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Archive: Dr. Tom 1

Albuterol and health risk
Q: I was told by my doctor that there are long-term health risks associated with using Albuterol. The short-term side effect of increased heart rate coupled with using Albuterol for many years may cause premature heart failure. Is this true?

Geoff

A: Dear Geoff, The use of albuterol, for relief of attacks of breathlessness is safe, based on years of experience, when used as prescribed. Excessive use may cause heart rhythm disturbances, but not heart failure.

Dr. Tom


Toprol and oxygen saturation
Q:
As both a cardiac and COPD patient, my cardio MD and pulmo MD differ on my taking Toprol medication

Having an oximeter, I notice a higher sat reading if I delay taking Toprol. What is the effect of Toprol on my oxygen saturation and why? Thank you for your help.

Dan

A: Dear Dan, Toprol is a drug that can cause bronchospasm in susceptible people with asthma and sometimes with COPD. When this happens, it can affect oxygenation. Great that you have an oximeter for home use. I believe that all patients who receive oxygen or have complex pulmonary and cardiac problems can benefit from home oximetry.

Dr. Tom


Pseudomonas aeruginosa and multiple rounds of antibiotics
Q:
My COPD was diagnosed in 1980 when I was 43—I’d quit smoking when I was 36. I had good management and few flareups.

I was hospitalized with pneumonia in May ’02 and Feb ’03. The second one didn’t resolve, and some weeks after coming home I had a series of sputum tests which showed a “light growth” of pseudomonas aeruginosa. I started TOBI, and felt some success but had to be hospitalized in May ’03 for what was diagnosed as pseudomonas bronchitis.

Upon release this time I was put on 3 weeks of home IV therapy with cefepime and tobramycin, plus continuous 60mg/day prednisone for a month.

Since that time I’ve had two minor flareups (Jan-Feb ’04), both treated at home with augmentin and prednisone.

I completed a rehab and have continued to exercise regularly and build strength since that time with no further incidents. I am on 3L of O2 for exercise and 2 for sleep (down from 5-6L in May ’03) and can do light chores and walking without any O2 while keeping saturations at 89 or above.

I am taking Spiriva, Serevent, Flovent, theophylline 600mg daily, occasional albuterol.

My only symptom during the past six or seven months has been a persistent low-level bronchitis, which, however, doesn’t keep me from normal daily activities.

My question: does my history suggest that the aggressive treatment of the p. aeruginosa was successful in eradicating the colony, or is it likely that it is still there? Some people claim that eradication is possible but I’ve not seen independent documentation of this.

Thanks for making this format available, and for all the work you’ve done.

John

A: Dear John, It is possible to eradicate pseudomonas with the aggressive antibiotic regimen that you describe. This is more likely to happen if the pseudomanas is treated early and before it does major damage to the airways. You are lucky. Keep it up.

Dr. Tom


Spiriva and Maxair best time to take it

Q: Hello Dr. Tom. I have COPD and am taking Spiriva. Should I be taking my Maxair first on mornings when my breathing is especially bad?

Linda

A: Dear Linda. Maxair contains a short acting bronchodilator that works through different mechanisms than tiotropium, Spiriva. Fine to use both together and start with the Maxair as you suggest.

Dr. Tom


Side effects of respiratory medication
Q:
I have COPD and chronic bronchitis. Every medication I take gives me congestion. I now take albuterol and it makes me shake and have heart palpitations. I have to have it and don't know what to do. I have told four doctors about this but they have only suggested Advair. I tried this and it suppresses my breathing with a tightness around my chest. Please help.

Rita

A: Dear Rita, Neither of the two components of Advair should give you tightness in your chest. Advair should relieve chest tightness, if it is related to asthma or COPD. Better get some more advice from a doctor who knows more about you than I do. But do not give up! There should be a solution to your problem.

Dr. Tom


Reliable Conserver
Q: What is the most reliable Conserver to use as I have had problems with mine.

Bobbie

A: Dear Bobbie, Sorry, there are so many, I cannot tell you the best one from experience. The technologies are changing all the time.

Dr. Tom


Trach removal and cleaning
Q: How long does it take to have a TTO trach mature so that removal for cleaning can be done?

Tim

A: Dear Tim, About a month.

Dr. Tom


70 yr. woman with Tracheomalacia

Q: I am a 70 yr. old woman who has moderate emphysema but just recently my pulmonologist did do a bronchoscope and found that I had Tracheomalacia (usually found in babies.) He sent me to a specialist who seems to be stalling as he told me to go to a gastroenterologist, which I did and he did an endoscopy. Everything was fine. This specialist wants to do another bronchoscopy so he can see for himself how far down the Tracheomalacia goes. All I want is for him to put a stent in to keep the trach open so I can breathe. It is quite difficult to breathe when I shower, dress or exert myself. I have oxygen but that does not help as much as my nebulizer containing Albuterol and Ipratropium. I think the Albuterol relaxes the Trach. Is it possible for you to tell me more about Tracheomalacia in adults and what should be done and if the specialist won’t put a stent in, where can I go to have someone correct this problem. I’m getting close to being housebound. Thank you for whatever information you can give me.

Thelma

A: Dear Thelma, Tracheomalacia is a weakening of the supporting structure of the trachea (cartilage). It comes from inflammation and forceful coughing in some people with COPD. Stenting is the treatment. You need to find a pulmonologist who is experienced in stenting. Ask your pulmonologist to refer you to a doctor, pulmonologist or thoracic surgeon who is experienced in placing stents.

Dr. Tom


25 year old with COPD?
Q:
I am 25 years old and was born pre-mature with 50% lung capacity. A few years ago I went to a pulmonary doctor and he took a CAT Scan and diagnosed me with COPD. I was born BPD and smoked for a couple years. My lung function has stayed the same since I was 20 (around 50%). Do you think it was maybe mis-diagnosed COPD?

Danny

A: Dear Danny. You most likely have fixed airways changes as a result of your BPD. Since this is measured as airflow obstruction, it is technically COPD. But the good news is that your prognosis is excellent, now that you have stopped smoking. Your lung function will decline slowly, just like a normal person loses a little every year. Stay well and enjoy life!

Dr. Tom


COPD/SOB

Q: I am in the early stages of emphysema as told to me in June, 2004. I feel short of breath even while sitting. I take deep breaths and try to yawn to get my breath. I’m told I shouldn’t be having symptoms by people in the Efforts support group but I am. Why?

Doris

A: Dear Doris, Shortness of breath is a perception of labored or uncomfortable breathing. You are the only one who knows how you feel. Start exercising more and see if you don’t breathe better.

Dr. Tom


PFT/Restrictive disease

Q: If you look at my PFT values, everything points to some sort of restrictive disease and not COPD. Is it possible to have both restrictive and obstructive diseases going on at the same time? BTW, we have definitely ruled out asthma. Thanks!

Elaine

A: Dear Elaine. It is possible to have both obstructive and restrictive diseases together. Better get another opinion about what is going on.

Dr. Tom


COPD and Yawning

Q: My husband has COPD for over a year. Can yawning be associated with COPD - especially when driving. Thanks.

A: Dear Elaine, Yawning can be normal or associated with COPD. It can also be “contagious.”

Dr. Tom


TB/Coughing up blood

Q: My doctor is on maternity leave right now. She wanted a TB test done as I have had blood in my phlem now over a year or two, even after antibiotics. After several rounds of antibiotics, it will be like old blood instead of fresh red blood, but soon will be back as fresh red blood.

I have COPD, and the bottom half of my lungs burn at all times. Also my lungs are over inflated.

The nurse practitioner did the TB test, read on the third day, the red spot was half the size of a dime. It was maybe a little bigger and had lump but not very noticable lump. The nurse read it as negative.

The next week I had to go to hospital to get blood drawn.

The lab had a diagram on wall for TB test. Since I still had the red spot and lump on my arm I asked the lab tech about it. She said it was a definite reaction to still be there and by the size of it.

The nurse practitioner did a phlem culture. The phlem came out negative. When I coughed at the doctors to give a sample for testing, I coughed up phlem from upper lungs. As I always know, the blood comes from the lower lungs. Can it be neg if I only coughed up phlem from upper lungs?

I have had xrays that apparently are normal for TB. I've never had a CAT scan on my lungs.

Where do I go from here? Can you have TB maybe in lower lungs and? I am tired of frequent infections. Help please. God bless.

Ginny

A: Dear Ginny, Blood in the phlem (sputum) requires an explanation. You probably need a bronchoscopy to see if the cause can be found. TBC is most commonly in the upper lobes, but can involve the lower lobes alone. Good that you had a sputum test for TBC and that it was negative. Follow through on the bronchoscopy by a pulmonologist.

Dr. Tom


COPD and Numbness of lips

Q: Is numbness in the lips part of COPD?

Arenflorence

A: Dear Arenflorence, Not usually.

Dr. Tom


Chiropractor adjustments and better breathing

Q: Would there be any benefits for improved breathing by going to a chiropractor for adjustments to the spine?

Kathleen

A: Dear Kathleen, I doubt it.

Dr. Tom


Cystic Fibrosis and Hypertension

Q: Have you ever seen hypertension (left ventricle) in patients with cystic fibrosis? What is the cause and treatment?

Lisa

A: Dear Lisa, Cystic fibrosis is not related to hypertension. Hypertension is a common disease and can be present in anybody.

Dr. Tom


Post nasal drip does oxygen cause this?

Q: During the past year I have been plagued with post nasal drip to the extent that I have almost “lost my voice.” The phlem seems to settle on my vocal cords which have been scoped to assure me that there is not a problem there. My oxygen use is only at night and while exercising and I was wondering if the O2 is the cause of this phlem which started at the time I got sick. I was very ill last year with pneumonia and blood clots to my lungs, and gradually through rehab and good exercise program have gotten off O2 during the day even though I live at 7200 ft. I really would like to get my “voice” back but just don’t know what to do.

Loraine

A: Dear Loraine. I doubt that your hoarseness is due to the oxygen. Sounds like a vocal cord paralysis. Better check again. Sometimes this recovers spontaneously, but there are vocal cord injections with teflon, that an otolaryngologist can do.

Dr. Tom


Flu shot and high risk groups—asthma?

Q: I know that there is a shortage of flu vaccine and that officials are trying to limit vaccinations to high risk groups. I have asthma. Does that put me in a high risk group?

Sharon

A: Dear Sharon. Chronic asthma is a risk of flu, like other chronic diseases. Talk to your doctor about antiviral drugs you can take if you start to come down with the flu with a hacking cough, fever, and muscle aching. It must be taken early to abort an attack of influenza.

Dr. Tom


Role of scoliosis and splayed ribs and COPD/bronchitis

Q: Would splayed ribs and scoliosis contribute to chronic bronchitis and/or COPD? Can COPD be observed on a CXR? If years of postnasal drip/sinusitis have been present, and the cause were corrected, would that stop the progression of disease?

Tina

A: Dear Tina, No for the ribs or scoliosis. No for a CXR diagnosis of COPD unless it is far advanced. Spirometry is needed to diagnose COPD. And spirometry can be affected by scoliosis, so it can be tricky. Best to get control of a postnasal drip with treatment, but it will not affect the progress of COPD. It makes you feel better and this is worth the effort.

Dr. Tom


Heart rate during exercise

Q: Doctor Tom, I am a 67yo male. I had lung cancer followed by lobectomy in 1983. My lungs are heavily scarred. I now have COPD.

My meds are: Uniphyl 200mg 2bid, Advair 250/50 2bid, Spiriva 1bid.

My resting heart rate (HR) is 98. When I arrive at rehab phase 3, HR is 126; it rises to 146 during exercise with a tendency to go higher toward the end of my exercise program.

My program consists of 4 min.@ 20 watts on arm ergometer; 15 min. @ no resistance on bike; on the leg/chest/arm ergometer – on chest, 3X15 reps @ level 4, plus on legs, 3X15 reps on @ level 4; t-mill @ 2.2mph for 15 min.

My question is, should I worry about the high HR, do anything about it, and what should be the maximum rate allowable before I slow down or stop? Other than the ailments mentioned, I am healthy with no other ongoing or recurring problems. Thanks in advance for the answer,

Edward

A: Dear Edward, Don’t worry about a resting heart beat of less than 100. Just means you’re are “rarin' to go”. Exercise as much as you feel comfortable doing. Don’t become preoccupied by your heart rate. Your body will tell you when to stop.

Dr. Tom


Scuba diving after lobectomy

Q: How long after a lobectomy should someone wait before scuba diving?

JJ

A: Dear JJ, Depends on why the lobectomy was done. Usually one month is enough time for healing.

Dr. Tom


Can exercise improve lung function

Q: Can “cardio” exercise (e.g., with heart rate in training range) improve spirometry readings? That is, would cardio exercise help counteract damage done to lungs with mild COPD?

Sarah

A: Dear Sarah, It will not increase your spirometry, but it will make you more physically fit and you will feel better. Go for it!

Dr. Tom

 

 

 

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