Wants to get off of Prednisone
Q: I've been trying to get off prednisone for months now after a particularly severe exacerbation.  Every time I try to go below 10 mg's my breathing gets more labored (I'm at 8 but it isn't easy).  I am also on “as needed” oxygen and various inhalers. Is there something else I can do?
Thank you.

Sharon 

A: Dear Sharon, I assume you are on prednisone for asthma and not COPD. Prednisone is the most effective drug to abort an exacerbation. But if you decrease it to quickly, i.e. before the inflammation in the airways heals sufficiently, you will relapse and thus require more prednisone. You must go down very slow. Do not try to reduce your prednisone until you have been wheeze–free and cough–free for at least 10 days. Then reduce very slowly at a rate of about 1 mg every five days, if you get down to 10mg. This is a general strategy and must be individualized.

Dr Tom

Inhaled Morphine
Q: What is the dosage, frequency and brand name of inhaled Morphine?

Lorraine

A: Dear Lorraine, I am not aware of a commercial preparation for inhaled morphine. The studies have used compounded material.

Dr Tom 

Echinacea usage
Q: What is your opinion of people with COPD (mine is emphysema with an asthma component also) using echinacea in the winter to build immunity and help prevent colds or flu?

Charlotte  

A: Dear Charlotte, I know nothing about echinacea for this or any other purpose. Beware of depending on herbs for untested purposes.

Dr Tom

Aspergillus’
Q: I have been diagnosed with Aspergillosis infections twice in the past three years. Does aspergillosis ever really go away? 

Mary

A: Dear Mary, Yes; depending on what kind of aspergillosis you have.

Dr Tom

Emphysema patient with leg aches
Q: I am a 47 year-old female and I have had emphysema for 13 years now. In the past several months my legs have been bothering me quite a bit. They feel very heavy sometimes and they ache, especially when I walk or at night when I lay down. Does this have anything to do with emphysema?

Kitty

A: Dear Kitty, Probably not. Maybe you just need to exercise more.

Dr Tom

COPD and reflexology
Q: I was diagnosed with COPD and put on oxygen 24/7 in 1998.  I was told that reflexology might be helpful for me.  Would this be of any benefit to me?

Betty

A: Dear Betty, I don't know. So many remedies are out there without any scientific proof of benefit.

Dr Tom

Helium with exercise
Q: I've read about helium gas being mixed with the supplemental oxygen to help exercise.  I sure could use a boost to help my exercise program.

Eileen

A: Dear Eileen. Helium with oxygen is used in emergency rooms. I do not know of any product for use outside of hospitals.

Dr Tom 

Seven–year–old asthmatic exposed to second hand smoke
Q: I have a seven year-old stepdaughter that suffers with asthma.  Her biological mother and stepfather continue to expose her to second-hand smoke and the residue that builds up in their household on everything. 

She visits them every other weekend, (resides with her father and I full time) and on returning home from these visits suffers from wheezing and asthma symptoms that progress to a chronic cough, the entire period lasting about 3-4 days. 

I immediately treat her, with an albuterol nebulizer, when she returns home and generally have to keep her home from school for 2-3 days.  We have had several (general medical) doctors write the mother notes, had legal papers drawn up that she signed promising not to expose her to cigarette smoke, but the mother refuses to believe our daughter’s illness is because of the cigarette smoke. 

My question is, based on the information, do you believe it is the smoke, or simply coincidental?  And secondly, why exactly do the symptoms progress to the chronic coughing (even with treatment) and what can be done about?

Laurie

A: Dear Laurie, I believe your stepdaughter is a victim of child abuse. I would get legal help.

Dr Tom

Saline irrigation when suctioning
Q: Where can I find information regarding the use of saline being placed down a tracheotomy tube before suctioning? Many respiratory therapists have told me that there is no real benefit to doing this and it places the patient at risk for aspiration. I need this to educate my nurses.

Kim

A: Dear Kim, Putting down normal saline to help mobilize secretions is a time-honored process. I know of no controlled trials against other substances. Water would be more irritating.

 Dr Tom

Air purifiers
Q: I have COPD-Emphysema and would like to know if you consider air purifiers to be helpful. I know you cannot single out a specific brand, but are there some things I should be looking for in an air purifier? Thank you.

Joan

A: Dear Joan, So-called air purifiers take some dust out of the air. I don't believe they are effective. I would not waste money on them.

Dr Tom

Flu season
Q: How come the flu “season” is in the winter months and not all year round?

Gretchen

A: Dear Gretchen. The A types of flu are seasonal, because they start in Asia and work their way east, arriving in the winter, usually, but not always. The B strains are not epidemic and are year round. I don't know why.

Dr Tom

Mechanical Lung
Q: Is there any medical science working on developing a mechanical lung?

Charles

A: Dear Charles. Yes. But the lung is extremely complex with more than 300 million alveoli and thousands of airways. I don't think that an implantable artificial lung is possible, but it is possible outside of the body. This is part of the technology of the heart-lung machine used for cardiopulmonary bypass. But never underestimate engineers.

Dr Tom