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Archive: Dr. Tom 98
Posted May 9, 2007

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

 

 

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Is it Safe to Take Combivent and Spiriva?
Q. I take Spiriva once a day and my doctor. also prescribed Combivent (2 puffs) four times a day as needed for SOB (shortness of breath). Inhalation therapist tells me that Combivent and Spiriva are not to be taken together but the doctor assures me it's safe.  Your opinion please.

Pat

A. Dear Pat, These two drugs can be taken together, but there are similarities in action between the tiotropium and the ipratropium component of Combivent. There is no danger in using them together.

Dr. Tom
                                   

Do I Need to Follow-up a CT Scan?
Q. I'm a 56 year-old female and I smoked for approximately 19 years. I was having shortness of breath and had a CT scan of my lungs. The first CT showed a nodule 7mm, unable to characterize.  I had another CT 3 months later. It showed the nodule to be 7mm and characterized as ground glass.  Would this require further test for a diagnosis, or is this ok?

R


A. Dear R., This is borderline in size for a follow-up, but  since it is of ground glass appearance, it should be followed up in 3-6 months.

Dr. Tom

 

Should I be Concerned with an X-Ray Report?
Q. I am 45 year-old male.  In December 2006, I was diagnosed with bronchitis.  As part of my evaluation, an x-ray was ordered that showed "subcentimeter nodular densities within both lower lobes." The report went on to say that "clinical correlation and 3 month follow-up is recommended for confirmation of stability."
In April 2007 I had a follow-up chest x-ray.  I haven't seen the report but my general practitioner's nurse said that it showed the same densities but that they had not changed in size.  She said she "didn’t know if this was good or bad" but wanted to tell me that the doctor was going to turn the file over to a pulmonary specialist in the doctor's group for review. 
This specialist is on vacation for two weeks.  So, I am sitting here wondering what this is all about? Should I see another doctor immediately or wait it out and worry?

Pat

A. Dear Pat, These findings are not alarming. I would wait and get a follow-up when possible.

Dr. Tom

 

Do I Need to Use Oxygen 24/7?
Q. I use 2 liters of O2 at night and during physical activity.  I recently had an attack of shortness of breath and went to the ER.  At admission I had an O2 test and registered 94% after using O2 for at least 30 minutes.  Does this indicate that I should be using O2 24/7? 

Sharon

      
A. Dear Sharon,  No, oxygen is prescribed from measurements when you are NOT on oxygen.

Dr. Tom                   

 

History of TB and Now has 4 Nodules
Q. My mom, in 2004, tested positive for TB. She went through the medicines prescribed to treat her.  They told her she would always test positive from now on.  Now she has had an x-ray and they have found 4 nodules on her lungs.  One is 3cm and is calcified and 3 others too small to biopsy. Why would one nodule, the biggest, be dead?
She has been suffering with a very severe case of fungus in the upper part of her mouth.  She has taken antifungal medicines and mouth washes etc. to no avail. Her voice is very scratchy sounding.
I understand TB and cancer both are very fatal if not treated promptly. The doctor only seems to want to do x-rays.  Is this right? How can she be properly diagnosed? How can you know if this is the TB coming back or if it is lung cancer?
Thank you for your time.

Sharon

A. Dear Sharon, A CT scan is much better for the follow-up of lung cancer; it is okay for tuberculosis. The diagnosis of TB is by finding the organisms in the sputum or tissue and the diagnosis of lung cancer by tissue biopsy.  
The calcified lesion is older than the smaller ones and is healed by calcification. The other lesions are probably more recent and require more follow-up.

Dr. Tom

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