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Archive: Dr. Tom 118
Posted March 7, 2008

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

 

 

Respiratory Exercises for COPD
Q. Are there any respiratory therapy or exercise that I can do at home?  I have COPD and use oxygen at night or on occasion during the day with a portable unit.  To get respiratory therapy is very expensive even when I have insurance. 

Peggy

A. Dear Peggy, The best exercise for your lungs and body is that associated with normal walking.

Dr. Tom

 

What Does MY Pulmonary Function Test (PFT) Report Mean
Q. Dear Dr. Tom, I received the following PFT report from my doctor.  Actually, he never gave me the report or commented about the test results.  He told me I had asthma and a moderate obstruction.

Would you tell me what the results mean?  I am 5'5", weigh 230lbs (I know), female 54 years old.  I quit smoking in 1997.  Do I have emphysema?

FVC  ref 3.24  pre 3.7  post 3.88
FEV1 ref 2.65  pre 2.04 post 2.31
FEV1/FVC  ref 83  pre 55  post 60
FEF25-75  ref 2.91 pre .78  post 1.03
FEF 75-85  ref 3.06  pre .16  post .2
FEF 50 ref 3.59  pre 1.16  post 1.5
FEF 75 ref 1.34  pre .26  post .33
pef ref 6.03 pre 4.15  post 4.36
DLCO ref 27.5 pre 17.7
DLCO adj  ref 27.5  pre 17.7

I apologize for the length of the post.  Thank you for your time.

Sandra.

A. Dear Sandra, Your doctor should go over the results with you. You do not have much if any emphysema, and your over all lung function is pretty good.

There are too many numbers in this report, and many do not mean anything. The major numbers, FVC, FEV 1 are near normal. The ratio is low, suggesting COPD, but not severe. The DLCO suggests some emphysema, but not advanced. Hope this helps.

Dr. Tom

 

What Should I do about White Spot on CT Scan?
Q. I got my chest CT Scan back, the Dr. said it was good but there is a small white spot they seen, what could the white spot be and what should I do?

Stan

A. Sear Stan, It could be many things, mostly benign. Your doctor should tell you what to do about it. If it is calcified, nothing needs to be done. If it is not, a follow-up is needed, depending on its size, and other factors. 

Dr. Tom 

 

High Heart Rate
Q. Tom, I am a 40 year-old male and I’ve been in the hospital 2 times in the past year for pneumonia. My pulse oximetry (O2 saturation) is around 95%, and my heart rate when resting is 100-120. What advise can you give me to help reduce my heart rate?

Tom

A. Dear Tom, This has many causes. It may be due to your medications. Ask your doctor about it. He knows far more about you than I do. 

Dr. Tom

 

Condition is Worse Since Leaving Hospital
Q. What flow rate should his oxygen be set on for a COPD patient with one lung? Right now he is on 6-8 liters 24 hours a day by cannula. Is this right?

 Now his sinuses are bad and he sleeps all the time. The lung was removed in July of 2007. He is in worse shape now than he was when he got out of the hospital. Need some answers please.

Ann

A. Dear Ann, The flow rate will be determined by his responses as measured by oxymetry. You did not say why his lung was removed.

Dr. Tom

 

Radiation Risk from CT Scans
Q. I just had a chest x-ray and then three CT Scans because the radiologist did not tell me to take off my bra that had metal clips in the back.  He had asked if there was underwire and I said no. I should think he would have known that all bras have metal clips. 

Well anyway am I in danger of developing cancer because of the amount of radiation I received? Dr. said I have a small nodule and emphysema diagnosis.

Carolyn

A. Dear Carolyn, You are not in danger of lung cancer or other malignancy, from the CT scans. I am referring to ordinary risks. CT scans do have a radiation risk, but it is very small.

Dr. Tom

 

Small Airway Disease and Spirometry
Q. My spirometry results showed evidence of air-trapping and small airways obstruction even though my FEV1 and FVC were normal (89% and 102%) and my FEV1/FVC ratio was 72 (which the report indicated was "reduced".  I thought <72 was bad.  Also my RV/TLC was considered elevated at 33. 

Could you elaborate on these results please?  My doctor said they suggested mild to moderate COPD.  Could they really be more than just mild?

Dave

A. Dear Dave, These results are nearly normal. Be sure you do not smoke.

Dr. Tom

 

My Symptoms Seems to be Getting Worse
Q. I was diagnosed with exercise-induced asthma along with the beginnings of COPD. I was a smoker for 20 years but haven't smoked for 24 + years. I am using Asmanex inhaler in the morning.

At first it seemed to work but now I can't walk up my stairs without severe chest pain and shortness of breathe.  Could I also have a heart condition? My cholesterol is 199 with a HDL of 66. I am starting to get worried it could be a blockage.

Deborah

A. Dear Deborah, The chest pain on walking could be angina. Discuss this with your doctor.

Dr. Tom

 

Worried that Father’s Age is a Factor in Follow-Up
Q. My father, 86 years old and just had a CT Scan of the lung (without contrast), which showed a precarinal 1.2 cm lymph node (right lung). We cannot determine from the report if it is a concern for cancer or if it is calcium deposits (?), etc.

 Results also show minimal bibasilar fibrosis or atelectasis.  Radiologist calls for a follow up PET Scan in 3-4 months. 

Our concern is that my father is 86 and the radiologist/doctor does not want to be aggressive in evaluation and/or treatment.  My father is in really extremely excellent health for his age - could outdo a lot of people younger than him. Your thoughts please. 

Gail

A. Dear Gail, In general, I agree that it is not necessary to aggressively follow the abnormalities found on CT. But then, why do the CT if you are not going to do anything about positive findings? A simple follow-up as advised by your doctor seems reasonable.

Dr. Tom 

 

Should You Move to Protect Health?
Q. I'm a patient with reactive airway disease and have relocated from New York to Virginia.  I'm able to breathe better in my new environment. New York City exacerbated my asthma.  Do you think it's medically necessary to relocate if the patient can afford it to protect good health?

Kenya

A. Dear Kenya, I do not think that such a move is "medically necessary", but it is a good thing when it helps the asthma.

Dr. Tom

 

What Do My Spirometry Numbers Mean?
Q. I am a 45 yr old male, smoked average of one pack a day for 25 years.  Quit about six months ago and was given a PF test. 

Result are:
FVC= 4.11L
FEV1/FVC= 56%
 FEF25-75%= 1.14.

From what I have been reading on the Net, I'm not really happy.  Can you provide some additional insight into the numbers?

Bill

A. Dear Bill, The ratio between FEV1 and FVC suggests COPD. Forget the FEF 25-75%, it is misleading.

Dr. Tom

 

What’s Going on With My Lungs?        
Q. I am 53 years of age and smoked from the age of 15 to the age of 38. (1-2 packs a day)

The following results were found when I went to have my heart checked for coronary artery calcium, which came back scoring zero's. Heart is in fine shape.

The CT of chest demonstrates at least two non-calcified pulmonary nodules with the largest appearing up to 4 mm in the upper or middle lobe. Adjacent calcified pulmonary nodule is present. Mild pleural-based densities scattered in both lungs are consistent with mild atelectasis or scarring.

What is going on in my lungs and where should I proceed from here?  They recommend a CT of the chest for further evaluation. Should I go to a pulmonary doctor for this or to my primary doctor?

Jacolyn

A. Dear Jacolyn, You should go to a pulmonologist to advise you. The non calcified nodules, are most likely benign, but with your smoking history, the risk of lung cancer remains. Usual interval for follow-up of such small lesions is four to six months.

Dr. Tom

 

 Why Do Infections Cause Fevers?
Q. Why does atelectasis cause fever in patients, when infections are present?

Jeremy

A. Dear Jeremy, The fever comes from the body’s immune response to infection. It is intended to help throw off the infection.

Dr. Tom

 

Can You Diagnosis Emphysema from a Chest X-Ray?
Q. Dear Dr Tom, I am 55 years old. Does 'emphysematous lungs' on an x-ray report mean necessarily that I have emphysema? I have just had a spirometry test, which was reported to be normal.

I had a bad dose of pneumonia when I was 38 years old and have had a chest infection recently. I stopped smoking at 38 - two months before I developed pneumonia! Apart from my student years I had been at worst a social smoker and had several childbearing years when I didn't smoke at all.

I am very scared of the prospect of emphysema as my father who was a life long heavy smoker died at 69 with emphysema and was bedridden and in much distress for the last five years of his life.

Marjory

A. Dear Marjory,  A chest x-ray is not an accurate way to diagnose emphysema. If your lung functions are normal, you do not have emphysema.

Dr. Tom 

 

Old Scan Showed a Spot but We Were Not Told About the Spot
Q. My husband had the flu and at the ER they did a chest x-ray, the doctor asked if he had ever been told that he had a spot on his lung and of course we have not been told anything, so he told us that he had pulled up a recent CT Scan. The spot was also on the CT. He used this as a comparison but was very vague on giving any info. What should we do?

Michelle

A. Dear Michelle, Follow your doctor's advice about further follow-up.

Dr. Tom

 

Is Edema a Side Effect of Spiriva?
Q. My husband was just diagnosed with emphysema. However I have read that this usually is a combination of shortness of breath, cough and phlegm. He only has the shortness of breath.

He started Spiriva around ten days ago, and even though he has had edema in his feet and legs before, it seems to be constant now. Is this a side affect of the drug?  He has started watching his diet, and has started walking. His shortness of breath seems a bit better, now I am concerned about the edema

Miriam.

A. Dear Miriam, Spiriva is not a cause of edema.

Dr. Tom

 

Mother Struggling with Non-Small Cell Lung Cancer
Q. Help!  Mother is 68 year old with non-small cell lung cancer diagnosed at stage three.  We started radiation last year at this time and have been doing chemo ever since then (about eight months now). 

She had a PFT last October and the results were as follows:  "Patient was unable to produce acceptable and reproducible spirometry data.  Patient was unable to do a complete effort on pre or post spirometry.  Patient reported dyspnea on Borg scale of 6-7 after three efforts during pre-spirometry.  Patient had more than five breaths during washout and would not drop below 2.8%.  Patient was instructed on proper use of inhalation devices and medication.  Patient was given 1.25mg of Xopenex via nebulizer".  Apparently she had done a prior PFT where her DLCO was 17.4, her DL asj was 17.4 and her DLCO/VA 3.71.

She is currently in the hospital because she got sick from the chemo. Tuesday she almost died because her carbon dioxide went to something like 57.  The lung doctor who is treating her there looked at this test and told us her diffusing capacity is 17.4%.

 She has recovered enough (still can't get out of bed due to shortness of breath) to bring her home.  They are providing a hospital bed, a BIPAP machine and other treatment.  They want to know if she is going to continue chemo.  They want to assign hospice and because she is on Medicare I guess we need to make a choice.  She is taking morphine daily already for the pain from her lungs when she breathes. 

What do you think her prognosis is?

Pam

A. Dear Pam, Her prognosis is not very good. I still suggest that you remain hopeful. Good that your mother is getting morphine for relief of her symptoms.

Dr. Tom

 

Undergoing Tuberculosis Treatment but Still Having Pain in my Chest
Q. I was diagnosed with tuberculosis where I had pain in my right chest, I have been taking drugs for three and half months now.  I still feel some pain in the chest, when will it go?

Ruth

A. Dear Ruth, I do not know what type of pain you have. Ask your doctor about it. Pain is not a common symptom of tuberculosis.

Dr. Tom

 

Fearful of Hearing Bad News
Q. Dear Dr. Tom, I have been a smoker for 20 years, but no history of cancer in my family.

A few days ago I was in the ER with what seemed to be appendicitis, turned out to be a ruptured ovarian cyst. A CT Scan of abdomen and pelvis was done which also showed a 5.9 mm noncalcified nodule in the right lower lung. I got so scared when I heard the news.

I was told to follow-up with my primary care physician. I have been feeling great and have had no other symptoms. To be honest, I am afraid to go to a follow up in fear of bad news. Does this nodule have to be bad news? Your help would be greatly appreciated

Tanja

A. Dear Tanja, The nodule is not bad news. It is what it is. You should have a follow-up in 4 to 6 months to look for change. You should see a pulmonologist about it if it is changing.

Dr. Tom

 

What is an Incidental Apical Lung Nodule
Q. Dr. I just received a MRI Cervical Spine C report which indicated Cervicalgia.  Also an "incidental left apical lung nodule for which CT chest is recommended." "Incidental note is made of a 7 mm nodule at the left lung apex. This is not visualized on the cervical spine radiographs”. I do not smoke, but had sarcodosis as a teenager.  Please clarify!

TJ

A. Dear TJ, There is no such thing as an "incidental nodule". The risk of cancer is very small since you do not smoke. Nonetheless you should have a repeat CT in four to six months to look for change.

Dr. Tom

 

 I am in a World of Confusion
Q. I am a 35 year-old female. Ceased smoking two years ago. I had been diagnosed with asthma from the primary care physician. I was treated with steroid shots in the office, albuterol neb treatments every four hours, Advair 250/50, Singulair. I went back to the pumonologist and he began treatment with Advair 500/50 and other meds remained the same. I was on disability from work for about 8 months after 1 month of this treatment.

I was hospitalized for five days in 2006 and was diagnosed in the hospital with COP and asthma. Treated with intravenous (IV) steroids and antibiotics. Sent home still not well still severe congestion in chest, rattling, wheezing and unable to shower.

I currently am unable to work or even do laundry. I have over the last couple months been seen by different doctors. They admitted me after an asthma appointment due to severe SOB. They then ran 13 vials of blood tests to include: lupus, alpha 1, cardiac enzymes, etc. I'm scheduled for echocardiogram this week.

I just saw my doctor and said my spirometer shows I'm not responding to treatment but the one I took on my appointment was better. I was put on seven days of 60mg prednisone, taking Singulair, Advair, albuterol and Atrovent inhalers.

I asked what is going on? He said we think you may have different type of asthma but don't want to give you a name because I don't want you to go on the Internet looking it up.

What is going on here? I was given a CT Scan and slight showing of emphysema. I don't understand what they are doing and why the doctor doesn't want to share their current theory. I also am in worse shape at night and wish they could do these tests then....I'm sure you understand that.

Please help I'm in a world of confusion and very fearful of what is going on. Thank you.

Kimberly

A. Dear Kimberly, Your doctor owes you an explanation of what is going on. Otherwise see another doctor, preferably a pulmonologist. It is not in your best interests to keep you in the dark about his suspicions, or diagnosis.

Dr. Tom

 

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