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Sunday, April 14, 2019

Are there other names for rescue inhalers?

Your Question. I've read an article lately where the rescue inhaler was referred to as an emergency inhaler? Before this I only heard it called rescue inhaler or the name of the drug. Has something changed?

My answer. Great question. es. For the longest time I only heard it called a rescue inhaler or the drug name. I'm almost thinking it's regional what it's referred to. Some refer to it as emergency. If you check out the GINA Asthma guidelines, they say both terms are acceptable. But, they prefer it be called a reliever inhaler. I guess it doesn't matter what it's called as long as it works, hey?

Wednesday, April 10, 2019

Oxygen Concentrators vs. Liquid Oxygen: What’s the Difference?

Hello all. The following is a guest post from Scott Ridl 

When patients are instructed to begin oxygen therapy, they have two choices: oxygen concentrators and liquid oxygen. The main difference between an oxygen concentrator and a liquid oxygen tank is how the oxygen is supplied: an oxygen concentrator creates oxygen from the air around it, while liquid oxygen tanks store oxygen in liquid form to save space.

Core Differences: Oxygen Concentrators and Liquid Oxygen

Both methods of supplying oxygen to patients have their advantages and disadvantages, as well as important considerations to keep in mind when using them.

Power: One of the main differences between an oxygen concentrator and liquid oxygen, also called LOX, is the need for a power source. Liquid oxygen tanks do not require any electricity, as the pressurization delivers the oxygen in the tank itself. Oxygen concentrators, on the other hand, must be plugged in or use a battery to supply power to the unit. While portable oxygen concentrators are useful in that you don’t have to lug around a heavy tank, it can be difficult if you’ve run out of batteries or the power is out — and you don’t have any backups.

Oxygen Supply: Because oxygen concentrators create the oxygen the patient breathes, it does not require a store of oxygen as tanks do. Liquid oxygen tanks must be replaced at least once every one to two weeks — once the supply in a single tank is gone, there is no more oxygen. This can be inconvenient for patients who would like to spend time outside of the home, or even dangerous for patients who have particularly serious illnesses.

Size: Most liquid oxygen tanks are large, heavy and unwieldy. This can make it very complicated or even impossible to move around — leading to many oxygen users who feel trapped at home. Oxygen concentrators, on the other hand, are made for portability.

Cost: The upfront cost of a portable oxygen concentrator may put off some users, but the cost of a liquid oxygen tank is ongoing — you must continuously have your new oxygen tanks delivered, and old ones picked up. Because this happens so frequently, the costs can add up well beyond the initial investment of an oxygen concentrator.

Leaks: Liquid oxygen tanks may also experience leaks — not only does this waste oxygen, it creates an increased risk of a fire. While oxygen itself is not flammable, too much oxygen in the ambient air creates an environment in which a fire burns more rapidly and intensely.

Travel Capability: According to the Federal Aviation Administration, compressed or liquid oxygen is not permitted on flights. Some airlines may allow portable oxygen concentrators or provide oxygen service, but this can be worrisome for patients who require continuous oxygen and use liquid or compressed oxygen tanks.

There has been some concern among patients who use portable oxygen concentrators regarding the units’ ability to be used at high altitudes, considering that liquid tanks are not permitted on airplanes. Most oxygen concentrators can be safely used at high altitudes — they may work less efficiently, however, and some may cease to function at exceptional elevations. Portable oxygen concentrators often come with operating ranges, which include not only temperatures but altitude.

One study, for example, completed for the National Space Biomedical Research Institute, evaluated both the SeQual Eclipse and SeQual Integra oxygen concentrators at 30,000 feet — well above their “intended” altitudes. The SeQual Eclipse II, an older model, “failed to operate above 22,000 feet,” though power consumption decreased and battery life increased before then at lower, but still high, altitudes.

The SeQual Eclipse 5 has an operating range of up to 13,123 feet, while the Respironics SimplyGo can go up to 10,000 feet. No adjustments have to be made to the unit to operate at these higher altitudes, but patients should be aware of the differences before flying — namely, that the unit may cease to operate at certain altitudes. 

Portable oxygen concentrators all have operating ranges that begin at sea level, and there aren’t many places on earth that are below that altitude. Since oxygen concentrators only showed signs of varying functionality at altitudes well above their intended operating ranges, patients can feel safe and secure knowing that their portable oxygen concentrators are by their sides. 


Wednesday, January 2, 2019

Happy New Year!!!!!

The times have changed. Independent blogging isn't as huge as it once was. Most of us are now writing for other health communities, is the reason. But, I've managed to keep this blog going. It's still here for anyone to enjoy.

Something I struggled with is who to make as my general audience here. Initially I wrote to respiratory therapists and patients. So, it was a unique situation to be in. It would have been easier just to focus on the  respiratory therapy profession. Here I share wisdom, but also poke fun at some of the unique situations we find ourselves in.

But, I started out also telling my story about asthma. So, this sort of spawned my asthma writing career. And I also wrote about COPDers. There are the types of patients we RTs take care of nearly every day. So, it's kind of hard to have an RT blog and not focus on the patients we get to know on a daily basis.

So, here we are going into our going into our 12th year. So many things have happened in that time. So many people have turned to the RT Cave for a tip or for a laugh. It's neat that we are still around. And it's neat that you're still popping in once in a while.

So, Happy New Year! We're going to make this the best ever!

Friday, December 14, 2018

The Dim Stethoscope

You see them in isolation rooms. They are usually referred to as Fake Stethoscopes. They are made by Fake Incorporated.

Sometimes they are referred to as "Dim Stethoscopes." It's because you can't hear lung sounds for crap. So, you find yourself just writing or clicking, "Diminished."

And sometimes you don't even bother using it. I mean, it's been in the same room as a MRSA patient for a week now. And the lung sounds have been the same since the patient arrived.

And so you just scan the patient. You start the treatment. And you just (if no one is looking, that is) go right to charting. And, without even touching the Dim stethoscope, you click: "Diminished."

There is one exception. If the patient is wet. That's the exception. Because, if that's why the doctor ordered it, it's mainly because of that audible cardiac wheeze. You don't need a stethoscope to here it. So, you can then click on "Wheeze"

So, that's your prototypical dim stethoscope. The patient is dim whether you use it or not, so you might as well just not. But, usually you do. But, still, it's dim and dimmer. Thoughts?

Wednesday, November 7, 2018

A Consensus Is Not Science

You cannot vote on science. Science either is or is not. So a consensus is not science.

In 2010, The CDC's Advisory Committee On Immunization Practice voted. They voted that everyone over the age of 6 months should be vaccinated against the flu. (1)

Personally, I'm in favor of the flu vaccination. But, I will admit this is my opinion and not science. It is not science that the flu vaccine will prevent you from getting the flu. In fact, the flu vaccine, in the years researchers are the most accurate at guessing what viruses will be in the air in a given season, is only 40-60% accurate. (2)

This is because there are many, many, many different flu viruses. It's also because the flu virus can mutate. So, even if you are vaccinated against the H1N1 influenza A virus, you can still get the H1N1 virus.

This happened in 2009. The H1N1 flu virus is one of the most popular flu viruses. You are vaccinated against it every time you get a flu vaccine. But, in 2009, the virus mutated as it passed from birds to chickens to swine. It picked up swine DNA. This made it a different H1N1 virus. Even if you were vaccinated against H1N1, you could still pick up this virus. (3-4)

Another good example of how a consensus is not science is global warming. Ninety-seven percent of scientists are said to agree with global warming. But, a consensus is not science. Science either is or is not. So, just because 97% of scientists vote in support of global warming does not make it so. (5)

This is compounded by the fact that their same data suggests there has been no increase in global temperatures since 1998. (6)

I'm just saying.


  1. "Key Facts About Seasonal Flu Vaccine," CDC,, accessed 11/7/18
  2. "Vaccines Effectiveness: How Well Does the Flu Vaccine Work," CDC,, accessed 11/7/18
  3. "The 2009 Influenza Pandemic: Summary, Highlights, April 2009-April 2019," CDC,, access 11/7/18
  4. Micklos, John, Jr., “The 1918 Flu Pandemic: Core Events Of A Worldwide Outbreak,” 2015, Capstone Press, Canada, pages 10, 12-13
  5. "Scientific Consensus: Earth's Climate Is Warming,", accessed 11/7/18
  6. Lindsey, Rebecca, "Did Global Warming Stop In 1998,", accessed 11/7/18

Monday, November 5, 2018

My Health Insurance Company Called Again!

Those dog gone suckers just won't leave me alone. My health insurance company, that is. They called me for the 4th time to talk to me about talking to a pharmacist to review my medicine.

I actually tried to be nice this time. So, I just said, "Why do I need it?"

To be honest, I think me asking this threw the person off her script. She didn't know what to say.

After a long pause, I said, "I already talk to my doctor about my medicine. Why do I need to talk to a pharmacist."

"Well," she said, "It's nice just to have your medicine reviewed by a second person."

I said, "Why would I need that. Like I have said every other time someone has told me I need to review my medicine. I already review my medicine with my doctor. I'm also a respiratory therapist. What more is there for me to gain?"

Once again I threw her off script. And, allow me to add again that I tried to be very pleasant with my tone. I was a nice boy. I was hoping to get a good answer that satisfied me. I was hoping she would tell me that it was required or something. But she didn't.

She just said, "Sorry to bother you." She pleasantly hung up. Unlike the last time they called. That lady abruptly hung up on me. They probably think I"m a jerk. They fail to see why this would be annoying to me.

Keep in mind this happens every year. My insurance company calls me. My pharmacist bugs me every time I go to pick up a prescription. Like, this gets annoying.

This leaves aside my other frustrations with my insurance company. Like, I used to be able to get prescriptions filled when I needed them. Now they limit me to one a month no matter what?

So, what if my Symbicort gets lost? For the past 30 years I've always had spare inhalers. Now I can only have one. So, what if I lose it.  I ask that rhetorically, because i know the answer.

In fact, I think I know what I"m going to say the next time they call me (which will probably be next week). If I answer the phone, I'm going to say, "I will talk to your pharmacist if you allow me to get an extra Symbicort. If I lose one then at least I have a spare."

Tuesday, October 30, 2018

Who Died And Made Insurance Companies Doctors?

I usually stay pretty cool about things. But, I'm getting rather annoyed that insurance companies have more control now than doctor's do. I'm just beside myself at how annoyed I am about this.

For starters, my pharmacist insists he needs to sit down with me and review my medicine. The past two years I have adamantly resisted this. I don't need to review my medicine. It's something I do with my doctor when needed.

Why would I need to sit down with my pharmacist so he can tell me what I already know. Besides the fact I'm a respiratory therapist who is a writer who specializes in asthma. Like, I read up on asthma every day. Asthma is my specialty. Not saying I know it all, but I certainly don't need to be lectured by my pharmacist.

So, today I get a call from my insurance company. It's a call I have not taken until today. But, considering they are persistent and keep calling frequently, I finally took the call today.

And, lo and behold, a nice lady is on the other end. She says, "It's time for your yearly pharmacy review."

I said, "I don't need to review my medicine."

She said, "Okay, did you already do your yearly medication review with your pharmacist?"

I said, "Why would I need to do that when I know more than the pharmacist about the medicines I'm taking?"

To my dismay, she hung up. Was my tone too rude? Perhaps. That's not what I intended. I actually wanted to continue the conversation, because I wanted to inquire as to why they insist on continuing to bother my about this.

Look, I have worked hard to get to the point where I am with my asthma control. Like, I know what medicines I take and why I take them. And, quite frankly, I use my medicines, sometimes, in ways the FDA does not approve of yet.

For instance, Symbicort is used as a rescue inhaler in Europe. The idea here is that, if you're having a flare-up, you should be getting the extra steroid along with the beta adrenergic. I find this works great for me.

But, I say this to the pharmacist and I get a lecture. It's like, "You know, you can't use it that way."

And I say, "Do you know they use it as a rescue medicine in Europe. The only way it's not approved for use this way in the U.S. is because the FDA lags long behind Europe in this regard."

Of course, I usually catch them off guard with such statements like this. And so, they read from the script they were trained to memorize: "You should use your medicine only as directed by your physician."

I think that most doctors agree that asthmatics are better at managing their medicine than most physicians. That's why, for most of my life, my doctor has allowed me to do this. So, I don't need a pharmacist doing this for me. I certainly don't need a person sitting in a leather chair who never has seen an asthmatic reviewing my medicine with me.

I understand pharmacists are just doing their job. They are told what to do by the insurance companies. That's why they bother me. So, I'm usually nice to them. I make it quite clear that I know it's the insurance company that I'm irritated with, not the pharmacists.

So when the insurance company itself called me, that set me off. Like, I don't think insurance companies should have more power than doctors. My doctor writes the prescriptions he thinks I need. The pharmacists roll is to fill those prescriptions. My insurance company's role is to pay whatever they agree to pay. And that's it.

I imagine, since the person hung up on me, this might come back to haunt me somehow. I suppose, the next time my pharmacist wants to sit down with me, or when my insurance company calls, I might have to indulge them. But, I'm not sure I will be able to do that without sounding so annoyed -- because I am annoyed.

So, frustration lingers long in my mind about this insurance company having too much control thing. I don't want to start repeating myself. If you want to read more on this check out my post, "Are Insurers Smarter Than Doctors?"