Mother was Former Smoker and Worried About Lung Cancer
Q. My Mom is 74 and is in the hospital for balance issues, high blood pressure, fever, cough and headaches. She had a double mastectomy for “large number of pre-cancerous nodules” about 20 years ago. She had implants done that leaked and were removed five years ago. Now she has the above mentioned symptoms, and her chest x-ray showed a nodule.
Do we need to be concerned about the possibility of lung cancer at her age? She smoked for 30 years before quitting 17 years ago.
A. Dear Peg,
Yes. The risk of lung cancer does not ever return to zero, no matter how long ago your mother stopped smoking. It is not great, but does deserve a checkup.
Health Problems after Acute Respiratory Distress Syndrome (ARDS)
Q. I am an ARDS survivor as of October 2006. I feel that my legs have really never been the same; I am now on a walker at 36. My legs go out from underneath and are real weak. Is there a link to ARDS or the treatment of ARDS for muscle wasting or weakness?
A. Dear Tobie,
Some degree of muscular weakness often follows a severe bout of ARDS. It usually improves with regular exercise. Keep on your walker.
Early Emphysematous Changes
Q. I am 52 and quit smoking five years ago—I smoked two packs/day for 25 years. I had an EBT CT scan last year that showed “Early Emphysematous Changes”.
I had PFT tests:
I jog two miles a day. I feel o.k. running but sometimes short of breath at rest. I think I aspirate some acid reflux at night and am worried that may be causing further damage to my lungs. Would you recommend a follow-up Electron Beam Tomography (full body scan) this year?
A. Dear Mike,
No. You don’t have much wrong with your lung function. Keep healthy and avoid all smoking areas.
What Does Diffusion Test Show?
Q. I had a PFT last week. My doctor said that the PFT looked good except I do not diffuse oxygen as well as expected. She has order a CT scan to look at my lungs. I am 58 and have breathing issues. Should I be worried?
A. Dear Linda,
The diffusion test measures the ability of your lungs to transfer gasses from the air side of the lungs structure to the blood in the capillaries of the lungs. You do not specify how much your diffusion is reduced. If low, a CT scan is worth doing as part of the evaluation. Dr. Tom
Lost Mother to Lung Cancer, Now Worried about Father’s COPD
Q. My father has this COPD, his doctor has not told him about any stages. I just lost my mom to lung cancer and we did not know till it was too late. Does he have long to live? I would like to know the truth.
A. Dear Julie,
You did not give me your father’s age or degree of function impairment, so there is no way to make any estimate. I would assume that he will achieve old age, assuming he has stopped or will stop smoking.
What Is a Pneumatocele?
Q. My husband had a CT scan, which showed a 16 cm air cyst on his left lower lung; his GP referred to it as a pneumatocele. What is the difference between a pneumatocele and a bulla? Are pneumatocele always caused by blunt trauma or infectious agents?
A. Dear Camy,
They are essentially the same thing. They are not caused by blunt trauma but may follow an infection. They are often congenital and require no treatment.
Q. Dr. Tom, I’m 42 and have smoked for 27 years. I do exercise (run) and only get out of breath while running. A recent CT Scan revealed “early/mild bullous disease”. My spirometry tests (taken on two different occasions) say I have 100% lung function.
Do these tests sound accurate, and can bullous disease be stopped/reversed?
A. Dear Michael,
Bullous disease usually refers to a minor abnormality with enlarged air spaces in the extreme upper regions of the lungs. They usually require no treatment and do not affect the function of your lungs, overall. Stay healthy.
Progression of COPD
Q. Thank you ahead of time for taking the time to review my question.
I just turned 47 in July. I was diagnosed with mild COPD about two years ago. I am not a smoker but my ex-husband was the 14 years I was married to him and so were just about everyone in his family. I did however go out to clubs for a few years where the smoke was awful!
I have been wondering since finding out about the COPD how fast the disease progresses and if there is anything you can do to keep progression at a slower rate? Can I still live to be in your 80’s or 90’s? I would appreciate your time at answering this for me.
A. Dear Kathy,
Stay out of smoking bars and avoid all second hand smoke. You can live well into old age. Enjoy your life ahead.
Difference Between Bronchiectasis and Bronchiolectasis
Q. Dear Dr. Tom, I hope you are doing well and thank you for your help to so many. Could you please tell us the difference between bronchiectasis and bronchiolectasis?
A. Dear Jeanne,
They are similar and relate to where the dilatation (ectasiasis) is located. Bronchiolectasis is in the smallest airways and bronchiectasis in the medium and larger sized airways.
Q. Can dysfunctional larynx cause breathing problems?
A. Dear Robert,
Yes. This needs to be checked out by an otolaryngology or pulmonologist who can look at your breathing during various conditions. Dr. Tom
Is the FEF 25%–75% Important?
Q. Dear Dr. Tom, I am 35 years old. I do not smoke or drink, and not over-weight. Back in January 2008 I had bronchitis (which I never had before) and was treated with Z-pack, Flovent and albuterol.
PFT done at my PCP in March 2008 revealed all normal results except FEF 25%–75% was 62%. My PCP was not concerned; he said in August that number would be normal. PFT was repeated the beginning of August and revealed the same results, low FEF 25%–75% was 63%. Should I be concerned?
I do feel SOB with this humid weather and a dry cough at times.
A. Dear Jan,
Do not be concerned. The FEF 25–75% is a calculated value that is often misleading. I think it should be abandoned, and gradually it is. Dr. Tom
Phlegm in Upper Throat
Q. I am a 60 year-old fit woman of normal weight. For the past month I have been suffering with a feeling of phlegm in my upper throat. I have never had allergy, sinus, asthma or acid reflux problems before.
I was sent to a gastrointestinal doctor as well as an ENT—an endoscopy was done about five days ago, and immediately following the procedure—the gastro physician said he did not see anything abnormal. He is treating me for acid reflux with Prilosec.
I do not have or ever had any heartburn, and possibly I’m just looking for a “quick fix” but this feeling of phlegm (present all day) is terrible. I really don’t want to eat.
Are there any other tests that should be done at this point? Any advice would be appreciated.
A. Dear Rosemarie,
I believe the phlegm is more likely due to a postnatal drip. I think your gastroenterologist should have thought of this. Prilosec will not help this.
I suggest nasal “douches”, i.e. the snuffing of salty water into your nose and then rinsing with water.
Q. Age 70 and a history of lifelong asthma. A few years ago I was told, from Pulmonary Function Test that I have the beginning of COPD. I use Combivent once or twice a day.
No doctor has been able to tell me what the wheeze I have in throat area is? It prevents me from exhaling as well as I should. The wheeze varies from not bothering me at all to giving me difficulty breathing, though I was told it is not a lung problem. My oxygen saturation is 97%. I would like to know what this “throat wheeze” is?
A. Dear Robert,
It is probably asthma. The severity of lung problems is not often related to the oxygen saturation that you achieve. It is fine to keep taking Combivent for symptomatic relief.
What Are the Signs and Symptoms of Early COPD?
Q. I am 41 years old and smoked around one pack a day for approximately 20 years; quit seven years ago.
I have no symptoms of COPD except I have mucus in my mouth every morning when I wake up. It is typically clear, on a rare occasion it looks “dirty,” though not bloody.
My father died from COPD complications. Does it sound like I have early stage COPD? Is there anything I can do to decrease my chances of developing it?
A. Dear Susan,
You have already done the most important thing in stopping smoking. Get your spirometry done to see where your lung function stands. You are probably normal, but with a family history, you should have it checked.
Asthma and PFT Results
Q. I am a 60 year-old female and use Combivent twice a day as well as take Singular at night. I have extreme allergies and am taking allergy shots. My allergist conducted PFT tests and I have the results, which I cannot understand, but the findings show “The Body Box TLC 1.24L>Helium TLC indicates Mild Gas Trapping. The Diffusing Capacity (DLCO) is Mildly Reduced. The reduced DLCO can be explained solely by the reduced lung volume. Spirometry is markedly improved post-bronchodilator.”
I have been diagnosed with allergies and asthma. Do you think this is asthma?
A. Dear Judy,
Asthma is the most likely diagnosis.
Worried about Keeping Daughter’s Environment Smoke-Free
Q. My daughter is suspected to have alports (an inherited kidney disease) and I was wondering what can someone do about someone who smokes outside but then comes back in around her. It is her grandpa and he and her grandma watch her once a week. I know that second hand smoke can get in her ears and potentially cause hearing loss but what are the effects when he goes outside and comes back in and what can we do to avoid it being on his clothes and harming her? I know we will not be able to get him to stop.
Her father and I are not together. It is her stepfather so I really don’t have a lot of say about what he does because I do not talk to him anymore really. I do, however, have say in what happens around her so I just wanted your advice.
A. Dear Kristin,
Her risk of second hand smoke is very low, under the circumstances that you describe.
Husband on Third Round of Antibiotics
Q. My husband has had a kind of chest infection since June 30 until now. He has a cough with mucus that is hard to expel. Sometimes it is green but most of the time it seems to be clear. He feels tightness in his chest. His eyes look always shiny and his skin some times has a strange smell.
He has taken three packets of antibiotics. The first two did not work. What can you recommend me to do?
A. Dear Barbara,
Obviously antibiotics are not the answer. I suggest seeing a pulmonologist for a diagnosis.
Prognosis for Pulmonary Hypertension
Q. I am 37 and diagnosed with pulmonary hypertension last Fall. I am doing rather well on oral meds and Ventavis.
Information about life expectancy is still pretty outdated on the Internet. My question is; if someone is responding to medication, based on your knowledge, what is a reasonable life expectancy now? Is it naive to believe I’ll continue to do well (no O2 therapy as of now) for several years? Or do today’s medications really make it so you cannot survive, but enjoy day-to-day life?
A. Dear Maddy,
Survival is quite variable. Sound like you are doing well and are responding to medications. Remember to LIVE each day.
Feels “Sick” When on Oxygen
Q. My husband has COPD and lots of times when he’s on oxygen he feels very sick and has to get off. I’ve “Googled” everything I could think of and have found nothing about this. Can you explain?
A. Dear Lorraine,
I cannot understand what you mean by “ get off”. Do you mean get off the oxygen? If so, it just may be that it makes him anxious.
What Can I Do to Help Myself?
Q. I’m 64 I have bronchiectasis, COPD, MRSA (in lungs), Lupus, and have strokes because I make blood clots. I have a vest, use Dornase, nebulizers, exercise, and eat well balanced meals. What should I do help myself?
A. Dear Donna,
Keep active and do something interesting every day.
Why is it so Hard for Me to Blow Up a Balloon
Q. I’m a 38 year-old male. I was a smoker for around 10 years and gave up entirely around six years ago.
My query is this: I find it very uncomfortable to try to blow up a balloon. It’s hard to describe but it’s as if the back-pressure from the balloon causes some kind of problem for me. It’s not out and out pain—it’s more like I have trouble catching my breath. It takes me some time (30 minutes perhaps) before I feel that my breathing is normal again and its very unpleasant. I take regular exercise and even heavy exercise does not cause me any difficulty.
Any information at all would be very welcome.
A. Dear David,
Ability to blow up a balloon does not correlate well with your lung function. Get spirometry done for your own piece of mind, and have some one else blow up the balloons.
Seeing Improvement in Spirometry after Stopped Smoking
Q. So I’ve been off cigarettes for six months now and you were a great help in my quitting. Did it cold turkey.
I’d like to get another spirometry to see if my results have improved because my last one reported some indications of air trapping. Is it too soon to see some real improvements? If so, when is a good time to do it?
A. Dear Dave,
Now would be a good time. You may well see some improvement in air trapping.
6. Two Readers Wonder: How was Dr. Tom’s Pulmonary Hypertension Diagnosed and How He is Doing?
Q. 1. Would you mind saying more about your pulmonary hypertension treatment? How were you diagnosed? What treatments are you now using?
2. In one of your posts, you state that you have pulmonary hypertension. I do too. I’m curious what your experience with it has been, what treatments you are on and how you are doing?
Mrs. Harris & Krisite
A. Dear Mrs. Harris and Krisite,
My pulmonary hypertension was diagnosed in conjunction with four open-heart surgeries. I have taken inhaled medications, i.e. Ventavis and sildenafil with some improvement. My own case is pretty unique and complicated with non-smoking COPD.
What is the Pleura?
Q. What is the pleura and what is pleural thickening?
A. Dear Dorothy,
The pleura is the lining around the lungs. Thickening is often due to inflammation of this very delicate membrane.
Aspiration of Food
Q. I think I aspirated on a piece of chicken yesterday. I have COPD and am still short of breath. It feels like the food is lodged. I feel terrible. I am also light headed.
A. Dear Claudia,
You should be seen by a pulmonologist and possibly bronchoscopy if you are pretty sure of this aspiration.
Does Dog Hair Effect Emphysema?
Q. This may sound like a dumb question, but someone told me that dog hair affects emphysema? Is that true? I always thought that was true with asthma, but not emphysema. Thanks for your help!
A. Dear Judy,
Dog hair does not affect emphysema.
Idiopathic Pulmonary Fibrosis (IPF) or COPD or a Combination?
Q. Dr. Tom, First of all, can Idiopathic Pulmonary Fibrosis masquerade as COPD in the early stages? I was looking back at my PFT’s from 2007, and saw the same restrictive pattern they see on this study—the only ’difference’ is that the numbers dropped 50%.
FEV1 77% in 2006, 34% in 2008
TLC 73% in 07, 48% in 08,
FVC 75% ’07, 34% ‘08,
DLCO 75% ‘07, 22% ‘08
From what I remember, those are the figures that indicate restrictive pattern, right? I smoked for many years, so figure that COPD was diagnosis until the numbers plummeted. I also have had 20 ’pneumonias’ in four years, six within the last six months. I had radiation to my right breast (breast cancer 2001—and the pneumonias seem to like to attack that lung (right) more than the left).
I was told that essentially, the sharp decline from ‘07 to ‘08 was one clue that it was IPF. Does this sound like idiopathic pulmonary fibrosis? And can it have a COPD/emphysema component(s) to it?
A. Dear Gina,
Your rapid decline is more typical of IPF. Of course you have other reasons for fibrosis with the radiation and multiple pneumonias. You probably have features of both fibrosis and COPD.
Hepatitis C Treatment and Now Have Lung Problems
Q. For seven weeks, I was on pegylated Interferon and ribavirin for treatment hepatitis C. After one month, developed respiratory problems. Quit treatment at seven weeks. X-rays/CT Scans show no abnormalities, but they are calling it mild lung disease that may reverse or not.
It has been one month since I’ve been off Interferon. Oxygen levels had been dropping as low as 77% during activity, but now holding at 97%. Use some oxygen, Albuterol neubulizer, prednisone, Advair. Some days are ok, some days a struggle.
It is stated that I am fortunate that I was only seven weeks on, and that my oxygen levels are returning to normal—and no obvious signs on scan/x-rays.
A. Dear Benita,
Most powerful drugs such as interferon can cause pulmonary reactions. I am glad you can be off it now and that your oxygen levels are stable.
A Thought about Medications and Pulmonary Hypertension
Q. I was reading through your wonderful website and love the information that you provide. I got your link through the PH association website. I have been diagnosed with pulmonary hypertension (mild) and we are taking a “wait and see” approach since my symptoms are mild and only mild heart changes (some valve regurgitation, no enlargement) at this point.
I’m also a pharmacist and one question in particular stuck out to me. The one from Stephen who suffers from chronic throat clearing. I would ask him if he’s on an ACE inhibitor and for how long. It could possibly be the culprit with his chronic throat clearing. If the timing of starting an ACE-I and the emergence of his throat issue coincide, that could be the problem. He did say that he suffers from HTN and is medicated for it. Just a thought...
Again, thanks for the info.
A. Dear Cora,
Your thoughts are good ones. Lots of drugs cause pulmonary reactions. ACE inhibitors usually cause a hacking cough and not throat clearing, but anything can be related.
Aerosol Treatments via BiPAP
Q. I have a patient who is a CO2 retainer and request that her aerosol treatments are given through the BiPAP machine, I give her treatments on 8LPM. First question can 8LPM damage her lungs; and is it beneficial given the aerosol treatments via BiPAP?
A. Dear Selena,
The 8lpm of oxygen will not damage the lungs. I do not know of any special benefit of aerosols delivered by BiPAP. If the patient has chronic, compensated CO2 retention, this is not bad and is not a reason to use BiPAP.
Swimming with Oxygen
Q. I need suggestions for an O2 dependent patient who swims for exercise.
A. Dear Ginger,
Most patients can swim with their oxygen, attached to a long tube and the source of oxygen placed at poolside.
Short of Breath After Accident
Q. I was crushed between a 24 foot trailer and a loading dock. I had between nine and eleven broken ribs. I did not have internal damage except for an abrasion to the lung.
Now I am experiencing shortness of breath and having difficulty breathing. I cannot seem to take a deep breath. I had a CT Scan and there seems to be no obstructions. I never smoked and now I am told that this accident has nothing to do with what happened to me.
I am aghast that this could be so. I was crushed to six inches-the cushion that stops the truck, not only once, but twice.
I am thankful to be alive. Is Hyaline membrane disease a possibility? I am so tired all the time and easily get out of breath. How could this not be from the accident?
A. Dear Denise,
Sometimes severe chest wall injury results in shortness of breath, because of rearranging the geometry of the thorax.
This may sound mystic, but there are length and tension relationships that affect comfort in breathing. I do not believe you will have a residual of hyaline membrane disease, which gradually resolves, even in severe cases. I expect that as you exercise more, your breathing comfort will improve. I hope so.
Oxygen and COPD
Q. How many liters of oxygen must be given for a patient with COPD?
A. Dear Marie,
The usual liter flow for COPD is one to three liters per minute; more during exercise. Use of oxygen is best monitored by use of a pulse oximeter to be able to titrate the actual liter flow delivered under different conditions. There is no “must” flow rate.
Can Bronchitis Cause Scarring on Lungs
Q. My doctor said a slight scarring showed on my left lung. He said I shouldn’t worry too much, just get another x- ray in three months. Could the scaring be caused by several bouts with bronchitis?
A. Dear Arlene,
Yes, this is possible, but it usually is not extensive and does not progress. You can measure the amount of damage by spiromertry. Dr. Tom
Respiratory Therapists Respect and Pay
Q. Why is Respiratory Care one of the least respected and lowest paid health care providers? Something to do with leadership?
A. Dear Bill,
I do not agree with your premise that it carries low respect and pay. I believe the leadership of the field has been excellent in recent years. Dr. Tom
Q. Would you have a drawing or sketch of a modified BiPAP to trach circuit that you would approve?
A. Dear Omar,
I am sorry that I do not have such a sketch. Textbooks of respiratory care would have them.
Side-Effects of Spiriva
Q. Can Spirivia make my Parkinson’s and asthma symptoms worse?
A. Dear Oscar,
I have not knowledge that this is possible.
Questions about Mucomyst
Q. Can you mix Xopenex with Mucomyst? And, is it so that Mucomyst will be phased out due to the damage to the mucosa?
A. Dear William,
As far as I know, Xopenex can be mixed with Mucomyst. I do not have any information that Mucomyst is being phased out. It has been used for about 40 years.
Spiriva and Advance Stage COPD
Q. I have severe COPD. My last test showed I only have 13% of lung function left. I had to change doctor because of insurance. My new doctor has taken me off of Spiriva; says it’s a waste of money because it doesn’t do anything with that low of lung function. I’m really concerned about being taken off of it.
I’ve read so many good things about it. I know I need to trust my doctor but sometimes I feel like maybe he makes more from the HMO if he gives cheaper meds. I need to know one way or the other if Spiriva can still help me or not.
I know you are busy but I hope you can just say yes or no so I can do what my doctor says or insist on the right medications. Thank you for your time.
A. Dear Rita,
Spiriva helps many COPD patients, even with advanced disease. Why does your doctor think it is not helping? He may not be measuring the right thing. Get a doctor who will listen to you and explain what he is doing, and work on your behalf.
Usefulness of Air Filters
Q. What you think of Air Filters for the home? I would love to possibly buy one and put it right next to my bed at night, as it seems my condition worsens while I sleep due to my bouts of coughing and phlegm in the AM.
A. Dear Michele,
Other than the air filters that are used with the furnace and specific equipment such as oxygen concentrators, I do not think that general hope filters do much good or bad. They do use electricity, that adds to your energy bill.
Bronchoscopy Risk and Myasthenia Gravis
Q. Hi, I am coughing up blood. My question is do you think it is safe for someone with Myasthenia Gravis to undergo a bronchoscopy procedure?
A. Dear Jodie,
Yes, this is safe to do. Be sure your bronchoscopist knows about your myasthenia gravis, but there is no particular risk from a necessary bronchoscopy.
What Does Tuberculosis Do To the Lungs?
Q. I went to see a pulmonologist because in my past x-ray they found some cavities in the apical part of my lungs. My Dr. sent me for a CT Scan to see if I do not have Tuberculosis?
What really happens in the lungs when a person has TB?
A. Dear Elena,
There are many x-ray and CT manifestations of tuberculosis of the lungs. Cavities in the apices are one of the most common. You need your sputum tested for the presence of TB and TB like organisms.
Q. I recently had the acoustic ceilings removed in a house that was built in ’63. I’m a little concerned about possible asbestos exposure. What seemed to bother me the most was when they began patching the ceiling and sanding it. I tried to stay outside most of the time but was in the house periodically, possibly 20 minutes exposure.
Afterwards I noticed I had a sore throat and slight congestion in my chest. Do I now have irreversible lung damage from this one-time exposure or will the congestion get better over time? I’m concerned I may have permanently damaged my lungs. I have asthma also and am hoping I’m just having a bad reaction to it. It’s only been three days since it happened. Please advise.
A. Dear Donna,
Even if you had a short, one time exposure to asbestos, it is highly unlikely that it did any permanent harm.
Getting Rid of Calcifications in the Lungs
Q. I need to get rid of calcifications in my lungs, calcifications in the lungs means that medically unfit to work overseas. Are there any treatments available to get rid of it?
My doctor says that I don’t need to worry about it since there are only few calcifications in the upper left lung.
A. Dear Dipendra,
There is no treatment to remove calcifications from the lungs, and no reason to be concerned about their presence. They will not interfere with your ability to lead a normal life including working overseas.
Having Hard Time Breathing and No Answers
Q. I am having a great deal of difficulty breathing especially on my right side. I am losing weight, three CT scans are clear, chest x-ray are clear. I have seen two respirologist who said it is not my lungs. Here are my latest results: I am 112 pounds at 5’8.
FVC pred 3.65, measure d4.00 % pred 110%
FEBV1 3.16, measured 2.91 at 92% predicted
FEV1/FVC 87 predicted and measured 73
SAT O2 is 98%
I am having such difficulty breathing with severe back pain and lying down the breathing is worse. Respirologist will no longer see me as they say my lungs are fine but yet I cannot breathe. Cardiologist also dismissed me. Your guidance is crucial.
A. Dear Nitsa,
I have no idea why you are having such symptoms. You will have to find another doctor to try to explain things.
Is Treatment Used in 70’s Still Done Today?
Q. In the late 1970’s I took my mother, age 68, to Chicago to a doctor who cut into my mothers Vagus nerve to treat her Emphysema. She felt a big rush of air into her lungs. It was done in a hospital and under a local.
The doctor had her stay in the Chicago area about 10 days. When she went home she walked all the way through the airport and wanted to go roller-skating. Is this surgery still being done.
A. Dear Larry,
No, and I have no reason to believe that it explains why your mother had such a great improvement.
Does Scarring from Chemotherapy Go Away?
Q. Hi! Dr. Tom, I am six months in remission for Hodgkin’s Lymphoma (YEAH!!). Bleomycin was one of four chemotherapy drugs I had; it was stopped after only a few treatments due to shortness of breath and PFT changes.
My PET scan shows lung scarring, and I still experience some shortness of breath.
Does scarring go away with time?
A. Dear Jeannie,
The scarring will not go away. You should avoid taking any oxygen in the future, in view of the fact that you had Bleomycin in the past. Your oncologists will understand this caution.