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Archive: Dr. Tom 61
Posted May 5th, 2006

Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

Air Cleaners
Q. I spent a lot of money to buy Sharper Image Ionic Breeze air cleaners to help with my asthma problem.  I just learned that these cleaners give off ozone.  Is this making my problem worst or not?  I don't seem to be getting better. I even moved to Tucson, Arizona, now I read that this move is not good.  Help!

A.J.

A. Dear A.J., These air "cleaners" just take dust out of the air, and are not terribly effective at that. They are not supposed to produce ozone. Some manufacturers advertise that they remove ozone! Tucson is a fine city, but of course there are desert allergens. There is no perfect place for asthmatics to live. Dr. Tom

 

Anesthesia and Low Oxygen Saturations
Q. I am 73 years old and am currently on oxygen 24 hours at  2 liters.  I will be having my nasal polyps removed in June and my sinus cavity widened.  The respiratory doctor said that with my 91% O2; the anesthesiologist might not use a general anesthetic. What else would they use to hopefully help me have a relatively painless procedure.

Rose

A. Dear Rose, There is no reason not to use a general anesthetic. Discuss this with your doctor and the anesthesiologist.

Dr. Tom 

 

What Does the Chest X-Ray Mean?
Q. Having a recent chest x ray for an unexplained slightly protruding bone at breast level came back with a diagnosis of having a high inflated lung. Can you explain what this means?

M.

 A. Dear M., It only means that you could take a large breath. No other significance. A chest x-ray does not measure lung function. Spirometry* does this and it is a simple technique suitable for all doctor's offices.

Dr. Tom
 * For more information about spirometry see the National Lung Health Education Program http://www.nlhep.org/

 

Asthma Symptoms and Diagnosis
Q. Hi, I am 33 years old. I went to the doctor a couple of months ago for bronchitis and the doctor said it sounded like asthmatic bronchitis but I have never been diagnosed with asthma.

Now that the bronchitis is gone I am having some unusual symptoms and I don't know if they are the usual asthmatic symptoms.  I frequently have a cough (sometimes dry, sometimes productive with clear sputum), itchy throat, sometimes cold symptoms like stuffy nose and sometimes the overall feelings that my lungs are partially full when I inhale. 

I use the inhaler often (which belongs to my daughter) and it seems to get rid of the full feeling and my cough seems to get very productive almost immediately, then it seems to disappear for a while. I don't wheeze though and that seems to be the one common side effect of asthma.  I even listened with a stethoscope and I don't hear anything. I have been in the medical field and was very much trained on the different lung sounds so I am pretty confident that I'm not just missing it.

Does this sound like asthma to you?  All of the cases I have seen in the past (in the hospital) had severe wheezing. 

Kathy

A. Dear Kathy, You may have asthma. You cannot tell by listening with a stethoscope unless you are having an attack. I assume your daughter has asthma, since she is using an inhaler.

You need a diagnosis. See a pulmonologist.

Dr. Tom

 

Should I Wait Until I have Asthma Symptoms to have a Spirometry
Q. I submitted a question earlier on my asthma symptoms.  I still have all of the same symptoms but before there was no wheezing. 

I know that I have got to go have the PFT done but what I am curious about is this:   if I am not having asthmatic symptoms at the time of the test will the test still be accurate or should I wait until I'm having symptoms?  I usually have the cough but only sometimes have the wheezing.

Thanks for you assistance.  You are doing a great thing here by taking your time to answer questions.  Not many people are willing to take the time to do these services to the public.

Kathy

A. Dear Kathy, It would be best to have the spirometry when you are symptomatic, and then see if bronchodilators and maybe corticosteroids will improve function to a significant degree. This will help diagnose asthma, which is reversible airflow obstruction.

Dr. Tom    

                  

Can You Take Foradil and Combivent Together?
Q. Can the Foradil Aerolizer be used in conjunction with Combivent?

A. Yes, but the side effects of the beta agonist bronchodilators, Foradil (formoterol) and albuterol (in the Combivent), may be additive. Combivent includes albuterol, which has an action like Foradil, but Foradil lasts longer.  

Better to take Foradil, a beta agonist bronchodilator,  with Atrovent, a short acting anticholinergic bronchodilator, or Spiriva, a long acting similar agent.

Dr. Tom

                                                              

Lung Transplants and Pulmonary Fibrosis
Q. Why is there never any mention of lung transplant for someone with Pulmonary Fibrosis (thickening and scarring of the lungs)? All you read about is medications and oxygen therapy to help survive.

Judy

A. Dear Judy, Lung transplantation is an established treatment for selected patients with pulmonary fibrosis. Unfortunately, the supply of organs is limited.

Dr. Tom

                                   

Lots of Coughing and is Concerned about Four Nodules in Right Lung
Q. Hi! I am a 40 year-old female who has four nodules in my right lung, I do cough a lot and I have been on several different antibiotics for quite a while. The nodules are 4-cm each (1.6 inches). The coughing gets so bad some times I cannot catch my breath.

My question is should a doctor perform a biopsy to find out what kind of nodule or spot is causing so much coughing? Also on my right side under my breast it is painful and it feels bloated. That’s the only way I can describe it.

Donna

A. Dear Donna, It is highly unlikely that the small nodules are causing pain or cough. Most nodules are benign. A follow-up CT in six months to look for growth would be a good follow-up strategy. Dr. Tom

                             

Healthy Living Tips for Asthmatics
Q. I am 55 years old and a non-smoker, although I did smoke for eight years while in my 20s. I have asthma and since Dec 2005 I have had bronchitis twice and pneumonia once.  My doctor says I have decreased lung capacity of 50%, confirmed by PFTs. 

Are there any exercises I can to either increase this capacity or, at least, maintain what I still have? Any suggestions would be greatly appreciated. 

Alison

A. Dear Alison, Normal walking or bicycling is a good exercise. It will keep you fit. It will not improve your lung function, but your quality of life will improve.

Dr. Tom

                                                                      

Is a Repeat CT Scan in 6 Months Reasonable for Newly Discovered Lung Nodules?
Q. I just returned from a visit to my doctor.  I had been having pain when deep breathing in the area of my right lung.  As a result, I had a chest x-ray taken recently and it turned out normal. 

The doctor ordered a CT Scan and it turned out that there were 4 or 5 subpleural nodules in my left lung.   The doctor advised me not to worry that the CT Scan did not show cancer and that the radiologist and he recommend I have another CT test in 6 months.

The original condition in my right lung has disappeared in the meantime.  Is the diagnosis appropriate under the circumstances and should I feel comfortable with it? 

Alex

A. Dear Alex, Yes, most of these small nodules are benign. A six months follow-up to look for growth would be appropriate. 

Dr. Tom

 

Can Physical Exertion Cause an Infection in Those Who have Bronchiectasis?
Q. Are there any medical reasons that physical exertion such as exercise would cause an infection in a person with bronchiectasis (abnormal destruction and widening of the large airways)?

Paul

A. Dear Paul, No, it should be just the reverse. Exercise is associated with deep breathing and increased mucus clearance.

Dr. Tom

Chest Tightness and Wheezing Continues to be a Problem
Q. I was on bedrest for two months at the end of my pregnancy.  The last month I developed a tight kind of wheezing deep in my chest.  I figured it was fluid in lungs from bedrest but after birth it didn't go away.

I have never smoked, had asthma a child and take only one medication Labetalol (medication used for controlling blood pressure) for heart palpitations (an abnormally rapid beating of the heart when excited by violent exertion, strong emotion, or disease).  My baby is now four months old. 

I have seen my general practitioner three times about this and they did EKG, Chest X-ray, and tried a course of Zithromax (antibiotic).

Then on its own it seemed to go away for about two weeks. Now it's happening again. It's a very deep tightening, wheezing feeling, even a little painful. It happens whenever I lay down for any period even in a recliner. It’s worse when on my back.  But I am not coughing anything up.  Also, it doesn't bother me during exercise. Any suggestions would be great. 

Heidi

A. Dear Heidi, You may well have a return of your childhood asthma. Your doctor did not do anything to evaluate your lung function. You need spirometry from another doctor, preferably a pulmonologist. 

Dr. Tom

 

Dr. Changed Oxygen Liter Flow After Arterial Blood Gases (ABG)  Showed Carbon Dioxide Retention
Q. I am in quite a situation as I am a follower of your opinions regarding CO2 and oxygen. I was recently hospitalized with a PCO2 level of 86, I am aware of only those figures. 

On 4/18, my doc checked my ABG (a blood test that is taken from the artery, not a vein, that measures the pH (acidity), oxygen content, and carbon dioxide content) with the following results.  PCO2 69, PH 7.35, PO2 74. Prior to this time, I was on 4 liters per minute (lpm) at rest but could use what I needed to get around which was up to 6 lpm and sometimes more if in exacerbation.

This last bout identified me, to them, as a CO2 Retainer and my oxygen was to be reduced to no more than 2.5 lpm sitting, 3-4 lpm when ambulating, and 2.5 lpm to sleep. I was put on a CPAP (Continuous Positive Airway Pressure used to help keep the airways open during sleep) many years ago and then a Bi-PAP (Bi-level Positive Airway Pressure - is a technique that is often used to treat sleep apnea and to provide airway support) this last time only to be told to take them off immediately after this last ABG test. Also, I was extremely “water logged” so also had Heart Failure.

I must admit that I am tolerating the oxygen change quite well, but need to know how I can get this CO2 reduced further to facilitate my better breathing. May I have your thoughts?

Gary

A. Dear Gary, Chronic CO2 buildup is not all bad. It allows for you to clear your body's CO2 at a lower level of breathing, meaning less work and less shortness of breath. This CO2 retention is NOT due to oxygen.

A lot of doctors do not understand this and the benign nature of chronic compensated CO2 retention.

I know you are compensated by your pH, which is normal; meaning that your kidneys are responded by retaining enough bicarbonate to balance the acid nature of the CO2.

I hope this is clear to you. It is NOT clear to many doctors and therapists.

Dr. Tom

                                   

Safety Issues Regarding Methacholine Challenge
Q. My 16 year old daughter will be going for a Methacholine challenge test (a test that can identify people with “sensitive” airways, often used to diagnosis asthma), because our general practitioner suspects she may have exercise-induced asthma.  How safe is this test? Has it ever been known to cause a severe reaction? Is there a better test for exercise-induced asthma?

Claire

A. Dear Claire, It is a safe test, if performed in an office with experience.   

Another way to diagnose exercise induced asthma, is to do spirometry  or even a simple peak flow measurement, then exercise vigorously until shortness of breath develops, and repeat the measurements. If lung function is low, try a bronchodilator and then retest to see if the bronchodilator improves lung function.

This exercise test is better than a methacholine challenge, because it reproduces the conditions of the symptoms.

Dr. Tom

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