What are the Symptoms of Bronchitis?
Q. The doctor says I have bronchitis, but I don’t
cough. Culd it be something else?
A. Dear Carlos,
Bronchitis is always characterized by cough. Ask your doctor again
about the diagnosis. You did not tell us any of your symptoms.
Do I have COPD or Asthma?
Q. I have been extremely out of breath for just
over six months now when I walk up stairs, etc. When I get severely
out of breath my jaw aches and my heartbeat is rapid. I had a
chest x-ray which showed hyperinflated lungs. This was followed
up with a spirometry test, which showed my lung age at 35, but
I am 36; what does this mean?
Doctor has diagnosed COPD but gave me no treatment plan. Asthma
inhalers don’t seem to help. Kind regards and many
A. Dear Simon,
You must not have COPD since the lung test showed normal for age.
I suggest you see a pulmonologist for diagnosis and treatment.
You should not have to suffer these symptoms. Dr. Tom
VATS Bullectomy Pleurodesis
Q. My younger brother, who is 21, is having a
VATS bullectomy pleurodesis. What is this please?
A. Dear Richie,
It is a surgical procedure done via a scope inserted through a
small incision, that allows the surgeon to take off local areas
of lung that are abnormal and irritate the area to avoid future
air leaks of the lung, known medically as pneumothorax.
Multiple Problems With No Answers
Q. My husband has a complicated case and I am extremely frustrated on where to go from here. He is a bone marrow transplant recipient, (ankylosing spondylitis, scoliosis) he has radiation therapy damage to his lungs and he is a former smoker.
Currently he is experiencing rapid weight loss, fatigue and
major issues with shortness of breath. His O2 saturations are
in the upper 90s. His PFTs show mild obstruction. His symptoms do not seem to fit his test
results. However, he cannot breathe at all.
One doctor believes the primary problem is Graft vs Host disease, another believes it is COPD, another believes the ankylosing spondylitis is causing most of the issues, and yet another thinks his scoliosis is causing chest wall problems.
He is on a variety of medications…steroids, immunosuppresants,
inhalers, anti-fungal, antibiotic, Singulair, etc. Nothing is
We go from doctor to doctor and are getting nowhere fast, yet
he is deteriorating rapidly. Any suggestions are deeply appreciated.
A. Dear Mica,
I suggest going to a center that deals with extremely complex
problems like you describe. Probably the best is the National
Jewish Center in Denver. I know the doctors there and they are
How Long Does It Take to Recover from Pneumonia?
Q. I had a severe case of pneumonia. I had very
few symptoms of pneumonia (only chest pain and breathing difficulties—I
never had a cold, sore throat, cough, or fever) so I am concerned
that I will relapse and not notice. My doctor said the x-rays
are clear and the CT scan is almost back to normal. I have been
off antibiotics for four weeks.
I still have green phlegm that I cough up daily, particularly
in the morning. The doctor said that coughing up phlegm after
pneumonia is “normal,” but how long can it last before
I should become concerned?
A. Dear Linda,
Your course of slow resolution is not unusual for severe pneumonia.
Your x-rays are showing clearing. I believe you will gradually
return to normal over the next few weeks.
What Does Lung Scarring Mean?
Q. The doctor told me that my lungs are scarred,
so I asked the doctor if he could tell me how this happened. He
told me that maybe it was from a cold. I told him that he was
wrong; I think that I was exposed to asbestos dust because I worked
down at ground zero.
A. Dear Joey,
You could be right. I suggest seeing a pulmonologist for diagnosis
Could I Have Gone from Mild to Moderate COPD in a Year?
Q. Last year a PFT test showed that I have a
mild COPD with the following result:
FEV1/FVC ratio 68% (normal is > 70%)
FEV1 2.91, 81% predicted.
This year's PFT test shows moderate COPD with a drop of 240
to 300 ml of FVC and FEV1.
Could I lose this much in one year and move from mild to moderate
when I stopped smoking two years ago?
A. Dear Has,
It is possible, but unlikely that this is all COPD. There may
be a component of asthma. I suggest seeing a pulmonologist.
How to Stop Smoking
Q. I have smoked for 35 years, and over the past
couple of years have started smoking about two packs a day. I
have quit several times but always start back smoking. I am scared.
I want to quit but do not seem to have the will power and now
I am afraid the pain I am feeling is something bad. What test
should I have done and do you have any suggestions for a successful
quit smoking program? I live in North Carolina. Can you recommend
a good doctor to see on the east coast of North Carolina?
A. Dear Anita,
There are many strategies used in smoking cessation and some over-the-counter
and prescription drugs that help in quitting. I suggest looking
for a specialist in smoking cessation in one of the major medical
centers of North Carolina, such as Duke, or the University of
Recommended Follow-Up on Calcified Nodule
Q. A couple weeks ago I had a gall-bladder attack
and ended up having about five tests done, one being a chest x-ray.
The chest x-ray showed what they called a button. Next I had a
CT scan and it showed a calcified nodule. I was told I needed
to repeat the scan in three months.
After reading up on calcified nodules I was under the impression
these were not harmful. If this is true why do I need a follow-up?
What are they looking for on the next scan?
A. Dear AC,
Calcified nodules are always benign and do not need follow-up.
Can You Give a Lung for a Transplant?
Q. My husband has nodules in his lungs supposedly
from his cancer that he has in his leg but they have never tested
them to see if they were cancerous or not. We were just wondering
if worse comes to worst would it be safe for him to get a lung
transplant and if I could possibly give him one?
If so would we both have a really good chance of being able
to live how we did before and do all the same things that we did?
A. Dear Stacey,
A diagnosis of the nodules is necessary before any consideration
of transplantation can be entertained. You cannot donate a lung
to your husband.
Could it be a Side Effect of the Antibiotic?
Q. I am getting over pneumonia in the right lung,
and after two weeks of ciprofloxacin tablets my face is sore and
bleeds when I shave. Can you help.
A. Dear Robert,
Maybe. I do not think the ciprofloxacin is the cause of bleeding
Shortness of Breath and Coughing Two Years after Lung
Q. Hello. I had spontaneous pneumothorax in 2005. I have been coughing for past two years with no apparent
reason. I have shortness of breath that disappears usually after
an hour of coughing, When mucus is finally out, it's easier to
breathe, but I still need to clear my throat. I went to a second
doctor already and I have been told that I have severe allergies.
None of the medicine seems to work. Can this be related to my
A. Dear Rafal,
I do not believe that your cough and mucus is related to
your bleb disease. I suggest you be checked for asthma.
Life Expectancy and Advanced Emphysema
Q. What life expectancy can be had for a 62-year-old
with very advanced emphysema, 26% lung function and a BMI of 19
and who stopped a two-pack-a-day 40-year habit, two years ago.
A. Dear Carter,
It is very hard to predict life expectancy in anyone with COPD.
I would guess, that you can look forward to 10 years or more.
The most important thing is to enjoy life, day by day.
Should I Go Back to the Doctor?
Q. I was recently diagnosed with a fractured
rib (10th rib on the right side). The x-ray also showed some irritation
(or something like that) to the pleura around my lungs. I recently
had to lift some heavy objects due to a flood and have physically
overdone it the last few days. I am worried that the pleura could
be damaged further as I am in more pain than prior to diagnosis.
What symptoms should I look for before I go to the doctor again?
A. Dear Brittney,
It is more likely that you have simple muscle strain. I would
wait a week or so before seeing a doctor, unless the pain is too
Should I See a Pulmonologist?
Q. I am 26 years old. I quit smoking four months
ago; I smoked for eight years, 1/2 pack per day. About a year
ago, I inhaled fumes for about 30 seconds of car a/c refrigerant
(R134a). Almost immediately I felt woozy and had intense pain
in my chest and trouble breathing. I read up on the chemical,
and they said that it displaces air in the lungs if breathed in.
The intense pain continued for one week. I’ve also had sharp
stabs of pain in my chest three times a week for the first few
Though the pain is a lot better now and I don’t have the sharp pains, I still have some chest tightness and difficulty breathing since then, and also still have pain in my lower left chest, mainly under my lowest left rib. Also, in the same spot as the pain, my whole lowest left rib has become increasingly raised up, from the center to the side. If you feel it, you can definitely notice a mountain-like bump in the difference of height between the xiphoid process and the beginning of the left rib.
I went to the clinic and the doctor said it sounds like a problem
with my diaphragm. I had x-rays done six months ago and the report
said nothing was unusual. This week I got a contrast chest CT
scan, and the results say—“Symmetric biapical parenchymal
scarring and bullous formation is observed." Is the
scarring and bullous formation noteworthy? Is this serious enough
to see a pulmonologist?
A. Dear Serge,
Scarring and bullous formation may or may not be important. I
suggest you see a pulmonologist and get a diagnosis, based on
more information, such as your lung function.
Progress in the Treatment or Cure for COPD
Q. This is an important question so I hope you
have the time to address it. All over the world there is research
into COPD; in the U.S. the University of Pittsburgh came up with
solid proof that COPD is an autoimmune disease, and they
are experimenting with cyclosporine to assist COPD sufferers.
How close, Dr. Tom, are we from a real breakthrough to really
help people with this disease, instead of continuing with medications
that only mask the symptoms. How many years, would you say, we
are from really getting a solid grip on this disease? Now a cure
may be a long way off , but so many are saying that some
real breakthroughs are just around the corner in regards to finding
some meds that may not cure the disease but will halt its progression.
What say YOU!!! Thanks.
A. Dear Philip,
There is a frantic search going on for drugs that will stop the
process of COPD. Many mechanisms seem to be involved, so there
are a number of therapeutic targets. I do not believe COPD is
simply an autoimmune disease, and I would be amazed if cyclosporine
would affect it, but this is the reason for controlled clinical
What does Biapical Changes Mean?
Q. I was recently told I have chronic changes
to the lung apices. The impression states findings appear to represent
chronic biapical change. Exactly what does this mean?
A. Dear Nina,
This usually means shadows that result from some remote inflammatory
process. If you are concerned, see a pulmonologist, and get your
lung function measured.
Feel Sliding Under Rib Cage
Q. I have always been active and involved with
sports. Less than two years ago I ran a half marathon without
stopping. A little at a time, the breathing got worse. Just 14
months ago I did a weekend adventure where I biked, hiked, canoed,
played golf, no problems.
Not long after that, I started having trouble catching my breath more and more. I also had a heart palpitation, which I had checked out at a physical and stress test and everything was fine.
Call this coincidence, but I felt something moving on my right
side under the rib cage. This occurred when rolling out of bed,
into bed, went on for weeks. Finally it went away, but the poor
I went to an allergist and got diagnosed with allergic asthma.
The problem is, I’ve taken asthma medicine but am still
lousy off and on. Now this has affected my exercise because I’m
paranoid and feeling worse due to the lack of exercise.
My question: Is it coincidence that I felt this “sliding”
under the ribcage and my breathing and everything else got worse
not long after, including the palpations? I had a chest-x-ray
and nothing there.
A. Dear Jim,
I do not know the cause of the “sliding” feeling.
You should not have to suffer from shortness of breath. I suggest
seeing another doctor, such as a pulmonologist to explain this
and get proper treatment started.
Is Coughing a Symptom of Sleep Apnea?
Q. The pulmonary specialist (who has done blood
test, sinus scan, lung scan and sleep study) said I have sleep
apnea and that could be causing my slight shortness of breath
and coughing Other than that, he finds nothing wrong. Where do
I go from here? Any thoughts?
A. Dear Mary,
In sleep apnea, one often awakens with a feeling of suffocation
and sometimes coughing. This should not persist through the waking
hours. But reflux is a common cause of cough. I suggest getting
treatment for this.
Follow-Up on Straight Back Syndrome and Asthma Difficulties
Q. You answered my question about straight back
syndrome by saying that it doesn’t affect asthma. I have
always, though, had difficult-to-control asthma in spite of good
breathing tests. I also have really bad allergies, which I can
control. All chest xrays and scans are normal.
I take Pulmicort, Foradil, theophylline, Singulair, Beconase,
Astelin. I have had allergy shots as well as Xolair; neither of
these helped much.
Can you think of any possible reason that I have so many asthma
difficulties? At times it’s fine but goes out of control
often, especially during high pollen counts. My last allergist did not believe me when I had asthma attacks since breathing
tests were good.
A. Dear Susan,
Asthma is a very complex disease, or group of diseases. You are
on a lot of medications that should control most asthma. Of course
it is common to have asthma attacks and still have normal lung
function between attacks. Maybe you should see another asthma
expert to help you manage your complex problem.
Oxygen Saturation and Need for Oxygen
Q. My doctor ordered an O2 saturation check a
week ago, I slept with it on all night. She called me today to
tell me it dropped below 88 sometimes. She was going to have an
oxygen supply company contact me tomorrow. What does this mean?
She really didn’t say anymore.
A. Dear Robin,
You need her to explain how often you had low saturations and
how low they went. Just starting oxygen for an occasional drop
in sleep saturation is not appropriate, in my opinion.
Can Pleural Scarring be Caused by Sleep Apnea?
Q. Can stable pleural-parenchymal scarring cause
A. Dear Richard,
Possibly, if there is aspiration of gastrointestinal contents
during sleep and periods of apnea. This should be checked out
by a pulmonologist or gastroenterologist, or both.
Is it COPD or Asthma?
Q. My PFT results: severe obstruction and no
restriction with significant improvement postbronchodilator
therapy. Diffusion capacity is within normal limits.
FVC pre drug 87% predicted
FVC post drug 13 % improvement
FEV1 < 50% pre drug
FEV1 60% post drug improvement
FEV1/FVC pre drug <58
FEV1/FVC post drug 42% improvement.
Is this asthma? I have no cough and walk approximately two miles
I have an appointment with a pulmonary doctor for the first
time and want to be informed.
A. Dear Pat,
It could be both. You have a definite reversible component suggesting
asthma. Discuss this with your pulmonologist.
Weaning off of Oxygen
Q. I am 25 years old and have respiratory insufficiency
due to a brain stem tumor when I was 3. I recently had a very
bad case of pneumonia, got a tracheostomy and am at home on oxygen 24/7. My doctor said that we can talk
about weaning me off of it once these constant tracheostomy infections
Is there any harm in going off and on oxygen for 1–2 hours
at a time if I feel o.k. Thank you in advance for your response.
A. Dear Marian, You should monitor your oxygenation
with a simple oximeter during periods when you are off oxygen.
For that matter, you should also monitor your oxygenation while
active too, and adjust the flow if necessary. Discuss this with
Concerned about Oxygen Therapy and Medications
Q. My father has severe emphysema bullous no air in right lung and bullous pushing left lung up into a corner
-- not a well man.
My question is: He has been put on 8lpm of O2 through a Venticaire
mask, 35%. Is this not a high lpm of oxygen to be on? Will he
not retain CO2 ?
My second question is that he is also on Spiriva and ipratropium
and tons of other stuff. I will send you a list if needed could
you get back to me asap.
A. Dear Lois,
Do not worry about CO2 retention. This is a very rare happening
in stable patients. A venti mask does not deliver high concentrations
of oxygen. As you state, only 35%.
I wonder why this is being used. Nasal canulae are much more pleasant and do not cause CO2 retention, as some health workers wrongly fear.
It is not wise to use both Spiriva, (i.e. tiotropium)
and ipratropium together. They do similar things and the
ipratropium may reduce the effectiveness of Spiriva. Discuss this
with your doctor.
What is a Dry Drowning?
Q. I received an e-mail from a friend regarding
a child that died from “dry drowning.” The child had
been swimming earlier in the day. As an RRT, what should be symptoms
and/or events that would alert one to dry drowning?
A. Dear Bobbie,
Dry drowning simply refers to the fact that severe spasm of the
voice box occurs during drowning and thus the lungs are not full
of water, as is commonly believed.
14 MM Node
Q. I had a chest x-ray, showing a nodular appearing
density anteriorly at the level of the diaphragm, measuring 14mm.
Would you explain this condition?
A. Dear Wade,
Your doctor will have to explain the significance to you. If not
calcified, it needs identification at this size. Maybe it could
be followed looking for growth for about three months. Whether
or not this is wise, or an immediate biopsy done, depends on your
general health and other considerations that are not known to
me by your simple question. Dr. Tom
I Really Need Help, My Father’s has Multiple Problems
Q. My father got chest x-ray and had these findings...
subsegmental atelectasis (on both lung bases), tortuous aorta,
marginal sized heart, diaphragm and sulci are normal bony thorax
is unremarkable. Could you please explain this result to me?
I am worried on atelectasis and aorta, my father also had findings
on EKG right bundle block, left anterior hemiblock and bifascicular
block, normal sinus rhythm please I really need help, Yes, he
was a smoker for many years.
A. Dear Gaby,
Your doctor should explain these findings. I do not know enough
about your father to be very specific. It is certain that he has
electrical conduction problems with his heart. Ask about the need
for a pacemaker.
Cough Following Surgery
Q. I am 47 tears old and have stage IIIA lung
cancer. I have had chemo plus radiation, an upper right lobectomy
and more chemo. The operation was April 14. Shortly afterwards,
I developed a cough that is still present -- not as bad, but still
there. Could it be from the cancer (apparently it’s gone)
or from the lobectomy? Is it normal?
A. Dear Antonella,
It is most likely that the cough is due to the irradiation. I
am sure you are being checked for cancer recurrence. I wish you
Nebulizer Treatment with Patients on Oxygen
Q. What is the right way to give a nebulizer
treatment to a patient on oxygen (nasal cannula for example)?
Do you give it with the oxygen? Do you increase the oxygen while
on the nebulizer treatment and if so why is that?
A. Dear G.G.,
The nebulizer can be powered by either the oxygen or a separate
pump. It makes no difference. You do not need to change the regular
nasal oxygen flow no matter which method of powering the nebulizer
that you use.
Shortness of Breath and Asthma
Q. I do have asthma but lately I am short of
breath just bringing out the garbage can. This doesn’t seem
normal. Is it?
A. Dear Linda,
You should see a doctor if you are concerned. I cannot make a
diagnosis from such a simple question.