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Archive: Dr. Tom 39
Posted August 10th, 2005

Bronchiolitis Obliterans Organizing Pneumonia (BOOP) and Lung Biopsy Recovery Time
Q. I was recently hospitalized for B.O.O.P. and had an open lung biopsy. How long does it normally take to recover from the procedure? It's been a month, and while I will be on prednisone for awhile I would like to get back into a more active physical regimen but the area where the biopsy was performed is still quite painful.

Kathryn

A. Dear Kathryn, It depends on what type of surgery was done. If it was an open lung biopsy, with a four-inch incision, about one to two months. If done by video-assisted thoracoscopy, VATS, it should be well healed by now. Better ask your surgeon.

Dr. Tom

 

Is smoking the Cause of the Bullae?
Q. I had a lung scan that revealed a large bulla (aired filled thin walled space in the lung) measuring at least 8 cm at the right lung apex. There are mild emphysematous changes at the left apex. Lungs are otherwise clear. I have smoked off and on for 30 years. Is this what caused the bulla? What can I expect or do now?

Tom

A. Dear Tom, The smoking caused the underlying emphysema, but not the large bullae. They are result of a weakness in local areas of lung development that you had at birth. Stop smoking and get the bullae taken out, if you have symptoms.

Dr. Tom

 

Worried about Mother on Ventilator
Q. Hello Dr. Tom, I am writing to you regarding my mom. She is currently on a ventilator.

Her story starts to the beginning of this year. She lost a lot of weight and experienced shortness of breath. Two months ago, she was started on Xanax (anti-anxiety medication). After two doses, I had to take her to the hospital; she stopped breathing later that night.

The doctors sent her to another ward to wean off the ventilator. During this time, she experienced 2 UTI's (urinary tact infection) and she was diagnosed with cacner of the breast and had a mastectomy of the right breast.

Weaning was not successful. Medically, doctors could not understand. So, she was transferred to another hospital. She is extremely weak, and I think if her strength was rehabilitated she may be able to breathe on her own. She is currently initiating her own breaths. Have you experienced anything of this sort with your patients? She is only 62 years and a non-smoker etc.

Sharan

A. Dear Sharan, Yes, she should definitely be able to be weaned, if it is done by experienced personnel. Today there are hospitals that specialize in weaning the ventilator dependent patient, such as Kindred Hospitals. I don't know if one is available in your area, but you should inquire.

Dr. Tom

 

Recently Stopped Smoking, What do You Think of Pulmonary Function Test Results?
Q. I am a 32 year old female, 5'2 141 lbs. I'm a previous smoker of 1 pack a day for 13 years, but quit June 15! I'm very proud of that (wish I could've quit sooner).

I have had SOB (shortness of breath) for the past year or so. I went to a pulmonologist in June and these are my PFT (Pulmonary Function Test) results. I am currently on pulmicort once a day and albuterol PRN (use as needed). Please tell me what the PFTs show.

I had a great response to the bronchodilator which is a good sign right? I'm just kind of scared as I am so young and these results don't look so hot! The pulmonologist said I have asthma, tell me what you think.

FVC             84%pre      96% post
FEV1           56% pre     67 %post
FEV1/FVC   53% pre     56%post
TLC1           83%
RV               397
TV/TLC       66
VC               84
DLCO          56

Will these numbers improve now that I quit smoking and will my lungs repair? Chest x-rays clear and lungs sound good. Thanks in advance for your quick reply!! PS.I have severe allergies...could this be part of it

Kanne

A. Dear Kanne, You probably do have asthma, but with some degree of emphysema as shown by the low diffusion test, DCO. However I do not know if this low value has been corrected for your large lung volume. Ask your pulmonologist.

In any case the functions are really pretty good, and it is great that you respond so well to bronchodilators. You should be able to lead a normal life and have a good life expectancy, since you stopped smoking. Never start again and avoid smoky places.

Follow your pulmonologist's advice about long-term bronchodilators and inhaled corticosteroids, i.e. Pulmicort.

Dr. Tom

 

Safety of Qvar?
Q. How safe is it to use Qvar for COPD flare-ups when a woman is past menopause and may have osteoporosis? Also, is it safe to have wine with it?

Terri

A. Dear Terri, Yes, Qvar is safe, even with some osteoporosis. It can be taken with wine. Enjoy your meals and be confident.

Dr. Tom

 

Short of Breath with Some Activities and Not SOB with Other Activities
Q. Why can I swim one half mile and not even breathe hard and yet get winded with two flights of stairs? And what is your opinion of Combivent for COPD?

Art

A. Dear Art, When you swim, you inhale very moist air. When you walk up stairs, you are often breathing in dry air. It is the level of humidity that makes the difference. The water vapor inhibits a trigger to bronchospasms caused by dry air. Combivent is great for COPD if it relieves symptoms and improves airflow.

Dr. Tom

 

Appropriate Treatment of Pneumonia
Q. I have a few questions about Albuterol. I am currently a respiratory therapist at a small rural hospital. Our physicians/nurses (and some therapists) seem to want scheduled Albuterol nebs for practically every patient with pneumonia. Do you think that is really an effective treatment? From what I have learned in school, pneumonia is a restrictive lung disease. About 90% of the articles I read, said nothing about bronchodilators in treating pneumonia.

Do you think that Albuterol really helps to mobilize secretions? Isn't it considered a rescue medication? Can a person build a tolerance to it? It just seems to me like one of the most abused drugs on the market. Unless a patient has an obstructive disease on top of the current pneumonia, I don't believe bronchodilators are effective. How about incentive spirometry, antibiotics, deep breathing? Any comments would be appreciated.

Matt

A. Dear Matt, Albuterol does not treat pneumonia. In theory it can stimulate mucociliary clearance. This response is usually not blunted by frequent use. I agree that albuterol for the purposes you describe is overused, too much reliance on it. Incentive spirometers or any deep breathing techniques, also help mobilize secretions. Good questions.

Dr. Tom

 

Preparing to Work for the AARC
Q. What do I have to do to prepare myself to work for AARC?

Susie

A. Dear Susie, Get ready of an exciting challenge. I applaud the work of the AARC. They are on the cutting edge of patient care and education of many health care professionals interested in pulmonary and other patients. Have fun!

Dr. Tom

 

Best Place to Live with COPD?
Q. Where in the USA would be the best place to live with COPD?

Sarah

A. Dear Sarah, There is no perfect place for all patients with COPD. In general a low altitude and a mild dry climate are suitable for most patients with advanced disease. Those with mild to moderate degrees of impairment can live anywhere they like, except at very high altitudes, such as greater than 6000 feet.

Dr. Tom

 

Racemic Epinephrine Dosage
Q. Is there a way to mix racemic epinephrine for use in a handheld neb (HHN) such as using epi 1:1000 solution (.5 mg) mixed with 2 to 3 cc of normal saline?

Todd

A. Dear Todd, Perhaps your pharmacist can answer this. Primatine mist contains epinephrine. Racemic epinephrine is an old drug that used to be widely used in a hand-bulb nebulizer. I have not seen this in practice in the past 30 years.

Dr. Tom

 

Trouble with Breathing for a Year
Q. A year ago, after a bad cold and a persistent cough that lasted weeks, I ended up in the ER with difficulty breathing. The doctor said the x-ray showed bronchitis, and sent me home with a diagnosis of bronchitis with wheezing and an inhaler.

However the situation got worse so a few days later I visited my primary care doctor and she diagnosed cough-variant asthma. I have been struggling with this for over a year now, and have had problems because I have terrible coughing fits, especially at night, some of which are not responsive to Albuterol. Advair seems to make them worse, though it helps my breathing.

I went to a pulmonologist yesterday, who said the new x-ray showed the same level of bronchitis as before and that my lungs sound bronchial. My lung function tests were normal and my x-rays were good other than the bronchitis.

I will be doing a CT scan and a methacholine challenge (a test that can identify people with “sensitive” airways, often used to diagnosis asthma) next week, but in the meantime he didn't make any suggestions about the bronchitis, and I forgot to ask.

Why would I have bronchitis for a year? Is something to worry about? I have never smoked. Thanks.

Shannon

A. Dear Shannon, A chest x-ray is not a good way to diagnose bronchitis. The findings are subtle and nonspecific. A CT scan would show airway thickening. The methacholine challenge will help to identify bronchial hyper-reactivity, that is the hallmark of asthma, but may occur in chronic bronchitis. Most patients with chronic bronchitis do smoke, but about 15% do not. They may have some other cause such as an asthmatic component, but Advair should help this. There are a myriad of other causes of chronic cough, and hopefully your pulmonologist will be able to sort this out.

Dr. Tom

I Have Trouble Breathing, What Should I do?
Q. I was just diagnosed with COPD in April and I am having a hard time breathing even when shopping. I was wondering if I should talk to my doctor about an inhaler and should I have a pulmonary doctor?

Sandy

A. Dear Sandy You should definitely see a pulmonologist, or an internist with a large experience with diagnosing and treating patients with COPD. If you smoke, you must stop. Most patients with COPD get symptomatic relief from bronchodilating aerosols that are inhaled from convenient hand held devices.

Dr. Tom

 

Damage from Smoking
Q. I was wondering if I did any damage to my air sacs in my lungs from smoking if they can recover/regrow?

Matt.

A. Dear Matt, There is no evidence that any drug will help the alveoli of the lungs regrow, as was once thought. But by stopping smoking, the damage can be stopped, and you can lead a normal life with the expected life expectancy of someone your age.

Dr. Tom

 

Questions about Cold Medicines
Q. In February I was diagnosed with mild COPD. I have never smoked nor has anyone in my family. I am on Spiriva at the present time. I was on Advair 100/50, but it made me too hoarse.

My question is, when I feel like I might be catching cold, I use Zicam (over-the-counter homeopathic medicine) and Coricidin HBP (over-the-counter cold medicine for people with high blood pressure). I also use Zicam for sinus problems. Is it all right to use these products, or will it cause irritate my lungs? I am going to try to get in with a pulmonary doctor soon.

Mary

A. Dear Mary, These products will not hurt. There is no good evidence that they work, either. Better see your pulmonologist and get on a good treatment program that controls your symptoms.

Dr. Tom

 

Lung Transplant for Father
Q. My father is a 92 year old man and having heart problems. He has a very good health otherwise. He’s 100% mentally sane. Do you think he could resist a lung transplant or is there any other way to improve his breathing problem?

Jesus

Q. Dear Jesus, Your father is far too old to consider lung transplantation. He has done well to reach such a fine old age. He just needs to continue to live and enjoy life as long as he can.

Dr. Tom

Coming to the End of the Long Journey of COPD
Q. I took the opportunity to read the questions and answers that have been submitted. Although they are very helpful and informative, none of them address the emotional issues that a person with end stage COPD has to deal with when they know they are dying.

I have an Aunt in Las Vegas who has been suffering with this dreadful disease for a long time. She never smoked a day in her life. I recently received a letter from her, and it felt like she was trying to say goodbye. What happens with the disease processes during this last phase of life and what can she and the family expect? How can we be supportive? God Bless her and all of you who have to work so hard for each and every breath to survive.

Carol

A. Dear Carol, Most patients with advanced COPD have anxieties and depression. They fear suffocating. But at the very end of life, as the carbon dioxide builds up gradually, there is relief of the symptoms of shortness of breath and it is a peaceful period, before the final transition. Death is not to be feared, but recognized as the normal end of human existence. But it is NOT the end of the human spirit. Have faith that your great aunt will be fine.

Dr. Tom

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