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Archive: Dr. Tom 114
Posted Februaruy 5, 2008

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

 

 

What Could Cause a 20% Decrease in FEV1
Q. What could decline FEV1 from 63% to 41% in just six months? I quit smoking the day of the first breathing test?

Diane

A. Dear Diane, There are many possible causes, maybe an infection or bronchospasm. See if your FEV1 increases in response to an inhaled bronchodilator, now that you are free of the irritation of tobacco smoke.

Dr. Tom

 Arterial Blood Gas Results
Q. I was diagnosed with asthma and when given a treatment with albuterol I was told I was not moving air. I have not found any inhalers that give me any relief. 

My ABG was 69% and I was told that was normal.  I thought the ABG was to be in the 90% range to be normal.  Why is it that I am "shutting down" after inhaler use instead of opening up? 

Leslie

A. Dear Leslie, The ABG measurement that you refer to is probably the oxygen tension, which is normally 65-95, depending on age and altitude. Oxygen Saturations (an indirect measurement, generally a clip is placed on a finger, of the percentage of hemoglobin which is saturated with oxygen) of 90 % are what we aim for with therapy or oxygen. The relationship between oxygen tension and saturation is not linear.

Dr. Tom

 

Medrol Dose Pack and Older Adults
Q. My father is 85 years old and has emphysema.  He was recently given a Medrol dose pack and seemed to have quite a bad reaction.  He also does breathing treatments four times a day. 

Is the Medrol pack a normal treatment for someone that old?

Gary

A. Dear Gary, The Medrol dose pack is safe for older people and may be beneficial. It is a steroid and the dose pack rapidly tapers the dose, which may not be appropriate for him.

Dr. Tom

 

BiPAP and Hiatal Hernia
Q. Is it safe to use BiPAP (Bi-level Positive Airway Pressure) if I have large hiatal hernia?

Lisa

A. Dear Lisa, Yes, although you may get some air trapping in the hiatal hernia. Go over this possibility with the doctor who prescribed the BiPAP.

Dr. Tom

 

Terrified Waiting for Follow-Up CT Scan
Q. Dear Dr. Tom, I had a CT Scan in Januray 4th because I dislocated my knee and fainted later that night. The ER did the scan to rule out a clot in my lung. No clot but they found a 6mm nodule in my left lower lung and said to have it checked again in sixmonths.

My doctor is doing another scan in three just be safe, he tells me not to worry that the report said it looked to be a granuloma or scarring. I am an ex-smoker. 33 years old and terrified! What do you think?

Lynne

A. Dear Lynne, I agree that waiting three to six months is the standard of care for small nodules that are not calcified. If it remains stable for two years, no more follow-ups are necessary.

Dr. Tom

 

Distinguishing Between Asthma, Bronchitis and COPD
Q. Dr Tom. Have had this bout of bronchitis for last three weeks and my doctor finally gave me a short burst of steroids (prednisone), which is helping.

I have this question. I was diagnosed with COPD with a large component of asthma. I do not get bronchitis every year; as a matter of fact I did not have an episode of bronchitis all last year. I did have influenza A last year but came through fine. I normally do not cough or have phlegm throughout the year.

When first diagnosed, my FEV1 was 25% of predicted then. three years later it was 38% of predicted, and my last test (four months ago) and after respiratory rehab my fev1 was 48%. This to me shows the reversible portion of my COPD, which is the asthma, now here is the important question.

Because my episode of bronchitis lasted more than two weeks, am I now in the category of having " CRONIC BRONCITIS" even though I do not get this on a regular basis? I have tried to find out, and what I have read some COPD sufferers cough and produce phlegm EVERY DAY, yet with me I rarely cough.

 I was given Advair 250, which I take twice a day, because I was wheezing only at night when going to bed and it kept me awake. My doctor said it was asthma and since taking the Advair I have yet to wheeze again.

 Do you think Dr. Tom this episode is my asthma kicking up or do you think I am on the road for chronic bronchitis?

Philip

A. Dear Philip, COPD, asthma and chronic bronchitis are labels for conditions that commonly co-exist, and respond to Advair and other similar drugs in varying degrees. It is more important to consider that you have COPD with a reversible component, and that gives you a good prognosis.

Dr. Tom

 

What Does Lung Scarring Mean?
Q. Dr. Tom, I had kidney cancer last year, had a CT Scan three month later the CT came back saying some lung scarring in the left lung base is identified. What does this mean?

A. Dear Cindy, This simply comments about the healing of some inflammation, in your lung.

Cindy 

Was it on the same side of the kidney? I do not have enough information to explain this finding. This is your doctor's responsibility.

Dr. Tom

 

Remodeling and Dust Throughout the House
Q. Hi! We are having our basement finished, and a large amount of concrete dust inadvertently got into the furnace and dissipated into the entire house (it is everywhere).  I was consequently exposed to the dust for about two days. 

My question is: should I be very concerned about developing a serious pulmonary ailment?  I know that you have not seen me and that medicine is not perfect, but do you think the risk is low?

Dear Breathing Concrete Dust Particles

A. Dear Breathing Concrete Dust Particles, The risk of causing lung damage from just two days of inhalation of particles is very small. I assume you have it all cleaned up now. The lungs have good defenses against dusts and irritants, but these can be overwhelmed by long term or repeated insults.

Dr. Tom

 

Sputum and Blood Borne Pathogens
Q. Is sputum normally considered a high-risk fluid for the transmission of blood-borne pathogens?

Jeremy

A. Dear Jeremy, Not in healthy people. The mucus produced normally in the lungs is sterile. Once the lung is infected with either air born or blood born particles, the mucus becomes infected with these organisms and can lead to transmission between humans. 

Dr. Tom    

                          

What Are Granulomas?
Q. Dear Dr. Tom, I am a 36-year-old non-smoker. I went to the doctor for a persistent sweaty right underarm, and he did a chest x-ray. He said he saw granuloma(s) in my lung(s), and wants me to come back in three months to do another chest x-ray to check for growth.

He also said that he thinks there is a 1 in 1,000 chance that it is anything bad, and thinks it is caused by previous fungal infection of the lungs. Should I be worried that this could be lung cancer?

Andy

A. Dear Andy, You should not be worried. A granuloma is one way the lung heals fungal infections.

Granulomas leave shadows. They are checked for growth once, or more, depending on their characteristics. When they calcify, they no longer need to be checked.

The fungi that lead to these multiple granulomas are very common in the Midwest, Southwest and East Coast. Different fungi are usually involved in these areas.

Dr. Tom

 

Can Cozaar Cause Sinus/Upper Respiratory Infections?
Q. Dear Dr. Tom, I have read that a side effect of Cozaar can be upper respiratory infection.  Since starting Cozaar, about a year ago, whenever I get a cold it is different than usual; I have much more mucus, which has blood sometimes. 

I was told last year it was a sinus infection, but no antibiotics worked.  I had a CT scan done which showed a very small nodule in the lower left lobe. 

If Cozaar can cause sinus/upper respiratory infections, do you think changing to a different BP medication would be worth a try?

Ruth

A. Dear Ruth, Cozaar does not cause sinus or upper respiratory infections.

Dr. Tom

 

Help, Father Does Not Wear His Oxygen,
Q. My father is 65 years old and has COPD. About a month ago the doctor put him on oxygen. He is to wear it all the time. At first he did good with wearing it, now he hardly ever wears it. My mom and I are always telling him to put it on; I think he is embarrassed to wear it. Any suggestion on how to let him know how important it is to wear his oxygen?

Kathie

A. Dear Kathie, He may be a good candidate for transtracheal oxygen. Here the oxygen is given directly into the trachea, by a small surgical tube, that is concealed by buttoning the shirt. Use of eyeglass frames that contain the cannulae is another way of partially hiding the oxygen. Ask you doctor about these possibilities.

Dr. Tom

 

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