WHAT IS PULMONARY HYPERTENSION (PH) ?!

Pulmonary hypertension (PH) is a condition where the blood pressure in the pulmonary arteries (the blood vessels carrying blood to your lungs) is high. This increased pressure causes progressive damage to the heart and lungs.

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When you exercise the heart beats more quickly to get more oxygen to the muscles. At the same time the pulmonary arteries expand to allow more blood through so that more oxygen can be carried to the muscles. They expand by stretching outwards slightly to create a larger inner area. In a person with PH, the walls of the pulmonary arteries are thicker, so are less able to stretch. Because of this the heart has to work harder to pump blood to the lungs, especially during exercise. If the heart has to work harder than usual over a long period of time then it begins to work less effectively and damage occurs.

PH affects many different types of people. In most people with PH, it is associated with another medical condition:
•    portal hypertension
•    connective tissue disease, eg systemic sclerosis
•    HIV infection
•    congenital heart disease
•    sickle cell anaemia.
Some people develop PH with no known cause which is referred to as idiopathic PH and in some rare cases it can be inherited.

Your stage of PH is classified as shown in the table below, depending upon when your symptoms occur.

WHO classification of PH:
Class    Description
1    No symptoms of any kind. Physical activity does not cause any symptoms
2    Comfortable at rest, but symptoms occur with ordinary physical activity
3    Comfortable at rest, but symptoms occur with less-than-ordinary effort (eg lifting the arms)
4    Symptoms while resting

Treatment for PH can be split into three categories:
•    Conventional therapy (often called background therapy), which can include the following:
•    Oxygen
•    Warfarin
•    Diuretics
•    Targeted therapy
•    Calcium channel blockers
•    Endothelin receptor antagonists
•    Phosphodiesterase 5 inhibitors
•    Prostaglandins
•    Surgery
•    Pulmonary endarterectomy
•    Atrial septostomy
•    Transplant surgery

Most patients will have a regime involving a combination of background and targeted treatment which varies from person to person depending upon the cause of the PH and what stage they are at.

Many patients will need oxygen therapy, although some only need it at night. Oxygen therapy increases the amount of oxygen in the blood and it can also help to relax the arteries in the lungs which leads to reducing the pressure in the pulmonary arteries. Oxygen therapy can reduce tiredness and breathlessness in some people with PH and it can improve concentration and the ability to do everyday tasks.

Having PH can make you tired and lethargic. This may make it more difficult to do ‘normal’, everyday things. Here are some tips from the PHA website from patients to help make life a little easier.

Housework
•    Where possible, avoid bending, lifting or over-stretching when doing housework.
•    Use a lighter vacuum cleaner and iron.
•    Do jobs sitting down where possible – a kitchen stool can really help.

In bed
•    If your duvet is heavy, consider buying a lighter one.
•    Use extra pillows to raise your head and make it easier to breathe.
•    If you use an oxygen concentrator, consider putting it outside the bedroom to avoid the noise disturbing you.

General
•    After a bath, open windows before the house becomes too humid.
•    Have chairs ready for places where you stand (eg, shaving or applying make-up).
•    Slightly larger clothes can be less tiring to put on and take off.
•    Put on a bathrobe straight after a bath or shower to avoid having to towel yourself dry.
•    If bending down to put your shoes on is difficult, use a long-handled shoehorn.

Out and about
•    Plan ahead to avoid having to rush.
•    Consider asking for a wheelchair.
•    If you drive, carry spare medication in the car.

References: http://www.phassociation.uk.com and http://www.who.int

Would You Like Your Very Own Robot?!

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Home Oxygen Therapy is a medical treatment for patients suffering from chronic lung diseases. It involves the use of an oxygen concentrator to deliver oxygen via a nasal cannula or face mask to the patient and some may require being tethered to the machine on a constant basis. COPD is an umbrella term for these conditions and patients have restricted airflow through the lungs and experience coughing, wheezing and shortness of breath. The effect on quality of life can be significant and some are unable to participate in physical activities and require help to move. Home oxygen therapy aims to improve the patient’s freedom, health and quality of life by allowing treatment at home. Patients are encouraged to try and maintain a certain level of activity as research has shown that if exercise and mobility are retained then lung capacity and respiration improves.

However some patients find this difficult as they are tethered to a pressurized oxygen container via tubing and the weight, which is typically 4kg, can make transporting and lifting awkward especially for the more elderly patients. Some patients use a small hand cart to transport their equipment around or use a portable unit which they can carry over their shoulder.  Despite the huge benefits of H.O.T it still imposes restrictions on the user’s movements, mobility, ability to participate in certain activities and quality of life.

A Follower Robot has been devised to help improve these patient’s lives. The robot can carry the equipment thereby reducing the physical burden and increasing freedom of movement. It is capable of following the patient’s movements and can follow behind the patient. It is simple to use, low weight, compact and at a low cost.

They have started testing these robots on H.O.T users to see if they are indeed beneficial and can aid them in their daily activities efficiently. Most users have found the robot easy to use and to manoeuvre with. It is hoped that after more trials are completed it can be manufactured and sold commercially for COPD patients. These robots could drastically improve patient’s lives allowing them to easily move around and enjoy more out of life which could have a positive effect on their health also. More importantly, how amazing would it be to have your own robot?!

References:  http://www.robomechjournal.com and http://link.springer.com

Respiratory Breakthrough!?!

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Scientists claim to have found the root cause of asthma which could also aid in the treatment of other respiratory diseases like COPD. This breakthrough could mean that there could be a new treatment within 5 years.

They have found a protein within the airways which they believe triggers an asthma attack. Asthmatics seem to have higher levels of this protein and when they breathe in a trigger such as dust or pollen these protein molecules cause a rapid increase of calcium within lung tissue cells. High levels of calcium within these cells make them contract and cause the airway spasms which trigger an asthma attack.
The presence of this protein makes cells more sensitive to any asthma triggers, which then makes an attack much more likely.

A drug already exists which can deactivate the protein and clinical trials could start within 2 years, raising hope that a treatment could be available within 5 years.

It is hoped that a few courses of treatment would be enough to stop asthma attacks. Not only this but there is hope that it may have a role in tackling COPD and chronic bronchitis for which there is currently no treatment. Hopefully at a minimum it may prevent flare-ups for these patients and make them less susceptible to the triggers such as dust, smoke and pollen, which can stimulate a severe respiratory event. This could help COPD sufferers enjoy fewer flare-ups and less respiratory distress improving their ability to lead more normal lives.

References: http://www.dailymail.co.uk/health

The dangers of summer

Whatever stage your respiratory disease may be at, preventing flare-ups is highly important to ensure you stay as healthy as possible and to keep your breathing as easy as possible. This means you need to be aware of the triggers and eliminating any exposure to cigarette smoke, fire smoke, dust, chemicals, excessive wind and pollution. Breathing can also be difficult at temperatures around or below freezing, above 90 degrees F, or on days with high humidity, ozone levels or pollen counts.

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Many patients have a component of asthma and some prefer warm, dry climates whereas others may prefer more humid environments.

Extreme hot or cold conditions can put stress on the entire body. In order to maintain a constant body temperature, you exert additional energy to warm or cool it down. This additional energy requirement also increases the amount of oxygen that your body is using. Breathing hot or cold air can also have a drying or irritating effect on the airway causing bronchospasm (contraction of the smooth muscle that surrounds the airway). This decreases the size of the airway and makes it more difficult to get the air in and out of the lung, increasing shortness of breath.
In general most patients find that they prefer minimal humidity levels of about 40%. This is also true of indoor humidity levels which can be difficult to maintain throughout the year, if it is a hot summer or a cold winter with the heating on. You can purchase a humidifier that works with your heating system or independent units for single rooms. De-humidifiers can also be purchased to help lower the humidity in certain rooms.

High indoor humidity is often also the source of mould growth in the home which is another trigger, as well as an increase in common indoor air pollutants like dust mites, cockroaches, bacteria and viruses. Also as humidity increases, the density of the air increases. This more dense air creates more resistance to airflow in the airway, resulting in an increased work of breathing (i.e. more shortness of breath).

Look out for common signs of high humidity:
•    flooding or rainwater leaks from the roof or basement/crawl space
•    poorly connected pipes or leaky pipes under sinks or in showers
•    carpet that remains damp
•    poorly ventilated bathrooms and kitchens
•    condensation build-up from humidifiers and dehumidifiers, air conditioners, and drip pans under refrigerators/freezers

Here are some helpful pointers for when it is hot, although many are applicable to other weather conditions as well:
1.    Drink plenty of fluids, fairly obvious for Australians, but please take into account if you have a fluid restriction.
2.    Wear appropriate clothing and sunscreen.
3.    Plan your activities carefully. Try to organise your activities or exercise for the coolest times of the day – early in the morning, or in the evening. When driving, park in shady areas if possible, and choose places to go that are air conditioned. Place sun protectors in your car when it is parked.
4.    Keep cool, indoors. Use your air-conditioner if you have one and remember you do not need it to be freezing cold. A second benefit of the air conditioner is that it removes a great deal of humidity from the air as it cools it. If an air conditioner is not available, use fans and open windows to circulate the air during hot days. Special programmes are available in many places.
5.    Use the buddy system. This means making sure that someone contacts you at least twice a day to check that you are OK.
6.    Avoid rigorous exercise or excess activity.
7.    Take your medications as directed.
8.    Pay attention to weather reports.

References: http://www.healthline.com and http://lungfoundation.com and https://rotech.com

OXYGEN ALSO NEEDS NITRIC OXIDE FOR US TO BREATHE!

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A new study conducted by Jonathan Stamler, a professor of medicine at Case Western Reserve University School of Medicine in Cleveland, OH, and colleagues has shown that the respiratory cycle involves three gases and not just two. He says their findings will transform our understanding of the respiratory cycle and could save lives as it will alter our treatments of various associated diseases linked to the respiratory system and also affect blood banks.
The current understanding is that the respiratory cycle uses blood to transport two gases – oxygen and carbon dioxide. Red blood cells pick up freshly inhaled oxygen from the lungs and carry it to cells in the tissues of the body; and then they bring back carbon dioxide as a waste product to be exhaled from the lungs.
However their study has proven that without the presence of Nitric Oxide it doesn’t matter how high the oxygen level is, the cells cannot accept the oxygen without it. The researchers show how nitric oxide controls the blood flow in small blood vessels inside tissue in a process known as “blood flow auto regulation.” It is the Nitric Oxide that controls the release of oxygen from red blood cells into the tissues that need it. Haemaglobin in the Red Blood Cells needs to be also carrying Nitric Oxide to enable blood vessels to open and to supply the oxygen it is carrying to the tissues.
Prof Stamler says “Within the tissues, the tiny vessels and the red blood cells together make up the critical entity controlling blood flow. Red blood cell dysfunction is likely a hidden contributor to diseases of the heart, lung and blood such as heart attack, heart failure, stroke and ischemic injury to kidneys.”
If you suffer from a condition where there is a lack of oxygen uptake to your cells, it may not be the answer just to increase the oxygen supply, but to also look at whether your Red Blood Cells are functioning correctly and if there is an adequate Nitric Oxide supply. Then if necessary treat the Red Blood Cell problem in conjunction with oxygen therapy.

The study also has implications for blood transfusions. Recent evidence shows that blood transfusions lacking nitric oxide have been linked to higher risk of heart attacks, disease and death. It’s not enough to just increase oxygen content of the blood via a blood transfusion. If the Nitric Oxide mechanism is failing then the oxygen will not be able to make it to its destination. Blood in blood banks are known to be deficient in Nitric Oxide and transfusing this blood may actually make things worse by plugging up blood vessels in tissues and to solve this the nation’s blood should be replenished with Nitric Oxide.
It may be the case that many sufferers on oxygen therapy in the future could be helped and treated even more by investigating their Nitric Oxide levels, as there could be additional failings in their respiratory system that could be investigated and more successfully treated.

References: http://www.medicalnewstoday.com and http://www.sciencedaily.com

Home exchanges can make holidaying so much easier!

Holidays can be the experience of a lifetime but they can also be expensive and stressful to organise. If you are older, suffer a disability or chronic disease then you may have the additional expense of insurance, organising medical equipment or oxygen and perhaps having to pay more in order to have suitable accommodation. Swapping homes with another person in the country you want to vacate in could be the answer.

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If they have similar circumstances then their home will be already adapted or suitable for your needs. It will feel more homely than a hotel room or apartment. The owner will have contacts for reliable services you may need whilst on your stay and have local knowledge and suggestions for places to visit. Most of all, you will save a lot of money on accommodation and can either save that money or spend it to do extra special things on your holiday that you may otherwise be ill-afford to have done.

Because you’re both swapping homes then both parties are in the same boat when it comes to safety and ensuring that your home is looked after. You can exchange concerns and wishes prior to the exchange and only confirm the exchange once you are happy to do so. There is also the support from the company that you do it through.

Some people swap for just a week or two, or some go on longer holidays for a few months and live in a different home in different countries and travel around the world. You may stay 2 weeks in Dubai, 2 weeks in Croatia a week in Spain and another in France, the world is you oyster. All you need to do is find a home exchange partner in each country that is available around the time of your holiday. There are members that have second homes or holiday homes with a lot of availability.
All you need to do is join, list your property, search for members’ homes that you’re interested in staying in, communicate all your needs and arrangements and then enjoy a fabulous holiday!

If you’re worried about arranging medical equipment or oxygen if you wish to travel from place to place then don’t be, there are global companies that can provide you continuous support for the whole duration of your holiday even across different countries.

Home Exchanges are becoming increasingly popular as the cheapest and best way to enjoy your holiday!

References: http://www.homeexchange.com and http://www.guardianhomeexchange.co.uk and http://www.oxygenworldwide.com

Oxygen Therapy and Smoking Does Not Mix

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Cigarettes on their own are the leading cause of house fires, but add to this the risk of oxygen being stored in the home and the danger dramatically increases.
Over the last few years there have been a staggering number of reports of people on home oxygen therapy being admitted to hospital with facial burns, eyebrows and hair burned off, death, smoke inhalation injuries and fire damage to their homes in the thousands of pounds. These occurred because they or a friend/family member were smoking whilst the patient’s oxygen equipment was in use.

However, do not interpret this to mean that oxygen therapy is something to be afraid of, it just needs to be respected.

General Advice when using oxygen equipment:

•    If you’re on oxygen, DO NOT smoke.
•    If you live with or visit someone on oxygen, DO NOT smoke around them.
•    Stay away from open flames, sparks, and gas (including gas stoves).
•    Turn the oxygen off while not in use.
•    Avoid petroleum-based products.
•    Do not use aerosol sprays nearby.
•    Comply with all safety instructions provided by your home medical equipment company.
•    Keep your oxygen concentrator in a well-ventilated area.
•    Never allow the tubing, cannula, or mask to be covered, as it can result in a build-up of concentrated oxygen.
•    Keep the name and number of your home medical equipment provider in a prominent spot for reference.
•    Post a sign stating ‘DANGER: No Smoking-Oxygen in Use’ for the benefit of engineers or visitors.

There are also health risks associated with smoking while on oxygen therapy. Smoking is the most common cause of many medical conditions associated with the requirement of oxygen therapy. Smoking got you here therefore it is highly recommended that you put as much effort as possible into trying to give up this harmful addiction, or to at least cut down. Smoking more will just continue to damage your lungs and increase the deterioration of your respiratory capability and make you increasingly more dependent upon supplemental oxygen. Using supplemental oxygen can improve your health and improve your medical condition but if you smoke you are hampering the possible medical benefits of the treatment.

There should be a respectful balance between your own lifestyle choices, your medical needs and the safety of yourself and others around you. Be aware of the dangers and make sure you take all possible safety precautions.

References: http://lambertshc.com and http://scienceblogs.com