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Archive: Dr. Tom 41
Posted November 28th, 2005

Pulmonary Rehabilitation
Q. What are some respiratory rehabilitation exercises or a web site that shows or explains them?  This is for my sister with COPD.

Marge

A. Dear Marge, There are many textbooks and manuals that describe the exercises used in pulmonary rehabilitation. “Advice for COPD” patients for all aspects for care, is available on www.nlhep.org and other sites.

Dr. Tom

 

Spirometry Results
Q.
I had a spirometry test at the mall, because it’s lung month. The result of my FEF 75% was only 61.6%, what does that mean? She said it had something to do with the small airways. I have had to take short small breaths more than usual, I’ve had cramps under my breasts and soreness in center of chest. The x-ray came back normal. Any ideas? Or is it just anxiety?

Vivian

A. Dear Vivian, Forget tests such as FEF 75% or FEF 25-75%. They really do not indicate small airways disease, which is a common belief. Only the FEV1 and FVC have clinical relevance. You should be relieved and not anxious about your breathing.

Dr. Tom

                                   

Worried about Dad’s COPD Symptoms 
Q. Hi, My father has emphysema. He has been SOB (short of breath) when he wakes up in the morning as he tries to get dressed etc. He's using oxygen at night and that was helping, but now it's not. Should he turn up the oxygen, the number of liters... or what can he do? I keep telling him to go back to pulmonary rehab but he doesn't seem to be able to.

Can he get a respiratory therapist to come to his house? Does he have to get his doctor to prescribe that?

Maryann

A. Dear Maryann, Increasing the oxygen flow will not likely reduce shortness of breath. This comes from the increased effort to breath. You father needs medications to help his breathing. I do not know if pulmonary rehabilitation services in the home are available in your area. Ask a local pulmonologist.

Dr. Tom

 

Medications and Primary Pulmonary Hypertension
Q.
I have taken Adipex (diet medication) for 20 years. If I haven't gotten PPH (primary Pulmonary Hypertension) yet, do you think I won't ever get it?

Mia

A. Dear Mia, Probably not. But be careful about any dietary medicine. Some are safe, and others are related to the development of pulmonary hypertension.

Dr. Tom                                 

 

Can You Use Inhalers on an Airplane?
Q.
I use an Albuterol inhaler for asthma.  While traveling recently, I was wondering if it is ok to use the inhaler on an airplane, where the pressure difference from the ground could change the amount of medicine supplied in each puff.

Jeremy

A. Dear Jeremy, Yes, it is fine to use inhalers on aircraft. The cabin altitude is between 5000 and 8000 feet, depending on the aircraft. This is like being in Denver, Salt Lake, Albuquerque, El Paso, and many other places. 8000 feet is like being in Aspen, Colorado, or other mountain resort areas.

Dr. Tom

 

Questions about Mother’s Tracheostomy
Q.
My 65 year old mother has a stroke 2 weeks ago after brain surgery for the removal of a tumor.  She currently has a tracheostomy (an opening surgically created through the neck into the trachea/windpipe).  For the last week and a half the doctors have been trying to deflate the cuff to wean her off although she is not coping. 

How long can you keep a patient on a trach?  How likely is it that she will be able to have it removed?  Her stroke was quite severe.  She is unable to talk and has no movement in her left side.  She follows basic instructions.  Please help - this has been a terrible time for our family and we are finding it extremely heard to get many options or answers. 

Marina

A. Dear Marina, A tracheostomy can be used indefinitely. It provides a route for suctioning secretions, and food, if it is "aspirated" i.e. "down the wrong way". This is common in stroke.

Dr. Tom

 

Niece has Exercise Induced Asthma
Q. My niece (16 years old) has been diagnosed with exercise-induced asthma (EIA) and continues to have attacks (as well as dizziness) daily at sporting events. She is currently taking:

Advair 500/50 1puff, BID (twice a day),
Singular daily
Zyrtec daily
Albuterol 1puff 15min prior to and 1puff immediately before exercise
Intal (same schedule as albuterol)
Weekly allergy shots

She has a noted heart murmur and her mother read an article relating to athletes diagnosed with EIA and actually having a heart condition, she thinks the initials for that condition were HCI.  Could you explain to me what this condition may be?

 I appreciate your concern, she is an excellent and well- conditioned athlete and this is very frustrating for us all.

Lindy

A. Dear Lindy, She is probably referring to HSS, which is Hypertrophic Subaortic Stenosis. HSS is a narrowing of the passage out of the left ventricle (main heart pumping chamber) due to enlargement of the heart muscle in ventricle area. It can be confused with EIA.

With all the medications, there should be complete control and prevention of the EIA.

Since a murmur is in the picture, HSS would be a consideration. Need to see a pulmonologist or cardiologist about this. 

Dr. Tom                                    

                                   

CT Scan Shows Heavy Calcification and Scarring
Q. I have recently had a chest x-ray, it showed some calcification of my lungs, and so I was sent to have a CT scan. The results of the CT scan said I have heavy calcification on the left lung from the apex to the diaphragm and scarring on the right lung. I was asked if I worked around asbestos.

I have not knowingly ever been around asbestos. I have not even lived more than 8 years in one place in my entire 47 years of life. I have lived all over the southern US along with a few other states and have lived in Germany and Romania a total of about 5 years each.

My doctor is testing me for TB, but I was tested only a year ago for my work. What other than asbestos can cause this? What are the problems that can occur with this, will it continue to get worse? What can I do?

I had a PFT and can only hold 1.5 liters of air in my lungs. I do get short of breath when exercising or walking fast.

I have 3 Harrington rods (surgically inserted rods used to treat spinal abnormalities) in my back from scoliosis. I have had these since I was 14 years old. My back doctor told my mother after the surgery that one of the rods is against my lung and therefore would have more limited lung space. I have had pleurisy, pneumonia, and bronchitis several times.  Could my body be trying to reject the rods and that is what is causing the calcification?

I am very concerned about these results. My doctor is sending me to a Lung Specialist, but can't get in until the end of January.  I am scared and very concerned. The CT did not show any cancer, so that is something to be thankful for. 

I also should mention, I can't get a hold of any past x-rays so far to compare. I had another PFT  (pulmonary function test) in Mississippi, but when I talked to the clinic, they said they didn't write any of the results down, just that I had the test, probably had asthma and gave me albuterol inhaler, and some Pulmicort.

My current doctor now has me on Advair and it is much better. Please reply so I know more of what to expect. 

Karen

A. Dear Karen, This is not a rejection of the rods. But if you have some scoliosis, this could be affecting your lung function.

The calcifications are not likely due to asbestos, since you have had no exposure. They are most likely a result of some infection in the past. You should not be worried about rapid or perhaps, any progression.

You do need to see a pulmonologist about this and there is no rush. He must be awfully busy to keep you waiting so long. Either wait, or find another pulmonologist who can accommodate you sooner.

Dr. Tom

 

What is the Treatment for COPD?
Q.
My 75 year-old mother has been diagnosed with COPD. Her main symptoms are chronic coughing and clearing of throat.  Shortness of breath is not a major problem.  What is the treatment for this?  Her doctor is not treating her for the cough.

Lisa

A. Dear Lisa, The answer to your question fills chapters of books and monographs. Get Frontline Advice for COPD Patients, which can be downloaded from www.nlhep.org, or from XLibris, or Amazon.Com. Dr. Tom

 

Quit Smoking is Life Still Shortened?
Q.
If you quit smoking does it still shorten your life?

Dallas

A. Dear Dallas, It all depends on the age at which you quit and the degree of impairment, if any, when you quit. No matter what, you will live longer and feel better, now that you have quit. Stay quit.

Dr. Tom

 

What is the Fastest and Safest Bronchodilator?
Q.
I work primarily with cardiac patients. What is the safest, yet fastest in bronchodilator for these patients when performing a pulmonary function?

Sam

A. Dear Sam, Rapidly acting bronchodilators include albuterol, pirbuterol, and ipratropium. The first two are beta  agonists and ipratropium is an anticholinergic. They work through different mechanisms. Some use both in testing for bronchodilator responsiveness. Available in a single MDI, known as Combivent.  Formaterol (Foradil), is also a rapidly acting bronchodilator, but has a duration of about 12 hours. It is not used for testing for bronchodilator responsiveness.

Dr. Tom

 

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