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Archive: Dr. Tom 142

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

Too Much Mucus

Q. I am 36 years old. I have a problem of mucus formation in the throat early in the morning, after lunch and after dinner. I have to go several times to the wash basin to cough it out.

I quit smoking in 2001, had tonsils removed in 2003, and had an operation for fluid in lungs in 2005. I have trouble sleeping as I have to swallow the mucus, otherwise it’s tough to breathe. Why does this happen and is there some way to stop it?

Kannan

A. Dear Kannan,

You will need a diagnosis made by a pulmonologist to explain this. I do not have enough information.

Dr. Tom

Can’t be Compliant with CPAP Due to Congestion

Q. I wear a CPAP mask, but I am not able to be compliant, as I become so congested, coughing, nose running and etc. I have tried changing the filter everyday, washing tubing and water holder every other day, added humidifier to room (have one on CPAP) and have wrapped the tubing.

I do not know what to do, and no one seems to have an answer. I need to wear the CPAP, as I have severe sleep apnea. Do you have any other ideas?

Dee

A. Dear Dee,

Sorry, I do not have any unique experience with CPAP. I suggest contacting a sleep specialist that will have far more practical experience.

Dr. Tom

Short of Breath at Nineteen Years Old

Q. I am a 19 year old female 5’5” 120lbs. I’ve had bronchitis twice since last May, it was decided that I didn’t rest enough to let my body recover considering I am a full time student and work as well.

Now with the cold weather and everything it takes a lot for me to walk up two flights of stairs. I am completely out of breath by the time I reach the top, and they aren’t large flights either. Walking at a fast pace to class even causes me to stop walking due to SOB.

There is a history of asthma in my family on both sides. I also have three cousins who have cystic fibrosis.

I was hardly ever sick at all when I was a child. My doctor says that with my history I shouldn’t worry about cystic fibrosis. What do you think could I just have asthma?

Whitney

A. Dear Whitney,

You need a diagnosis from a pulmonologist. It is more likely to be asthma than CF, but you should be checked for both.

Dr. Tom

How Do You Diagnose Asthma?

Q. I had a lung function test done and the doctor told me my lung volume was low. I was diagnosed with asthma. I have had an ongoing cough for many months.

They will do a bronchoscopy on me to check for lung infections. Why do I need that? Why not do a scan instead?

Sol

A. Dear Sol,

Consult a pulmonologist for this many questions.

Dr. Tom

Want to Help Mother Get a Better Quality of Life

Q. My mother was diagnosed four years ago with COPD. She sees a pulmonologist, a general practitioner and goes to a respiratory center for rehabilitation (a supervised workout) twice a week. Recently she has had some problems related to her condition (blood clots in the nose), sinusitis, depression, etc.

It seems like each doctor she sees treats just the one aspect of her condition. The doctors don’t seem to communicate with each other. She’s not getting the best possible care as a result and I’d like to know if there is an organization or type of caseworker that can help with the day-to-day aspects of living with COPD and get her a better quality of life?

She’s developing anxiety over going out of the house and using her portable oxygen. She’s afraid she’s going to run out, so she’s becoming house bound.

Any advice you have to help this situation, I’d appreciate it. I live in New York and can’t go with her to doctor visits.

Barbara

A. Dear Barbara,

You need a specialist in COPD, probably a pulmonologist who can coordinate all facets of her care. It is a complex situation, and beyond any simple explanation I can give you here.

Dr. Tom

Package Pricing for COPD

Q. Do you know of any facility that offers package pricing for COPD?

Sandra

A. Dear Sandra,

No.

Dr. Tom

Odors are Causing Problems with My Lungs

Q. I cannot be around perfumes, smoke, cleaning chemicals, body sprays, or anything that has an odor. I was told that I have mild to moderate asthma.

I cannot get my doctors to understand that these smells hurt my lungs. They think that I am nuts. I have been sick since May 2008. I am seeing MDs at UNC Chapel Hill, N.C.

I get better and then I come in contact with something and I am right back to where I started. Do you have any suggestion of what I can do or whom I can see? Please let me know.

Rose

A. Dear Rose,

These reactions to smells are common in asthma. Be persistent and see one who will deal with your total problem, maybe change doctors.

Dr. Tom

Life Expectancy for Someone Who has COPD

Q. How long can someone live with COPD?

Raymond

A. Dear Raymond,

It depends on the age, comorbidities, and degree of impairment. Many with COPD live 10 or more years.

Dr. Tom

Recently Diagnosed with Alpha-1

Q. I have been recently diagnosed with Alpha 1, specifically, the null allele. I know this is bad, but what can I expect in the next few years?

I am only 35 years old and I have made a few life style changes to protect my lungs, but I don’t know what to expect. My doctor tells me that my null variant is very rare and they really don’t have anything to compare my situation with.

The Internet offers little help when it comes to the null variant. I just want to know.

Jay

A. Dear Jay,

The null variant can be treated with replacement therapy just like other forms of AAT deficiency. Don’t despair. Find a pulmonologist who is experienced in replacement therapy.

For more information see Alpha-1 Foundation: http://www.alphaone.org/

Dr. Tom

Would Like Closure to a Question my Family Has

Q. You have always been so helpful with my questions regarding my 76 year-old mother. She had been on 2L oxygen therapy for three years for her bronchiectasis. Unfortunately, she was diagnosed with pancreatic cancer and because of her frailty; no treatments were advised.

Sadly, my Mom passed away after four months of being diagnosed.

I do have a question and none of the physicians have answered it for our family. A few days before my Mom passed away, we took her to the ER. Although she felt short of air her oxygen level was 100%. She NEVER had it this high. The physician listened to her lungs and said there was little air intake. How then could the number be 100%? Any information would be welcome. We need some closure. Thank you.

Rose

A. Dear Rose,

The number was probably an error.

Dr. Tom

What are the Risk Factors for Lung Cancer?

Q. I have never smoked, but my mother did and now has stage IV lung cancer. I lived with her for the first 23 years of my life. I also live in a home that where the previous owners smoked, though no one smokes inside our home now.

I have heard that lung cancer can be genetic. Is that true? Does what I’ve told you make me more likely to develop lung cancer than someone else even though I don’t smoke?

Molly

A. Dear Molly,

A family history doubles the chance of lung cancer, even in non-smokers.

Dr. Tom

Can’t Afford Medication and Just Don’t Like Taking Medicines

Q. For about a year and a half I have started wheezing and coughing, mainly at night, the cough is productive I also have episodes sometimes when I am playing basketball with my son. Not all the time.

I have gone to my internal doctor and she prescribed me Advair, which seems to work. She told me I probably have asthma. I haven’t been taking it regularly lately because of cost and I hate taking medicine. I have had x-rays, and have had breathing tests done which came out very slightly abnormal.

What do you think I should do now?

Dawna

A. Dear Dawna,

I think you should take Advair as advised by your doctor. Asthma seems the most likely diagnosis and cannot be ignored.

Dr. Tom

Symptoms of COPD

Q. I have been diagnosed with COPD. However I do not have the symptoms you list on this site. I have shortness of breath on any exertion but I recover faster than when I smoked. I don’t think it’s progressing or getting worse. I guess I just need a second opinion?

Tom

A. Dear Tom,

A second opinion is always wise if there are serious questions about diagnosis and treatment. Shortness of breath with exertion is the most common symptom of COPD. You also need spirometry to see about your lung function.

Now is the time to take care of yourself and avoid complications down the line.

Dr. Tom

Husband Diagnosed with Severe Emphysema; What are His Chances for Surviving Another Two to Three Years?

Q. Three years ago, my husband’s physician said my husband would PROBABLY be dead in one year. His diagnosis was severe, advanced emphysema (which had been diagnosed seven years previously),

At that time the diagnosis was primarily based on the following: he was smoking about two packs a day, he weighed 138 pounds, pursed lip breathing, barrel chest, very impaired stamina, an FEV1 of less than 26.

Two months afterwards he stopped smoking and remained a non-smoker for these past three years. He has continued to use the Nicotrol inhaler. He uses Spiriva and Advair.

He has not seen a physician in almost a year. He has gained six pounds. He never misses a day of work, but when not working is almost completely sedentary.

His pursed lip breathing has disappeared almost entirely. For someone with this history, what are his chances of surviving another two to three years?

Kate

A. Dear Kate,

They are excellent. Keep encouraging your husband to enjoy life.

Dr. Tom

Aging of the Lungs

Q. What affect does aging (non-smokers) have on the lungs?

Jake

A. Dear Jake,

There is a slow loss of lung function as you age.

Dr. Tom

What is Hilar Prominence Mean?

Q. My doctor said I have an abnormal left hilar prominence. Can you explain that better to me?

Charles

A. Dear Charles,

It is an enlargement of the base of one of the lungs. It is up to your doctor to explain this to you and to make a diagnosis. There are many possibilities.

Dr. Tom

Worried that Grandmother Will Not Live Another Ten Years

Q. My Grandmother was diagnosed about three years ago with COPD.

She has failed to do any of her breathing treatments and can barely walk out to the car without getting out of breath. She rarely showers because it is so difficult for her. She uses oxygen 24/7.

She has ideas of living another ten years but I was wondering realistically with her lack of breathing ability what you would say her life expectancy is at this point and what can we do to help her?

Brittany

A. Dear Brittany,

Her life expectancy depends on her age and degree of impairment now, as well as co existing diseases. She may well live 10 years in spite of advanced COPD and need for oxygen.

Dr. Tom

Believe Inhaler Caused Voice Changes

Q. I’m a 60 year old singer who hasn’t been able to sing the past several years because of diplophonia, which I believe to be related to years of inhalers—most especially, Advair. I’ve seen a couple of ENTs in past years, but they can’t see anything and give me the standard advice to keep well hydrated (which I do).

My question: Since my asthma is mild (since moving to the Southwest) could I take a different medication, thus, hopefully, reversing the damage caused by Advair? Can the damage be reversed?

Mary Lee

A. Dear Mary Lee,

The dysphonia is most likely due to Advair. Try taking it only once a day or an equivalent Symbicort as a wet inhaler, not the powder of Advair. The damage is reversible.

Dr. Tom

Are Vocal Volumes Affected by Lower Lung Capacity?

Q. I have a strange question about an acquaintance but I hope you can help. He has something like 50%-70% of his normal lung capacity. Should he still be able to speak loudly and/or shout if necessary?

James

A. Dear James,

Yes, this is enough lung power to be able to shout or speak loudly.

Dr. Tom

Nineteen Years Old and Constantly Yawning

Q. I am a nineteen year-old female. For almost a year I have had difficulties breathing. I feel like my lungs are not filling up with air and I am constantly yawning and taking deep breaths. I have been to my normal doctor multiple times and she has run tests for asthma and done chest x-rays and everything comes back normal.

I had my left tonsil removed and I thought that might help and it did for a little bit but now it is just as bad as it was before. I have tried stopping medications that I started when my breathing problems started but nothing is helping.

I am getting increasingly concerned for my health, and it’s honestly really annoying to me and to my college roommate that I am constantly taking deep breaths.

Can you help?

Ashton

A. Dear Ashton,

This may be hyperventilation syndrome. If so, it should get better during exercise.

Dr. Tom

Another Question about Father

Q. Thank you for your answer.

This is in continuation with my question subject, “Worried about Father who is on a Ventilator”. Today my dad is on the 24th day on the ventilator. As you had suggested, we looked for a ventilator hospital but we don’t have such facility hospitals in our area. His lungs are clear some days, and then again some days he goes bad.

Please advice what needs to be done.

Praseetha

A. Dear Praseetha,

You need to try to wean very, very slowly. It should finally succeed.

Dr. Tom

Best Way to Administer Aerosol to Children

Q. Is there any difference in aerosol delivery to a child using a mask vs the blow-by method? After 13 years as a therapist I feel it is better to use blow-by on a relaxed child vs trying to keep a mask on a screaming child constantly pulling the mask off and turning his back and forth while trying to hold the mask to his face.

Gary RRT

A. Dear Gary,

Many studies have shown that blow-by by delivers almost no aerosol to the lower airway. Even holding an aerosol tube absolutely still in front of an open mouth, more than 85% of the usual deposition is lost at a distance of less than an inch. In our studies we have found that young children tolerate blow-by and mask delivery equally well (or poorly). The screaming child who lets you hold blow by 6 inches gets no medication in their lungs. Blow by should never be used.

Dr. Bruce

© 2017 American Association for Respiratory Care