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Archive: Dr. Tom 143

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

Is Singulair Safe for Babies?

Q. My four month-old son has a cold that causes him to cough and the doctor has prescribed Montelukast Sodium. I have seen a big improvement just after one dosage but cannot find anything on the net that says it is ok for his age. Is this medicine suitable for a baby of four months?

Gabriel

A. Dear Gabriel,

Monteleukast (Singulair) has been approved for children age 12 months and older but it has been safely used off-label in several research studies to treat infants as young as one or two months of age with bronchiolitis (generally without success).

Many medications have not been specifically approved for infants and young children but can be used safely and often effectively in the very young. It sounds like this worked well for your son and that is good news.

Dr. Bruce

Oxygen for Preterm Baby

Q. Dear Doctor,

May I ask how much oxygen is a preterm baby (35 weeks 1.790 Kg) getting if the he/she is receiving 0.025 LPM of pure oxygen in one minute if the baby is breathing 40-60 breaths per minute?

Roel

A. Dear Roel,

I love questions like this! There are two good answers.

When I am teaching students, it gives me the opportunity to build equations to calculate the fraction of inspired oxygen (FIO2) based on tidal volume (about 7 mL/Kg) and respiratory rate giving minute ventilation, then taking into account dead space and how this changes with increasing respiratory rate, and ambient air (0.21 oxygen) entrainment we can derive a rough approximation of the inspired oxygen. Whew! But this is great for teaching physiology.

The second answer is really the correct answer–it doesn’t matter. Babies will have changing airway surface area, minute ventilation, and dead space so what we try to do is give the least amount of oxygen necessary to keep the oxygen saturation greater than 90%. Give just the amount of oxygen that it takes and you will support that infant. Beware that if the baby’s oxygen requirement to maintain saturation is going up, this probably means trouble.

Dr. Bruce

Is There a “Safe” Way to Smoke Marijuana?

Q. I recently had a partial lung collapse (approximately four centimeters). I was given a chest tube, and sent home within two days. My lung feels okay right now with no issues since the chest tube.

I was a smoker of three years, but quit cold turkey when this happened. I am a chronic marijuana smoker of five years, and have plans to decrease the amount of marijuana I smoke, but not completely stop. I’m wondering if this is a bad idea. I don’t plan on smoking very much, or taking large deep inhales. And possibly smoking marijuana with a vaporizer, which I’ve been told would be the best idea. But my health is my number one priority.

Jay

A. Dear Jay,

There is no safe way to smoke pot. Don’t be silly. Give it up.

Dr. Tom

What Stimulates You To Breathe?

Q. What is the stimulus to breathe for the patient with severe COPD? I always thought it was a low PaO2 level but now I’m not sure. I was told it was a high PCO2 level?

Sandy

A. Dear Sandy,

There are multiple drives to breathe, which are CO2, oxygen level, muscular effort and many more. This is not a simple subject.

Dr. Tom

Maximum Oxygen Level on Room Air

Q. What would cause a PaO2 of 200 on room air?

Linda

A. Dear Linda,

An error.

Dr. Tom

Should I Worry About Lung Scarring?

Q. I recently had a chest x-ray as a routine prior to my hysterectomy. It came back as abnormal and my doctor asked if I had been sick with a cold or pneumonia, I had not. She then ordered a CT Scan, which revealed that I had lung scarring and to follow-up with a Pulmonologist.

Could you please tell me what does this lung scarring mean, and should I be worried?

Terri

A. Dear Terri,

It just means that at one time there was inflammation. There are many causes for this. I would pay no more attention to these x-ray findings, unless you get symptoms such as progressive shortness of breath or chronic cough.

Dr. Tom

Very Fit but Lungs Feel Stiff

Q. Hi Dr. Tom, thank you very much for this ‘service’, if I can call it that. Access to a person with your knowledge is so appreciated.

I have just come back from a two-hour walk across rough terrain with my dogs! I feel fantastic. I eat well, I’m not over weight… and I suppose I should add that I love life! I am very active.

Here is my question: I am a forty-eight year old man. I gave up smoking when I was thirty-three. The thing is, when I push myself in any sort of activity, I get a sort of ‘wooden’ feeling in my lungs. It is as if they will not expand!! Also, where I walk is normally mountain regions and yet I do not ‘feel’ the fresh air… I labor to breathe (but seem to be able to ‘out-walk’ all the others!).

Thanks again for access to your knowledge base…

I hope this mail finds you all in the very best of health.

Noel

A. Dear Noel,

I cannot explain your unusual lung symptoms. You sound very healthy and should remain so.

Dr. Tom

Teaching Tracheostomy Care

Q. I am a nursing instructor at an Associate degree program. We are preparing to teach tracheostomy care. There is debate on the prevalence of non-disposable inner cannulas.

Can you provide any insight into the prevalence of non-disposable inner cannulas. Should we should teach our students trach care with a disposable inner cannula only or do you think non-disposable inner cannulas are still fairly common?

We live in an isolated area, so it is hard to tell what the national trend is. Any insight would be great.

Karla

A. Dear Karla,

I have not done ICU care for a number of years. I do not know the current status of disposable vs. nondisposable cannulae.

Dr. Tom

Byssinosis

Q. Are there any current issues or research on byssinosis? If so, where could I find information?

Jennifer

A. Dear Jennifer,

Read a textbook or chapter in a general pulmonary book, on byssinosis. It is a pneumoconiosis caused by cotton products.

Dr. Tom

Chronic Interstitial Changes

Q. I recently had a chest x-ray after reporting to my allergist that I had mild wheezing on exhalation and shortness of breath on exertion.

The x-ray showed that I have mild chronic interstitial lung changes, as well as mild spleen enlargement. The allergist suggested I consult a GP about both. Should I be concerned?

My family history includes COPD and lupus, and I do not smoke.

Elaine

A. Dear Elaine,

I think these findings require an explanation. I can think of many possibilities. I suggest consulting with a pulmonologist.

Dr. Tom

RESPIRATORY CARE Journal and Peer Review

Q. I have had many doctors tell me that our RESPIRATORY CARE magazine is not peer reviewed; is this true? If so what does it mean to be peer reviewed?

Christopher

A. Dear Christopher,

RESPIRATORY CARE is the science Journal of the American Association for Respiratory Care. An important aspect of the scientific process is peer review. Following the peer review process, the editor has the manuscript reviewed by experts (peers) who advise the editor about whether the paper should be published or rejected. The peer review process also provides feedback to the author about how the paper can be improved, or to support the recommendation to reject the paper.

The majority of papers submitted to RESPIRATORY CARE are peer-reviewed, and most of those are returned to the authors for revision before they are acceptable. Some papers submitted to RESPIRATORY CARE do not pass the rigors of peer review and are rejected. This serves as a measure of quality control in that only papers of acceptable quality are published. RESPIRATORY CARE is the premier journal of its subject matter and it is recognized worldwide. This has been recognized by inclusion of RESPIRATORY CARE in PubMed (Index Medicus) and the ISI’s Web of Science.

Dr. Dean, Editor of RESPIRATORY CARE

Questions about Bronchiectasis

Q. Hi. I am 33 years old. About five years ago I was diagnosed with bronchiectasis in my lower left lobe. I end up being on antibiotics six to seven times a year to control infection (often I catch a cold from one of my children and it goes straight to my chest).

Do you know of any treatment that is more effective to help control Bronchiectasis, than constant use of antibiotics?

My doctor keeps saying there is nothing else to do. But I have to wonder, that at my early age, I have to deal with this for the rest of my life. I am on an inhaler, but I don’t really find that it makes a lot of difference. Will this new inhaler Spiriva help for bronchiectasis?

And what do you think of the possibility of a lobectomy? Also is bronchiectasis considered a COPD? Thanks for your help!

Susan

A. Dear Susan,

If the bronchiectasis is really limited to one lobe, which is distinctly possible, a lobectomy can be amazingly effective. Pursue this possibility with your pulmonologist. A CT will tell about the localization of disease.

Spiriva is okay, but won’t change the basic pathology. Using antibiotics frequently for diffuse disease is safe and effective.

Dr. Tom

Is It Better to Keep Active if I Can Still Do My Job?

Q. First: I was diagnosed with COPD, severe. Second: I deliver home heating oil, (dragging the hose to peoples’ homes to fill with diesel fuel) in Pennsylvania.

The pulmonologist diagnosed this after making me walk (extremely fast, almost a jog) down the hallway and back 4 times. I was not short of breath, but my O2 level dropped. He stated I should be on O2 and quit work, apply for disability. Right, who can live a year without income?

Anyway, question is, if I can do my job, wouldn’t it be better to keep active, Instead of quitting, worrying about an income and paying bills, and going on O2 (which my insurance will not pay for).

Pam

A. Dear Pam,

I agree with you that if you can do your job without oxygen and undue distress that you should keep right on working.

Dr. Tom

Strange Feeling in Lung Since Quitting Smoking

Q. Hey, I’ve been a smoker of weed for the last six years or so with a short break here and there. I’ve just stopped for good and I’ve noticed in my right upper lung it has a odd feeling to it and it has a sharp acute pain (in one little spot) and only comes as I do heavy activities. I’ve noticed my right upper lung just feels a little different from my other lung.

Is this in my head, or is it after effects of smoking and my body is trying to do something, or is it something worse? Any reply will be greatly appreciated thank you for reading this.

Matthew

A. Dear Matthew,

These strange sensations on stopping pot are hard to explain. They will subside. You will remain well.

Dr. Tom

Lungs Look Like a Smoker’s Lungs but Have Never Smoked

Q. I was told during an echocardiogram that my lungs look like a smoker’s but I have never smoked and don’t live with a smoker. What else could cause this?

Donnamarie

A. Dear Donnamarie,

A misinterpretation. You cannot identify a smoker’s lung from an electrocardiogram.

Dr. Tom

Managing Asthma

Q. Dear Dr.Tom,

I’m 35 and scared. Do I have asthma or COPD and will these breathing flare-ups ever stop or only get worse?

As a child I had bronchitis quit a few times and pneumonia once. I had no problems with breathing just bad allergies until about four years ago. I moved to a wet colder climate with a lot of plants and redwood trees and had my first SOB incident which sent me to the emergency room.

I finally have a referral to see Pulmonologist because I have had poorly controlled asthma (or maybe it is COPD) for about three years now. I am fine for weeks at a time and then something sets me off but I don’t know what. I live with cats that I’m allergic too but usually this past time it was cold wet weather and the time before that a bad cold/flu.

I’m scared. Could it be COPD? I smoked around 10 cigarettes daily for 15 years with regular quits of up to six months before this. I quit for good when this all started.

I like albuterol, it helps a lot, but I tend to use it a little compulsively and go through it quickly. Sometimes I take prednisone with a bad flare-up but I won’t take Advair etc daily because I think they prevent me from losing weight. (I am 10-20 pounds overweight but normal BMI range).

I have bad breathing at night and a nonproductive cough that makes my head hurt when I’m having a flare-up but not at other times. When this happens I just can’t get enough air.

Sad and wheezing, Carolina

A. Dear Carolina,

It seems most likely that you have asthma and need both bronchodilator and inhaled steroids for it. You will not gain weight on inhaled steroids any more than oral steroids.

Dr. Tom

Acapella Breathing Device

Q. How does the acapella breathing device work?

Bobbi

A. Dear Bobbi,

It sets up high frequency vibrations that tend to promote mucus flow. I have not been impressed with it.

Dr. Tom

© 2017 American Association for Respiratory Care