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Archive: Dr. Tom 67
Posted June 22, 2006

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

 

Shortness of Breath and Prescribed Medicines

Q. I recently visited a pulmonologist and he said I had moderate COPD.  He took me off Advair, put me on Spiriva and sent me home.  I got worse and could barely breathe.  I went back and he put me back on Advair, took away the Spiriva and said he'd see me in July.  I continued taking the Spiriva until it was gone and started to feel better.  Does this mean I should take both?  That's very expensive.

Sharon

A. Dear Sharon, Both drugs are useful and compatible in COPD. Indeed, they are expensive.

Dr. Tom

How Can My Aunt Be Weaned off the Mechanical Ventilator?

Q. My aunt was in an MVA (Motor Vehicle Accident) on 05.13.06. She is a COPD patient and was currently on O2 daily. She has been on a vent (mechanical ventilator) since hospitalization. She also has a trach now. How can we wean her from the vent and what is the prognosis? Please let me know what to do?

Renee

A. Dear Renee, Most such patients can be weaned from mechanical ventilation. Good that she has a tracheostomy in place. You should find a center that specializes in weaning such patients, such as a Kindred Hospital, if there is one in your area.

Dr. Tom

Side Effect of Medication

Q. I have been taking Hifenac-pain killer (Aceclofenac is the generic name for Hifenac which belongs to a group of drugs called non-steroidal anti-inflammatory drugs. This drug is not available in USA), though not regularly. I want to know if there are any side effects for taking this painkiller?

Nandita

A. Dear Nandita Yes, This drug may have all of the side effects of NSAIDS. These include fluid retention and stomach upset. Sometimes bleeding. Ask your doctor about the risk/benefit ratio for you

Dr. Tom

Could there be a Link Between Dust from Cutting Optical Lens and Asthma? 

Q. I am a 29 year old woman who has suffered from severe asthma with shortness of breath for about three years.  I recently lost my job and am feeling much better.  Do you know of any incidents linking opticians cutting lenses/lens dust and asthma?

Marianne

A. Dear Marianne, No, but most any dust can precipitate asthma.

Dr. Tom

Please Answer a Question about Respiratory Physiology that Came up Over a Cup of Coffee

Q. There are a number of receptors, three if I remember correctly, in the body that work together to regulate respiration. What are the stretch receptors in the lung called?  This was the topic of conversation over coffee this morning and none of us could remember.

John, CRT

A. Dear John, They are called stretch or sometimes J receptors. Many other receptors affect breathing.

Dr. Tom

Very Worried about Brother's Health and Whether Stress can Compromise His Health

Q. My 42-year-old, mentally challenged brother has advanced COPD, with an oxygen level of about 80 and CO2 level of about 89.  He has had diminished lung capacity since birth, and I guess his body has gradually adjusted to higher and higher CO2 levels.  At this point, the nurse at his group home says he is operating on Hypoxic Drive and oxygen administration will only exacerbate his problems.

2 questions:

--Do you agree that oxygen at this point is counterproductive?

--Could the stress of being a witness in an abuse case (one of his caregivers physically abused him) cause him enough stress to compromise his health significantly, especially since the abuser will be in the courtroom?

I am trying everything in my power to preclude his presence in the courtroom. 

Diane

A. Dear Diane, The oxygen will not make his CO2 retention worse. He should avoid the stress of a court appearance if possible. This will probably require a letter from his doctor, who knows his situation better than I do.

Dr. Tom

 

Taking Medicine but Still Have Problems Breathing

Q. I had pneumonia three years ago and obtained asthma due to this.  My doctor prescribed Singulair, albuterol and now Spirivia.  I still have problems in the spring and have a very hard time taking deep breaths.  I have had blood test, x-rays and so on.  What should I do?  Not being able to breathe sometimes frightens me.

Adi

A. Dear Adi, You need to see a pulmonologist for the control of your asthma. The medications you take are all appropriate for asthma, but there are a great number of alternatives and strategies that can be used to control your asthma.

Dr. Tom

 

Diagnosed with Pleurisy in the Fall, and Now the Pain has Returned

Q. Last fall, I had to go to the emergency room because every time I breathed I had an extremely sharp pain.  They told me I had pleurisy and that it should heal in two weeks.  Well, it hurt for months afterwards.  Most of the time it did not hurt that badly. 

However, now it is June and I have increased the amount I have exercise recently.  For the last month, I have been able to feel myself breathe.  It is like I can feel my lung go up and down.  It is not always constant, but it happens throughout the day and is worse in the morning and at night.  It can also be quite painful at times, so much so that I think my pleurisy is coming back.  Then an hour later, it doesn't hurt anymore. 

A friend that is a doctor told me that I probably had scarring in my lungs.  Is there anything hat can be done for this?

Amy

 

A. Dear Amy, You may have chronic pleurisy and some adhesions that give these sensations. Ask a pulmonologist about what to do. The cause of the pleurisy should be determined, if possible.

Dr. Tom

 

Do Bronchodilator Treatments Help Pleural Effusions?

Q. Do Albuterol treatments help in the treatment of pleural effusions and how?

L.C.

 

A. Dear LC, They may promote the absorption of fluid, but mostly beta agonists such as albuterol stimulate absorption of fluid within the lungs.

Dr. Tom

 

X- Ray Results, Bad Cough, and Awful Taste in Mouth has Me Worried

Q. Last month I had a appointment with my doctor. With my past history of smoking and a one time experience with pneumonia, is it common for him to have a chest x-ray taken?

I have noticed a decrease in my breathing in recent years also.  The last x-ray was taken two months ago reported this:  In the Left Upper lobe, there is a focal area of nodular bronchiectasis. Previous interstitial abnormality in the apicoposterior portion of the right upper lobe is improved. There is a slightly increased interstitial infiltrate involving the inferior right middle lobe.

I did, on my doctor's suggestion, make an appointment in a few months with a specialist, but I am worried. For over a week now, I have suffered from a very deep cough, one that leaves me breathless at times and gasping for air.  Along with this is an awful taste it leaves in my mouth. I have tried the normal over the counter meds, but nothing seems to help.

I have gone through bad colds and bronchitis that is accompanied with bad coughing fits, but this "taste" is new and not very pleasant.

I guess I am wondering if I have some kind of infection and should be taking antibiotics, or is this something more serious.  I'm sorry, but I am reluctant to go back to the doctor right now.  Just looking for a little advice.

Lisa

 

A. Dear Lisa, The bad taste in your mouth may be due to an infection in the damaged part of your lungs with bronchiectasis. Better see a pulmonologist about treatment. You should improve with antibiotics.

Dr. Tom

 

What Can I Expect with a 25% Lung Capacity?

Q. I was told by my doctor that my spirometer test showed I only have 25% lung capacity left; yet I still go to work and I do not need oxygen. Am I doomed or can today's medicines help in keeping my condition fairly level. PJ 

 

A. Dear P.J. Assuming you have stopped smoking, your lung function can be maintained or decline slowly from age, by medications. I believe you have adapted well to your loss of lung function. Your prognosis is probably pretty good.

Dr. Tom

 

Is COPD Hereditary?

Q. Is the disease COPD hereditary? My grandmother on my father's side died of it. I'm a 32 year-old female who quit smoking in 2003. I have two daughters who are 1 and 2 years old. My husband does still smoke, so I'm concerned for us.

Toni

 

A. Dear Toni, COPD does cluster in families, and there are a number of genetic mechanisms considered. One specific genetic defect has been identified, the Alpha One. It is responsible for about 3% of COPD patients, but is worth checking out, if several family members or generations have the disease. Alpha One can be identified by a simple blood test.

Dr. Tom

 

For more information on Alpha-One see: http://www.alpha1.org/

 

Woodworking and Lung Disease

Q. I am 28 and don't smoke and am healthy. About two years ago I got a new job in a woodworking shop. Most of the time I was machining MDF (Medium Density Fiber Board). I wore a mask but there were times I didn't. Anyway I started getting coughs, sore eyes and throat fairly often. I went to the doctors and was told I had a chest infection.

After 12 months of this job I walked out as I think my health is more important than a job. I haven't been doing the job now for about a year but still tend to get coughs and sometimes can't get a full breath when I breathe. Do you think I could have done some long-term damage? I thought you had to be working with wood and MDF for years to do any harm.

Robert

 

 A. Dear Robert, I doubt if only a year will cause any lasting damage. If you continue to have shortness of breath, get spirometry done to test your lung function.

Dr. Tom

 

For more information about spirometry see: National Lung Health Education Program: http://www.nlhep.org/spirom1.html                               

 

Health Care Advancement Questions

Q. I am a licensed respiratory therapist and also a licensed practical nurse. Do I qualify to challenge the exam for my CRT and also how can I go about getting my ACLS (Advanced Cardiac Life Support) in CPR? Please answer soon

Tamisha

 

A. Dear Tamisha, I do not know the criteria. Please check with the NBRC.

Dr. Tom

 

For information about the National Board for Respiratory Care (NBRC) see: http://www.nbrc.org/default.html

 

Lost 11% of Lung Function in One Year

Q.  I was diagnosed with COPD a year ago. My FEV1 was 64% and my report read moderate obstructive ventilatory defect, gas transfer mildly reduced consistent with lung parenchymal and or/pulmonary vascular dysfunction.

At that stage I was a smoker of 60 cigarettes a day. I have weaned myself slowly so that now I am smoking only 6 cigarettes a day. I had a lung function test this past Tuesday and my FEV1 is 53%. My report reads severe obstructive ventilatory defect please note CoHb4.1% unable to obtain TLCO. Patient could not hold breath for duration of test.

I understand I need to stop smoking all together and I am going to, but should my lung function decline this fast? I know we all lose lung function as we age but to lose 11% in one year, is this normal? My pulmonologist has said there is not much I can do apart from totally stopping smoking and be careful of aerosol cans etc.

I am really scared if I lose this much lung function it won't be more than three years and I won't have any. Please can you explain the normal amount we are supposed to lose?

Leah

 

A. Dear Leah, The amount you lose each year depends on your height, age and sex, but it is far less that 11%. I doubt if you have really lost this much. Do completely stop smoking now and have your lung function measured again in about six months. You may be surprised that your lung function is not dropping as fast.

Dr. Tom

 

What does Lordosis of the Thoracic Spine Mean?

Q. I just had a chest x-ray.  The results:  minimal areas of scarring in the left lower lobe and right upper.  Also evidence of slight lordosis of the thoracic spine.  What does that mean?

Debra

 

A. Dear Debra, It just means a slight bowing inward of your spine. It is not of any great significance.

Dr. Tom

 

What Can I do to Preserve the Lung Function I have Left?

Q. I recently had a follow up PFT and I am scared to death. I am 33 years old and I am currently taking Pulmicort 2 puffs once a day, and Singulair at bedtime. I am being considered for Xolair injections.

My question is:   I quit smoking a year ago, and is it possible to do anything to preserve what lung function I have left? Can you tell me what to expect for the future?

Here are my results...

FVC   Best 78%     Post 89%  15%chg

FEV1 Best 50%     Post 56%   13% chg

FEV1/FVC  best 51

RV- 159%

DLCO- 74%

Dana

 

A. Dear Dana, You did not tell me your diagnosis. I assume from the medications you are taking and considering that you have asthma. Good control of your asthma will stabilize your lung function, which remains pretty good. You have already done the most important thing, which is to stop all smoking. Stay out of smoky environments.

Dr. Tom

 

Humidification for CPAP Machine

Q. Is there any type of medicine that can be used in the humidifier of a CPAP machine ( Continuous Positive Airway Pressure machine - used to help keep the airways open during sleep to help breathing)? I have asthma.

Connie

 

A. Dear Connie, Sorry, I do not know. I do not have much experience with CPAP machines. But you could take nebulizers intermittently by taking your CPAP off for a few minutes.

Dr. Tom

 

 

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