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Archive: Dr. Tom 104
Posted September 6, 2007

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



Breathing Resistance Exerciser
Q. I have been using an "Expand-a Lung" which is a breathing resistance tool which they advertise helps with COPD;  their web site is  . I have been using it about 6 months but started walking seriously about the same time. My breathing and stamina is better but I don't know if it is a result of both or just the walking. My FEV1 is 17 but I am not on oxygen. Wondering if I should keep using.


A. Dear Joe, Keep up what you are doing. Don't quarrel with success.

Dr. Tom


Tanstracheal Oxygen and Humidification
Q. I have a TTO and was told I needed a heated humidifier on my concentrator but I keep getting condensation in my tubing; can anything help to correct this?


A. Dear Ann, Many people with TTO feel they get value from a humidifier. Condensation will occur, particularly in long tubing. You might try using a shorter delivery system.

Dr. Tom


Clinical Trials and New Medication for Bronchiectasis
Q. Hi Dr. Tom, Glad to hear you have mostly recovered from your ordeal. Just wanted to let you and your readers know about something I've been following, the clinical trials and approval for Bronchitol. As a person with traction bronchiectasis from repeated bouts of bronchitis and old scarring from PAP, I watch and wait for new treatments. This sounds close to coming to fruition!


A. Dear Armand, I do not know much about this product. I will await news of its effectiveness through controlled clinical trials.

Dr. Tom


Chest Hurts and Doctor Says Problem is in Cartilage
Q. Hi Dr.Tom.  I have been diagnosed with emphysema 3 or 4 years ago.  I cut down a lot on smoking when I found out and then my smoking went up again.  I get chest pains and my GP tells me that you don't feel pain in the chest and he keeps saying that I have a problem with cartilage in my ribs which is causing inflammation and that is the reason I experience pain. he had advise to take Nurofen.
I have also been diagnosed with asthma that runs in the family. I have no idea how much this disease has progressed. I am currently on Spiriva daily and doesn't help much when I am in pain.  I know I have to administer on a daily basis, but I have been hearing so much lately about steroids and it discourages me. 
I take Ventolin during bad season.  My chest hurts almost every single day and I want someone to tell me why and where I can find the answers.


A. Dear Zena, Emphysema or COPD are not causes of chest pain directly. Cartilage irritation is commonly used to explain it, but I do not believe this is the answer for all cases. You should see a pain specialist, in my opinion.

Dr. Tom


Emphysema Diagnosed by Routine Lung Scan
Q. Dear Dr Tom, I am a 35 yr old man with mild emphysema (diagnosed after a routine lung scan). A recent spirometry showed my FVC at 110%, my FEV1 at 110% and my FEV1/FVC% at 77%.
My doctor is positive and believes that as long as I never smoke again I won’t have any problems. I have not touched a cigarette in a year and will never smoke again. I feel ok except for a slight morning cough. Although my FEV1 is good, I feel that my doctor is not telling me everything about emphysema. I've read that it's a progressive disease and that people who get it have a shortened life span.
My question Dr Tom is what is the truth about this emphysema? Will it inevitably get worse for me in the future? Can I expect a normal life span based on my present lung function (FEV1 110%)? Any insights would be really appreciated.


A. Dear Paul, You can expect a normal life expectancy. Great that you have stopped smoking. Your damage is small, and has not affected your overall lung function. I wish more people had their diagnosis made early, even by spirometry, when the decline in lung function can be slowed to the normal age related value.  Stay well.

Dr. Tom


Airway Bypass
Q. Hi Dr. Tom, My name is Pam we have talked before on the emphysema chat room. And I need your help again because I have a chance to go to Sarasota Florida and see about the lung stents. I am on 02 24/7 my last fev1 26%. But I have not heard too much about these.
The hospital sent me literature about the stents and they said in the beginning of the study there was some unexpected bleeding and even a death. But I got the impression that was fixed since then.
I know with the other study with trulane or sphirion valves there are a lot of testimonials about how people were doing since they got them. But with the EASE sents I haven't heard anything good. So I am confused.
 Should I wait until the FDA approves them?  But maybe they will be so expensive I won't be able to afford them.  I just don't know what to do please tell me anything good or bad. 


A. Dear Pam All of these stents are under study. All have potential risks and benefits. I would wait until we know more about them.

Dr. Tom


CPAP and Rib fractures and Pneumothorax
Q. Can you put a patient on CPAP therapy, for sleep apnea, if they have fractured ribs and a previous pneumothorax (3wks ago)?


A. Dear Michelle, Yes. There should be no problem with this after three weeks of healing.

Dr. Tom


Well Wishes
Q. Dr. Tom I wish you a speedy recovery I have been trying to reach you!


A. Dear Kitty, Thanks. It is great to be in contact with my friends again.

Dr. Tom


Bronchial Brushing and Bronchoalveolar Lavage
Q. What is the rationale of doing bronchoalveolar lavage and a protected specimen brushing at the same encounter time?


A. Dear J., The purpose is to isolate the organisms found in the lungs, from contaminants that live in the mouth and pharynx.

Dr. Tom


Patient Caught in the Middle of Dispute about Who is Responsibility for Their Care
Q. Dr. Tom, Roles reversed now since you answered my 7-24-07 question. You asked me a question within your answer about the patient ventilator classification upon discharge from acute to SNF (Skilled Nursing Facility). We agree 100%, the patient was on a ventilator. Your question was, "Why would anyone think otherwise?"
The local SNF then our hospital experienced a patient dump after the discharging facility told the SNF that the patient was only on BiPAP. A long ugly story shortened: in less than two days, the SNF sent the dumped to our ED (Emergency Department) being manually ventilated to her trach, we placed her on a vent and went through tremendous amounts of stress, resources and time consumption for the next 36 days to find another home for the vent dependent pt.
The original University setting facility that transferred the patient to a SNF here, consistently refused / still refuses to acknowledge that the patient was on a ventilator. I asked you the obvious question, to validate our position that YES indeed this is a vent patient.
This is nothing I wish to see posted and do not expect another response from you, but felt compelled to explain after receiving the answer from you that I anticipated. I deliberately couched the question so as to not bias or influence your answer by explaining why such an obvious question was even submitted. We appreciate the response and expert opinion.


A. Dear Eric, It really disturbs me, when any one in medicine or respiratory care, denies the facts or changes. The only issue is what is best for the patient! Today the patient has become almost irrelevant, for which we should all hang our heads in shame.

Dr. Tom 


Does Chronic Rhinitis Effect COPD?
Q. My ENT doctor told me I have chronic rhinitis which can make breathing more difficult, I mentioned this to my pulmonary doctor and he said with my mild COPD this is not true, which side do you take? I one more item I see clinical trials again for a gamma retinoid treatment.


A. Dear Don, Of course chronic rhinitis can aggravate any degree of COPD. There is excess mucus, cough, sometimes aspiration of mucus, etc. Strange question, since the answer seems obvious.

Dr. Tom


Stopping Smoking Grass yet Chest Feels Hot and I am Wheezing
Q. Hi Dr. Tom, I have smoked on and off grass since I am 18 years old, now I am 27. I rarely have smoked tobacco throughout this time.
I have always been into sports and eaten healthy as well, no meat etc. Lately I've been hearing some wheezing when I exhale hard, specially after I smoke the grass.
I am a bit worried, I went for a spirometry and the results are OK. I am quitting smoking for good, I am afraid I've done damage to my lungs. I have quitted now for 2 weeks but I still feel sometimes my chest is hot and the wheezing is there when I exhale hard.
Should I be worried and go for other tests or with some time will my lungs cleanse. I really appreciate your help Doc.


A. Dear Daniel, Y our lungs will heal now that you have stopped the pot. It is a stupid drug to inhale. Marijuana is very irritating and damaging to the lungs.

Dr. Tom


Have COPD and Feeling the Effects of Altitude
Q. I have very severe emphysema, complicated by asthmatic bronchitis.  This weekend I was in the mountains at an elevation of 1,700 feet under very humid and hot conditions.  As soon as I stepped out of air conditioning I was barely able to breathe.  Everyone tells me the altitude was not high enough to cause a problem, but it sure felt like it did. 
Was that low an altitude detrimental because of my condition and should I avoid it in the future?


A. Dear Joanne, This is only a mild altitude, and I doubt that it is dangerous to you. You can't spend all your time at sea level. Remember to live!

Dr. Tom

2024 American Association for Respiratory Care