Ask Mark …

Aparna, a nursing student, asks what the normal oxygen satura- tion level of someone with COPD should be.

Mark answers, There is no ‘normal’ or ‘standard’ oxygen satu- ration level for those with COPD. The normal range for oxygen saturation should be at or above s95%. A one’s COPD worsens,

image055and the FEV-1 (Forced Expiratory Volume in one second) falls be-  low 30% of predicted normal, we increasingly observe oxygen ‘desatu- ration’. There are some whose FEV-1 is greater than 30% who exhibit desaturation. Others may not exhibit desaturation until falling below 20% of predicted. The COPD population, as a whole, falls within a wide range of variation in terms of when they begin to exhibit desaturation.

Causes for desaturation include loss of blood circulation to the alveoli or air sacs in the lungs, loss of numbers of air sacs and air-trapping of stale air in the air sacs. Fresh air coming into the lungs cannot sufficiently raise the oxygen level because stale air cannot be expelled. When saturation is below 95%, lung disease with worsening oxy genation is under way. When satura- tion falls below 88%, supplemental oxygen to raise oxygen levels to above 90% is considered neces- sary. While I can’t give you a direct answer to your specific question, we want to see oxygen saturation 90% or above at all times, with or without supplemental oxygen.

Carolyn’s pulmonologist told her not to get a pulse oximeter so she wouldn’t concentrate on the numbers. He preferred her to concentrate on exercise, proper nutrition, taking her meds and getting proper rest.

Mark responds, I disagree with your doctor about his recommenda- tion not to get a pulse oximeter. The ‘problematic’ reference he made was probably that you’d  obsess  about  it and constantly be checking your saturation. While curiosity and novelty do tend to grab some folks when they first get their oximeters, it is usually short-lived. Most find that there are times when they should check their saturation and adjust their oxygen. They also learn when there are times that their  satura-  tion remains good or stable and doesn’t warrant checking. A balance is easy to achieve. As long as you don’t know what your saturation’s doing, you are at avoidable risk. In this case, ignorance is not bliss, or without consequence.

Sandy from Canada asks when should she take an antibiotic? She gets a cold that lasts for at least six weeks every Fall!

Mark replies, If one has a “cold,” antibiotics are not appropriate, as colds are caused by a virus. There is controversy about prescribing anti- biotics for “exacerbations” of COPD (what it sounds like you suffer from)

– not all physicians employ them right away when their patients have symptoms. Looking at sputum, or culturing it, is one means to get an idea if there is a bacterial infection going on. You may need steroids, rather than antibiotics.

If you are getting prolonged symp- toms like you describe, keeping in frequent touch with your doctor is a must. He/she needs to know that you are not well and not getting better in a reasonable amount of time. Use of antibiotics may be a desirable option farther down the line if your symptoms don’t improve. Don’t be afraid to present your argument to your doctor and ask if you should get antibiotics.

Shirley has been having throat irritation and wonders if it is a side effect of her Symbicort, ProAir and Spiriva inhalers.

Mark explains, Throat irritation from candida albicans yeast infec- tion, called thrush, is common in those who inhale corticosteroids (which Symbicort contains) if they don’t take proper precautions and rinse after dosing with them. Ask your doctor to check your throat. You may need some medication to resolve an infection.

Mark Mangus RRT, BSRC, is a member of the Medical Board of EFFORTS (the online support group, Emphysema Foundation For Our Right To Survive, www.emphysema. net). He generously donates his time to answer members’ questions.