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Archive: Dr. Tom 13
Posted March 16th, 2005

Recovery Time for Bronchitis
Q. I have severe COPD and since Oct 2004, I’ve had bronchitis, green phlegm, some with streaks of blood, and on and off antibiotics. My chest x-rays and sputum all come back good, but I am not getting better. Is this normal?

I also have an ache in my right side, off and on during the day. It’s not as bad as pneumonia pain but it is the same area. Thank you.

Becky

A. Dear Becky, Cough and mucus may persist for a few weeks following an infection that flares up COPD, or even without COPD. The mucus color should soon become white and subside.

Sometimes anti-inflammatory drugs are needed in the short term to reduce the inflammation. See your doctor about this. The ache is probably from muscle strain from coughing.

Dr Tom

 

Home Oxygen Equipment for 15 liters per minute
Q. My mother was admitted to the hospital for surgery 22 days ago. The surgery was an exploratory to examine a mass in her colon.

She is still in the hospital because she has COPD and her lungs are failing. There was nothing the surgeon could do about the cancer so we would like to take her home with Hospice. However, we have been told that 100% oxygen with a nonrebreather (15 liters per minute) cannot be maintained at home. Any ideas?

Celeste

A. Dear Celeste, Your mother probably will not require such high flows for long. It is possible to get as high as 15 liters at home with powerful concentrators and liquid systems used together.

Dr Tom

 

Awaken Feeling Short of Breath
Q. I currently sleep with 2L of 02. I use Spiriva, Advair and Albuterol as needed. I frequently awake with a feeling of extreme shortness of breath.

Is it possible I am experiencing desaturation while I am sleeping? Or, what are other possibilities?

Fran

A. Dear Fran, It could be that you are experiencing some heart failure at night, or have sleep apnea. You should have a sleep study with monitoring of your oxygen saturation while sleeping.

Dr Tom

 

Too Many Drugs?
Q. I have severe emphysema (FEV1 40%). I am on 3 liters of oxygen. I feel well, although I still smoke.

I think my doctor may have gone overboard on meds. Are all of these necessary? Spiriva, Foradil, Pulmicort, and Combivent for rescuer (which I rarely use). Thanks for your opinion.

Jane

A. Dear Jane, All these drugs make sense, but smoking does not.

Dr Tom

 

Life Expectancy for People with COPD
Q. I was told three years ago that I had COPD, and 40% lung capacity. I have since been on disability. I sleep with oxygen at night. It seems that I am getting worse and can do less and less.

Is there some way to know how long I might be able to live? If possible I would really like an estimate from someone. Thank you.

Jim

A. Dear Jim, How old are you? Do you have any other illnesses? You could live for 10 years or more with an FEV1 if 40% of predicted, if you take care of yourself.

Dr Tom

 

Traveling with Oxygen
Q. Would it be possible to take a trip to Germany. I am on 02 at night at 2lpm and use it occasionally during the day. I use liquid 02 via Helios (a portable liquid oxygen device) during the day.

How would I make arrangements for 02 overseas?. How about traveling within the U.S. Thanks for any help you can give me.

Incidentally I am 81 and have COPD-emphysema. I quit smoking years ago but have had a spinal fracture recently which set me back some.

Karla

A. Dear Karla, Some European carriers will allow Helios onboard, according to what I have heard. You could also take a portable concentrator such as the new Inogen One. It plugs into the power outlet used for laptops, and has a three hour battery supply. It’s very quiet and weighs only 9.5 pounds. It is approved by most overseas carriers, and is soon to be approved in the USA. It does not have any oxygen in it, but extracts the nitrogen from the air and gives you the oxygen to your nose. Slick, huh?

Dr. Tom

 

How Do You Diagnosis COPD?
Q. I quit smoking three years ago, had severe pneumonia last year with respiratory failure, and was told I had COPD in the hospital.

I was put on Spiriva and Theodur. My recent PFT shows a 79% FEV1. Now the pulmonologist says I don't have COPD.

I don't know what to think. I desaturate on exertion, have some shortness of breath, and all my heart tests are normal. Should I see someone else?

Larry

A. Dear Larry, See a pulmonologist. He can make the diagnosis of why you are short of breath and desaturate with exercise. It could be a pulmonary disease not related to COPD such as one of the so-called interstitial diseases, heart disease, or something else. You need a diagnosis from an experienced pulmonologist.

Dr Tom

 

How Often Should I Get a Spirometry?
Q. I have COPD and had a PFT test done in 2001. How often should this test be done?

Richard

A. Dear Richard, It all depends on what your values were and how you are progressing.

If your results were normal, you have no symptoms and do not smoke, maybe never again. If you are on treatment for COPD, your responses should be monitored whenever medications are changed, and annually to see if you are maintaining your function.

No set formula. Good that you had spirometry, the most valuable medical test for an indication of longevity that we have.

Dr Tom

 

Breathing Troubles but Have Normal Test Results
Q. Hi Serge here. I’m 40 living in Madrid and I had a High Resolution CT Scan (HR CT Scan) + Pulmonary Function Test (PFT) for suspected lung trouble eight months ago. At the time I was complaining of dry bronchial spasmodic cough for a year, inability to catch my breath and an unusual sensation in my chest. I also had consistent back and chest pain like pleurisy all this time. My chest physician and cardio doc did lots of tests and could find nothing.

One of the problems I am having is describing the feeling to my primary care doctor. I am now feeling noises/sensation in my chest, not a wheeze or a crackle, (feels more like a gurgle to me). When I wake in the morning my breathing is worst and it’s like when I am inhaling, I inhale a full breath but the lung expands a little more after the end of the inhalation. It’s like my lungs are stuck together. I also get SOB for no reason. It’s like the lungs are not working 100% all the time.

I still feel like this is the start of something and I am at the earliest stages of a lung disorder. I can nearly feel that my lungs have stiffened up. With a good PFT (FEV1 + DCLO >100%) and High Resolution CT with no heart trouble, is eight months later too soon to re-test? This change in my breathing function has caused a lot of anxiety and I feel constantly off.

From your experience when should I ask for a re-test? And also with interstitial lung disease is it normal for people to notice lung problems before the tests show problems? I also had bronchoscopy (a doctor uses scope view the inside of the lung) and lung volume tests.

Serge.

A. Dear Serge, You have sure had a lot of tests, but they are all appropriate for your symptoms.

It is possible to have symptoms, trouble breathing, with no measurable abnormalities very early in diseases such as the interstitial lung diseases.

I would get another set of tests now, by a pulmonologist, not a cardiologist.

Dr Tom

 

Stopped Smoking but Still Have a Cough
Q. Hi, I gave up smoking 18 months ago (after 20 years of closet smoking) because I had developed a cough. I still cough a number of times a day, sometimes with a little clear sputum, sometimes not. It was worse in the morning. This is constant, but not as bad as when I was a smoker.

My family doctor says this is normal in all ex–smokers and not to get concerned. I fear this is bronchitis. I have read that bronchitis leads to emphysema.

I did breathing tests in his office and they were “perfectly normal.” He tells me I could have a few more miles on the clock than most, as I smoked. I find this hard to accept as I am only 38.

I don’t want to have a cough and sputum for the rest of my life. I have no reflux or nasal drip (tried acid blockers and steroid nasal spray for three months). Is this cough normal and nothing to worry about?

I have gone on a bit, thanks for listening. Worried...Wanda.

Wanda

A. Dear Wanda, It is common for some cough to linger for a few months after stopping smoking, because the inflammation may be slow to clear. Sometimes excess mucus production continues.

Atrovent is a simple and safe bronchodilator that may help this. It is inhaled twice daily for convenience. There are other things to try too. Your cough will probably finally leave you after a few more months.

Dr Tom

 

Dry Unproductive Cough for 5 Months
Q. My husband has had a dry, unproductive cough for over five months now. It has been diagnosed as bronchitis and he was prescribed antibiotics and oral and inhaled steroids (Advair).

There aren't any clear triggers to the coughing fits. They are daily, however, they are inconsistent in duration and severity. There was never any mucus/sputum, fever or any other symptoms.

Any ideas? Thank you.

Linda

A. Dear Linda, This dry cough always suggests the possibility of an emerging interstitial lung disease, i.e., inflammation between the alveoli.

Get a spirometry and a diffusion test as well as oxygen measurements at rest and while walking. This should help sort this out.

It may be nothing serious, but better to know exactly what it is.

Dr Tom

 

“Target” Heart Rate During Exercise
Q. I'm asthmatic with my main trigger being viral infections. My doctor has me on Advair 250/50. I exercise regularly and find my heart rate above 200. Two hundred BPM is way above my target heart rate though I feel OK, with normal SOB for strenuous exercise. Should I calculate my target heart rate differently than a normal healthy person for a good cardio workout?

George

A. Dear George, I do not see any point in pushing your heart rate to 200. The use of the target heart rate calculations are too rigid, in my opinion.

Keep working out each day, but do not try to “hit the wall.”

Dr Tom

 

TB and Smoking
Q. I have Pulmonary TB. What will happen if I continue smoking?

Genevieve

A. Dear Genevieve, It will not affect your TB, assuming your TB is under proper medical treatment, but it has a good chance in hurting your lungs through the development of more inflammation on the pathway to COPD. It raises your risk of heart attack, stroke and other cancers. Stop smoking now.

Dr Tom

 

 

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