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Archive: Dr. Tom 44
Posted December 15th, 2005

Feel an Increasing Need for Oxygen
Q.
Two years ago I started out using a concentrator at night only. Then the doctor moved me to liquid oxygen, starting with 2 liters at rest and six when active.  I now am up to 6 at rest and 8 when active but I am still active. I am retired.  But every day I work outside my home, raking leaves, shoveling dirt, and cleaning typical home things.  Now I realize when I say,  "work," I do so for five minutes and rest ten. 

My question is this.  As my oxygen flow appears to need more assistance, I am concerned as to where this might be leading.  Any comment would be appreciated.

Bob

A. Dear Bob, Increasing the liter flow, is not often the solution to shortness of breath. Shortness of breath comes from the work you have to do to breathe. This is greatly increased in COPD.

Very few patients with COPD have an objective, that is a measured oxygen need by oximetry (a test that measures your oxygenation by using a machine called an oximeter) for those using oxygen for more than 4 liters. Better see your pulmonologist about this and have pulse oximetry done while you do various exercises.  Keep active!

Dr. Tom

 

Lung Problems
Q.
I have had pleural (the lining that covers the lungs) thickening of the right lung base and mid lung.  Doctors have ordered antibiotics but it doesn't do anything. One doctor said that I lack oxygen in my blood.

Greta

A. Dear Greta, Pleural thickening is usually a scar from an old infection. Antibiotics will not help this. Did your doctor measure the oxygen in your blood? If not, he is just guessing.

Dr. Tom

                                    

How Can I Improve My Oxygen Saturation?
Q.
I have been treated for COPD for a few years now. I currently use a concentrator at 2 liters. When I am home I work in the morning and my oxygen saturation levels at times get down to 42 with a pulse of 135. I am 76 years old. When I am on the oxygen concentrator, my saturation level runs about 72-78%.  Anyway can I improve that output when off the machine? 

Dave

A. Dear Dave, Your oxygen levels are quite low. Maybe you have interstitial fibrosis, and not COPD. 

The feeling of shortness of breath and your oxygen levels can be helped by “pursed lip breathing”; it will slow down the number of breaths you take and allows each breath to do more good for you.

Steps to Pursed Lip Breathing

  • Inhale slowly through your nose, with your mouth closed.
  • Slowly exhale through pursed lips, shape your mouth as you do when whistling. It should take you a longer time exhaling (blow out) than to take a breath in.

 

Dr. Tom                              

Source of pictures:
National Lung Health Education Program
Frontline Treatment of COPD:
PDF: http://www.nlhep.org/books/trtmnt_COPDed2.pdf or
http://www.nlhep.org/books/TrtmntCOPD/1_titlePage.html

 

Side Effects of Prednisone on Skin
Q.
I would just like to know what are the side effects to Prednisone.  I took this steroid often as a child when my asthma was at its worst.  Now it seems like my asthma is obsolete though I still take Qvar (an inhaled steroid used as a control medication) twice a day and Albuterol for emergencies.  I haven't had an asthma attack in over 10 years, but I am suffering with a condition that I was told by a dermatologist was caused from the use of steroids.

It starts with a bump that looks a lot like a mosquito bite, but it doesn't itch, it hurts and is warm to the touch.  Sometimes these bumps get about as big as the size of a nickel and sometimes it is about as big as the size of 3 quarters put together.  About a week later it goes down and sometimes forms a blister with this nasty white discharge.  After it is completely down it leaves an ugly black mark.  I have been getting these bumps for over a year now. 

My doctor tested me for diabetes but the results showed that I am not diabetic.  She referred me to a dermatologist who told me that this was a side effect to steroids, but the strange thing is, they only form on the front and side part of my legs and thighs. 

Do you think that Prednisone could be the cause of this, and do you know if the effects are permanent?  I am disturbed by the appearance but I am more concerned because I haven't heard too much about this condition.  I never wear skirts or shorts anymore!

Sonya

A. Dear Sonya, This is not from prednisone. Consult a different dermatologist.

Dr. Tom

                                  

Emergency Room Guidelines for CPAP and Bi-Pap
Q.
We use CPAP (Continuous Positive Airway Pressure, a machine that is used to help keep the airways open during sleep) in our emergency room often for the CHF (Congestive Heart Failure) patient.  Some doctors want CPAP others Bi-Pap (a machine that aids with oxygenation and ventilation). Can you think of an article or where can I look to find something I can show the ER (Emergency Room) docs exactly what Bi-Pap does vs. CPAP, how should be ordered, etc.

The more technical stuff than what I seem to find when doing searches is what I need. Something for more in the acute ER setting and not home CPAP/Bi-Papa or OSA (Obstructive Sleep Apnea) therapies.

Thanks.

Beth

A. Dear Beth, There are lots of articles in various journals about BI PAP used for non-invasive ventilation. Also on CPAP, which does not help ventilation, much, but has other beneficial effects on respiration. Consult the published literature.

Dr. Tom

 

Bothered by “Smoker’s Cough” yet Never Smoked
Q.
I'm 36 and have had a “smoker's cough” for my whole life.  I have never smoked. 

I was diagnosed with asthma in my 20's after a scuba-diving accident (don't ask).  I only wheeze occasionally, and have tried to keep taking Atrovent and Pulmicort regularly.  I have also been jogging regularly for the past 20 years (I am not very fast.) 

My question is:  how come I still have this embarrassing “smoker's cough?”  My spirometry FEV1 is usually normal, but my FEV1/FVC is usually around 70%.  Second question:  Is my smoker's cough going to turn into something worse, like COPD or emphysema. 

Penny

A. Dear Penny, This is not a smoker’s cough, since you have never smoked. It will not lead to emphysema. Of course you could have a smoker's cough if you are exposed to environmental tobacco smoke, such as in bars or restaurants, or other places. But you need a diagnosis. Could be mild asthma. Consult a pulmonologist.

Dr. Tom

                                                                      

Adair’s Benefits and Side Effects
Q.
My job is giving complete PFT's (Pulmonary Function Tests) and brief asthma education at the hospital where I work.  I have done almost 3000 PFT's and many of them have been patients with asthma. 

Many of the most recent asthma patients have stated that since they have been using “Advair” their symptoms have greatly decreased and life styles have improved.  Physicians state less emergency room visits for asthma.  I read recently about some bad side effects for using “Advair.”  What is your opinion about this?

Patricia

A. Dear Patricia, Advair is very helpful in the maintenance management of asthma. Side effects in the long term are due to the corticosteroid component, flutacisone. These may include cataracts, diabetes and skin changes. Even osteopenia (a decrease in the amount of calcium and phosphorus in the bones), but these side effects are not common.

Dr. Tom

                                   

Can Drugs cause Lung Problems?
Q.
I hope you can help me, as my situation is different.

Several months ago my wife started having a hard time breathing. She quit smoking immediately and went to pulmonologist, believing she had advanced COPD. Her PFT's were all normal and her pulmonologist says it is anxiety.

She has been on methadone for 12 years prior to an addiction to Percodan and Hycodan for eight years. I have read that long-term use of methadone can cause lung problems. Can you please give us any information on this? She is currently de-toxing from the methadone. Anything at all you can tell us or please guide us.

Mr. Travis

A. Dear Mr. Travis, Methadone will not damage the lungs, if used in prescribed doses. She does not have COPD since here spirometry measurements are normal.

Dr. Tom

                                    

Thick Phlegm
Q.
For the last month I have been coughing up phlegm. I do not have a cold and do not feel congested at all. The phlegm actually gets stuck in my throat and I almost make myself vomit to get it to come out. Could this be something to worry about?

Kim

A. Dear Kim, It certainly requires a diagnosis. Consult a pulmonologist.

Dr. Tom                        

                                 

Support Information for People Living with Tracheotomies
Q.
My mother had a trach (tracheotomy an opening surgically created through the neck and a tube is placed into the trachea/windpipe) put in about a year ago and that coupled with other health issues she has, has been hard for her to adjust. I was wondering if you had some suggestions of books she could read about people living with a tracheotomy. She is 59 years old and also on oxygen. I'd like to put her in touch with some books that aren't written for a medical professional, if possible.

Thanks! 

J.R.

A. Dear J.R. I do not know of such a book, written for patients. Sorry. DR Tom

You might want to try an Internet site called Aaron’s Tracheotomy. This site was started and is maintained by the Mother of a child (Aaron), who has a tracheotomy. The site is geared to children and their parents, however there is quite a bit of information that may be of help to your mother.

Dr. Tom

                     

Criteria for Post Bronchodilator Spirometry
Q.
In our PFT (Pulmonary Function Test) lab, we recently changed our policy on when to do a post bronchodilator study.  We do not administer a bronchodilator and do a post spirometry study on any patient who has an FEV1/FVC ratio of 0.70 or higher.  Does your PFT lab have the same criteria?  Do you agree with this?  Thanks.

Brian

A. Dear Brian, In general I agree. But I think that post bronchodilator tests are over rated. Quite a few patients do not show an improvement in airflow on testing with a single bronchodilator in the clinic or office. Later they may have a large effect if bronchodilators and sometimes, corticosteroids are prescribed. Just like blood pressure. You do not expect the antihypertensive to work in 20 minutes.

Dr. Tom

 

Looking for Dr. Wendell Petty
Q.
I'm trying to locate a Dr. Wendell Petty, who I'm told lives in Colorado and who is the owner of a building in Storm Lake, Iowa, that is of interest to me. A Dr. Wendell Petty in Idaho Falls, ID, referred me to you, thinking you might be of assistance. Thanks much for your reply.

Bill

A. Dear Bill, I have never heard of Dr. Wendell Petty. There are several other Dr. Pettys in Colorado, but no Wendell. Did you consult a directory?

Dr. Tom

 

Her Patient is having a Hard Time Finding CPAP
Q.
I am a respiratory therapist for a home care company.  I recently set up an elderly patient on   CPAP (Continuous Positive Airway Pressure is a machine that is used to help keep the airways open during sleep).  She is having a hard time using standard masks.  During her sleep study she wore a Small Comfort Gel.  She wore her dentures with this mask.  She doesn't normally sleep with them in. 

After she was set up at home with this same mask, she started having pain from keeping her dentures in.  She couldn't wear this mask without them.  We then tried to fit her with different masks all in which she felt weren't working. We tried the Petite comfort gel, Small Profile Lite, Breeze, Nasal Aire II, Respironics Full Face (Panic Attack), and the Swift. 

She is currently on the Swift, but unhappy.  Do you have any suggestions about a different mask?   It would have to be simple, easy to put on and adjust.  She has limited mobility.  Thank you for any suggestions, Amy

Amy

A. Dear Amy, You have tried all the masks that I know about. I admire your diligence. Sorry I do not have more suggestions.

Dr. Tom

                                    

A Request to Review DVD
Q.
Thank you Dr. Petty for previewing "Smoke Busters" years ago.  Feb 2002 we were in the Tulsa Newspaper together "Catching Your Breath" - (framed in my exam room).

I have recently upgraded "Smoke Brake" (change the name to match the theme) and would like for you to view it once again.  Dr. Grunberg is our scientific consult among others that is transforming it into one of the best programs (and freely available).  The DVD is now a 59-minute multi-media production. 

Steve

A. Dear Steve, I would be happy to review your DVD. Send it to my office at 899 Logan, Suite 103, Denver, CO. 80203.

Dr. Tom

                                                          

Pseudomonas and COPD
Q.
Dear Dr Tom, My elderly relative with severe COPD (more chronic bronchitis than emphysema- lots of mucus produced in lungs) picked up a nearly fatal pseudomonas infection (infection is caused by a bacterium) in hospital earlier this year. Eventually the infection was controlled and seemingly cured, but 2 1/2 months later the pseudomonas is back. It seems there is now a long-term colonization.

There is not much information about pseudomonas in COPD but there is a lot about pseudomonas in cystic fibrosis. Does chronic infection with pseudomonas in COPD follow the same path as in cystic fibrosis e.g. development of the mucoid form and then steady deterioration of the lungs?

Thank you.

Jennifer

A. Dear Jennifer, In general this is correct. You may want to try the inhaled Tobramycin an antibiotic used in CF, known as Tobi.

Dr. Tom

                   

Bad Taste after using Spiriva
Q.
Hi, I am currently taking Spiriva for asthma, and COPD. The problem is that it gives me a bad taste in the mouth, and sometimes I have a hard time tasting food because of this. Do you have any suggestions?

Terri

A. Dear Terri, Sorry, no. I have not heard of this side effect.

Dr. Tom

 

Oxygen Saturation Targets at Rest and with Exertion
Q.
I first heard your name 13 years ago by an instructor of mine (Jeff Kline) in Detroit. It’s a pleasure to finally talk to you. I am an RRT (Registered Respiratory Therapist) in homecare.

My question is in regards to oximetry testing while ambulating COPD and fibrosis patients. What are good target values for each (resting and with exertion)? Also what adjustments should be made so far as the liter flow to maintain these numbers?

Gerry

A. Dear Gerry, Liter flows should be monitored by pulse oximetry. Target saturations for rest and exercise are 90%-94%. It is hard to accomplish this in some fibrosis patients. Saturations in the range of 80-85% are well tolerated unless there is marked tachycardia (the heart is beating faster than a normal rate) or respiratory distress.

Dr. Tom                         

 

Worried about Mother’s COPD Diagnosis
Q. I need your advice desperately. I am an only child, nearly 30 and have just recently quit a heavy smoking habit. My mother also has quit, but unfortunately for her a little too late.

She has a terrible cough, and I managed to force her to get an X-ray. These are the results.

Moderate COPD  
FEV1 2.05(84%)
FVC 3.29(101%)
DLCO 50%

CT scan showed extensive emphysema right upper lobe, calcified pleural plaque.

He said she has borderline bronchodilator response. Pre bronchodilator FEV1 was 1.83 (75%) compared to post bronchodilator 2.05(84%), denoting a 12% change in FEV1. He said that she is a small group of smokers that have a susceptible gene to developing emphysema, and said I probably have it too.

How long can my mother live? Since she stopped smoking her cough is gone. I live in New Zealand, and want your advice please. I am trying to find out as much as I can. Can she expect to live longer than 10 years...or more?

Your advice would be appreciated. 

Angie 

A. Dear Angie, Your mother's FEV1 is pretty good. She should live at least 10 years, since she has stopped smoking. This assumes no other disease is present. COPD does cluster in families. The Alpha One Antitrypsin Deficiency (additional information resources are listed below) is the only proven hereditary risk factor that can be identified by a simple blood test. Your doctor will know about this blood test.

Dr. Tom

For more information on Alpha One Antitrypsin Deficiency see, Alpha 1 Foundation and/or Alpha 1 Net.

                                     

Peak Flow Meter Measurements
Q.
Peak Flow Meter (is a device that is used to measure the amount of air flow that can be expelled from the lungs) measurements: if I did three measurements and got 165, 175, and 185 do I have to do one more or take the average?

Alzahrani

A. Dear Alzahrani, Take the top one. Peak flow is just that, i.e. the airflow at the instant of maximum flow. It varies with effort. 

Dr. Tom

 

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