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Archive: Dr. Tom 45
Posted January 3rd, 2006

4th Grade Student Needs Help with Science Project
Q.
Dear Dr. Tom, I am a 4th grade elementary student and I have a question about measuring lung volume.  I have chosen this for my science fair project because I wanted to do a project in the math category. I also suffer from asthma.

I am going to measure lung volume by blowing into a balloon and then figuring out the volumes. I will do the experiment as a sort of bronchial challenge test - exercise in cold weather will be the trigger and I will repeat it before and after taking my Advair (my doctor says it is safe for me to do this as my asthma is not so serious). 

I would like to know what are the most meaningful measurements to take. I was thinking of doing FEV, FEV1 and Tidal Volume.  Or would it be enough just to do FEV?

I also really need to know how to read my results after I do the experiment.  What would be a normal range for a kid of my age?  I am 10 years old.  I am 51.5 inches tall and I weigh 66lbs.       

I do have a peak flow meter but I'm not sure this is useful in the experiment.  Do you think so? A spirometer is difficult to get hold of and they are too expensive. Also, what information would I need to plot a flow volume loop graph?

I hope you can help me with these questions and thank you for your time.

Olivia

A. Dear Olivia, You have asked very good questions. Do not try to use a balloon, because the elasticity of the balloon will compress the volume some, and this elasticity will change each time you blow up the balloon. It gets overstretched.

Spiromerty measures both flow and volume. Asthma affects flow more than volume. I think using a peak flow meter would be fine, before and after a cold challenge. Then you would block this effect with your Advair. Flow volume curves give flow over volume, which is the same as standard spirometry, which is flow over time. They show the same thing, but in a different way.

There are some cheap spirometers such as Koko Peak, but these give peak flow and FEV1, but not the whole volume, which is FVC, as you know.

At age 10 and 5-1 inches, and female, I assume, your FVC would be 3.08 liters and FEV1 2.87 liters, but the charts start at age 20. There are predictions for "kids", but they are variable, by race and other factors.

I think your experiment would be good, just using peak flow, which is a snap shot of flow. Get a baseline, then after a cold challenge, and then later after Advair. Do the tests on successive days. Let me know the results. I am so pleased you are interested in lung and lung function.

Dr. Tom

 

Having Trouble Getting a Home Ventilator that Meets the Changes Prescribed by the Doctor
Q.
I have used pressure ventilator for 11 yrs. due to post polio. I recently had a sleep study and the doctor ordered a new VPAP S/T with settings of 18/4, with a back up rate of 6. My medical care supplier will not order the VPAP until my old Quantum breaks.  The Quantum’s are no longer made and I need something I can count on since as I use my Quantum 12-15 hours a day.  It has broken three times and it takes 3-4 months to have it fixed.  Any ideas???

Jean

A. Dear Jean, Get a new supplier. Let the Quantum stay broke.

Dr. Tom                             

                       

Having a Sharp Pain in Lung Area
Q.
Dear Dr. Tom, I am a 39 year-old female and I have smoked for 27 years. For the past three years I have been smoking a lot about 2 1/2 packs a day. I have times when I will get an odd sharp pain in my lung area it is extremely sharp and when I breathe deeply it is almost unbearable so I have to take shallow breaths. It is almost like a catch it also is worsened when I stretch out. However, I know from experience of this that if I will stand up and stretch it out and take a deep breath it will hurt very badly but then goes away.

I am wondering if it could be an air bubble and let me explain why I ask this. About 10 years ago I had a lung collapse on me while I was sleeping, I went to the hospital and they inserted a chest tube (insertion of tube into chest to allow lung to re-inflate) but it took 5 days due to some complications. During that time the doctor had technicians bring a large x-ray machine to my room and the doctor would tell me that I still had an air pocket in the top part. The pain that I feel now is the same kind of feeling of where that air pocket was then. Then I could feel pain in the area of that air pocket when I would breathe deeply. The pain I am describing is the exact same as when my lung collapsed yet it goes away like I said when I stand and stretch and take in a deep breath. It takes me a long time to get myself to do that though because it hurts so badly.

Recently like for the past three days I have been having this happen 4 and 5 times a day. They are brief like for a minute or so and then I do the deep breath and it goes away. I am just hoping you can tell me if this is something to be concerned about. I have had this going on for years but never like this as far as the frequency. Thanks so much for your time.

Hannah

A. Dear Hannah, It sounds like you may have an adhesion (adhesions are fibrous bands of scar like tissue that form between two surfaces inside the body) of your pleura, the lining of the lung, which is related to the old lung collapse. I think your stretching exercises make sense, even if they hurt. Maybe try to take some Advil or another drug to relieve pain when you stretch. Ask your doctor. 

Dr. Tom

                                   

Environmental Pollutants and Effects on the Lungs
Q.
Dear Dr. Tom, I would like to know the possible effect of continuous exposure to diesel exhaust and coal burning fumes unleashed in the environment where we live. We are a group of middle-aged citizens suffering of unusual respiratory symptoms. 

I have developed asthmatic bronchitis and have been diagnosed with thickening of the right lung.

Hope your answer can make light on this matter.

Thank you for your time.

Gina

A. Dear Gina, It is possible that the air pollution is causing some problems, yet unlikely in most cases. You might want to contact the EPA (Environmental Protection Agency) if you really have exposure to excessive air emissions.

Local air quality and ozone information can be found at this EPA site: http://www.epa.gov/epahome/ozone.htm

Dr. Tom.  

                                   

Having Back and Chest Pain Since Starting CPAP
Q.
I started on a CPAP (is a machine that is used to help keep the airways open during sleep) 2 years ago, for minor sleep apnea.  Since then, I've been having bad chest and back pains that come and go. I also have acid reflux and take Nexium BID (twice a day). 

Four months ago I had my gall bladder taken out.  The chest pains and left arm and side (rib cage) pains have increased also.  My doctor says it’s a nerve problem in my shoulder and my reflux, nothing to be worried about.  I've had my heart checked-stress echo was fine.  What should I do?  Thank you!

Shaun

A. Dear Shaun, You should not be having any reflux with Nexium twice a day. This needs an explanation, such as an esophogoscopy, i.e. a tube to look directly into your esophagus. I do not know what is causing the chest pain. You need consultations to find out all that is happening.

Dr. Tom

                              

How Can I Get a Clear Picture of my Condition?
Q.
Dear Dr. Tom, I am a 58 year-old woman & was diagnosed with COPD a year & a half ago.  I have had 2 PFT tests (Pulmonary Function Tests) within the past year.  On both occasions I was unable to blow out enough for the technician to even get a sample (practice) reading. 

I recently had 2 Cat Scans that showed E, but I don't know to what degree.  My doctor has said that he is concerned about the asthma component I didn't even know that I had asthma until this year. 

My question is are there any other methods to get a general idea as to what your stats are? My O2 readings are usually between 93-95 & my doctor doesn't think I will need oxygen for at least 10 years.  He does feel that my E is in the moderate range. 

He would like for me to have a sleep study but since I use the VA Hospital in Atlanta there is a year waiting list for the sleep lab.  I have a great deal of sleeping & staying asleep & occasionally wake SOB (short of breath).

Any advice you can give me would be appreciated.

Patti                                   

A. Dear Patti, You should be able to blow into a spirometer to get a measure of your lung function. An experienced pulmonary function technician can help you do this.

Dr. Tom                          

  

Need Help to End the Confusion about the Condition of Father-in Law on Mechanical Ventilation in ICU
Q.
My father-in-law is in ICU with complications arising from a colostomy.  Today is day 40 since the operation.  He had pre-existing pulmonary fibrosis and is now on mechanical ventilation via a trach tube (tracheotomy tube, is a tube that is inserted into trachea/windpipe through an opening that has been surgically created ). It was likely needed due to sepsis and the fact that he aspirated a CAT scan marker dye during intubation (a tube that is placed in a person’s airway to deliver oxygen, and medication). 

There is no physician consensus for his prognosis in the ICU, and repeated questions and the resulting answers suggest there is no consistent plan for weaning (a planned process to remove a person from a mechanical ventilator), although there does appear to be ad-hoc nurse efforts.  Attending physician prognosis wildly varies from hopeless to helpless. 

We want to begin discussing options with my father-in-law, as he is mentally alert, but don't know where to start.  How can we get help to evaluate his condition and consider alternatives such as special care facilities, for weaning and rehab (rehabilitation), or home ventilation? 

We've been told there is no single physician who is the lead for getting an aligned voice.

Mark

A. Dear Mark, You need a "take charge physician". Insist on one! There are special hospitals that deal with ventilator dependent patients, such as Kindred and others. Inquire if such a facility is available in your area and try to arrange a transfer. Weaning needs to be systematic and follow a definite strategy to be successful.

Dr. Tom

                                                                   

Two Questions; Spriometry Results and What Causes the Fatigue Associated with Chronic Bronchitis?
Q.
Hello Dr. Tom, Firstly Happy Christmas to you and your family, thanks also for your dedication in maintaining this site over the last year.

Secondly I have two questions you might help me with.

The first one relates to the FEV1/FVC ratio, in the presence of a Normal FEV1- does anything over 70 exclude an obstruction? I ask this because I have seen predicted values for the FEV1/FVC ratio for a male my age and height at 82. Mine is between 75 and 77.

My second question relates to tiredness and chronic bronchitis, what is the reason for this tiredness, what is the process that causes this?

Thanks again Dr. Tom.

Conn

A. Dear Conn, I am glad to provide advice via this service.

The FEV1 and FVC are best compared with percent of predicted values for each, based on age, sex and height. The percent predicted of the ratio, is not used much and can be confusing. The normal FEV1, percent of FVC is >70%. Less than 70% is an indication of airflow obstruction IF the FVC is normal. A high percent suggests a restrictive ventilatory disorder.

Tiredness often comes from the effort in breathing and physical deconditioning.  

Dr. Tom

 

Racemic Epinephrine
Q.
The dilution ratio and clinical data of continuous racemic epinephrine therapy to ped's (pediatric) patients.

Rob

A. Dear Rob, I do not know what you are asking here.

Dr. Tom

                                   

Help in Understanding PFT Results
Q.
Can you help me understand my PFT results? I was a very heavy smoker for 25 years and have quit. My doctor says I have mild emphysema. Here are my results:

FVC 85%
FEV1 76%
FEV1/FVC 73%
FEF25-75 52%
TLC 106%
RV 141%
DLCO/VA 87%

 

Thank you.

Kim

A. Dear Kim, Forget the FEF 25-75%. This is misleading and should be disregarded.

All of your other results are within the normal range, except RV, which is high, indicating that you do not empty your lungs normally. This is called air trapping. These results can indicate some small airway disease, but your over all function is good and you should remain healthy, now that you have stopped smoking.

Dr. Tom                        

                                   

Inappropriate Use of Albuterol Inhaler
Q.
How can you tell if someone is misusing albuterol inhaler, if they really don't need it? If they are using it to get a buzz.

Karen

A. Dear Karen, You don't get a buzz from albuterol if used as directed, which is 4 to 6 times a day, with two puffs. If more than this is used, it may be to get a feeling of a high. Dangerous.

Dr. Tom

 

Croup Tents
Q.
What are the protocols to croup tent use and where can I find studies that claim the use of croup tents are overrated?

Kathryn

A. Dear Kathryn, I have not used a croup tent for years, being an adult physician. Sorry I cannot give you advice here.

Dr. Tom

 

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