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Archive: Dr. Tom 131

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

 

 

Could Smoking Be Causing my Lung Problems?
Q. I’m 20 and a smoker for three years and not too much active anymore. I went for chest x-ray and they told me I had hyper-expanded lungs. I am still not quite too sure on what this means, but I’ve been having chest pains very frequently, almost like an intense heartburn, when I take breaths my lungs hurt.

What’s wrong with me?
Jemal

A. Dear Jemal,
Probably nothing. Hyperinflation just means that you took a deep breath, as instructed, when you had the chest x-ray done.

This does not explain your symptoms, however. I do not know what is causing these, from the limited information in your question. They will probably just go away. Stop all smoking.
Dr. Tom

Worried about Husband’s Lungs
Q. I’ve noticed that my husband’s breathing while sleeping seems very shallow and the breaths are short. It’s almost as though  he  “puffs” the air out.   He often breathes two breathes for my every one.  Sometimes the breaths seem to fade to nothing and I hear no breathing (almost like apnea but with NO snoring).

He is a distance runner and runs generally 40 miles per week when he’s not training for a long race.  He is 53 years old and is healthy.  He has a history of asthma from childhood and early adulthood.  He found that running alleviates the symptoms.

The only meds he takes are for seasonal allergies (Claritin). He had a PFT recently for a physical and it showed hyperinflated lungs and just shy of normal FEV1/FVC (68).

What could be going on?
Kim

A. Dear Kim,
He may have sleep apnea, even though most with this disorder are heavy snorers. Hyperinflation on a chest x-ray does not mean much. It is not an abnormality.
Dr. Tom

Is It Safe to Use All These Medications?
Q. Is it safe to use Sprivia, Serevent, and Xopenex  together?
Patty

A. Dear Patty,
Yes, but Xopenex and Serevent have similar actions.
 Dr. Tom

Do You Know of Good Place for Care Near Palm Desert?
Q. I live in Palm Desert; have been diagnosed with COPD (via pulmonary tests) and would like a referral to the best pulmonologist in the desert. I am 67 years old. HELP please.
Rita

A. Dear Rita,
I do not know any pulmonologists in your area. You will have to ask your friends or other doctors in the region.
Dr. Tom

Haven’t Done Anything Different but My Saturations Have Dropped
Q. About a week ago I started noticing my saturations were dropping to the low 90’s upper 80’s on my 2L of 02. Haven’t done anything different and I feel great. Don’t have any SOB or anything. I turned 02 up to 3L and saturations are better.

Any thoughts on what might be going on and was it OK to turn the 02 up?
Sally

A. Dear Sally,
I do not know the reason that you take oxygen in the first place. Daily needs change. It is fine to turn up the flow as guided by your personal oximeter.
Dr. Tom

Please Tell Me About FEV1
Q. What is FEVI and what do the different %’s mean?
Doug

A. Dear Doug,
This means the forced expiratory volume in one second. It is expressed as % of normal for age, height and sex, and also as % of the whole breath i.e. the forced expiratory volume in six seconds, or longer, called the FVC. Normal is >70%.
Dr. Tom 

BreathPlay
Q. I’ve been busy, very busy—doing homecare with folks with neuromuscular breathing problems. I teach BreathPlay to all of them, and their caregivers. On weekends I’m writing my book about BreathPlay—I’m 3/4 done.

My question is about asthma.  Why is the respiratory community clinging to medication-based solutions that do not address the cause?

I am still addressing the respiratory tide against teaching BreathPlay which relaxes the body from the inside out—This inexpensive remedy requires personal commitment, and it works.
Betsy, RRT

A. Dear Betsy,
I have no idea what “breath play” is, but there are various breathing maneuvers that are helpful in asthma. The medications that are used are necessary to combat the inflammation and bronchospasm that is the underlying abnormality in severe or sustained asthma.
Dr. Tom

Could Muscle Pull Cause Breathing Problems
Q. It hurts to laugh, cough and take deep breaths. I know I’m breathing, because I’m alive and can talk, but it feels like I’m being smothered, if I lie on my side its better for a moment. The only physical activity I have been doing lately is “dipping” a female while dancing. I’ll admit, she WAS a little heavy. Could I have pulled something?
Todd

A. Dear Todd,
It is possible that muscle strain is the answer.  Your symptoms sound more like a pneumothorax, which is a partially collapsed lung, which may occur at any time, including exercise.

You will have to see a doctor and get a chest x-ray to confirm this. The air leak of a pneumothorax may subside spontaneously, or may require the placement of a small tube to let the air out.
Dr. Tom

What are the Symptoms of COPD
Q. I am a 54 year old woman who has been smoking about 20 cigarettes a day for the past several years. In March I had a terrible cough for about two weeks, then I began what I thought was a smoker’s cough in the mornings only. When this happened I coughed up a very small amount of phlegm, but was retching. Next I had a constant urge to clear my throat. About two weeks ago I began coughing up considerable amounts of phlegm.

I think I have COPD, but I don’t have any other symptoms? Could I be wrong and have something less dire? 
Sharon

A. Dear Sharon,
You could have COPD, or just the residual of an acute viral bronchitis. You should have your lung function measured by spirometry and of course, stop all smoking.
Dr. Tom

Could Medications Cause Hoarseness?
Q. I have COPD and use Advair,  Spiriva, and  albuterol puffer when needed.. At least daily, my voice goes very hoarse and I have difficulty breathing and talking.  Is there something I can do about the hoarseness?
Mickey

A. Dear Mickey, The hoarseness is most likely due to the Advair, if you use the discus. Stopping this for about a week will result in the clearing of hoarseness if this is the cause. If so, ask your doctor for a metered dose device with the same material. This preparation is associated with less hoarseness.
Dr. Tom

What are Ground Glass Infiltrates on Chest X-Rays? 
Q. Recent comments as result of CT Scan indicate “mild basilar scarring”, some ground glass infiltrates in the left lower lobes.  What does this indicate, and what could be the source of the “glass”?  I am now 78 years old, and had TB in my early 20’s.

No other respiratory history.  Have allergies.
Mary

A. Dear Mary,
Ground glass usually refers to an inflammation. It can also be a manifestation of malignancy. It would be important to compare your present chest x-rays, with any you have saved from the past to compare. This could be the residual of TB too. I suggest you see a pulmonologist.
Dr. Tom

Target Heart Rates for Exercise
Q. I have an FEV1 of 50% of predicted.  Been that way for 20 or more years (smoking quit).  So now I’m “brisk walking” with a heart rate monitor.  At 62 and a resting pulse of 55 according to “calculators” I’ve used. Should I exercise in target range of 129 to 144 however, after I get above a 125 rate it seems to hurt?  I seem to have a low tolerance for pain.  Will I hurt myself if I push for the target range?
Gary

A. Dear Gary,
I suggest not pushing yourself, to the point of chest pain. This could be an angina equivalent. It is not important to meet a target heart rate, just exercise at a slower rate and you will accomplish the same fitness.
Dr. Tom

Disqualification for Lung Transplant
Q. I am trying to get a lung transplant. Would a mycobacterium avium complex infection disqualify me?
Debra

A. Dear Debra,
Yes, at least until it is cured with drugs.
Dr. Tom

How Can You Evaluate the Need for Oxygen?
Q. My wife was recently hospitalized for 60 days for aspiration pneumonia. Her underlying disease is multiple system atrophy (diagnosed 2002). She ended up coming home with the tracheostomy because some muscles near her voice box had weakened and were collapsing when she inhaled. This may have been caused by the original two weeks that she spent on the ventilator. She was prescribed to be on 2L of O2 per minute.

She can spend hours with her Speaking Valve or HME (Heat/Moisture Exchange (HME) filters) with no oxygen and her saturations remains between 96%and 100%. How can we determine if oxygen supplement is even necessary?
David

A. Dear David,
You can use your oximeter to find out if she remains saturated above 90–92% without the oxygen.
Dr. Tom

Do Hyperinflated Lungs Indicate Emphysema
Q. Hello Dr. Tom First I would like to start out by saying that I appreciate your time and effort in answering the questions that people submit.  I have read through your archives and have found your answers very informative as well as positive.  Most of the information on the web regarding COPD is presented in a less optimistic manner.

Now to get to my concerns.  First I will give you a brief history since I believe it is relevant to the questions.

I seek answers for the following. At 26 years of age I got a spirometry done and it came back normal. At 31 I pulled a muscle in my ribcage and went to the ER to make sure everything was okay (I has chest pain). The doctor did a standard x-ray which showed bilateral hyperinflation. The ER doctor came to my bedside and said I had the lungs of a 60 year old smoker. He asked if I ever had smoked. I replied no. He then said I had genetic emphysema and left my bedside.

I was stunned.  First of all, he did not ask for a further history.  If he did he would have found out that as a hobby I teach high intensity aerobic classes, run, hike, bike—with never being out of breath. So I went and got a full cardiac work up and another spirometry test. The cardiac work up showed that I have a strong heart with a very low resting heart rate . My spirometry numbers all came back over 100% or  close to 100%.  The volume flow rate curves all looked normal.  I recently looked up what normal volume flow rate  curves look like and that is what mine looked like.

At 39 I got bronchitis or some bad cough so I went to my GP.  I told her I would like to repeat my chest x-ray. I still had all my old results, chest x-ray and spirometry data.  The chest x-ray was identical to the one done 8 years ago.  I still had bilateral hyperinflation with no active lung disease.

I am currently 42.  I am never short of breath, teach high intensity kick boxing, and play sports where I sprint with people less than 30.  My recovery after anaerobic activity is rather short.

I guess my questions and concerns are about the chest x-rays.  Since they were pretty much identical are my lungs just that way?  The only person that pointed to emphysema was that ER and doctor and all the web information on COPD.  I would greatly appreciate your thoughts on this matter.
Barbara

A. Dear Barbara,
As I have stated emphatically before on these pages, hyperinflation seen on a chest x-ray is pretty meaningless. It just indicates that you took a large breath as instructed when the technician took the x-ray. Doctors do a lot of people a disservice by commenting on this simple fact. You are normal.

Stay healthy and critical of doctors who do not make sense.
Dr. Tom

Scared that I Might Have Lung Cancer
Q. I am a 35 year old woman and a smoker for at least 25 years. I had a CT Scan done May 21, 2008. They found a 6mm nodule posterior segment on my lower lobe of my right lung. My doctor has put in for another CT Scan for next month to see if it has grown, but I am scared. No one is really saying anything to me could this be lung cancer?
Sheree

A. Dear Sheree,
The reason for the repeat CT is to look for growth as an indicator of possible lung cancer. Wait for the results. About 90% of single noncalcified nodules are benign, but it is best not to wait too long for the malignant ones to grow and maybe spread.

Waiting three or four months for a small nodule like you have is standard procedure and safe.
Dr.Tom

Cause of Granulomas
Q. I am 45 years old and recently had a chest x-ray which, found lung granulomas.  As a child and early teen, I had severe asthma, bouts of bronchitis, pneumonia and pleurisy. Could the granuloma be from these childhood illnesses?
D

A. Dear D,
The answer is yes. By calling the finding granulomas, I assume they were calcified, which makes it certain that they are not cancer. You may want to check that they were calcified.
Dr. Tom

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