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Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited. Appendix 7 Rules for PEEP/ CPAP/ EPAPt : So, when do you increase PEEP. To answer this we have to understand what PEEP is.  PEEP is an abbreviation for Positive End Expiratory Pressure. When used on a ventilator it is called PEEP. When referring to noninvasive ventilation it is called EPAP, which is an abbreviation for End Positive Airway Pressure.  When used alone, it is referred to as CPAP (Continuous Positive Airway Pressure).  Essentially, PEEP, EPAP, and CPAP are the same thing, only the terms vary depending on what type of machine is applying the pressure (ventilator, BiPAP, or CPAP machine). The unique terms help caregivers tell know what device is being referred to: Ventilator, CPAP, or BiPAP.  Whether called PEEP, EPAP or CPAP, it is a constant flow during expirati...

The following was written by me and published at healthcentral.com/asthma on January 11, 2016 How I Conquered Exercise Induced Asthma To say I  never  exercised as a kid is not telling the whole truth.  A more accurate statement would be to say that I rarely exercised when my asthma was acting up.  And considering I had brittle asthma as a child, there were many times I was unable to exercise with it.  Now I exercise every day, so what changed? Essentially, I conquered exercise induced asthma (EIA), or what is now referred to as  exercise induced bronchospasm  (EIB). Here are five reasons I credit for helping me conquer EIB. 1.   Brittle asthma .  During teenage years airways increase in scope and size with the rest of your body.  So my airways are now bigger and less brittle.  Now, this does not mean they are less sensitive.  It just means when my airways spasm, there is more room than there once was. So now, when I'm exp...

Considering the design of the inhaler has not changed since it was invented in 1957 , we are long overdue for a revolutionary breakthrough. Say hello to Bloom, an inhaler the size of a credit card that can easily fit into a wallet. Traditional inhalers are nice in that they are small, lightweight, easily portable. Yet they are still bulky, and -- let's face it -- they are easy to forget. How about an inhaler that is always with you, snug nice and secure inside your wallet. When you need it all you do is open your wallet and there it will be.  Now, the idea here is you purchase a regular inhaler. You take out the cannister and insert it into the top of the Bloom inhaler. You then squirt it six times. Bloom saves the medicine without wasting any of it. Now you place Bloom inside your wallet for safe keeping. Six puffs will be available whenever you need them. No need to worry about forgetting your inhaler. No need for stuffing that bulky inhaler inside your pocket.  The product ...

The following was written by me and published at healthcentral.com/asthma on November 4, 2015. What is Severe Asthma?  Researchers have learned that 5-10 percent of asthmatics do not respond well to traditional asthma medications, making their asthma difficult to control.  In order to better help these asthmatics, researchers now categorize them under a special asthma subtype  called Severe Asthma. So, what is severe asthma, and what does it mean if you have it? What is it?   Sally Wenzel, professor of medicine at the University of Pittsburgh, defines severe asthma as “patients who require high dose inhaled glucocorticoid (GC), or continuous or near continuous oral GC treatment to maintain asthma control or who never achieve control despite that treatment.”  It was defined as an asthma subtype less than 15 years ago. What is it  not ?   Severe asthma must not be confused with other causes of difficult to treat asthma, including: Asthma exacerbated...

The following was written by me and published at healthcentral.com on October 6, 2015. 9 Ways to Live Longer with End Stage COPD End Stage COPD , also known as Severe COPD or Stage IV COPD, severely limits your airflow, making it hard to perform any basic activities. At this stage you may have also developed Cor Pulmonale or Congestive Heart Failure. While your quality of life may be limited, this is not a death sentence—there are still ways to live in the "end stage." You may, however, have to alter your life to adjust, starting with... Quit Smoking . Studies show that quitting smoking,  even in the late stages of the disease , is the most effective way of prolonging life. This is why your doctor will encourage smoking cessation  even in the later stages of disease  -- if you haven’t quit already.   COPD Action Plans . These are agreements you create with your doctor to help you decide what actions to take when you feel symptoms.  Read my post “ What Is A COPD ...

The following post was originally published by me at healthcentral.com/asthma on September 11, 2015 Links Between Testosterone and Asthma Even though asthma was first described over 2,500 years ago, why some people develop it, and why some have it worse than others, remains a mystery.  Yet by observing trends between male and female asthmatics, researchers now suspect a link between asthma and a hormone called testosterone. Researchers have been studying asthma for many years now, and are well aware of the following trends regarding male and female asthmatics. Boys are more likely to have it than girls. During teenage years this trend reverses, and women are more likely to have it than men. Women are more likely to have allergic asthma. Women are more likely to have difficulty controlling asthma.  Therefore, women are more likely to suffer from more severe asthma than men. Women are also more likely to develop adult onset asthma. Women are more likely to have an adverse reacti...

The following post was written by me and published at healthcentral.com/copd on September 29, 2015. What is End Stage COPD? So you, or a loved one, have been diagnosed with End Stage COPD.  What is this, and what does it mean for you or your loved one? First off, it must be understood that there is no generally accepted clinical definition to End Stage COPD. What it means for one physician may not mean the same thing for another.  In fact, The Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) defines "severe COPD," but it does not even mention the phrase “End Stage COPD.” That said, here is what End Stage COPD  might  entail, if this term is used by your doctor. Stage IV COPD or Severe COPD . What is it? Severe airflow limitation, meaning it’s very hard to blow out a candle FEV1 during pulmonary function testing ( PFT ) will be 30 percent or less. Unlike asthma, this does not improve with medicine. However, medicine can help you take a deeper breath and...

The following post was written by me and published at healthcentral.com/copd on October 6, 2015. MacGyver-like Doctor Saves Asthmatic Child Set the scene: an asthmatic toddler is having an asthma attack aboard a transatlantic flight from Spain to the U.S. The parents realize they had accidentally packed his asthma supplies in their checked luggage. What are they to do? Thankfully a MacGyver-like genius was on board and steps in to save the day. When he learned the two-year-old boy's oxygen saturation was only 87-88 percent , Dr. Khurshid Guru, director of Robotic Surgery at the Roswell Park Cancer Institute, sprung into action to create a makeshift nebulizer and oxygen delivery device out of supplies readily available aboard the Air Canada flight. During an interview with an ABC News reporter, Guru said he was able to obtain an oxygen tank and an albuterol inhaler.  He then collected oxygen tubing, a bottle of water, and a water cup. He connected one end of the tubing to the oxyg...

The following was originally published by me at healthcentral.com/copd on on September 2, 2015 What is Bullous Emphysema? Essentially, emphysema starts in the lung parenchyma, which consists of the small bronchi, alveoli, and capillaries. For a quick review of pulmonary anatomy, see  take my journey down the respiratory tract . Alveoli . These are small balloon-like structures that inflate like balloons when you inhale. After full inhalation, elastic recoil allows them to resume their natural shape, allowing exhalation to occur. They join with capillaries, so it’s here  gas exchange occurs . Emphysema . Certain conditions -- like smoking -- cause alveolar walls to become inflamed and breakdown.  They lose their elasticity, or their ability to regain their normal shape after a full inhalation. They eventually rupture, creating small air spaces. This also destroys surrounding capillaries, creating alveoli that no longer participate in gas exchange.  So emphysema i...

The following was written by me and published at healthcentral.com/asthma on December 21, 2015 Looking to improve your repiratory health in the new year? As one of HealthCentral's health guides,  I was asked to write an article with a list of my best articles going forward into 2016, with an explanation of why I chose each one and why it’s important to respiratory health readers. Here are my picks for the best respiratory health articles from 2015:  1.   The Natural Progression of COPD . This is probably the most important article I’ve ever written, and I refer to it every time I’m encouraging my patients to quit smoking. I discuss the Fletcher-Peto Curve.  It’s a telling visual for anyone with COPD because it shows that smoking speeds up the progression of the disease, and that quitting smoking at any age slows the progression of the disease, thus prolonging life.   2.   Smart Inhaler the Future of Asthma Control . This article is neat becau...

The following was originally published as a slideshow on healthcentral.com/asthma on April 8, 2015. Your Daily Asthma Checklist Asthma can be managed, allowing you to live a normal life, as long as you take the proper steps and maintain compliance. Here is a checklist to guide you through your day to help maintain asthma control. 1.   Take Your Asthma Controller Medicine .  They reduce airway inflammation and keep your airways open so your breathing stays normal. They also make it easier to treat and control asthma attacks when they do occur. Most are long acting, meaning you only need to take them once or twice a day. A good tip is to take them just prior to brushing your teeth in the moring and at night. 2.   Keep Rescue Medicine Nearby . Rescue medicine opens airways to quickly end an asthma attack. Its fast-acting medicine helps you catch your breath. Nebulizers and inhalers work great for home. Inhalers are small and compact, and ideal for when you’re on-the-g...