How Bad is Severe COPD?
Q. My mother has been diagnosed with COPD at the end of 2004. Since then she has had two spirometry tests, which gave a lung age of 94 (July 05) and 98 (March 06). Despite severe shortness of breath at times she is still smoking (pack a day).
Thankfully, she has not been hospitalized for her condition to date. Please could you explain how bad she is? What is an average lung age maximum? If she continues to smoke and deteriorate at this rate (spirometry tests indicates aging of four yrs in seven months time) how soon is she likely to die? I have been advised that I do not understand fully the condition and I would like to know just how serious she is.
A. Dear Sharon, You did not tell me your mother's age. In spite of advanced COPD, she can still live quitea while. She would live longer if she stopped smoking.
Former Smoker and have Questions about Spirometry Results
Q. Hi Dr. Tom, I just got test result back on a spirometry test I had due to shortness of breath. I am 33 years old and I had smoked from age 16 to 27. I am concerned about the results. My mom has recently been diagnosed with COPD. I am 5'4 and weigh 99lbs.
My results are:
Could you please tell me what these results mean?
A. Dear Shannon, These results are pretty good. They should be expressed in percent of normal for your age, sex and height. For example, if you are 5 foot 4 inches, your FEV1 is about 70% of normal. Pretty good. Never smoke again and avoid environmental smoke. Stay well.
COPD and Lung Scarring
Q. Does COPD cause scar on the lungs?
A. Dear Paul, It usually does not cause major scarring. A few patients do have scarring with COPD, but it may be do to a separate process.
Worried that Mother’s Lung Cancer has Returned
Q. Dr. Tom, My mom had an itchy throat cough that moved into her chest and a sip of water would calm it. She had a little blood in the sputum so she went to her doctor who did a blood test for cancer, a sputum test, and a CT scan. She then put her on antibiotic, which seems to be clearing up the cough.
Her blood test came back negative for cancer, and the sputum test also, came back negative but the CT scan showed spots on her lungs. She is a 9-year lung cancer survivor, so she is very worried.
Does this sound like a return of cancer? She is a nonsmoker, age 76.
A. Dear James,These new spots may be a return of cancer, but the interval suggests against this. In any case she needs to have the spots re-evaluated in the future byCT.
Mother is Deteriorating Quickly
Q. My mother (54 years old) is suffering from severe COPD. As a child I always remembered that she frequently had either bronchitis or pneumonia. She was a smoker but stopped about 10 years ago. My grandmother (her mother) died at the age of 30, as far as I know she also had COPD.
During the last two years I have seen my mother deteriorate to such an extent that she takes up to 80 mg of cortisone per day and sometimes suffers from blackouts. According to a specialist she is classified as a severe COPD case. What is the life expectancy of a COPD patient?
What is the chance that this disease was also passed on to me? I am 30 years old and have never smoked in my life. Both my parents did however smoke when I was younger.
Do you recommend that I go for tests to determine my status? I rarely get bronchitis, only upper respiratory infections maybe once a year. I am quite worried, seeing that she is deteriorating so fast.
A. Dear Ninette, It is possible that you have a genetic susceptibility to COPD, known as Alpha One. A simple blood test will tell you. Have your doctor get this done.
It is hard to predict the prognosis of any single patient, but in general, rapid deterioration carries a poor prognosis.
For more information about Alpha-1 Antitrypsin Deficiency: www.alpha1.org
Cause of E. Coli and Pseudomonas In Lungs
Q. I have an 18-year-old nephew that has severe brain damage from cardiac arrest; he was on a ventilator for two weeks he has now been diagnosed as having E. coli in his lungs. Could the ventilator cause this? He also has pseudomonas in his lungs; what causes this?
A. Dear Loretta, These organisms are common with severe underlying lung damage, that commonly occurs in brain injured patients due to aspiration of mouth and stomach contents. These organisms do not come from ventilators that are properly cleaned.
Advancement in Future Treatments for COPD (Follow up to Dr. Tom 66)
Q. Dr. Tom you were kind enough to answer a previous question I have COPD and try to educate myself on the web, I recently read a article on Medscape which stated that with the current state of research there probably won't be any significant advancement in treatment for probably about 5 years. I would like to hear your thoughts.
A. Dear Don, I do not agree with this dismal outlook. There are many drugs under study that may well change the course of COPD. So far, smoking cessation helps the most, and there is a new drug to help promote this.
Long Term Oxygen Therapy (LTOT)
Q. Is there any data out there to suggest, on average, the length of time a person is on LTOT from first diagnosis? I realize all patients are different and the answer would vary based on cause.
I have an idea for a system to make home use of O2 safer and more convenient. One question in my mind at this point... How long is long term?
A. Dear Bruce, Many patients who require LTOT live 10 years or more. One of my patients lived 22 years with LTOT. I would guess that most on LTOT live 3-5 years.
Worried that Father has COPD
Q. Dear Dr. Tom, my Father is in his seventies. He has had persistent congestion and phlegm, plus a fever that comes and goes for the past 2 years. His treatment has been several courses of antibiotics and steroid inhalers. He was also given a bronchoscopy. He has not smoked for 20 years. But I am worried in case he has COPD and his doctor is not telling us. I would appreciate your opinion.
A. Dear Sharon, Well, your doctor needs to start with spiriometry to measure his lung function. This is the first step in diagnosingCOPD and all doctors should do it in cases such as your dad.
Hope Chronic Cough and Mucus Would Stop after Polyp Removal
Q. Dear Dr. Tom: I have bronchiolitis and have just had my nasal polyps removed three weeks ago (several polyps and severe infection). Although I feel that I receive more oxygen when I inhale (2L 24 hours with nasal cannula, I still have my chronic cough and I continue to spit up mucus (light colored).
I had hoped that these symptoms would have decreased following my surgery. What are your thoughts?
A. Dear Rose,There may be other causes of your mucus. I cannot make a diagnosisfrom the limited information that you give me.
Just Diagnosed with Mild Emphysema and Wonder What to Expect in the Future
Q. Hi Dr Tom! I’ve just been recently diagnosed with mild emphysema. I’m 34, I’ve stopped smoking but I’m wondering about my future quality of life. Is it a disadvantage to have this illness so young, since I assume it gives the disease more time to progress in your body. In other words, might I develop severe emphysema in another 10-15 years?
A. Dear Paul, You need to know your spirometry numbers, the forced expiratory volume in one second (FEV1), which is the flow test and the forced expiratory volume in second seconds; (FEV6) or the forced vital capacity (FVC), both of which are a test of the total air you can blow out of fully inflated lungs. You need the percent of normal for your age.
You are young to have emphysema. Does it run in your family? If so, you need a blood test for this, called Alpha One. Do NOT accept the diagnosis of emphysema without this information.
For more information about Alpha-1 Antitrypsin Deficiency: http://www.alpha1.org/
Coughing Up Small Amount of Blood
Q. Hello, I am a 31 year-old male who had relatively bad childhood asthma, which has almost completely subsided. A few days ago I woke up feeling congested and coughed hard in the shower and a little bit of blood was in the phlegm. I had pain in my right lung (I think) throughout the next couple of days it was very sharp and got worse when I took a deep breath.
I went to the doctor, and had x-rays done and an exam. The x rays were clear, and my O2 saturation was 99% and I was not short of breath.
The pain subsided, but I am still coughing up small amounts of blood in my phlegm right after I wake up in the morning (three mornings in a row), but have no more pain. Any ideas? I'm still not at all short of breath and my doctor doesn't seem worried.
I have scheduled a blood test for Factor V Leiden to see if I have a propensity to develop blood clots.
A. Dear Neil, The Factor V Leiden test will not tell if you had lung clots. It only identifies a tendency to clot, as you stated. You need other tests for lung clots, called emboli, if the suspicion remains.
Your small amount of blood may have been due to vigorous coughing, but if it continues, you need bronchoscopy to look in the air passages for a source. This is done by a pulmonologist.
Breathing is Getting Worse, What can I Do?
Q. Dear Dr. Tom, I have been using Combivent for a few year and now I notice that I am having a hard time breathing. I have emphysema and was wondering if there is something else I can take to help me breath better. I tried Spiriva and it did not help me at all.
I am getting so depressed cause I get so out of breath. Please Dr. Tom what else can I do?
I have not been to see a pulmonologist Dr. yet I am just so scared. I was doing so well with Combivent and sometimes in between I use albuterol with the nebulizer.
Does the bad air quality and 95 degree days affect my breathing even if I stay indoors, seems like it does?
I stopped smoking in 1981 but I guess the damage was already done.
Please Dr. Tom I am looking forward to your answer and I was wondering if you knew of a good doctor in Atlantic City, New Jersey, I have only been living here for about four years. I come from New York.
A. Dear Marie,You do needto see a pulmonologist. There are excellent pulmonologists all over New Jersey. Maybe try the Deborah Lung Center if it is not too far away. There are other medications that may help you.
14. Breathing Exercises and Asthma
Q. Why is it that almost no one teaches asthmatics to do breathing exercises?
A. Dear Jack, I don't know. Breathing exercises and breathing retraining, stressing slow deep breathing and exhalation against pursed lips as in the act of breathing, helps many asthmatics.
Question about Spiriva
Q. My doctor recently prescribed Spiriva to replace Serevent in the treatment of my asthma. I've only read that Spiriva is for COPD. Does this treatment make sense to you?
A. Dear Denise, Spiriva is only approved by the FDA for COPD, but it also works in asthma. It is in a different class of drug than Serevent.
16. Worried about Father’s Health
Q. Hi! I'm very concerned about my father, he's turning 50 this year but has been diagnosed late last year with diabetes, he also has high cholesterol and hypertension, and two weeks ago the doctor told him that he has a scar (or scars- I don't know) in his lungs! The doctor gave him anti-TB (Tuberculosis) medicines.
Can this cure the scar? Can the diabetes be causing the lung scar? What are other causes of lung scarring and what other cures can we explore?
He smoked for many years, but was not a chain smoker. My dad's so young to be sick. And he's got me very worried.
A. Dear Claire,There aremany causes of lung scars. Apparently your doctor thinks that these are due to an oldTB infection that is now "latent". Since your father has diabetes, this consideration is realistic.
Assisted Living and COPD
Q. What kind of therapy is given at a assisted living home for COPD?
A. Dear Bernie, It depends on the patient. Often it is assistance with oxygen, sometimes breathing machines, and assistance with the activities of daily living.
Worried about Cancer
Q. I had breast cancer six years ago. I recently was in the hospital with a blood clot in my leg. They did two surgeries and after the second I had a PE.
I have had some shortness of breath since but never had really felt like I have fully recovered. I went for a CT during my yearly oncology follow up where it revealed a 6mm subpleural noncalcified nodule that was not there when they did the scan that show the PE.
Should I be concerned that this is metastatic disease. A radiologist recommended follow up for that. Are cancers calcified or noncalcified?
A. Dear Marie, Cancers are not calcified. Although the risk of cancer, either from your breast or an independent lung cancer is low, you do need a follow-up CT in about 3-6 months.
Worried about Husband’s Emphysema
Q. My husband is 55 and has been diagnosed with emphysema a few years ago. He's on several medications, and should be on oxygen 23 hours a day, but refuses. He sleeps under it at night.
We've been told he has 26% lung capacity. He is still smoking but wants to quit.
My question is, if he quits now, would his lung capacity go up over time, or has the damage already been done. How long can you live with a 26% lung capacity. I worry so much, and feel so helpless.
A. Dear Rhonda, Your father's lung function may go up a little, when he stops smoking. But the important thing is that it lung function will not decrease so fast, as if he continues to smoke. He can live a long time with his lung function, particularly if he does succeed in stopping smoking. There new medications that can make addicted smokers more likely to quit.
Questions about Alpha-1
Q. What is the life expectancy after confirmation with Alpha-1. I have not been confirmed but my grandmother died of Alpha-1 and my mother was just confirmed to have the disorder. Also, what is my chance of having Alpha-1 and what type of test do I need to have done.
P.S. I have limited contact with my mother I was adopted at an early stage of life. My maternal mother contacted me over the weekend to let me know her situation.
A. Dear Robert,You may have the Alpha One deficiency without much or any lung damage. You need a test of your lung function known as spirometry.
For more information about Alpha-1 Antitrypsin Deficiency: http://www.alpha1.org/