Questions about Spirometry Results
Q. Hello Dr. Tom, I had some yearly Spirometry testing done and my FVC is 62% and FEV1 is down at 21% from same time testing in 2005, the readings from last year were FVC 79% and FEV1 were 60% just to let you know. I was wondering if this is due to some meds that I taking for blood pressure or is it just a test that was not done correctly.
A little history might be useful here. I have a tracheotomy due to severe Obstructive Sleep Apnea but at rest my Pulse Oxymeter (a machine that measures your oxygenation) always reads 96% and up any ideas on this?
Also I used to smoke heavily but quit 5 years ago and I am now 42. I cough up clear sputum but I have a feeling this is due to the irritation of the tracheotomy and having this open to the elements.
A. Dear Yves, It is hard for me to believe that your FEV1 is down to only 29% of normal so quickly. You need a diagnosis, and confirmation of these results. Maybe the test was faulty due to the tracheostomy. You have normal oxygenation.
Worried about Reoccurring Lung Infections
Q. I'm a 29 yr old male, 6'2" tall, and 183 lbs. For about 8 yrs I've had reoccurring bronchial infections, and pneumonia. I have constant throat and lung clearing of clear mucous, and chest pain. I've been checked and tested for what I feel like is everything, I've had a stress test, and EKG, and both were perfect. I've had lung function tests, which I pass with flying colors, sinus CT, lung CT, blood work, HIV testing, and all were okay.
They say I have post nasal drip, but I can’ t feel anything running down my throat, the doctor currently has me taking Mucinex to help clear mucous, which it seems to work great, I just have to take it all the time. Claritin-D for possible allergies or PND, (post nasal drip) and I prescribe myself a regiment of Vitamin-C 6 grams, and daily multi vitamin. These things just seem to mask symptoms. I want to know why I am producing excess mucus. Allergies are a possibility because they do run in my family, but I did have allergy testing with no results. I'm very particular with what I eat, no yeast, gluten free, healthy eater, but all this still does not seem to matter.
Finally I was diagnosed with severe GERD (Gastroesophageal Reflux Disease) and I decided to have surgery done since medication did not seem to help. I had Nissen Fundoplication (anti-reflux surgery) and I have felt better since. It seems to have lessened my symptoms but they still have not gone away all together.
Every day I still have difficulty breathing, chest pain, cough, constant throat clearing, and clear phlegm. I can blow 700 on the peak flow meter every time (a Peak Flow Meter is a portable hand-held device that can be used to in the home to measure lung function) so the Doc. said I don't have asthma. I've never smoked, and I don't use any types of drugs. My only bad habit is alcohol once or twice a month.
I think the doctors here in Green Bay are giving up, I don't know where to turn. I feel like a kid living in an old mans body, some days I cough like I’ve smoked for 50 yrs. There is no reason I should have a lung problem, I never had any issues in childhood, or in my teens, this all began at age 22. I think I truly need the help and advice of an expert in this field. Please help
A. Dear Cory, You may have some problem with your immune system. See a pulmonologist or an allergist.
Oxygen Delivery Devices for People Nasal Passage Problems
Q. My father was recently diagnosed with pulmonary fibrosis and was prescribed portable oxygen and a concentrator. Unfortunately he has suffered from nasal problems for years and generally breathes through his mouth so the nasal cannula isn't as effective as it should be. Is there another delivery system that might help him?
A. Dear Lynne, He could use a mask. Another possibility is Trans Tracheal Oxygen, i.e. oxygen delivered directly into the trachea (main windpipe). This works well for many pulmonary fibrosis patients, particularly when they require high liter flows. It is a simple procedure done, usually by an otolaryngologist, working in conjunction with a pulmonologist.
Usefulness of Albuterol and Atrovent in the Treatment of Pneumonia and Bronchitis
Q. Dr Tom, I am a Respiratory Therapist with 22 years experience, and I have recently had a "dialogue" with a Family Practice MD in regards to the administration of HHN (hand held nebulizer) with Albuterol and Atrovent in the patient with Pneumonia and/or Bronchitis. He asserts that the nebulizer treatment is "useless" and not indicated. Could you give me some feedback?
A. Dear Jamie, He is probably correct if it is pneumonia without complicating bronchospasm.
Lung Reduction Surgery Results
Q. I have had lung volume reduction surgery, what is your general opinion & prognosis after this surgery, i.e. treatment, medications, & usual life span of the patient? Thank you
A. Dear Margaret, This surgery is helpful in improving quality of life in selected patients. You should remain active and hope that you get a good long-term result. It does not improve length of life in groups of patients, but may be remarkably successful in some.
Worried About Son’s Health
Q. My 21 year-old son had been home for Christmas but a week before the new term started he was treated with 5 days of azithromycin (antibiotic) for sinus infections. He was still feeling ill and went to an ENT M.D. who did a CAT scan of his sinuses who said he still had sinus infections and was put on Levaquin (antibiotic) for 21 days. He had 2 days of Levaquin and was feeling better and went back to school.
The day after he got back to school he called us to say that he was having severe right chest pain on inspiration. He was taken to the hospital where an EKG and chest x-ray was done and both were negative. A CAT scan with dye showed something in the right lung area where he complained of pain. The resident said he didn't know what it was, but called it a mass. The pulmonologist was called in and said he wasn't really sure what it was but he was going to call it an a-typical pneumonia. He did not have any other symptoms, no fever or cough just pain.
He told my son to finish the Levaquin that the ENT M.D. had put him on and he also started him on Prednisone. One dose was given intravenously before he was discharged. The next day my son felt better.
Is the prednisone masking something? Wouldn’t it be unusual to get pneumonia without fever and also since he was already on antibiotics wouldn’t it be strange to get pneumonia? Should I be content with this diagnosis?
I feel like the pulmonologist was taking a guess. Also is 21 days an extremely long time to be on Levaquin? Is another CAT scan a prudent thing to do?
My son is far from home and I am worried that a previously healthy guy within one week has been diagnosed with severe sinus infections and now atypical pneumonia. What would you do if this were your son? Thank you Dr.Tom.
A. Dear Laurie, I agree that the pulmonologist is guessing. It can still be an atypical pneumonia. 21 days of Levaquin is way too long. 10 days should be enough, in view of the other antibiotics. This presupposes that the Levaquin is treating a bacterial sinusitis. Does not take that long to treat atypical pneumonia. Prednisone may well be masking his symptoms.
In general I would not continue this, but remember that I am NOT giving you specific advice for your son. I do not have enough information to do this, and I DO NOT practice medicine on the Internet. Prediction: your son will be fine in about two weeks, no matter what you do. I believe a follow up chest x-ray is all that is needed.
Question about the Use of Vaseline When Oxygen is Being Used
Q. I am a registered Respiratory Therapist and there is much controversy regarding whether oxygen devices can be safely used with Vaseline, or other petroleum based products, on the patient’s lips? Can petroleum products be used while patient is on oxygen device? Is the hazard only with the oxygen equipment? Thanks for your time.
A. Dear Connie, The problem with Vaseline and other petroleum products is that combustion could cause a severe burn in the environment of oxygen. Use non-petroleum lubricants such as water based.
Can You Get “High” from Multiple Doses of Albuterol
Q. I found about 20 little plastic pouches of albuterol inhalants (all empty) in my teenager’s trash. Are there ways for them to use this drug to get high?
A. Dear Brenda, No, you cannot get high, but you could get dead! Seriously, heart rhythm disturbances can be caused by huge doses of albuterol, but this is rare. Tell him to stop the nonsense.
What Should We do about Son’s Tracheotomy Tube that is “Stuck”?
Q. Have you ever heard of someone's trach (a tracheostomy is an opening surgically created through the neck into the trachea, windpipe. and a tube is usually placed through this opening to provide an airway, and this tube is called a tracheostomy tube or trach tube) getting stuck? Our son went to have his changed and they cannot get it out and the doctors are not returning our calls to inform us on what they plan to do. This is all new for us.
Can leaving this in cause problems? They told us in the beginning that it had to be changed every month. We can change the cannula, but what are the risks of not changing the track?
A. Dear Mae, Probably no problem, but the trach canulae should be able to be changed with out forcing it. If the trach is old, it should come out easily and be replaced with no difficulty. Get your doctors to talk with you about this, or get someone who will.
I Have had Multiple Lung Collapses, What Can I Do?
Q. Dear Dr. Tom: I am a 38 year-old female. Back in 1987 and 1988 I had about 6 reoccurring pneumothorax (spontaneous pneumothorax is a collection of air or gas in the chest that causes the lung to collapse), all on the left side. In 1988 I had a left thoracotomy (surgical incision of the chest wall and often lung tissue is removed.) and resection (he surgical removal of part of an organ i.e. lung) of apical blebs and pleurodesis (a procedure to prevent recurrent fluid build-up between the lung linings). I was in good shape until December of 2005. I had another left pneumothorax.
I was admitted into my local hospital, where the ER (emergency) surgeon saw all the previous chest tube scars and ordered a CT scam so the Radiologist could put in the chest tube that I needed. The CT scan showed that I have Giant Bullous Emphysema (enlarged air sacks). They did get a chest tube in, and five days later I was sent home.
The lung has stayed up since then. My pulmonary doctor here has ordered a full pulmonary diagnostic testing for me in the middle of February 2006. He said other than saying my emphysema is 'significant' at this point, these tests will give him the numbers he needs to give me an accurate picture of just how bad I am. He also says that with my past history, I am likely to have a reoccurrence of another pneumothorax. At which time, he thinks I should have another thoractomy.
I think that I may have better options for surgery than just a thoractomy. I have a 20 month-old baby girl and want to be around to see her turn into a young woman. My questions to you are these:
1. What do these pulmonary diagnostic test show?
2. Can you refer me to a lung specialist/surgeon who has experience with Giant Bullous Emphysema and pneumothorax, in preferably the Pacific Northwest or Northern California. I live in Eugene, Oregon.
3. Do you think if I do have another pneumothorax that another thoractomy would be like putting a Band-Aid on a festering wound? Wouldn't it be wise to deal with the bullae that are causing my problem?
Also, any info you can provide to me regarding my situation would be very much appreciated.
A. Dear Denise, I would go to an expert. I suggest Dr. Louis Libby of Portland. He is in the Portland Lung Center. Use my name as a referral when you make your appointment.
You may have “isolated giant bullae”. These are large “bubble like” regions of abnormal lung development, which may occur in the absence of generalized emphysema. If this is correct, the whole region can be removed, leaving good lungs to fill up the space. CT and other scans such as ventilation/perfusion scans are used to prove and localize these areas.
A pulmonologist, such as Dr. Libby will also do a battery of lung function tests, to see what your overall capacities and gas transfer function are. You may well have a good prognosis, with definitive surgery.
Questions about Nuclear Stress Test
Q. I had a Nuclear Stress Test in August of 2005. The test revealed that there was blockage in an artery behind my heart. I forget what you call the test but they inserted a device in an artery in my groin and checked out the blockage and discovered it was 100% blocked. I subsequently had an Echo Heart Test and was told that there was no damage to my heart; the other arteries had taken up the work of the blocked artery.
I have now been told that they want to do another Nuclear Stress Test. Any idea why the Tx doctors would want this test redone? I am trying to have lung TX at the VA hospital in Madison, WI.
A. Dear Buford, They are probably evaluating you coronary arteries, i.e. the arteries that supply the heart muscle, to see if you have good vessels and function, to be able to withstand a lung transplant.
Questions about Pulmonary Function Test
Q. Dr. Tom, I am a 38-year-old Caucasian female, 156cm (5 foot one inch), 130lbs. Pulmonary Function Testing results are:
FVC (Forced Vital Capacity): 138% of predicted
FEV1: 127% of predicted
I hear that anything from 80- 120% is considered normal. I just wondered if there was any problem if higher than 120%?
But my diffusion (this test measures how well gases move through the lung and into the bloodstream) and airway resistance tests and Raw Airway Resistance (RAW) were 66%. Can this still indicate a COPD of some kind?
A. Dear Kirsten, You have super normal lungs and do not have COPD. The airway resistance measures do not fit you spirometry.
HIV (Human Immunodeficiency Virus) Testing and Diagnosis
Q. I took a HIV (the virus that causes AIDS) test about 6 months ago before my husband left for deployment (he is in the Navy) and another one two and a half years ago when I got out of the navy. I have not had sexual contact with anyone except my husband for almost 4 years, and I have had at least 3 AIDS (Acquired Immunodeficiency Syndrome is caused by HIV) tests (all negative) and I believe these tests have to be done before going on deployment.
I am 7 months pregnant and will get another HIV test done and my question to you is should I be worried about having the virus or is there a chance I might be a bit of a hypochondriac?
A. Dear Kim, I do not think you are a hypochondriac. Get another test if you are worried.
Effect of Higher Altitude on Son’s Oxygenation
Q. Hi Dr Tom, I'm trying to figure out the risk of moving from sea level to Denver to be closer to family. My 3-1/2 yr old son has Trisomy 21 (Trisomy 21 is also known as Down syndrome that is a chromosome abnormality, usually due to an extra copy of the 21st chromosome) and a history of secondary pulmonary hypertension (continuous high blood pressure in the pulmonary artery is caused by, or occurs because of another condition.). He had an ASD (Arterial Septal Defect, a child is born with a hole between the two upper chambers of the heart) repair 2 months ago and was on nebs (nebulizers), etc for lung damage due to ECMO (Extra-corporeal membrane oxygenation is a complex therapy that involves a pump that circulates blood through an artificial lung back into the bloodstream of a very ill baby), but is now past all that.
His last cardiac catheterization, in October 04, showed his pulmonary pressure to be 35. He requires a little O2 when asleep due to airway issues not lungs or pH (a measure of acidity and alkalinity of a solution such as body fluids) related. When not on O2 asleep, his saturations are 88-95%; awake he is 100% on room air.
Would living at ~5000' possibly cause his PH issues to return? Would he need O2 all the time or would his body adjust to the moderate altitude? Thanks so much. I suppose we wouldn't even consider such a move except for the other benefits being close to family would give us.
A. Dear Kate, Denver is not at a very high altitude. It might make a small difference. No way to predict for sure.
Want a Plain “English” Explanation of CT Scan of Lungs
Q. Hello, My husband has been going to a lung Dr. for about 3 yrs., he sent him to have a CT scan done on his lungs. Could you tell me what it means? The CT report reads:
1. Combination of central lobular emphysema, paraseptal emphysema and bullous emphysema in both upper lobes with prominent bullae in both pulmonary apices. Combination of paraseptal emphysema and pulmonary fibrosis with honeycombing in the periphery of both lower lobes. Linear fibrotic changes in the posterior subapical areas bilaterally.
2. Stable appearance of subcentimeter indeterminate nodules in the anterior and lateral basal segments of the right lower lobe since 01/12/2002 consistent with benign process.
3. Borderline precarinal adenopathy unchanged from 2002. Whole granulomatous disease with calcified left hilar lymph nodes.
Please tell me what this all means in English.
A. Dear Sheila, It means there are various areas of lung damage. It does NOT tell how his lungs are functioning as a unit. Get spirometry to tell about airflow and air volume. Also, perhaps a diffusion test to tell about gas transfer, and lung volumes.
Worried about Husbands Lungs Following Lung Surgery
Q. My husband was diagnosed with Stage I lung cancer and lost 1/2 of his lung. The next day his lung ruptured, and it took 30 stitches to repair it. Now almost 3 months later he is still wheezing and tiring easily. He is back to work, mid-management, doing well. Yet at night, if he has to talk long time, and or doing stairs he can get short of breath and does a lot of wheezing and whistling.
At his family doctor’s office today his oxygen saturation was 98% and x-rays looked good. They are referring him to a pulmonary specialist on Monday.
Can he be having serious lung problems with an oxygen saturation of 98%? Could it be asthma? Thank you, we are a little frightened.
A. Dear Mimi, Better go and see what the pulmonologist finds. I do not want to speculate.
Correct Way of Using Nebulizer
Q. Dr. Tom, What is the proper way of using a nebulizer?
A. Dear John, Depends on the nebulizer. What type and what medication? Your doctor or respiratory therapist should be able to instruct you.
A Dark Spot on My Lung was Found on CT Scan
Q. About a month ago I went to my doctor with a sharp pain in my chest when doing strenuous activity. After getting an x-ray I was told that I had emphysema and that there was a dark spot on my lung and a CT Scan was necessary and I was told that there was a 3milimeter spot on my lung and it would be necessary to get another scan in three months to check if it had changed. I was diagnosed with emphysema after x-ray but wasn’t even mentioned after CT Scan.
I had been a smoker of a pack a day for ten years but quit after this diagnosis. What concerns me is that I have no problems with my breathing or shortness of breath whatsoever. My father in law has emphysema and has one of those things that go on the end of your finger to measure your oxygen (an oximeter is a machine that measures your oxygenation) I borrowed this and it stayed a 99% all night. I even got on the treadmill for 25 minutes and it dropped to 98% for a brief second then went back to 99%.
I have no cough at all and the pains have subsided to a mild pain barely noticeable and infrequent. I was so concerned about the spot that I didn’t ask much about the emphysema and was wondering why if I had emphysema wouldn’t it be standard procedure to do test to see how bad it has progressed? It was diagnosed a month ago and when consulting about the CT Scan was so worried about that that I didn’t ask about the emphysema. However it seems that the doctor should have informed me of what to do about medication or oxygen or breathing classes or something.
I know that my father-in-law has had numerous tests done and attends classes and I am concerned that I should be doing something to slow the progression of this disease if I do have it.
A. Dear Gregory, Get a simple spirometry to tell about the functioning of your lungs. Sounds like you have good capacities. Oxygen is normal at exercise. The small spot is most likely benign, but does warrant a follow up to see if there is any growth.
Spot on Lung found on MRI
Q. I recently had a spine MRI, and although my spine is normal, I noticed a black spot on my lower left lung. I would say it's about the size of a golf ball. Does this mean anything? Thanks!
A. Dear Melanie, Yes, it needs explanation. It should be biopsied if there is a question of malignancy.
Worried about Father’s Breathlessness when Oximeter Saturations are Over 93%
Q. Dr Tom, My father is 85 yrs young and has PF (Pulmonary Fibrosis). I am sure he has had scarring for many, many years. He never smoked but worked heavily in construction. He was doing fine (light gardening etc) until about 3 months ago and just recently was in hospital with pneumonia.
They did not know for sure about the pneumonia though as his x-rays were obstructed by the scar tissue so they treated him as if he had an infection of some kind. He did great in hospital, eating and very upbeat.
Since arriving back home he seems so short of breath but when I take his oxygen level (I own a pulse oximeter) it is almost always over 93%. He has oxygen in the house when needed but if his sats (oxygen saturations) are so good what is the point of getting dependent? He was prescribed oxygen only when level was 89% in doctor’s office walking in from New York 95-degree heat!
I am very puzzled as to why he can’t even walk from one room to another if his saturations are so good? He is not on meds (medications) for lungs but is on Plavix (antiplatelet medication), Toprol (a beta-blocker used to reduce blood pressure), and aspirin. Also is on a systemic enzyme therapy.
Well my questions are: Does he need the oxygen even if his saturations are high? Will Spiriva or albuterol help with the breathlessness? Please help!
A. Dear Linda, Oxygen does not usually relieve breathlessness, because this is due to the effort of breathing. Better get a diagnosis and treatment from a pulmonologist.
Worried about Lung Cancer
Q. Dr. Tom, I have had chest pain and back pain for about 6 months. The chest pain seems to go away and come back often! The back pain seems to bother the center of my back between my shoulder blades and behind my right shoulder and it seems to move and come and go.
I am a little worried that it might be lung cancer! I have had an x-ray, pulmonary function test, methacholine challenge (a test that can identify people with “sensitive” airways, often used to diagnosis asthma), EKG, and blood work; all of those tests come up negative.
My question is do you think, in your opinion, have I ruled out lung cancer or should I pursue some different tests and if so what tests? I still feel pain and discomfort and I am having problems breathing as well from the beginning.
A. Dear Frank, These tests do not rule out lung cancer. Better see a pulmonologist and probably get a CT scan to learn if there are any spots that need attention.
Bad Taste Associated with Spiriva
Q. Hello. Before I had written to you about the bad taste of Spiriva, and you said you never heard of that. To me there is sometimes an awful medicinal taste that is so bad it interrupts the taste in my mouth, and makes everything taste terrible! Do you know of anything else that can be used in place of Spiriva for COPD? Thank-you very much.
A. Dear Terri, There are other medications such as Atrovent, which is related to Spiriva, Combivent which is a combination of atrovent and albuterol, and other long acting bronchodilators, known as Serevent and Foradil, that can be prescribed by your doctor.
Questions about Spirometry
Q. Hi Tom, I have written before and I have a follow-up question regarding a recent Pulmonary Function test performed by a nurse at my GP's office with a handheld spirometer.
I had to opportunity to take this tested three times.
FVC o 5.45 L
FEV1 of 4.1
For the last two years:
FVC of 6L
FEV1 of 4.6
Three years ago:
FEV1 was 4.99.
In the last three months I have switched from Symbicort (not available in USA) to Seretide (not available in USA) and feel no worse or better, I still have a cough, sputum, chest aches and inability to get a deep breath but I am getting along fine.
What could cause this pattern, considering the values are still normal for my height 181cm and age 37 years old? I am not scheduled to see my Pulmo this year, do you think I should try and get to see him sooner rather than later regarding this trend?
By the way my last Histamine challenge (2004) was negative for Asthma.
A. Dear Conn, Your lung functions are normal. Stay healthy.
An Update and Question from Brenda
Q. Thank you for answering me. I am on hospice now. I have oral morphine. When I am smothering I get a small amount of relief from 10mg prednisone and a Benzodiazepine. Would it matter to give me a booster of prednisone at this stage? You are in my prayers.
A. Dear Brenda, A boost of prednisone to make you more comfortable is fine. Anything for comfort and peace. Thanks for your prayers and I will add you to mine. You will be fine.
Read Brenda’s question from last week...
Struggling with End of Life Decisions
Q. I have exacerbated COPD am on oxygen and nebulizers. I also have blockages in femoral and carotid arteries, peripheral neuropathy, CAD (Coronary Artery Disease), degenerative disc disease, history of angioplasty and on and on.
I lay in bed on oxygen gasping for breaths. I am on prednisone, blood pressure meds, also Lasix and potassium due to CHF (Congestive Heart Failure). Also last month I was in the hospital and was informed I did not have gallstones but my gallbladder does not work (hope it doesn’t get gangrene).
I live in a small town with a band-aid hospital; I am a widow and only have Medicare. Tell me why, with COPD I am on Lortab 10, 40mg oxycontin every 23 hours, Xanax, sleeping pills and on and on.
I am in so much pain, but it is either breathe or suffer. I know I am dying and I want some quality of life, when is it time to make a choice for yourself to be pain free as much as possible and deal with it? Thanks you for your very limited and precious time.
A. Dear Brenda, You should have a doctor who puts pain relief as your top priority. You are already getting significant amount pain medications, yet since your pain is not being controlled, ask your doctor about oral morphine and do not be concerned about the warnings of “depressing respiration”. When respiration begins to decrease from either the progression of disease or its treatment, carbon dioxide begins to build up. This is pleasant since carbon dioxide acts like a narcotic. It should not be of concern if this happens.
Although carbon dioxide buildup may herald death, it is also compatible with months even a few years of comfortable life. An old physician knew this fact and called it ‘sleep therapy’. I have observed this in many of my patients and have written articles about it.
You should look forward to each day for what it brings, and remain optimistic.
Update From Thelma
Q. I sent a question to you last week and you requested my source of information; the surgeon in Boston sent me a letter saying he would be doing a Loring Bronchoscope in the AM and an AIRWAY CT Scan at 12:45pm on April 10th.
I was wondering what was the difference between an ordinary Bronchoscopy and a normal CT Scan?
Thanks for your help.
A. Dear Thelma, A bronchoscopic examination looks inside your large airways for problems, a CT takes images of the more distant reaches of the lungs. The two procedures are complementary.
Read Thelma’s question from last week...