Breathe Magazine 2017

A MAGA ZINE PROMOTING GOOD HEALTH

www.thelungspecialists.com

CMharnoangiceCmaernet PRODUCED BY THE LUNG DISEASE
CENTER OF CENTRAL PENNSYLVANIA
Pulmonary care beyond the office walls
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Welcome to BREATHE 2017 • 3

Welcome to the
6th Edition
of Breathe
magazine. It is
hard to believe
the Lung Disease
Center is 6 years
old. We seem
to be going stronger
than ever and in this issue we
have some exciting news about a new
initiative for our patients, along with
some follow-ups on previous topics.

This issue contains updates on
e-cigarettes, which continue be used
by more people despite reports
continuing to come in about risks and
harmful side effects. New government
regulations are also part of the
picture. Our Early Detection Program
(EDP) for patient’s at high risk for
developing lung cancer continues to
show benefits. Since we started our
Early Detection Program, which by
the way was the first formal program
in our area, we have enrolled over
300 patients and continue to find
early cancers which can be treated
aggressively.

The biggest news is in our article
on Chronic Care Management. This
program will be open to specific
Medicare patients and I encourage
any of our Medicare patients who see
us for COPD or other chronic lung
disease to read this article. We like to
think that the Lung Disease Center and
the Altoona Lung Specialists stand
at the forefront of pulmonary care in
Central Pennsylvania. This program
is designed to help us extend our
care outside the walls of the Lung
Disease Center. This program is
focused on long term management
and monitoring of patients with
chronic lung disease and certain co-
morbidities.

Thank you for accepting this 6th
Edition of Breathe magazine. I hope
the information is helpful to all.
WWW.THELUNGSPECIALISTS.COM

Lung Disease Foundation

Named Tobacco
Control Service
Provider for Blair and
Bedford Counties

October 2016 brought a through education. The TATU Smoking, PA Free Quitline,
new endeavor to the Program allows students ages FAX to Quit, and the American
Lung Disease Foundation 14-17 to mentor youngsters Lung Association’s N-O-T (Not
of Central Pennsylvania. The about the dangers of smoking. on Tobacco) Teen Cessation
American Lung Association These programs, as well as Program. Many of these
in Pennsylvania named the tobacco prevention education, programs are free of charge and
Foundation the Tobacco Control are offered to youth throughout offer the tools necessary to assist
Service Provider for Blair and schools, youth organizations, in the effort to quit tobacco use.
Bedford Counties. The focus clubs, and religious youth groups,
of the Tobacco Control Service etc. Prevention education is SECONDHAND SMOKE: To
Provider Grant is as follows: offered to adults via health fairs, eliminate non-smoker’s exposure
presentations to organizations to secondhand smoke through
PREVENTION – The focus of and at employer sponsored policy initiatives such as: Young
this initiative is to prevent the events. Lungs at Play (playgrounds and
initiation of tobacco use among recreational areas); Worksite
youth and adults through TRU PROMOTE QUITTING: To Policy (creation or strengthening
(Tobacco Resistance Unit), TATU promote quitting among of policies for worksites); and
(Teens Against Tobacco Use) and adults and youth through the Multi-Unit Housing (creation
Tobacco Prevention Education. American Lung Association in or strengthening of policies for
The TRU program aims to prevent Pennsylvania’s adult cessation those who operate multi-unit
and stop youth tobacco use program Freedom From housing).

4 • BREATHE 2017 WWW.THELUNGSPECIALISTS.COM

HEALTH DISPARITIES: To cessation with chronic disease Please contact Sherri L. Stayer,
identify and eliminate tobacco- initiatives. Executive Director of the Lung
related health disparities among Disease Foundation for more
population groups through We look forward to undertaking information on any of the above
educating local legislators, these efforts and feel that this initiatives. Sherri can be reached
conducting targeted cessation grant is a perfect fit with the at 814-946-2845 x 200 or sherris@
outreach for identified mission and vision of the Lung altoonalungspecialists.com .
populations and integrating Disease Foundation of Central
Pennsylvania.

WWW.THELUNGSPECIALISTS.COM BREATHE 2017 • 5

2017 Update on

Early Detection Program

for Lung Cancer

Data continues to show that of health care experts, now
annual screening for lung recommends that CT scanning be
cancer, using low dose conducted on individuals between
CT scans, helps detect early lung the ages of 55 and 80 who have
cancers which are potentially at least a 30 pack year smoking
curable. The Lung Disease Center history. (Pack years are the
of Central Pa. was the first in this number of packs of cigarettes
area to develop an Early Detection smoked per day times the
Program (EDP) based on a large number of years smoked.)
population study showing the
benefits of annual screening in high Locally, we find
risk groups. To be sure, even early abnormalities on
detection cannot always insure we chest CT scans every
will find curable cancers, but the day. Recently, some
reduction in mortality noted to be criteria have been
about 20% in the original study, is advanced that will
significant given that the overall help to determine
survival time from diagnosis to which findings
death in patients with lung cancer are worthy of more
from all causes is a little over one aggressive follow up
year. and study, preventing
the need for further procedures or
CT scanning, as a screening biopsies. More refinement in the
tool, is expensive and has caused screening technique is certain to
many insurance companies and occur, but the current best results
the federal government to be are when the patient participates
slow to acknowledge the benefit. in an Early Detection Program
The US Preventative Task Force, annually.
an independent volunteer group

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companion services Provided in the Setting You Want:
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855.280.2576

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6 • BREATHE 2017 WWW.THELUNGSPECIALISTS.COM

E20-1C7 Uigpdaatreeotntes
E-cigarettes and vaping continue
to be discussed by health care to 2015. Addiction to nicotine can resulted in serious injury. Some
providers at every level of begin with young users who feel the of the e-cigarette accidents have
involvement. Last year the federal devices are “safer” than traditional led to permanent disfigurement
government decided that it would cigarettes. However, studies have and disability. Moreover, at least 67
regulate e-cigarettes the way it shown that e-cigarettes can provide accidents have led to major property
regulates traditional cigarettes and the same blood levels of nicotine as loss beyond the e-cigarette itself.
smokeless tobacco. One of the regular cigarettes, especially with The culprit behind these accidents
reasons seems to be the increased chronic users who tend to inhale appears to be the battery used in
use of e-cigarettes by younger age more deeply and use the device the device. Some of the accidents
groups. While it is known that 1 in 10 more intensely. Vaping can deliver occurred when extra batteries were
adults in the US has tried e-cigarettes particulate matter similar to regular in the users pocket along with coins
at least once, the number of high cigarette smoke. or keys which caused the battery to
school students who use or have tried short out and create a localized fire or
e-cigarettes has risen 900% from 2011 Aside from the inhalational risk, explosion in the pocket.
there have been over 137 incidents
where device malfunction has THERE IS NO SAFE CIGARETTE.

• Respiratory Recovery Program
• Pain Management
• Wound Care
• Lymphedema Therapy
• Orthopedic Injuries
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• IV Therapy
• Diabetic Monitoring

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Phone: (814) 684-0320 | Fax: (814) 684-0540 | www.guardianeldercare.com

WWW.THELUNGSPECIALISTS.COM BREATHE 2017 • 7

8 • BREATHE 2017 T he care of a patient does not
end when the office visit is over.
The care of a patient does not
end following a hospital discharge.
The care of patients with chronic

disease states such as COPD,
heart disease or diabetes has
been made more difficult by
the fragmentation of medical
care. Patients are seen by
one physician in the office
and another physician in the
hospital. They are seen by
specialists caring for one
organ system or the other.
How can we manage
the care of patients with
chronic disease states and
keep track of problems
before they arise?
Patients with COPD
are told that their disease
cannot be cured. They
are told that their disease
is progressive and to tell their

lung doctor if they are having
more problems. It is not feasible
to see a patient with chronic lung
disease with the frequency that
could keep them from developing
problems which often results in
hospitalizations. The three basic
goals for the treatment of patients
with chronic lung disease such
as COPD are: relieve symptoms,
preserve lung function and prevent
hospitalizations. Patients are asked
to notify the office if they are having
problems or if they run out of
medicine, but often these requests
go unheeded or occur at times
when the information cannot be
conveyed to a health care provider.
Most patients are seen in the office
at some reasonable interval e.g.
every 6 months but what if some
simple problems arise between visits
and resolving them could save the
patient an ER visit or hospitalization

WWW.THELUNGSPECIALISTS.COM

if it was acted upon early? Consider the chronic disease patients but this is a Patients in the program will be
patients that are hospitalized between worthwhile start. called monthly between visits by a
office visits. When they return to the The Lung Disease Center of Central certified heath care worker and asked
office they may even forget to mention Pennsylvania and the Altoona Lung about their condition and problems.
the hospitalization. Medications may Specialists clearly recognize the Medications will be reviewed and any
have been changed, but they cannot potential benefit of a Chronic Care ER visits, or hospitalizations will be
recall what was done Management noted. These phone visits and any
or why. Program for the many problems they detect will be conveyed
Medicare recognizes Starting in 2017 patients suffering to the patient’s lung physician at the
patients of the from COPD and Lung Center and if the problem is
the need to have more appropriate for the family doctor
more aggressive Altoona Lung other debilitating he/she will be notified. This service
and timely chronic Specialists who lung diseases. This will take place utilizing the electronic
care management. are covered by recognition has health record at the Lung Center and
It believes that a Medicare will prompted action. notes from the phone visits will be
program devoted be encouraged The Lung Disease made part of the patient’s chart record.
to greater in-home Center of Central Patients will have a 24/7 phone number
supervision of patients Pennsylvania to a health care professional to access
with chronic diseases and the Altoona for non-emergent problems. The need
between office visits to enroll in the Lung Specialists for an early visit to the physician will be
will improve the care Chronic Care have developed a conveyed directly to the Lung Center.
of these patients and Management partnership with This will allow the lung physician to
save money spent Program. SPAC International, better monitor and provide the best
on ER visits and a company certified possible care. Details and enrollment
hospitalizations. To to provide services forms will be given to Medicare eligible
this end, Medicare for this Medicare patients at the time of their office visit.
has set up a Chronic Care Management initiated program. Starting in January
Program and allocated 17 billion of 2017 patients of the Altoona Lung Continued on Page 10
dollars for its implementation. No Specialists who are covered by Medicare
program can take care of all the will be encouraged to enroll in the
problems associated with the care of Chronic Care Management Program.

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WWW.THELUNGSPECIALISTS.COM BREATHE 2017 • 9

M&T Bank. Continued from Page 9
Understanding
what’s important. This new and innovative service for
pulmonary care will only be available
At M&T Bank, understanding what’s to Medicare patients. The Lung Disease
important means realizing the role a Center and the Altoona Lung Specialists
bank plays in people’s lives. And then have chosen SPAC International as
living up to those responsibilities, their partner in this effort because of
by helping families, businesses and their current track record in providing
communities thrive. It’s what we’ve population health management services,
been doing for more than 160 years. medication reconciliation, and chronic
Learn more at mtb.com. care management services to over
500 providers in the United States and
covering thousands of patient lives. SPAC
International also works with national
pharmaceutical firms and hospitals. We
will monitor these services to be sure they
provide the desired outcome, which is less
ER visits, less hospitalizations, and better
patient outcomes.

The Chronic Care Management Program
at the Lung Disease Center of Central
Pennsylvania is another way the Altoona
Lung Specialists are demonstrating
their commitment to our patients and
community. Offering this new and
innovative program will help extend our
pulmonary services beyond the office
walls and help bring 21st century care to
our Medicare patients with chronic lung
disease.

Equal Housing Lender. ©2017 M&T Bank. Member FDIC. WWW.THELUNGSPECIALISTS.COM

10 • BREATHE 2017

Advancement IBy Alan J. Kanouff, D.O. is very soft and more appealing. They
of Treatment f you have tried CPAP (Continuous are also getting smaller and lighter with
Positive Airway Pressure) in the past smaller headgear.
SleepOptions for for sleep apnea and failed, it is worth
Apnea trying again. I have been seeing multiple Advances in alternative treatment
patients that were intolerant to CPAP have continued to improve and new
in the past and are now able to use it. I treatment options are available. One
believe the reason for this change is of the alternative treatments is a
comfort. The two main reasons for not dental appliance. This is not new,
tolerating CPAP are high pressure and but advancements have been made
an uncomfortable mask. As with all in the development to make it more
technology, multiple advances have been comfortable and affordable. Dental
made in how positive pressure devices appliances are typically more comfortable
provide air, making it more comfortable. than CPAP and are very small, requiring
If unable to tolerate CPAP, one option no power to use. They are not as effective
is to try BiPAP (Bilevel Positive Airway in severe sleep apnea, but we have
Pressure). BiPAP is one pressure when used them in patients that are unable to
breathing in and less pressure when tolerate CPAP. Insurances are starting to
breathing out. CPAP delivers the same help pay for these appliances especially
pressure at all times. This is beneficial for for patients that fail CPAP. We are working
patients that have trouble exhaling with well with local dentists who make the
CPAP or have issues with excess gas in molds in their office so that they are
the GI tract from their CPAP. The latest designed specifically for you. The newest
change with CPAP is how pressure is device for OSA is a hypoglossal nerve
delivered to the patient. Flex is the name stimulator. It is FDA approved and is
implanted in the chest with a wire that is
given for what is called expiratory positioned next to the hypoglossal nerve.
pressure relief. The machine is This stimulates the nerve to help keep the
able to monitor the patient’s upper airway muscles and tongue tense
airflow during expiration during sleep. Initial studies were mainly
and reduces the pressure done in patients with a body mass index
in response to the of less than 32, but did reveal significant
patient’s needs. Toward improvement. Ongoing studies are being
the end of the expiration, done to further evaluate this option.
the pressure is increased
again to prevent airway The monitoring of CPAP in the past was
collapse. This has made typically to measure compliance with
a difference in compliance treatment. Now, we use this monitoring
with CPAP and BiPAP. The to evaluate how well a patient is doing
pressure delivered is more on their current settings. We call this
tailored to the individual smart CPAP just like smart TV’s and smart
patient and therefore, more Blu-ray players. They can monitor the
patient through the night and tell us if it
comfortable. is working properly. This is something
The masks have also changed with that can be monitored by the patient as
advancements in technology making well with their smartphones. These new
them more comfortable. 3D printing has advancements are just the beginning
allowed for more contoured molds to for patients with this disease and we will
better simulate a person’s facial structure continue to stay updated to provide the
and newer masks are the result of these best services for you.
changes. The silicone used in masks

WWW.THELUNGSPECIALISTS.COM BREATHE 2017 • 11

The Lung Disease Foundation of success with the Lung Cancer Early
Central Pennsylvania (LDF) is Detection Program and we’re excited
dedicated to inform, empower about the Foundation being named
and educate individuals on how to Tobacco Control Service Provider for
improve all aspects of lung health. Blair and Bedford Counties. Through
To accomplish this, the Lung Disease the Tobacco Control Service Provider
Foundation partners with community Grant, the Foundation is using a
businesses and organizations, their comprehensive approach in delivering
staff and volunteers to raise awareness tobacco control programs including
of lung health issues, and assist with prevention, quitting and eliminating
lung cancer patients and their families’ exposure to secondhand smoke. (See
needs. page 4 for more information.)

Every November during National Over 158,000 Americans died from
Lung Cancer Awareness Month, the Lung Cancer in 2015 and many others
Foundation works especially hard to suffer from this terrible disease. More
raise funds and contributions to enable people die of lung cancer each year
the Foundation to continue their than breast, prostate, colon and
programs. Educational materials are pancreas cancers combined. Often,
distributed and events are held with by the time you see the symptoms,
presentations by the Lung Disease there is little chance to do any type
Center of Central PA (LDC) physicians. of surgical removal, which is the only
Thanks to a special partnership with know reliable cure.
Applebee’s in the Logan Valley Mall,
our “Dining To Donate” event takes The Lung Disease Foundation,
place on Tuesdays in November with a 501(c) (3) nonprofit foundation
15% of the diners’ meal checks donated founded by Dr. George M. Zlupko, is
to the Foundation. located at the Lung Disease Center of
Central Pennsylvania in Altoona, PA.
The “Beacon of Light on Lung Cancer We are always looking for volunteers
Walk” is held every August as the kick and new ideas on how to raise funds
off to “Health-O-Rama”. Walkers from for this very important cause.
across the Central Pennsylvania region
join the Foundation to raise money Be sure to like our Facebook page
by signing sponsors and then walking for information on upcoming events
inside the Logan Valley Mall for two and lung health news. For more
hours prior to the health fair beginning. information on the Foundation,
Every year the walk has continued to their services and programs,
receive strong community involvement please visit our website at www.
and participation, and is the lungdiseasefoundation.org, or contact
Foundation’s largest fund raiser. Sherri Stayer, Executive Director, at
814-946-2845, ext. 200 or email her at
The Foundation has had great [email protected].

(Left to right) Connie
Miller of Select Specialty
Hospitals, sponsor of the
Beacon of Light on Lung
Cancer Benefit Walk;
Michael Harf, walker
recognized for the most
laps walked; Barbara
Gerrity was the winner
of the most donations
raised; Dr. George M.
Zlupko, Chairman of the
Lung Disease Foundation
of Central PA.

12 • BREATHE 2017 WWW.THELUNGSPECIALISTS.COM

George M. Zlupko,
M.D., FCCP

Our Doctors Dr. George M. Zlupko is the senior
partner and founder of Altoona Lung
Timothy A. Lucas, M.D., FCCP Specialists. He is the Director of optic bronchoscopy, followed by
the Lung Disease Center of Central navigational bronchoscopy, and the
Dr. Timothy Lucas joined Altoona Disease, and Critical Pennsylvania, which he founded, new technique of Endobronchial
Lung Specialists in 2000. He received Care Medicine, as well along with one of his partners, Dr. Ultrasound most recently introduced
a Bachelor of Science Degree in as the American Board Timothy Lucas. He also founded the by his son, Dr. Michael Zlupko.
Biology from the University of of Sleep Medicine. He Lung Disease Foundation of Central
Pittsburgh. Dr. Lucas attended enjoys the distinction PA. Dr. Zlupko’s mission has been
medical school, performed his of being a Fellow of to provide high quality pulmonary
internship, residency, and fellowship the American College Many of the current advanced medicine services which would rival
training, all at The Pennsylvania of Chest Physicians. procedures used locally in tertiary care facilities, close to home
State University College of Medicine pulmonary medicine had their for more convenient patient care.
in Hershey, Pennsylvania. Dr. Lucas has beginnings more than thirty
privileges at years ago when Dr. Zlupko arrived
Dr. Lucas is certified by the UPMC Altoona and is the Medical Director of the Sleep in Altoona to add knowledge,
American Board of Internal Medicine Disorder Network in the Lung Disease Center of Central direction, and expertise to the
in Internal Medicine, Pulmonary Pennsylvania critical care unit and respiratory
care department of the, then,
Altoona Hospital. He brought
with him the techniques of fiber

Michael C. Zlupko,
M.D.

Alan J. Kanouff, D.O., FCCP Dr. Michael C. Zlupko joined the
Altoona Lung Specialists July 1,
Dr. Kanouff received his Disease Center of 2013. He graduated summa cum Medicine, Pulmonary Disease,
education at the Pennsylvania Central Pennsylvania laude with a Bachelor of Arts in and Critical Care Medicine.  He is
State University spending his in 2009. Biology from Franklin and Marshall licensed to practice medicine by
first two years in Altoona before College in Lancaster, PA.  Dr. Zlupko the State of Pennsylvania with
finishing up at University Park. He Dr. Kanouff is received his medical degree from privileges at UMPC Altoona, Tyrone
completed his medical education certified by the the University of Pennsylvania Hospital, HealthSouth Rehabilitation
at the Philadelphia College of American Board of School of Medicine in Philadelphia, Hospital of Altoona, and the James
Osteopathic Medicine. He performed Internal Medicine in PA.  He performed his internal E. VanZandt Veteran’s Memorial
his residency at Conemaugh Valley Sleep Medicine and medicine residency at the University Hospital.
Memorial Hospital in Johnstown, Pulmonary Diseases. of Virginia in Charlottesville, VA
Pennsylvania, and underwent his He is also certified and completed his pulmonary and
pulmonary training at Allegheny in Critical Care Medicine and Internal Medicine, and critical care training at the Cleveland
General Hospital in Pittsburgh, is licensed by the State of Pennsylvania as a Doctor of Clinic Foundation in Cleveland, OH.
Pennsylvania. He joined the Lung Osteopathy. Dr. Kanouff has the distinction of being a
Fellow of the American College of Chest Physicians. Dr. Michael C. Zlupko is Board
Certified by the American Board
of Internal Medicine in Internal

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WWW.THELUNGSPECIALISTS.COM BREATHE 2017 • 13

Our Justyna
Sleep Disorder Network
Kylie Haley Chris

Te a mClerical
Clerical Sleep Disorder Network

Lisa Cynthia We would like to thank Shirley Jenice
Clerical Clerical each member Clinical Sleep Disorder Network
Sonia Tricia of the Altoona Haley
Clerical Clerical Lung Specialists’ team for their Clinical Rose
Tamara loyalty and dedication to the Clinical
Clerical needs of our patients. Our team Michele
members play an integral part in Clinical
the success of the practice. Each
and every team member has
medical background and extensive
training in their respective role,
including Receptionists, Medical
Secretaries, Certified Medical
Assistants, Radiology Technicians,
and Registered Sleep Technicians.
Our team members are diverse
in age, educational background,
training, and the number of years
they have been a member of our
team; however, they each have
an important common thread
and that is their dedication to
being compassionate, caring, and

professional in their effort to
insure that each and every
patient of Altoona Lung
Specialists receives the best
care and customer service
available in their given field of
expertise. Thank you!

Sherri Stayer Carolyn
Practice Manager Clinical
Lung Disease Center of
Central Pennsylvania Samantha
Clinical

14 • BREATHE 2017 WWW.THELUNGSPECIALISTS.COM

Introducing

PURSED LIP BREATHING DEVICE
“Your answer to getting the old air out and getting the new air in!”

After years of watching his The Pursed Lip Breathing
patients suffer from shortness of Device helps solve these
breath, Doctor George M. Zlupko problems. It can be easily worn
believed there must be a way to around the neck for quick use
help relieve their discomfort. He and is very affordable. Stop by
was right. Dr. Zlupko invented the the Lung Disease Center of
Pursed Lip Breathing Device which Central PA in Altoona, PA to
is now patent pending. This tool learn more about the Pursed
is designed to help perform the Lip Breathing Device and
pursed lip breathing maneuver watch for more information
which is extremely helpful in coming soon on the Lung
relieving the symptom of shortness Disease Center’s website,
of breath that usually occurs with www.thelungspecialists.com.
exertion in patients with COPD.

When breathing rapidly, patients
with COPD have difficulty getting all
the air out of their lungs before the
next breath because their airways
are narrow. To help alleviate this
discomfort, patients are instructed
to blow out air with their lips tightly
pursed, like when whistling. But for
some, performing this maneuver
can cause anxiety and distress
resulting in them forgetting to
do the maneuver, perform
the maneuver improperly,
or be reluctant to do the
maneuver in public in fear
of being embarrassed.

PURSED LIP BREATHING DEVICE BREATHE 2017 • 15

Invented By Dr. George M. Zlupko
Helping you relieve shortness of breath

WWW.THELUNGSPECIALISTS.COM

Can’t Sleep?

Maybe it’s a sleep disorder.

Call the Sleep Disorder Network today.
What do you have to lose,
except another sleepless night!

814-946-2845 800 Chestnut Avenue
Altoona, PA 16601
www.thelungspecialists.com