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Archive: Dr. Tom 30
Posted August 10th, 2005

Concerned about Son’s Asthma Diagnosis
Q. Hi Dr. Tom, Thank you for your help. I’m worried about my son. He is 5 years old & lives with his mother (we are divorced). She has told me he has asthma & also that his asthma has turned into pneumonia 3 to 4 times.

He has been taken to the ER (Emergency Room) for dyspnea (difficulty breathing) a few times. He was treated with a nebulizer & sent home. ER diagnostic tests show normal chest x-ray …unremarkable.

After I reviewed his medical records of the last 4 years, I see he has been treated, over the past 4 years, for asthma based on symptoms the mother explains (i.e. he wheezes when he exercises and albuterol makes him feel better). About 5 doctors (specialist included) have treated him symptomatically.

All physical findings have been negative as have been the tests. A doctor has witnessed no signs. One Dr. has suspected a cough variant variety, but wanted to wait for a ph probe to r/o an anatomical lesion (he also has a phantom cough) before diagnosing and again based on symptoms described by the mother. p/e was benign a x-ray showed mild subsegmental atelectasis (collapse of the lung or part of the lung). Another showed hyper inflated lung field 7, aerophagia (swallowing air) in the abdomen.

My questions are:

What are the side affects, if any, of unnecessary or long-term use of albuterol, Xopenex, Proventil, Alupent & prednisone?

Does asthma turn into pneumonia?

Are asthmatics more prone to upper respiratory infections?

Can hyperventilation cause hyper inflated lung fields?

Can use of above meds or hyperventilation cause atelectasis?

Lastly are any of above meds used to treat pneumonia? 

Thank you for any information.

 Sincerely a concerned father,

Chad

A. Dear Chad, You have multiple questions, and I will attempt to give you a good answer.

First the diagnosis; Soon (when your son is able to perform the tests) your doctor should be able to measure peak flow and even spirometry. There should be evidence of airflow reduction, during attacks, and the doctor should be able to hear wheeze.

Albuterol by the inhaled route is safe, as are the oral medications except for prednisone, if used for prolonged periods. Predinsone in the short term to abort attacks is safe.

Asthma does not become pneumonia, but pneumonia may complicate asthma.

Hyperventilation does not cause hyperinflation.

Your son will grow and with proper medication, and may expect to gain complete control of attacks, assuming that the right diagnosis is asthma.

Dr. Tom

 

Losing Confidence with Doctor
Q. Jan 2005 I got flu three times, after two lung x-rays, my doc said they wanted me to get a CT scan cause they saw a spot. The CT scan came back and the office called my emergency contact for me to contact them, then they said they did not call me, but when I went in for CT scan results they said they did call.

That day he said I had a glucogonoma tumor, but because they were slow growing, not to get another CT scan for 6 to 9 months. My liver enzymes were high so he said he wanted another blood test in 3 weeks, which I got and returned to him in the 3-week period.

When I brought the glucogonoma tumor up, he said I did not have that and that I must have misunderstood him that I have a granuloma (calcium growth) in my lung.

First of all I could not have made up that word let alone pronounced it. The day I returned their, so called emergency call they also got me mixed up with someone else, when I told them I was returning their call.

This is making me worried and feeling like a nut. I have no faith now in what he says is going on. I am considering changing doctors. The communication must be really bad to have come to this. I am on Medicare and have Medicare insurance.

Should I have these tests redone? Help confused....

Cheryl

A. Dear Cheryl, Sounds like you have a granuloma, which is a calcified (usually) infection in the fungus family. Very common in the Midwest.

Change doctors and get someone who can communicate with you. Communication is the first step in caring for patients.

Dr. Tom

                      

Worried about Mother Who is on a Ventilator
Q. Hi, my mother was just admitted four days ago in to the hospital with acute exacerbations (worsen condition or flare-up) of her COPD.  They have had one unsuccessful attempt at discontinuing her from the respirator (mechanical ventilator). They say she is still to weak and her bronchioles are extremely tight. 

Do you think it is a good idea that she is given a tracheotomy (is an opening surgically created through the neck into the trachea, windpipe) and then tried to wean off of that.  I am just concerned she will get stuck being on the ventilator for life. 

She is only 53, and has severe emphysema.  Smoked up to the day she was taken by ambulance.  Can someone’s lungs be that bad by such an early age?  

Jennifer

A. Dear Jennifer, A tracheostomy is more comfortable for the patient that an endotracheal tube (tube placed in the airways through the mouth or nose). It will allow for better suctioning of secretions. It is also a good step in weaning, that may take more than a few days.

Advanced emphysema in the 40s and 50s is fairly common. Women are more susceptible to cigarette smoke than men.

Your mom can still recover, and be rehabilitated to the point of a good quality of life.

Dr. Tom

 

Will Angioprim Help with Buildup of Plaque in Arteries?
Q. Found an article on Internet about Angioprim (antioxidant). It is a Synergistic combination of amino acids that are the building block of proteins, the essential elements of good health. 

I want to know what you know about this product and if you think it’s safe and will help with buildup of plaque in arteries.

A. Dear Jim, Never heard of it. I would not trust that it will do any good. Save your money.

Dr. Tom

 

Difficulty Breathing Causes Nervousness
Q. Hi Tom, I am Kishore, I have difficulty in breathing and I have to suck air most of the times thru my mouth. I am 30 year old and I have this for more than 12 years.

I visited several doctors they said it’s due to allergy. Sometimes I undergo tremendous pressure and I could not breathe, and it lets me get nervous. I am suffering from nervousness because of this.

I have been on medication since January 2005; I am using Stemetil 5mg, Levosiz, Nutrisan, lol20 (propranolol hydrochloride), Tancodep, Libotryp DS.

I am suffering with this at every moment of my life and I want to get rid of this one, can you give the solution?

Kishore

A. Dear Kishore, I am not familiar with all these medications. I may know them under different names.

I do not know your diagnosis, so I cannot give you much advice.

Maybe you are just nervous and this causes conscious breathing that is distressing. If I am correct in this assumption, your breathing should get better when you walk or exercise. Try walking instead of all these medications.

Dr. Tom

 

Questions about Spirometry Results
Q. I recently had a free spirometry test (COPD screening test).  I am an ex-smoker.  I smoked about a pack a day from ages 14 - 19, and started again at age 30.  I just quit 2 months ago, and I am 39 years old.  During my 30s I usually smoked just under a pack a day.  

I was fairly confident that I didn't have COPD.  But was surprised when my results indicated a restrictive process.  My best values were:
FVC: 3.20 (80%)
FEV1: 2.78 (85%)
FEV1%: 87%

Could my low FVC value be due to my recent smoking?  Will it improve on its own with time?  Should I have additional tests?  Any information will be appreciated - I am very worried.

Suzie

A. Dear Suzie, Your results are borderline. Not really abnormal.

I do not mean to get personal, but the “restriction” could be a matter of weight. If you are not overweight, forgive the suggestion.

Dr. Tom

 

Breathing Difficulties
Q. Hello Dr. Tom, I am a 28 year-old female who has a chronic cough and episodes of breathing difficulty.  The cough began over three years ago and within the past year my breathing troubles began. 

I am a non-smoker and have grown up in a non-smoking household.  I recently had a spirometry, lung volume and DLCO tests. 

My question is regarding the lung volume test, as my numbers were higher than predicted. 

TLC (total lung capacity) was 114% of predicted
VC (vital capacity) 102% of predicted

FVC was 94% of predicted
FEV1 was 98% of predicted

I have been reading that higher TLC, VC and RV/TLC% values are higher in patients with COPD.  Do my values reflect an abnormally high result, indicative of COPD?  Thank you for your time.

Jennifer 

A. Dear Jennifer, You do not have COPD. The slightly high TLC just means that you can take in a very large breath. Stay well.

Dr. Tom

 

Ionizers and Emphysema
Q. Recently I have heard that ionizers can work adversely for emphysema patients?  Is there any truth to this?  I am researching for my aunt who is in the latter stages of this disease and uses a Hunter with a Hepa filter.

Vicki

A. Dear Vicki, Ionizers just take dust out of the air. They will not make emphysema worse, and won't make it any better either.

Dr. Tom

 

Effects of Not Using CPAP Machine for Sleep Apnea
Q. My husband was diagnosed 10 yrs ago with severe sleep apnea and was recommended CPAP (Continuous Positive Airway Pressure). He chose not to use one.

He still snores very badly, is very tired during the day, about 30 lbs overweight.  He stopped smoking about a year ago.  

My question is - what kind of damage could he be doing to himself by not using the CPAP machine that was recommended to him.  I understand his pulse oximeter (measures the oxygen content of blood, saturation) during waking hours runs around 92-94 but have no idea during sleep.  Could this lead to a more serious condition or will it resolve itself?

Sue

A. Dear Sue, Your husband is not greatly overweight.

The question is: what is his oxygen level during sleep? Has he ever had a formal sleep study? It would be a good idea to settle the question about the need for CPAP.

Dr. Tom

 

Life Expectancy and Emphysema
Q. What is the life expectancy with emphysema? 

Karl

A. Dear Karl, It depends on the age, sex and the level of lung function when the spirometry is done. If diagnosed early enough, the life expectancy may be normal with stopping smoking and good treatment.

Dr. Tom

                           

Compressed Oxygen or Liquid Oxygen for Congestive Heart Failure (CHF)
Q. I recently heard from a local Pulmonologist that he preferred to use compressed 02 as opposed to Liquid 02 for his patients with CHF due to a reaction on the heart? 

Do you have any Idea what he could possibly be referring to?

Roland

A. Dear Roland, No. Liquid oxygen becomes pure oxygen as it comes from the container. It is exactly the same as compressed oxygen. Oxygen is oxygen.

Your physician should know this.

Dr. Tom

 

Differences of Chronic Bronchitis, COPD and Bronchiectasis?
Q. Hi, Dr Tom Many thanks for this forum. It is really helpful. 

I presented my girlfriends symptoms to you a few weeks ago. Her doctor previously diagnosed her with chronic bronchitis.

You said that she probably does not have chronic bronchitis but bronchiectasis instead.  Following your advice we have booked an appointment with a pulmonologist for another diagnosis (I will let you know the outcome of that when we visit him). 

I just have one question in the interim.  What are the essential differences between chronic bronchitis, COPD and bronchiectasis?  Which has a worse prognosis?

Anashen

A. Dear Anashen, Chronic bronchitis is chronic inflammation of the air passages, usually from smoking.

Bronchiectasis is also chronic inflammation, but usually from infectious causes, and the air passages become dilated and tortuous, so that they are commonly the site of bacterial infection.

Both may be treated with antibiotics, but antibiotics of a different nature may be needed in bronchiectasis, compared with the antibiotics used in flares of chronic bronchitis.

COPD is an inclusive term that includes chronic bronchitis, emphysema and asthmatic bronchitis. Bronchiectasis is not included in the COPD designation.

The prognosis of all these diseases is variable and a result of the age of the patient, the degree of measured impairment and the success of comprehensive treatment.

Dr. Tom

Read Anashen’s question from the July 28th post.

Need Information about Chronic Bronchitis
Q. Hi Dr Tom, My girlfriend has chronic bronchitis.  She is now 23, first diagnosed with the condition 4 years ago, and the medical specialists attending to her at the time indicated that it could have started as much as 5 years before that (13/14 years old).  Does anyone know how chronic bronchitis occurs at this young age?

All of the articles I have read about chronic bronchitis do not talk about chronic bronchitis in teenagers.  Most of them also refer to smoking being the main cause of chronic bronchitis, yet she has never smoked in her entire life, how could she have then developed the condition? 

I ruled out any genetic defects (Alpha-1 Anti-Trypsin Deficiency), because her folks and her brother and sister are in perfect health.

She normally gets sick about 4 times a year; difficulty breathing, coughing up blood and sputum and running a fever), and it lasts between 2 weeks to a month.  Is this normal for someone with chronic bronchitis? 

Are her lungs undergoing further damage each time she gets sick?  She had a spirometery test recently, while she was sick, the results were around 68% lung capacity. Was this reading poor because of she was sick at the time? 

How does one reduce the frequency and duration of these illnesses?   Also, does being out in the cold or drink cold beverages contribute to getting sick?

As she has started displaying these symptoms at a very young age, what can her expectations be as she grows older living with the disease?  How would her quality of life be affected and what would her life expectancy.  What would your prognosis be?

I know have asked a ton of questions, any help would be really appreciated.  Thank you for taking the time to read this letter and thanks for the advice that you have provided.

Anashen

A. Dear Anashen, This is not chronic bronchitis. I suspect that she has a disease known as bronchiectasis, which commonly had repeated chest infections, large amounts of mucus and coughing blood from time to time.

Cystic fibrosis is one cause of bronchiectasis and she should be checked for this with a “sweat test”.  She needs to see a specialist to make a definite diagnosis. The prognosis is good with careful treatment by an expert. 

Let me know.

Dr. Tom

 

Can Anxiety Cause Shortness of Breath (SOB)
Q. Does extreme anxiety effect the sob with COPD. Thank you for your web site.

Shelby

A. Dear Shelby, Yes, anxiety may cause too much breathing, known medically as “hyperventilation syndrome”. It subsides with exercise.

Dr. Tom

 

Promoting Lung Health
Q. Dear Tom, Hope all is well with you. I have continued to promote lung health up here in Bowmanville Ontario. Thanks again for all the help you provided me with in the years past.  This is a wonderful website. Best Wishes.

Bob

A. Dear Bob, Thanks for the good wishes. It is nice to be appreciated.

Dr. Tom

 

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