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Archive: Dr. Tom 9
Posted February 4th, 2005

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


Emphysema at 20?
Q. I am twenty years old and recently had a spirometry. The doctor that I am seeing says he thinks that it is emphysema.

Could this be possible since I am only twenty years old? I did smoke but only for two years. Also should I get a second opinion about this, and is there any way it could be asthma.


A. Dear Kelly, It is much more likely to be asthma. If so, your function will improve with bronchodilators and anti-inflammatory drugs such as inhaled corticosteroids.

Emphysema is extremely rare in the 20s and is usually associated with a genetic abnormality called Alpha-1 Antitrypsin Deficiency. If your doctor really thinks this is emphysema, get an Alpha-1 test done. This is a simple blood test.

Dr. Tom


Q. I had pneumonia in my left lung. I finished all of the antibiotic (Tequin). I feel a lot better, almost like my old self.

My doctor listened to my lung and said that it doesn't sound much better. What could be the cause of this? I thought that my lung would sound clear because I feel so much better.


A. Dear Avis, It may take months for all the excess secretions to clear. You need a follow-up x-ray, to see if the pneumonia has cleared or is clearing.

Dr. Tom


Q. My father has entered pulmonary rehab. No meds seem to work for him. They told him his lower lungs look like Swiss cheese. Because he is almost 68 they say he is too old for a transplant because the usual cutoff age is 65. So because he is two years older they are basically saying “sorry, too old?” It does not seem fair. Do you know of people over the age of 65 that do get transplants?


A. Dear Lisa, People over 65 can be candidates for lung transplantation. It depends on their general status and other factors.

Dr. Tom


Q. I have had asthma most of my 51 years. I have asthma everyday and often wake at night with shortness of breath and tightness. I use an albuterol inhaler about four times a day and take Singulair once a day to treat my asthma.

My questions are: Which is worse, leaving my asthma as it is and using the albuterol to treat it or the long-term effects of using steroids to treat my asthma? I've seen what long-term use of prednisone does. My mom had to take it for years and I'm not sure I want to take it, even if it would make it easier to breathe. Does asthma cause any permanent damage to the lungs? Please help.


A. Dear Suzie, Your asthma should be controlled with some combination of medication. Usually a combination of long-term bronchodilator and inhaled corticosteroids is effective. There are few side effects from corticosteroids. When asthma fails to be controlled, remodeling of the small airways may occur and give chronic airflow obstruction. Keep trying to get complete control.

Dr. Tom


Air Purifiers
Q. Do you know if the Sharper Image Ionic Breeze Quadra air purifier is helpful to a person with COPD or harmful because of the ozone it produces to clear the air? Also what would cause scarring on the lung after a bout with pneumonia? Thanks


A. Dear Sunny, I don’t think much of air cleaners in the home. They mostly catch dust.

Scarring may result from pneumonia. It is a result of intense inflammation and healing, resulting in what doctors call fibrosis. It may not be harmful, but is just a marker of old inflammation.

Dr. Tom


Q. What is the difference between Advair and Spiriva in reference to how it works in the lungs exactly?


A. Dear Stacey, These inhaled products are quite different.

Advair contains a long-acting bronchodilator, known as salmeterol, combined with an inhaled corticosteroid, fluticisone. This combination is very effective in most cases of asthma.

Spiriva is an ipratropium, a long-acting bronchodilator that works through a different mechanism compared with salmeterol, a beta agonist. Spiriva works best in COPD. Both Spiriva and Advair are compatible and may be taken together, if your doctor prescribes them.



Q. I was diagnosed by my pulmonologist two days ago that I have COPD, level 4, the most severe kind. He said he doesn't know how I managed this long. Well I managed on what my doctors, through the years, prescribed me until they gave up saying we have run out of options for you so referred me to a specialist, the pulmonologist.

What is level 4 COPD? How does the doctor determine what level you are? Thank You...


A. Dear Loretta, The levels or grades of COPD are based on how reduced your airflow test is. We call it the Forced Expiratory Volume in one second, i.e. the amount of air you can blow out from fully inflated lungs in one second FEV1. This is measured with a simple spirometer.

Level 4 may mean your FEV1 is a value of 30% of normal for you, or less. But you can still do well with this level of deficit, by avoiding all smoke, treating lung infections quickly and taking bronchodilator drugs. Stay with your pulmonologist for your detailed care.

Dr. Tom


Scuba Diving
Q. I have been an amateur scuba diver for about 20 years, with approximately 250 dives in that time. Just under two years ago I underwent a quintuple coronary bypass, after an M.I. The doctor said there was a 20% residual damage to the right rear wall of my heart. I also have a diagnosis of COPD. I was a smoker of cigarettes as well as marijuana and hashish. I am in reasonably good physical condition and am able to walk at my target HR of 144 for 30-45 minutes with an occasional jog of 1-2 city blocks.

My big question to you is whether in your opinion is it still safe to do recreational scuba diving, and if so should the depth of my dives be restricted.


A. Dear I, You sound healthy enough for scuba diving, but would not do deep dives, just to be safe. Your doctor will know more about you than I do, from this limited information, so check with him for final advice.

Dr. Tom


Need CPAP Information
Q. Is there a site where I can get patient education on bipap/cpap (how it works, how it helps, etc.), including pictures, written at a 6th grade level?


A. Dear April, You can get this from some respiratory therapy departments and at some pulmonary rehabilitation programs.

Dr. Tom


Idiopathic Pulmonary Fibrosis (IPF)
Q. My husband was diagnosed with “Idiopathic” (of unknown origin) Pulmonary Fibrosis (IPF). I have read this disease only lasts about five years. He has been on 24/7 O2 for two years already and 6 liters doesn't cut it any more.

How long can you keep going on this high dose without affecting other organs? When he walks or moves, his oxygen saturations drop to low 80's and sometimes high 70's.


A. Dear Beverly, The oxygen will not damage other organs. Don’t worry about the flows. Has your husband been evaluated for a lung transplant? I would suggest this.

Dr. Tom


Q. What is the gold standard for diagnosis of TB?


A. Dear Guzman, The gold standard is finding the TB bacilli in the sputum for lung involvement, blood and/or urine. Specimens are sent to a laboratory to identify for TB bacilli and to test for drug susceptibility.

Dr. Tom


Sleep Apnea
Q. When was sleep apnea first described?


A. Dear Guzman, It was first described by Dickens in the Pickwick Papers. I can’t remember the date. This was far before medical descriptions.

Dr. Tom


Respiratory Therapists
Q. A respiratory Therapist works under the supervision of whom? Could you name what types of patients a respiratory therapist treat?

Thanks Dr.


A. Dear Guzman, Respiratory therapists work under the supervision of the medical director of the department, a physician, who is usually a pulmonologist.

Respiratory therapists take care of a wide variety of clinical conditions, such as asthma, COPD, pneumonia, interstitial fibrosis, respiratory failure, postoperative state, trauma, the full range of respiratory disorders.

They are key professionals in getting many people well following a crisis or in the long-term maintenance management of patients.

Dr. Tom


Fatty Growths in Lung
Q. The doctor said I had a fatty growth on my lungs between the rib cage and lung lining. He said it was about size of football right in front on the heart and on the lungs, going in about three inches or so. He also found four nodes. He is doing a new CT scan in three months.

Can they take it out? My primary doctor said no, surgery is not an option.



A. Dear Ginny, It is difficult to answer your question, because I do not know the location or other features about the so-called fatty growth. Almost all of the fatty tumors are benign and are only removed if they are pushing on critical organs, or of cosmetic significance, since they are growing on the chest wall.

My guess is that they can be left alone at least for now.

Dr. Tom


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