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Archive: Dr. Tom 87
Posted December 5, 2006

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

 

 

Believe That Spacers Used With MDI Are Beneficial
Q. Dear Dr. Tom, Wow. I am so surprised that you do not understand the benefits of a spacer with an MDI!
Have you forgotten the science/research that shows particle size, inspiration flow rate and airway diameter all contribute to drug distribution in the upper airway vs. the distal targeted airways? A mouthful of medicine is not going to make the experience a pleasant or effective treatment!
I can tell you from experience that a spacer makes a HUGE difference! Where do you get your information that it doesn't? I hope you'll answer this for me because up until now I've respected what you've said.

Dolores

A. Dear Dolores, I know about all the "research". By placing the MDI three inches in front of the mouth, you get the same shrinkage of particles, to the size best deposited in airways. I find most patients won't use a spacer anyway. Just trying to be practical.

Dr. Tom

 

Cause of Recurring Pleurisy
Q.
Dear Tom, I write again, you may recall I have a problem with pleurisy (pain described as dull, achy, sharp, ‘a catch’, and/or burning). Well I have it again, the fourth time this year. The pain is severe. It always seems to come after I take my asthma inhaler, I do inhale deep and hard.
Subsequent to my last pleurisy bout I had a chest x-ray three months ago and it was normal. I also have "very" normal PFT's (Pulmonary Function Tests). I have a diagnosis of mild asthma at the moment but suffer SOB (short of breath) daily despite asthma treatments.
The pleurisy concerns me and is hard to deal with, as it is regular. My GP (General Practitioner) diagnosed non-viral pleurisy, which you have not heard of. Neither have I; or it seems the WWW (World Wide Web).
Anyway what can be the cause of this constant pleurisy, it does go away after a week or two. Is this a cause for concern?
Hope you are well,

Conn. 

A. Dear Conn, You may have some chest wall irritation causing pain on deep breathing. I do not know any other reason for your "pleurisy".

Dr. Tom

 

Twin Sister and I Have Both Smoked, She Now Has COPD at Age 40
Q. I have smoked for 25 years and I have now quit for 21/2. I also have been doing artificial nails (lots of dust) for 10 years. My twin sister just got diagnosed with COPD or emphysema and she smoked just as long but quit a year ago. She has had a cough for a while. I decided to get a chest x-ray also and it came back as mild pulmonary hyperinflation. What does this mean?
I do have a doctor’s appt. next week but I feel I need to know something now before I get all worked up about it. My sister and I are only 40 years old. Also should I totally quit doing nails and working with all that dust and fumes?
I just had my lung testing done and the therapist said that one of the tests I had done (not sure of the name) where you blow out really fast was at 110% which showed no obstruction but another test he did where you would breath in oxygen for 3 minutes showed air still in the lungs.
 He didn't quite understand why since the other test was normal. We did the test again and it was still abnormal. He said this test (oxygen) was supposed to be around 220 and I was around 260. What could this mean?
A. Dear Kim, The chest x-ray cannot diagnose mild pulmonary hypertension. I do not know what those other numbers mean; I guess your spirometry, i.e. FEV1 and FVC, and the ratio between the two are normal. If so, you do not have COPD.  
Smoking is far more dangerous to the lungs than working on nails, which should not be much of a hazard. Be sure your clients don't smoke!  Dr. Tom
                                    
Where Can You Find Low to No Cost Oxygen
Q. I have a friend who is looking for a little to no cost oxygen concentrator or canisters. Where can I assist her in finding one?? We live in Ohio.

Lucille

A. Dear Lucille, There is no such thing as no cost oxygen, except the oxygen in the air. I do not know what your mean by "low cost".

Dr. Tom

 

Mixed Connective Tissue Disease
Q. Dear Doctor, My wife delivered our second child on 11-MAY-2005 (5 weeks pre-mature) and after that for the next 3-4  months or so her hair started failing ,losing weight, fatigue, mild fever daily.
She weighed 160 lbs before pregnancy and she was 167 lbs at peak during pregnancy. She was diagnosed with MCTD on 10-Oct-2005.
She was prescribed steroids, but due to all the side effects of steroids and my foolish reading on the internet and unwise decision connected her to a Homeopath.
For 6 months she did not get much benefit and in fact kept on losing weight, ultimately reaching 120 lbs.
She then switched to Allopathy (usual practice of medicine) and was put on methotrexate (is classified as an antimetabolite drug, which means it is capable of blocking the metabolism of cells) once a week  for 2 months and still did not get much benefit.
Finally we met a doctor who started using prednisone 30mg/day.
She did improve dramatically with no fatigue and was happy and energetic. She then developed a fever with some infection and prednisone was stopped and antibiotic started for her. After a while she finally came out of the fever and 30 mg/day prednisone was started again.
She did well for a few weeks and then she developed a DRY cough on 18-AUG-2006 and from which she has not felt totally relieved as on 20-NOV-2006
Our doctor did an HR CT (High Resolution CT Scan) scan twice and it showed ILD (Interstitial Lung Disease)  with some fibrosis in her lower lungs. He also did a PFT test and some tests, which test oxygen levels in the blood from her wrists. The results were a little surprising to him as he had expected that the ILD would cause her oxygen levels to fall but they seemed good to him. The doctor has always stuck to the fact that ILD causes shortness of breath and not Cough.
He has put her thru antibiotics (15 days). He has also put her thru antifungal treatments (for 15 days) with and without steroids But she did seem to get some relief and but not too much. The cough has some barking type sound and now the sputum is also there.
Now the Doctor has just put her back on steroids and no cough medication with just saying that it could be allergy,could be something causing allergy at home/etc etc.
He says its dryness in lungs. He recommends steam but whenever my wife takes it gets even bad cough for her. Could you please advise on this all? I highly appreciate your time on this.

Praveen

A. Dear Praveen, I do not know what criteria were used to diagnose mixed connective tissue disease. Prednisone is the most common treatment for this.   

Many things can cause cough. Try a week out side of your home if possible, and see if the cough gets better. I assume you have no pets or birds in the home.

Dr. Tom

 

Devices to Help with Clearing Excessive Mucus
Q. Hi, Dr. Tom,  My name is Steven and I am suffering  from  chronic  bronchitis  and  a  little bronchiectasis (abnormal destruction and widening of the large airways). Because of too much mucus in my lung, I have to take lots of medicine everyday. Now I am searching for some kind of device, which can help with the excess mucus in my lungs, So I come to know that there is a product called, G5Vibracare, I am not sure if this device is really effective for easily clearing the mucus out of my lung?
Is G5 percussor really great and the best one than other CPT devices as the General Physiotherapy, Inc. advertises? So could you possibly give me any opinions? G5 vibracare is really the best CPT device?
It will be highly appreciated if your responding is available soon. 

Steven

A. Dear Steven, These cough assistive devices can be helpful for retained mucus. The chest percussion device has some reasonable science behind it as does the flutter device. You have to try them and learn the effect, which depends on the individual.

Dr. Tom

 

Need Information to Help Educate Pediatric Patient’s Parents
Q. Dr. Tom, I have a 26 year old friend who is at Craig Rehab Hospital here in Denver.  She had a C1-C2 injury and currently requires continuous ventilatory support.  Last week she had a text for phrenic nerve response and is considered a candidate for a phrenic nerve pacemaker. 
Her father is exited but her mother is concerned.  Kali is her name, and actually she is making progress.  She can talk for 15 minutes each day with her cuff slightly deflated.  Might you please recommend any information or studies that I follow up on to assist her parents in determining what is best for Kali.
 Thank you very much for your help.  I have not worked actively in RT for quite some years so I do not think that without some further study I could give the best counsel.  I pray that you are well!

Sister Esther

A. Dear Sister Esther, I am writing this for the readers, since we have discussed Kali in person recently. The fact that there is some response to phrenic stimulation is encouraging. I do not have any personal experience with phrenic stimulation, but the doctors at Craig are excellent and you can trust their advice and treatment.  
I appreciate your prayers, which are felt each day.

Dr. Tom

 

Does Holding on to The Treadmill Rails
Q. I have severe COPD. Try to walk on TM 5 times a week.  Read on COPD website that if you hold on to rails while walking you will not benefit from walking. 
I do hold on to rails as I feel like I'm falling if I don't.  Do you think I get any benefit if I hold to rails?

Gwyn

A. Dear Gwyn, Of course you are getting benefit! Keep it up. A fall would be disastrous. You do a little less leg- work by holding on, but it is still valuable.

Dr. Tom

 

Organizations Associated with Respiratory Therapy
Q. What organizations are associated with Respiratory Therapy?

Catherine

A. Dear Catherine, The organization that  certifies and registers respiratory therapists is the American Association for Respiratory Care (AARC). The American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), has many members who are respiratory therapists.

Dr. Tom

American Association for Respiratory Care
American Association for Cardiovascular and Pulmonary Rehabilitation

How Big is 3mm?
Q. What is the size of the nodules that are 3mm

Dan

A. Dear Dan, About three time the size of the head of a pin. Very small,  and usually benign.

Dr. Tom

 

Lung Health with Smoking History and Exposure to Ground Metal 
Q. Does smoking have any thing to do with hard metal disease? I was a smoker for eight years, about 1/2 pack a day I ground a lot of metal at work. 

David

A. Dear David, Yes, smoking can contribute to lung damage from welding and other metal work.

Dr. Tom

 

My Lung Collapsed and Now have Pleural Effussion
Q. I am a 45 yr old female who has smoked for 25 years.  I had what we thought was pneumonia in July and haven't fully recovered. I am short of breath and have "rib" pain. Turns out I have a pleural effusion that has cause an atelectasis or collapse of the lower 1/3 of one lung.  I have seen a lung specialist and they said, quit smoking obviously and that it should resolve itself.
Will my lung re-inflate? Shouldn't the fluid or effusion be drained? Could that fluid, if left alone, get worse instead of better? I am worried because it has been there so long (July) and a friend who is an RN said I could damage my heart if it is not drained and that I should have an echo.
Is there anything else I can do such as breathing exercises to regain my full capacity?
Thank you so much.

Catherine

A. Dear Catherine, You should have the effusion drained, mainly for diagnosis. The association with atelectasis requires explanation. You could have a lesion in your air passage to that lobe of lung, which could be the cause of the pneumonia in July.
You should see another pulmonologist for this. I can't believe that any "lung specialist" would just wait for resolution. A bronchoscopy to look directly into your lung and a tap of the fluid would be in his area of expertise.

Dr. Tom                        

 

Mother has Severe COPD, Can She Live for Another 5 Years?
Q. My mother has severe COPD she takes Pulmicort & albuterol four times a day in neb. Foradil four times a day and Spirvia once a day. She is oxygen dependent. She has had this for over five years and her lung capacity if getting about 25% out of 100%.
In your experience and opinion what is her state of life in years of existence? I know it hard to say, but could she live five more years with this disease, since I am taking good care of her.

Kim

A. Dear Kim, Depending on her age and other problems that she has, she could certainly live five years or more, assuming she has stopped all smoking. If she continues to smoke, her prognosis would be much worse.

Dr. Tom

 

Am Having Biopsy as Because of CT Scan Results
Q. I had a CT scan and now have an appointment. for a biopsy. Small nodule right lobe of thyroid gland, mass subapex left
Upper lobe and scarring at apex of right upper lobe. I was a smoker up until the time of the CT scan I need answers how bad is it?

Lucinda

A. Dear Lucinda, I can't tell from your question whether you are going to have your thyroid biopsied, or the apex of your lung.

Dr. Tom

 

Can Asthma Symptoms Include Pain Below My Shoulder Blades?
Q. Dear Dr. Tom, I'm a 26-year-old Asian female. As a child, I suffered from chronic asthma that was usually set off by exercise, humidity or dust. After two years of using an inhaler, my asthma symptoms disappeared by the time I was 13.
Then when I turned 24, I stupidly began to smoke. On average I probably smoked about 3-5 cigarettes a day. About three months ago, I finally quit.
Now about a month ago I’ve been having similar symptoms as my previous asthma - shortness of breath and constriction in my throat. My doctor has prescribed to me Advair as well as albuterol as an emergency inhaler. While the medication definitely does help with my breathing, I am concerned that I still feel sharp, stabbing pains near my ribs and just below my shoulder blades. Is this due to my recent return of my asthma, or has my two years of smoking caused other problems?

Neela

A. Dear Neela, These pains are not from just two years of smoking. They are probably from your chest muscles, that may have become strained with coughing or shortness of breath from asthma. They should completely subside with control of your asthma, if my suspicions are correct.

Dr. Tom

 

Second Hand Smoke Exposure
Q. Dear Dr. Tom, I am 48 years old and I have been having occasional shortness of breath since 2001. I did tell my doc and she did a lung test and told me I have allergy asthma.
For the last several months I have been coughing when my husband smokes and having shortness of breath. It seems to be getting worse even though I have purchased three air purifiers (his mother has been staying with us and she also smokes).
I went to the family doc I am seeing now and he did a lung x-ray, I have inflamed lungs which could be COPD I also had several blebs on my lung when I was 21 years old one ruptured and caused a hole to come in my right lung. I have a staple in upper part of my lung.
My question is could I have bronchitis that is not chronic and if I stay out of smoke it will get well. Also, I smoked for ten years quitting when I was 24 years old. I am really worrying about this; I have had an aunt and an uncle die with lung cancer.

Nina

A. Dear Nina, You may well be very sensitive to second hand smoking. I believe you should INSIST that there be no smoking in your home. I do not think that the risk of lung cancer is much at your young age, but you must protect your lungs for a lifetime.

Dr. Tom

 

Worried About Father’s Diagnosis of Bronchiectasis
Q. My father has been diagnosed w/ bronchiectasis. His original diagnosis was COPD. After a scan the diagnosis changed to bronchiectasis . Is this possible?
He has been battling this condition for several years now, on and off antibiotics, inhalers and aerosol therapy. How does one get this condition?
He did work with and asbestos based material for a number of years, however the condition did not surface until later in life (70yrs). What can we do to cure this condition, or what can we do keep it from accelerating? In addition, are there any resources to check the material he worked with years ago to see if there is a connection? We appreciate your feedback.

Toni

A. Dear Toni, Bronchiectasis is usually associated with repeated bacterial chest infections. The large airway passages get damaged and cannot clear mucus normally in bronchiectasis. Bronchiectasis also causes airflow obstruction, and some of the treatment strategies are similar COPD. With poor clearance of mucus, lung infections are common and often cause more lung damage".
Repeated use of antibiotics for at least 10 days is usually required for a chest infection where there is fever, more mucus and a change in mucus color. This treatment will retard the progress of disease. Bronchiectasis is not usually a complication of asbestos exposure.

Dr. Tom

 

Recurring Infections with Repeated Antibiotics
Q. Dear Dr. I am having a problem with recurring infections. Which make me not able to breath my fev1 32% but I have Medicaid so therefore I have just a regular primary doctor.
I have told her repeatedly to please give me an antibiotic longer than the 6-day pack of Zithromax. She will not and then I’m back with an infection again. And then when I call her it takes five or six days before she sees me, which makes me even sicker.

Please help me, this goes on month after month, what can I do? Also I called Medicaid for a scooter type wheelchair and they told me to get a doctor ok and they would approve one. I went down and picked the least expensive scooter, $1600.00 and the doctor would not approve it. She even called the scooter store and told them no. I feel like crying all the time I can't even get out of this house.

Pam

A. Dear Pamela, You need another doctor. You can INSIST on this. Six days of Zithromax or other antibiotic is often not enough in the case of damaged lungs. Ten days or more is reasonable. You are not restricted to seeing only a primary care physician, just because you use Medicaid. Try to see a pulmonologist.
Although motorized scooters are useful to some, most with COPD are able to walk and walking is good for your general health.

Dr. Tom

 

Infections and Transtracheal Oxygen (TTO)
Q. I have a TTO (scoop) for O2 at two and a half flow.  The topic of infection from this comes up from time to time. What is the reality of this concern or idea?

Jim

A. Dear Jim, Infections associated with TTO are not usually much of a problem. Exceptions are in diabetes and when drugs that suppress the immune system are used.

Dr. Tom

 

Can Infections Cause Scarring of the Lungs?
Q. Wife had walking pneumonia in June spent seven days in hospital had pleurisy as well. Treated released regained strength. Follow-up chest x-ray still showed some infection-stayed course with drugs and Mucinex.
Months later still showed something on x-ray had CT scan and now shows resolving infection. Is there possible scar tissue resulting from the pleurisy that is showing up? They want her to take a TB test to rule that out. No symptoms of any kind currently.

Tom

A. Dear Tom, Pleural infections may lead to scarring. Although TB is rare in natives of this country, a TB test would be a good thing to do. It does not make a certain diagnosis, but helps to rule it out, or leads to more tests to prove the presence of TB.  

Dr. Tom

 

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