Mark Mangus, RRT EFFORTS BoardAlex from Minneapolis, MN, asks Mark about exercising when you have pulmonary hypertension (PAH). Mark explains,

of paramount importance is to maintain adequate oxygenation while exercising. If not maintained relatively high, breath- lessness and anxiety will rule, bring- ing those who suffer them to their knees. If you are not able to keep your saturation greater than 94% while exercising, this could be the reason you are struggling. If you don’t have a pulse oximeter to measure your oxygen saturation, then you have no way of knowing what your saturation is running and that is likely the key


Folks with significant PAH require very high amounts of oxygen to keep them adequately saturated, either in high enough flow at fixed concentra- tions (high-flow Venturi mask, like I use in my clinic) or high concentra- tion masks with more than the usually recommended flow (as a non- rebreather mask). So if you find that you’re not saturating well enough and find that your oxygen system resources can’t get you there, you need to find a place where you can get the needed oxygen in the right amount.


To humidify or not to humidify?

That is the question!

Mark advises, while evidence suggests that not a whole lot of humidity/moisture is added to oxygen as it passes through water in a humidifier, nevertheless “some” moisture is indeed added. On the downside, humidifiers are a site of contamination and potential prolif- eration of bacteria that can cause respiratory infections. They are also a site for leaks when not assembled properly and tightly.

Just because humidifiers can be a source of problems doesn’t make it good practice to simply not use them. As my friend and colleague, John Goodman RRT advises, use of humidifiers is a must for Trans- Tracheal Oxygen users, regardless of how little moisture they may be construed to add. We know that not using them results in complications that are not seen when they are used. Regardless of how much they add, it is nevertheless a critical amount! Care in keeping humidifiers clean and changing them out at regular intervals is the solution to avoiding potential problems.

Humidity in the air has virtually nothing to do with whether or not the dryness of oxygen flowing across your mucus membranes will cause irritation, bleeding and potential infection. Use of a humidifier should never be tied to the question of atmospheric humidity.


Penny from EFFORTS asks what the difference is between Perforomist and Brovana and is one preferred? Mark replies,

Perforomist is For- moterol. Brovana is Arformoterol. They are similar except that Brovana is the Formoterol molecule that has been “split in half, lengthwise” and is only the active half. Formoterol has the two halves together, one of which does not cause the desired action. Some would argue that in theory, Brovana is better. Clinically, it varies among individuals. The only way to know is for an individual to use each for a period of time and see if they can tell a difference. For many, they won’t

notice a thing.


Linda was wondering if Daxas® will replace a steroid, is it in a class by itself? Do users overseas take a steroid inhaler in addition to Daxas®?

Mark tells us Daxas® roflumilast has been approved in the E.U. for the maintenance treatment of severe COPD in patients with chronic bronchitis and a history of frequent exacerbations. It will be used as an add-on to bronchodilator treatment. It is not intended to replace any component of the inhaled medications currently used. It is intended to serve as yet a fourth prong in the classes of drugs used to treat COPD, particularly chronic bronchitis. Phosphodiesterase inhibitors help reduce an irritant that is responsible for causing inflamma- tion. Some folks may find that they can do just as well without their inhaled steroid if Daxas® is effective for them. Others may benefit from the action of

Daxas®, but still need their steroid.


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.