God formed man of the dust of the ground, and breathed into his nostrils the breath of life: and man became a living soul—Genesis 2:7
Breathing is life. We breathe approximately 15 times per minute, 900 times per hour, and 21,600 times per day. That is a lot of breathing. We don’t think about each breath, and the body automatically regulates the rate and volume of each breath based on chemoreceptors throughout the body. The air that we breathe needs help to be acceptable to the body. The nose is the primary regulator for the air needs of the body. The nose warms, humidifies, and filters the air we breathe. If the air quality is not what the body needs, the nose kicks in to attempt to fix the air. What happens when the nose can’t do the job?
Today we are very aware of what we eat or drink. We eat about three times per day and should be drinking eight glasses of water per day. Neither one of these comes close to the 21,600 breaths we take each day. Health-conscious people make sure they drink filtered water and eat organic food; do these health-conscious people ever think about the air they breathe? They should.
Air pollution is the major cause of chronic lung disease. Air can be polluted with cigarette smoke, industrial pollution, or any other contaminant that can damage the fragile lung parenchyma. Particles in the air are often triggers for allergy and asthma and can create a significant problem for patients with reactive airways.
Respiratory care professionals are aware of the many contributing factors that impact breathing, yet they have been in the reactive rather than proactive mode in treating the negative effects. Health care reform is going to require a new way of addressing our health care dilemma, and critical thinking skills will focus on how we can prevent disease and the associated complications as opposed to waiting until a disease occurs and treat symptoms.
We have all heard of bad air quality days. What does that mean? For patients with chronic lung disease or reactive airways, it means stay in the house and keep the air conditioner running. Elevated particle count or chemicals in the air can trigger a bronchospasm or worse, and many patients have experienced shortness of breath when they get caught in a bad air environment.
Our air is getting more polluted with particulates and chemicals, and we are adapting (poorly) and paying the price in significant increases in chronic lung disease.
Air filtration is becoming a more popular option for cleaning the air we breathe. Different approaches to air filtration include gross particle filters, HEPA (high efficiency particulate air) filters, and ozone generators for most commercial applications. Depending on the need for air filtration, capability and cost are usually the deciding factors.
The challenge with air filtration is to make it practical for continuous use. Home filtration systems try to clean the entire environment; the larger the size of the room (or house), the greater the challenge for the system. Furnace filters are a first step; room filters are options. Filter masks are used for obvious air filtration needs, yet patients do not wear a mask on a daily basis. Sleeping is an ideal zone for filtration as the patient is not moving and there is little concern about appearance when sleeping. Many sleep-related issues can be triggered with particulates in the air. More research is necessary to determine the benefits of continuous air filtration and the best “zones” for filtering air (Figure).
Air Temperature Control
Our airways are very fragile when it comes to temperature control. The nose does the best job it can to regulate inspired temperatures, yet if extremes exist, the nose will not be able to compensate. We typically avoid extreme temperatures, as not only does our nose not like the extremes, the rest of the body will complain when temperatures are outside our comfort zone. Any airway temperature outside normal body temperature will require regulation. Hot temperatures are typically better tolerated than cold (within reason). Cold temperatures cause airway reaction and constriction. During the winter months in the north, chronic lung patients try to avoid going outside as much as possible. This creates a sedentary lifestyle that can have a negative effect on secretion removal and overall conditioning.
Home remedies for breathing cold air include scarfs or masks. The problem with this approach is the exhaled cold, moist air will condense on the scarf and freeze. This reduces the effectiveness of the warming, plus it will increase the breathing work load. An effective mask should be able to heat the inspired air, prevent condensate, and not increase the work of breathing. A mask that acts as a heat moisture exchanger (HME) can treat the patient’s inspired air similar to systems used in hospitals for artificial airways.
Air Gas Mixture
Typical ambient gas mixtures are well regulated by nature. If some environmental issues cause the gas mixture to vary, the body will compensate with an increased respiratory rate. Lung damage is a major reason for chronic lung patients to require supplemental oxygen; even though the balance of gas is adequate, gas exchange efficiency is less so. Supplemental oxygen systems are available for both stationary and portable use and increase the fraction of oxygen the patient inspires. Carbon dioxide elimination is accomplished with respiratory rate control. If the patient cannot regulate CO2 on their own, augmented ventilation is required.
The old adage of closing the barn door after the horse is gone has been around for years, indicating that it is better to prevent a problem rather than trying to solve it. Patients with chronic respiratory disease need to be vigilant and responsible regarding their health. They depend on their clinical team to help them understand their disease and what they can do to prevent complications and exacerbations. The team approach to medicine requires a good understanding of the options available to prevent complications. Technology exists to address most issues, yet an understanding of what products to use based on capabilities and value is the challenge in today’s market. How do you know what a product can do and if the claims are truthful? Asking questions and researching is a good first step, yet the majority of home care products do not have many peer-reviewed articles available.
Common sense medicine can be effective for basic preventive care. Patients who react to particles should use a filtration system to remove particles that would trigger a breathing event. Patients who react to cold air should be encouraged to use an effective mask system that will heat and add moisture to their inspired gas. Patients who become hypoxic with activity should be evaluated by a clinician to determine if there is a need for supplemental oxygen. Many patients think they are out of shape when they have difficulty breathing. This could be a fact with a very sedentary population, yet if a disease exists, going to the gym is not going to get the patient back in shape until optimal treatment of the disease is accomplished. The patient can work to the best of their capabilities once their treatment is optimized and gain conditioning that will improve their overall health.
Controlled studies are the best evidence of an effective therapy. Published data in a peer-reviewed journal is ideal, yet the cost of this type of study prevents most research. Patient experiences that are documented can help to give a feel for the effectiveness and acceptance of a product, yet can be affected by either patient or clinician bias. Personal experience and word of mouth are the most used method in home care, which drives most products to a consumer preference rather than effective medicine.
Proactive, common sense prevention of respiratory-related events is necessary to reduce overall health care costs. Simple solutions are available to help respiratory patients prevent triggers that will exacerbate their disease. Wearing an effective heat moisture exchange mask when going out in the cold is a good idea. Filtering the air the patient breathes can prevent contaminants from entering the respiratory tract and triggering a reaction. Providing adequate oxygen to a patient who needs it, to prevent a sedentary lifestyle, is a good idea. Blowing off CO2 to reduce the work of breathing and give the respiratory muscles a break can reduce acute episodes requiring hospitalization. We need to take action to prevent problems for respiratory care patients as opposed to treating a problem that already exists.
Taking a preventive approach to controlling the air a respiratory patient breathes can help prevent complications. Simple, common sense solutions exist and do not require sophisticated medical intervention to accomplish significant health benefits. Using an air filtration system that prevents the inhalation of particulate material can prevent exacerbations. Having a filtration system that the patient can use consistently is a challenge that can be overcome with newer technology that targets breathing “zones.” Warming and adding moisture to the air a patient breathes in cold environments has been used by mothers for years, yet the home solutions need a little help. New technology that uses hospital principles is available and will improve the effectiveness of “Mom’s scarf or muffler.” Effective oxygen therapy is a challenge that has been evolving and new understandings and products are improving efficiency. Noninvasive ventilation is being used earlier in a patient’s disease process and helping to prevent the complications of hypoventilations. Simple solutions and common sense will help us treat the air a patient breathes and prevent costly complications before they occur.
Robert McCoy, BS, RRT, FAARC, is managing director, Valley Inspired Products, Apple Valley, Minn. For further information, contact [email protected]