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Archive: Dr. Tom 101
Posted August 20, 2007

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



Chest X-Ray Showed Nodule
 My x-ray report shows a 6mm nodule. What does this mean?


A. Dear Deanna, It could mean many things. Most of these are benign. You need a follow-up in about four months to check for change. Better see a pulmonologist.

Dr. Tom                             


Training Nurses to Do Nighttime Respiratory Therapy
 I am a registered therapist living in a small town in Texas.  The hospital I work for has recently eliminated respiratory care during the night.  They are requiring that the staff therapist "train" the nighttime nurses to do our job.  Texas laws are very grey about doing this.  I have been told to do this, or lose my job. 
I do not want to cause friction, but do not want to do anything to jeopardize my license.  What are the current laws on the training of nurses to do respiratory care?


A. Dear Virgie, I do not know the practice laws of any state. Better check with the AARC.

Dr. Tom                          


Best Way to Take Multiple Respiratory Medications
 I am now on Foradil and Spiriva. I also nebulize Xopenex and Ipratropium and Pulmicort. There are so many different opinions out there on what order to use these drugs. Would you please give me your opinion on what would be the best way to take them.
Right now I am taking Foradil, Spiriva when I get up in the morning. Then later I nebulize with the Xopenex, Ipratropium and Pulmicort. Then later I neubulize again with the above three.  Before going to bed I take the Foradil again.

Thank you and I am so happy to see that you are up and about again. 


A. Dear Jeanne, The sequence can be most anything. If you are doing well, I would continue. This is a complex program with several drugs that work through similar mechanisms. Better check further with your pulmonologist, and I do believe you should be seeing a specialist for such a program.

Dr. Tom


Stem Cell Transplant for COPD
 I wondered what your thoughts are on stem cell transplants for COPD?
I received umbilical cord stem cells on 4/5/2007 for severe COPD (FEV1 31%) and have noticed improvements in my breathing and less need for inhalers because my shortness of breath has been reduced by over 50%. When I use my peak flow meter I used to get a reading of 65 at best and now I am getting 120.  I am going for a new PFT in August and I wondered if the improvement I notice in the peak flow meter readings will be apparent on the PFT test and if so, will it show and increase in the FEV1?


A. Dear Jeannine, I have no idea what to expect. I was not aware that umbilical cord cells were being used in COPD. Is this under a research protocol?

Dr Tom


Best Treatment for Multiple Lung Conditions
I have IPF, COPD and PH. I am being treated with Spiriva and prednisone. Do you recommend any other treatments? 


A. Dear John, Other treatments may be worth considering. You should see a super-specialist for this, i.e., someone who deals daily with this combination of problems.

Dr. Tom


Have Emphysema and Want to Know the Best Way to Exercise Lungs
I have had emphysema for seven years. Lately it seems my breaths are shallow and more frequent. How can I exercise to expand the depth of my breath. I must do rehabilitation in water. Thank You.


A. Dear Karren, You can improve your general conditioning with the water rehab. There is no way to "exercise" the lungs, but your overall function and shortness of breath may improve.

Dr. Tom


Question about Prednisone
How many times can you have prednisone before it does damage and how often can you take it?


A. Dear Linda, Prednisone can be taken many times, intermittently for exacerbations of COPD, without much risk of the main side effects. It can be taken for months or years in low dosages, i.e., 5-7.5mg per day, if needed for maintenance control.

Dr. Tom


Stages of COPD
Dear Dr Tom, I have COPD following a fire seven years ago; I inhaled toxic fumes. I have been on oxygen for seven years now. I manage pretty well. I have Transtraecheal Oxygen for my oxygen and have had for two years. I am very lucky as it is not very common in the UK.
I just wondered if you would tell me what stage my COPD is at. I do try to stay active, but I have been getting very short of breath these days. I still remain very positive.
My results are:
FEV1...........0.55     20% predicted
FVC............1.60     49%
PEF............  60     15%
FER%...........  34     40
I would be grateful for an honest answer. They always seem to change the subject when I ask. I will remain positive whatever.


A. Dear Lynn, Your classification would be advanced or stage 3 disease. But you can still live a comfortable and productive life for a good long time. Enjoy each day.

Dr Tom


Side effects of Medication
Hi Dr. Tom, I have bronchiectasis.  I was taking Advair and Atrovent.  The Advair gave me thrush constantly but the Atrovent was great.  I switched the Advair to Spiriva but now I cannot use the nose runs all day long!  I tried Nasalcrom, which lasts about a half hour for me.  Any suggestions?  I don't think I want to go back to the Advair if I can avoid it.


A. Dear Mary, Nasalchrom is a good thing to take, and has few side effects. You can use Atrovent in your nose without diminishing the value of Spiriva in your lungs.

Dr. Tom


Worsening of Emphysema after Quitting Smoking
I quit smoking 13 yrs ago. I had lung surgery that is the reason I quit. My question is could the degree of my emphysema have worsened since then I quit smoking?


A. Dear Mary, Your degree of emphysema should have stabilized, since quitting and surgery, unless you are exposed to additional irritants.

Dr. Tom


What does Spiral CT Scan Results Mean?
Mom is 78 yrs old. She had spiral CT for AAA-found a 4mm and a 5mm non-calcified nodules in the pleural space-lower right lung--she also has scoliosis (right side), rheumatoid arthritis and her RA factor is high-does this mean lung cancer?


A. Dear Mary, No. These small lesions are most likely benign. They should be followed by at least one more CT in about six months to check on stability. 

Dr. Tom


Very Worried about My Emphysema
Hi Dr. Tom, Thank you for taking my question.  I am 58 years old  and was diagnosed in May with Emphysema.  My FEV1 was 41% pre and 48% post. I have had problems for years and used inhalers, but kept smoking like a fool. 

I quit on January 1 with Chantix, and felt great till about April when I noticed the asthma type feeling.  I was scared to go to the Dr., but I went. I am on Spiriva, Serevent, Theo 24 and Max Air. I cannot use Advair, I have tried many times but it makes me congested terribly on my chest.

Dr. Tom my question is how long can I live with this if I exercise and try to take care.  I am terrified and have spent the last two months just crying everyday. Thank you for this wonderful service.


A. Dear Mary, Your prognosis is good, with cycling or not. I suggest regular exercise, but do not become preoccupied with it to the extent that you avoid other pleasurable activities.

Dr. Tom

2024 American Association for Respiratory Care