Ask Mark

image066Brian from COPD Canada ( asks Mark if there are recommendations for indoor environments or air filter use for people with COPD.

Mark advises, Indoor air quality is an ongoing and difficult issue that affects folks very individually. Where one lives, the local and immediate pollutants, allergens and weather seem to contribute much to the difficulties and resolutions that end up being effective. There is no blanket recommendation for what folks should do with regard to conditioning the air within the home, aside from restricting smoking of any kind and being careful with cooking smoke and odors, etc.

Generally, it is always recommended that during the winter, you should try to keep the humidity of indoor air higher than the weather will usually supply. Around 40% seems to be a good level. But, most folks don’t have suitable equipment to measure humidity. So, comfort has to be the litmus. On cold days, steamy windows indicate that the humidity is usually at least 40%, if not higher.

Some folks find it helpful to use an air filter of some sort, whether a HEPA placed in a central air/ heat unit or a free-standing device. But, adequately filtering the large volume of air within one’s home is a daunting and difficult task. One can spend considerable money for less than a stellar return. Also, with many air filters producing ozone as a by-product, it can be a challenge to find a device that will not add that pollutant to the environment and counter efforts to improve air quality. So I make no recommendations in that regard.

JW asks if Mark if he could explain the asso­ ciation between COPD and anemia. He has low iron despite taking an iron pill daily and eating spinach and iron rich foods.

Mark says, Anemia is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. The normal range for RBC levels is 4.4–5.9 mil/uL (millions per cubic millimeter) for men and 3.8–5.2 for women. Hemoglobin (Hgb) is the protein in your red blood cells that carries oxy- gen. A normal reading for men is 13–18 g/dl (grams per deciliter); for women, 12–15 g/dl. When you take your oximetry reading, it is read as a percent, which is the percent the hemoglobin is saturated with oxygen.image096-1

Hemoglobin carries 97% of our oxygen, and when we have anemia with a deficit of 10% or more, getting sufficient quantities of oxygen to the tissues becomes a challenge – one that increases the more severe one’s anemia is. Folks with anemia have a precarious relation- ship with regard to oxygenation. Your physi- cian may determine either a blood transfusion or medication to stimulate the bone marrow to produce more RBC or Hgb is in order.

Bottom line: Many people have low levels of red blood cells and hemoglobin and do just fine. The more advanced one’s COPD, especially if oxygen supplementation is required, the more consideration must be given to anemia and its consequences. Red meat is a good source of iron, enzymes and vitamins that help with anemia even more than supplements. Also eat foods that provide plenty of vitamin C, which helps your body better absorb the iron. Those who are anemic should be very sure to discuss their concerns with their doctor and get an adequate explanation that they are doing what can be done to either remedy the con- dition or keep the anemia stable and exerting the least negative influence possible.

Fred asks why after four months of using the Advair discus inhaler as prescribed, it burns his lungs when he inhales it. He takes it at night because that’s when a phlegm problem forces him to sleep just about sitting up.

image099Mark replies, It certainly is possible that Advair is not the right medicine for you. But, in taking it only at night you are not taking it as you should. It is supposed to be taken twice a day and as close to 12 hours apart as possible. It is not osusepdp to be taken for “phlegm control” though it should help reduce phlegm over time. There is a possibility that part of your difficulty with it is because of the once-a-day dosing pattern.

Ask your doctor if you can try Symbicort and about taking Spiriva, another very COPD- specific med that could help with phlegm.