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Archive: Dr. Tom 140

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

Can One Time Exposure of Asbestos Damage Lungs?

Q. At work the other day we had to take two ceiling tiles out and there was dust everywhere even the corridor was dusty. I was only in there about ten minutes. Anyway I’ve since found out they had asbestos in them.

Since then I’ve had a sore throat and chest. My work mates say it’s nothing to worry about as you have to be exposed to it over a long period of time to do any damage. Do you think I could have damaged my lungs with this one time exposure?

Robbie

A. Dear Robbie,

It is highly unlikely that this short exposure damaged your lungs. You are wise to ask.

Dr. Tom

What Does My Spirometry Mean?

Q. My spirometry says

FVC 85%
DLCO 50%
DLCO/70%
FEV1/FVC 85%

Is it normal?

Raffaele

A. Dear Raffaele,

Not normal, but pretty good in general. You will have to ask your doctor about the specifics. These numbers do not make a diagnosis.

Dr. Tom

I Faint when Doing Spirometry

Q. If you recall I am the gentleman who has trouble taking a spirometry test because I faint. When I asked you about this you said that even if you could give one good blow, it is impossible to blow a false number. So I had my test a few days ago. My specialist is Dr. Robert Hyland from St. Michaels hospital here in Toronto.

I gave one good blow, and my FEV 1 was 48% of predicted. The last test I had was about a year ago and my FEV1 was 38%. Now, I have COPD with a fair component of asthma, and I have been going to the gym every day, and working out for 30 minutes. I attribute my improvement in my FEV1 to the exercise program that I have been doing from Westpark Hospital.

The interesting thing is I took four puffs of Ventolin post test and rested for ten minutes, and then repeated the test. The results were worse, as I could feel myself getting very lightheaded, so I did not give a good max effort.

Could you explain, Dr Tom, why I faint when exhaling hard? It seems to happen every time. Otherwise, I am in good health, with no problems.

Phil

A. Dear Phil,

You reduce the return of blood to your heart by generating high pressures in your chest when you really blow hard. This is not indicative of any serious disease.

Dr. Tom

How do you Relieve Dryness from Oxygen

Q. How do you relive dry O2 that my mom is on continuously? She has water hooked up to it but still suffers from dry nasal passages.

Marilyn

A. Dear Marilyn,

You can use non-greasy lubricants such as KY jelly.

Dr. Tom

Father-In-Law has Been on a Ventilator for Twelve Weeks

Q. My father-in-law is stuck in the hospital in Florida (we all live in Washington State) on a ventilator for COPD and/or emphysema. My wife keeps flying down to be with him and as it has now been about 12 weeks, we are wondering if he is ever going to get better.

He has had a trach put in, but is pretty much in bed, as they seem to be limiting their help to “maintaining” him. They have tried to “dial him down” and get him breathing on his own, but it just does not seem to be working.

When she is with him, he does much better and shows improvement. Unfortunately, we have jobs and she can only get down there for a few days a month. The rest of the time they seem to try half-heartedly and keep him medicated for the most part.

Part of the problem, in my opinion, is his lack of insurance although she was able to get him on Medicaid. I know she has been trying to get him Medicare, VA benefits, etc., but is just really getting anywhere.

He is only 61 and is fairly strong other than the fact that his lungs are failing. Does anyone know of an organization that can help us determine what other options are available to us (lung transplant, transfer to a rehabilitation center closer to us, etc.)?

We are not ready to give up on him, nor does he wish the same. Any thoughts would be much appreciated.

J.

A. Dear J.,

There are facilities for weaning such patients such as the Kindred Hospital chain.

Using medications for shortness of breath or anxiety may work against weaning. Most patients, such as your father, can be weaned by experienced staff. Never give up.

Dr. Tom

No Improvement in Spirometry after Several Months of Prednisone

Q. I'm a 32-year-old female with mild asthma. Over the past couple of months I began treating my asthma with a daily inhaled steroid (Pulmicort) in the hopes that I would improve my spirometry tests. I also took an initial dose of prednisone as my pulmonologist wanted to clear out the existing inflammation.

Two months and three spirometries later, there has been no improvement. My FVC has improved but my FEV1 remains around 2.3 to 2.5 (79%), and on certain tests actually got slightly worse.

What could be going on? Should I be concerned there's been some airway remodeling or something of that nature?

FYI, I have scoliosis, corrected with a rod, and a couple of my doctors believe that might be impeding me from fully using my lungs. I appreciate any insight you might have.

Andrea

A. Dear Andrea,

Your functions are pretty good. The rod can be playing a role. You may have some airway remodeling, but not bad. I would not continue to take oral prednisone.

Dr. Tom

Newspaper Headline Seems Misleading

Q. Dr. Tom, The newspaper reported a brief article titled “Studies show steroids don’t help wheezing kids”. The New England Journal of Medicine was the reference. The study was not about inhaled corticosteroids but oral prednisone. Do you agree this was a misleading headline relating to treatment of childhood asthma?

An asthma educator

A. Dear Patricia,

The headline is misleading.

Dr. Tom

Can’t Seem to Beat Bronchitis

Q. I was diagnosed with sleep apnea and pulmonary hypertension about nine months ago. I use a Bi-PAP and oxygen machine at night. I have been fighting bronchitis since the first of November and gone through three rounds of antibiotics, however I continue to have a tight chest and am coughing up dark green phlegm, usually in the morning. I am concerned that this does not seem to be resolving itself.

I have replaced all replaceable oxygen equipment and I soak mask and humidifier in water with vinegar. Is there anything that you can suggest that may be causing this, and anything extra that I may do to help this situation?

Linda

A. Dear Linda,

You are doing all the right things. I doubt if your equipment is the cause of the problem. You should get more specific advice for your case from your doctor.

Dr. Tom

Could ‘Ugly Cough’ and Thick Phlegm be Caused by Dust I Inhaled in Iraq?

Q. Lately I have had a very ugly cough. By ugly I mean the sound it makes when it happens. Also the phlegm I produce is so thick sometimes I feel as if I am going to choke. I do not have a cold, and I am not a smoker.

I recently came back from Iraq, could the cause be the accumulation of sand from the desert in my lungs or something more serious?

Hector

A. Dear Hector,

I doubt if your problem is caused by the sand dust. I suggest seeing a pulmonologist.

Dr. Tom

Can you Give Xopenex and Mucomyst Together

Q. Can I mix Xopenex and Mucomyst together or do I need to give them separately? Also, what can you tell me about Pulmozyme treatments?

Louie

A. Dear Louie,

As far as I know these drugs are compatible and can be used together. I do not know anything much about Pulmozyme.

Dr. Tom

Dealing with Symptoms of Upper Respiratory Infection

Q. I have been battling upper respiratory infection (excess sputum production during the day and massive collection in my throat early in the morning before rising from the bed) sharp pain in the left side which refers to the back and spread to the shoulder blade causing pain. Now I tend to have tightness in the breathing pipe quite frequently. Being in a cold place triggers stabbing pain and phlegm.

What can I do and should not do?

Help is needed.

Amanda

A. Dear Amanda,

You should see a pulmonologist for a diagnosis and treatment. You should NOT procrastinate.

Dr. Tom

Questions about Symbicort

Q. I have been diagnosed with mild to moderate asthma about four months ago and was prescribed Symbicort. I was told by the doctor to take two puffs twice daily.

I am a teacher and found that the dose made me really irritable towards my students and I had trouble sleeping at night. Therefore, I reduced my dose to two puffs in the morning so that it would be out of my system at night so I could sleep.

Then after I went to the lung association, I realized that I should take it every 12 hours. So I started taking it two times a day again, two puffs in the am and two puffs in the pm. Once again, I had the same symptoms as before and I was feeling depressed. So I switched to one puff in the am and one puff in the pm.

Now I have a lung infection; not sure what it is but it feels like it's deep in my chest. I haven't had one in years. I feel like this has been brought on by Symbicort and I am wondering if I should be taking this medication while I feel like it has caused my chest infection?

Is it OK to just stop the medication or should I continue on it? Is there any other medication I should try? I've never taken an inhaler before. Thank you and I hope to hear from you soon.

Colleen

A. Dear Collen,

The Symbicort did not cause a chest infection. You can take it once a day if it agrees with you. You should see a pulmonologist for further evaluation.

Dr. Tom

What Affects Life Expectancy for Those with COPD?

Q. I am a 51-year-old male ex-smoker (by two days) with COPD diagnosed about three years ago. My symptoms have been bad enough over the last three years to warrant regular JetNeb and inhaler use. I often have bronchitis and am able to spit up very little mucus. Is it possible to guess at a life expectancy for me?

Dee

A. Dear Dee,

This is very difficult to make accurate predictions about prognosis. You should live into your 70s if you take care of yourself.

Dr. Tom

Avoiding Lung Infections and COPD

Q. My wife has COPD resulting in chronic breathing issues. Doctors have kept her using an antibiotic of some type or another for 20 years, and always say this is scaring your lungs and you need to avoid getting these infections.

Seems the infections are worse in winter. So are there any areas in the U.S. that would let her get through the winter with out so much difficulty? Would a southern humidity be worse?

I cannot seem to get an answer from the people she sees.

Lee

A. Dear Lee,

There is no perfect place to live. Warm dry places are usually best.

Dr. Tom

Trying to Figure Out Why Son is Short of Breath

Q. My son is 23. For five months now he has had bouts of extreme shortness of breath. Everyday he is mildly short of breath and yawns a lot to receive air. Does not wheeze. Denies stress.

He has been to a general practitioner and pulmonary doctor. Had ECG, CT Scan of chest, pulmonary function pre and post medication. All tests came back negative. Doctors presume it is anxiety.

This man is outgoing, works, attends school and has a girlfriend. He is happy not at all stressed.

Could you recommend another test or what step should I go to next. He now is wearing a 24-hour Holter heart monitor.

Marilyn

A. Dear Marilyn,

He needs a diagnosis. There are some rare things; he could have such as pulmonary hypertension. I suggest seeing a cardiologist.

Dr. Tom

Chronically Bringing Up Phlegm

Q. My husband has been bringing up phlegm for approx eight months. It has gotten to the point he throws up all the time. The color is yellow and green. What can we do to?

Mary

A. Dear Mary,

You do not give me enough information to make a suggestion. Obviously you need a diagnosis. I suggest a pulmonologist.

Dr. Tom

Mother has COPD and MRSA, How Can I Help Her?

Q. My mother is 73, has a pacemaker (100% pace maker dependant) and has COPD. Her pulmonologist told her yesterday, after her hospital follow-up, she has only 40% lung function. On top of that she contacted MRSA during this last hospital stay.

I want to know what to expect, and what I could do to help her?

Patti

A. Dear Patti,

Lots of people who have been in hospitals or have received antibiotics “carry” MRSA in the nose and throat. It may not be an infection and does not require any treatment.

Dr. Tom

Wondering about Spirometry Results

Q. Dr. Tom, I just had spirometry test yesterday. The results are:

FEV1 - 2.09
FVC - 3.28
FEV1/FVC - 63.83
FEV3/FVC - 81.18

The tech says this is not bad, but my doctor says it is moderate Emphysema. Can you give me your opinion?

Vicky

A. Dear Vicky,

These tests do not make a diagnosis. They measure lung function. Discuss the diagnosis with your doctor and perhaps get confirmatory tests such as a measure of diffusion and lung compartment sizes. A CT will also help diagnose emphysema.

Dr. Tom

CT Scan or PFT

Q. In general, do pulmonary function tests or CT of the chest reveal more information regarding possible scarring or airway remodeling due to asthma? We financially cannot afford both. Our doctor is not helpful in helping us choose, but the CT seems to give us a good baseline and seems the best investment.

Dawn

A. Dear Dawn,

Spirometry, i.e. PFT is much less expensive than CT and gives a measure of lung function. CT tells about lung structure. I would go with PFTs.

Dr. Tom

Smokeless Tobacco’s Effect on Lung

Q. Does using smokeless tobacco have the same effect on your lungs that cigarette smoke does?

Richard

A. Dear Richard,

No, but it is bad for the gums and teeth. Stay away from it.

Dr. Tom

© 2017 American Association for Respiratory Care