How to breathe when inhaling GM-CSF
First, exhale the air that has accumulated in your lungs.
→Inhale for 3 seconds→Hold your breath for 3 seconds→Exhale for 3 seconds (9 seconds in total, 7 breaths per minute)
- First, exhale while squeezing the area below your navel, trying to exhale all the air remaining in your lungs.
- Place the mouthpiece of the inhaler in your mouth, press the spray button, and inhale slowly for 3 seconds, making your stomach inflate.
- Release the spray button. Hold your breath for 3 seconds.
- While holding the mouthpiece in your mouth and releasing the spray button, exhale slowly for about 3 seconds, making sure to dent the area below your navel.。
- Repeat steps 2–4.
- When the drug solution runs out, the nebulizer spray sound will become hoarse. Until then, repeat steps 2, 3, and 4. Stop inhaling when the mist that comes out is only visible occasionally.
When you can't breathe properly
Do not be disappointed if you can't inhale properly. This treatment lasts over 24 weeks. Just think of it as practice for about a week. If you get tired of inhaling, you can turn off the switch and take a rest. Do not rush; inhale at your own pace
What is abdominal breathing?
The correct way to do abdominal breathing is to expand your belly when you inhale and deflate your belly when you exhale. You can breathe more deeply by focusing on expanding your belly instead of your chest. If you are not used to it, it is a good idea to focus especially on breathing. Belly breathing naturally occurs when you lie down, so it is a good idea to do it while lying on your back until you get used to it, and then try doing it while sitting or standing.
What does it mean to hold your breath?
When the air containing particles with GM-CSF reaches the respiratory bronchioles before the alveoli, it slows down to a very low 0.9 mm per second. There is a gap of more than 1 second between the trachea and the alveoli for air to enter the alveoli, and even during exhalation, the incoming air moves into the alveoli. You hold your breath for 3 seconds to allow the air you breathe and the GM-CSF particles in it to move into your alveoli and stick to their walls.
About inhalation therapy when receiving home oxygen therapy
If you breathe for a total of 9 seconds (3 seconds of exhalation, 3 seconds of inhalation, and 3 seconds of breath holding), you will be breathing 7 times per minute.
Adults breathe 12 to 20 times per minute, so this is a fairly slow breathing method. Patients who feel short of breath with even the slightest exercise or walking have reduced lung capacity and may find it difficult to breathe this slowly. For such patients, we recommend the following method:
- Wear a pulse oximeter on your finger to measure oxygen saturation.
- Breathe 3 liters/min of concentrated oxygen through the home oxygen nasal cannula.
- Check that the oxygen saturation on the pulse oximeter is 96% or higher.
- With the oxygen concentrator and nasal cannula still in place, turn on the inhaler and begin GM-CSF inhalation.
- If you find it difficult to breathe or the oxygen saturation level on your pulse oximeter drops below 90%, stop inhaling and breathe in oxygen from the nasal cannula to help you breathe.
- One inhalation may take more than 30 minutes. Inhale at your own pace without rushing.
Generally, in patients with autoimmune pulmonary alveolar proteinosis, waste products often accumulate in the alveoli in the lower lung field (lower part of the lungs), so if you inhale while sitting, it seems that the mist that is efficiently inhaled easily enters the lower lungs.
This is because mist tends to enter the bottom due to gravity.
However, in critically ill patients, waste products accumulate not only in the lower alveoli but also in the upper lung fields (the upper part of the lungs), so it cannot be said that a sitting position is best.
If you are breathing oxygen, stop breathing oxygen, wear a pulse oximeter on your finger, and try the following positions.
- Supine position (lying on the back)
- Right lateral position (lying on the right side)
- Left lateral position (lying on the left side)
- Prone position (lying on the stomach)
- Sitting position (sitting position)
Patients who cannot stop oxygen inhalation even temporarily should discuss the inhalation method with their attending physician. Patients with severe alveolar proteinosis who have reduced lung capacity may have an increased amount of carbon dioxide in their arteries. If such patients are suddenly given high concentrations of oxygen, their breathing rate may decrease and they may lose consciousness (CO2 narcosis). Although it is highly unlikely that patients with extremely severe conditions like this would be able to start GM-CSF inhalation therapy at home, it is best to start the treatment in the hospital under the supervision of a doctor or nurse.