Can you Give Too Much Oxygen?
Q. Dear Dr. Tom, I am a LPN working at a long-term care facility. I have a 92 yr old male resident who has had a recent chest infection beginning of January 2006. He was treated with ten days of Avelox but still struggles with SOB, Dyspnea and oxygen saturation often <80%. When I am on I often administer supplemental O2 via cannula of 2-3 lit/min (liters per minute). This usually doesn’t bring his saturations up to much more than >85%. I obtained an order for Combivent nebulizers QID (four times a day) which also have minimal effect.
Last evening my resident laid down in bed at 15:15 (3:15 p.m.) and at 16:10 (4:10 p.m.) I discovered his hands were freezing cold and nail beds and lips cyanotic (a bluish or purplish discoloration due to inadequate oxygenation of the blood). His oxygen saturation was only 67% on room air. His LOC (level of consciousness) was decreased greatly and I could barely rouse him, his eyes were glassy and almost rolling back in his head.
I quickly applied a non-rebreather mask (oxygen delivery device that can deliver high concentrations of oxygen, 80 to 100%) but couldn’t apply as our oxygen concentrator only goes to 5 lit/min (to operate properly, the non rebreather masks require 10-15 liters per minute). I applied cannulas and set the oxygen for 5 lit/min. After 30 minutes his saturations were still varying from 66-74% on 5litres.
He was transferred to hospital via ambulance. The RN who was on with me told me that I should have only given him 2-3 liters per minute as I could have wiped out his drive to breath. He does not have a hx. (history) of COPD. He has dementia and possible CHF, but has never been diagnosed with any lung disorders. Do you agree that he should have been given only 2-3 lit? His respirations were 38 per minute and he was breathing rapidly. The paramedics applied a non-rebreather mask so I am sure they applied over 6 liters. I am curious...did I do the wrong thing?
A. Dear Trista, No, you did the right thing. The old belief that oxygen by nasal or oral delivery will diminish the respiratory drive is wrong. But it is in old textbooks, and you can’t seem help to erase this wrong information. The RN needs to get up to date oxygen therapy.
Having Chest Pains
Q. Dr Tom, I've had chest pains for the last week. They are on my right side and are now accompanied by a slight gurgle when I breathe in. I noticed the gurgle for the first time this morning. The pains are sharpest when I breathe in, laugh, sneeze or otherwise apply pressure. My right chest area is also a bit sore to the touch.
I've had a cold over the last few weeks. I haven't had much of a cough but there has been a thick, phlegmy feeling in the back of my throat. An expectorant did little to clear this. I visited a physician who prescribed Zithromax (antibiotic) and an inhaler though she couldn't give me any definitive answers. Precautionary x-rays and blood work were done. Nothing was found. Would you be able to diagnose my problem?
A. Dear Cindy, It may be pleurisy that is not seen on the x-rays. If this guess is correct, it should clear up in about a week or two. If not, consult your doctor again.
How Often should You be Use an Inhaler?
Q. My girlfriend has chronic asthma and uses her albuterol inhaler alot usually one inhaler a week. Her doctor says there is no harm and use as needed. But I read that too much is as bad as too little? I think she abuses the inhaler what is your take?
A. Dear Bradley, It is okay to use it as needed. But the need for frequent use indicates that the asthma is not well controlled, and "controller medications" are needed. These are often inhaled corticosteroids, or oral leukotriene blockers (long term control medication given as a pill), that should be prescribed by her physician.
Q. My Father has COPD, hereditary emphysema. I have had a blood test to see if I have it as well. It came back negative. I was wondering if this can be passed onto my daughter?
A. Dear Koreen, No. But there is some clustering of emphysema, in some families, that is not identified by the blood test that you had. Be sure no one smokes.
Questions about Medications
Q. Dr. Tom...I've been a fan of yours for many years. You won't recall, but we've even met. My question has to do with Xoponex (Levalbuterol) vs. R- albuterol. I have physicians advocating the use of both, alternating one with the other... and, at frequencies that clearly exceed manufacturer's recommendations.
Still, I'm a therapist...and the MD is the man or woman. Is there any definitive data that supports or refutes the notion that both can be used inter-changeably? Are there any data supporting the notion levalbuterol can/should be given at frequencies up to and including Q1-Q2 (every 1 to 2 hours) hours?
I understand the jury is out but, I've seen this topic come up a dozen times the past 2 years on the AARC's Management List Server... and there remains a great deal of debate on both subjects...
Thanks for your time and your willingness to share.
Hal, LRCP, BSHS
A. Dear Hal LRCP, BSHS, I remember meeting you at some past meeting. There is no good evidence that L albuterol is really superior to the racemic substance, but there are some theoretic advantages. No head to head randomized clinical trials have been done, to my knowledge. Having to use Beta agonists frequently is generally safe, but it indicates that the basic problem causing the bronchospasm is not under control.
Can My Fatigue and Weakness be Caused by COPD?
Q. Dear Dr. Tom, I am a 49yr. old female diagnosed recently with COPD. I had a chest x-ray done last April, and the Radiologist's report was: "COPD with air trapping. No acute process."
I plan on seeing a Dr. for further diagnosis and care, but in the meantime I am wondering if you can answer this question? Is it common for people with COPD to experience severe fatigue and weakness? I mean a debilitating weakness, which makes it very hard to function normally. The Radiologist thought that the disease might be in the early stages.
A. Dear Emily, A chest x-ray is not a good way to diagnose COPD in any but the late stages of the disease. You need spirometry to measure your lung function. Fatigue is common with COPD, but only becomes debilitating in very advanced stages. You need a solid diagnosis and not just a chest x-ray.
Can Medication cause a Metallic Smell?
Q. I am a 48 yr. old female who was diagnosed with severe asthma approx. 8 years ago. I am maintained through Advair and Singulair. On occasion, when I nap in a reclining chair, I awaken smelling a very strong metallic odor. Have you heard this complaint before?
A. Dear Susan, Yes, I have, but it is not common. I do not know what causes this symptom.
Can Your Lungs Recover after You Quit Smoking?
Q. Dr. Tom: I am 61 years old and have smoked since I was 16, which I am not proud of it and now it frightens me. I have quit now for a month and know I will never smoke again. How much of my lung capacity can I recover? I jog 5 days a week for 40 minutes at a time and I don't get out of breath.
I do not cough or spit-up anything nor do I get any respiratory problems at all and rarely get a cold. I assume so far I have just been lucky, as I know what smoking does. Is there anything I can do at all to reverse any of the damage I have done to my lungs and body?
I take 10 grams of vitamin C and 10 grams of Lysine plus 30 milligrams of Q10 which I got this information from the Linus Pauling Foundation. As you are an expert in this field, I would greatly appreciate your input.
A. Dear Richard, You may be amongst the lucky who are somehow protected from the harmful effects of tobacco smoke.
You must have good lung function, to be as active as you are. Get simple spirometry to check you lung function if you are curious, and I would advise this in all smokers over age 45, which is the recommendation of the National Lung Health Education Program, NLHEP. You may want to consult the web site, http://www.nlhep.org/ . Stay smoke free and you will probably remain healthy.
Congratulations on quitting.
Questions about Medications
Q. I am using Spiriva since June and I am also using Combivent, is it safe to use the two together. I don’t feel like it is helping me, would it be dangerous to just stop it. Do I have to wean off of it or can I just stop it.
Also I am noticing my hair is thinning out and these medications could be causing it. I hope to hear from you.
A. Dear Marie, The two drugs can be given together, even though the Combivent contains a short acting drug that works like Spiriva.
They do not effect hair growth.
They can be simply stopped, if they are not working. I would check with your doctor, however, and get spirometry to be sure you don't lose function if you stop. Bronchodilator medications should always be used with the guidance of spirometry, otherwise you and your doctor are “flying in the dark”.
Quit Smoking Marijuana and Have Questions about Lung Damage
Q. Dr. Tom, I have smoked cannabis regularly for approx. 4 years, with periodic breaks for 2-3 months at a time every year. Recently, I have noticed a marked decline in my lung function, evidenced by shortness of breath and a feeling of not getting enough air into the lungs. I can function normally (walk, run, exercise, etc.) without any severe problems; I am simply breathing very quickly and deeply almost all of the time.
I have done my research and determined that I likely have mild COPD as a result of the smoking. I try to exercise regularly and have begun taking vitamin D supplements and multivitamins. I also make sure to drink at least 1.5-2L of water per day. What else can I do to help my lungs out, apart from quitting smoking? For how long must I refrain from smoking to give my lungs adequate time to repair themselves? Many thanks in advance.
A. Dear Jack, Pot smoking really tears up the lungs in some people. Stay off the grass, and all other products and get your lung function tested by spirometry. If your doctor does not do spirometry, go to another one who is practicing modern medicine.
Are there any Travel Precautions when have Asthma
Q. I want to travel to Armenia from North Carolina. I have asthma though. Would it be possible for me to travel there for two weeks?
A. Dear Meredith, Yes, of course, but take your asthma medications with you. Bon Voyage!
Can Medication be the Cause of Tooth Loss?
Q. After using Spiriva for 18 days, I woke up with severe toothache in all teeth I lost 2 teeth, and am going to loose more. I was not taking any other medication, except Tylenol, and Xanax (antianxiety medication).
I am trying to find more information and Pfizer recommends us to get an attorney. Have you heard of this problem, and do you know of any attorneys that would be learned in this field.
A. Dear Jean, I do not believe that Spiriva has been shown to cause tooth loss. I have not heard or read about this. Don't waste your money on a lawyer, unless you have solid evidence.