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Ask Dr. Tom
Dr. Tom

Thomas L. Petty, MD, answers your questions about lung health.


“Patients, therapists and physicians alike have a growing need to learn more about the importance of maintaining lung health and preventing and treating both acute and common respiratory disorders. I am eager to answer your questions in short and clear language. This is intended to be an active dialog.”

Dr. Thomas Petty, MD

Questions and Answers
Posted April 14, 2009

Nebulizing Fortaz

Q. Do you have any information on nebulizing Fortaz? I have heard that it has been done but not sure where to look for the information.

Marie, RRT

A. Dear Marie RRT,

I have no information about this. Sorry.

Dr. Tom

Does Air Trapping Mean Emphysema?

Q. Hello, I am 51 years old, have never smoked, and was put on 2 liters oxygen in May 2008 after hospitalization for hypoxemia. I was labeled with Idiopathic ILD/UIP (Interstitial Lung Disease/Unusual Interstitial Pneumonia) after a lung biopsy in Nov 2008. I was discharged with diagnosis of unknown viral pneumonia after they eliminated bacteria and Influenza A and B.

My latest non-contrast CT scan showed air trapping in February and my respiratory therapist, at pulmonary rehab, says this means emphysema.

How can I have emphysema if I never smoked and haven’t been exposed to second hand smoke in the house for 35 years?

Aline

A. Dear Aline,

Air trapping cannot be equated with emphysema. It may occur in ILD/UIP.

Dr. Tom

Side-Effects of Isoniazid

Q. Can Isoniazid (INH) cause problems with the disc in your back?

I've never had problems with my back until I was diagnosed with INH induced hepatitis, now I've had four discs fused in my neck and am due to have two more in my lower back.

Joseph

A. Dear Joseph,

NO. These disc problems are not related to INH.

Dr. Tom

Help, Husband Is Not Taking Care of Himself

Q. My husband was told he had COPD six years ago and was told he had emphysema four years ago.

He is 69 years old, has high blood pressure and told he has diabetes. About a year ago he started having angina, since he was told that he has given up all medical care and takes no meds except his Combivent, which he over takes (can go through 200 inhalations in less than a week).

The angina has gotten so it is almost a daily thing and the last two weeks he has started to cough a lot and now is coughing up a mucus which is sometimes white to a green looking color. He coughs so hard now it makes him throw up.

I have begged him to let me take him to a hospital but he refuses any care. Can you give me any insight as to what I am about to deal with or what is happening to him? I am so in the dark. I have read a lot about COPD/emphysema but nothing really seems to tell me anything.

By the way, he still smokes and has since he was about 18 years old.

Jennifer

A. Dear Jennifer,

At least a major part of his current problem is smoking. He must stop or the symptoms will continue.

Dr. Tom

Cause of E. Coli in the Lungs

Q. Dr. Tom, My grandfather recently passed away from pneumonia. He had bacterial pneumonia, which consisted of Moraxella and E. coli. I later learned that my grandfather had eaten raw blood sausage, which he loved.

Could this have been how he obtained E. coli in his lung or do you think it was a secondary bacteria, due to the fact he was on a vent until he passed away?

Amanda

A. Dear Amanda,

The E coli was not from the sausage. It was probably due to the use of an airway and mechanical ventilation.

Dr. Tom

Having a Hard Time Getting a Oxygen Saturation

Q. I am a respiratory therapist, currently working doing Pulmonary Rehab. We are having difficulty getting saturations via pulse oximetry on a patient with scleroderma. We have tried and tried with the finger probe and ear probe.

Do you have any suggestions? He desaturates easily and we really need to monitor him.

Susan

A. Dear Susan,

I have no experience using oxymeters in the case of scleroderma.

Dr. Tom

No Explanation from Doctors

Q. My attending physician sent me to another doctor for allergy testing because they could not find out why my white cell count kept coming up elevated and why I had some allergic reactions to some tests.

This other doctor sent me for a CT Scan and diagnosed me with emphysema. My doctor just wrote it off and never discussed anything with me.

What should I do?

Lynne

A. Dear Lynne,

Get another doctor who will explain things to you.

Dr. Tom

Can You Trim a Nasal Cannula?

Q. Is it safe to trim a nasal cannula for an adult patient to minimize nasal sores? Can you give me a resource that backs it up medically?

Theresa

A. Dear Theresa,

You can trim for comfort. There is no specific formula.

Dr. Tom

Pain After Pneumothorax Treatment

Q. Hello Dr. Tom, Seven months ago, at the age of 39, I suffered what was thought to be a spontaneous pneumothorax (5'10", 118 lbs.). It was over 30% of my lung, but was left to resolve on its own. I should also note that I had smoked for approximately 22 years (< pack/day) prior to the first collapse. I have not smoked since that day.

I suffered another collapse approximately a month later, and underwent VATS mechanical pleurodesis with resection of apical left upper lobe and a parietal and visceral pleurectomy. My CT scans at the time showed multiple blebs on both lungs. The pathology from the surgery indicated emphysematous changes and subpleural blebs, so I would imagine my collapses were due to bullous emphysema and not really spontaneous.

I am now six months out from surgery and still have significant "pulling" pain at the bottom of my rib cage on the surgery side. I also have very little strength in my stomach muscles on that side as well.

I have asked if a “Sniff Test” is in order, but my pulmonologist doesn’t seem to think that's necessary.

What could be causing such pain? Is it possible an adhesion was formed between my lung and diaphragm? Any opinion on this would be appreciated.

Thanks for taking the time to read this.

Susan

A. Dear Susan,

Adhesions could explain this. Sometimes VATs correction is needed.

Dr. Tom

Treatment for Idiopathic Pulmonary Fibrosis

Q. Hi, My father has been diagnosed with Idiopathic Pulmonary Fibrosis (IPF) yesterday. For about a year he had been complaining of difficulty in breathing, which used to happen when he took some walks. But that was neglected all these days as some minor problem. Now it is diagnosed as IPF after CT Scan.

We live in India and my father's age is 74 years. My father has a history of smoking in his younger days, but it is more than 30 years since he got rid of that habit. He is diabetic for over 25 years, but has maintained good health till now with his strict dietary habits.

Nowadays he is complaining about difficulty in breathing even for a short walk of, say like 100 yards or so. He is not having any cough symptoms, though once in a while he does cough.

What are the possible treatments available at present and what could be the best one to follow for a person like him at least to keep the situation under control? What are the options available in homeopathy or any other type of medications?

What care should be taken and is there any particular diet he has to follow? Please let me know about the best possible treatments. I’ll be desperately waiting for your reply. Thanks a lot.

Zafi

A. Dear, Zafi,

There is no proven treatment for IPF. See a pulmonologist to see if there are any experimental drugs.

Dr. Tom

Tubing Length

Q. I am using D size tanks with a Chad pulse dose conservator. What is the maximum length of cannula tubing that I can use with a setting of two or three liters?

Macel

A. Dear Macel,

Up to about 50 feet.

Dr. Tom

Concerned about Husband’s Medical Care

Q. My 64 year-old husband has COPD with 20% lung function. He had a severe bout of bronchitis in December, so bad the Dr. said that he really should have been hospitalized.

His GP and his pulmonologist never ordered an x-ray or CT (at the time or afterwards for follow-up) nor scheduled a follow up appointment for three months. When I called his GP the week before his appointment to tell him that I could still hear significant wheezing and wondered if one or both of the tests should be done before the appointment so as to have them for reference I was told no.

Should we be concerned? We have good insurance. Given his status shouldn’t he have regular x-rays and CT scans?

Also the times he has been on antibiotics (maybe once a year) the five day never seem to take care of it. The ten day does better but they keep prescribing the five day stuff.

Is it time to seek different medical care? Even when we tell the doctors of our concerns it seems like no one is listening.

Cindy

A. Dear Cindy,

He should have a chest x-ray and a CT to see if an underlying additional problem is present.

Dr. Tom

Diffusing Capacity and COPD

Q. Have you ever heard of an increased diffusing capacity in a severely obstructed (COPD not asthma) patient?

Harold

A. Dear Harold,

Yes, in states of marked hyperinflation. There is no significance to this finding.

Dr. Tom

Bad Smell in Oxygen Tubing

Q. I use supplemental O2 at night for low O2 saturation levels. My problem is that I am reacting to something in the tubing. It starts out as just a bad smell of the plastic, which I try to ignore. However, when I finally fall asleep, I wake up with burning in my nose, throat and chest.

I have been advised to use a nasal lubricant, a nasal spray, and use a humidifier attachment (with distilled water which I change every day). I have had the concentrator checked out and it is operating properly. I also use a room humidifier. (I live in the dry Southwest.)

It has come to the point that I have stopped using the O2, as I really need to get some sleep. My physician has explained the danger in this, but I really do not know what to do. My oxygen supplier knows of no other type of tubing. Do you know of anyone else who has had this reaction and what I can do?

Zara

A. Dear Zara,

Sorry. I do not know of any other type of tubing for long term oxygen therapy.

Dr. Tom

Mold Found in Air Handler Unit

Q. I have lived in my apartment for one year. I have been hospitalized twice for breathing problems, both times gasping for breath and not able to fill my lungs. I have asthma.

Last week we discovered dense mold on the inside of my air handler unit. I need to decide in a few days whether to move out, or see if a new unit fixes the problem. If I stay here over 3-4 days I get the breathing problem again. When I stay somewhere else I don’t have it.

What do you think? I am 70 years old. I have read so much conflicting info; I am undecided as to the best action. Please help with your two cents.

Corky

A. Dear Corky,

You must avoid the mold, which will continue to damage your lungs. Do it now.

Dr. Tom

Medications

Q. My Dad is 86 years old and has COPD. He is under the care of hospice and he feels that they are trying to finish him off by giving him medications that the doctor says he needs. He takes Mucinex, Xanax, Lortab, Flomax, theophylline, Advair, Duoneb, and he is on oxygen.

He constantly complains of pain all over so they recently prescribed Morphine orally because he said the Lortab was not helping and he has refused the morphine because again they are trying to kill him.

He is constantly sick at his stomach, has a headache, cannot urinate like he thinks he should, complains about his bowel movements and on, and on and on. He is just about to drive my Mom and me crazy so my question to you is this are this just things go along with the COPD?

Oh and by the way he still smokes!! THANKS FOR YOUR HELP.

Loretta

A. Dear Loretta,

Unfortunately these are the nagging problems that accompany COPD, particularly in the elderly. A controlled amount of oral morphine such as 15mg twice a day in a sustained release tablet is safe and often very helpful.

Dr. Tom

Fatal Asthma Attack

Q. My husband was an asthmatic, when he died his lungs were hyper inflated and overlapped. He had his rescue inhaler in his hand. Was this just a fatal asthma attack or something else? He was in good health.

Carla

A. Dear Carla,

This was most likely a fatal asthma attack.

Dr. Tom

Dangers of Second-Hand Smoke to Children

Q. I have a seven year-old nephew with primary ciliary dyskinesia. His parents smoke, but outside.

What harm are they doing to him? How is the second and third hand smoke dangerous to his health? What are the dangers of having it on clothing and in the cars?

I have begged them to stop smoking. I need information to show them it’s hurting him. Please help. Thanks

Lori

A. Dear Lori,

The dangers and risks of second-hand smoke are very real. Secondhand smoke is especially harmful to young children. Secondhand smoke can also aggravate symptoms in children with respiratory disorders as tobacco smoke lingers in the air, fabrics and clothing for hours after cigarettes have been extinguished.

Second-hand smoke exposure on top of impaired ciliary function with reduced or absent mucus clearance abilities, can lead to chronic recurrent respiratory infections, including sinusitis, bronchitis, pneumonia, and ear infections.

Tim BS, RRT-NPS

Grandsons have Trouble Breathing at Night

Q. My grandchildren, ages four and six, have not been breathing through their noses at night, and some of the day. Their doctor wants to push up the palette in their mouths. What do you know about this? What problems can this bring about?

Barbara

A. Dear Barbara,

It’s not clear what the doctor means by pushing up the palate. The palate is made of bone and cannot be pushed. Surgery on the palate is done in some adults with severe sleep apnea as a last resort, but this is not done in children. I think you should talk to the doctor to get a better idea of what she or he has in mind. There are certainly many things that can be done to relieve nasal stuffiness and these should be done before considering any surgery.

Dr. Bruce

Is Medication Safe for a Four Month Old?

Q. My four-month old son has a cold that causes him to cough and the doctor has prescribed Montelukast Sodium. I have seen a big improvement just after 1 dosage but cannot find anything on the net that says it is ok for his age. Is this medicine suitable for a baby of four months?

Gabriel

A. Dear Gabriel,

Monteleukast (Singulair) has been approved for children age 12 months and older but it has been safely used off-label in several research studies to treat infants as young as one or two months of age with bronchiolitis (generally without success).

Many medications have not been specifically approved for infants and young children but can be used safely and often effectively in the very young.

It sounds like this worked well for your son and that is good news.

Dr. Bruce

Pre-Term Baby’s Oxygen Requirements

Q. Dear Doctor, May I ask how much oxygen is a preterm baby (35 weeks, 1.790 Kg) getting if he/she is receiving 0.025 LPM of pure oxygen in one minute if the baby is breathing 40-60 breaths per minute?

Roel

A. Dear Roel,

I love questions like this!

There are two good answers. When I am teaching students it give me the opportunity to build equations to calculate the fraction of inspired oxygen (FIO2) based on tidal volume (about 7 mL/Kg) and respiratory rate giving minute ventilation, then taking into account dead space and how this changes with increasing respiratory rate, and ambient air (0.21 oxygen) entrainment we can derive a rough approximation of the inspired oxygen. Whew! But this is great for teaching physiology.

The second answer is really the correct answer - It doesn’t matter. Babies will have changing airway surface area, minute ventilation, and dead space so what we try to do is give the least amount of oxygen necessary to keep the oxygen saturation greater than 90%. Give just the amount of oxygen that it takes and you will support that infant. Beware that if the baby's oxygen requirement to maintain saturation is going up, this probably means trouble.

Dr. Bruce

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