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Archive: Dr. Tom 11
Posted February 23rd, 2005

Tuberculosis (TB)
Q. I am a hospital worker. About 17 years ago I had active TB. I was never sick and had no symptoms. It was found by accident on a routine chest x-ray. I was treated by my internist and a pulmonologist and have had no problems since that time. My question is if I completed the full course of treatment at that time, what are the odds of me getting TB again? Also, someone told me that it old TB cavities turn into cancer. Is that true?

Peggy

A. Dear Peggy, If you received a full treatment course and your organisms were susceptible to the drugs used, you are probably cured of TB. The chance of relapse from dormant organisms is extremely small.

There is no proof that the old TB cavities will turn into lung cancer. This was the old concept of a ‘scar’ causing cancer. More likely is that the cancer is associated with some scarring. Be sure to avoid all tobacco smoke.

Dr. Tom

 

COPD
Q. I have COPD with emphysema. I recently had a COPD flare up and am on Prednisone and Tequin. I am very short of breath (SOB) and also have Gastroesophageal Reflux Disease (GERD), which I think, contributes to my condition.

I am not on oxygen. Does this disease always get worse or can it be halted from progressing by taking better care of oneself? Thank you.

Pat

A. Dear Pat, COPD/Emphysema can be stabilized and retarded by stopping smoking and all exposure to smoke. GERD may be made worse by prednisone, taken for your flare-ups. You should not remain on prednisone, unless your doctor has specific reason to continue. You should do well.

Dr. Tom

 

Pulmonary Function Test (PFT)
Q. Is it possible for PFT results to be influenced by generalized anxiety disorder with hyperventilation syndrome? I am speaking specifically about FRC, RV, ERV and TLC values showing elevated numbers (136, 137, 133, 115 respectively). I was told I have mild-moderate COPD, but my FEV-1 was 89% and FVC was 105%.

I have had the anxiety related problems for years, and am just wondering if results could be skewed somewhat by poor breathing habits. Thank you.

Pam

A. Dear Pam, Yes, these elevated numbers may just mean that you have not taken the time to fully empty your lungs, before doing the spirometry. You have normal lung function by the FVC and the FEV1. Stop doing the other numbers, which do not indicate disease in your case.

Dr. Tom

 

Morphine Via Nebulizer
Q. I would like to ask some questions on the use of aerosolized morphine on end stage COPD patients. What are the indications of use and is it safe and effective? Please give me some input on this possible treatment course.

Melody

A. Dear Melody, Inhaled morphine has been studied under research conditions, and may reduce shortness of breath. It is safe. I do not think there are any commercial products available for the inhalation of morphine.

Dr. Tom

 

Lung Nodules
Q. Dr. Tom, I am 48 years old and smoke one to two packs a day. I have cut down. They found two nodules in right lung 5mm in size and calcification in upper right lung. My GP doctor wants me to wait three months for another CT scant.

My aunt died from lung cancer and my mother died from ovarian cancer. Should I get a second opinion and proceed more aggressively?

Jannis

A. Dear Jannis, Repeating the scan in three to six months is wise. If the non–calcified nodules have grown, they will require a biopsy or simple removal. Calcified nodules are not cancer. Stop all smoking now!

Dr. Tom

 

Spirometry
Q. Thank you Dr. Tom for your last answer. I did have the spirometry. I had to look it up to see what it was and that is definitely what I had. My doctor told me, after she received the results, that I have the beginning of COPD/chronic bronchitis. I understand that it is normal for me to cough up mucus/phlegm.

My question is: What does it mean if someone has an FEV1 of 1.65 and another says theirs was 46%. Does this mean the 1.65 is FEV1 and the 46% is the FEV6 for the other person? And what do they each mean?

Cheryl

A. Dear Cheryl, The FEV1 is sometimes expressed as a percent of normal. But the FEV6 is also expressed as a percent of the FVC (or FEV). Normal is 70% or more. Thus, the confusion. Hope this helps.

Dr. Tom

See Cheryl’s previous questions: Question 1, Question 2

 

Chemical Stress Test
Q. Thank you for answering my question last week, about my heart. But my real question is. Do you think that another chemical stress test will cause me to pass out or even worse? My lungs are very weak and I can barely breathe as it is.I have had this done before and pleasant it is not. The cardio did mention the heart monitor and I thought that would be a more conservative way to go, rather than a stress test. I was informed that no cardio would be present at the testing time. Your thoughts on this would help me decide. Thank you again, Dr.Tom.

Ann

A. Dear Ann, I suggest skipping the chemical stress test since you did have a bad reaction before. But discuss this with your doctor.

Dr. Tom

See Anne’s previous questions: Question 1, Question 2

 

Bullous Emphysema
Q. I would like to know if there is a way to differentiate between bullous (enlarged air sacks) lung disease and bullous emphysema? As far as that goes is there a different prognosis for bullous emphysema and the more common type? Thanks.

Bob

A. Dear Bob, Bullous lung disease may occur without emphysema, or with it. Lung function tests help to distinguish between the two. In isolated bullous disease your airflows are normal, unless giant bullae take up too much lung space, i.e. vital capacity. CT scans can also distinguish major isolated bullae from the bullae associated with diffuse emphysema.

Dr. Tom

 

Mixing Albuterol and Atrovent
Q. Is it safe to mix albuterol and atrovent in a continuous aerosol for an extended amout of time?

Melissa

A. Dear Melissa, Yes, These two drugs come in a metered dose device known as Combivent, and in a solution for nebulization known as Duovent. The two drugs work through different mechanisms. They can be used in maintenance over the long term.

Dr. Tom

 

Oxygen
Q. My father was diagnosed with emphysema in his 40's. About five years ago he was diagnosed with stage 3B non-small cell adenocarcinoma. He underwent treatment (chemotherapy, etc). We were told then that he had maybe six months to live. Surprisingly, even after numerous bouts of pneumonia, etc. he is still here.

Last week he got sick extremely fast, and ended up on a ventilator. They extubated (removed the airway tube that connects the mechanical ventilator to the patient) him after one night, but he does not seem to be getting better. They said he had respiratory failure due to advanced COPD (no viral infection). The doctor instructed me to talk to dad about his O2 at home. He is on 6L nasally and uses another 6L in his mouth. The doctor said we have to get him down to 4L because his CO2 levels are near 80 and this will kill him.

My question is how quickly will the CO2 kill him? At this stage, he will be quite miserable and struggling to breathe on 4L, but if the difference is a matter of years we’ll certainly work with him to try and get his O2 levels down.If the difference in longevity is not significant we think he should just be comfortable. I cannot get a straight or direct answer out of his physicians. Many thanks.

Jennifer

A. Dear Jennifer, No. He may have what is known as chronic compensated CO2 retention.

Here the lungs are working hard to get rid of CO2, but the work of breathing is too much. This causes CO2 build up which creates an acid condition in his blood. But the kidney senses this and generates enough bicarbonate, (like baking soda) to return the acid level to normal. This is measured as pH. His pH may be compensated to above 7.35, which is the low range of normal.

I have had many patients live for a number of years with CO2 levels in the blood higher than 80.

Dr Tom

 

Oxygen Equipment
Q. I have moderate COPD and go to local pulmonologist. I have “all the tools” including recording pulse-ox (a machine that measures oxygen saturations) and liquid oxygen portable but, of course I have problems finding places to fill. I have made many, many changes in the last year including a new home with a/c - in-floor heat, weight loss of 19 lbs., I use the airway clearance system twice daily - go 1 1.2 mi. at 3 mi per hour 2 to 3 per week. I completed pulmonary rehabilitation and get several newsletters.

My friend, a doctor, sent me your original home oxygen booklet from her old records and I have purchased your “All You Ever Wanted to Know About Oxygen” and have given several to providers, HOWEVER, THEY ARE NOT TOO KNOWLEDGEABLE ABOUT DEVICES.

My husband and I are looking at the new Inogen One (an oxygen concentrator) that would handle my daytime oxygen needs. I don't need oxygen with pacing at Grand Junction altitude even shopping. I am on 2 liters at night with a room concentrator that is too loud to have guests. I realize the Inogen is a pulsating delivery, but one party claimed it was so sensitive that it would suffice for “shallow breathers.”

What criteria would I use to determine if it would be adequate for my sleep?

I have been on Spiriva at least four months and it is WONDERFUL. I live at 6200 ft. in altitude in Glenwood Springs.

Sorry to be so “wordy,” but that's who I am.

By way of compensation, you are free to stop off when you are in the area and fish in my trout pond...I have some rainbow 7 yrs old that are huge and mega many that fight good that are rainbow and cutbow. If you bring your cook, there is a charcoal grill at the pond. My husband is getting me a dock for Valentine's Day and it should be in by June, I hope. I only allow my grand children and the underprivileged here to fish once a year so they don't have a lot of pressure. Thanks for your patience.

Charlotte

A. Dear Charlotte, I love Glenwood Springs, and have done several COPD studies there.

The Inogen One is very quiet and sensitive. Studies show that it can be very effective during sleep. Inogen One is now on the market, and is quite portable. Battery life is about three hours, and it is powered by your house electricity, or car battery, when not on a battery.

Dr. Tom

 

Pulmonary Function Testing (PFT)
Q. Dear Dr. Tom, I am a 47 year-old welder and grinder. Since September I developed a cough with some mucus, shortness of breath when exercising, and sometimes a little chest irritation.

My CT scan was good. My PFT shows FVC 111%, FEV1 103%, FEF 25-75 was 79%. My DLCO was low at 65% on first test, but my last PFT showed a normal DLCO. I still have a cough and am short of breath when exercising.

I am no longer welding and I don’t smoke. My pulmonary doctor thinks may be chronic bronchitis. I was wondering if it is chronic bronchitis, with my PFT test being good, can I live a fairly normal life since I don’t smoke and am avoiding all lung irritation? Thanks.

Bill

A. Dear Bill, Yes. You will lead a normal life and the cough should gradually subside, now that you are not welding and do not smoke. The FEF 25-75% test is misleading and does not indicate disease. It is wonderful news, that your lungs are not damaged.

Dr.Tom

 

Shortness of Breath
Q. I have a terrible shortness of breath and I also yawn almost every minute. I don't know what's going on with me. Please, reply as soon as possible. Thank you in advance.

Al

A. Dear Al, You need a spirometry to test your lung function since you feel short of breath. Yawning is not a part of COPD.

Dr. Tom

 

Congestion and Dry Cough
Q. I am an asthmatic and have been one for the past 15 years. However, I haven't suffered with any major problems for about 10 years. I just need your advice on something. I came down with a severe cold last Saturday. All of the cold symptoms where gone by Monday afternoon but I am suffering from this dry cough. I feel congested like my phlegm is hard and dry and when I wake up in the morning my voice is a little raspy. The doctor put me on an antibiotic called Zithromax on Tuesday (approx 44 hrs ago) and I will take my last pill on Saturday this week.

So far, the antibiotic has helped tremendously with the pain but not the congestion. I have also been taking Mucinex (2 pills of the 600mg) but this isn't really working for me. I am also drinking a lot of cold and hot fluids especially water and trying my best to avoid drinking or eating too much dairy.

The first time this happened the doctors made me suffer for about two weeks before giving me the steroid prednisone, but nothing else seems to work. I have tried Vicks vapor rub, Mucinex, Tylenol cold, steam from shower, fluid hot and cold.

Do you know of anything else that might help? I am sorry for the long question; I just wanted to explain my situation so that is might better assist you in answering my question.

Corrine

A. Dear Corrine, I think that prednisone is withheld for too long by most doctors, when there is what amounts to an asthma flare-up, which may simply be characterized by cough and phlegm. Short courses of about 10 days will usually abort the problem.

Zithromax is fine too, and may actually have a cortisone–like effect in addition to its antibacterial properties.

You should aim for complete control of your asthma symptoms. Probably need maintenance control with inhaled steroids.

Dr. Tom

 

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