Ask Mark …

Bob has Pulmonary Hypertension (PH) and wonders why his physician has not ordered an inhaler for him.

Mark explains, If your PH is the primary cause for your shortness of breath then all the inhaler use in the world will not have any beneficial effect to improve either your breathing or your oxygen saturation!

When PH is the predominant problem, only oxygen will offer the strongest benefit and a reduction in pulmonary artery pressure – a must in order to thwart the natural progression of right heart dysfunctio that results in right heart failure over time. Oxygen is a powerful pulmonary blood vessel dilator and works better than anything else, short of the few drugs introduced of late that are shown to directly relax the vessels, resulting in dilation. But, bronchodilators have no effect to improve pulmonary blood pressure and not surprisingly, since they act on the bronchial tubes and not the blood

One of the departures from the approach to treating those with more purely COPD is that people with PH should use oxygen to try to push saturations up to 96% and higher. It is not only safe, but it is “imperatohiuavte” ty maximize your oxygen saturation for the dilating effect it has on your pulmonary blood vessels and the reduced strain it fosters on the right side of your heart.

Philip from EFFORTS is fearful of having a heart attack while try- ing to reach his maximum heart rate especially with high blood pressure and being overweight.

Mark replies, We often see people who exercise vigorously who lower their systemic blood pressure to the point that many reduce the medica- tions they take to control hyperten- sion. Heart rate – in and of itself – is not the ‘trigger’ for myocardial infarction (MI or heart attack). It is one factor among several that “com- bined” will predispose one to MI.

Instead of pushing yourself to reach a heart rate number, I would suggest that if your breathing and physical tolerance of an exercise causes you to reach a heart rate and you are “tolerating” the inten- sity, then there’s no reason that you should back off or stop simply because you have hit that number. My bet is, for you and others, that your breathing limitations would hold you back from reaching maximums long before the heart rate alone would.

Moe from Canada takes Symbi- cort and it really has improved his breathing, but he finds he wakes up often and has restless sleep.

Mark advises, Steroid medications can cause disturbed sleep, though it is not often observed with use of inhaled steroids. Since your breath- ing has improved, I would suggest you continue the medication as the alternative might be much less tol- erable than the sleeping difficulties. Another consideration would be to exercise and stay active during the day to help you get tired enough to sleep better. Check to be sure you are not consuming any foods that might be causing the disturbance in your sleep. Consistent research studies find exercise-related activities during the day increase total sleep time!

FK from California notes that he always takes Advair first, then Spiriva but lately also needs to use his nebulizer with Xopenex. He wonders when to use the Xopenex.

Mark says, Xopenex is a fast- acting bronchodilator that is known to have less side effects of shakiness and jitters than Aluterol does. If you find you need to start the day with Xopenex, wait two to three hours before dosing with Advair. If you should need the Xopenex again, take it about three to four hours after your Advair. Then wait until after your evening dose of Advair to take the Xopenex. That would give you three treatments if you need that many.

If you need only one or two Xreoatpmeneenxts,t try to space them equally between the Advair doses. Be sure it has been at least two hours since your Xopenex treatment be- fore taking the Advair. It is important to keep your Advair doses as close to 12 hour intervals as possible.