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Archive: Dr. Tom 121
Posted March 18, 2008

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

 

 

Should I be Concerned That I Have COPD?
Q. I smoked for 30 years. My primary care doctor did an x-ray of my lungs, which said I had hyperinflated lungs. I also had a spirometry test with methacholine challenge, which came out normal. My doctor said I was fine. He did not mention the hyperinflated lungs.

A month later, I went to the Mayo clinic for a smoking cessation class. They did a spirometry test, which was different than the original one, this one was in a booth, and the results are as follows:

                 Found      %Predicted
FVC           3.78      108%
FEV1         2.84      101%
FEV1/FVC   75.0
FEF25-75      2.1   86%   
FEFmax         7.8   128%     

Comments: normal control spirometry.

The doctor at the Mayo Clinic said I did not have COPD and if I stopped smoking my rate of decline would be like the normal population. 

I was not concerned until I requested a copy of the x-ray done by my primary doctor, which said I had hyperinflated lungs.

Should I go to a pulmonologist or be concerned given two spirometry tests said I had normal results? Should I be concerned that I have COPD?

Roberta

A. Dear Roberta, You definitely do not have COPD. All your lung functions are normal. Hyperinflation on a chest x-ray means nothing and should not be reported. It only indicates that you took a full breath, which is what the technician instructed you to do!

Dr. Tom

 

Feelings of Breathlessness
Q. I am a 31 year old woman and for the last several months I have been experiencing feelings of breathlessness.  At first, it seemed almost constant without any other symptoms (no wheezing, no coughing, no recent respiratory infection). 

I have had spirometry performed and the values were within normal range.  I have also had a clear chest x-ray and CT scan. The pulmonologist told me that it was stress and wanted me to return to my regular doctor to get medication for anxiety.  I don't doubt that there has been an anxiety component to this, as it has improved since I know there is nothing life-threatening.  However, I still have episodes of feeling breathless, and I am not anxious and am not an anxious person by nature. 

The things that seem to bring this on include minimal exercise like walking up stairs and yelling.  However, sometimes it seems to happen for no reason at all.  The feeling passes when the activity is over, and in the instance of "spontaneous episodes" it seems to resolve on its own within a few minutes to an hour. 

This is very frustrating to me because it seems that there is nothing left to do but live with this uncomfortable feeling until it goes away.  I have been avoiding exercise because I don't want to be uncomfortable, but I know that this is not the correct way to handle this.  Do you have any suggestions?  Your help is much appreciated.

Sarah

A. Dear Sarah, Do not avoid exercise. These transient feelings of shortness of breath are only a nuisance. You will learn to ignore them. Stay well.

Dr. Tom

 

Stopped Smoking: Will Emphysema Progressively Worsen?
 Q
. I'm 41 years old and a 25-year smoker.  My doctor told me awhile ago that most people with my history have some form of emphysema and if I stop smoking (which I did!), it wouldn't progress any. 

Then a pulmonologist told me that information was not entirely accurate. He said only 10% to 15% of smokers get emphysema and there's no guarantee that it won't progress.  In fact, it could even be sort of dormant for a long time and start progressing years from now.  What's the lowdown, doc?  Is my regular doctor just talking generally about emphysema-like symptoms and not actual COPD?

Dave

A. Dear Dave, The pulmonologist is correct, but in general, the rate of decline of lung function is only that related to age, once a patient stops smoking.

Hope that you are in the group that follows this rule.

Dr. Tom

 

Mother is having a Hard Time Recovering from Respiratory Infection
Q. My mom has emphysema and has been on oxygen 24/7 for almost six years and is 57 years old.  She normally gets around pretty well, exercising 2-3 times a week.  She has had some upper respiratory infections over the years but has gotten past them. 

This time seems different.  After three rounds of antibiotics and a round of steroids, she is mostly better, but the increased sputum is still there (although mostly clear or lightly colored) and she is still tires very easily. 

She is having some intermittent swelling in her left leg and is having a lot of trouble sleeping.  Is she getting better?  Could it just take longer this time?  Or may she not recover to her level of health just before this infection?  I want to give her support and hope, but not be unrealistic.

Sonja

A. Dear Sonja, You had better discuss your concerns with your doctor. I do not have enough information to give you a solid answer. The swelling in her left leg needs explanation.

Dr. Tom

 

COPD and Conscious Sedation
Q. As a 51-year old patient with stable COPD, it is safe to have conscious sedation during a colonoscopy?

Terri

A. Dear Terri, Yes, in general it is. The person who gives you the sedation needs to take into consideration that deep sedation in your case is not desirable.

Dr. Tom

 

What Does a “Shadow on the Lung” Mean?
Q. On an x-ray, what can cause a "shadow on the lung"? My dad is 83, has had mild COPD for years, doesn't require oxygen, no blood in the sputum, no loss of weight or appetite, no fatigue, no clubbing of fingers, walks his treadmill an hour daily, reacts well to his steroid inhalers -- but he had a bout with the flu two weeks ago. We took him in a week ago and he had the chest x-ray.

Could the shadow be related to the acute bout of flu or illness? His doctor thinks so but wants to do a CT just to be safe rather than sorry.

Renee

A. Dear Renee, Don't freak out. The shadow could be from the flu. I would wait a month and repeat the chest x-ray. I see no reason for a CT right now.

Dr. Tom

 

Correlation of FEV1 and Severity of COPD
Q. I had a PFT and was told I have COPD.  Was told it was on the severe side of severe. My FEV1 was 39%. They did many times like they could not believe this.  Just how bad is this?

Peggy

A. Dear Peggy, It depends a lot on your age, and smoking status. In general it appears to be of moderate severity. Not too bad.

Dr Tom

 

What is a Subcarinal Lymph Node?
Q. What does borderline-sized subcarinal lymph node mean?

Patsy

A. Dear Patsy, A slight enlargement of the lymph node that is us just below the place where the trachea divides into the right and left main airways to each lung.

Dr. Tom

 

Can Staples From Lung Surgery Cause Discomfort?
Q. I am a 65-year old female.  I had my left upper lung removed (surgery date was 9-03-07); my lung cancer was adenocarinoma (size of a small raisin) and no other involvement was found. I am now cancer free. Pulmonary function test was given three months after surgery.  The results were excellent.

I have seem to have muscle tightness below my left rib, and this causes daily discomfort. The doctor does not give me a reason.  I do deep breathing--stretching--walking but it does not relieve the discomfort.  It was suggested by a nurse that maybe the staples in my lung were too tight. Can you suggest help for me?

Myra

A. Dear Myra, Staples in the lung do not cause symptoms. Better get another explanation of your discomfort from your doctor, not the nurse.

Dr. Tom

Should Daughter Continue Inhalers While Waiting for Final Diagnosis?
Q. I have a daughter (13) who has had some breathing issues, shortness of breath, wheezing over the last six to eight months. The Doctor prescribed inhalers first PROAIR HFA six months ago and a week ago ADVAIR DISKUS 100/50. She ordered an x-ray this time and it showed one 8 mm nodule on her lung.

We live in Phoenix, AZ, (Valley Fever) so the doctor ordered a blood test. Should she continue to use the inhaler ADVAIR while we find out what is wrong? Also would you have any suggestions as to how we should proceed? 

Mike

A. Dear Mike, A nodule in this area in a young person is almost always from a fungus called cocci. Your doctor will know about this and it requires no attention.

Your daughter can use the inhalers if needed for relief of symptoms, or as maintenance therapy for asthma, if your doctor believes this is the right diagnosis.

Dr. Tom

 

I Have COPD, What Signs and/or Symptoms Should I Report to My Doctor
Q. I was recently diagnosed with mild-to-moderate emphysema with the use of oxygen test, sitting and walking, as well as a CT scan that validated the doctor’s theory.

Secondly, I've had epilepsy all of my 69 years of life, migraine headaches, and tuberous sclerosis on the brain for the last 10 years.

Consequently, my concern is: what items should I be aware of as far as change is concerned--so as to note and notify my doctor. -- much like I do with my neurological impairments.

Kay

A. Dear Kay, You are the only one who knows how your feel, i.e., what symptoms you have. Tell him everything that concerns you. Since there is a question about symptoms, I wonder why and how the diagnosis of COPD was entertained.

Dr. Tom

 

Heavy Smoker and Worried about ABG’s and FEV1
Q. I am a heavy smoker, and not long ago I got stabbed on the right side of my chest. On admission to hospital my blood gas measurements showed a high arterial PCO2 and a low arterial pH of 7.15.

When the stab wound had been repaired, my arterial PCO2 returned to normal and so did my pH. However I still continue to smoke heavily and my lung function tests revealed a low FEV1 and a slightly reduced FVC. What’s condition am I now suffering from?

Joanna

A. Dear Joanna, You should stop all smoking no matter what degree of COPD you may or may not have. It is possible that your results are still from the trauma of the stab wound. You doctor would know more about this.

Dr. Tom

 

Retaining CO2 and Emphysema
Q. Can one go from being a non-CO2 retainer to a CO2 retainer, and does this mean emphysema is worsening?

Bridget

A. Dear Bridget, Yes and yes. But you should have a doctor to determine exactly what is going on. Do not let the label of CO2 retention keep you from getting oxygen, if it is needed in your case.

Dr. Tom

 

Does this Sound like Bronchiectasis?
Q. I am 60 year-old female and had pneumonia last year in April and during this time I have been under tremendous stress. I am caregiver for my 88-year old mother with dementia and back problems. I just had a follow-up CT and following are results. Comparison is made to the previous scan performed on 10/4/2007.  There has been complete resolution of the superior lingular infiltrate since then, but there is now a new infiltrate in the anterior segment of the right upper lobe inferiorly, with similar characteristics as the lingular infiltrate, air bronchograms are seen within this alveolar infiltrate and there is evidence of volume loss relating to this infiltrate on the coronal reconstructed images. This is perhaps mild underlying bronchiectasis although in this setting of acute inflammation bronchiectasis is difficult to document.

There are smaller patchy areas of infiltrate and volume loss in the anterior segment of the left upper lobe medially, in the right middle lobe and in both lower lobes, these are essentially new in these locations as compared to the previous examination. Again seen is a calcified granuloma in the inferior right upper lobe. There are calcified right hilar lymph nodes. Thank you and please advise on what this.

Antonette

A. Dear Antonette, Ask your doctor. It is not my responsibility to evaluate your CT reports, and impossible to do without seeing the films.

Dr. Tom

 

What Symptoms can Atelectasis Cause?
Q. My Chest CT Scan Results states the following:
Mild linear scarring or atelectasis in the inferior aspect of the right middle lobe Similar linear density at the left lung base is probably due to mild thickening of the major fissure, although it could reflect some adjacent mild parenchymal scarring.

1. Does this explain my backache just to the right of my spinal column?
2. Does this explain my shortness of breath when I exercise?
3. Does this explain my frequent lung infection, which requires antibiotics like Zithromax?

Noel

A. Dear Noel, No, no and maybe. Ask your doctor who knows you best.

Dr. Tom

 

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