Worried about Father’s Multiple Health Problems
Q. My Father is 67 years old. He had been a smoker from the age of 20 to the age of 60. Now, he is in the bed and needs oxygen at every interval of one hour. He is diabetic and asthmatic.
We got his lung test done a year back. Report says the lungs have the efficiency of only 40%. What does this mean for him? Pease advise. It would be the great help.
A. Dear Deepak,
This means he has a moderate degree of airflow obstruction, probably from smoking. He can still have many good years ahead.
Antidepressants and Scuba Diving Pressures and Decompression
Q. I am on Cymbalta for depression and have recently heard that diving on certain meds like these can cause serious pressure and decompression issues... Is this true and is Cymbalta on of these meds I cannot dive on?
A. Dear Thea,
I have no reason to believe that this drug will have anything to do with decompression issues.
Singulair and FEV1
Q. I am 46 year old non-smoker, hockey player, golfer, and I workout three times a week. At my workplace, we have had breathing tests administered since 2000. My FVC was in the 90's but my FEV1 has steadily declined from 76 tops down to my latest test of 69. The report said I had “minimal obstruction at this time”.
The woman said the FEV1 number was the elasticity of my lungs. The testers sent me a letter saying I should consult my doctor immediately for further testing as my numbers were low for my age bracket.
My doctor recommended I take Singulair for the next two months to see if my results get better chest x-rays were clear and lungs sounded good. Any feed back on the Singulair or the numbers from the tests.
A. Dear Brian,
If the slight reduction of airflow is from mild asthma, Singulair may improve airflow and symptoms related to exercise. Dr. Tom
Should I See a Lung Specialist?
Q. I am 55 years old and I quit smoking about 30 years ago. I have worked in a nail salon with strong chemicals such as methalacrylics and polymers and molymers.
I have had tightness and shortness of breath for a while and it seems to get worse. My x-ray just came back suggesting COPD. The doctor said I don't need anything for it yet. Do you think I need to go to a lung specialist?
A. Dear Vickie,
This would be a good idea. Get your spirometry done to see what your lung function is when you see the expert.
Questions about Pleuris
Q. I seem to get pleurisy every time I get flu, three times in the last year and a half. I never used to get this before. Is there a need for concern and what can I do to stop getting pleurisy?
A. Dear Rozanne,
Pleurisy is common with lung infections of all sorts. But you should be checked by a pulmonologist to try to determine the reason for the frequent chest infections.
Can’t Tolerate Paint Smells
Q. I am an artist and use a mask and/or nose plugs because I can't tolerate the smell of paints. Because the mask and nose plug interfere with normal breathing I was wondering if a CPAP machine would be useful as a sufficient deterrent to paint smells while simultaneously allowing natural breathing.
A. Dear Harry,
CPAP is not natural breathing. I doubt if it will help your symptoms.
Recurrent Pseudomonas Infections
Q. I am a 28 year-old woman and at the moment I am off work due to getting recurrent pseudomonas infections in my sinus; I am waiting to see if I have cystic fibrosis.
I work in a supermarket and was wondering could that make my condition worse if I have cystic fibrosis. Would I be better off being in an office than an air conditioned supermarket where I am likely to pick up lots of bugs.
A. Dear Emma,
I do not believe a supermarket is a serious source of your pseudomonas infections. Checking for cystic fibrosis is a good idea.
Is it Safe to Vicks Vapor Rug While Using Oxygen?
Q. My mother has a cold and has always used Vicks Vapor rub, but now she uses oxygen two liters at night. Is it safe to use oxygen and Vicks together?
A. Dear Emma,
No! Vicks is petroleum based and should not be used with oxygen. The fire hazard is high.
Best Diet for Those With Lung Disease
Q.My sister has lung problems; her lungs have water in them and are they are getting smaller. What’s the best food for her to eat? I will look forward to your answer.
A. Dear Aiko,
She should learn to read labels and avoid salt as much as possible. All non-salted foods are fine.
Asthma and Wheezing
Q. What makes an asthmatic wheeze?
A. Dear Serge,
Narrowing of the air passages with bronchospasm, inflammation and mucus.
Bullous Lung Disease and Treatment
Q. Can you tell me what is bullous disease and what if anything can be done about it?
A. Dear Donna,
Bullous disease of the lungs, usually refers to localized areas of abnormal lung development or damage in the extreme upper parts of the lung. It is not usually related to diffuse emphysema, absent smoking.
It requires no treatment unless the area of damage is large, in which case surgery can be used to remove the nonfunctioning part of the lung making more space for the remainder of the undamaged lungs to use.
Worried about Pulmonary Hypertension
Q. I have had shortness of breath since about April; initially was really bad and now is much better, but still have it every day.
Chest x-ray, chest CT scan, pulmonary function test, methacholine challenge test, stress echocardiogram and echocardiogram all normal, with the exception of pulmonary artery pressure of 35 (which cardiologist read as high normal).
I am scared to pieces that this is pulmonary artery hypertension and am scheduled for another echocardiogram in one week for comparison of pulmonary artery pressure.
Pulmonologist said that if it was 35 again, then no further testing was needed, but if high, then a cardiac catheterization. I can't get over the worry that it might be pulmonary artery hypertension.
Appreciate your thoughts, as I understand you, too, have pulmonary artery hypertension.
A. Dear Lisa,
These are not very high levels of pulmonary pressures, but they are hard to estimate. An exercise study will tell whether these pressures increase with exercise. You are wise to pursue this.
Q.I have Ehlers-Danlos Type III (A heritable disorder of connective tissue with easy bruising, joint hypermobility (loose joints), skin laxity, and weakness of tissues). I have had two PFT tests one in 2005 and one 10 days ago. I was sent to have the test because of shortness of breath and fatigue.
Everything is fine except the diffusing capacity, which is considered mildly reduced. In 2005 it was at 78% and now three years latter 75%. The rest of the test is all close to 100% normal. My doctor does not think this is a significant finding. Do some people just have a low DLCO?
A. Dear Peggy,
Yes, and some patients with ED syndrome have reduced DLCO.
Does this Sound Like a Respiratory Problem
Q. Hello, I am an 18 year old suffering from occasional (once every couple days) spots of becoming extremely short of breath accompanied by quick, sharp pains in my upper chest. I've been to doctors (not specialists), and they've all said the same thing: I have some sort of inflammation and stress is partly to blame.
I've been prescribed Ibuprofen in various mediums, and have taken as prescribed, but I still get these attacks.
I'm pretty certain I have to see some sort of a specialist, but I don't even know where to begin. Does this sound like a respiratory problem? Any suggestions would be greatly appreciated.
A. Dear Lauren,
This may be a respiratory problem, or a musculoskeletal syndrome. I think it is a good idea to see a pulmonologist for a diagnosis and treatment.
What are the Important Spirometry Numbers?
Q. My husband has been diagnosed with asbestosis, COPD and other lung problems. He has had three spirometry tests in the last year or so.
We do not how to interpret the results to determine how much his lung capacity has diminished since the first test. Can you tell me what to look for on the tests?
A. Dear Cindy,
The important spirometry numbers to remember are:
FVC: Forced Vital Capacity, measures the total volume of air you can forcefully blow out.
FEV1: Forced Expiratory Volume in One-Second, measures the flow of air that you can blow out in the first second of exhalation. Typically FEV1 is considered “normal” if greater than 80% of predicted. FEV1 is reduced in both obstructive and restrictive lung disease.
Also the FEV1/FVC ratio is important.
Normal FEV1/FVC is >70%.
Lower than this means airflow obstruction. In those with severe obstructive airway disease, the FEV1/FVC can be as low as 40-50%.
Much higher, i.e. > 80%, suggests lung restriction from scarring processes.
Past Pneumothoraces, will High Altitude increase Risk
Q. In 1993 I had three spontaneous pneumothorax. At that time a bleb was discovered and I had a pleurodesis. I have not experienced any difficulty in the 15 years following the surgery.
I am planning a trip to Yellowstone National Park where the altitude reaches 8700 feet. Will this high altitude pose a risk?
A. Dear Connie,
The risk will be very small, particularly since you have not had a reoccurrence for 15 years following a pleurodesis. Enjoy the high altitude flowers!
Can Pneumonia Cause Lung Scarring?
Q. My mum was born in 1932 and when she was 18 had pneumonia and was told she had a scarred lung, She was prone to winter colds and flu and had breathing problems which she treated with OTC tablets but was ill one night and was diagnosed with asthma.
Within about four years her condition worsened and tests revealed emphysema she died at age 57 from this and cor pulmonale. Is there a link between her pneumonia damaging a lung and her history of respiratory problems?
A. Dear Beverley,
Yes, this is all possible. You did not tell me about smoking, which, if she did, could have been a major part of the problem. Most emphysema and cor pulmonale occurs in smoking, but it can result from repeated chest infections and scarring. Dr. Tom
Q. In 2006 I was diagnosed with ARDS and was put on a ventilator and also had a tracheotomy and was in intensive care for four weeks. I have since recovered quite well.
I am very concerned as of late as every time I sneeze I feel a flutter in my right lung, Even though its brief it concerns me as when I was recuperating in hospital I remember the same sensation in my lung, but more stronger then. I am well in all other aspects, no flu, fever or cough and have some chest pain that radiates to my back and that’s all.
Please do you have any ideas what this flutter could be only when I sneeze.
A. Dear Annemarie,
It is possible that you still have some small air leak of your lungs that becomes evident during the high lung pressures that occur with sneezing. A chest x-ray taken during the act of breathing out, could show this at a time that you feel the fluttering. If it is a small leak, which is common in early stages of ARDS recovery, it will heal spontaneously and in that case the symptoms will be gone.
Thus I suggest waiting a month or two before investing this non-risky possibility.
Mucus that is Hard to Cough Up
Q.I am 46 years old and have seasonal upper respiratory illness (asthma/bronchitis?) and find that I am retaining too much CO2 and not breathing in enough O2. I have a lot of mucous that builds up in my chest area and is hard to cough up.
My health care provider told me I needed to learn to relax and start breathing normal. He told me to do the old bag “trick”; covering my nose and mouth with a paper bag to get to normal breathing. He prescribed Mucinex, and prednisone.
Do I just need time for the meds to work so that I won't feel like I'm still retaining too much CO2 and not breathing in enough O2?
A. Dear Donald,
Breathing in and out of a bag will raise the CO2. Are you sure your CO2 is elevated. Was blood measured? Mucinex and predinsone may help thin the mucus.
Removing Bird Dander from House
Q. I am trying to remove bird dander from my parent’s house before my dad (with respiratory problems) gets out of the hospital (the birds will be leaving too).
Do you have any idea of the actual size of bird dander particles? I know that HEPA filters catch particles as small as 0.3 microns, but I am wondering if bird dander is actually that small. I am thinking of using a shop air cleaner that moves a lot of air very quickly (so good for cleanup) but only catches particles as small as 5 microns.
I've been trying to find out and the only web site I've found says bird dander is between 12-100 microns. If you know anything about this, I'd appreciate your advice.
A. Dear Kathleen,
I do not know any more than you have been able to find out on the size of bird dander particles. I would guess they would not be smaller than 5 microns, which is quite small. You might ask a veterinarian.
Pneumonitis, both and Atheromatous Aorta
Q. Dr. Tom my friend has been diagnosed with pneumonitis, both and atheromatous aorta? What does this means?
A. Dear Jonah,
These are not related. Pneumonitis means an irritation of the lungs, and atheromatous aorta means cholesterol deposits in the main artery coming out of the heart.
Q. What does a FEV1 reading of 67% mean?
A. Dear Charlotte,
It could be 67% of normal for your age sex and height, or 67% of the FVC. Normally the FEV1 is greater than 70% of the FVC.
Q. I am 28 years old and quit smoking in January, I had two relapses, each for about two weeks. During my last relapse I started feeling like I could not get a deep breath like normal. I did find a term that I feel describes it better, air hunger. I'm not coughing or wheezing with this. It has been a month and a half and it's still going on.
I've had a clear chest x-ray, normal breathing test and been to a cardiologist and that was normal. Anyway, didn't know what direction to go now.
A. Dear Courtney,
Sounds like you are pretty healthy. I suggest getting more exercise and see if this reduces the uncomfortable sensation of air hunger.
Q. I have purchased a salt pipe. Can this help to alleviate my asthma symptoms? I have also decided to become a nonsmoker and am having sessions with a hypnotherapist to reduce my anxiety, which I have discovered can bring on an attack.
A. Dear Elaine,
I have no idea what a salt pipe is or does. Hypnosis may help you stop smoking.
How to Find a Good Pulmonologist
Q. I am looking for a pulmonologist who specializes in MAC infection (Mycobacterium Avium Complex is a serious bacterial infection) in northern Virginia or the Washington DC area. Can you recommend one, or tell me how to find one? Gene
A. Dear Gene,
I would try to get advice or see, Dr. Alpha A. Fowler, of the Medical College of Virginia in Richmond. He will know about MAC, or get you in contact with one of the few experts in this difficult infection.
Lung Calcification and Pain
Q. I have been told I have had histoplasmosis and have calcifications and nodules in both lungs. Can it cause pain years later?
A. Dear Peggy,
No, these multiple small, healed, areas do not cause pain.
Blood Pressure Medication and COPD
Q. Have recently developed high blood pressure. Have tried many blood pressure medications and everything makes me short breath and wheeze. Do you know of any blood pressure medications that COPD patients can take without these side effects?
A. Dear Gwyn,
COPD patients can take most medications for hypertension. The diuretics are well tolerated. However, the so-called ACE inhibitors can cause cough, but there are alternatives.
Shortness of Breath
Q. I am 33 weeks pregnant and I have been having a lot of shortness of breath and when I woke up this morning I had blood clots in my mouth, so do having shortness of breath have anything to do with waking up with blood clots in mouth?
A. Dear Jennifer,
Possibly. This needs to be investigated. I cannot guess where the blood is coming from.
Could Exposure to Drywall Dust Cause Asthma?
Q. I'm a 37 year-old male who was exposed (in my 20’s for a few years) to quite a bit of drywall dust due to an unfinished renovation in the condo where I grew up. There was quite a of dust in that part of the condo, and my parents were not good at cleaning up the mess.
Anyhow, for the last few years I've developed asthma and bronchitis, and am usually wheezing. My onset of asthma also was precipitated by a LOT of sneezing, which makes me think allergies came first.
It’s been a year and I've had chronic green phlegm from my sinuses and chest, and get short of breathe easily when I exercise. I few years ago I came down with pneumonia and the doctor asked me if i was exposed to a lot of dust at any point, so he must have seen something (I think I remember him saying I had “markings”).
I’m worried. Any chance I have permanent lung damage from the dust? Any chance of something more serious, like cancer?
A. Dear JW,
The dust could have precipitated asthma. You are not dealing with cancer.
Wheezing at Night
Q. I can not stop wheezing at night, its preventing me getting my eight hours sleep, I'm 18 and I've smoked ten cigarettes a day for about two years now. I'm going to stop as soon as possible.
It’s not just wheezing that's bothering me; I also get a very tight chest too. These things happen every night about five minutes after getting into bed. Its getting very distressing for me as I can't even cough loud because of my parents always shout at me and blame smoking but I'm not sure it is this. I am always sneezing around my family cat could the cat be the problem?
It would be great when I can breathe properly at night.
A. Dear Robert,
You are probably dealing with asthma. Stop smoking and get rid of the cat.
Shortness of Breath Feeling and Normal Oximetry Reading
Q. I am a male in my mid 30’s who recently quit smoking. I am over weight (265, but have lost 85 pounds in a year). I also have severe GERD that is not easily controlled medication.
I have been having shortness of breath issues with normal pulse oximetry readings. My doctor had me do a cardiac stress test, which was normal. I can do strenuous exercise (i.e. cardio machines) for at least 30 minutes.
My question to you is what could cause the shortness of breath feeling I get when sitting around--My doctor thinks it’s just anxiety brought on by GERD--digestive issues etc--what do you think?
A. Dear Mr. X,
It is probably your weight deconditioning that explains your shortness of breath.
Questions about a Collapsed Lung
Q. My tall, thin 19-year-old grandson has just had surgery to abrade his chest wall after experiencing a second spontaneous collapse of his left lung in less than 9 months. There were no blebs or other abnormalities found, but a day or two after the surgery, a 10% collapse of the right lung has occurred. How common is this and what is the likely prognosis & probability of further recurrences?
A. Dear NM,
This is fairly common in tall thin people. You are wise to have abrasion procedures on both sides. His prognosis is good.
Recommended Follow-UP for Lung Scarring
Q. My father's doctor found scarring on one of his lungs in a CT scan. The doctor said that it was due to his past smoking. As far as I know my father has not smoked in over 20 years. However, my father has worked in asbestos over the years before it was known to be dangerous, but again it has been 20 years ago. He is a retired contractor.
My question is, why is the doctor waiting six months to do another CT scan. I thought three months was the normal wait time (mother has had cancer twice and that is the time limit she always waited for follow-up). My Father's Father died from lung cancer because of smoking and his Mother died young from heart disease.
I would think that he would have to go back sooner for a follow-up because he is a high risk? Should he demand to go earlier?
A. Dear Sandy,
I agree that the follow-up should be sooner rather than later.
Climate Effect on Pulmonary Fibrosis
Q. My mother (age 83) received a diagnosis of pulmonary fibrosis about three years ago. She is on the standard treatment of daily prednisone and oxygen when needed.
We live in upstate NY her doctor has recommended that she move to a dryer climate like Arizona especially in the winter. We have no family or friends in that area and my mother was not very open to this idea. My parents have lived in their town for over 60 years.
My father is concerned that we do everything possible to make her comfortable. My question is what are the advantages if she were to move to this dryer climate. At her last check up she was told that the disease has not gotten worse.
A. Dear W,
There are no advantages to a climate change for your mother, and all of the disadvantages of moving. Stay put.
Oxygen Saturation Drops During Sleep
Q. I have been treated for apnea, but my doctor at sleep center says that episodes are not bad, but that during sleep my oxygen drops to 82% and she is not sure why.
I smoked for three years 10 years ago. I take Depakote and am seeing a lung doctor soon. Is it possible that the smoking or the Depakote (2500 mg day) is making it hard for my lungs to process the oxygen?
A. Dear Mark,
I doubt that either is involved in your sleep apnea, which explains the drop in oxygen.
Skin Breakdown and ET-Tubes
Q. How often should an E-T Tube be rotated to minimize tissue break down around the lips?
A. Dear Will,
Usually these tubes are replaced once a week, or oftener if there is irritation.
Will Repeated Pneumothoraces End My Scuba Diving
Q. I am a 31 year-old man in pretty good health. I am 5'11, 185 lbs and somewhat active.
When I was 19 and a sophomore in college, I had two episodes of a spontaneous pneumothorax about a month and a half apart. The first time, I spent a week in the hospital and the problem "corrected" itself. The second time, the lung (left again) collapsed and I spent almost a month in the Pittsburgh hospital with two surgeries to repair the lung. I have had NO problems or complications in the past 12 years.
I am interested in taking a scuba diving course to become certified, and eventually becoming active in scuba diving. Is it a problem to start or participate in scuba diving? I look forward to your response!
A. Dear Tony,
I doubt if you will have any problem, but approach scuba diving cautiously.
Q. My diaphragms are paralyzed. As long as I am standing straight up or sitting straight up my diaphragms work. I do get a lot of gas but I am able to breath. The minute I lay back my lungs collapse. I am unable to sit in a chair that leans back or go into a swimming pool above my stomach.
I spent 11 days in Memorial Hosp. in Jacksonville Florida. I was seen by at least six specialists including a neurologist. No one can tell me anything. Yet the condition exists and I have nowhere to go with it to see if it can be corrected. Do you have any ideas, please!
A. Dear Mike,
Sometimes this improves with time. It may take months to recover diaphragm function, but it has happened in cases like yours.
Stop Taking Medication
Q. I was diagnosed with Chronic Bronchitis and been treated for several months with Pulmicort, Spiriva, Singular & Flonase.
Can I abruptly stop taking the Pulmicort and/or Spiriva?
A. Dear Dallas,
Yes you can.
Worried about Chronic Cough and Spirometry Results
Q. I am a 29 year-old female, healthy weight and have never smoked. I have had a chronic cough for about three years, in April my cough got worse and I could feel a rattle in one lung and I was diagnosed via x-ray as having a mild pneumonia in the middle and bottom of my left lung. After oral antibiotics for a week, the cough went back to the same mild one it had been for a few years. Follow-up x-ray in August showed clear lungs
I had a spirometry test done earlier this month and these were the results before taking Ventolin: FEV1 106%, FVC 98%, FEV1/FVC 90%, PEF 117% FEF 25-75 106%, RV/TLC 29. They said they would send a report straight to my doctor, are these results bad?
I still have a rattle in one lung, especially when lying down and still cough up clear mucous, why could this be? I have an appt with a lung specialist next month, should I be worried about cancer?
A. Dear Sharee,
Your lung function is normal. No special concerns about cancer. Keep your appointment with the pulmonologist.
Can Plaquenil Damage Lungs
Q. I am 44 and have an unknown underlying autoimmune disorder (very positive ANA - SSA and SSB). I took Plaquenil (a medication to treat malaria and symptoms of rheumatoid arthritis and discoid or systemic lupus erythematosus) for one year twice a day and then stopped per new Rheumatologist's instruction and I restarted, per doctors instruction, for one week and then became very short of breath - it got worse and worse and I am trying several inhalers, seeing an allergist, going for pulmonary function tests.
Is it possible the Plaquenil caused lung damage? I had always been mildly short of breath but never to this extent and it came on so suddenly. Perplexed if it can just be asthma showing up at 44.
A. Dear Mary,
Yes, Plaquenil can cause lung damage. It may be reversible. I would follow the instructions of your rheumatologist.
Recovering from a Pneumothrax and I am Short of Breath
Q. I am 33 year-old female suffering with SOB. I had a pneumothorax four weeks ago and find myself getting out of breath walking up the stairs or leaning over the bath such a chore; my heart races so fast, even resting it races away.
I am an ex smoker who packed up only three weeks ago but have smoked 20 a day for 20 years, what do you think is possibly wrong with me.
A. Dear Amie,
It may be that your pneumothorax has not resolved. See a pulmonologist.
Blood clots in Lungs
Q. I had multiple blood clots in my lungs (three in one side two in the other) about five years ago.
They found no reason as to why I even had the to begin with. What are my chances of them coming back? Are my lungs permanently damaged from this?
A. Dear Sarah,
You should be checked for an abnormality in your clotting mechanism. It is possible for clots to return and they can damage your lungs.
Trouble with CPAP Machine
Q. I went on a CPAP machine in early August. All was great for two weeks until I woke up with severe chest pain and shortness of breath.
I went to the emergency room where they did an EKG, lung x-ray, chest CT-scan, blood tests, etc. and found nothing wrong. (I had also just had a stress test a couple of weeks before and passed with flying colors).
They said it could be pericarditis, but didn't know. Ever since then the pain has subsided, but I'm still short of breath and having anxiety attacks. I have found that breathing into a paper bag helps (resets my CO2 levels?). My sleep doc says she's never heard of this before. Today my lungs hurt, especially when I breathe in. I definitely believe the CPAP machine is the root of all this. Can you offer any info?
A. Dear Michele,
I cannot relate your symptoms to your CPAP. There are many possibilities.
Long Term Antibiotic Therapy in COPD Patients
Q. What are the advantages of long-term doxycycline in COPD?
A. Dear Ken,
This is under study now. The use may prevent the decline in lung function.
Q. I have asthma and I also have a paralyzed right vocal cord and paralyzed right diaphragm.
Peak flow is about 200.
FVC 66 %
They have me using a BiPAP machine to try to stretch the lungs. I have seen no improvement after a month. Will long-term usage of the BiPAP help?
A. Dear Olive,
Probably not. What is the cause of the paralyzed vocal cord and diaphragm?
Do Respiratory Therapist Handle Blood/?
Q. I'm looking into a career as a respiratory therapist and was wondering if they have to handle blood? If so, how much?
A. Dear Mercedes,
Yes, if they do samples of blood gases. There is exposure to blood in the ICU when patients are receiving mechanical ventilation.