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Archive: Dr. Tom 116
Posted Februaruy 19, 2008

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

 

 

Eighteen Month Old Son Has Bilateral Subglottic Narrowing
Q. My son just saw a pulmonlogist and they did a soft neck tissue x-ray, which showed bilateral subglottic narrowing in an hourglass shape. He does not have croup and they are diagnosing him with a complete tracheal ring.

Is there anything else that could show up like this on an x-ray? He has had chronic respiratory issues almost since he was born; he is 18 months old. Oh, they are doing a bronchoscopy next.

Jamie

A. Dear Jamie, There are other things that could appear like this on x-ray which is precisely why it is important to have the bronchoscopy performed.

Dr. Tom

 

Cystic Fibrosis Cure
Q. Is there any chance of finding a cure for cystic fibrosis (CF) in the next few years?

Rene

A. Dear Rene, Possibly. The care of CF patients is increasing steadily. When scientists can deal with the basic genetic defect, a cure can follow. However, I doubt if this will happen in a fewyears.

Dr. Tom

 

What is a Non-Calcified Nodule?
Q. Lab report says I have a noncalcified nodule of the left lung base measuring 1.3cm in diameter. A CT scan should be performed. What does this mean?

MT

A. Dear MT, It means there is no calcium in it. It is known as a solitary pulmonary nodule and these types of nodules need explaination.

At this size it needs a PET scan to see if it is active, and probably a biopsy to rule out cancer.

Dr. Tom

 

Cause of a Low Diffusion Capacity
Q. I have a question about my lung function test.

I was told it was very good with the exception of a low diffusion. A brief history: I became ill in Bolivia two years ago. Symptoms were many PVCs, shortness of breath, chest pressure, fatigue. After a year everything is better except for the PVC's, which I still have to some degree.

I have had many lung CT's (all normal), many cardiac tests, and other tests again normal.. Here are my test results from last week. They are virtually same as a year ago.

Function pred meas %prd
FVC (L) 3.75 4.33 121%
FEV1 (L) 2.95 3.64 124%
FEV1/FVC 0.82 0.84  

 

DLCO      
Function pred meas %PRD
DLCo(ml/m/mmHG) 27.57 14.71 53%
DLCO/VA 5.48 2.60 47%
DLCOcorr 28.76 14.42 50%
DLCO/VAcorr 5.71 2.55 45%

 

My doctor has no answer as to why the diffusion is low. He says sometimes he sees this for no apparent reason or maybe its a result of the illness in Bolivia, but all the other tests look fine, so in one year a "disease" process should have gotten worse according to him. He does not seem worried, but I am.

I am 44 5'4" about 112lbs. I exercise and am healthy otherwise. Should I be concerned? Thanks!

Lori

A. Dear Lori, I also do not have an answer. I would just check it yearly and see what develops. It could be some identifiable disease, and the list is long, or it could be an innocent abnormality.

Dr. Tom

 

Oxygen Saturations Dropping with Exertion
Q. I had started back maintenance exercise class after a long period of no exercise. After about 3 weeks, all of a sudden my oxygen saturation starting dropping into the 70's upon any exertion at all. Had no infection, so I was given a round of prednisone.

On third day of prednisone became extremely swollen in legs and ankles. I had quit smoking a month prior to all this and was expecting to feel good. Also, had been put on Advair 500 at same time quit smoking.

Quit exercising. Swelling was gone after about 90 days. Still having problems with saturations dropping but not as low and I can walk a little further. Any ideas on what the cause could be and should I try to exercise again?

Debra

A. Dear Debra, I do not have a simple explanation. I would try exercise again.

Dr. Tom

 

Can Albuterol Help with Sinus Pain?
Q. Can using either a nebulizer treatment, or inhaled Albuterol help with sinus pain in any possible way? I know these are not prescribed for sinus problems

Angie

A. Dear Angie, This is not likely. It could help with clearance of fluids in the sinuses and thus the pain. But, as you know, it is not used for this purpose.

DR Tom

 

How Bad are My Spirometry Results?
How bad is this? Spirometry is mildly obstructed.
FEV1 2.91, 81% predicted
FEV1/FVC ratio 68% (normal is > 70%)
FEF25-75% is 41% predicted.
FVC 4.28

Interpretation: Bronchodilator response is seen at the level of the small airways. Lung Volumes are normal. Diffusion capacity is normal.

Hassan

A. Dear Hassan,Some of these results are only mildly abnormal. Overall the picture is favorable to a good prognosis.

Dr. Tom

 

Can Inhalations of Gases Cause Bronchiolitis O bliterans with Organizing Pneumonia (BOOP)
Q. Dr. Tom I was diagnosed with BOOP in 2002. I was told it was idiopathic. But the last time I had my PFT the technician asked if I was around jet fuel, I told her no but I had been a diesel mechanic for 25 years. Can jet, diesel or kerosene cause BOOP?

Mark

A. Dear Mark, Yes, amongst other things including smoking.

DR Tom

 

Is This the Same Thing that Was Seen on Previous CT Scan?
Q. During my recent annual physical, a chest X-ray shows a white patchy spot or opacity in my lower right lung. I had pnuemonia 20 years ago in my right lung.

A CT scan five years ago mentioned some pleuroparenchymal scarring.

From this description, should I assume that there's a very high probability that this chest X-ray is seeing this scarring and the radiologist is unable to tell?

Dave

A. Dear Dave, Yes, this is a likely explanation.

Dr. Tom

 

Cigarette Smoking and Oxygen Saturations
Q. I just wanted to know why O2 saturations go up immediately after patients smoke a cigarette?

A. The pulse oxymeter estimates the amount or saturation of oxygen circulating in the capillaries of the blood. This estimate is based on two wave lengths of light. The presence of carbon dioxide from smoking, gives an estimate of oxygen that is falsely elevated, by complex factors that deal with the affinity of oxygen for hemoglobin. The amount of shift is not great, and usually not of much clinical significance

Dr. Tom

 

Oxygen Saturation On and Off Oxygen Therapy
Q. Mother was in hospital seven days with a cough. She was discharged oxygen saturation was 82% and given strong antibiotics for 10 days. She was given 3 liters oxygen, her lungs partially cleared and the oxygen level was 93% but if it is off it goes back down to 82% why? Mother is 81 has been in perfect health until know thank you.

Ligia

A. Dear Ligia, The lung damage from the pneumonia is the probable reason. This may still resolve.

Dr. Tom

 

Surgery Concerns for Those Who Have COPD
Q. I am 42 with COPD and am having gallbladder surgery soon. What are the surgical concerns for some one with COPD? What about the recovery?

Randy

A. Dear Randy, The surgical concerns are retention of mucus and not enough drive to breath, if your COPD is severe, which is doubtful at your lung age. Discuss these risks with your surgeon.

Be sure to take your bronchodilators the morning of surgery, and have surgery scheduled in late morning or afternoon, so you can clear out your mucus, if this is a problem for you.

Dr. Tom

 

Can You Tell if Someone is Not Giving Their Best Effort While Performing Spirometry?
Q. Dr Tom. Is it possible for someone to blow a false number on a Spirometer test? If the person did not give his or her best effort, would it show up on the test, and if so would the numbers be better or worse?

Philip

A. Dear Philip, It is possible to do a less than full expiration, but difficult to repeat this. This is why at least three expiratory tests are done.

It is not possible to fake the numbers high. You cannot blow our more air than is in your lungs.

Dr. Tom

 

Need Help in Understanding Spirometry Measurements
Q. My husband has been diagnosed with Stage 2 COPD. He has applied for disability because he has problems with breathing when just climbing our stairs or walking short distances.

The Social security disability qualifications say lung function should be less than 1.45. But the spirometry readings are given in percentages. I don't understand the difference in the two readings. Can you explain?

Kathy

A. Dear Kathy, Spirometry values are given as absolute numbers (liters) and percent of predicted for the person's height, age and sex. There are tables for these predictions.

Dr. Tom

Recommended Follow-Up for Non-Calcified Lung Nodule
Q. Dr. Tom, I recently had a CT abdominal, pelvic with contrast to determine reason for right flank pain . A 4mm right lung base nodule that isn't calcified was found. Also, there was a small left bochdalek hernia (diaphragmatic hernia) . A twelve-month follow-up was recommended, only if I was considered high-risk.

I still do not know the reason for my right flank pain. Can you please help me to determine the source of pain and to alleviate my fear of cancer?

Kathy

A. Dear Kathy,Neither the nodule or the hernia is casing flank pain. The follow-up of such a small non calcified nodule is a repeat scan in four to six months, to looking for growth.

Dr. Tom

 

Past Smoking History and the Possibility ofLung Cancer
Q. Dr. Tom, I recently had a chest x-ray done and they found a 1cm nodule in my left upper lung. I quit smoking over 25 years ago and have been a marathon runner ever since. This nodule was found after having bronchitis and looking for pneumoniA. I just had a CT Scan done. Do you have any info you can offer me? Do you think it can be malignant or benign?

Thanks for all the information you can give me.

Jerri

A. Dear Jerri, The nodule has about a 10% chance of being malignant, depending on your age. It should be studied further with a PET scan to see if it is active, and a biopsy, if it is.

Dr. Tom

 

What does Increased Volume Mean in Chest X-Ray Report?
Q. I recently had a chest x-ray as I have been suffering on and off for a few months with a tickly cough (this has now been identified as post nasal drip). The x-ray report stated 'increased volume suggestive of COPD'. I am 35 & an ex smoker but have no symptoms what so ever so am a little confused. I have an appointment for spirometry but wondered whether you could tell me what else could be causing the increased lung volume. I gave birth eight weeks ago so wondered whether that would cause any lung changes?

Jane

A. Dear Jane, These reports of increased lung volume just mean that you can take a deep breath. They do not relate well with spirometric tests. You should have simple spirometry to relieve your concerns.

Dr. Tom

 

Lung Cancer in Remission, What Can I Do to Remain Healthy?
Q. Dr. tom I am in remission from small cell lung cancer, one year. I have mucus all the time and it seems I get infections every three months. Is this normal?

I am going to the gym three times a week and I am 53 years old. Can I do any thing more to help my self?

George

A. Dear George, Live each day to the fullest. Discuss follow-up exams with your doctors. Treat the infections, which are not normal, with the antibiotics chosen by your doctor.

Dr. Tom

 

I am Worried About Mother’s Diagnosis of Emphysema
Q. My mom was just told she has early stages of emphysema (COPD). How long can someone typically live after they are being told they have early stages?

Erin

A. Dear Erin, She may live a long time. You did not tell me her age or degree of impairment, so it is impossible to predict.

Dr. Tom

 

Has Aloe Vera Been Used in Nebulizers?
Q. Since aloe vera juice is touted for having healing properties, has it ever been used in nebulizers?

Latresa

A. Dear Latresa, I doubt it and think it would be dangerous to try to get it into the lungs. I doubt if it will nebulize.

Dr. Tom

 

What Should I Expect After Tuberculosis (TB) Treatment?
Q. Am still on TB treatment and will be finishing the treatment on 24 February 2008.The problem is one week ago I had the flu and this week I am having cough. Could this be normal? And, will my TB be gone?

Rudo

A. Dear Rudo, I do not know what drugs were used and if there was any complication to your treatment. About 95% of TB patients are cured with the use of effective drugs.

Dr. Tom

 

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