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Archive: Dr. Tom 15
Posted March 30th, 2005

All About Phlegm
Q. This may seem frivolous but I am really curious. What makes us have phlegm? How and why does it form? Why some time real heavy and other times hardly any? Also how can I stop post nasal drip? Thanks


A. Dear Carol, The medical term for phlegm is mucus. Mucus is secreted by glands, under the lining of the body passages, as a protective material that also help to cleanse these “tubes.”

Mucus is present in the nose, sinuses, mouth, lungs, gastrointestinal tract, and elsewhere. Mucus also cleanses these passages.

In the lungs the mucus moves by cilia, i.e. hair–like structures that “sweep” the mucus toward the large airways where it is coughed up or swallowed.

In states of inflammation, more mucus is produced as a defense against whatever is causing the inflammation, such as a virus or bacteria.

The postnasal drip is treated with antihistamines, decongestants, and sometimes nasal steroids. Results depend on the cause.

Dr. Tom


Breathing Trouble and Gastroesophageal Reflux Disease (GERD)
Q. I have been diagnosed with GERD and have been having breathing problems. I have been given a proton pump inhibitor, Rabeprazole, to help my stomach become less acidic. Should the breathing problem resolve in time?


A. Dear Barbara, If GERD is causing irritation of the lower part of the swallowing tube, i.e. esophagus, it may also irritate its neighbor, the lungs’ air passages. This may cause spasm and mucus production. Stopping the GERD will relieve this, if it is the cause of the breathing problem. Dr. Tom


Bullous Lung Disease
Q. I have a history of bullous disease and had lung reduction one year ago. I’ve also had an upper lobe removed on the left side and I have nodulars on my left lung and 7cm. bulla on my right lung.

My question is how much lung function is necessary to be able to function? I am very blessed to be able to have a few hours of energy at a time.


A. Dear Kathy, When large bullae are removed, very little if any normal lung is sacrificed. You can have surgery on both sides to remove the major bullae, and still have normal or nearly normal lung function.

Dr. Tom


Can You Lead a Normal Life with One Lung?
Q. My son was born with one lung; the other lung did not develop. What future can I expect for my child? He will turn three years old in May.

He has been in the hospital for pneumonia and gets really bad when he gets a cold. He does get his flu shot. My question is have you ever had a patient with this condition, and if you have are they able to live a normal life when they’re adults?


A. Dear Griselda, Yes, a normal life can be expected. When one lung does not develop, or has been removed in childhood because of disease, the other lung grows larger than usual. Often children have near normal lung function as adults. Infections must be treated, and influenza and pneumococcal vaccines should be used.

Dr. Tom


Can Oxygen Cause a Rash?
Q. Will a constant flow of raw oxygen when used for the sleeping hours cause a rash in the hair (where oxygen escapes out the nostril hose)? Will this cause a skin rash?


A. Dear Jim, No. I have never heard of a rash from oxygen. It can cause irritation of tissues, but not a rash.

Dr. Tom


Reactive Airways Disease (RAD)
Q. I just requested my medical records since I had to change medical plans and I also got a new doctor. I looked over my records and my records show that I have RAD and COPD as well. The COPD, I did not know about.

I called my former doctor of eight years and asked about it. He said that RAD and COPD are the same.

His nurse told me that all he could do for me was to refer me to a pulmonary specialist. What would be the purpose of this?


A. Dear Jennifer, RAD stands for “reactive airways disease.” It is not a standard diagnosis, and refers mostly to asthma. There is some increased reactivity of the lungs of COPD patients, and this is treatable with bronchodilators. It would be a good idea to see a pulmonologist about this and future treatment.

Dr Tom


Alpha-One MZ
Q. I was diagnosed as being Alpha-One MZ three years ago. I am also a lifelong asthmatic. The last several years I have had recurrent respiratory infections (especially in winter). Yesterday, an enlarged lymph node in the hilar region appeared on my CT.

What are your opinions of the benefits of Prolastin or similar therapy? My doctor is considering these, dependent upon the results of my blood work.


A. Dear Steve, Alpha-0ne MZ type is usually not associated with serious degrees of pulmonary disease. It could be a factor in your asthma, however. It does not explain the enlarged lymph node in your hilar (root of the lung) region seen on CT. This requires an explanation.

Prolastin is rarely required in MZ Alpha-One, because the levels in the blood are only slightly low.

Dr. Tom


Q. My 89 year–old mother has COPD and congestive heart failure. She has been bedridden since a recent fall. Although she gets out of bed to go to the bathroom, sometimes unassisted, she feels too weak to sit in a chair to eat.

She is having occasional hallucinations. I can’t tell whether they are dreams or waking visions. Is there anything that a hospital visit could do for her? She does not want to go but I think she’s too weak for a doctor’s office visit.


A. Dear Duffy, Hallucinations can be caused by carbon dioxide buildup, but unlikely. If these are not too disturbing, they do not require an explanation.

Dr. Tom


Postnasal Drip
Q. I have just been diagnosed with COPD. One of the things that aggravates me is my nonstop postnasal drainage, which I’m told is due to “Nonallergic rhinitis.”

I’ve tried every antihistamine and decongestant in existence but nothing alleviates it. Do you have any recommendations?


A. Dear Jeri, These are the usual remedies for postnasal drip. Inhaled corticosteroids may also be useful. Ask your doctor to consider giving them a try.

Dr. Tom


A Word About Proper Oxygen Flow Rates
Q. I am a Respiratory Therapist working for a homecare company for the last 20 years.

I understand the concern of over-oxygenating COPD patients but find most other well-meaning, but poorly informed, healthcare professionals (doctors, nurses, as well as RTs) end up giving everybody too little oxygen, especially during exertion and that limits their ability to exercise.

I know the answer is titrating with oximetry but find it to be underutilized in the real world. Thought a comment from you about this might help.


A. Dear Mark, Giving too much oxygen, has been a concern, believing that it will cause CO2 buildup. This rarely happens and should not be the reason to fear too much oxygen.

The concept of “tissue oxygen toxicity” is another matter that we will have to investigate in the future. For right now, titration of liter flow with a pulse oximeter is the best way to set the liter flow, particularly during exercise.

Dr. Tom


COPD and Heat/Humidity
Q. I live in Southern California where there is a lot of pollution is going on all the time. I’m considering moving to Tulsa, OK where my circumstances would be better financially (I am retired). The air quality is better there, but was wondering if people with COPD could handle the heat/humidity there. Thanks for your reply.


A. Dear Patricia, Tulsa is a GREAT city. Very friendly people and good economics. Excellent medical care there. It is sometimes more humid and hot than Southern California, but this is tolerated by most. Air conditioners are great inventions.

Dr. Tom


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