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Archive: Dr. Tom 82
Posted October 17, 2006

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

 

 

Should You Perform Pulmonary Function Tests for People with a Pulmonary Embolus (PE)
Q. We are having a problem in our PFT lab.  Historically, we would hold PFT studies on patients that were admitted with a Pulmonary Embolus (is a blockage of an artery in the lungs by fat, air, clumped tumor cells, or a blood clot) until the diagnosis was ruled out.  Presently, we have a fairly "new pulmonary" team that routinely orders PFTs on their patients. I spoke to the ordering physician and he stated that the INR (International Normalized Ratio is used to monitor anticoagulation therapy, i.e. coumadin) had been stable over the past few days and it was ok to perform the test. 
I spoke to our medical director and he was not totally sure so he said if the patient was ready for discharge and able to ambulate that it should be acceptable to do the study.  In the meantime I am to research it and we will meet to discuss a revision in our policy/procedure to address this issue. 

Connie

A. Dear Connie, I see no reason not to do pulmonary function on PE patients at all. But the results may change as the effects of the PE on ventilation and perfusion resolve. I do not believe that pulmonary function will adversely affect a pulmonary embolus.

Dr. Tom

What’s Your Opinion on Lung Reduction Surgery and Lung Valves?
Q. I hope you enjoyed your fishing trip. I am 76 years young. I have had 12 years of COPD.
I have tried to take as good care of myself as I can. I have not smoked for 12 years. My condition is starting to get worse. I am in excellent health except for the COPD. I have some moderately high blood pressure and am on cholesterol medication.
My pulmonary doctor said that I have tolerated the disease very well and that I may be a candidate for lung reduction surgery.
Can you tell me your opinion of Lung Reduction and also about the procedure of placing valves in the branches of the lungs to help with the emphysema? I appreciate your knowledge when it comes to lung care.

Don

A. Dear Don, Lung volume reduction surgery improves exercise tolerance and quality of life in a limited number of selected patients. Your doctor will have to decide if you are a candidate, based on the published studies.
In general, the benefit is where upper lobe disease predominates along with hyperinflation, and exercise responses to pulmonary rehabilitation are poor. Survival is not improved in this group. The use of valves to accomplish some local degree of lung volume reduction are currently under study.

Dr. Tom

Any Thoughts about a Chronic Cough?
Q. I have been having a curious condition for four months. I have a dry cough, primarily at night, though about 10% of the time it's during the day. The cough lasts for about an hour; then stops. It's terribly disruptive to my sleep.
We tried a few things:  allergy medicine (Clarinex D) - no change, reflux medicine - no change, raising the head of my bed - no change, spirometry - normal, chest x-ray - normal.
Now we have tried Advair and it has stopped the cough, though I can tell "it" is still there because I have a minor cough two or three times a day and it feels as it's felt.
I am 50 years old, have NEVER been bothered by allergies, have NEVER had a hint of asthma or any other kind of breathing problem. I quit smoking six years ago.
Any possibilities this brings to mind?

Sherry

A. Dear Sherry, Chronic cough may be the only manifestation of asthma. Since you have responded to asthma therapy, this is the best diagnosis.

Dr. Tom

Suggestions for Breathing Exercises and Chest Hurts During Exercise
Q. My brother, 51 yrs. old, diagnosed with emphysema, and he has no computer access. He asked me to ask you if whistling helps situation to remove CO2 from lungs as other exercises do?
What would you suggest is best exercise for building diaphragm and expelling CO2?
Also, he seems to get air trapped around heart when trying breathing exercises and it hurts his chest, neck and left arm as if heart attack, but then goes away after burping well. Is this something to be concerned about?

Linda

A. Dear Linda, Exercising with pursed lips breathing as in whistling improves breathing efficiency and CO2 elimination. This should not cause chest pain.

Dr. Tom
  

How Long does it Take for Tuberculosis (TB) Medicines to be Absorbed into the Body?
Q. After how many hours are TB drugs assimilated in the body? I have lymph node TB and I am treated with isoniazid, rifampin, and ethambutol.

Lately I have problems with my stomach and sometimes I throw up. I would like to know after how many hours from swallowing the medication it is safe to throw-up.

Ana

A. Dear Ana, These three drugs are absorbed within one hour. Perhaps you should find out why you have stomach problems. These drugs usually do not upset the stomach.

Dr. Tom

My Family has a History of Lung Disease, How can I Keep My Lungs Healthy?
Q. I'm 39 and concerned about lung health.  My father had pulmonary fibrosis & a lung transplant nine years ago and he passed away three years after the transplant.  Mother has asthma and bronchitis often!  I too have minor asthma and I am a daily mucus machine. 
I'm looking for tips to help overall lung health (food, supplements, etc.)  I do exercise, but today I read a little about a "lung cleanse" product.  Is there any validity on lung cleansing?  Any other tips I can do procure healthy lungs?

Jane

A. Dear Jane, Do not smoke and avoid smoky places. Eat lots of fruits and vegetables that contain antioxidants. There is no such thing as a lung cleanse product.

Dr. Tom 

What is the BODE Index?
Q. Can you explain the BODE Index prognosis to me?  My husband has emphysema and his fev1 is 38, but he has good exercise tolerance.  I am confused and thought I would ask. 
I love you website and appreciate the way you explain things to patients and family members. 

Janis

A. Dear Janis, This stands for Body, Obstructive, Dyspnea, and Exercise tolerance. Body refers to weight and height, called Body Mass Index, Obstructive refers to the degree of airflow obstruction as judged by FEV1. Dyspnea is the degree of shortness of breath and Exercise is the ability to exercise, usually measured for six minutes. It is a good prognostic indicator.

Dr. Tom

Nonspecific Lung Nodule Found on Chest X-Ray
Q. Dear Dr. Tom, my husband recently went for an x-ray and was told that he has a 5mm nonspecific nodule on his left lung.  He also has hyper-inflated lungs but everything else was good.  His spirometery test was also good.  A lung x-ray from two years ago made no mention of the nodule.  Should he be concerned?

Sue

A. Dear Sue, Not yet. Repeat the CT is six months and see if there is any change.

Dr Tom

Black Spots in Phlegm
Q. Hello my name is Bill I have a question. I’ve been feeling very badly for about three days now. I think its a common cold I’m spitting phlegm out which is normal but I noticed it had some black spots in it, do you know what that could be?

William

A, Dear William, It could be most any dust, or perhaps old blood. Have it checked if this continues.

Dr. Tom

Will Blowing Up Balloons Improve Lung Capacity?
Q. Is there any benefit to the lung capacity by blowing up a balloon as a regular exercise? 

Frank

A. Dear Frank, No, but it is a lot of fun.

Dr. Tom
                                    
What are the Criteria for Lung Transplant Acceptance?
Q. Dear Dr. Tom, My doctors' choice of transplant hospital has turned me down for an interview because I have heart stents (one single, one multi). Otherwise, I am in excellent condition except for my lungs. The stents have been in place since 2003 with no additional problems.
They gave me names of about four different hospitals, in other parts of the country, I could contact that may consider accepting me. 
My question is...why is the criterion not the same for all certified transplant facilities?  It’s a sad thing to think the reason is because certain conditions may end up having a poor reflection on their success ratings numbers. Is there a national guideline they are required to follow?

Sandra

A. Dear Sandra, I know of no absolute guidelines. Obviously the presence of heart disease is always a consideration.

Dr. Tom                     

What is Your Guess on Time Frame for Drug/s that will Halt the Progression of COPD?
Q. Dr Tom, I know I ask a lot of questions but I do feel that an educated consumer is the best kind.
I know that research is going on all over the world, and I found out that there are at least 70 new drugs being developed for COPD and emphysema, but the one that is really needed is the one that halts the progression of the disease. Some argue that the pharmaceutical companies really do not wish to find one, because they would loose billions of dollars by having to take all their other drugs off the market.
 Now in your estimation Dr Tom, how long do you project it will take to really make inroads here? Would you say 1- 5yea,rs 5-10 years or 10-20 years? What would be your educated guess?

Thanks Phil

A. Dear Phil, Several drug companies are looking for drugs to halt the progression of disease. The idea that drug companies do not want to find one is nonsense. I predict it will take 2-5 years to find one that is really effective in the long term, with acceptable side effects. I wish it were sooner.

Dr. Tom

No Trouble with Six-Minute Walk but My Doctor Says I Have Severe COPD
Q. Dr Tom. I just changed doctors, and my new specialist had me do an oxygen-walking test with a clip on my finger.
Before the test at rest my CO2 was 96. I walked for 6 minutes at a normal gait, and walked approx 350 meters, or about 325 yards. I did not have to stop once to catch my breath, and my CO2 never dropped below 91. Also I had a blood gas and all numbers were in the range of normal.
Now the other doctor diagnosed my as severe COPD, yet my walking test was almost as good as someone without COPD. How do you figure the severe rating?

Phil

A. Dear Phil, It was NOT your CO2, it was your O2, i.e. oxygen that was monitored while you exercised. This is still possible with advanced COPD. The severity of COPD is judged by FEV1, not the need for oxygen.

 Dr. Tom

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