expect from this new test? Isn't 4 lpm high for someone who has never been on 02. I've been diagnosed since 1991. I'm very confused, again scared and feeling left out in the dark. I want to keep going. I am very physical and have kept that up but I'm worried about the strain on my other organs. One thing that he mentioned and I'm not quite sure what he meant, was that on room air only I walked at 69% predicted. I was just terminated from my job for being off ill and am now applying for LTD from my insurance company and CPP. I realize there are a lot of questions here and perhaps you may want to respond to my email only. I have no one else to ask and now my respirologist is being very closed - just wants me to follow his direction but doesn't want to answer questions and there's no use trying to find another doctor here in Ontario. Its impossible to even get a GP these days. Thanks  Shelley

A Hello Shelley,
Each province has its own guidelines for home oxygen prescriptions and coverage of costs.
The US likely has many different guidelines throughout different individual states as well and I cannot speak about why these rules differ throughout.
I have pasted a website for from Ministry of Health in Ontario that may be helpful to you.  There is a toll-free number at the bottom of this website page for you to call with specific questions.  This may be of more benefit to you since I cannot answer specific questions regarding Ontario's home oxygen guidelines.
When I read the website it seems similar to those of NS but are unspecific with the actual details. I can explain to you what happens here in NS and this may be similar to Ontario's and perhaps this can help you understand the process:
Home oxygen can only be prescribed by a Respirologist or other designated physician.  Medical eligibility can be determined when certain criteria are met; oxygen therapy must be required for a minimum of 18 hours per day or must be required during exercise or sleep.
For those with resting hypoxemia (a low blood oxygen level) 2 ABG samples must be drawn over 2 days to confirm a resting oxygen level below 55mmHg in order for medical coverage of costs.
Some people require oxygen during sleep but I will not go into this since it does not seem to me of concern to you.
Some people can be prescribed home oxygen for use during exercise (i.e. basic daily activities at home or outside the home).  Oxygen levels must drop below 80% in order for medical coverage in NS.
Regarding your questions about your walk test: since you state that you have very severe COPD a resting saturation level of 93% seems fine.  This level naturally decreases slightly as we age and with COPD this level may get lower more quickly than others without the disease. Many people with COPD have much lower resting levels than someone with healthy lungs but it all depends on the individual (some people function very well with lower levels and others require a higher level-there are no set rules for this).
You asked about the 4 lpm of oxygen and whether or not it was a high level.  This also depends on how fast you walked, how you were feeling that day (weather, temperature, anxiety, etc) since it is possible that these may affect your walking distance.  I cannot explain the 69%-I do not know what your physical was referring to with this number. If the 4 lpm relieved all of your symptoms this should not matter so much-just the fact that you felt better should be important.
I understand why you are frustrated at not getting the answers that you need from your respirologist and all I can suggest it that you continue to ask him or her to answer your questions or forward you to someone who can answer them for you; perhaps there is a COPD educator in your area that you can speak with who knows this inner workings of Ontario's rules for medical coverage and the prescribing of home oxygen. Also-try the website that I already mentioned and you may be able to get help there and if not ask them where you can go or who you can call in your area.
I hope that this information helps-good luck,



Q.  Headaches & Dizziness with COPD?

I was diagnosed with COPD as well as Asthma a couple of years ago. At that time I was in the process of getting my disability because of complications from multiple surgeries and a left leg amputation. The Dr I was seeing then for my COPD wrote a letter for me and I have a copy of it. He told them that most of my levels predicted for a man my age were below 50%. Now this was about 2 years ago. I had been going to  place called Carolina Allergy and Asthma. This is the Dr that has watched over me for about two years. My Primary Physician finally put me on Oxygen for 24 hours a day due to my oxygen levels dropping upon much of any exertion. He had me put the clip thing on my finger and we walked around the hallways as the nurse walked beside me and watched the meter. It did not take long for my level to drop to 88. Whe it got there, she said that is all we need to qualify you for Oxygen. Iam on Medicare. So I have been on the oxygen since January. I still have periods where I get really lightheaded and feel like I may pass out. I have also started with headaches at times. The last time I went to the allergy Dr. He begged me to get into see a Pulmonary Specialist. So I have to go see him in a few weeks. Do you think my numbers have even gotten worse by him begging me to get to a pulmonary Dr? I got an oximeter, and even on oxygen therapy it shows around 90 most of the time even at rest. Have you heard of the dizziness and headaches like that with the COPD?  I get really scared at times, and I fear one day I will die fighting for every last breath. Do most folks get the dizziness and the headaches with COPD? I HAD A nUCLEAR sTRESS tEST AND THE HEART SEEMS TO BE ALRIGHT FOR NOW.         Don

A   Hello Don,

The symptoms that you speak of-lightheadedness, headaches and the feeling that you may pass out are common for some people with COPD.  If these are new symptoms for you there may be a change in your breathing tests (spirometry) which may be affecting how well you are breathing.  There may also be a change in your oxygen and carbon dioxide levels in your blood.  Your physician can decide whether or not a blood sample may be warranted to check these levels in your blood (arterial blood gas-usually taken from and artery in your wrist) to aid in a diagnosis of these new symptoms. Your physician should also check your blood pressure to see if it is elevated (hypertension) since headaches are common in people with hypertension.



Q, Weather & COPD

My husband (77yrs) has acute COPD. He is on oxygen and takes Oxese and Spiriva which seem to keep him going okay. We have checked with his respirologist and he is not a candidate for lung reduction nor transplant.

He often has very bad breathing days and other days not so bad and even good for him. (like most people with this disease).

question is...does the changes in barometric pressure have anything to do with this.  It seems whenever there is a change in the weather...he feels the affect. Whether cold to warm, sunny to cloudy, still to windy.


A.     Hello Lori,
There are many air quality factors than can affect the breathing symptoms of someone with COPD.  Some of these factors include:indoor and outdoor pollutants and changes in temperature.  
Inside the home, smoke from cigarettes or cigars, household cleaning products, dust and strong odours can adversely affect symptoms. Factors than can affect breathing symptoms outside the home include pollution, fumes, extreme heat or cold, wind or humidity.
If at all possible it may be beneficial for your husband to avoid going outside on days when the weather/air quality may affect him.  This may be difficult to avoid on some days but as you both become more aware of what affects his breathing the most then you can do your best to avoid or reduce his exposure to these factors.
Some suggestions to avoid poor air quality include:
avoid second hand smoke when outside and in restaurants
avoid string odors in your home such as cleaning products, paints, perfumes, etc.
avoid smog by checking the weather/air quality information for the day
Some suggestions to avoid changes in temperature include:
cold air-cover you mouth with a scarf to avoid cold and wind and wear other appropriate clothing
warm air-try to stay in air conditioned areas and wear appropriate clothing and also drink lots of water unless your doctor tells you that you shouldn't. 
Also, avoid strenuous activities on both cold and war days (shoveling, mowing the lawn, etc.)
I hope that this information helps both you and you husband!@
(This information has been taken from the Living Well With COPD educational program: )


Q: Quitting Smoking/Disease Progression

I was diagnosed with mild COPD on april 4th... quit smoking four days later (after having the habit for 25 years)... and wanted to know if what I've been told is true: "that due to the fact that it is in the beginning stages; quitting smoking should stop it from progressing any further"... I should note that whether or not this is true, I still intend to stick with being "smoke free" ... even though going "cold turkey" actually proved physically painful... but, as upset by this news as i have been, I guess I'm looking for any hope that there may be.... despite that bad habit, i had maintained a fairly healthy level of activity for years... so this comes as quite a shock.        Jennifer

A   Hi Jennifer,

Congratulations on quitting the smoking habit!  I am sure that this was a very difficult thing for you to do but it is the best thing that you could have done for your lung (and overall) health!

Smoking cessation is the most effective way to reduce the risk for developing COPD in the first place and it has been proven that this is the only way to stop the progression of COPD.  (This information has been taken from the Canadian Respiratory Society Recommendations for the Management of COPD).



Q. When to Take Meds/Sequence


I have chronic bronchitis and COPD, I take spiriva, salbutamol and advair.  In what sequence should I be taking them and is there a waiting period in between inhalers.

Thank you, Maggie

A.  Hi Maggie,

 You should always start with your salbutamol and wait 30 sec-1 minute between puffs.  If you have the time you can wait 15 minutes after your salbutamol to take your Spiriva but most people are not able to spend that much time taking their medications.  Otherwise, take your spiriva a minute or 2 after the salbutamol.  Your Advair can be taken last, a minute or so after the Spriva.  If you have more than 1 inhalation of Advair-wait 30 sec-1 minute in between each.

I should also mention that if you are using salbutamol and /or Advair as an MDI you should definitely be using a spacing device in order to get optimal distribution of these medications in your lungs! Ask your physician or pharmacist about a spacing device if you do not currently use one.



Q.  Reaction to Meds and Info on Zermaira 

Spiriva and Fordial cause my esophagus to swell. The only thing I have is Albuterol and Pulmicort updrafts.

I have tried  about everything out there. can you help?

(Updrafts are used with an air pump, to use the vials of albuterol and pulmicort in a nebulizer. )

What do you know about Zermaira? used for emphysema.  Thank you Alan

A Hello Alan,

I believe that by ‘updrafts’ you mean aerosolized therapy using an air compressor to deliver your inhaled medications via a facemask. 

Your family doctor has prescribed a short acting (reliever) medication along with a steroid (maintenance) medication for you.  Since you are allergic to certain medications such as Spiriva (maintenance) and Foradil (maintenance) your family doctor is somewhat limited in what can be prescribed for you.

 Zemaira is a new treatment for people who have a hereditary condition which can lead to emphysema, COPD, asthma and other respiratory disorders.  This medication is not for all people with emphysema and COPD.  You should speak to your physician to see if there is a possibility you may benefit from this medication.  A screening blood test is required to see if you have this hereditary condition known as Alpha-1 Antitrypsin Deficiency, or Alpha-1




Q  Exercise AFTER an Infection

Hi Tracy. I have been on a rehab program with Westpark Hospital, and was doing great, and almost ready for discharge. I have copd with a high component of asthma, and I was doing my exercises faithfully until I got a sinus infection that has hung on for the last 2-3 weeks, and I have not exercised due to the illness. Before the illness I was doing 30 minutes treadmill with speed 2.5 and incline 2.5. I was also doing my home exercises. Now that I have been away from the exercises, I feel that I have deconditioned, and it is almost like starting over. How long will it take to get back to where I was before this sinus infection? Also would exercising 3-4 times a week be enough. My thanks, Philip

A:  Hi Philip,
I am certainly no expert when it comes to exercise although I am trying to get better at it myself!  I think that generally, the body will tend to 'remember' your previous exercise from your time at pulmonary rehab. Most likely your body will not take as long for you to get back to where you were exercising before your infection.  So, in some ways it may feel like you are starting over (as it would be for anyone who was exercising and then stopped due to illness) but it shouldn't take you as long to get back on track.  Your rehab group would be able to give you more specifics on what routine would be best for you but if you are unable to access their help I think that you should gradually start to build up to what you were previously doing.  Try not to be hard on yourself since these things take time and since you seem very motivated-you will be rewarded by your effort in the long run!  Great job,




Q  Reducing Air Trapping?

Is there anything a person can work on at home to help reduce the air trapping?  Thank You.  Tim

A  Hi Tim,

 Air trapping is the accumulation of an abnormal amount of gas in the lungs after a person has breathed out (exhalation).  There are a couple of exercises that you can use to try and reduce this amount of air in your lungs.  See the link to the Lung Association website for information on pursed lip breathing and diaphragmatic breathing 

(Note: Added by the Webmistress :   Also here at the COPD Canada site under Breathing Distress)



Q.  Oximeters & Gas Ranges

(Note:  This has been edited by the webmistress of this site)

Tracy, I have a couple of comments on some of your answers, which for the most part I find very good, just a couple of exceptions :

You said " and it (the oximeter) meant to be used by someone trained in using this equipment."

 Currently Dr. Thomas Petty (renowned pulmonologist)  is stressing every patient should have an oximeter.  He has written a booklet and it can be obtained free by patients
or "Titrate when you migrate" Tom speaks

Hi Roxlyn,
As a Respiratory Therapist I have been taught that you need to be trained on any piece of equipment that for medical use.  Only with proper training can the person using the device know if it is working properly and how to use troubleshooting techniques when it is not working properly. Many people without a medical background can certainly be trained in the proper use and function of an oximeter. 
I am not a physician  so I cannot argue with the information from Dr.Petty about everyone using an oximeter.  I can only comment in what I am aware of as common practice in my field.  This may vary across Canada and the US.  Since you are using the term pulmonologist and say that you are from Denver, CO standards and commonalities in practice may vary quite a lot from what I see as current practice here in eastern Canada.

You also mention a patient shouldn't worry about CO2 from a gas range...I am not sure on this except for my personal experience, but

In  Neil Schacter MD book he recommends using gas stove with a window cracked open for fresh air intake.  I poo pood this until last winter we were constantly heating pots of water on our gas range, to add to the dry humidity in Denver CO.  I was having lot s of coughing...and remembered that passage in the book.  We stopped the gas stove being used for heating/humidifying and all discomfort stopped.  The stove is  functioning properly.
 I don't hesitate to get near it to cook...just watch proximity of plastic tubing...but if prolonged stove top cooking...I use exhaust fan on low,  now.
Thanks for your great Q & A site.
to add a PS to my last post on the gas stove and CO2.

 My husband further explained that even a properly adjusted gas stove emits NITROGEN OXIDES which are IRRITANTS and not desirable.

 CO2 if in large quantities (not likely but possible) can be suffocating.
A Roxlyn,
I am not an expert in emissions from stoves, etc and cannot comment further.  I researched my response on the web and with colleagues.  I do not claim to be an expert and am answering to the best of my ability.  Please seek advice from other sites or resources as you feel necessary.



Q:  Lung Function/Which Numbers Are Usually Used

Tracy;I am so darn confused.  Which spirometry number BEST indicates lung function?  I have read so much and talked to so many people about this including my own Dr.; seen stuff recently posted on forums ....Everyone seems to have a different opinion!!!  So which numbers/values is it? I know you're probably going to tell me that it depends upon the individual but if you didn't KNOW the individual ,what would it be?  Is there a standard number or numbers?Thank you; Marsha
A  Hi Marsha,
Physicians will  look at all of the different values when interpreting lung function tests.  I think that if the individual does not already have a diagnosis, the physician interpreting the test looks at all numbers equally.  Certain disease processes have differing higher, lower or normal values depending on the disease.  This may be why you see a variety of opinions.  That being said, the FEV1 and FVC are very important values to be interpreted. 
Yes, there are standard values which are calculated by using the person's height, weight, and age individually.



Q. Bronchial Thermoplasty & Seretide 

Do you think bronchial thermoplasty can help COPD'ers.
Is seretide available in Canada yet and can a prescription be had for this from my physician??
At present I am on Advair and Spiriva.
Thanks Tracy......Barry

A.  Hello Barry,
Bronchial thermoplasty is the use of thermal energy applied to lung walls in an attempt to reduce the amount of muscle in the lungs that may constrict.  Constriction is a component of both asthma and COPD.  The only information that I have been able to find on it has been studies involving people with asthma, not COPD.  I believe that this procedure is still in the initial testing stage for this treatment in North America.
The medication combination of salmeterol/fluticasone is marketed in Europe as Seretide.  The same combination is marketed in North America as Advair.  So, yes, it is available in Canada and you say that you are currently receiving it.



Q. Switching from Albuterol to Xopenex in Nebulizer

Hi Tracy,

I am a 63 y.o. male, I've been on Albuterol for my nebulizer, and I wanted to switch to Xopenex. My pharmacy send the unmixed kind and my question is , can I just use it and not dilute it with anything. I think that's what they did the last time I was hospitalized. What if I added the undiluted Xopenex to the diluted Albuterol ? Would that work? 

Thanks for any info.  Tommy
A Hi Tommy,
Xopenex is not used where I work so I cannot speak about whether or not you can dilute it or not.  You should speak with your local pharmacist about this issue.



Q. Exercising AFTER Rehab

Hi Tracy,
Is there a limit to how far a patient can push themselves AFTER pulmonary rehab...assuming they do not have other serious health issues,  that they do monitor their sats with an oximeter, and that they have worked up to walking 30-60 minutes without stopping to rest?

A.  Hi Roxlyn,

I think that you should follow the program that you used during pulmonary rehabilitation unless you have had specific guidance from your family doctor and / or physiotherapist who you saw in the program.  It may be possible to push your self but you definitely need to get guidance before you change the routine that you were started on.



Q  Exacerbations- Infections & Disease Progression

Hi Tracy
Hope you don't mind but this is like 3 questions.

When you have an exacerbation or flare up is it always due to an infection?  I guess I mean is it possible to have a flare up without having an infection and if so how can I avoid it?  Also do the flare ups get worse (in frequency or severity)as the disease progresses?

Thank you very much , Marcus

A.  Hi Marcus, 

COPD flare-ups (exacerbations) are most commonly caused by an infection in the lungs (such as bronchitis or pneumonia).  Air pollutants can also cause an exacerbation but many times the reason for the exacerbation cannot be determined.  Some are thought to be caused by problems with the heart, exposure to chemicals, or allergic reactions.

Exacerbations usually involve an increase in shortness of breath, sputum production (and or a change in its color), breathing rate and cough and may worsen as the disease progresses.

In order to try and avoid exacerbations you should avoid any triggers that you know affect your breathing (i.e. air pollutants, places where there may be strong cleaners in use or perfumes, etc.).  Washing your hands frequently (especially during cold and flu season) may be beneficial in trying to avoid infections.  Your doctor can help you with more information on avoidance of exacerbations specific to you.



Q. Oxygen & Exercise

Tracy, I'm on oxygen 24 hours a day. I have severe copd. I'm also really out of shape and I don't walk much because I'm short on breath. If I exercised more and forced myself to walk is it possible that I won't need to use as much oxygen?  I guess I'm saying would it be  possible that I can  use less liters. I know I'd probably still need oxygen but would or could it be less?
Thanks Dennis
A. Hi Dennis,
This is a difficult question to answer since each person with lung disease responds in different ways to exercise and activity.  It is possible that exercising may help strengthen your muscles and  by strengthening your muscles you may help them be more efficient than they are right now.   
If you are able to exercise (with your physician's approval and guidance) you may be able to do some of your regular, daily activities with more ease and less distress than usual.  This may, in turn, make you feel less short of breath and help improve your quality of life.
Whether or not this affects the amount of oxygen that you require, is unknown but it is possible that you can use less liters of oxygen.  Again, this is a totally individual thing so I cannot really say one way or another.  Your physician and home care company that you use will be better able to guide you since they will know the history of your oxygen usage and severity of your illness.
I hope that this helps,



Q.  Oximetry Accuracy & Smoking

Hello Tracy,
How accurate is an oximeter if/when a person still smokes a bit?  I've heard some say it's still pretty accurate within a few points.  Also how many hours of not smoking would it have to be for an accurate reading?

Thank You
A. Hello Marsha,
Pulse oximetry is an indirect measurement of the amount of oxygen in your blood.  Is it usually measured with a probe that fits on the finger, toe, earlobe or nose. Many factors can affect the accuracy of pulse oximetry readings such as cigarette smoking (or pipes and cigars too), cool extremities (fingers, toes), nail polish, etc.  Carbon monoxide (CO) also affects the readings of pulse oximetry (making them appear falsely higher than they should) by taking up space that oxygen would be using in the blood.  CO is exhaled from the lungs and over time CO levels can return to normal (we all have a small amount of CO in our blood but it much higher in those who smoke).
The hours that are required to not smoke in order to have an accurate reading (by reducing your CO level) will vary from person to person and it also depends on the number of cigarettes smoked, and the pattern of smoking (how deep and frequently the cigarette is inhaled).  Some say that this make take up to 48 hours of non-smoking in order to get CO levels to that of a non-smoker.
So, to answer your question-there is no exact time that is needed before readings can be completely accurate unless a blood sample if taken in from you (arterial blood gas) and then an analyzer can give exact oxygen and carbon monoxide readings.  It is likely that if you did not smoke for some time (a few hours or more) that your readings would likely be somewhat accurate.



Q. Xanaz & Anxiety

My question is I take Xanax 0.25 mg twice daily for my anxiety and it
does help somewhat. While in the hospital they were giving me 1 mg of
xanax, I was thinking about asking my Doctor about raising my dosage to
1 mg twice daily, what do you think?    Tommy

A. Hi Tommy,

Since Xanax is an anti-anxiety medication, it is not something that I
can comment on with any authority.  Anti-anxiety medications are
appropriate for some people with lung disease but any alterations to
your dose, etc will have to be determined by your family doctor and or




Q. Chronic Respiratory Failure

What does Chronic Respiratory Failure mean if a person has severe COPD?


A. Hi Mark,

Respiratory failure can take place when someone has a problem with gas exchange (oxygen and carbon dioxide) in the lungs.  When we breathe in air, our body takes in oxygen and gets rid of carbon dioxide with every breath.  If we have a problem with this exchange of gases, it can be called respiratory failure and either the carbon dioxide or oxygen
components can be affected; the oxygen level can be lower than normal
and the carbon dioxide level can be higher than normal. Respiratory
failure can be either acute or chronic.

Chronic respiratory failure takes place over several days to months
whereas acute respiratory takes place over a relatively short period of
time.  Each can be caused from any number or breathing problems ( lung
diseases, muscle weakness, medication overdoses, etc). Acute respiratory failure usually requires hospital treatment but chronic respiratory failure can usually be treated at home with oxygen and management of the disease involved.

Please let me know, and  I hope that this helps!




Q. Strengthening of Lungs 

Tracy; is there such a thing as strengthening or building your lungs?

Also; I've read about harmonica playing for c.o.p.d as well as a new
device called a Breather which supposedly optimizes lung power. Please
don't tell me to talk to my Doctor; he doesn't know much about c.o.p.d
treatments and rehab isn't an option for me here in Nfld.  Thank You


A. Hi Natasha,

There are several breathing techniques that can help to improve
breathing capacity.  Although you do not have access to pulmonary
rehabilitation , you should still be able to get some expert advise in
this area.  Physiotherapists are a integral part of pulmonary
rehabilitation and are able to teach many different overall body
strengthening exercises and breathing techniques to help with your
breathing capacity.   

Even though you feel that your family doctor does not know about many
COPD treatments you can ask to have a physiotherapy consult and perhaps spend some time with a physiotherapist to learn how to improve your breathing.

Also, you can contact your local Lung Association and get some advise
from them.  They may be able to help you find resources in your area and they also have instructions for breathing techniques on their site.
This can help to get you started!

I found a little information on the "Breather' but not very much.  I
have seen similar devices used for people with breathing problems but
not this specific device.  Again, the physiotherapist would be a great
resource for a device like this since they would likely see more types
than I have in the past.




Q.  Low Oxygen Saturation & Organ Damage

How long can a person maintain an oxygen saturation level in the 80's before damage is done to their organs?



A. Hi Debby,

 For people with healthy lungs, oxygen saturations (pulse oxymeter readings) are usually in the mid-high 90’s.  As we age, our lungs age as well and do not perform as efficiently as they may have at one time and this may lower our pulse oxymeter readings.  Some people with chronic lung diseases may have lower readings since their body has gradually gotten used to having less oxygen (due to lung damage).  How long a person can maintain a level in the 80’s before damage is done to their organs is completely individual to the person’s past history and current illness. 



 Rehab Ctr - Toronto

I would like to help you with some information on respiratory rehab centre. I live in Toronto, Ontario. Westpark Healthcare Centre, address 82 Buttonwood Avenue Toronto, Ontario M6M-2J5 web site Their  program is number one in rehab for COPD. It is run by Doctor Goldstien. Passing on helpful information to you from some one who likes to help others with COPD.


A. Hi Ron,

Thank you very much for sending out information on the pulmonary rehabilitation program in your area.  I hope that you enjoy your time in the program and learn about how you can make adjustments to your daily routine to help improve your quality of life!



Q.  COPD Meds....which Order?

Hi Tracy.

I am in a respiratory rehab program at Westpark Healthcare Centre. I have learned a new way of taking medications for my c.o.p.d  I have severe emphysema.  When people take there med in the morning;   I take my Advair 500  first.  I then wait for 30 minutes,  then I take my Spiriva.  All the people have tried this and found breathing much better for them. I would like to pass this information to other people who have c.o.p.d this information needs to be investigated;  very helpful. I was asked to be involved with groups because my age is 56.  I am considered a baby in the group. My goal is to try and help others.  I love to get involved with copd and make people aware of this. I am from Toronto Ontario. We need to wake up people who smoke to this copd.  I  have learned people do not know of  copd; We need to wake up society. I am amazed at how many family doctors know nothing on copd.

A.  Hi Ron,

Some people may take their medications in a specific order and may also take a break in between medications to optimize distribution of medications in the lungs.  The order in which to take your medications should involve you family doctor and / or pharmacist and will depend on which medications you are currently taking. 

 It sounds like you are learning a lot about emphysema and COPD at your pulmonary rehabilitation program.  Keep up the good work!



Q. Thrush & COPD Medicines

Tracy  I hope you can point me in the right direction.  My mouth is so sore from thrush which I'm sure is caused from my COPD medicines.  Is there anything I can buy over the counter to get rid of it?


A.  Hi Tracy,

Oral thrush is a fungal infection in the mouth which shows up as white or yellow sores on the tongue. These sores may be painful and may bleed if rubbed or scraped.

 If you are taking inhaled steroids (Flovent®, Advair®, Pulmicort®, Symbicort®) there are 2 ways to help prevent thrush; 1) always use a spacing device with your inhaled MDI’s  and 2) always gargle and rinse your mouth after taking inhaled steroid medications.

Antifungal medications are commonly prescribed for oral thrush.  These medications can come in lozenges, tablets or as a mouth rinse.

There are non-prescription treatments that are commonly used for oral thrush, gentian violet is one of them although you should consult your family doctor before starting to take this (or any other herbal supplement) to make sure that it does not interfere with other medications that you may be taking. Your pharmacist may be able to help you with finding non-prescription treatments for this problem. 



Part 2 of A Question by Marge on Arthritis & Wheezing

A. Hi Marge,
I have been unable to find a relationship between COPD and arthritis pain. Perhaps there is another reason for your symptoms that is not surrently apparent to you.  You should discuss this with your family doctor during your next visit. 



Q.  OxyArms

Dear Tracy;
I'm interested to know what you think about the OxyArm vs the old nasal cannula. The reason I ask is that the nasal one dries out my nose really bad but my concern is whether I'd still get enough oxygen using the OxyArm since it's so open.  thanks Pete

A. Hi Pete,

The OxyArm is a device that looks similar to a headphone with a
mouthpiece that has tubing that comes from on oxygen source
(concentrator or tank) and directs oxygen towards the nose and mouth. Some people may feel that this device is more comfortable than nasal cannula since it does not sit directly in the nose (this may be less irritating to the nose).  I have not seen the Oxyarm in clinical use, only on the internet. The company claims that you will get  the same amount of oxygen with it as you would with nasal cannula. I was unable to find clinical studies that supported this claim but a lot of reviews from people that currently use it-supported that it gave them adequate flow compared with nasal cannula. Perhaps you can ask your home oxygen provider if they have any information on this device since I am not very familiar with it. 



Q. Arthritis Pain & Wheezing

 I have  bad arthritis, I'm 67 with severe but stable COPD. (For the
past year)  Every once in awhile I'll wake myself wheezing. I use to be
that way all the time until I got on Symbicort. I've noticed that it
only seems to happen when my arthritis is acting up.  Do you think it
can be casued from the pain since I don't have any current infection or
breathing problems at other times;  other than having COPD.


A.  HI Marge,

I am not aware of any direct relationship between arthritis pain and
wheezing.  I will try to find some more information for you and post it
later on this week.

 Interpreting Spirometry Numbers

Sandi; please forward your test result numbers.



Q.  Exercises to Strengthen Back/Shoulders

 Can you suggest any particular exercises to help strengthen my back or point me in the right direction.  I have severe COPD and I'm noticing that my shoulders are starting to slouch forward. thanks, Ted


A.   Hi Ted;

A physiotherapist would be the best health care professional to suggest exercise to strengthen your back muscles.  Leaning forward on a table may make it easier for you to exhale (which you may currently be doing).  If you are, this leaning forward may make you feel as though you are slouching.


You can ask your physician if there is a pulmonary rehabilitation program in your area that you can be referred to.  Pulmonary rehabilitation programs are found in many cities across Canada.  That being said, there is definitely a need for more programs across the country as more people are diagnosed with the disease. These programs educate people with COPD (and other breathing disorders) about their disease, how to recognize and control their symptoms, and exercises to help improve their quality of life.


If there is no program in your area perhaps your family physician or Respirologist can guide you further.  Since you say that you have severe COPD you should definitely speak with your physician before trying any new exercises for your own safety.




Q.  Low Oxygen Sat Levels But No COPD


Hi Tracy;

My hubby has COPD. He also has a finger pulse oximeter which he uses occasionally.  Recently I used it a few times to check my own oxygen levels...I was feeling lightheaded.  On and off over the past couple of days it's read 92 or 94.  What can cause drops like that in a healthy person? Thank You



A.  Hi Ruthie,


A pulse oximeter is a devise that is primarily used in the hospital environment although it is used in the home setting as well.  It is a measurement of the oxygen traveling through your blood and is measured using a small clip on your finger. With proper training, this reading can give health care professionals added information about a person's breathing status.  Keep in mind that readings can be affected by many factors such as nail polish, cold fingers, etc. and it meant to be used by someone trained in using this equipment.  For healthy individuals-readings are usually in the high 90's. 


As we age, our lungs age as well and do not perform as efficiently as they may have at one time and this may lower our pulse oximeter readings.  Without knowing your age or medical history it is difficult to assess why your readings may be a little lower than usual although 92-94% is not necessarily low.   If you are feeling lightheaded-you should speak to your family physician and get his or her opinion about why this may be taking place.



Q.  CO2 and CO - Relationship to COPD

Tracy -- What is the relationship to COPD of both CO2 and CO. Is one much worse than the other or are they about the same effect? I'm referring primarily to gas ranges and ovens...when enough burners are on and the windows are closed, I have to leave the area as I have great difficulty breathing and at times my nails take on a blue tint. Thanks, Vic

A.  Hi Vic; CO2 (carbon dioxide) is a product of the body's normal metabolism and we all have it!  The CO2 level may be increased for people with COPD due to lung damage.  The body attempts to compensate for this increase in CO2.

CO (carbon monoxide) is not normally produced in the body like CO2.  CO is produced when certain fuels are burned (natural gas, propane,
kerosene, wood, oil, etc.). We inhale CO every day in small amounts but
it is not usually harmful to us unless inhaled in larger amounts.

If your gas range is working properly-it should not produce enough CO to
affect your breathing.  NEVER use a gas range to heat your home as this
is very dangerous!  It is possible that the heat from the stove may have
an affect on your breathing but you should definitely speak with your
family doctor or respirologist about this and the blue tinge (cyanosis)
that you notice on your fingers.  He or she can further investigate the
reason for your shortness of breath and cyanosis.



Q. Asthma, Emphysema, Isocyantes

I have severe emphysema as well as asthma caused from . If i did not have asthma caused from isocyantes would my severe emphysema be less?  Ron

A.  Hello Ron; This is a very difficult question to answer since some of your symptoms of asthma and emphysema may be similar. It is possible that exposure to isocyantes may worsen your symptoms of emphysema but this  would be difficult to determine.



Q. Peak Flow Meter & COPD

Hi Tracy;
Is it possible to have COPD and still blow normal, or close to normal for one's age and sex etc, on a peak flow meter?

Thanks, Mike

A  Mike; Yes,  you can have a normal peak flow measurement with COPD.  A peak flow meter measures the fastest  flow of air from your lungs when you blow out.  This measurement is useful for people with asthma to help
manage their disease. 

The most important measurement for COPD is the FEV1 (forced expired
volume in 1 second).  This measurement is taken during a breathing test
called spirometry.  Most people with COPD have a reduced FEV1 measurement for their age, height and weight.



Q.  Home Oxygen & How It's Prescribed (this question has been edited)

Dear Tracy;

My question - Some people with COPD are on oxygen at night, others on oxygen 18-24 hours a day.  If the sleep labs are as backlogged as I've been told, how is it determined that  a person might need oxygen?

God Bless, Maryanne

A.  Maryanne; People that may require home oxygen therapy do not go to a sleep lab for assessment.  Although many sleep labs may be backlogged, sleep labs primarily help to diagnose sleep associated disorders.

In Nova Scotia (where I live),  home oxygen must be prescribed by a
respirologist and requires a blood test (arterial blood gas / ABG) and
an oxygen measurement during exercise.  The number of hours that a

person is prescribed home oxygen is determined by the referring
physician and oftentimes in conjunction with the respiratory home care
provider that you use.




Q. Emphysema & Isocyantes (this question has been edited)

Tracy thank you . It says "causes distress to emphysema." Explain this to me in simpler terms. I have read the reply from u.a.w. site . I have a w.s.i.b. judicator to explain to help my claim with w.s.i.b. I have been told that i can not work with isocyantes from the o.h.c. at St. Mikes on Bond Street in Toronto.  Question for you would my severe emphysema be as severe?


A.   A variety of irritants that we inhale may cause breathing problems
(smoke, perfumes, gases, pet dander, etc.). Since people with emphysema already have  lung damage, inhaling these irritants can cause their lungs to react more strongly than it may for those with more healthy lungs.

Unfortunately, since I do not live in Ontario, I am not familiar with
the references that you mention (WSIB, OHC, St.Mike's). 



Q.  COPD MEDS & Sexual Dysfunction

Tracy, my husband Tony is 40 and was dx on 7/7/06 with emphysema from smoking. He quit that day! Question he is on Foradil, Asmanex and Combivent(for fast acting). We have never had a problem until now last 3 Months) we are experiencing sp? sexual problems. MY concern is that it has to do with his blood circulation. or maybe the med? Please Advise


A  Hi Donna,

Your husband should be commended for quitting his smoking habit!  It is the most important step that he could have taken to slow down the progression of his lung disease.

As a respiratory therapist I am knowledgeable of the respiratory and
cardiac effects of COPD medications but am not qualified to give advice about sexual dysfunction.  Your pharmacist should be able to counsel you on this topic.  He / she may suggest that you and your husband speak with your family physician to further explore this problem.



Q.  FEV1 % with One Lung

Hi Tracy; although this isn't COPD related per se; I was wondering.....
My uncle had a lung removed  ; the other is working fine and he's doing quite well overall.  Everyone speaks of their FEV numbers.  My question: although he has only one lung, and it's functioning fine, does it automatically mean that his FEV1 has been reduced to 50% (assuming the lung he still has is disease free) or can the one lung compensate for the missing lung to a much higher number? 

Thanks, Jean

A.  Hi Jean,

The FEV 1 refers to the amount of air that that you can exhale
forcefully in 1 second during a test called spirometry.  Spirometry is a
commonly used diagnostic tool for lung disease. Your uncle will most
likely have a reduction in his FEV 1 measurement (compared with his
pre-surgery measurements) but it would not necessarily be an exact 50% reduction.  There have been medical studies done to predict the decline in the FEV 1 but there is no definitive answer to your question.  The best way to find out would be for your uncle to ask his physician after he has
spirometry done in the future.



Q.   Smoking & Workplace Environments....Emphysema

I have worked with isocyanates for 34 years in flexible food  packing.  I worked also in a dusty workplace. I also worked with plastics breathing carbon monoxide fumes. I was a smoker as  well. I have severe emphysema as well as asthma. When I started working my lungs were as good as people who did not smoke. I believe not just smoking causes c.o.p.d. I believe my workplace as well as smoking caused mine is this true?       Ron 

A.  Hello Ron,
Although there are many risk factors for COPD, cigarette smoking is the most common cause.  Genetics, infection and inhalation of certain irritants can also play a factor in this disease.  It is possible that your lung problems may be due to both your smoking history and workplace exposure to isocyanates. Isocyanates can be used to make pestecides, rubber materials and adhesives.  It has been shown to cause a variety of lung and skin reactions such as asthma-like symptoms and rashes.  Keep in mind that the signs and symptoms of COPD are not usually seen until a person is in their 40's. You may have already had damage to your lungs from smoking without noticing the effects until later on in your life.
I have copied a link for the Canadian Auto Workers Union with more information on isocyanates.



Q. Oxygen Reserve/Retention

I am a COPD'er. My question is, when one is on 02 for a short length of time, does your body build up a reserve and retain 02, much like a battery that has been re-charged? I heard that it does and the effect will last at least a couple of months even after coming off 02.?




A.   When you receive supplemental oxygen (usually via your nose or a mask on your face) in either the hospital or home care environments the effects do not last for long periods of time once it has been stopped.  Unfortunately, our bodies do not respond like rechargeable batteries!
In the home care environment most improvement has been seen when long term supplemental oxygen is worn for 24 hours per day. Long term oxygen therapy can be prescribed for shorter periods of time during the day and night depending on what the physician feels is best.



Q  Importing Meds

Hi Tracy, is it legal to order medications and bring them in from suppliers outside of the country since Spiriva is so much cheaper?

(Note:  This question has been edited by the website owner)




A.    I do not have an answer for you about ordering your medications from countries outside of Canada. You should speak with your physician about this question.


This page was last  last updated August 7th, 2011

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