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Archive: Dr. Tom 105
Posted October 11, 2007

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

 

 

Having a Flare-up, Will I Get My Strength Back?
Q. Dr. Tom, I am a 48 year-old woman with emphysema and COPD from smoking. I have quit smoking some time ago, but I have felt great and rehab has been wonderful. Here's my problem I have a cold, and it’s a bad one that has left me bedridden and an emotional wreck. Its been a week I am on a Z-Pak and prednisone 20mg but I am feeling worse. I can breathe to walk which at therapy my numbers were always above 88%. I have my Helios here and am using it. My doctor is in Chicago and I live in Michigan.
Could I lose more lung function from this cold? I just got back from Cleveland for an evaluation for a lung transplant and was deemed too healthy. But I’ve gotta tell you I don’t feel like that now. Will I get my strength back?

Irene

A. Dear Irene, Your strength will gradually come back. The exacerbation (flare-up) caused a lot of inflammation in your small airways and it may take a few weeks for this to resolve. Glad you are too healthy to consider a lung transplant. Your own lung will probably last you a long time.

Dr. Tom

 

Quit Smoking and I’m Experiencing Gut Wrenching Cough
Q. I smoked for 20 years and I quit eight months ago. However about one month ago I got this burning mucus releasing cough.  I don't fill sick but I cough about 5 to 10 times a day (gut wrenching).  Could this be related to the smoking and should I be concerned?

Cory

A. Dear Cory, It may be that the new cough is not related to smoking, and has another cause. If this continues I suggest seeing a pulmonologist. There are many causes for such a cough.

Dr. Tom

 

Father Died after Suffering a Fall caused by Tripping Over Oxygen Tubing
Q. My Father just died after suffering as fall as a result of tripping over oxygen tubing.  I have seen a Patent listed for a tubing retractor but no products on the market. Do you know of such a product or do you have any hints as to preventing this from happening?

Karen

A. Dear Karen, This is a common problem with no good solution so far. I have never seen a tubing retractor, but I will inquire further. The extra tubing that accumulates on the floor and causes hazards in walking, can be stuffed into a shopping bag, and taken out as needed for more range. I much prefer a liquid portable system, that has no tubing lying on the floor to cause such a tragedy.

Dr. Tom

 

Would Like Information about Cough Syncope
Q. Dr. Tom, I recently did a complete PFT on an inpatient.  Upon a forced exhalation or any strong cough he would pass out.  He did not pass out when he exhaled slowly.  I have done some research and have found limited literature on "cough syncope".  Do you have any insight?

Kathy, RRT-AE-C

A.  Dear Kathy RRT-AE-C, Cough syncope is when high and usually sustained pressures develop in the thorax, during cough or straining activities. This causes a temporary impediment to blood flow through the lungs, and lowers blood pressure transiently. It is usually not serious, but can be under certain circumstances such as while driving a car or using heavy machinery.

Dr. Tom

What Should You Do with Unused Oxygen Tanks?
Q. I am cleaning out my mom's house and there are two oxygen tanks left over from when my sister was alive.  I don't think the tanks were ever used twice.  I was told not to put them out for disposal or else I will get a ticket.  Any ideas or suggestions?  I live in Queens, New York. I know this question is a little unusual but I thought you could shed some light on this matter.

Patricia

A. Dear Patricia, I suggest calling an oxygen supply company and donate these two tanks. Most of these have sufficient value to justify a company coming to retrieve them. The heavy ones will be too much for you to handle, so see if the oxygen supply industry will help you with disposal. The tanks are not dangerous, but the high oxygen pressure, if released from a slightly open valve can cause a torpedo action. I am assuming these tanks are high pressure oxygen cylinders.

Dr. Tom

 

Should I Worry about Bi-Apical Pleural Thickening
Q. I am a male, 56 and had my annual check up, and chest x-ray. The doctor noted to me that there was Bi-apical Pleural thickening in the x-ray. When I was a young boy, around 20 or so, I got Pneumonia.  Why didn't this x-ray show this in the past x-rays?  After years, one develops this Biapical Pleural sign? 
Bottom line is, should I be concerned about this? The doctor did ask me if I had pneumonia in the past, and I said yes, years ago; so what do you think? Get another x-ray in a month or next year? What can be done about this thickening?

Billy

A. Dear Billy, The thickening is most likely due to the remote pneumonia, and is of no importance. It does not need a follow-up. It was probably ignored on previous films, as being inconsequential. It is a fairly common finding.

Dr. Tom

 

Should Take Spiriva or Advair First?
Q. Should you take Spiriva or Advair first.  My husband takes Advair twice a day (morning & night) and Spiriva once a day (usually in the middle of the day).  Is this the correct way to take this medicine? 

Iris

A. Dear Iris, It does not make any known difference what sequence you use.

Dr. Tom

 

Lidocaine Use Prior to Bronchoscopies
Q. One physician has requested lidocaine treatment via nebulizer prior bronchoscopies.  Do you see a problem delivering the medication via nebulizer?

Eileen

A. Dear Eileen, No. This is a common practice in some pulmonologist technique of bronchoscopy.

Dr. Tom

 

Could Hyperinflated Lungs be the Caused of My Illness
Q. Dr. Tom, I have recently returned from a vacation to Mexico and have been sick everyday since.  My symptoms started with mid-sternal pressure radiating to into my back between my scapulae.  The pain increased somewhat with inspiration, my temperature has been within normal the highest being 37.6 Celsius (low grade fever) I have been aching all over. I have been feeling unwell for over five days now which is very unusual for me...my throat hurts and my chest still hurts and needless to say my chest muscles are getting very sore from all the coughing...
Sounds like I have picked up a flu bug.  My question is: I was schedules for a cardiac ultrasound (I have a pacemaker) during my examination the tech said my lungs were hyperinflated.
I guess I shouldn't have been surprised as I have been coughing like crazy to the point of almost vomiting. My cough is dry, no phlegm. I do have a history of mild asthma which I take Advair twice a day and Ventolin prn. 
I saw my Doctor the other day and he really doesn't want me on Ventolin because of my cardiac history. I have been told not to use pseudoephedrines as well. 
Could my hyperinflated lungs be as a result of the cold/flu or could I have picked up something whilst traveling. 
So I have resolved to use a humidifier, a cough suppressant DM, and plain Tylenol for my aches.
Any suggestions as to what I can do?  I am 46 years old.  Prior to this illness I was able to run to 30km/wk.

Mary Anne

A. Dear Mary Anne, I do not believe you should take the word hyperinflation seriously, unless complex lung function tests have been done. You certainly did pick up some respiratory virus. It will resolve. You could take Atrovent as a bronchodilator, and it should help the cough. It is an anticholinergic and does not stimulate the heart like beta agonists i.e. Ventolin. 

Dr. Tom

 

Diagnosed With Chronic Bronchitis at Age Twenty-One
Q. I am twenty one years old and was diagnosed with COPD (chronic bronchitis), about five months ago.  It is getting harder by the day, to the point where I can barely hold my child and walk at the same time without gasping for air and coughing up mucus.   From the research I have done, it is usually diagnosed in people who are 45 years or older, but I am 21!  Is it possible that this was misdiagnosed?   And if I am suffering from chronic bronchitis am I going to die in 20 years?  I am really scared and need the facts shot to me straight.  Thank you very much. 

Kelly

A. Dear Kelly, I am sure your do not have COPD or chronic bronchitis. Maybe asthma. You should see a pulmonologist for a diagnosis.

Dr. Tom

 

Bronchiectasis at Higher Elavations
Q. I have bronchiectasis. I live at 3300 ft. Is this affecting my disease?

Barbara

A. Dear Barbara, Probably not. 3300 feet is not much altitude. Denver is at 5230 feet, as is Salt Lake and Albuquerque.

Dr. Tom

 

Breathing Treatments to Infants on Mechanical Ventilators
Q. Why can’t a breathing treatment be given through an oscillator? Question 2 If perfusion to the lungs is causing the problem with the infant only getting 4% of blood perfusing right lung, how is Pressure Control helping infant more than Volume Control.  Infant was having ABGS (CO2 in high 90's on VC, switched to PC and CO2 low 70's?

Pamela

A. Dear Pamela, I can answer the first question. The HFOV is not a good mechanism to administer aerosol therapy due to active inhalation and exhalation with this particular device. In addition, “breaking” the circuit for aerosol delivery results in lung de-recruitment, and patients with obstructive lung disease that respond to bronchodilators typically do not benefit from HFOV and are at serious risk for air-trapping and hypercapnia.
Not enough information about the situation or patient to attempt an answer at question number 2.

Timothy R. Myers BS, RRT-NPS (a friend of Dr. Tom)

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