Can I run on a treadmill if I have COPD and use oxygen?

Your question:  Can I walk on a treadmill if I have COPD and use oxygen?  I want to lose weight and strengthen my heart and lungs.

My answer:  The goal for any person with COPD is to stay as physically active as possible. I think that walking on a treadmill, even if you have oxygen, would be a great place to start. Just make sure you are careful, and know your limitations. On a side note here, it's always a good idea to talk to your physician before starting any workout program especailly if you have a disease like COPD. It's also a good idea to make sure you are not alone in your home when you are doing this. A good, safe, and highly recommended place for patients like you with COPD to get in shape, and strengthen your heart and lungs, is to talk to your doctor about participating in a pulmonary rehabilitation program. This way you will be able to get the exercise you need in a safe and professional environment. 

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COPD: Can I improve my lung function?

Your question:  I have been diagnosed with COPD.  My pulmonary function test shows moderate restrictive airway disease.  My FEV1 is 60% and FVC is 60%.  Can I improve these numbers?  Can I improve by lung function?

My answer: Lung function generally declines gradually in all people as we age, although smoking tends to speed up this process. Stopping smoking can prevent further damage caused by smoking. You can improve your lung function by taking medicines that help keep your airway open, such as Advair, Symbicort, Pulmicort, Brovana, Spiriva, Albuterol and Xopenex. You can improve your lung function by learning the best methods of producing a good and effective cough in order to clear secretions from your airway.  You can improve your lung function by avoiding things that irritate your breathing, such as cigarette smoke, strong smells, air pollution, strong chemicals, allergens, etc. You can improve your lung function by staying physically active. Those are all things that help to keep your air passages open and clear for the smooth, easy passage of air.

However, once lung tissue is destroyed (emphysema) it cannot be regenerated. Likewise, chronic irritation may cause inflammation and eventually scar tissue develops that causes chronic changes to your air passages.  This can cause permanently obstructed air passages in certain locations of your lungs.  

Your best bet regarding emphysema (a restrictive disease) and airway changes due to scar tissue is to stop smoking, and you've done that.  So you are well on your way to a healthier you. Good luck

Bottom line: You can improve lung function by staying positive and working with your doctor on a regular basis.  However, once airway tissue is damaged or destroyed due to smoking, this damage cannot be undone.  Stopping smoking, however, will prevent further damage in this regard.  

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What is pulmonary wasting?

The following is from the COPD community at healthcentral.com.

Your Question:  What is pulmonary wasting?

My answer:  I believe what you're referring to is the wasting of muscles due to inactivity as a disease like COPD progresses. A significant reason for inactivity may be progression of the disease, which may be indicitive of incresased shortness of breath, decreased energy, and depression. Muscles that may become wasted are those used for walking, standing, and eventually breathing. This is one of the reasons why the medical community encourages all people diagnosed with COPD to stay as active as possible, such as can be done at a pulmonary rehabilitation program. Another reason it may occurr is the loss of ability of your body to absorb necessary nutrients. For this a physician may refer a patient to a dietician, who may recommend eating smaller meals more often, and eating food high in nutrients (such as protein) that your body needs for muscle growth.

I have COPD? Why is my CO2 rising

The following question is from a community member at healthcentral.com.COPD.

Your Question:  I have COPD.  Why is my CO2 rising

My answer: CO2 is a waste product made made during the process of cellular respiration. When you inhale you take in oxygen needed for this process, and when you exhale part of what you are exhaling is CO2. When the lungs become diseased, the body may become less efficient at getting all the CO2 out of the blood. This may occur due to natural progression of the disease. Emphysema causes the breakdown of lung tissue, meaning there are areas of your lungs not ventilated, and this will increase CO2 in blood. Chronic bronchitis results in increased secretions in lungs that the patient is unable to get out, and this results in a breeding ground for infections such as pneuonia. The part of the lung with pneumonia is not being ventilatied, causing a rise in CO2. Another reason may be an exacerbation of COPD, and this may be caused due to pneumonia, but it may also be caused by some other trigger, such as a strong smell, mold, dust, allergen, etc. The best treatment and preventative measure is to work with a doctor on finding the best methods of controlling the disease.

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COPD: Why can't I take a deep breath?

The following question is from the COPD community at healthcentral.com. 

Your Question:  Why can't I take a deep breath

My Answer:  This would be a great question to ask those who take care of you, such as your nurse, physician, nurse practitioner, etc. We could attempt to answer it here, although we do not have access to your medical records to know what's going on with you. There are a variety of factors that could inhibit your ability to take deep breaths, such as progression of your disease, pneumonia, acute COPD exacerbation, muscle wasting, fatigue, etc. Your best bet is to work with your physician and the medical team around you for all the answers you need.

Is a humidifier beneficial if you have COPD?

Your question:  Does a humidifier help with chronic bronchitis, emphysema, or pneumonia? 

My answer:  I would not recommend a humidifier for any person who has a lung disorder, especially if you have asthma, chronic bronchitis, emphysema, cystic fibrosis, or any similar disorder.  Why?  To learn more you can check out this post. 

Note:  the post is written for asthmatics, but the information also applies for the other diseases mentioned. 

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Why does smoking cause emphysema

Your humble Question:  Why does smoking cause emphysema

My humble answer:  The best answer I have found so far to this question comes from this press release from the University of Iowa regarding a recent study that suggests a CT monitoring blood flow in the lungs can detect emphysema in the early stages: 

Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease.  The study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate.

The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung "optimizes gas exchange" and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.

This study suggests that the ability to distinguish when

I think that's a pretty good explaination of why smoking causes emphysema. 

to turn off or when to ramp up blood flow is defective in some people -- probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.

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Can humidifier cause fluid retention (edema)

Your question: I have noticed increased edema since being put on a bi-pap machine with moisture. I have a fluid restriction of 1 liter daily, but have not increased fluid intake. Could the distilled water that we put in the bi-pap machine each night contribute to fluid retention?


My humble answer: Good question

If you use a BiPAP without a humidifier your mouth and nose become dry and your lips crusty. So basically all the humidifier does is make up for this loss of oral and nasal humidity. So I wouldn't think this would have anything to do with fluid retention. However, it is fluid intake, and it is inhaled, and some may make it to the lungs, so it's possible this intake is overlooked by some physicians. Yet my humble opinion is this wouldn't be enough to "cause" a problem. If you perceive that it does, you should turn off the humidifier and call your physician. You should actually call your physician regardless, because he should know about any new "edema."
I will see if I can find any research or studies done in this regard and let you know what I come up with. Good luck. Rick.


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COPD attack, no one around: what can you do?

A patient just asked me: "I have emphysema, and I was lucky that I was with a friend because I had bronchospasms so bad I couldn't talk, and I couldn't help myself. What can I do if this were to happen and no one was around?

My humble answer: The best thing for you to do is ask that same question to your doctor. Although, if I were your doctor, I'd make sure you always have a rescue inhaler on hand so you can at least try to use it. However, I think the best way of dealing with a situation like that is to not let it happen. I think your doctor will make sure you get put on a medicine like Advair or Symbicort and/or spiriva, all of which are proven to improve lung function. On these controller meds you should be able to prevent an attack as you described, and, if you do have an attack, it won't be as severe.

Difficulty breathing through races? Why?

Every day at COPDConnection.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: my step son runs cross country but has a difficult time breathing through out his races we have tried zyrtec,claritin,cetirizine I know there is something that has to work but what.

Your Question:I can empathize with your stepson, because I've also been having a tough time with fall allergies, as I wrote about in my most recent post here. I find that even while new allergy medicines help, those pesky allergens still manage to find a way to cause problems.

The best thing to do is to discuss your concerns about your step son with his doctor (or have him do it if he's old enough). There are still other medicinal options available to you, as you can see in this post. Another option to discuss with your doctor is allergy testing and allergy shots, if you haven't done so already.

Obviously I can't diagnose your stepson, yet what you describe here makes me wonder if perhaps your step son might have exercise induced asthma or asthma in general. If this is the case, asthma preventative medicines might help.

At least these are some options to consider. Either way, you should definitely have a discussoin with his doctor, because there are options.

If you have any further questions email me, or Visit COPDConnection.com Q&A section.

Are there different kinds of COPD?

Every day at COPDConnection.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: I have asthma/copd,and basement 60%musty humidity. i want to move out of this house, but husband won't, what do i do about musty humidity?">COPD Connection.com we get lots of COPD related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: is dissiness a nicotine withdrawal symptom

My humble answer: I do not see dizziness listed as a withdrawal symptom. You can check out the symptoms in this quit smoking guide from the Michigan Dept. of Community Health or in this post. If you're feeling dizzy, and even if it is caused by quitting smoking, this can be a sign that something serious is going on, and you should call your physician.

Your Question: Are there different kinds of COPD?

My humble answer: Most of the time when a doctor is referring to COPD he is referring to either emphysema or chronic bronchitis. Yet occasionally asthma can fall into the COPD category when asthma becomes more severe. In most cases, however, when a doctor is referring to COPD he's referring either to emphysema and chronic bronchitis caused by smoking. Most people diagnosed with COPD usually have both chronic bronchitis and emphysema to some degree. I actaully go into this in more detail in this post.

If you have any further questions email me, or Visit COPDConnection.com Q&A section.

Can COPD be inherited?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: Can COPD be inherited?

My humble answer: That's a great question. Actually, about 98% of COPD cases are not inherited. However, your parents can give you the genetic disposition whereby if you smoke you will have a greater chance of getting COPD. For example, if you have the asthma gene, and you smoke, you are much more likely to get COPD as, say, someone who does not have the asthma gene.

A very small percentage of people, like 2% of COPD patients or 0.2% of the U.S. population, have what is called an antitrypsin deficiency. These people are predisposed to developing emphysema, a type of COPD, before the age of 45.

If you have any further questions email me, or Visit COPDConnection.com Q&A section.

What's the best method of airway clearance

Where I work, all patients get your plain old chest physiotherapy where you clap on their back or chest with cupped hands and position the patient accordingly. Sometimes we have a CF patient bring in their own mechanical percussor, yet that doesn't happen too often.

I've heard that acapella and flutter work good, yet since those devices are not reimbursed by medicare, our hospital does not want to absorb this cost.

So what means of sputum enhancement really is the best for our patients. The truth is, there really is no scientific evidence to support the use of any one over the other. The best method of proof lies in the eyes of the patient.

So, that in mind, I was doing my weekly perusal of medical blogs this past week and came across a post by Cystic Fibrosis fatboy called, "Acapella, Flutter, Vest, or Manual CPT?" Which one works best?.

Here is what CF fatboy writes in his own words:

• Manual CPT – In my opinion, this is THE best method for airway clearance when done properly. The downsides are the obvious space/time requirement, as well as a willing second party unless you’re somehow able to do it yourself. You can’t help but cough if you have anything in a particular lobe that needs to come out. If I had unlimited time and resources, I’d opt to have this as my treatment, but I have a life/job, and so does Beautiful. It just wouldn’t work for us.
• Flutter - I’d rank this as the second best. I was able to get the percussion sensation longer with Flutter than Acapella, so I think it did more, and I seem to remember it being a stronger feeling, even though the Acapella is adjustable. It’s so small, it’s ridiculous, not to mention it only being 3 parts and the easiest thing in our arsenal to keep sterile.
• Vest – Not all vests are created equal. I couldn’t be happier with my inCourage Vest system that I got last August, but it serves a purpose, but not the one I thought. I don’t go crazy coughing with it, but it does a fantastic job alleviating any wheezing I have at the time. It’s quite expensive, even with insurance (our durable medical equipment co-pay was still $1200, and I have an excellent HMO package. Is it worth it to me? Absolutely.
• Acapella – I have 2 of them that I bought out of pocket because my HMO wouldn’t pay for the device. I was keeping one in the car for my way to school if I had a wheeze and I keep one by my Vest. I find using both the Flutter and Acapella exhausting to use because of the deep breathing and strenuous spasms that follow, but I know they work.

I think it's important to listen to our patients so we can improve on what we do, which is why I follow chronic lunger blogs. For more on the perspective of CF bloggers, check out CF fatboy's blog, or these lung links.

Does it matter what inhaled steroid we use???

A new study published in the Journal of Allergy and Clinical Immunology and reported on here might prove that it does matter what inhaled corticosteroid a doctor prescribes to control your asthma.

The study, performed by General Practise Research Database (GPRD) studied 2,000 individuals with asthma, and compared the performance of QVAR and Flovent in the United Kingdom for one year.

The study "revealed that those treated with QVAR™ either as initial therapy or with an increase or step-up in dose had a similar or better chance of achieving asthma control than patients who were treated with fluticasone. Asthma control was achieved in the QVAR™ population at lower doses of drug versus those in the fluticasone population. The full article is available at www.jacionline.org/inpress."

GPRD is a not for profit organization, and I have found no evidence that the makers of QVAR (Graceway Pharmaceuticals) had anything to do with the funding of this study. If you know otherwise leave a note in the comments below.

This might be significant research, since recently (as I wrote about here) we in the asthma community have discussed the "theory" that QVAR might have a particle size that reaches deeper into the lungs, way down to the smaller air passages. This may be the reason for the better asthma control.

So if you're having trouble gaining control of your asthma on Flovent, or Advair, or even Pulmicort, you might want to discuss with your physician the possibility of trialing QVAR either instead of your current medicine, or in conjunction with it.

What is severe COPD?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: What is severe COPD?

My Humble Answer: Usually, severe COPD often refers to the last stage of COPD, where your heart is starting to wear down due to working hard to pump blood through your lungs which are severely obstructed. On an X-ray, or CT, this can be seen as an enlarged heart. Usually at this stage you become short of breath with minimal exertion. Now, I don't know if this describes you or not.

If this does describe you, our sister site has some great information to help you live well, check out this link for one example.

To receive the best answer to your question, you should discuss this with your doctor. He should be able to answer every question you have regarding your COPD.

Good luck.

If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section.

COPD Q&A

The following are quesions sent to me from COPD patients:

Question: Is there a treatment for copious secretions? I've been given different diganoses by different doctors...COPD, asthma, chronic bronchitis.My worst symtom is copious amounts of mucous. At times I have been on 5 different meds, but none of them get rid of the mucous. Looking for any advice about natural supplements or your favorite med that helps with this. I\'m already taking mucinex, either in pill or cough syrup form. Helps, but doesn\'t get rid of it. I cough up about 1/4 cup in the morning, then it continues all day long.

My humble answer: I'm afraid I don't have an answer for you. I don't know of any medicine that would remedy this.

This probably won't be any consolation, but it's not really a bad thing to be coughing up mucous. The purpose of your body generating it is to keep your lungs sterile. When bacteria and foreign materials get into your lungs mucous is formed and you generate a cough to get rid of it. This is one of many of your bodies defense mechanisms. If your body is not able to get this junk out this may result in lung infections you don't want.

I'm not trying to dissuade you from continuing your search because I want you to do that. Yet before you start taking any new medicine or remedy make sure you contact your physician before you do so.

Any further questions please inquire.

Can Advair & Spiriva be taken together?

The following question and answer is from a Q&A session at the HealthCentral network.

Question: What is the point of taking Advair and Spiriva together?

My humble answer: Great question. They are both preventative medicines. As you know every person is unique, and one person's asthma may be more difficult to control than another person's asthma. Therefore, it is the job of the doctor to work with you to find the best concoction of medicines to control your asthma.

There are basically your usual front line medicines that are recommended to treat asthma, and your second line medicines that aren't usually needed but sometimes can help control asthma. Advair is a front line medicine because it usually works fine by itself to get asthma under control. If, on the other hand, Advair alone isn't getting the job done, your physician may resort to trying second line medicines like Spiriva.

That said, Advair has both a corticosteroid (Flovent) to treat the underlying inflammation component of asthma, and long-acting bronchodilator (serevent) to prevent the bronchospasm (airway narrowing) component of asthma. Serevent is a beta-adrenergic medicine that causes bronchodilation (relaxes smooth muscles). It attaches to beta receptors in the lungs, and when this happens the lung muscles relax.

Spiriva is a long acting bronchodilator that works by blocking cholinergic receptors in the lungs that cause bronchoconstriction (airway narrowing) when stimulated. Thus, Spiriva is an anticholinergic medicine. In this sense, it is often referred to as a "back-door bronchodilator." It is not as good of a bronchodilator as Serevent, and therefore is a second-line therapy for asthma.

Recent studies, however, do show Spiriva improves lung function in COPD patients and some difficult to control asthma cases. Therefore, if front line asthma medicines like Advair do not control asthma, Spiriva is a good medicine to "try" in conjunction with the recommended front line medicines.

Of course, there's always the chance your doctor has a different reason for prescribing both Advair and Spiriva for you. Therefore, it is always a good idea to talk to your doctor so you are on the same page with him or her.

For more information, click here and here.

COPD: What causes anxiety and tremors?

The following is a question and answer session from MyAsthmaCentral.com

Question: My mother has chronic COPD she is on a xopenex inhaler & xopenex liquid for a nebulizer. PLUS she is using Spiriva once a day & Advair twice a day. She is on oxygen 24/7. She is suffering tremendously from tremors, shakes anxiety attacks as well as panic attacks that simply exacerbate her inability to breath...... She is 70 years old & weight approximately 82 pounds! Her pulmonary doctor has all but told her she has to "deal with it & stop bothering him" this is after ONE office visit & a follow up phone conversation from her to him because she is scared to death....... Can these symptoms be being caused by too many inhalers/ albuterol products?

My humble answer: Wow! I can't believe a doctor would say that. Perhaps your mom should seek another doctor? I can actually understand where he might be coming from, but one would think he could be more tactful than that.

That said, great question. First it's important you know your concerns are not uncommon, and that developing tremors is a common side effect from both the Xopenex and the Serevent in the Advair. If your mom is taking systemic corticosteroids (or was recently on them), this too can cause tremors, as well as other medicines your mom might be on.

Xopenex is supposed to be the best bronchodilator available with the fewest side effects. So, if this medicine is working to control your mom's COPD, there really is no better alternative. You certainly wouldn't want your mom to stop taking a medicine that can help her catch her breath as well as this medicine can. You just want to make sure she is only using it when needed, or as prescribed.

I am not aware of any COPD medicine causing anxiety attacks or panic attacks. While it could possibly be the meds, another option worth discussing with your mom's physician is anxiety caused by the COPD itself. The "fear" of becoming short of breath -- or being short of breath -- has been known to cause anxiety. A lot of the COPD patients I take care of are on some type of anti-anxiety medicine like Xanax. This is perhaps an option your mom might want to discuss with her doctor.

I wish there was an easy answer to your questions, but there really isn't. I wish you and your mom the best of luck.

Q&A about Advair and Symbicort

What follows are some of the most common questions asked in the Q&A section of MyAsthmaCentral.com and my humble answers.

Keep in mind that both Advair and Symbicort are generally the same type of medicine, both having a long acting bronchodilator to prevent bronchospasm, and a corticosteroid to treat the underlying inflammation prevalent in most asthma patients. They are also used for other respiratory illnesses, like COPD.

1. Can Advair cause you to bruise easily?: Even though bruising is not listed as a side effect of Advair, I know a lot of people who use Advair who complain of bruising. Yet, if this is an actual side effect, I also wonder if it could be eliminated with proper technique, i.e. rinsing after using it. I suspect this might be true, but I don't know for certain.

It is true that inhaling Advair directly into the lungs is supposed to eliminate systemic side effects, like bruising. At the same time, not rinsing your mouth out after using it can cause your body to absorb a small amount of the medicine, thus causing some minor systemic effects.

I'm interested in reading what other experts might have to say about this.

2. How long should anyone use anAdvair Diskus and can I use it every now and then? Advair is a medicine that is intended to treat chronic inflammation associated with asthma and prevent bronchospasm. It usually takes 2-3 weeks of continued use to fully get into your system. Therefore, it is an asthma controller medicine that must be used all the time, whether you are feeling good or not.

The corticosteroid component of this medicine (Flovent) strengthens you lungs, reduces inflammation, and creates more receptor sites for your rescue medicine to sit on, and thus makes your Ventolin work better. The long-acting bronchodilator component (Sevevent), works to prevent bronchospasm.

In this way, if you have Adviar in your system at all times, when you are exposed to your asthma triggers your lungs will be better able to prevent them from causing acute asthma symptoms, or make asthma symptoms less severe. And, in this way, the Advair may be working and you not even realize it.

So if you quit taking it on a daily basis you take away all the benefits of Advair, and risk even worse asthma symptoms when you are exposed to your triggers -- and no asthmatic wants that.
So, to answer your question, this is the type of medicine you may need to take forever to control your asthma. Do not change your asthma medicine regimen or dose without first talking to your physician.

For more information, check out this link.

3. I am using Symbicort twice daily can I use anything else to back it up for occasional relief

When I started taking Advair, which is a similar medicine to Symbicort, I had the same question.
The answer to your question is YES! Even though you are taking Symbicort twice a day you may still feel short-of-breath on occasion, and on these occasions it is safe to use your rescue medicine (Albuterol, Xopenex, Pirbuterol) as needed or as directed by your physician.

4. What is an alternative to advair and symbicort with less of an oral thrush side effect? There really is no alternative to Advair and symbicort, as they are the only meds that have both the long acting bronchodilator and the corticosteroid combination to prevent bronchospasm and combat chronic inflammation.

However, it's such a great medicine for asthma I'd hate to see you quit using it due to thrush. Thankful, there is a way to prevent and treat thrush. Check out this link here for some solutions.
5. could long time use of advair cause sore, white spotted tongue and red roof of mouth: The answer is YES.

The steroids that settle in your mouth may wipe our the normal bacteria that live in your mouth that prevent the buildup of yeast or candidiasis in your mouth. Absent this bacteria, yeast may build up and cause white patchy spots in your mouth called thrush.

After using inhaled corticosteroids for over 25 years I I had thrush only once and my doctor prescribed Diflucan. It is a pill I took for only five days, and it worked great. Nystatin is a rinse that works fine too.

Here is a good tip: The best way to prevent thrush is to rinse and spit after every use of Advair or any other inhaled corticosteroid.

6. Can inhaled steroids like Advair cause cavities?: I did read recently that inhaled corticosteroid use has been linked to cavities too, and it is a good idea to brush your teeth after using an inhaled corticosteroid along with rinsing.

If you have any further questions about asthma you can set up an account at MyAsthmaCentral.com. Or you can email me any question at freadom1776@yahoo.com

COPD: Is Spiriva, Advair or Xopenex right for you?

The following question was emailed to me, and I've decided the answer would be of interest to many of my readers.

Your Question:

Hey - I'm a student therapist right now but I was talking to my manager about her mother and she has emphysema. She's on home oxygen and her doctor prescribed xopenex BID via HHN, advair BID, and spiriva QD. I'm wondering if this is a little excessive considering xopenex and salmeterol are both beta-adrenergic bronchodilators and considering xopenex is a short acting bronchodilator while salmeterol lasts much longer why is the doctor prescribing the xopenex? She doesn't have asthma so I don't believe she has a need for a fast acting bronchodilator. Also since shes taking salmeterol (in advair) twice a day, is the spiriva really needed as well?

My Answer:

Great question. I think your doctor is right on track with the Advair and spiriva. Advair has both a long acting bronchodilator and corticosteroid component to prevent bronchospams and control inflammation. Spiriva, believe it or not, has been proven to improve lung function, something every emphysema patient could benefit from.

Xopenex should definitely be ordered, but only on an as needed (prn) bases to treat acute episodes of shortness of breath due to bronchospasm. In my opinion, there is no added benefit from pre-set frequency of Xopenex unless the patient is often short of breath despite all the other medicines.

Here's an exception to that last statement: some COPD patients have trouble deciding when they need to use their rescue medicine. For these patients, a set frequency may be indicated. For the most part, however, Xopenex should only be used if it is needed.

One of the neat things about Spiriva only being needed once a day, and Advair twice a day, is this improved patient compliance with these meds. With improved compliance, the rescue medicine (Xopenex and Albuterol) should be needed less often.

Note: All asthma and COPD patients should have either a xopenex or Albuterol inhaler handy at all times, and perhaps, if indicated, the capability to take breathing treatments.