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Archive: Dr. Tom 115
Posted Februaruy 13, 2008

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

 

 

Green/Yellow Smelly Mucus
Q. I apparently been diagnosed with COPD and probably emphysema - its genetic - my mum died of emphysema at 56. I have 68% of lung function left and have been bringing up green/yellow smelly yuck for the last four months.

Lynne

A. Dear Lynne, You may have an element of bronchiectasis as an accompaniment of your COPD. Your lung function is pretty good.

I suggest you get under the care of a pulmonologist that you like, and one that will take enough time with you to manage your illness. Your prognosis should be pretty good.

Dr. Tom

 

Doctor Did Not Tell Me Whether Spirometry Results Were Good or Bad
Q. Hi Dr. Petty, I am a 69 year-old female weight 171 pounds, height 5-foot 2inches. I had a spirometry report last week, my pulmonologist didn't say whether they were good or bad, could you please enlighten me?

Here are the results:
 FVC 2.11,   %pred 98,
 FEV1 1.18, %pred 68,
FEV1% 56,      %pred,  68,
FEF 25-75 (L/S) 0.58, %pred 32,
BEST FEV1% 56.

Frances

A. Dear Frances, Your doctor should have explained this simple test to you. Your FEV1 is pretty good. Forget the FEV25-75%, which tends to be misleading.

Dr. Tom

 

 Are Chest X-Ray Results Due to Flu?
Q. My son in law has been sick and had a bad cough for over a week.  A swab of his nasal cavity last week showed that he had the flu. 

He had a chest x-ray today, which showed that he has bronchitis as well.  However the x-ray also showed that the lining of his lungs was starting to thicken and his lymph nodes were swollen?  Is this from the bronchitis or is it a sign of a more serious condition?

Debbie

A. Dear Debbe, This is most likely from the flu and the bronchitis that goes with flu. These findings and his symptoms should resolve soon.

Dr. Tom

 

Need Help with Science Project Demonstrating a Pneumothorax
Q. Dr. Tom, My son is in grade eight and is doing a science project on pneumothorax. A friend of his suffered from this last year and ended up in the hospital for a time.

The question is, is there any simple experiments he could do on this condition to show the kids what happens to the lung when this happens. I have looked all over the web but cannot find anything to help.

Sally

A. Dear Sally, You might have him put a balloon in a plastic glass and seal off the balloon leaving space in one area where the balloon does not touch the surrounding glass.

Dr. Tom

 

Can Bruised Ribs Cause Pleurisy?
Q. I was working on the 15th of January when I slipped using a wrench and bruised my left ribs. On January 30th, while at work, around 6:30 p.m. I started having trouble breathing and having severe, stabbing, chest pains. As time progressed the pain became quite unbearable and I went to theemergency room.

I was diagnosed with pleurisy. Is there a link between my ribs being bruised and pleurisy? Can bruised ribs lead to this problem?

 My employer claims my pleurisy has nothing to do with the fact that I bruised my ribs a few weeks ago. Please shed some light on this for me.

Mark

A. Dear Mark, Bruised ribs are very painful and the pain increases with each breath, suggesting pleurisy.  Although this is not pleurisy in the technical sense, it has equivalent pain.  

 

Dr. Tom

Worried about Father, Is He in End Stage COPD?
Q. Hi.  My father has had COPD, emphysema, for many years. He will be 70 in April. He is not doing so well now, he is on oxygen 24-7. He can barely walk across a room, showers rarely as it is hard on him, shakes, recently cannot hold a fork very well, memory is going, confusion at times.

These latest things have come on fast. We are so worried and his doctor says there is nothing else they can do.  My mother has to remember his stuff.  He even cannot remember how to put his mask on at night, when he takes his puffers, pills, etc.  Is he at the end-stage?

 An honest answer would be appreciated.  He is truly suffering.  Lately he has been sleeping lots, and barely eating.  Has been to doctors, etc. this past week.

Cheryl

A. Dear Cheryl, It is hard to define "end stage" with emphysema and many other chronic conditions. His spirometry would tell the degree of functional loss. His doctor should consider other causes of forgetfulness. He should be seen by a pulmonologist since he is not presently doing well.

Dr. Tom

 

What Numbers are Important in a Spirometry Test?
Q. I am 25 years old and am applying for a job that requires a medical. The test that I am having problem with is the Pulmonary Function Test. The first time the readings were a bit low. They gave me a second try a week later and every reading was higher. All I changed was my technique.

My FVC 0.5 was still a bit low and my 25%-75% was a bit steep. The doctor is sending me to a more advanced testing site to make sure there are no underlying problems like asthma or an allergy.

I have no previous history of either of these and I have always been active, am in good to great shape and a few months ago I did a maximal VO2 max test as part of the physical portion of the application process and my VO2 max was at 52.6l/kg. I was well above the average for the VO2 max test.

After failing the first PFT test, I did a 1-mile time trial to see if I had gotten really out of shape in the last couple months and I was still in good to great shape. I am a personal trainer as well.

Can I possibly have a little asthma and have never known about it? Is there a way to practice breathing to increase my FVC 0.5 or my 25% - 75%? My FVC1 was at just over 80%. My total volume was 110%

Brian

A. Dear Brian, Your FVC cannot be 0.5 if your FVC was just over 80%. This is borderline normal. I submit that the person doing the spirometry is not very experienced. Forget the FEF 25-75%. It is often misleading.

From all that you tell me, I conclude that you must be pretty normal.

Dr. Tom

 

Is It Too Late to Quit Smoking? 
Q. I am a 35 yr old female smoker.  I want to quit, but am afraid it’s too late.  I had some pulmonary tests last year.  Here are the results.  Could you look at them and see what you think?  Is it COPD?  I'm really worried and want to quit soon.
FVC   pre 106% post 108%
FEV1 pre 99 post 99
FEV1/FVC pre 93% post 91%
TLC pre 128% post 127%
ERV pre 120% post 127%
FRC pre 150% post 160%

The doctor told me results ok. I played the clarinet and trumpet in school. Please help.

Michelle

A. Dear Michelle, Your lung function is normal. Stop smoking now and your lungs will stay well.

Dr. Tom

 

Scared about Chest X-Ray Results
Q. Dear Dr. Tom, I am a healthy 40 year-old female nurse.  In a routine pre-employment physical I had a CXR done.  Expecting normal results I was shocked to find "no suspicious infiltrates are noted.  Minimal left basilar fibrosis with mild tethering to the left hemidiaphragm is noted". 

I am completely asymptomatic and exercise regularly without SOB, etc.  What could this be? 

In 1988 I received BCG immunization (for TB) in nursing school in Canada. Upon arrival in US, I had chest x-rays done in lieu of PPD as I was expected to test positive. In 1998 I got a 2-step PPD test and was positive (this was also a pre- employment physical- they said after 10 years the immunization wears off so needed to skin test).  I had a CXR done and it was normal, so declined treatment for TB thinking it was the immunization that was making me positive and I was healthy. 

So now 10 years later my CXR is abnormal.  I was exposed to my fathers second hand smoke as a child but haven't been around smoke in 20 years, I've never smoked. 

The only remarkable history I have is that the last couple of years I have had wheezing 1-2 times a year along with sinus hay fever problems.  I tested highly positive for dust allergy and have been doing well with no recurrence on Allegra-D.

I'm so scared. I have three small children and need to live a long, healthy life!

Thank you for your time and expertise.  I do have a follow-up appointment with my family physician in ten days but I'm having nightmares about pulmonary fibrosis...

Ell

A. Dear Ell, This so-called x-ray abnormality is a minimal and trivial change in your lungs structure. It has no clinical importance, no reason to cause you to worry.

Dr. Tom

 

Do You Think a PET Scan is Needed?
Q. Dear Dr. Tom, Would you do a PET Scan if you were an ex-smoker of 30 years diagnosed with laryngeal cancer via D/L biopsy. CT and x-rays note opacities, bibasilar atelectasis, layering pleural effusions. Although the tumor was identified in Larynx, would you do a PET to rule out spread to lungs?

Mary

A. Dear Mary, No, A PET scan is not a screening test. It is normally directed at a specific shadow, such as a nodule. A CT scan would be reasonable at this point.

Dr. Tom

 

Fenoterol Related Deaths
Q. What did fenoterol contain that made it cause many deaths in the 1960s?

Omar

A. Dear Omar, I do not know. It is a beta agonist similar to others in wide use.   It was never licensed in the USA. Most of the deaths included high doses, by today's standards, and were in severe asthmatics.

Dr. Tom

 

Have a Five Month Old and I am Experiencing Shortness of Breath and Chest/Back Pain:
Q. Dr. Tom, I am 32 year-old who had a baby five months ago.  A month after giving birth I began having shortness of breath.  Doctor did chest x-ray and asthma test everything came back normal.

 A about a month and 1/2 ago started getting chest pain and continued to have the shortness of breath.  Did a stress test, passed, did an echo and wore a holter monitor. Found I have mitral valve regurgitation, which they gave me Toprol XL.

 I continued to have severe chest, back sometimes neck pains, shortness of breath. They did a MRI of my chest and found I have a nodule.  Doc said they would recheck this in 4 months. I am freaking out that it is lung cancer.  I have never smoked, but was around my mom who smoked for 40 years and now she doesn't.

 I am pretty healthy. I am now starting to have some stomach/rib pains along with the chest/back pains and shortness of breath. Should I go to a specialist or just wait 4 months. Doc didn't seem too concerned, but I am very! Thank you for your time.

Worried Mom

A. Dear Worried Mom, This is very likely NOT a cancer, but it deserves another check in four months. Try to forget it in the interval. I know this is difficult, but when you consider the very rare likelihood of cancer, perhaps you can be content and have bliss in your life.

Dr. Tom

 

Stopping Advair
Q. Hi Dr. Tom, I was wondering if Advair could be stopped suddenly, after being on it for 2 1/2 years?

Beth

A. Dear Beth, Yes. I know of no hazards in stopping it.

Dr. Tom

 

Still Not Feeling Well After Being Diagnosed with Pneumonia a Month Ago
Q. I was diagnosed with pneumonia month ago, and took 10 days of Biaxin.  One month later, I am still coughing and can feel a gurgle in my chest.  I am worried.  What do you suggest? 

Betty

A. Dear Betty, You need to see a pulmonologist. You should be feeling better again, if what you had was a common community acquired pneumonia.

Dr. Tom

 

Stopped Smoking and Would Like to Know about Breathing Exercises
Q. Hi, Dr. Tom, I'm a 42-year-old woman in the process of quitting smoking after 20 some years. Can you recommend a simple breathing exercise I can do any time, anywhere that might help me recover some lung function? I'd like to use this "respiratory therapy" as a tool to counteract my urges to smoke...so that I can tell myself I'm doing something good, not bad, for my lungs. Thank you, Jeni

Jeni

A. Dear Jeni, Normal walking is good exercise for your whole body. Just walk and smell the spring flowers. Your urge to smoke will fade as you increase your exercise.

Dr. Tom

 

Recently Diagnosed with Emphysema
A. I have been newly diagnosed with emphysema; by a practice nurse after a spirometry reading last month my FEVI is 61%.

I was a 20-30 cigarettes per day smoker for 30 years. I am 49 years old now and I have quit smoking for good a week ago and does my nurse recommend using a combination of nicorette inhaler and lozenges. Is this O.K. and also should I seek a second opinion and ask my doctor to refer me to a pulmonologist?

Also I am concerned about the FEV1 READING. What will it mean for the future/life expectancy assuming I maintain a healthy lifestyle (i.e. life regular exercise and good nutrition)?

I am just concerned about the possibility of a normal life span and leading as normal a life as possible given my new diet and lifestyle changes?  

Vanda       

Q. Dear Vanda, You can have a normal life span, with no more smoking and with a good diet and exercise. Your lung function is only mildly abnormal.

Dr. Tom

 

Is Scarring of the Lungs Something to be Concerned About?
Q. My wife recently was discovered with scaring of the lungs, she has suffered with asthma from age 20. Is there any cure for her condition?

Ricky

A. Dear Ricky, It depends on the extent and nature of the scarring. You should see a pulmonologist.

Dr. Tom

 

The Effect of Composite Wood Dust on the Lungs
Q. Hi I belong to a wood shop Guild with about 550 members and have a concern about the new composite lumber being sold for decking and railings. Is the sawdust more toxic than regular wood? And, why can’t I find any data on the subject?

I know that a mask should be worn when sawing sanding dust is present but the people in our club feel that this is not needed. I would like to find out if any studies are done to see if this dust from composite stay in your lungs and does more damage

Bob

A. Dear Bob, Sorry, I know nothing about this wood dust.

Dr. Tom

 

Special Considerations in Weaning a Quadriplegic Patient Off of CPAP
Q. Dear Dr. Tom, I have question regarding a patient who is currently on CPAP with PSV 10 and PEEP 5, 35% FiO2 and 100% Sat. The patient was intubated with 6.5 ET-Tube 22cm at the teeth and tolerating the CPAP setting. The patient was diagnosed with quadriplegia and with dislocated C5-C6 fracture and had brain surgery secondary hematoma 3 years ago.
 What is the best recommendation when to wean the patient? I was researching it a bit and needed some help.

Rachelle

A. Dear Rachelle, I have no experience with such patients.
If I did, I would have to tell you that every patient is different.  I suspect that weaning will have to be very gradual and something the patient will help you discover as you begin to lower the degree of external respiratory support.

Dr. Tom

 

Blood Abnormalities and Effect on Sleep
Q. Dear D. Tom, I have been having many different problems of late.  Even though my PFT was normal, except for mild hyperinflation and my high resolution CT showed a small area of atelectasis in the lower left lung I wake up breathing fast through my nose. The strange nose breathing wakes me up (I had a sleep study and was told my sleep is extremely poor (50%) and this was with AMBIEN).

I saw a hematologist yesterday and he tells me I have secondary polycythemia.  My erythropoietin level has been 11 and 13 right in the middle of the range.  What are the chances this high hematocrit (47-48) is related to my lung issues?

I thought that if the erythropoietin level is not high it is unlikely to be heart & lung problems. Please explain the connection Thank you so much.

Resa

A. Dear Resa, A hematocrit of 47 to 48 is normal.

Dr. Tom

 

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