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Archive: Dr. Tom 63
Posted May 22th, 2006

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


Medicine Interacting with Other Medicines

Q. I have COPD due to childhood asthma and pneumonia five times as a child. My chest x-ray shows small lung size and lung and bronchial scar tissue. I am a 61-year-old female. I do not have asthma attacks or lung fluids and have not been a smoker. I have tachycardia, resting pulse between 90 and 100 when not on ZIAC. My cardiologist could not determine a cause for the high pulse rate. My current medications are Adviar Diskus 250/50 and ZIAC (Bisoprolol/HCTZ ) 10/6.25mg one tab per day.

I understand the beta-receptors and beta antagonists in the two medicines I take cancel the benefits of the Advair. Since starting ZIAC my resting pulse is 70-75 but my breathing quality has diminished.

Would switching from Advair to SPIRIVA and staying on ZIAC be something that I might benefit from? Will the ZIAC and SPIRIVA benefits cancel each other out?

Sandy

A. Dear Sandy, This will have to be determined by your doctor. ZIAC contains a beta-blocker, but it will not oppose Spiriva, as Spiriva is not a beta stimulator, it is an anticholinergic.  

Dr. Tom

Sleep Apnea and Asthma

Q. I am 39 years old, am not overweight, and have been diagnosed with sleep apnea.  I currently use a CPAP at night, which I would describe as being moderately effective.  I also have allergies, and have been taking allergy shots for a year and a half now, which have reduced the severity of many of my allergic symptoms. 

How much is known about any connection between environmental allergies and sleep apnea?  I also feel shortness of breath during the daytime, though an asthma test has not shown me to have it.  Is it common for sleep apnea to cause daytime shortness of breath?

Keith

A . Dear Keith, Not much is known about environment allergens and sleep apnea. If the allergens are causing nasal irritation, this can be contributing to upper airway obstruction and thus sleep apnea. Sleep apnea is not directly related to shortness of breath while awake.

Dr. Tom

Lung Treatment for Sickle Cell Anemia Patients

Q. Do you have any advice on the effectiveness of using EZ-PAP vs. IPPB for pediatric sickle cell anemia patients?

Dee

A. Dear Dee, Sorry, I have no specific information. However, if the EZ-PAP, or similar devices, can avoid nighttime oxygen reductions this could help sickle cell anemia.

Dr. Tom

Positive Methacholine Challenge

Q. I've asked a couple of questions in the past, and have another thought for you. I'm the guy that's been worried about silicosis over the past few months.

I had a methacholine challenge at St. Luke's yesterday, and after the first dose of methacholine, I had a 48% change in my lung function. After the test, I had an appointment with my pulmonary doctor who said I definitely have asthma and put me on pulmicort.

Any reason to doubt this diagnosis?  He said it was a very dramatic result and a very easy diagnosis for him. Sound right to you?

David

A. Dear David, Yes, right on. This is confirmatory of asthma, and this is not related to silicosis.

Dr. Tom

Medications and Hair Loss

Q. I am having hair loss and don't know what is causing it. I take Glipozide and Avandia for sugar diabetes and Cozaar for high blood pressure and Combivent. At first I thought it was the Zetia causing it so we discontinued that, but I am still having hair loss. Please, Dr. Tom, what do you think is causing it? If I just find out, maybe I can change medications.

Marie

A. Dear Marie, I do not know any connections between the medications you are taking and hair loss.

Dr. Tom

 

Is “Rest” Beneficial for Bronchiectasis Patients?

Q. My question is in relation to bronchiectasis patients - regarding the subject of “rest”.  We all know that certain parts of the body need rest to heal properly after an injury.  But what about the lungs... is 'rest' a required component in the healing process of a lung?  

For example: if a bronchiectasis patient has a full-blown episode (fever, coughing, congestion, etc), would a bare minimum of physical activity be beneficial, or would it not matter?

Paul

A. Dear Paul, Rest each day is a necessity. Exercise does not worsen bronchiectasis. It is important to stay active.

Dr. Tom

Annual Update Concerning Lung Condition

Q. You answered a question for me a year or so ago. I've been diagnosed with moderate restrictive lung disease, caused by scarring from an old lung issue, and traction bronchiectasis from repeated bouts of bronchitis.

As an aside, I started taking effervescent Acetylcysteine from Germany a year and a half ago. I went from two bouts of bronchitis a year, to once in the last two years. Strictly anecdotal, I know.

Anyway, in my newest round of PFT's (Pulmonary Function Tests) my TLC (Total Lung Capacity, the volume of air in the lung at the end of a maximal inspiration) had actually increased from 58% to 64%, the FEV1/FVC ratio was unchanged, but the DLCO (Diffusing Capacity) went from 60% to 48%. FRC (Functional Residual Capacity, the volume of air in the lung at the end of normal expiration) and RV (Residual Volume, the volume of gas remaining in the lung at the end of a maxima l expiration) were both greatly increased. Hard to believe because I feel the best I have in two years. Of course I'm waiting for my pulmonologist's take, but thought I would ask you as well. 

Armand

A. Dear Armand, This is good news. The small drop in the diffusion test is not alarming, and it still represents good gas exchange function. The elevated RV and FRC are also not of great concern.

I believe there is increasing evidence that oral acetylcysteine can be helpful in your particular type of restrictive lung disease. Stay healthy.

Dr. Tom

Consequence of Giving “Too” Much Oxygen

Q. Is it true that if you give the patient too much O2 that it will increase the CO2 in the body causing less respirations and just put the patient to sleep, permanently? 

JT

A.  Dear JT, No. This is a very common misconception. When CO2 goes up with high concentrations of oxygen, it is NOT from a decreased drive to breath. You do not achieve high oxygen concentrations from nasal oxygen.

Dr. Tom

Difference Between Bronchiectasis and Chronic Bronchitis

Q. What is the difference between Bronchiectasis and Chronic Bronchitis?

Sandy

A. Dear Sandy, They are both chronic inflammatory processes of the linings of the air passages. There is deformity and destruction of the large air passages in bronchiectasis. Bacterial infection is a far more common problem in bronchiectasis than it is in chronic bronchitis.

Dr. Tom

Can Granulomas be a Cyst or Adhesions?

Q. I have severe allergies, which have been verified through many allergy tests.  During this time of year they are especially bad and my breathing becomes strained.  I lose my breath when going up stairs and always feel as if they are struggling a bit for air. 

I have had the methacholine challenge and do not have asthma.  I have been taking allergy shots once a week for 7 months, and have had no improvement; in fact I think it is getting worse. 

I have had two chest x-rays and they shows multiple granulomas on my lungs.  I have a long history with adhesions and had a hysterectomy at 32 years old, (after many other surgeries for adhesions).  I have also had a long history with polyps and cysts.  Had gall bladder out- filled with polyps, had multiple cysts on ovaries, cyst in sinus etc. 

My concern is with my lungs and allergies.  Are granulomas something to worry about?  Do they get worse with time?  Could the x-ray be wrong, and actually be adhesions or cysts and not granulomas.  Thank you for any information!  I see my doctor frequently and they seem to think it isn't a big deal.  I just wanted the re-assurance. 

Christine

 A. Dear Christine, Granulomas in the lung are commonly healed and of no significance. They do not relate to cysts or adhesions. Some active granulomas are present in certain allergic reactions on the lung surface, but these allergic processes are not the same as the common granulomas seen on chest x-rays.

Dr. Tom

 

Worried about Husband's CT Scan

Q. My husband had a chest X-ray. The doctor said that there were spots and he had a CT scan. When the doctor read the scan he said he had thickening and the spots were due to his smoking.

I'm still concerned about this, my husband has a smoker's cough and has smoked for many years. I want him to see a lung doctor for a second opinion just to make sure; is this a good idea? His MD just seemed so vague in his reason for the thickening and spots.

Stacey

A. Dear Stacey, This all sounds vague. So-called spots are usually benign, but those that show change are suspicious of lung cancer. Better see a pulmonologist.

Dr. Tom

 

Brother and Sister Have Asthma, What are My Chances

Q. I have not being diagnosed with asthma yet; I did however use an albuterol inhaler for about a month.  My brother has being recently diagnosed with asthma; my sister had being asthmatic since ninth grade. Is it possible for me to have asthma but not yet diagnosed? Could I be the one who has asthma as well? My family goes to the same doctor. How do I change my family physician? I am 22 years old last time I went to the doctor was in 2004 for a cough. 

Eric 

A. Dear Eric, Since your brother and sister both have asthma, you are also at risk of developing it. But this is not certain. If concerned, you should see an asthma specialist, either a pulmonologist or an allergist.

Dr. Tom

 

Update from Craig

Q. Thanks for your last reply (asthma, silicosis worries). You had asked me to provide you with the results of my methacholine challenge. After just one dose of the methacholine (doctor said they do as many as 4 doses to determine sensitivity) and retesting PFT's, I had a 48% decrease in lung function.

They diagnosed me with asthma and gave me Pulmicort- two puffs, twice daily. I've been taking it for a week now, at least I think I'm taking it- I really can't tell if I'm inhaling anything or not, although I've followed directions. 

I haven't had any real change in how I feel in the past week. I have some upper abdominal aching/pain that I've had off and on for a few months sort of on my sides. Not sure if that's related or not. Seems to be.

Anyway, let me know what you think about the diagnosis, and if indeed Pulmicort seems the way to go. I've heard it can take up to a month for it to fully work. Thanks as always for your time and attention.

Craig  

A. Dear Craig, Your methacholine challenge is confirmatory of asthma. Pulmicort is an anti inflammatory drug that will take some time to work. It does not treat bronchospasm, and you may need a bronchodilator, such as albuterol for symptoms. Pulmicort is a controller of asthma, and albuterol a symptom reliever.

Dr. Tom

 

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