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Archive: Dr. Tom 108
Posted November 29, 2007

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

 

 

Online Sleep Apnea Website
Q. We at Fort Meade, S.D. are looking for a good patient CPAP support group online website since our patient's many times live some distance from the VA at Fort Meade.

Pat

A. Dear Patrick,  I am sure there are websites that deal with patient support and sleep disorded breathing. I suggest trying EFFORTS (http://www.emphysema.net/) and maybe “Google” for sleep.

Dr. Tom

 

Worried about Brother’s Diagnosis of ‘Generalized Emphysema’
Q. Hi Dr Tom! My 33 yr old brother was recently diagnosed with "mild generalized emphysema" after a scan of his thorax. He is a former smoker but stopped immediately on getting the results of the scan. He is extremely worried about what this emphysema may mean for his future, and has become depressed and withdrawn.
His spirometry test however showed that his lungs are still in good shape. His FEV1 was 109%, his FVC was 110% and his FEV1/FVC% was 77%.
Could you say anything about his possible life span based on this information? Can he expect a normal life span or will it be reduced? He has perfect body weight, exercises regularly and has always been very conscious about eating healthy. Any light you might be able to throw on this would be extremely helpful.

Sharon

A. Dear Sharon, No one knows the long-term significance of "mild generalized emphysema" detected by CT Scan. His lung function is normal and he should have a normal prognosis.
This represents overuse of CT, in areas where we do not have the science base.

Dr. Tom

Multiple Disease Conditions
Q. Last year I was told to get my husband affairs in order, as he was really ill. My question is how long can someone with COPD and CHF and renal failure go on and what can be done to help him?

Linda

A. Dear Linda, Your question is too vague to be able to give an answer. You do not specify the degree of involvement, patient age, etc. Prognosis may be better than any doctor predicts.

Dr. Tom

 

Are Drugs Causing Dry Mouth and Metallic Taste in Mouth
Q. I have been on Foradil and Spiriva for four years, now using Foratec and Tiova from ADC (India). I also take Generic Zestril and Generic Procardia XL30 and I started a water pill four weeks ago.
I am getting dry mouth with sensations on my tongue and inside cheeks and a metallic taste. Started rinsing after inhalers but mouth still the same.

Alan

A. Dear Alan, I do not know anything about the drugs you get from India. Most any drug can give dry mouth, such as Spiriva, and many a metallic taste.

Dr. Tom

               

Laser Printer Emissions and Effect on Lungs
Q. In the past week, I have run across multiple mentions of a study that found a majority of common office laser printers emit harmful particulate matter that is as damaging to the lungs as secondhand smoke. Link to the article: http://drbenkim.com/laser-printers-lung-damage.html .
Are you hearing anything about this among your colleagues? I work in an "open" office (cubicle) environment with several people using laser printers at their desks...and no chance to open windows to ventilate our shared office space.

Chris

A. Dear Chris, Sorry, I do not know anything about this potential risk. I do not hear what you do.

Dr. Tom

               

Worried about Lung Test Results   
Q. Just had a lung function test. The impression was:

1. Normal spirometry without evidence of airflow obstruction. 
2.  Lung volumes demonstrate mild hyperinflation. 
3.  Diffusion capacity for carbon monoxide is normal. 
4.  Room air arterial blood gas is normal. 

I also had a high resolution CT Scan it said Normal with these comments Minimal dependent atelectasis left base the lungs otherwise are clear also says Prominent pericardial recess extending into the AP window region. 

I have been waking up in the am after taking an Ambien CR and I feel I am not breathing right.  I am very worried about the hyperinflation.  Although the doctor never mentioned it he said the test was normal.  Also is my heart in an odd spot??

Teresa

A. Dear Teresa, These CT reports really do not mean much. Forget them.

Dr.  Tom

 

Could Librax make COPD Worse?
Q. My husband has COPD the symptoms were under control and his doctor prescribed Librax. After he took them for a few days his COPD became worse. Is it possible that Librax caused this?

Susan

A. Dear Susan, Librax is sedating and may make the symptoms of COPD worse. I suggest discussing this with the prescribing doctor.

Dr. Tom

 

Calcium Deposit Doubled in Size
Q. Five years ago I was diagnosed with small intestinal cancer. The Dr. took part of the small intestine out. It spread to the ovaries and I had a complete hysterectomy.
Five years ago I had a few very small calcium deposits on my right lung. One of the spots doubled in size since five years ago. It is now the size of a pencil eraser. I had a lung biopsy on Thursday and I am waiting for the results. My question is...is it possible the calcium deposit got bigger or could this be something worse?

Robyn

A. Dear Robyn, This calcium deposit is not a malignancy, and it is very small. I see no reason to evaluate it further.

Dr. Tom

               

Need Help with Understanding Spirometry Results
Q. Hello I am a 31 year old and I had a spirometry test done my FVC 3.19  pred. 2.14 % pred is 148 , FEV1 is 1.20 pred.1.97 pred %60 , fev1 % 38 pred 93 pred % is 41. I am not quite understanding these figures. What is my lung capacity percent, is it 60%?

Nichole

A. Dear Nichole, This report is not clear to me either. Looks like your airflow is 60% of normal which is pretty good.

Dr. Tom

 

Lung Pain
Q. I developed severe lung pain in August now it is November and the pain is less but still hurts with deep breaths.  No cough, sometimes I can hear the rub and whistle sound. Took Medrol dose pack (a corticosteroid) and felt great and now pain back. 
CT Scan to rule out pulmonary embolism; saw inflammation.  Chest X-Ray was negative, no fevers, TB test negative,  autoimmune work-up neg. 
I now have flare-ups some days no pain then it starts again.  Motrin helps.  What is my next step and how long does pleurisy last? 

Marisa

A. Dear Marisa, The next step is just to wait. This sounds like a resolving pleurisy.

Dr. Tom

 

Exercises for People with Severe Restrictive Lung Disease        
Q. What are some breathing exercises that you would recommend to a patient with severe restrictive lung disease?

D.B.

A. Dear D.B., Simple deep breathing is the best for patients with severe restrictive lung diseases and exhalation against pursed lips. The restriction limits the size of the breath, but is still worth trying.

Dr. Tom

 

Surgery Incision Effects on COPD and Asthma
Q. I was diagnosed with COPD and asthma in 2006, in June of this year I had surgery for a twisted bowel. My incision is approximately 9-10 inches vertical on my stomach.  I have now got a hernia and have been waiting to get in to see a surgeon.
My question is, it is really getting big and it hurts terribly, especially when coughing. But can this cause my breathing to be worse?  I am doing worse either because of this or the COPD. I have not seen a pulmonary doctor yet.

Lori

A. Dear Lori, A large painful abdominal hernia can interfere with comfortable breathing. It is usually best to repair these. You should see a pulmonologist for his input into the decision and for your overall management of COPD.

Dr. Tom

 

I Have COPD, How Often Should I Have Spirometry Repeated?
Q. One year ago I was diagnosed with severe emphysema. I had all the tests PFT, spirometry, 6 minute walk, etc. How often is it recommended to have these tests repeated to determine my condition?

Kevin

A. Dear Kevin, A yearly follow-up will help determine if you are maintaining lung function. I assume you are on treatment, and spirometric measures after starting a new drug will help document its benefit.

Dr. Tom

 

What is Lung Density?
Q. What does lung density mean? It showed up on my chest x-rays.

Kathy

A. Dear Kathy, It is a not descript report of an abnormal shadow in the lungs. It needs better definition.

Dr. Tom

 

How Long Does it Take for a Chronic Cough to Stop after Quitting Smoking?
Q. As a long time smoker have had a dry chronic cough for several years, mostly when I lie down. I have never been short of breath. About five years ago (I was 43 then) my PFT tests were normal  except that I experienced a 28% decline in FEV1 after methacholine. The post BD response only showed about 2% reversal but the final FEV 1 was 73.
Five weeks ago I quit smoking after a new doctor said he still suspected COPD though my symptoms have not worsened.  He will perform new PFT tests next month.
This is my question. About 3 days after I stopped smoking my cough disappeared completely. Do chronic coughs resolve that quickly in a patient suspected of COPD?
Thank you for a terrific website.

Emily

A Dear Emily,  These chronic coughs can indeed stop very quickly on stopping smoking. Usually it takes a few weeks, but you are lucky. Never smoke again and stay healthy.

Dr. Tom     

 

Availability of New Drug to Treat Fibrotic Diseases
Q. Hi Dr. Tom, Is it FG-3019 already out of the market?
A. Dear Erwin, Not that I know about. There are a number of new antifibrotic drugs that are being tested and one or more of these will see the market soon, I hope. Dr. Tom
                                   
        
Questions about Pulmonary Fibrosis
Q. My daughter was diagnosed with pulmonary fibrosis (scarring). What would cause this? She has had several CT Scans and it didn't seem to get worse.
They want to do a lung biopsy and she is very worried about that.  I don't think she would get it.
She has also been tested for Alpha1 and I think they said she was a carrier.

Betty

A. Dear Betty, Alpha One is not usually associated with fibrosis. There are many causes including environmental exposure and drug reactions that your doctor should rule out.
The "idiopathic" fibrosis group has the worst prognosis. She should have the biopsy to determine what kind of fibrosis she has and if she is a candidate for new drug trials or even a lung transplantation down the line.

Dr. Tom

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