Q. I’ve recently had a spontaneous pneumothorax, and it was determined it was a
congenital bleb at the apex and repaired with pleurodesis. But a week later, there is now a banana-shaped
air pocket under the bottom of the same lung. How could this happen?
I’m not a smoker, have had no trauma or injuries in many
years. I have an appointment with a pulmonary doctor but would like some
A. Dear Jan,
You still have a small leak. Discuss this with your
Is Part Time Smoking Bad?
Q. I am taking Sprivia but I still smoke (some times) but
don’t smoke full time. Is this harmful?
A. Dear James,
Yes, all smoking is harmful.
I Am a Former Smoker and
Wonder about My FEV1
Q. I am a 25 year-old male and am 71
inches tall and 160 pounds. I smoked three packs a day for three
years and I am wondering how significant a decline in FEV1 I can expect and how
much this will affect my cross country running abilities.
I don’t know what my FEV1 was before I began smoking but
using a handheld asthma device (Microlife PF 100) I can sometimes get an FEV1
of 4.70L/min when I inhale very deeply, but usually get about 4.4 L/min.
How normal is this and can the handheld “spirometer” be
trusted? Is there any possibility that I will regain any of my lost lung
function? I had an X-ray done that was normal. What residual health effects can
A. Dear Interested Reader,
A hand held spirometer can be accurate. You are obviously
pretty normal and can expect a normal life span.
Can Exposure to Paints
Q. Can the exposure of oil paints and pastel paints cause COPD?
A. Dear Angela,
Not unless very excessive exposure, or a family history of
hypersensitivity to such paints.
Extra Moisture for Your
Nose While Using Oxygen
Q. I use oxygen, what can I use in my nose instead of Vaseline?
A. Dear X,
Use a non-petroleum product such as KY jelly.
Is Incentive Spirometer
a Good Exercise for COPD?
Q. I have COPD and am trying to delay any increase in my
breathing problems by going to rehab two to three times a week. Will I benefit
by using an incentive spirometer deep breathing exerciser?
A. Dear Cynthia,
No, but it will give you a good way to amuse yourself. Just
be active and make measurements about monthly.
for Lung Nodule that has Shrunk
Q. I had a lung nodule that was found about eight months
ago, CT Scan. The pulmonologist upon looking at the nodule thought it was
related to my Crohn’s disease but couldn’t be sure because it had an
irregular border and suggested follow up every three months to monitor stability.
Well, I had my nine month CT Scan and the nodule has
shrunk from 1.4 cm down to 8 mm and it had a more faint appearance on the scan.
The Dr. was very pleased but said I still need to complete
the follow-up until we reach two year mark.
Should I be relieved or concerned that they still want to
follow-up in six to twelve months?
A. Dear Pat,
You should be relieved and do not need the follow-up.
Turned Down Due To Hyper-Inflated Lungs
Q. An insurance company turned me down for coverage citing “hyper
inflated lungs” as the main reason. My physician never mentioned this to me and
I was wondering if I should be concerned?
A. Dear Cathy,
No. The insurance company is not up to date. Insist on spirometry.
Exercises for Cystic Fibrosis
Q. What kind of exercises can a CHF patient do at home?
A. Dear Sherry,
Any exercise that is comfortable.
Hallucination in the Hospital
Q. My dad is in hospital as we speak. He has congestive
heart failure and now a nurse tells us, he has COPD. Ever since he has been in
hospital he has been hallucinating. What could be causing this? I’m really scared.
A. Dear Lisa,
It could be drugs, or the severity of his disease. Maybe it
is sleep deprivation. Be sure he is placed by a window during the day and has
darkness at night.
Flow Meter for Liquid
Q. Where can I find a liter reader for my liquid oxygen? I
know there is an item out there that you stick in the tubing to see how much
oxygen the reservoir is putting out. It’s about the size of a pen and is made
of glass. Please help me.
A. Dear Carol,
I will refer your question to Bob McCoy, who is
expert in all these technologies. I have one of these flow meters, but it does
not have any identification on it.
Does Oxygen Increase Dementia?
Q. Dear Dr. Tom,
I apologize for my lack of medical terminology in advance.
My mother is caring for my stepfather who has a host of
issues, such as COPD, dementia, eye problems, muscle issues; the whole nine
He has been in and out of the hospital recently with bouts
of pneumonia. He has been on oxygen therapy for some time, but lately on it
most of the day and night.
One of his daughters heard that too much oxygen will
increase his dementia, and my mother wanted to know if this were a fact or
fiction. I had always thought that the less oxygen to the brain, the more
chances of dementia. Can you please straighten us out… thanks so much for your
A. Dear Kim,
There is no way to get too much oxygen to the brain, by use
of ordinary oxygen delivery systems. Too much oxygen does not cause dementia;
too little oxygen does.
Rheumatoid Arthritis and
Q. Can you give me any information on pulmonary nodules when
a person has Rheumatoid Arthritis? Have been periodically checking size of
nodules by CT scans as both parents have died from lung cancer. Any info will
Also, I recently was diagnosed with Asthma and have trouble
breathing with increased SOB.
A. Dear Nancy,
Nodules from the rheumatoid process are fairly common, but I
would be much more concerned with your family history. I suggest seeing a
pulmonologist now and working out a screening schedule.
What to Expect with
Q. I am 63, just diagnosed with chronic bronchitis. Can I
live a good normal life? I am so afraid I will rapidly become worse.
A. Dear Marilyn,
Chronic bronchitis does not necessarily carry a poor
prognosis. Get your spirometry measured to check on your lung function. Avoid
inhaling all dusts and smoke of any sort.
Q. My husband has crystalline silica in his lungs. Should we
move to a dryer climate? Will it help?
A. Dear Cindy,
This will make no difference. You should see a pulmonologist
for monitoring of the silicosis, which will not have a bad prognosis, as
long as the exposure has ended.
Optimal Capacity of
Small Volume Nebulizers
Q. Dr. Tom,
Here’s a respiratory question for you; what is the optimum
filling capacity of a small volume nebulizer?
A. Dear Jerry,
It depends on the size of the nebulizer. Check the specs.
What Should I Expect
from My Visit with the Pulmonologist?
Q. I am 50 years old. My father died at 64 years old from
lung cancer. He smoked and I inhaled a lot of his smoke as a child.
After an abnormal chest x-ray I had a CT Scan with contrast,
which was also abnormal.
I was told to see a Pulmonologist.
Should I be worried about Lung Cancer?
What should I expect at the
Pulmonologist visit? Do you think he will want to do a lung biopsy on the
A. Dear Liz,
Your pulmonologist will likely
want to do a lung biopsy by needle, and in view of the risks, I would follow
I Am 43 And Diagnosed
with Mild/Moderate COPD
Q. What is the life expectancy of someone like me? I was
diagnosed at 43 with mild/moderate COPD, emphysema. I am on Spiriva and Advair.
I was hoping my life expectancy would be close to normal.
I read your comments about life expectancy being 10 years or
so, and wanted to know if that was for advanced disease, as well as mild. I
want to be realistic, and know what to tell my kids.
A. Dear Deborah,
It depends a lot on your spirometry now and whether there is
a response to therapy. Your prognosis should be good, or near normal.
What Causes a Dry Cough?
Q. I have had severe COPD for 12 years and have never been
bothered with the bronchitis or bronchial cough. Recently I have been having a
dry cough. What would cause this?
A. Dear Sharon,
There are many causes of dry cough. See a pulmonologist.
Q. I am 59, will be 60 in July. I quit smoking in January of
2007. I emailed you a year or so ago, but did not have all my numbers.
These numbers are from May of 07.
FVC ref is 3.08, mine is 2.96
FEV1 Ref is 2.51, mine is 1.02 before medicine and 1.22
after which comes to 41% pre and 48% post.
My FEV1/FVC is 43 pre and 41 post.
My DLCO/VA is 70%.
I have lost 60lbs since then as I went on a diet. I am
scheduled for a new breathing test in Sept.
Dr. Tom this is scary, can I live 15 years with these
numbers? I know you are not God, but please tell me your best guess.
Thank you so much and I know you are not well and appreciate
what you do to help us with COPD.
A. Dear Mary,
Not too bad! You can live 15 years with these results if you
take good care of yourself.
How Can I Protect Myself
from Asthma Triggers?
Q. I learned recently that I have asthma. I am 64 years old
and I never had asthma as a child. Before I was diagnosed with asthma. I have
an inhaler that is for emergency use. Also I have an inhaler that I take twice
a day, and Singulair that I take once daily.
I want to go on vacation to India and am wondering how can I
limit the pollution, dust, and all the elements that trigger this asthma.
Please help me, as I need some advice from you.
A. Dear Tiny,
Trying to avoid dust pollution in India is
very difficult. Do your best and enjoy. Try to anticipate attacks and take
a preventive short acting inhaler as you would with exercise asthma.
How Does Hemoglobin
Affect Oxygen Saturation?
Q. Can you explain if having low hemoglobin or high
hemoglobin affects the pulse ox reading; can you elaborate on both conditions.
A. Dear Barb,
Hemoglobin does not affect saturation. Consult a physiology
Expected Recovery from a
Q. Dr Tom-I am a 47-year-old male who was diagnosed with
COPD in April of 2008. My FEV1 was at 48% and I showed mild hyperinflation of
the lungs. I quit smoking the day I was told and my Pulmonologist opted not to
put me on any medication at that time.
I worked all summer long feeling pretty good—no breathing
issues! In fact I was happy to see my oxygen level stay strong at 98%—I even
played tennis! Unfortunately, a few weeks prior to Christmas I was exposed to some
paint fumes, wood smoke, and some really strong cat urine odor. One of those
exposures sent me in to a tailspin and started an exacerbation.
I had a new spirometry where it showed I dropped 12% points
on my fev1 score. My Pulmonologist said he didn’t feel such a large drop in
function was typical of COPD. His opinion was that I had irritated my airways
and would probably regain the lost function.
It’s been three months and I feel worse than ever. My oxygen
has gone from a steady 98% to 96%-down as low as 94% when I am half asleep. I
am afraid to find out what level I’m at when I am in a deep sleep. I will say I
have hope because with just a deep breath I bounce right up to 98%.
I am constantly SOB with a stressed muscle feeling in my
diaphragm, a tight chest, and I have a constant bloated feeling in my stomach. I
don’t have any mucus secretions but I do have a stressed voice.
The last symptom I can think of is I have a lump feeling in
my throat--almost choking. My Pulmonologist has me scheduled for an endoscopy
to explore the possibilities of GERD.
Although I wouldn’t be surprised if I am experiencing some GERD—I have my
doubts that GERD can cause all of my symptoms.
What I’m really looking for is some confirmation that my
Pulmonologist is steering me down the right path. I guess if I wanted you to
answer any one question it would be as follows: Do you think it’s possible to
have symptoms like I’ve described and rebound back to my original status prior
to the exacerbation?
A. Dear Worried Sick,
Yes, it is possible to make a complete rebound. An endoscopy
for GERD is also a good idea.
Q. I am a physical therapist and I have a patient who is 70
male with severe COPD. He started to tolerate about 20 feet of walking without
oxygen, O2 Sat is 98% but he has moderate SOB on exertion in spite of good
saturation. Will it help to give him O2 @ 2 liters when his walking to tolerate
more walking with standing or sitting rest stops?
A. Dear Antonette,
He will be able to exercise more with oxygen than without
it. Give it a try.
How to Explain Cancer in
Terms One Can Understand
Q. Hi! I’m a nursing student. I just want to ask how can I
say to a 10 year old girl what is cancer in words she would understand because her
6 year old brother has leukemia.
A. Dear Greyel,
This is not easy. Explain that lung cancer is caused by
smoking and includes cancer cells. That may do.
Q. I am a 41 year old male, don’t smoke, drink or drugs.
Active, slim build and can hold my breath for 1 min 45 seconds. I have never
smoked, no shortness of breath at rest or exercise, do have no productive dry
cough in morning during allergy season and suffer postnasal drip and draining.
I recently reviewed some medical reports from a visit to the
ER with chest pain in August 2008. They did chest X-rays and I was told I had
long lungs and they had to retake one of them. The report states in the
impression that I appear to have hyper-inflated lungs although may be
secondary to technique and appear to show flattening hemidiaphragms. They never said anything to
me in the ER to follow up on it. I am wondering now if I should be worried and
follow up. Should I be worried about COPD or can other things cause this?
A. Dear Jim,
No. This report is a common error in people who can take a
large breath. Forget about it.
My Brother Needs to be
Weaned from Ventilator
Q. My brother needs to be weaned off the vent. He is very
weak. We live on Long Island, NY. Any good places you know of? We are willing
to go anywhere to give him a chance to better his life.
A. Dear Lorraine,
The best places are weaning centers such as the Kindred
hospital group. There is one in Denver. There are other options. More than
50% of long-term ventilator patients can be gradually weaned in experienced
Q. How can one tell if breathlessness is because of anxiety
or biological concern?
I am 45, a nonsmoker although I had smoked sporadically in
the past (during crises) then stopped. I sometimes notice my heart is beating
fast and it feels like breathlessness when I awake and when I first lie down to
go to sleep (occasionally).
My lungs showed clear but I read mild hyper inflated. Would
you suggest any other tests? The breathing is good with exercise and when I
take pain pills (currently for a pain in back).
Doctors recently found a 3 mm vegetation or
thrombus on my mitral valve following a small cerebrovascular accident: (with
no deficits except for nominal speech disorder sometimes).
How much can arthlerosclerosis play into breathing and maybe
I have it?
A. Dear Marie,
You need spirometry to measure your lung function.
Arthlerosclerosis does not cause shortness of breath. The mitral
vegetation may need investigation. I suggest consulting a cardiologist.
Dad has Lung Problems
and Now has a Bad Pain in Back
Q. My Dad has been going to doctors also Veteran’s doctors
and regular close to home doctors. He has a lot of lung problems. On oxygen 6
lowest 7-8 at high levels. Swells in the feet also but he takes medication for
Well, now he has lower back left side back pain and he
can barely walk. All the doctors gave him pain pills and want to take a chest
x-ray which has nothing to do with his back. They did rule out kidneys and
cancer and bladder and prostate; what else could it
be? Thank you for any information.
A. Dear Tony,
There are many things this could be. I suggest consulting a