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Archive: Dr. Tom 56
Posted March 24th, 2006

What Can I do for Husband who has COPD?
Q. My husband has COPD. He was told about a year ago he only had 25% lung function left. Recently he has had no appetite, started vomiting, and chest pains. What do I do?

Katherine

A. Dear Katherine, You need to take your husband to a pulmonologist that is interested in COPD. Stopping smoking is the first step along with medications to improve airflow. Pulmonary rehabilitation will help most people with advanced COPD. Home oxygen is very useful for selected patients. There is no simple recipe, for the treatment of COPD.

Dr. Tom

 

Have Asthma and Want to know Best Cities to Live in for Those Who Have Asthma
Q. I am an active 18 year old and I have asthma. I do not have asthma attacks very often but when I do they are usually severe. I live in a metropolitan area both at home and school. At home there is more pollution though, and I do notice a difference in my breathing when I am at home. I was wondering what are the best cites or places to live for a person with asthma?

Jennifer

A. Dear Jennifer, Lots of places are good. Pick a community with low air pollution. The west coast of Florida and the Gulf of Mexico are good for most, or non-industrial communities in the Midwest or West. There is climate or location that suits all asthmatics.

Dr. Tom

 

Certain Smells cause Chest Pain
Q. I have had COPD for some time. Now every time I smell certain things like perfume, food cooking in the oven, and laundry detergents in the store and at home I get chest pain. Do you know any reason why I would get chest pain every time I smell certain things? Was wondering if you could explain.

Terri

A. Dear Terri, Patients with asthma commonly get chest tightness, when exposed to the things that bother you but usually not chest pain. Chest tightness is due to bronchospasm and may be a factor in COPD.

Dr. Tom

 

Beneficial Supplements for Health Lungs
Q. The news is full of studies that suggest certain foods, vitamins, minerals, amino acids, etc., are, or are thought to be, beneficial for certain organs or body functions. I have never heard any such information relating to lung health. Are there any specific studies that are known to have a positive effect on lung health beyond general diet, exercise, etc?

Paul

A. Dear Paul, No good studies. However, there is good reason to take antioxidants, such as vitamin C, selenium, and Coenzyme Q10. Calcium supplements with vitamin D are also good as a preventive for osteoporosis, which is common with COPD.

Dr. Tom

 

Is Exposure to Crystalline Silica Something to Worry About
Q. I am a 27 year-old man, with a history of some brief exposure to crystalline silica (crystalline silica of respirable size is primarily quartz dust occurring in industrial and occupational settings in the form of fine, breathable particles) while siding a house with material that's currently on the market and being used like crazy. This was about 2-3 years ago. For the past two months, I've had a very slight wheeze that is only audible when I'm in a very quiet space (turned off car, etc). My wife thinks I'm crazy, but I'm worried about Silicosis or something along those lines. 

I am generally healthy, and active, although I've also had some dull abdominal and upper back pain. I had an x-ray in January, and my doctor and radiologist said it looked fine (they are aware of my concern).  I was just in yesterday for a full slate of PFT's, and am hoping that they come back normal.

I had some slight asthma that went untreated when I was a kid, and I do have pretty severe allergies to cats and dogs and other allergens.

My question is, first and foremost, what are your thoughts on my silicosis fears? (dumb way to phrase that) Also, can asthma cause a constant slight wheeze, rather than episodic wheezing? 

Also, when I play tennis or run on a treadmill, I don't have any trouble breathing.  Curious if asthma can behave like this, or what your thoughts are.

If my PFT’s are not normal, I plan on seeing a pulmonary doctor at the University of Chicago Hospitals.

Craig

A. Dear Craig, I doubt if short exposure to silica is enough to cause silicosis. It usually takes months or years of continuous exposure. Mild wheeze that is intermittent is common in asthma. Your lung function may be normal between periods of asthma.

See this link for more information on Crystalline Silicosis: Health Effects of Occupational Exposure to Respirable Crystalline Silica National Institute Occupational Safety and Health (NIOSH) HAZARD REVIEW.

Dr. Tom

 

CT Scan Showed a Lung Nodule
Q. History - frequent bronchitis in the past and diagnosed with small airway disease and some thickening of the upper plural lining.

Cardiac Calcium scoring CT showed a 3mm nonspecific nodule on my upper left lung. My primary doctor says I can wait until my physical in a few months to discuss this finding? Does that sound right?

R.

A. Dear R. Yes. The great majority of tiny nodules are benign. But it is wise to get a follow up in about six months to see if there is growth.

Dr. Tom

 

Back Pain
Q. I have had two back surgeries and fell out of bed July 05. I had an MRI and flex x-rays and have been seen by a neurosurgeon and found that nothing was wrong but I was fine before.

I am now going to a pain clinic. I am on two kinds of muscle relaxers and hydrocodone. They do not help. It’s going on three months now at this clinic and I don't want to become dependent on these pain pills.

Are there any more tests for the back after having surgery? I asked for a disc o gram{?} but the docter says there’s no room to stick needles in because of the fusions surgeries.

Any ideas and is second opinion allowed?

Reymarie

A. Dear Reymarie, I am no expert on back pain. I have a lot of problems myself. MRI is the best way for neurosurgeons to evaluate back pain due to degeneration or disc disease.

Dr. Tom

 

Spot on Lung
Q. I have a very bad cold about a month now. My doctor did an x-ray and found out I have pneumonia. She gave me some medications and I went home.

Today four days after the x-ray she called to tell me she found a spot on my left lung. Now I have to do more testing. I never smoked or drank, but my parents smoked all of my life. They are cancer survivors, twice. My mom had lung cancer and had one lung removed.

I am worried it could be cancer, but could it be only from the pneumonia? Thank you Ada.

Ada

A. Dear Ada, This needs a follow-up. Your risk factors for lung cancer are; your family history and exposure to environmental tobacco smoke. The spot could still be a resolving pneumonia.

Dr. Tom

 

Told That She Was in the Beginning Stages of Emphysema
Q. I was told a couple of days ago that I have the beginning stages of emphysema. This has me very worried.

I had a chest x-ray that shows mild hyper- inflation. The report on the x-ray report states: 1. Mild hyperinflation, which is probably on the basis of over inflation secondary to the patient's young age. 2. No acute infiltrate is present.

I have for many years, become short of breath easily. I have never been checked for asthma. I also hear a wheezing when I breathe in. This wheezing is almost everyday.

I am only 34 years old and I do not smoke. The doctor did not conduct any other test. I had a spiromtery test done at a different office and the results were

FVC    94%
FEV1 95%
FEV1/FVC 100%
FEF 2-1.2 82%
FEF 25-75 101%
FEF 75-85%
PEF    68%
FEF50   95%

The report said that these results were normal. I just don't understand how I can have emphysema. Is there anything else this could be?

Cindy

A. Dear Cindy, These results are normal, except the FEV1/FVC.  Normally this is above .70.  Hyperinflation on a chest x-ray does not mean anything.

You could still have asthma, which would explain your wheezing. The spirometry may just have been done while in remission. You should be tested again when you are wheezing.

Dr. Tom

 

Can Staph Infections Affect on the Lungs
Q. Hope you are well and I wish you a Happy St Patricks Day from Ireland. I have another question for you regarding my on-going malady.

You may recall from a previous post I have normal spirometry with an FEV1/FVC of 77 or 78. I also have had a constellation of symptoms that have continued for nearly three years including; pleurisy (is an inflammation of the pleura, the lining of the lungs, causing pain), excess sputum, SOB, vague joint pains, nasal crusting etc. I also had asthma as a kid and smoked for most of my adult life.

I went to my general practitioner two weeks ago with tendonitis, bursitis (is inflammation of the fluid-filled sac, bursa.  that lies between a tendon and skin, or between a tendon and bone) and painful boils under my arm and on my side requesting that he get to the bottom of this as it had been going on so long. The boils were new, everything else was ongoing, and previously connective tissue disease was ruled out.

Here’s the thing, he diagnosed me as having a Staph (Staph, staphylococcus, is group of bacteria that can cause a many diseases) infection in my blood and put me on Klacid (antibiotic) for two weeks. It has helped and the joint pains and boils cleared quickly. The excess sputum remains.

My questions for you are: Could this Staph infection potentially be the cause for my pleurisy? Can a staph infection affect the lungs?

Because I may have some chronic bronchitis am I more likely to get these infections?

Conn

A. Dear Conn, This should not be due to staph, which usually is an acute (means sudden or severe; symptoms appear, change, or worsen rapidly) infection.

Dr. Tom              

 

Will Medication for Rheumatoid Arthritis Impact Lung Transplant Elgibility?
Q. I have Alpha 1 and rheumatoid arthritis (a usually chronic disease that is considered an autoimmune disease and is characterized especially by pain, stiffness, inflammation, swelling, and sometimes destruction of joint).  When I went on Enbrel (medication used to treat R.A.) shots for the R.A., my pulmonologist commented that he didn't know how that would impact my eligibility for alung transplant. Can you explain why one would impact the other?

Jill

A. Dear Jill, I am not a lung transplant expert. I doubt if the medication will affect your transplantation status.

Dr. Tom

 

Carbon Dioxide Retainers and Oxygen
Q. Could you please elaborate on the myth of CO2 retainers not being affected by higher levels of O2? I work in Respiratory Therapy and also teach Pulmonary Rehabilitation. It was always drilled into us that CO2 (carbon dioxide) retainers should keep their SPO2 (oxygen saturation) between 88-90%.

Our staff MDs and Pulmonologist still write orders as this is the case. I am willing to accept this as no longer the case, but what information or studies I can cite to discuss with them as well as educate my fellow Respiratory Therapists?

Linda

A. Dear Linda, This is a long story. Your doctor is wrong, and you are right.

We did the first blood gas determinations in 1965 in people with COPD exacerbations (worsening condition or flare-up). We found no CO2 retention at 1 to 3 liters, even if PO2s went above normal.  Most modern doctors no longer believe this old myth.

Dr. Tom

 

Unable to Tolerate the Mask
Q. I have been a CO2 retainer.  I was unable to tolerate the masks at the hospital. They sent me home on hospice.  Should I give the masks another try?

Connie

A. Dear Connie, Yes, but you should be able to use nasal canulae, at controlled low flow. Your doctor should not be afraid of long term CO2 retention.

Dr. Tom

 

Long History of Lung Problems
Q. I have a long history of various lung problems, and had a left upper lobectomy (surgical removal of the lobe of the lung) when I was 18 for atypical (not conforming to the usual type or expected pattern) TB (tuberculosis) that was unresponsive to meds and rapid growing. 

I did smoke for 43 years and quit 10 years ago.  I am now diagnosed with COPD - emphysema.  My CT Scan shows many large bullae (enlarged air sacks), diffuse but primarily in the lower lungs, worse on the left side.  Because of my prior lung surgery and diffuse bullae I am not a candidate for LVRS (Lung Volume Reduction Surgery).

 I get quite SOB and have a FEV1 in the mid-20% range.  Is there anything that could be done to help my symptoms, short of a lung transplant?

Mary Ann

A. Dear Mary Ann, The techniques of pulmonary rehabilitation should help you with SOB.

For more information on Pulmonary Rehabilitation see:

Frontline Advice for COPD Patients (PDF) - Pages 35-53

Get going and Take the First Step to Healthy Exercise:Pulmonary Rehabilitation is a Safe Place to Start an Exercise Program
Read and listen to stories of those with lung diseases who know the benefits of rehabilitation.

For more information on LVRS:

The National Emphysema Treatment Trial (NETT):
Evaluation of the Lung Volume Reduction Surgery for Emphysema
Source: Department of Health and Human Services
National Heart, Lung, and Blood Institutes
Medicare and Medicaid Services;

Lung Volume Reduction Surgery (LVRS) 
Source: U.S. Department of Health and Human Services:

Dr. Tom

 

Lots of Phlegm
Q. Sometimes in late afternoon, I start coughing and gagging from a great deal of phlegm in my throat. I use Mucinex which helps to bring the Phlegm up. I have used the maximum of four tablets within a 24 hour period. Is there anything that I can do to stop the creation of this phlegm 

Arline

A. Dear Arline, Excessive mucus is a big problem. N-Acetyl Cysteine, available over the counter may help.

Dr. Tom

 

Spots on Lung
Q. I was diagnosed with COPD in Oct 05. My doctor told me that I had spots on my lungs. What stage am I at?

Jason

A. Dear Jason, Your stage of COPD will be judged by spirometry. The spots need follow up in most cases.

Dr. Tom

 

Questions about Selecting a Tracheostomy Tube
Q. We have a patient who has a massive air leak around his # 08 shiley cuff trach (type of tracheostomy tube) and we replaced it w/ # 8.0 Biova foam fill trach which has solved the problem leak for now. The patient has stage 4 ARDS (Acute Respiratory Distress Syndrome, is breathing failure that can occur in a critically ill person) and high PEEP (Positive End-Expiratory Pressure) and rates.

What are the pros and cons of this foam fill trach with this type of patient.

Garrett

A. Dear Garrett, I cannot give you a simple answer here. Sounds like you have a trach tube that is doing okay.

Dr. Tom

 

Follow-up Question
Q. I submitted a question last week, and here's a follow up.  I mentioned I was having a mild constant wheeze, and throat clearing, with an occasional cough.  Typically in the morning for the first hour after I wake up the cough is productive of maybe a teaspoon of yellowish sputum. I have some minor abdominal pain that I would say is very dull at best. No real chest pain, although some back pain. I am not short of breath at all, and on exertion am not in any discomfort either.

I had a chest x-ray and the full PFT testing, and all were shown as normal and healthy.  I had told my doctor that I was exposed to some silica dust for a couple of weeks about three years ago, so they are aware of my past exposures. I work in a professional office, so there's no trouble there.

I feel well about 95% of the time, but the constant slight wheeze (which is at the very end of my expiration) bugs me. My doctor said the spirometry tests show that I didn't have asthma. I'd love to hear your thoughts. I am a healthy 27 year old man, and although I'm a bit overweight (6'2" and 245 lbs), I exercise regularly.

Craig

A. Dear Craig, Sorry, I cannot answer your question with any certainty. With a persistent wheeze, you may want to see a pulmonologist and have a bronchoscopy which is placement of a tube to see what is going on in your large air passages.

Dr. Tom

 

Is Exposure to Cystalline Silica Something to Worry About
Q. Hello, I am a 27 year-old man, with a history of some brief exposure to cystalline silica, while siding a house with material that's currently on the market and being used like crazy. This was about two-three years ago. For the past two months, I've had a very slight wheeze that is only audible when I'm in a very quiet space (turned off car, etc). My wife thinks I'm crazy, but I'm worried about Silicosis or something along those lines. 

I am generally healthy, and active, although I've also had some dull abdominal and upper back pain. I had an x-ray in January, and my doctor and radiologist said it looked fine (they are aware of my concern).  I was just in yesterday for a full slate of PFT's, and am hoping that they come back normal.

I had some slight asthma that went untreated when I was a kid, and I do have pretty severe allergies to cats and dogs and other allergens.

My question is, first and foremost, what are your thoughts on my silicosis fears? (dumb way to phrase that) Also, can asthma cause a constant slight wheeze, rather than episodic wheezing? 

Also, when I play tennis or run on a tread mill, I don't have any trouble breathing.  Curious if asthma can behave like this, or what your thoughts are.

If my PFT's are not normal, I plan on seeing a pulmonary doctor at the University of Chicago Hospitals.

Craig

A. Dear Craig, I doubt if short exposure to silica is enough to cause silicosis. It usually takes months or years of continuous exposure. Mild wheeze that is intermittent is common in asthma. Your lung function may be normal between periods of asthma.

Dr. Tom

 

Pulmonary Function Testing (PFT) Results
Q. Dear Dr. Tom: Could you kindly look at the below test figures and tell me what you make of them.  The first figure is the actual result.

Lung volumes:

TLC 7.01; 157%pred; 4.48 pred
FRC 3.70; 146%pred; 2.54
RV 3.51; 206%/pred; 1.71 pred
VC 3.50; 206%pred; 1.71 pred
IC 3.31; 171%/pred; 1.94 pred
ERV 0.19; 23%pred; 0.83 pred
RV/TLC 50; 131%pred; 38 pred

 

Spirometry:

 

FVC 3.44; 124%/pred; 2.77 pred
FEV.5 1.52
FEV1 2.18; 109% pred; 2.01 pred
FEV3 3.26; 121%/pred; 2.69 pred
FEF 25 - 75% 1.36; 57%/ pred; 2.38 pred
MET 126
FEFmax 5.38; 95/pred. 5.67 pred
FEV1/FVC 63; 88%pred; 72 pred

While doing a short walk in my doctor’s office with an oxymeter attached to my finger, my saturation went to 88%, while at rest it was 96%.

I am 62" tall and weigh 128 lbs.  My age is 64. I am quite perplexed by the figures, and my physician is not very responsive in answering questions.

I very much appreciate your comments and your time.

Lisa

A. Dear Lisa, Your lung function test, which contain too many meaningless numbers, do not make sense. Better see another pulmonologist and get an answer. Your drop in oxygen as measured by a finger oxymeter is abnormal, and requires an explanation.

Dr. Tom

 

Questions about Rapid Progression of Lung Problems
Q. I am a 73 year-old woman.  I was diagnosed with “adult asthma” when I was 65. I have never smoked.  During the summer I experienced shortness of breath (unusual for me).  I went to my asthma doctor and had a CT SCAN.  He said they noticed a nodule...but couldn't find it the second time.  He rescheduled me for another CT in July 2006. 

I contracted viral pneumonia in December 2005.  I was admitted to the hospital and received an “early” CT scan.  They told me I have damage in both my lungs and one doctor told me I have the “lungs of a person who has smoked for 60 years!”  I am now on oxygen 24 hour at a 2L level.  How could so much damage occur from July/05 to December/05?   Is this common? 

Rose

A. Dear Rose, The apparent rapid progression of disease is very unusual. You need an explanation of this whole picture. I do not doubt it, but the possibilities are many and a suggested diagnosis would require speculation.

Dr. Tom

 

Is Supplemental Oxygen Addictive?
Q. My pulmonary doctor recently (within the past month) prescribed oxygen for me: 2LPM on exertion and for sleep.  I am a 56 year-old female with severe COPD.  My question comes from my husband who is concerned that I may become psychologically addicted to the oxygen, primarily because I have a history of alcoholism and drug addiction (I have been in recovery for many, many years) and because I had a bad panic attack shortly before going on oxygen when I was very short of breath. 

I'm not sure how to answer him, because I'm not sure if I am using the oxygen as a crutch.  I only use it when needed; I have a pulse oximeter and use it when my saturation levels drop to 90% or lower, and remove it on rest and when my levels are again acceptable (94%). 

Patricia

A. Dear Patricia, You will not get addicted to oxygen. From what you tell me, you are using your oxygen correctly.

Dr. Tom

© 2017 American Association for Respiratory Care