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Archive: Dr. Tom 102
Posted August 23, 2007

Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

 

 

Do the Lungs Heal after You Quit Smoking?
Q. I was never told any about underlying serious lung diseases (e.g. COPD, Emphysema) due to smoking - but was always told by my MD the lung usually heals in about three to six months - thus my excuse not to stop smoking until just recently (45 years a smoker). Was it my doctors or is it generally the rule that folks are told to quit and your lungs will heal - I sure had a rude awakening.

Randi

A. Dear Randi, The lungs can heal after smoking 45 years, but that does not mean they will become normal. Alveoli are lost in the process of emphysema. These alveolar walls cannot be replaced. The inflammation of the conducting airways usually heals and this is accompanied by reduced cough and mucus in a few months.

Dr. Tom

 

Positive TB Test
Q. Last week my TB test was done and it was positive. I am from India. There is a possibility that because of BCG this test came back positive. Also, I was taking Tussionex - an antihistamine and narcotic cough syrup at the time of my test.

Thanks

A. Dear Sir, The positive TB test is most certainly due to BCG. Tussoinex will not have an effect.

Dr. Tom

 

Doctor Wants Me to Stop Prednisone and is Worried about CT Scan
Q. I am 60 years old and smoked for 35 years.  I quit smoking 13 years ago.  Since then I have developed moderate emphysema.  A month or so ago I developed a cough, which, is not very productive though incessant.  I started wheezing and have been very short of breath.   In addition, I am constantly fatigued and have difficulty keeping up with my responsibilities.  I am also losing weight and have been hoarse. 
My GP gave me an antibiotic and a prednisone taper and my symptoms have improved.  When I finished the prednisone they quickly returned.  He returned me to a maintenance dosage of prednisone, 10mg a day, until I saw my pulmonary doctor and did a CT scan, which showed a new 6 mm nodule. 
My pulmonary doctor wants to wait for four months and re check the nodule again.  He said to stop the prednisone.   I do not want to wait considering my symptoms and history.  I also do not think I can survive without the prednisone and the doctor did not make any recommendations about how to do this. What do you think?

Agnes

A. Dear Agnes, Waiting for four months to check on a tiny nodule is reasonable. You and your doctor will have to decide whether the benefit from prednisone outweighs the long-term side effects.

Dr. Tom

 

Side-Effects of Singulair and Albuterol
Q. I am currently taking Singulair and albuterol to treat my asthma. The albuterol makes me shake for a little while after I take it and I have lost some weight... is the weight loss caused by either of these medications?

Cee

A. Dear Cee, Weight loss is not caused by either medication. A transient tremor often follows the use of albuterol.

Dr. Tom

 

Pleural and Parenchymal Scarring
Q. Can you please tell me what is bibasilar pleural and parenchymal scarring?

Connie

A. Dear Connie, This simply refers to evidence of old inflammation in the lungs and lining of the lungs.

Dr. Tom            

 

Life Expectancy and COPD
Q. Dr Tom, Please don't think this is a horrible question. I am just curious, if my husband has been sick with COPD for 2 1/2 years now and is on 0xygen 24/7, can he live many more years?
He refuses to diet and exercise and has been in the hospital with pneumonia four times. He also had a quadruple bypass and mitral valve repaired. He is 57 and a reformed smoker.

Barbara

A. Dear Barbara, It is very difficult to predict survival in chronic illness states, particularly with no measurements of lung function, almost impossible. He could live for a number of years, depending on his current lung status and his ability to avoid infections. He would be better with some modest exercise each day.

Dr. Tom

 

Reasons to have Sleep Testing
Q. Dr. Tom, Welcome back. My pulmonologist wants me to do an overnight sleep study. I am 76 years old and am on three liters of O2 24/7. I had an ultrasound for pulmonary hypertension, (he said something about 60, but said it was okay). I am currently in pulmonary rehabilitation and doing well. I never wake up feeling like I am lacking air and sleep pretty good. Diagnosed in 2005, quit smoking in 2001 after 55 years.
Do I really need this sleep study and if so why? Are there certain questions I should ask before doing this?
Thank-you in advance and take care.

Betty

A. Dear Betty, I do not see a clear reason for a sleep study, from what information you tell me. Your pulmonologist may suspect sleep apnea, but this should be clear. If it is just to see if you remain saturated at night, this is easy and can be done at home with a recording oximeter. A formal sleep study, to diagnosis sleep apnea, is done in a special lab and is quite an undertaking.
 I assume the pulmonary hypertension of 60 is the systolic measurement. If so, it is in the moderate range and compatible with a good prognosis.

Dr. Tom

 

Flying with Oxygen
Q. My doctor says that I need oxygen when I travel 30,000 ft. high up in the air.  Presently I only use my home oxygen machine at night because I think I have more energy the following day.  
I understand that for flights within the US there is oxygen available upon request.  However on overseas flights, there is no provision for oxygen.  Of course I am not allowed to take an oxygen tank on board, be it ever so small.  I would like to travel to Europe and ignore my doctor's advice.  However, once over the Atlantic, there is no emergency landing possible.  My question is: don't the cups that pop out from overhead, the ones they talk about at the beginning of every flight when emergency procedures are explained, deliver oxygen?  And why do airlines not provide the same emergency oxygen on overseas flights that are routinely provided on flight within the US?    

Brigitte

A. Dear Brigitte, The emergency oxygen is not for routine patient use. It is delivered in high concentration and only for 20-30 minutes, i.e. long enough to descend or deal with some other emergency.
You can take portable oxygen concentrators aboard aircraft in the USA and Europe. Need prior approval of the airlines and a rental concentrator, of which there are at least four. Many people now travel with the portable oxygen concentrators.
Is your doctor guessing about the need for oxygen while in flight? The cabin altitude is only about 8000 feet. If you are low on oxygen at sea level, it is a fact that you need it while flying. Bon voyage!  

Dr. Tom

 

Well Wishes
Q. Dr. Tom, so very good to know you are improving. Prayers that you will continue to do so.  Don't forget to take time to smell the roses.

Joan

A. Dear Joan, Thanks. It has been the prayers that have carried me through so far. Not out of the woods yet, but definitely better. Thanks for caring.

Dr. Tom

 

Life Expectancy and Lung Cancer
Q. A member of the family; a 57 year old female was recently diagnosed with lung cancer.  Confirmed with PET.  I was told at first she had six months, and was just told she has up to four years.  Is it possible to diagnose lung cancer this far in advance?

Joyce

A. Dear Joyce, It all depends on the stage when the diagnosis is made. About 15% are cured with surgery. Others live varying periods, depending on extent of disease, response to therapy and co morbidities.

Dr. Tom

 

Heated Aerosol on a Fresh Tracheostomy
Q. I was always under the impression, that you should not put a heated aerosol, on a fresh Tracheostomy (not ventilated patient).  Am I wrong?  I could not find a reference.

Mary

A. Dear Mary, I assume that "heated means body temperature. If so, there is no reason not to use it.

Dr. Tom

 

“Getting-Off” Inhalers
Q. Is it ever possible to get completely off Spiriva (or ANY inhalers) if diagnosis is "very slight, almost insignificant, COPD” and tests show "no significant damage to lungs”?

Melba

A. Dear Melba, Sure. Give it a try and see how you feel. Also have your doctor check your spirometry. I wonder why Spiriva was prescribed in the first place.

Dr. Tom

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