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Archive: Dr. Tom 20
Posted May 4th, 2005

Newly Diagnosed With COPD and Have Questions
Q.
I was told four weeks ago that I have COPD, and am now on home oxygen.

My question is do you know why my chest feels as though it is on fire inside? This just started when I got sick, should I be concerned? I just wonder if other people have this problem. Also, I have noticed that the burning is after I eat, and yes I take Nexium.             

Since I am new to all this; can you tell me what is the best state to live in? I now live in Michigan and really don't know what kind of weather is best for COPD people.

Mable

A. Dear Mable, Patients with COPD have all kinds of strange feelings in their chests from time to time. Burning is not directly related to COPD.

 I wonder why you are already on home oxygen. You certainly should be receiving other medications, such as bronchodilators as well.

Where to live depends on lots of factors. You just don't want to leave all your friends, and family and go around the country trying to find the best place. Generally a low altitude, mild climate, and an area free of allergens are best. This suggests the Gulf of Mexico, or Southern California. Life style and economic considerations are also important.

Dr. Tom

 

How Much Oxygen Should I Be Using?
Q.
How much and when should I be using my oxygen?  My latest test (arterial blood gas) using 1 liter per minute of oxygen are:

pH-7.381
PCO2-50.6
PO2-72.8
HCO3act-29.3
tCO2-30.9
BE (vt)-3.7
sO2-95.3

I would like to know what setting I should have my concentrator on and if there are times I don't need to be on it at all?

I visit my neighbors without my portable oxygen and just got to wondering, if I had an oximeter, would it be alright to not wear the oxygen until I reached a certain level?

Bufford

A. Dear Buford, Since, your oxygen saturation of 95% and oxygen tension of 73 are in the normal range, I wonder why you are on oxygen at all.

Normally oxygen reimbursement is based on having an oxygen tension of less than 59 and saturation of 88% or less. These values are based on extensive studies.

Your oxygen may drop with exercise. Here is where an oximeter comes in handy. Keep your saturation about 90% is a general guideline.

Dr. Tom

                                 

Where Can I Find Glutathione?
Q.
Where can I find a doctor who will prescribe nebulized glutathione near the Pensacola, FL area? My father has emphysema (bad). None of the medical doctors or the naturopathic doctors will help.

Thanks for any help.

Angie

A. Dear Angie, There is no scientific evidence that nebulized glutathione is either helpful or safe. There are reasons to believe it could work, because it is a powerful antioxidant. It is widely used in
Europe, but not in this country.

Oral N-Acetyl Cysteine is converted in the body to glutathione, and is available in drug stores without prescription.

Dr. Tom

                    

Are There Health Benefits Associated With the Sport of Blow Gunning?
Q. My name is Jock Elliott. I am a fulltime freelance writer. I have written about high-tech and medicine for thirty years.  I am also the National Correspondent for the National Sport Blowgun Association. One of our associates from Japan claims health benefits from blow gunning. These include:

  • Decrease of stress
  • Better digestion
  • Increased lung capacity (due in part to better utilization of normally “dead air” pockets);
  • Abdominal muscle and organ strengthening (due to the super-oxygenation of the blood
  • “Massage” of the organs from the use of the diaphragm in deep breathing)
  • Stimulation of the autonomic nervous system
  • Increased focus due to directed concentration

I figured that if anyone knew if these claims have any validity, it would be someone in respiratory care. I called the American Association for Respiratory Care and they referred me to you.

Jock

A. Dear Jock, An interesting question. Blow gunning takes breath control and a good force to blow the object toward its target. At a minimum, it should be a good sport and relaxing.

It will not change underlying lung function, but might improve breathing coordination. I doubt if the other claims are valid.  

Dr. Tom

 

Quit Smoking and Has Asthma
Q.
My 71 year-old wife stopped smoking about 3-1/2 years ago.  She had smoked since the age of 19, and smoked a little less than a package a day. 

It seems that since she stopped smoking she has developed asthma. She never had signs of this before. The asthma came on suddenly. She has a very dry unproductive cough, usually treated with prednisone. She also uses inhalers and a nebulizer when it is bad.

Do you believe that this asthma is the result of stopping the smoking?

Ralph

A. Dear Ralph, No, I do not believe this is the cause of your wife's asthma. Asthma may come on at any time of life, even in later years. Be sure the diagnosis is asthma, and not something else making her wheeze. 

Dr. Tom

                           

What Can You Do to Decrease Exposure to Allergens
Q.
Sir, am working as respiratory therapist in a hospital outpatient clinic. I need to teach my patients about allergen control measures. Will you please suggest some web sites?

David                   

A. Dear David, Best to avoid allergens when you can, such as known triggers, such as cat dander, pollens, dusts, molds, etc. Also see the web sites listed below.

Dr. Tom             

 

Mucomyst 
Q.
Dear Dr. Petty! One of our local pulmonologist has suggested using Mucomyst (a physician prescribed medicine used to thin mucus) systemically for the treatment of interstitial lung disease. Do you have a reference for that study?

Pete

A. Dear Pete, Mucomyst is N-Acetylcyeteine, it is converted by the body, to glutathione, a potent antioxidant. Antioxidants may be beneficial in some forms of interstitial lung disease. I do not have a scientific reference to quote as I write this.

Dr. Tom

 

VENT Surgery for COPD
Q.
I was diagnosed with emphysema in 1997 and am noticing a decline in my breathing.  Although I am still fairly active with golf, I do get SOB quickly with walking or any kind of physical activity.  Should I consider Endobronchial Valve for Emphysema Palliation Trial (VENT) before I get worse or try it now?

John

A. Dear John, NO. These valves are currently under study. They are not of certain value. They will not stop the progression of emphysema.  Better to keep playing golf and maintain your state of physical fitness.              

Dr. Tom       

 

Benefits of Spirva and Atrovent
Q.
What is/are the medication(s) in Spiriva? And what is the benefit of using Spiriva as opposed to nebulized Atrovent?

Jenifer         

A. Dear Jenifer, Spiriva is in the class of anticholinergic drugs, as is Atrovent. They work through slightly different mechanisms, but are otherwise very similar, except that the duration of action of Spiriva (tiotropium) is at least 24 hours and that of Atrovent (ipratropium) about 5-6 hours.

Dr. Tom

 

Oximeter Readings While Standing and Sitting Down
Q.
Why are my oximeter readings different when I am laying and/or sitting down? Shouldn’t they be the same? Is there a correct position to be in when taking them?

Jeff

A. Dear Jeff, Oximeter readings may be lower while lying down, in heavy weight people. This is because the weight of the abdominal contents pushes up on the diaphragm and decreases the depth of breathing. 

Some rare ‘disease states’ involving the liver have much lower oxygen saturations readings lying down than standing. A doctor must diagnose these ‘disease states’.

Dr. Tom

 

Emphysema and Oxygen Saturations
Q.
Dr. Tom, Several of us are wondering about emphysema and oxygen saturations.  In a clinical or hospital setting, if a person is diagnosed with chronic bronchitis and/or emphysema, how can their oxygen saturation rate be above 97%?

Jackie

A. Dear Jackie; et al, The only way for an oxygen saturation to be above 97% is with marked hyperventilation or by supplemental oxygen. DR Tom

 

Has Asthma and Gets Little Relief from Medicine
Q.
Hi Dr.Tom, I have been diagnosed with asthma. I have pain on the right side of my neck radiating up to the head and in the back below the shoulder blade. I had a CAT scan and it was negative. These symptoms seem to be predominately to the right side of the body.

I'm on the nasal spray and the powder disk medication. I see a little relief. What else can I do?  I have been on this medication for about 4 weeks, but the symptoms don't seem to get better.

Ronnie

A. Dear Ronnie, These pains are not explained by asthma. Better get another opinion.

Dr. Tom

 

Wants to Travel to Ireland and Needs Oxygen Supplier
Q.
I was surprised to see there was a question submitted to you from Dublin, Ireland. I hope to make a trip to Ireland at the end of this summer.  If I can't find an 02 supplier there I won't be able to make the trip. 

I am presently on 4-liter flow with activity -- I have a fanny pack that holds a bottle of 02 with a conserver. The system lasts from 4 to 6 hours.  I have successfully managed to ski with this equipment for the past 13 years.  

My question is: Can you help me find a supplier in Ireland who may have similar equipment for a 14-day tour? 

Ducky

A. Dear Ducky, Oxygen is available in Ireland. I doubt if liquid portable is available there, but concentrators certainly are, as are lightweight oxygen compressed gas cylinders.

Ask your supplier to connect you with someone in Ireland.

Dr. Tom

 

Nasal Suctioning for a Sputum Culture?
Q.
While working in the Emergency Room (ER) recently the ER doctor requested that 2 people, with pneumonia, be nasally suctioned for a sputum culture. These patients were awake and alert and able to produce a good cough which were not productive.

My response was the order was not appropriate, given the patients condition.  Just because you have pneumonia doesn't mean there will be sputum. 

What would your response be?

Cheryl

A. Dear Cheryl, I agree with you. If patients are coughing up sputum, there is no reason to suction for it. Particularly nasal suctioning, since you will also sample the organisms that reside in the nose.

Dr. Tom

 

Question About COPD
Q.
Dear Dr. Tom, Thank you for your help.

I am a 38 year-old female who is reasonably healthy and active. My family doctor recently ordered a chest X-ray because I was complaining of night sweats and weight loss for about a year. While the tests, X-Ray and blood screening, showed no serious causes for my symptom however, she told me that my X-ray revealed signs of "early obstructive pulmonary disease".

Of course, I have been a smoker off an on for about 20 years. My pattern was to smoke for a year or two, quit for 1-3 years, start again. I quit again last week and intend it to be my last time!

I have been doing some research on my own but have a few questions I hope you can help me with...

1. I understand that the damage done is permanent. If I quit smoking tobacco, will the disease continue to progress? Will I still lose lung function faster than a normal person?

2. I've read several papers that claim a chest X-ray is useless for early detection of emphysema, because the changes that might appear in an X-ray are associated only with advanced stages of disease.

So I'm confused, and wondering how severe my damage is. My Doctor said there were signs of hyperinflation. She never used the word emphysema and stressed, "these are early signs". I consider myself asymptomatic, though I was probably discounting my throat clearing and phlegm, but I have no disabling symptoms.

3. My Doctor did not perform any other lung function tests. Do I need them? Would it be best to see a pulmonologist?

In any case it seems that quitting smoking is the course of action that I should take. I don't want to undergo needless testing and consultations just to find out what I already know: that smoking is killing me and must be stopped. On the other hand, I am confused as to what stage I'm in.

I think that the more knowledge I can get will help me to make informed decisions. Knowledge of this problem certainly “empowered” me, in a very scary way, to quit. Thank you for your important work!

Amy

A.  Dear Amy, You need a spirometry test to tell you if you have any airflow obstruction. If damage is present, it may reverse, at least in part on stopping smoking.

A chest x-ray showing hyperinflation tells nothing about emphysema. It just shows that you took a big breath. If your doctor relies on x-rays to diagnose emphysema, get a new doctor.

Quit smoking now and save at least $5 per day and it will save you 10 years of life. Don't quit for me, quit for you! Good luck.

Dr. Tom

 

Discontinued Inhalers After Spirometry
Q.
I had a spirometry test, they tested me first without my inhalers and then tested me again with my inhalers. My doctor took me off the inhalers because apparently it was the same result both before and after the test. I scored 95%. At first he said it was early emphysema then he said it was chronic bronchitis. He has confused me what do you think, doctor?

Diane

A. Dear Diane, If your FEV1 was 95% of normal for your age and height, that is great. You do not have early emphysema.

If you cough every day and have mucus, you do have chronic bronchitis. Chronic bronchitis may not have an effect on airflow, but it usually does. In any case, you should avoid all tobacco smoke.

Dr. Tom

 

Medicine for Allergies
Q.
Living in the allergy-polluted Susquehanna Valley of Pennsylvania, we have witnessed a continued explosion of patients with allergies.  Additionally, it appears to me that many of them have become less sensitive to the medications over the years. 

Given today's plethora of medications, which ones appear to be the most effective? And which medications appear to stave off patient's becoming less sensitive.

Garry

A. Dear Garry, There are a lot of antihistamines that work in most patients, plus the newer anti-allergy drugs, in the leukotriene class. Your doctor will know about these, or you can ask your pharmacist.

Dr. Tom

 

The Effects of Poor Sleep
Q.
I have sleep apnea, I didn't use my CPAP machine (Continuous Positive Airway Pressure machine is used to help keep the airways open during sleep) for about a month, because I had sinus congestion and pain. Can going for a long period of time with out good sleep cause you to make unwise choices?

Patricia

A. Dear Patricia, Yes. Sleep deprivation (poor length of time or quality of sleep) can cause auto accidents, accidents at the workplace and impair other mental processes.

Dr. Tom

 

Questions from a Respiratory Therapist in Brazil
Q.
Dear Dr Tom, It’s a pleasure to send you an email. I am a Brazilian RT and I work with Dr. Amato in Sao Paulo. I was an AARC international fellow two years ago. Can I send you more ARDS (Adult Respiratory Disease Syndrome) emails?

Valeria

A. Dear Valeria, Of course. I am glad that you are interested in ARDS and respiratory care in general. I am also pleased that these messages are reaching South America. Send me your questions and I will do my best to answer them.

Dr. Tom

 

Is it Bronchitis or Asthma, or what?
Q.
Doctor Tom, I am 34 and smoked on the weekends for most of my adult life. My asthma was a little out of control when I smoked but not much.

I also had the Alpha One test and it was negative. I had an asthma challenge test (Methacholine Challenge is a test that is helpful in diagnosing asthma) that did not show asthma.

After two years of complaining to my doctor about my uncontrolled asthma, intermittent SOB, chest pains and a morning cough (sometimes dry + sometimes with sputum), he finally tells me I may have bronchitis.

I am floored by this diagnosis and needless to say I am not looking forward to a life of not being able to breathe normally.

I stopped smoking a year ago and every day I have symptoms. What are the chances of this clearing up? Over a long time cough, sputum etc?

Also, which meds are best for bronchitis? I have tried Advair 250 and it does not help me much! I asked my pulmonary doctor about Spiriva and he said I didn’t need it because my FEV1 is normal and DCLO too. He says Spiriva is for emphysema.

Also is chest discomfort a symptom of Bronchitis? I am worried I may have something else.

Fiona. 

A. Dear Fiona, Spiriva may help your cough. A less expensive medication that works the same way is Atrovent. I would try this first for cough.

You should avoid all tobacco smoke. Chest pain is not a symptom of chronic bronchitis. You may need another opinion, but you have had the most important tests done.

Dr. Tom

 

Pain in the Throat
Q.
My throat hurts when I laugh or cough. It's a very scratchy dry painful feeling that lingers for a good few minutes after a cough or laugh.

I went to an ENT, two of them, and they found nothing and said maybe it was acid reflux. I personally feel like that is not it. I tried the purple pill for a couple of months and it did not help me.

In the beginning it used to hurt when I talked, now it's just after a good laugh or cough, or if I shout or scream. I think I can trace it back to a rowdy scream during a football game, but both my ENTs said there was no damage that they could see.

Could this be a pinched nerve of some sort? It's been around for 3 months! Any ideas?

Ryan

A. Dear Ryan, I always have ideas, but they may not answer your own question. Sounds like you have some irritation, that is causing your cough.

Sometimes voluntary cough suppression works. What I mean is concentrating on NOT coughing. Or taking hard candies, or so called cough tablets to suck and swallow saliva, may inhibit cough. Once you get the cough stopped for awhile, the irritation, which ITSELF is caused by the cough will finally disappear.  

Dr. Tom

 

Lots of Medicines
Q.
My husband is presently taking DuoNeb breathing treatments; theophylline; Combivent inhaler; Albuterol inhaler; Singulair; Mucinex.

Do you think any of these are working against each other? He’s still having problems breathing.

He’s on oxygen at night and liquid oxygen most of the day set at 2 liters per minute. Maybe he needs to up the ante? Just some thoughts on your part would help.

Cindy for Husband Paul

A. Dear Cindy and Paul, The medications are all compatible with each other. I would not add more. Are you sure your doctor has the right diagnosis? 

Dr. Tom          

      

Carbon Dioxide Retainer
Q.
I have been diagnosed with emphysema as part of

COPD. My family doctor says it is also asthma since my obstruction reverses with medicine.  Eight years ago I was on a vent and came off of it in 5 days.  Today, I have a 95% O2 saturation on room air.

My COPD flared-up last week, which is, of course, due to my emphysema. Now I am told for the first time, by the PA, that I am a CO2 (carbon dioxide) retainer.

I left the hospital after a one-day stay and had a 92% O2 saturation on room air and now I am back to 95%. 

Can I be a CO2 retainer suddenly and have 95% O2? Or could the increase be a result of a lingering asthma attack?

Sorry for the long question but I never know what to ask.

Also, I quit smoking 8 years ago and have had terrible sinus congestion, and I start coughing mucus when I am around cologne, perfume, etc.

Bridget

A. Dear Bridget, You may have some CO2 retention on oxygen, but this is not necessarily bad. Your kidneys can compensate for the CO2. But what is your FEV1?  This will tell the status of your airflow now. Asthma may be chronic, and this may be an explanation.

Lots of asthmatics have cough and increased mucus when exposed to odors from cologne, perfume, cooking odors, etc.

Dr. Tom

 

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