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Archive: Dr. Tom 14
Posted March 22nd, 2005

Hearing Crackles In Lung
Q. Hi, I have been suffering with chest discomfort (back and front) and a change in my breathing, anxiety, and a sense of being unwell for 15 months now. My doc cannot hear anything and says I have a clear HR CT.

However, I am hearing crackles from time to time when I lie on my side (not all the time). These crackles are like cracking bubble wrap. When I move position they go and don’t return for days. They do not go when I cough.

Interstitial Lung Disease (ILD) concerns me and the crackles scare the hell out of me. In ILD are crackles there constantly or do they come and go? I have a history of mild asthma, allergies, nasal polyps and smoking (past).

Cheers, thank you for your help.


A. Dear Cecil, Maybe you hear better than your doctor. If you have the crackles of interstitial lung disease, they do not clear with coughing.

Go to a pulmonologist or internist and get him or her to listen carefully with a stethoscope. Also get spirometry to see if your lung capacity is okay. This will answer the problem and deal with your anxieties.

Dr. Tom


Lung Nodule found on CT scan
Q. A nodule was found on my left lung during a chest x-ray. I was sent for a CT scan. As per radiology report: It is a 1.0 1.4 centimeter left upper lobe nodule anteriorly, adjacent to the pleura. The inferior margin is somewhat irregular. It is not definitely calcified, and continued follow-up is recommended.

No evidence of effusion, mediastinal, or hilar adenopathy is seen. The heart is unremarkable, as are the upper portions of the abdomen.

My doctor (internist) said not to worry, but I am going for another CT scan next month, which is three months after the first one. I had an x-ray for a car accident one and one-half years ago and it was not seen then.

Do you think I really should worry? The fact that the radiologist said it is “not definitely calcified”is throwing me because I do not really know what that means. What does that mean?


A. Dear Harriet, Calcified nodules are almost always benign (not cancerous) and need no further investigation.

Non-calcified nodules of this size need to be taken out if new. Certainly if growing.

Some recommend a needle biopsy, but if it misses the nodule, you get false information. Better to get it out and be rid of it and know if it is cancer.

Many nodules can be taken out through a scope called a thoracoscope and this is only a small operation, and usually only one night in the hospital. A thoracic surgeon does them.

Dr. Tom


Mother Tripped on Oxygen Tubing
Q. My mother (age 90 and very sharp mentally) needed to use oxygen 24 hours a day after a bout of pneumonia in December. She had a concentrator in her apartment with long lengths of tubing that enabled her to travel from room to room.

Although she was careful, the inevitable happened. She got tripped up in a loop of tubing and fell, breaking her hip. Now she is in rehab, and will soon be returning to independent living.

I'm wondering about that tubing! Is there any strategy you know about that will keep that tubing safely reeled as she moves about? I am so worried that she will trip and fall again. (Presently, she still needs the oxygen at the 2-liter flow level to maintain adequate saturation.) Any advice? Places to contact?

Many thanks!


A. Dear Helen, I have tried to get the oxygen industry to develop tubing that reels in, but with no success.

New portable concentrators that can be moved from room to room may be one answer. The other is to tape the tubing down to the floor or put rugs over it, so that the tubing will not trip her.

It remains a problem when there are coils of tubing on the floor.

Dr. Tom


Asthma and Exertion
Q. My son, 16, has been diagnosed with asthma (severe to moderate) since 4th grade. He uses Advair, Singulair and Albuterol. My question is in regard to exertion. His feet and hands go numb when he has overexerted (such as football, track or wrestling) so much so that sometimes it scares him. I haven't been able to really find where this is attributed to asthma.

Do you think this is related or may something else be causing this? He would have four or more bouts of bronchitis a year until he went on meds and now maybe once or twice a year.


A. Dear Marilyn, His hands should not go numb with sports as a result of asthma. There maybe some other explanation.

He should always take his albuterol before he exercises to prevent an exercise–induced asthma attack.

Dr. Tom


Lung Diseases and New Liver Problem
Q. I was diagnosed having Marfan syndrome (an inheritable condition that affects the connective tissue) when I was little. I am now 39. This past November, I was diagnosed having bullous lung disease and restrictive lung disease. I am receiving treatment for these lung diseases.

Yesterday a CT scan revealed some low-density area in left lower lobe of liver, as in the right lobe of my liver. How much danger am I in this being fatal? Considering my lung and liver conditions, what is the probability rate or my survival rate?


A. Dear Tim, I do not believe the liver shadow is due to your Marfan's disease. Maybe just a cyst or something else benign (non–cancerous).

Your main risk is a weakness of a major vessel, such as your aorta, but I am sure you have been advised about this.

The large bullus in the lung is a manifestation of Marfan’s. It can be safely removed if it takes up too much breathing space. Many people with Marfan's disease live normal lives, many think that President Lincoln had Marfan’s.

Dr Tom


COPD and Pulmonary Fibrosis
Q. What is the difference between COPD and pulmonary fibrosis? I was told I have the former and recently daughter told she has the latter.


A. Dear Suzanne, These are quite different diseases.

COPD has airflow obstruction and fibrosis has airflow restriction. In COPD it is the flow out of the lungs that is reduced.

In fibrosis, the lungs may be scarred and do not fill to a normal volume.

Your doctor should do spirometry to tell them apart.

Dr. Tom


What is a “Touch of Bronchitis”?
Q. I'm 44 I have been told by my doctor I have a touch of chronic bronchitis (from closet smoking since teens). I have this more or less under control with Symbicort (not available in the USA). It is an inhaler that combines anti-inflammatory corticosteroid budesonide and long-lasting bronchodilator formoterol. I take 1 x 200mg puff twice a day; however, much to my dismay I have a lot of back and chest discomfort. It’s worse in the morning when my back and whatever side I have slept on feels stiff (sore when I inhale, going on a year now).

I am also feeling really tired at times when I should be fine. Is this all caused by my touch of bronchitis? My sputum is always clear and I cough up very small amounts, 2 x teaspoons daily.

A much older friend (67) has chronic bronchitis and he has a cough and sputum but no constitutional type stuff going on.

What is the long-term prognosis? Is there a chance this may clear up?


A. Dear Randolfo, I do not know what a “touch of bronchitis” is. This is not a diagnosis.

You may have asthma, controlled by your Symbicort. This combination is quite similar to Advair, used in this country containing also a long–acting bronchodilator, salmeterol and an anti–inflammatory, fluticasone propionate.

You should have spirometry done to measure your airflow and responses to Symbicort.

Dr. Tom


Heat Causing Cough
Q. I want to thank you for answering my question about my cough (see February 4). I have another question. Why is it when I am in contact with dry heat, smoke, etc. my throat gets dry?

I don’t know if it makes any difference or not, but I am in remission from Hodgkin’s and had radiation to my chest and neck. As soon as I turned on the heat in the house, I have cough, my ears plug up and I have to drink lots of water. Thanks


A. Dear Teresa, The hot dry air may be irritating to your lungs. Does not sound serious, but it is a nuisance. Maybe you need a humidifier for your home, but keep it clean and free of organisms that may breed there.

Dr. Tom

See Teresa’s question from February 4th

February 4th Question and Answer
Chronic Cough

Q. I have been coughing for about 14 years and it is very annoying. I cough everyday and have taken so many things to stop the cough.

I was diagnosed with Hodgkin’s Lymphoma, and have been in remission for five years. My doctor said that a lot of my coughing is due to scar tissue from radiation.

My prayer is I can finally stop coughing. As long as I have coughed I feel like I am damaging something. Do you have any suggestions? Do you think that there is no cure?


A. Dear Teresa, Sometimes chronic cough following radiation can be troublesome. We actually do not have any great cough medications or drugs that deal with excessive mucus formation.

Mucus is a response to inflammation and when the normal clearance mechanism, the ciliary activity of the lungs is exceeded, or damaged, retained mucus and cough are the result. Consult your doctor about taking regular antibiotics of the macrolide class, drugs such as erythromycin, azithromycin, and claritromycin. These drugs have anti-inflammatory qualities separate from their antibacterial action, that tend to quell inflammation and excess mucus production.

Dr. Tom


Quit Coughing but Ribs Still Hurt
Q. I have COPD. I’ve had another bout of bronchitis and now went into some heavy coughing. My ribs hurt even though the coughing has stopped. Why is that?


A. Dear Linda. You probably stretched the cartilage (connective tissue) connections with your ribs. The pain and soreness should subside soon, if the coughing has stopped.

Dr Tom


Can FEV1 and FVC Improvement?
Skiathitis asks:
S. Skiathitis Age: 56 Weight 83 Kg Height 176 Cm
Syros Island Greece
Q. In June 2003 I stopped smoking. I was a heavy smoker—40 per day, I couldn’t breathe. A doctor, having a spirometer, visited my company and advised me to stop smoking immediately.

Since then I lost 12 kgs (95 to 83 in 3 months by diet and hard exercise that continues today). Now I can climb steps or walk for long time easily.

I visited my doctor five times and each time FEV1 30% - 41% - 42%-45%-50% and respectively FVC 36%-57%-75%-62%-83%.

My medicine is Seretide (50+500) every morning and often use of flutter and power breath devices. My question is (as they told me COPD is not reversible) how does my FEV1 and FVC improve? Will I continue to see improvement of FEV1 and FVC? If yes, is there anything else to advise me?


A. Dear Skiathitis, You have indeed improved with stopping smoking and taking medications for your inflamed bronchial tubes.

You are a classic example of how COPD can improve under good treatment. You will maintain this improvement and stay well. Good job that both you and your doctor can be proud of.

Spread the word that COPD should always be considered at least partly reversible.

Dr. Tom


Nebulized Iloprost
Q. Do you think a patient with COPD and pulmonary hypertension should receive nebulized pulmonary vasodilators (Iloprost) at home ?


A. Dear Ron, Inhaled Iloprost is used for primary pulmonary hypertension and should not be necessary for the modest pulmonary hypertension associated with COPD. This is best treated with oxygen.

It is possible that Iloprost could help some COPD patient with higher than usual levels of pulmonary hypertension that are not responding to oxygen.

Dr Tom


What is Causing the Dry Cough?
Q. I'm an 80-year male. I married my wife in December 2000. She was a very heavy smoker when I met her. She stopped smoking a year later, four years ago. Now she has a hard time breathing. She thinks that it is asthma.

My question: is it asthma? She coughs a lot. It’s a dry cough that never has anything come up. She uses cough drops by the pound. She has told me that she never complains to the doctor about it but I will today.

What I want to know is, is it the smoking? She said that she never had that until she stop smoking, I just want to know if it is what caused it.

I have been trying to find answer on the Internet, but I guess I have not asked the right question. That is the reason for my note to you. Please let an old man know. Thank you very much for taking the time.


A. Dear Ralph, This could well be asthma, coming on in old age. Sometimes a cough is the only manifestation of asthma, but your wife is also short of breath.

Have your doctor do a spirometry to see about airflow obstruction and then give her inhaled bronchodilators and an inhaled anti-inflammatory drug in the steroid family and note the improvement. Let me know how this turns out.

Dr. Tom


Ear Infection
Q. Recently I developed a sore throat and was told I had a bacterial infection in my ear as well. I took a Z-pack and it helped the throat, but the right ear is still infected and I still can't hear out of it.

I'm taking Cefuroxime 500mg for the ear now. My doctor was surprised the Z-pack didn't clear up the ear.

This the second week I'm dealing with this.

When I finish the second round of medicine and my ear is still clogged up should I follow-up for the third time with my doctor?


A. Dear Leontyne, Have your doctor look into your ear to see if it is plugged with wax and to see if the eardrum is still inflamed. Two weeks of antibiotics should have cleared up a common bacterial ear infection.

Dr. Tom


Nebulized Glutathione
Q. I have a patient demanding that I write a prescription for nebulized/inhaled glutathione. I cannot find any good scientific evidence in regards to its use, and furthermore I can not find any side effects to using it either.

I'm very leery, but willing to consider the prescription if I can see some good research to back it up.

Dr. K

A. Dear Dr. K, I have had a number of similar questions. Glutathione is a powerful anti oxidant. I do not know of an approved commercial product. Oral N-acetylcysteine, available over the counter elevates glutathione in the body and is commonly used in Europe for COPD.

Dr. Tom


Lung Damage and Arthritic Drugs?
Q. I have been diagnosed with hepatitis C with rheumatoid arthritis. I have had COPD for at least 12 years.

Would Ribavarin cause further lung damage to me? Also I hear Enbrel and Humira could do the same.


A. Dear Ann, These potent anti-rheumatoid disease drugs may unleash a latent lung infection such as tuberculosis or a fungus, as the warnings state. Consult your doctor.

Dr. Tom




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