The sun could help to treat asthma
The summer has finally started to rear its head and for many people who suffer from respiratory disease the summer months can potentially worsen their condition. An increase in air pollution, pollen, dust and other allergens can irritate the lungs and worsen breathing. The general advice is to stay indoors at peak pollen or air pollution times. However on the flip-side of this advice is that exposure to the sun may actually be good for you, especially asthma sufferers.
A study by King’s College London has found that the Vitamin D that the sun provides may have a calming impact with asthma sufferers as Vitamin D helps to lower an asthmatic’s over-active part of their immune system.
Many asthmatics have high levels of Interleukin-17, which causes part of their immune system to be over-active and contributes to their respiratory reactions to allergens and is part of the cause of some asthma attacks. Some asthmatic sufferers do not respond to steroid treatment and find difficulty in managing their symptoms. This group of asthmatics tends to have very high levels of Interleukin-17.
Researchers have found that if Vitamin D levels are increased then this lowers the levels of Interleukin-17 and helps to calm down the immune system leading to a lessening of symptoms.
"We know people with high levels of vitamin D are better able to control their asthma - that connection is quite striking," said researcher Prof Catherine Hawrylowicz.
The sun is an easy natural source of Vitamin D (the body can make Vitamin D in the presence of sunshine) rather than taking synthetic supplements so the more you are out in the sun, the more Vitamin D your body will get and the happier your immune system.
Many asthma sufferers also have concerns about the side effects of their medications so if Vitamin D is shown to improve their condition then many may have to rely less on medication and can improve their quality of life.
Researchers have suggested that covering up too much and using too much sun cream has actually contributed to increased asthma rates. Obviously too much sun is bad for you and you should ensure that you protect your skin to avoid sunburn and potential skin cancers.
So there needs to be a balance of going outside and increasing your levels of Vitamin D versus avoiding high pollen counts and sunburn.
Here are a few tips to help you enjoy the summer despite your condition:
• Check the Air Quality Index: Avoid peak times or areas with poor air quality.
• Always Take Your Medication: Whether this is ant-histamines, inhalers, steroids or supplemental oxygen.
• Check the Pollen Count: Try to avoid going out at times where pollen is particularly high.
• Use Air Conditioning Instead of Opening Windows: Open windows will just allow more pollen and allergens into your home or the car.
• Wash regularly: Washing your hair and clothes regularly gets rid of any allergens that may have settled on you.
• Talk to your doctor for advice.
References: http://www.healthoxygen.com and http://www.bbc.co.uk/news/health
Aspergillosis and your lungs
Aspergillosis is the group of diseases caused by the fungus Aspergillus. It is an opportunistic fungus that exists as moulds and is found in organic debris, dust, compost, foods, spices and rotting plants. It is the second most common fungal infection. Aspergillus fumigatus is the most common species followed by flavus and niger.
Symptoms can include fever, cough, chest pain and breathlessness which also occur in many other illnesses which can make diagnosis difficult. Usually only patients with weakened immune systems or pre-existing lung conditions are susceptible.
The major forms of disease are:
* Allergic bronchopulmonary aspergillosis – this affects patients with respiratory disease such as asthma, CF and COPD.
* Acute invasive aspergollosis – a form that grows into surrounding tissue, common with patients that are immuno-compromised such as those with AIDs or receiving chemotherapy.
* Disseminated invasive aspergillosis – an infection that spreads throughout the whole body
* Aspergilloma – a ‘fungus ball’ that can form within cavities, especially within the lungs. The fungus settles in a cavity and is able to grow freely because some elements of the immune system are unable to penetrate into the cavity. As the fungus multiplies, it forms a ball, which incorporates dead tissue from the surrounding lung, mucus, and other debris.
The Aspergillus spores are inhaled and spread by airborne transmission. The spores are in the atmosphere all year round but are at their peak during the late autumn. If inhaled by a healthy individual you are unlikely to present with any symptoms however if you are susceptible then you may present with weight loss, a cough, shortness of breath, coughing up of blood, fever, tiredness and chest pain.
Bed rest, humidified oxygen therapy and cough suppressants are normally enough to treat an infection. However, if the symptoms are graver then postural drainage, anti-fungal drugs or lung surgery may be required. Aspergillosis typically heals with treatment though it may reoccur if you are repeatedly exposed to the fungus. Complications include airway blockage, respiratory failure, kidney damage, and bleeding in the lungs.
Oxygen therapy helps not only to relieve the symptoms caused by the fungus but also because the fungus cannot survive in high oxygen levels If the fungus infection is within the lungs themselves or nose and throat then they will be surrounded instantly and continuously by the higher oxygen levels breathed in by the patient and it will help to disperse the fungal infection.
Those patients who have lung diseases or are otherwise susceptible to infection are advised to check their homes and environments for mould and to check their bedding and not inhale near composts or rotting vegetation. If you get any symptoms then check with your doctor who can test for the presence of a fungal infection and treat accordingly to the type of infection that you have, as different species of the fungus will present with differing symptoms and may need to be treated slightly differently.
References: http://en.wikipedia.org and www.nacpatients.org.uk and www.healthline.com
The future of the oxygen market
20 years ago the exhibitions were filled with oxygen cylinders and now business is bigger and has progressed a lot. Most people know very little about the oxygen marketplace but it's very much part of the 'home-care' marketplace although opportunities are emerging for retailers too.
In America oxygen is big business and millions of them use oxygen, but it has high pressures on it due to the 'competitive bidding' programme, as Americans have the private healthcare system so there are many companies competing for low cost products. In the UK it isn't as prominent but it's definitely there and has grown. It's a business that has gone from nothing to millions in just a few years. Over here the market is about delivering oxygen to patients at home. 70% of them are COPD patients and the numbers involved and the growth rate is huge and is thought to be the second biggest disability in the USA.
The two main products are either static oxygen; which is produced from oxygen concentrators plugged into the mains, or ambulatory oxygen; necessary for patients who want to use oxygen outside of the home. This is achieved by the use of portable oxygen concentrators, transportable oxygen concentrators or devices such as home-filling, where the patient can fill gas cylinders from their static concentrator. A patient is diagnosed with a respiratory disease and either via a doctor or an oxygen assessment clinic their oxygen needs are assessed for a prescription. This prescription is sent to the contracted oxygen provider for that area of the country, of which there are 11 in England and Wales. At the moment the provision is mostly dominated by gas providers which is similar across Europe. This is due to the fact that traditionally the delivery model involved producing liquid oxygen, putting the gas into cylinders and transporting these and therefore gas companies were better equipped to deal with this process.
However oxygen concentrator technology has really taken off over the last few years in the US and has allowed healthcare companies to come into the marketplace and lower the price of the service considerably, as the need for delivery of cylinders and refilling these cylinders is being eradicated as now you can just buy a one-off product. Europe and the UK are slowly catching up with the idea.
There are millions of people diagnosed with COPD around the world and 15% of these are prescribed oxygen. The number of COPD patients coming into the market is increasing and is expected to continue to increase for many more years. COPD patients are also increasingly being prescribed oxygen until the end of their life expectancy combined with the fact that COPD is being diagnosed earlier in life due to an increased awareness of the condition means that many more people will be requiring oxygen for longer periods of time. The demand for oxygen in the UK is being driven by the high levels of smoking. If you smoke for more than 30 years then it is likely that your lungs will become damaged. According to the UK government the number of people diagnosed with COPD is just the tip of the iceberg compared to people who actually have the disease. The NHS needs there to be more competition in order to bring down costs and invest in bringing the newest technology into the UK market. There are private companies coming through though such as Virgin Care who are involved in COPD management and pulmonary rehab management and their next logical step would be to also get involved in oxygen delivery as well. In Scotland the model has already evolved, which although was time-consuming and expensive in the short-term will help the NHS in Scotland long-term and there will be a £2 million saving on the pharmacy oxygen budget for them. They managed to link a manufacturer to a contractor and to the Scottish NHS in a three-way relationship via competitive quotes. Hopefully in the near future this will also happen in the NHS in England and Wales.
It is hoped that there will also be opportunities for retailers too. There are already a small number of specialist retailers in the marketplace. OxygenWorldwide and it's services can give expert advice and arrangement when travelling with oxygen. Your local provider cannot allow you to take your oxygen equipment abroad on a plane. As demand increases the pressure to produce equipment to hire or buy in order to travel abroad will also increase, as what happened in the US. It was the main driving force in the US for manufacturers to produce portable concentrators that were cheaper and lighter. Cylinders were too awkward to take abroad and airlines charge a fortune. This increasing demand and expectation will help to improve and cheapen the market over here as well.
Consumers increasingly want lighter, longer-lasting, smaller oxygen concentrators and this will be the way forward for the marketplace. The main problem is battery life which is what happened with laptops and mobile phones. As the products become lighter and smaller then the marketplace will grow for retailers to sell them to their customers who want to get out and about more easily and to go abroad. The internet has also opened up the market and has encouraged transatlantic sales which has opened-up the eyes of the UK market to what else there is out there and in combination with an increase in private sales the Department of Health has responded positively. In the future it is expected that the marketplace will continue to open up and will take advantage of the new technology and delivery methods. Patients will still have static oxygen in their homes but will have an ambulatory device tailored to suit their needs. It is envisioned that in the future there could be oxygen monitors positioned on a patient's ear or finger being programmed back through blue tooth technology, with a device on the hip which will then deliver the amount of oxygen they need at any point in time. Data can be fed and analysed to confirm that the patient is using it efficiently and that the oxygen purity is at the right levels.
As with other markets, the private companies drive the technological advancements and increased demand helps to bring down costs and then these cheaper better products filter down into the public domain. In the meantime before the future gets here, if you are unhappy or feel restricted by the equipment that is currently available via your local supplier then take a look at a private company like OxygenWorldwide for portable oxygen concentrator hire across the world and not just for travelling abroad, costs have come down a lot recently and the technology available is more advanced. It's worth a look and it's an investment into your health and quality of life.
References: http://www.thiis.co.uk
Is supplemental oxygen considered a performance-enhancing drug for athletes?
You often see a football player on the side-lines breathing oxygen after running a long distance or having worked hard during a long series of plays, but is it actually doing anything?
In athletic performance oxygen controls many things and a lack of it causes loss of muscle control, poor stamina and an inability to concentrate. At its very worse it can cause complete and literal collapse. Many athletes try to extend their stamina and performance by using oxygen supplementation but does it work?
How oxygen supports performance
Kenyan nationals have become next to unbeatable in marathon running and one supposed reason for this performance was oxygen surplus. Kenyans are born and train in an atmosphere with lower oxygen and when they compete in marathons they are usually doing so in countries at lower altitudes and therefore they experience a natural oxygen surplus. Some believe this allows them to have higher stamina and a faster, stronger performance than people who train in more oxygen-rich atmospheres. It also boosts the idea that supplemental oxygen increases performance. Even if this theory is true, the question still remains as to whether artificial sources of oxygen can help you achieve Kenyan stamina. There have been a few studies that have shown that when pure oxygen is used prior to an athlete's performance that they can lift weights quicker and cover short distances quicker. However during these few studies the participants knew that they were breathing pure oxygen and raises the question that perhaps the result was due to a placebo effect.
Confirming the studies
If there was significant proof that oxygen could enhance performance then there would have been an immediate debate as to whether breathing pure oxygen was deemed a performance-enhancing drug and whether it should be regulated or banned. The science of oxygen consumption and the studies that have been carried out answers the question with a resounding no. In healthy athletic people, such as professional football players, nearly all of the oxygen in the blood is carried by haemoglobin and only a very small percentage (1.5%) is dissolved in blood. Even if an athlete breathes pure oxygen, haemoglobin cannot be more than 100% saturated and therefore does not change and the amount that is dissolved in the blood only raises to 5.6%. This minimal affect will nearly instantly disappear after you have stopped breathing the pure oxygen and is not enough to affect recovery or performance.
One study looked at football players given 100% oxygen or a placebo after exertion before they had to exercise again. There was no increase in performance during the second bout of exercise. Another study also concluded that supplemental oxygen may have a placebo effect, but there is “no real physiologic benefit.”
Supplemental oxygen is therefore not considered a performance-enhancing drug because it doesn't work, the science and studies cannot provide supporting evidence and at best it may just have a placebo effect, which has a similar result that lucky socks do.
References Skeptical Scalpel
Supplemental oxygen can potentially improve eyesight
Diabetes can cause many health problems for sufferers and one of these is macular oedema. This is a fluid build-up in the part of the eye that is responsible for central vision. Diabetic macular oedema affects up to 10 percent of all patients with diabetes. It is caused when high blood sugar eventually causes damage in blood vessels of the retina and a decrease in the supply of oxygen and nutrients. When the retina experiences low oxygen levels it releases vascular endothelial growth factor (VEGF) and other substances that cause the retinal blood vessels to become leaky and stimulates the growth of new blood vessels. The leakage of fluid into the macular causes it to become thickened and results in vision loss. Many patients have laser treatment to try and correct it, however many patients find that they still suffer persistent oedema.
A pilot study has monitored diabetic patients breathing supplemental oxygen through a nasal cannula and found that it helped to reduce fluid build-up and swelling and in some cases improved their visual acuity fairly dramatically. Patients were given 4 litres per minute of oxygen via a nasal cannula and asked to use it continuously for three months day and night.
After the three months it was found that there was an average 50% decreases in the excess thickness of the macular, the excess thickness of the fovea (responsible for sharpness of vision) and in the macular volume. Also a third had improved visual acuity with the ability to read two lines higher on an eye chart.
In addition it was noted that when the supplemental oxygen therapy was discontinued the subject's vision slowly worsened. However in those where their eyes had returned to within the normal range whilst on supplemental oxygen, their eyesight did not worsen but remained within the normal ranges once the supplemental oxygen was stopped.
It appears that supplemental oxygen reduces the production of VEGF, which reduces the amount of leaking in retinal vessels and therefore lessens the severity of macular oedema.
Researchers believe that this could be used in conjunction with eye laser treatment to improve oxygenation to the retina to provide long-term eye stability. The oxygen treatment could reduce the thickness of the retina prior to laser treatment in order to make the laser treatment more effective and long-lasting, for when supplemental oxygen is ceased. There are also oral drugs being developed that block receptors for VEGF and could be used in conjunction with supplemental oxygen to help improve results.
References: http://www.hopkinsmedicine.org and http://iovs.arvojournals.org
What the consumer wants from their concentrator
A recent research study by DeVilbiss Healthcare has looked into what consumers believe to be the most important attributes of an Oxygen Concentrator.
According to the study, failure rate is the most important factor at 36% followed by price (26%), warranty (19%) and energy savings (11%).
The study was carried out in order to understand the needs of customers that use the concentrators and to identify which attributes are the most important. It was clear from the results that customers see the long-term value of the product to be the most important factor. They want a product that is built to last to reduce the costs of customers having to keep repurchasing every few years as the machines wear out.
Consumers such as the NHS and other healthcare providers are now looking at long-term saving rather than the initial short-term saving of a cheap product to purchase. They want to be able to focus their efforts on delivering excellent oxygen therapy services rather than being distracted by repairing equipment they have supplied and the costs that are involved in repairing and replacing equipment.
The business landscape of the oxygen supply industry has changed over recent years as increased failure rates have meant higher operational costs for the suppliers and they have struggled to keep prices down for the consumer.
“Increased failure rates were driving up our operational costs,” said the National Procurement Manager for RHS Canada, “and with lower reimbursement, we really have to work closely with manufacturers to attain effective, safe and reliable equipment at a price point that works for all individuals in the industry. Reliable equipment in the field is crucial to the success of our business and to providing quality patient care.”
Hopefully the industry will respond to reflect the findings of the study and it would be financially sound for them to do so. Manufacturers can spend more money making oxygen equipment that is durable and long-lasting with less fear that it may drive the initial cost up slightly as many oxygen provider companies will not mind paying slightly more in the short-term if it reduces their long-term costs.
This will mean that the patient will be using more reliable and efficient equipment in the future, which is of obvious benefit to reduce the stress of when products break and need to be repaired or replaced. But more importantly also to prevent emergency situations from occurring when the product breaks down. If you are constantly reliant upon the product to breathe and it breaks down then there is a chance of fatality.
At the moment however until these changes make their way down through the chain in the years to come, the advice is to always ensure that you have a back-up concentrator to hand in case of emergencies, whether at home or travelling on holiday. Even if product failure rates decrease, there is always unfortunately a chance that technology can break down and it can save your life to have a back-up concentrator ready for emergencies. If your normal provider cannot arrange one then there are national and global private companies such as oxygenworldwide that you can purchase them from, and it would be a sound and wise investment, as it could save your life.
References: http://www.devilbisshc.com
Biology meets technology to produce oxygen
London's ecoLogicStudio has designed a prototype of its urban algae canopy. It is the “world’s first bio-digital canopy that integrates micro-algal cultures and real time digital cultivation protocols on a unique architectural system” with flows of water and energy regulated by weather patterns and visitor usage.
This is a 'bio-digital' structure that combines biology with technology. In the structure there is fluid filled with micro-algae organisms that are pumped around a transparent canopy which provides shade to the space underneath the canopy. It also produces energy in the form of biomass and produces a large amount of oxygen. An additional feature is that the structure can respond to the presence of visitors by producing interesting visual effects.
In the presence of sunlight the micro-algae will photosynthesise naturally and grow in numbers and volume which turns the almost transparent fluid into a deeper shade of green to provide shade to anyone standing underneath the structure. This means that the structure is weather=pattern dependent and will produce more in the presence of high levels of sunlight.
The interactive parts works by electro valves in the structure being triggered by the presence of someone walking into each different area of the canopy. The valves alter the speed at which the fluid flows through the canopy creating different colour shades and effects.
The prototype will hopefully be scaled up to a larger installation that will be able to provide the same amount of oxygen as four hectares of woodland and also produce 150kg of biomass.
Using micro-algae colonies rather than relying on woodland photosynthesis also results in a massive reduction in the amount of CO2 produced which benefits the atmosphere.
Integrating organic systems with artificial ones opens up possibilities for everything from temperature control to power generation methods using the advantages of both natural and digital parts. There are even designs being put forward for smog-eating algae street lamps among many other fascinating ideas.
As ecoLogicStudio puts it: "We believe that it is now time to overcome the segregation between technology and nature typical of the mechanical age, to embrace a systemic understanding of architecture. In this prototype the boundaries between the material, spatial and technological dimensions have been carefully articulated to achieve efficiency, resilience and beauty."
References: www.gizmag.com and http://weburbanist.com
You can sometimes feel short of breath even when on oxygen
Many patients with advanced lung cancer can sometimes feel short of breath even when they are on oxygen and showing that they have an acceptable oxygen level of over 90%. There are a few reasons why this can happen.
If your oxygen level drops below 88% this signals to the brain that you need more oxygen and initiates dyspnea (shortness of breath) and a sense of air hunger. This signal is also triggered when other pulmonary test levels are low. The Vital Capacity is how much air there is from the beginning to the end of a breath and the FEV1 is a measure of how much air you can forcefully exhale in one second. Even when your oxygen levels are good at 90% if any of the other values are low then the body can sense dyspnea.
The use of an inhaler can be very effective in improving the Vital Capacity and FEV1 and can immediately improve breathing symptoms and stop the feeling of shortness of breath due to the effect the inhalers have on widening the airways.
Also many patients can be not very physically fit due to a combination of the medical illness, age and obesity. Introducing more exercise into daily life can help to improve cardio/respiratory fitness thereby improving the Vital Capacity and FEV1 and helping to reduce the frequency of periods where you feel short of breath.
Low blood counts (anaemia), heart disease and advanced kidney disease are conditions that can also cause dyspnea even if your lungs are working effectively.
Vital capacity and FEV1 are pulmonary tests that your doctor can perform to see how effectively your lungs are working so regular check-ups are important and your doctor can help ensure that if you suffer from these situations that they are treated to help improve your breathing. Some patients find that when these other factors are dealt with that they are less reliant upon their oxygen.
If you suffer from bouts of breathlessness then there are things you can do to help yourself:
• If you smoke, get help to quit.
• Try some breathing techniques. If you practise these and use them every day, they will help you when you are active and getting breathless. They will also help you manage if you get short of breath suddenly.
- Blow as you go: breathe out when you are making a big effort, such as standing up, stretching or bending.
- Pursed-lips breathing: breathe out with your lips pursed as if you were whistling.
• Be more physically active. Physical activity could be walking, gardening, walking the dog, housework or swimming as well as going to a gym. If you have a lung condition, you can be referred to a pulmonary rehabilitation (PR) programme by your doctor, and if you have a heart problem there are cardiac rehabilitation services too. These classes help you to get control over your breathlessness, get you fitter and are also lots of fun.
• Drink and eat healthily and manage your weight. If you are carrying excess weight you will require more effort to breathe and move around, and it will be more difficult to get control over your feelings of breathlessness.
• Get treatment if you feel stressed or anxious.
• Use the right medication in the right way. If you use inhalers, tablets or liquids to control your breathing ensure you know how and when to take them correctly.
• Ensure your oxygen flow rate is correct. Another reason why regular check-ups are important so your doctor can monitor your oxygen requirements and adjust your oxygen flow rate accordingly for your oxygen concentrator.
References: http://www.coalitionforpf.org and http://www.blf.org.uk
Your eyes and oxygen
The cornea is one of the few parts of your body that doesn't have blood vessels supplying oxygen to it, along with tooth enamel, hair and nails.
The cornea needs to be transparent so that light can pass through so there can be no blood vessels there, otherwise the light would be obscured. Without blood vessels the cornea must get it's oxygen directly from the air. The oxygen first dissolves in the tears and then diffuses throughout the cornea to keep it healthy. Carbon dioxide is released via the same process back out to the atmosphere. Some oxygen can diffuse through the aqueous humour within the eye but this is slow and limited. The main pathway is through the front of the eye so if this is restricted by your eyes being closed for extreme periods of time or via the use of the wrong type of contact lenses, then the cornea can become oxygen deprived.
Without enough Oxygen the cornea will warp, become less transparent, less able to detect pain and can develop scars. Additionally, new blood vessels from the sclera (the white part of the eye) can grow into the cornea and cause further damage and scarring. A blood shot eye happens in response to the cornea looking for another way to get more oxygen. Since the cornea is without blood vessels, the retina pumps up its veins in attempt to absorb more oxygen. This response can lead to other problems over time like corneal neovascularization and macular degeneration disease.
The oxygen supply to the cornea is slightly less absorbed when contact lenses cover the cornea. Contact lenses nowadays are a lot more permeable in order to allow more oxygen to pass through to the eye and some are designed to be in for long periods of time. Check with your optician to make sure you have the correct type to avoid damaging your eyes. Early symptoms of a lack of oxygen include dryness and irritation as well as blood shot eye. Solutions and moisturisers are available to help keep your eyes healthy and oxygenated.
References: http://www.aclm.org.uk and http://www.avoideyestrain.com
Air travel with a lung condition
For those people who suffer with any type of lung condition they may have difficulties when travelling by air. This is due to the reduced air pressure in the aircraft cabins as well as the lack of mobility for long periods of time. Air pressure in an aircraft cabin is lower than air pressure at ground level and feels like being at 6000 to 8000 feet on a mountain. At high altitudes blood oxygen levels fall in everyone, and some people may feel a little breathless. In most people this has no health effect, but if you already have low blood oxygen levels because of your lung condition, then the extra dip that happens while you are in the plane can cause breathlessness and discomfort for you.
As long as you meet a minimal fitness criteria agreed with your doctor then it is still possible to fly, even if you require constant oxygen therapy.
Before departure :
If you are able to walk 100 metres on ground level without needing oxygen, at a steady pace without feeling breathless or needing to stop, then you are not likely to be troubled by the reduced pressure in aircraft cabins.
If you cannot do this then you will need to talk to your doctor about whether you should travel by air. You may need to have some breathing tests to show if a fall in your blood oxygen level is likely to be a problem to you while travelling.
You should also check your travel insurance policy to make sure you are fully covered for any medical costs that may arise in connection with your lung condition. It is important that your travel medical insurance includes the cost of return by air ambulance if you were to become too ill to return on a commercial flight.
Many policies will not cover you for costs from your lung condition unless you have a written note from your doctor that he or she feels you are fit to fly.
Oxygen and air travel :
If tests show that your usual blood oxygen levels are so low that air travel may be a problem for you, you may still be able to travel by air, if oxygen is provided for you. Airlines can arrange extra oxygen, but remember that most will charge for providing oxygen. Different airlines have different charges; check with each one before you arrange your flight. Don’t trust to luck that planes will have oxygen on board. They carry emergency supplies but not enough for several hours.
You will also need permission from the airline to take on board and use any electrical equipment you need for your treatment. Equipment must be battery driven, and you will not be allowed to use it during take off or landing. Using an inhaler with a spacer is just as effective as using a nebuliser.
You may find it easier to organise your oxygen needs via a company that can arrange oxygen for both the plane and the entirety of the holiday, just in case you need oxygen throughout your trip or if you just want to arrange to have a 'back-up' supply just in case. It's easier to have dealings with just one company rather than multiple, especially if you're travelling to more than one place during your trip.
Essential Tips from the NHS website to remember before flying:
1. Ask your doctor well in advance for a letter to take in your hand luggage with details of your condition and medication.
2. Be sure to take your inhalers in your carry-on bags. One of the most common problems is that people pack their inhalers in the luggage that goes into the hold.
3. If you get breathless when walking, make sure you have help at airports. Distances to departure gates can be long. Disabled assistance at airports can be arranged before you travel.
4. When you are in the aeroplane try to move about every hour or so and exercise your legs. Sitting for too long can lead to blood clots in the legs.
5. Drink plenty of water and non-alcoholic drinks during the flight.
6. Remember the golden rule: If in doubt about travelling, check with your doctor.
References: http://www.fitfortravel.nhs.uk
