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Respiratory Disease Management

Good breathing is vital to your overall health; conditions that affect your lungs and respiratory system can impact your quality of life.

To help improve breathing function, your healthcare professional may prescribe more complex respiratory care, such as a device for non-invasive ventilation (like the Trilogy or Astral™), airway clearance (like CoughAssit T70) or high-frequency chest wall oscillation (like AffloVest®). These innovative care devices can assist you on the road to better breathing! Frontier and our team of respiratory experts will be at your side for each and every breath.

Program Overview
Your Lungs & Breathing
Respiratory Devices
Program Overview

Program Overview

At Frontier Home Medical, we aim to provide extraordinary patient disease management, improve quality of life, achieve measurable outcomes and change home healthcare delivery. We work to match the right equipment to your needs and support you in your journey.

Your Frontier Team

As your home-based care manager and equipment provider, we have partnered with your physician to provide the best care possible. Your Frontier Non-Invasive Ventilation team includes:

• Respiratory Disease Manager to oversee overall care and device management
• Respiratory Care Specialist to manage and monitor day-to-day health progress and perform machine- and care-related visits
• Customer Service Representatives to accommodate resupply, billing and scheduling needs
• Patient Care Technicians to provide and service oxygen

Your Lungs & Breathing

Your Lungs & Breathing

Every cell in the human body needs oxygen to function properly. When you breathe in, your nose cleans, heats and humidifies the air. The air then moves through your windpipe (trachea) and into the bronchi (air passages) of your lungs.

At the end of each airway are grape-like clusters of air sacs (alveoli); this is where oxygen gets transported into your bloodstream via small capillaries. Then, oxygen passes from those capillaries and is transported throughout your body.

As you breathe in, your chest and ribs expand and the diaphragm moves downward; allowing air to fill your lungs. As you breathe out, your diaphragm and rib muscles relax and air leaves the lungs out of the mouth and nose.

The Gas Exchange

As the body uses oxygen, blood carries the waste gas (carbon dioxide) back to the lungs. The carbon dioxide then leaves the body with the air you exhale. The process of getting oxygen into the body and carbon dioxide out is called gas exchange and it is your body’s fuel system to live a healthy life.

Tips for Better Respiratory Health

• Stop smoking and avoid secondhand smoke.
• Stay active. Exercise as directed by your doctor.
• Sit up straight. Better posture can make more room in your chest for air.
• Avoid infections by washing your hands often, using hand sanitizer and staying away from people with respiratory infections.
• Stay hydrated. Getting enough water is important to your lungs and body.
• Help prevent lung infections by regularly cleaning all respiratory equipment.
• Be sure to get vaccinations, including flu, pneumonia and COVID vaccines.
• Stay away from irritants (particles that irritate your airways), like strong odors, scented products, allergens and chemicals.

Respiratory Devices

Respiratory Disease Management Devices

When you need support for your breathing, your healthcare professional may prescribe a respiratory assistive device. To get set-up with the device and have ongoing care as you utilize it, that’s where Frontier comes in. Our promise to you: Frontier will be there every step of the way!

Respiratory Disease Management Devices include:

• Philips Respironics Trilogy Evo
• ResMed Astral™
• Philips Respironics CoughAssist T70
• AffloVest®

Non-Invasive Ventilation
Benefits
Respiratory Disorders
Medical Devices
Compliance
Oxygen
Humidification
Masks & Mouthpieces
Cleaning & Maintenance
FAQs
Travel Tips
Non-Invasive Ventilation

Non-Invasive Ventilation

When your healthcare professional prescribes Non-Invasive Ventilation (also known as NIV), this can be a method to better provide respiratory support and treat respiratory failure. 

Goals of Therapy

• Improve rest and sleep quality
• Improve daytime sleepiness and fatigue
• Improve overall energy level
• Improve shortness of breath and reduce work of breathing

Potential Outcomes

• Minimal to no unexpected doctor’s visits, hospitalizations or ER admissions
• Prevent exacerbations and pulmonary infections
• Overall improvement in quality of life

Benefits

Benefits of Ventilation Therapy

When used according to your care plan, you may experience many benefits with ventilation therapy:

• Enjoy a better quality of life
• Rest respiratory muscles
• Improve the work of breathing
• Improve shortness of breath
• Improve oxygen requirements
• Reduce daytime sleepiness and morning headaches
• Improve sleep quality
• Improve the oxygen/carbon dioxide levels in your blood
• Inflate lungs more fully
• Reduce hospitalizations
• Improve strength for speaking, eating and drinking
• Improve energy levels
• Improve energy and activity levels

Respiratory Disorders

Understanding Respiratory Disorders

Difficulty breathing occurs when the process of breathing is interrupted due to muscle weakness, blocked airways, chronic conditions or respiratory disorders. Symptoms will vary depending on the type and severity of the condition. Not breathing well can mean diminished oxygen levels, increased carbon dioxide levels and can challenge overall health. Improved breathing can improve your quality of life.

Respiratory Conditions

Many disorders, or a combination of such, can worsen breathing functions. Understanding respiratory symptoms will help you understand the importance of ongoing therapy and treatment. Non-Invasive Ventilation (NIV) is used to treat respiratory failure related to disorders resulting in high blood carbon dioxide and or low blood oxygen or progressive neuromuscular illnesses when all other therapies have been tried and failed.  Disorders most commonly treated are:

• COPD
• Progressive Neuromuscular Illnesses, such as ALS, Muscular Dystrophy and MS
• Obesity Hypoventilation Syndrome

When left untreated, severe or life-threatening health problems may develop. These include abnormal heart rhythm, heart failure, stopping breathing, brain injury, comas and more.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease, or COPD, is a set of disorders that include emphysema, chronic bronchitis and bronchiectasis. COPD is characterized by chronic airflow limitations in the lungs making breathing in or breathing out difficult. Airflow limitations result from damage to the lung units responsible for the exchange of oxygen and carbon dioxide. Smoking and irritant exposures are the leading cause of COPD. COPD is a common, but serious, life-long condition that is preventable and treatable.

What are the symptoms?

When you get less air in, less oxygen gets to the body and it gets harder to get rid of the waste gas carbon dioxide. Symptoms can vary from person to person and mainly depend on your overall health as well as the severity of this illness. These symptoms may be more severe with activity or during flare-ups. In general, people with COPD experience the following:

• Shortness of breath at rest and with activity
• Confusion
• Morning headaches
• Chronic cough with mucus production
• Chest tightness
• Reduced ability to perform daily activities
• Inability to tolerate exercise
• Inability to tolerate cold, humid and hot temperatures

Neuromuscular Diseases (NMD)

Progressive Neuromuscular Disease causes the muscles we use to breathe (including the diaphragm and intercostal muscles) to weaken. Expanding your chest can be become difficult, which causes breathing to become shallow and difficult. Illness progression can also result in a weakened cough with difficulty clearing retained mucus in the lungs. This can lead to mucus plugs and infections (commonly known as pneumonia). Common illnesses often requiring NIV include ALS (Amyotrophic Lateral Sclerosis; Lou Gehrig’s disease) and Muscular Dystrophy.

What are the symptoms?

Symptoms of progressive neuromuscular illness result from weakness of the muscles of the upper and lower respiratory tract. Symptoms may include:

• Difficulty taking big breaths
• Difficulty breathing when lying flat, resting or with activity
• Fatigue, weakness
• Weakened ability to speak and eat
• Morning headaches
• Anxiety

Obesity Hypoventilation Syndrome (OHS)

OHS (Obesity Hypoventilation Syndrome) is a breathing disorder caused by excess body weight. When excess weight is carried in the abdomen and chest, it restricts the movement of the diaphragm and supporting muscles used to breathe. (This is also referred to as restrictive lung disease.) As moving air in and out of the lungs becomes increasingly difficult, it leads to lower oxygen and increased carbon dioxide levels in the blood.

What are the symptoms of OHS?

The symptoms of OHS develop over time as a result of decreased air movement into and out of the lungs. Symptoms can include:

• Lack of energy and fatigue
• Breathlessness
• Headaches
• Confusion
• Carbon dioxide retention
• Poor sleep quality and daytime sleepiness
• Depression and anxiety

Medical Devices

Non-Invasive Ventilators

NIV is a type of therapy that aides in improving carbon dioxide and oxygen levels in the body. It is used when all other therapies like oxygen and PAP therapy have not worked.

The Non-Invasive Ventilator uses a mask or mouthpiece to provide breathing support during sleep, during the day (when awake or napping) and for rescue, all as prescribed.

There is no limit to how much or how often NIV can be used. You may only require NIV during sleep or naps, or you may require NIV assistance for rescue breathing or even 24 hours a day with a mask.

Trilogy 100

Philip Respironics’ answer to Non-Invasive Ventilation, the Trilogy is versatile and easy to use. With its lightweight and proven technology, the Trilogy 100 makes non-invasive treatment less complicated.

Astral^™

From ResMed^®, the Astral^™ is a user-friendly and easy-to-operate Non-Invasive Ventilation medical device. At only seven pounds, it is lightweight with simple, smart technology. Its versatility gives therapy options for a variety of respiratory complications.

Compliance

Compliance & Care

Compliance refers to your successful adherence to Non-Invasive Ventilation therapy. The best way to achieve the best outcomes with NIV is to follow your specialized NIV care plan. Insurance does require compliance with NIV therapy for it to keep billing.  Frontier will be monitoring your progress and encouraging you along the way!

Always know there is support for you here at Frontier—we are a phone call away! Don’t give up. Compliance with ventilation therapy is very important to your health.

Compliance Requirements

• Will be a minimum of 4-5 hours per day based on your individualized treatment plan of care
• Overall compliance requirement is 85% or better

Measuring & Monitoring Your Success

At Frontier Home Medical, our chronic care management and ventilation team strives to obtain the best outcomes possible. We believe success with this can be measured by preventing hospital visits and improving your quality of life. To do this we are committed to providing superior quality care by integrating the use of technology with our highly skilled team of Respiratory Therapists and connecting us to you to your lung doctors. Your ventilator is connected to either a blue-tooth hub or modem. This allows your lung doctor and Frontier Home Medical Respiratory Care Specialist to access your NIV therapy data every eight hours. 

• Reducing the number of health-related appointments in the home.
• Faster therapy optimization via 24/7 access to your respiratory specialist means quicker response to changes needed to improve therapy delivery or comfort.
• Enhanced Therapy Adherence resulting from continuous support from the entire care team.

Oxygen

Oxygen & Ventilation Therapy

Are you prescribed oxygen therapy—either continuous or nocturnal? If so, this can be done in conjunction with your non-invasive ventilation therapy. Please note: portable or pulse dose oxygen cannot be used with the Non-Invasive Ventilator. Utilizing the built-in oxygen port on your device will allow you to get both the oxygen flow and air pressure that you’ve been prescribed.

Safety Tip: Be sure to shut off oxygen supply to the device when not in use.

Humidification

Heated Humidification

Non-Invasive Ventilation allows you to breathe through your nose, which is the body’s best air purifier and humidifier. Staying hydrated will also help to maintain lung humidification. However, when that is not enough, external heated humidification may be necessary.

If you experience any of the following symptoms after starting Non-Invasive Ventilation therapy, it may indicate a need for humidification:

• Chest tightness
• Difficulty clearing thick mucus
• Excessive mouth or throat dryness

Keep in mind that adding a heated humidifier requires extra care and cleaning; it also involves additional risk. Heated humidifiers can tip during use, causing water to leak from the mask into your body. The device requires weekly cleaning and monthly disinfecting; this can mean an increased risk of pulmonary infections. Consult with your Frontier Home Medical Respiratory Care Specialist to determine if a heated humidifier is right for you.

Humidification Safety

• Always position the hose lower than your airway.
• Do not set open liquid containers on or near the device.
• Ensure the humidifier is securely mounted.
• The operation of high-frequency surgical apparatus, short wave or microwave equipment in the vicinity of the humidifier may adversely affect its function.
• Do not immerse the humidifier in any liquid.

Masks & Mouthpieces

Getting to Know Masks

Together with your Respiratory Care Specialist, you will choose the best mask to fit your ventilation needs. Frontier offers a variety of masks—both full face and nasal—to achieve comfort and therapeutic benefit.

Getting to Know Mouthpiece Ventilation

With a mouthpiece system, you’ll gain flexibility with ventilation therapy. The mouthpiece system gives you breathing support on demand. By sensing your touch to the tip of the mouthpiece, it will provide breathing support until it no longer senses you.

Mouthpiece ventilation can allow freedom to breathe without wearing a mask—a great solution if you are in a wheelchair, experience limited mobility or need extra support following exertion or anxiety. Mouthpiece ventilation can also provide freedom for those with neuromuscular disorders.

Cleaning & Maintenance

Cleaning & Maintenance

To correctly clean your supplies, use warm water and mild dish detergent or baby shampoo. Cleaning wipes can also be helpful for easy daily care practices.

Cleaning Tips

• Establish a daily routine to wash and care for your supplies.
• Clean equipment prevents bacterial growth and decreases the risk of infections.
• Allow supplies to dry completely before use.
• Never use bleach or cleaning solutions for care.
• Dishwashers, washing machines and clothes dryers are NOT recommended for cleaning.
• Never smoke near your machine.

FAQs

Living with Non-Invasive Ventilation

For some, starting ventilation therapy is not exactly a walk in the park. Getting used to the device can be a lengthy process that requires gradually adapting to the therapy; however, Frontier is here to help make your journey a little easier. Here are a general few tips:

• Try to breathe into the mask like you normally would.
• Focus on the positive benefits that ventilation therapy can bring to you.
• Recruit your partner, friends and/or family members to support your efforts.
• Like most things, this therapy gets easier in time and eventually becomes second nature.

Issues & Solutions

Using a Non-Invasive Ventilator can be frustrating as you try to get used to it, but it’s important you stick with it. The treatment is essential to avoid complications of respiratory failure, such as heart, kidney and brain damage. Regular visits with Frontier and your physician can help you troubleshoot any issues you have with your ventilation therapy. Always remember, with time and patience, using your Non-Invasive Ventilation device can positively impact your quality of life and health.

Fear & Anxiety

Relying on a medical device for your survival can feel overwhelming. If you experience anxiety as you adjust to life with your Non-Invasive Ventilator, there are many tools you can use to overcome those feelings.

• Take a time out. Remember, anxiety can make breathing even more difficult for you. Focus on relaxing; take a step back from the situation to clear your head.
• Identify your triggers. What is causing your anxiety? What are your fears? Writing down your feelings, thoughts and emotions can help to calm them.
• Talk to someone. Living with chronic illness can be a lonely experience. If you are having feelings of anxiety, talk to your healthcare professional, therapist or trusted person in your life.

Wrong Size OR Style Mask

• Everyone has a different facial structure, so the right style and size mask for someone else may not work for you.
• Consider a different mask. We have a range of masks available. Some feature full-face masks that cover your mouth and nose, with straps that stretch across your cheeks. This works well if you prefer to breathe through your mouth during sleep. Also, they provide a stable fit if you move around a lot in your sleep.
• Nasal masks and pillows may work well if you wear glasses or read with the mask on, because some don’t block your eyes as much as full-face masks do. However, this may not be an option if you move around a lot in your sleep, sleep on your side, breathe through your mouth during sleep or require higher breathing pressures.
• Pay attention to size. Most masks come in different sizes. Just because you’re a certain size in one mask doesn’t mean you’ll be the same size in another. If you need a new mask or size, call Frontier to set up a face-to-face mask fitting.
• Ask Frontier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can help show you how to do this. A properly fitting mask shouldn’t be uncomfortable or cause pain.

Trouble Getting Used to Wearing the Device

First, try wearing just the mask for short periods of time while you’re awake—for example, while watching TV. Then try wearing the mask and hose with the device turned on during the day while you’re awake.

Once you get used to how that feels, start using the device every time you sleep—including naps. Just wearing the Non-Invasive Ventilation device every now and then may delay getting used to it. Stick with it for several weeks or more to see if your mask and pressure are right for you.

Feeling Claustrophobic

Practice using your mask while you’re awake. First, hold it up to your face without any of the other parts. Once you’re comfortable with that, try wearing the mask with the straps.

Next, try holding the mask with the attached hose on your face, without using the straps. Turn on the machine. Next, do this using the straps too. Finally, try sleeping with the mask and machine on.

Difficulty Tolerating Forced Air

You may be able to overcome this by using a machine with a ramp feature. This setting allows you to start with low air pressure. The machine then automatically, and slowly, increases the air pressure to your prescribed setting as you fall asleep.

Leaky Mask

A leaky or ill-fitting mask means you’re not getting the full air pressure you need, so try adjusting cushions and straps to get a better fit. Check your resupply schedule to be sure your mask is up to date; replace as needed.

Dry, Stuffy Nose

Be sure your mask fits well. A leaky mask can dry out your nose. If you have to tighten straps often to prevent air leakage, the mask does not fit properly. Using a nasal saline spray or sinus wash at bedtime also may help ease a dry, stuffy nose.

Dry Mouth

If you sleep with your mouth open, some devices may worsen dry mouth. A chinstrap may help keep your mouth closed and reduce the air leak if you wear a nasal mask. A full-face mask that covers your mouth and nose also may work well for you. (Remember, adding a heated humidifier is not indicated for mouth dryness, but is only for lung humidification.) Using dry mouth products also may help, such as Xylimelts® or Biotène® brand products.

Bloated Feeling

Swallowing air during ventilation therapy can lead to bloating, gas and discomfort. It may help to sleep at an incline by using a wedge-shaped pillow or utilizing an adjustable bed. If swallowing air is causing heartburn, be sure to consult with your Frontier Home Medical Respiratory Care Specialist.

Bothersome Noise

First check to make sure the air filter is clean and unblocked and that your hose and mask are clean. If this doesn’t help, notify Frontier. We can ensure that the device is working properly. If the device is working correctly and the noise still bothers you, try wearing earplugs or using a white noise sound machine to hide the noise.

Oxygen & NIV

Your NIV machine is designed to function without an oxygen source. If your physician has prescribed oxygen, tubing from your concentrator will connect to the back of the machine via an oxygen adaptor. Your Respiratory Specialist will do this for you during the set up.

Facial Hair

Some people may find getting a proper mask seal more challenging with facial hair. Using beard wax and trying different mask styles can help.

Can I survive a night without my machine?

Yes. For many, you can spend one or two nights away from the machine; however, you may not be very comfortable and run the risk of hospitalization without adequate support for your breathing.

What if I have to use the restroom during the night?

Leave your mask on; just detach the hose using the quick release clips. When you’re done, reattach the hose and start your machine. If you use oxygen, consult your FHM Care Specialist for further instructions.

Will I need this forever?

Yes, NIV is used to treat respiratory failure caused by advanced chronic illness. In very rare cases, such as post successful lung transplant, it may only be temporary.

Do I need to bring my NIV machine if I am admitted to the hospital?

Yes, always take your machine, tubing and mask for scheduled hospital procedures and emergency visits; however, leave your communication hub at home. Please contact your FHM Respiratory Specialist as soon as possible to alert us of the hospitalization.

My machine is uncomfortable or gives me a breath at the wrong time. Is this normal?

If your machine does not feel right, please contact your Frontier Respiratory Care Specialist.

Are there alternatives to NIV treatment?

There are no similar alternatives to NIV treatment. This is the best option for non-invasive respiratory therapy.

Travel Tips

Non-Invasive Ventilation
Travel Tips

When you leave home, always bring your Non-Invasive Ventilation device along. Follow these tips to get the benefits of better breathing while traveling:

• Bring all the pieces. Double check for power cords, hose, mask and machine before leaving home and after each use.
• Bring extra supplies. This will ensure you’re never without proper equipment.
• Remove water from the humidifier. Water left in the chamber can cause damage to your other devices.
• Plan for your power source. Battery power, car chargers and international power adapters may be necessary.
• Have back-up ventilation available in case of emergency.
• Always travel with the device manual and Frontier set-up books. They include your settings and can assist with troubleshooting.
• Always carry a copy of your NIV prescription and qualification documents when traveling.

Air Travel Tips

You may need a letter from your healthcare professional stating your need for the medical equipment, including your level of dependency on the device.

• Identify the carrying case with a medical equipment luggage tag.
• A non-invasive ventilator is generally not considered a carry-on item.
• Because your device can be damaged during flight, it should not be checked; but rather, carried on.
• Security may need to inspect the device; be sure all pieces get back into the bag. Also, allow extra time at security checkpoints.
• Do not use the humidifier on the flight; aircraft turbulence increases the risk of water spillage and damage to the device.
• Do not use the connectivity modules during flight.
• Check with the airline before flying with your device. Each has its own policy on medical equipment—including use while in flight.

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Frontier Home Medical is fully accredited by the Healthcare Quality Association on Accreditation (HQAA). HQAA is a healthcare accreditation organization providing accreditation for home medical equipment (HME) and durable medical equipment (DME) companies nationwide.