Hello, I know we all have different problems with emphysema. I am told I am end stage. Is that stage 4? I am on 3 ltrs at night and 4 ltrs during the day . When I feel a flush ( not too often) I immediately start my breathing exercises . I draw in thru my nose a good deep breath and use pursed lips to exhale. I try to extend the exhale so it is longer than the inhale . This helps clear the lungs . I also do at least five of these in and out before I use my inhaler . (Trelegy) . I have asked my pulmonologist about a bipap . He also has a sleep center. He says I need to spend the night at that center. lol. I guarantee. That won’t happen . I don’t go out much . When I do it’s with a good mask . I am not spending a night anywhere but at home . Love and Light to all of you. *hugs* from Crystalina