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Archive: Dr. Tom 109
Posted December 26, 2007

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

Progress Report and Question about Combivent
Q. I have written to you in the past and just thought you might like to get some good news. Last year my FEV1 was 38% of predicted, and this time it was 48%. I have a large component of asthma with my COPD.
My specialist was thrilled, and I feel it had to do with the exercise program I was on at Westpark Hospital here in Toronto Canada under the direction of Dr. ROGER GOLDSTEIN. I go to the gym EVERY DAY and work out for 30 minutes and it has made the world of difference.
One aspect of the spirometer test produced a very rare result. After taking the spray (Ventolin ) - 4 puffs, and then waiting 10 minutes the results of the test were slightly WORSE. The person giving the test said that some people are sensitive to the spray, and sometimes instead of opening the airways; it can have the reverse effect.
Have you heard of such a thing, Dr Tom? I was told it is rare but does happen.
Also, I used to take Combivent, and it has now been replaced with Ventolin. Could you tell me what happened to Combivent? I was told the company stopped making it yet when I "GOOGLED" Combivent the worldwide sales are in the billions.
Why did they stop producing this rather excellent medication?


A. Dear Phillip, A very few patients have what is known as a paradoxical response to the bronchodilators. The mechanisms are multiple and this does not mean that the medications are ineffective in the long term.
As far as I know, Combivent is still being made and sales are strong, as you point out.

Dr. Tom

Where Can You Find Demonstration Inhalers
Q. Do you know where I can obtain demonstration inhalers to teach patients proper technique?


A. Dear Vicki, Most drug representatives can provide you with a demonstration unit for the device they market. All inhalers have different characteristics and differ in ways to correctly use the devices.

Dr. Tom

Do You Know Anything about Bugle?
Q. I have been asked to inquire about a device called a BUGLE. Apparently it measures inspiratory and expiratory pressures in/at the mouth.
I cannot seem to find it anywhere on the Internet. Do you have any information on this device, if so I await your response?


A. Dear Deborah, This device helps set up vibrations in the airways as you breathe in and out. It is marketed as a device to augment your own cough mechanisms in mucus clearance. Widely used in cystic fibrosis community.

Dr. Tom

What Do You Think about Pulmonary Function Testing Results?
Q. Dear Dr. Tom, I earlier submitted a question regarding the report on my PFT, I since have gotten my numbers. The doctor told me it was normal but the report says otherwise. What do you think?
Act Pred % Pred
FVC(L) 3.13 3.10 101
FEV1 (L) 2.65 2.52 105
FEV1/FVC % 85 81 104
FEF 25% 4.34 5.02 87
FEF 50% 3.54 3.80 93
FEF 75% 1.56 1.35 115
FEF 25-75% 3.06 2.66 115
FEF Max 4.65 5.38 86
FIVC 2.41
FIF 50% 2.24 3.53 63
FIF Max 2.39
Thanks for this wonderful service, very confusing information & I was not referred to a pulmonologist.


A. Dear Teresa, Your results are normal, taking all the numbers into consideration. Far too many numbers are reported. Many of these are derived values, i.e., internal calculations that are confusing.

Dr. Tom

How to Prevent Lung Disease?
Q. What can I do for overall good lung health? What can I do to prevent lung disease?


A. Dear Lisa, No personal smoking, avoid all passive smoking, avoid being overweight and get regular exercise as in walking.

Dr. Tom

What Are Normal Arterial Blood Gases Results
Q. My pulmonologist said my ABG was 69% and that was normal. I thought it sounded low. I was hospitalized two years ago and it was 53% and I was on 3 liters O2. There has never been a definite diagnosis and I have been on different inhalers that have no effect on my SOB.


A. Dear Leslie, It depends on altitude. A saturation of 69%, in reference to oxygen, is low. Normal is 92--95% with supplemental oxygen.

Dr. Tom

Catching My Breath
Q. I recently had a cold that was on and off for about six weeks. I have just gotten over it again for the most part, but now it seems I'm always out of breath, and the only thing that helps, is coughing. When I cough, there is no mucus, nothing at all. It's just merely an action that I need to do in order to catch my breath again. What could this be?


A. Dear Laura, Many things. Probably just a residual of your severe cold, and acute bronchitis. See your pulmonologist if it does not subside in another three to six weeks.

Dr. Tom

My Dad, Brother and I Have a Strange Cough
Q. Well, I have a strange situation. My father (age 62) had a terrible cough last winter ('06-'07) that ended up being double pneumonia. At one point it was very serious, but with strong, multiple anti-biotic treatments, he beat it.
Now, this year, I , my brother, AND my dad (I'm 36, my brother is 39) all have had a terrible cough for over three weeks. Nobody else in our family has it - there are many small children, ages 2 to 11, and neither them nor our spouses are sick. But the three of us have this terrible cough.
My dad had a pneumonia shot a few weeks ago, before the cough set in. My brother and I haven't had a pneumonia shot. My brother and I both were on Zithromax, but it didn't help.
My dad is in the worst shape right now - running a fever now too, currently at the doctor's office for the 4th time. I've been to the doctor twice, same with my brother. I'm in better shape than my dad and my brother, but still, my chest feels tight, I'm coughing or stifling a cough all the time, and coughing up yellow mucus (I'm coughing up more "stuff" than my dad or brother).
Why do the 3 men in the family have it and the worst anybody else in the family has is a sniffle? All of our coughs started as colds, and my brother was in China on business in early October (not that I think that matters, but I figured it was worth mentioning, because I'm a little afraid he brought some weird respiratory illness back with him - then again, my dad had a lot of these same problems last year - BUT, me and my brother did NOT have these problems last year). We live in Minneapolis, Minnesota.
What is going on? Could it be the super-cold adenovirus? Pertussis? Just a whopper of a bronchitis? Any ideas? Any insights would be greatly appreciated. None of us are smokers


A. Dear Dan, It could be any persistent infection. Your doctor should culture sputum and see if he can isolate anything. The coughs will probably subside slowly.

Dr. Tom

Have Had a Cough for Over Two Years
Q. I am a 50 year-old female who has had a persistent cough for well over 2 years. I have been to doctors and emergency room where once I was told I had something on one of my lungs. I reported this to pulmonologist and he said it was nothing.
Fast forward now two years later, the cough has gotten worse, I have pain that radiates down left arm with middle two fingers going numb. Again I was sent to pulmonologist, where new lung tests showed that my lung volumes had decreased since last seeing him. His official diagnosis was, that my cough was caused by being overweight.
I do not think this man knows what he is talking about. I feel like I am having a heart attack with the chest pain, caused by my coughing. No one seems to be listening to me, what can I do or where do I go from here? Coughing persistently has interfered with all functions of my daily life. I have not been able to control my bladder! The chest pain radiating down left arm along with the headaches has me deeply concerned.
My regular physician has given me inhalers along with Advair to help me breathe easier. The lung doctor did nothing at all except tell me to lose weight!! Please, please can you help?


A. Dear Yolanda, I do not have enough facts go give you a good e-mail suggestion. I suggest a referral to another very experienced pulmonologist such as at National Jewish Health Center in Denver.

Dr. Tom

Is a Non-calcified Nodule Lung Cancer?
Q. I have a 5mm non-calcified nodule in mid lung area-- do I have cancer?


A. Dear Samantha, Highly unlikely, but it is of the size that you will want a follow-up in 3-6 months.

Dr. Tom

Smoking and Short of Breath
Q. I am 22 years old 155lbs and for the last 2 years I have been short of breath on most activities I do. On 5/17/06 I was admitted to the hospital and doctors performed a pulse oximetry test and it was 92% to 100%. Tests on my heart and lungs were performed including MRI and they said everything looks good and discharged me with anxiety.
I still feel short of breath and have been a smoker for at least 7 pack years. I was in the military and had a VO2 max of 44.62 and never felt short of breath and that was just two years ago.
I was wondering if there is anything the doctors missed or is this just really in my head.
My second question is when I walk around and work my pulse is much higher than it was 2 years ago. Could this be deconditioning?


A. Dear Nathan, The fast pulse is most likely deconditioning. The chronic cough needs an explanation. I suggest seeing a pulmonologist rather than an internist for this.

Dr. Tom

Son’s Chest is Visibly Depressed
Q. I recently noticed that the right side of the chest rib cage of my 12 year-old son’s is visibly depressed. Possibility of scoliosis has been ruled out. What can be the cause of this depression and what needs to be done? Is this an alarming condition? Your immediate response will be appreciated.


A. Dear Ayesha, This is a common abnormality of the chest wall. It is not dangerous and needs no treatment.

Dr. Tom

Lung Collapse a Year Ago and Still In Pain
Q. My lung collapsed a little over a year ago and I have pain every day and it's getting worse. I have gone to the ER a few times and they act like I am lying. I am in a lot pain. What could it be? It collapsed 2 times in 24 hours; I spent a week in the hospital. I want the pain to stop.


A. Dear Jeremy, The pain is probably coming from the lining of the lung that is still irritated. Sometimes a nerve root injection with xylocaine helps, at least temporarily. You should see a pain specialist.

Dr. Tom

Need Help to Understand CT Scan Report
Q. I am a 39 year-old single mother of four. I had a melanoma 11 years ago on my upper left arm. I have a swollen lymph node above my left collarbone, which is why I sought medical attention. I am uninsured and experiencing extreme anxiety over a CT scan report that has yet to be translated for me by a doctor
The report reads as follows:
“Findings: The examination shows prominent lymphatic tissue of the mediastinum, particularly the left hilar region and the subcarinal region as well. No other foci of lymphadenopathy of the mediastinum are seen. There are no other significant soft tissue abnormalities of the mediastinum.
The lung windows demonstrate two nodules, one within the right upper lobe posterior segment measuring 7.9 mm in greatest diameter, the other within the left lower lobe medial segment measuring 12 mm in greatest diameter. Neither of these nodes is calcified. No other worrisome pulmonary parenchymal lesions are seen. There are no other worrisome pulmonary findings. No infiltrates are identified.
The upper abdominal windows are unremarkable except for a simple cyst of the left renal anterior cortex measuring 18mm.”
I just want to know what is going on so I can devise a plan of action. The unknown is scaring me.


A. Dear Cynthia, You should have a biopsy of the most accessible, the larger nodules. It is possible that the melanoma is still lurking in these nodes. You will be reassured if this is not the case, and a candidate for some therapy if it is.

Dr. Tom

Should Patients Have Pulse Oximeters at Home?
Q. I'd like to buy another pulse oximeter...the one I have had is very old and something happened to it, I called my pulmonary doctor's nurse and she said she didn't think he would write a script for one because they don't like patients to have them...and sure enough rang and he doesn't want his patients to have them.
He is rather new, just out of school a year or so but this seemed more like the old days when blood pressure was a secret. What’s your idea on owning one of these, I have dropped in the past in the high 70's.... I find it helpful when walking.


A. Dear Dorothea, I believe that all oxygen patients who are active should have their own oximeters. Why keep important medical measures a secret?

Dr. Tom

What is Important in PFT Results
Q. Hi Dr. Tom, I'm confused about my PFT's results and what they mean.
In PFT's do they only look at FEV1 and FVC. Or do they also look at FEV1/FVC.
It says Flow rates are normal. Total Lung Capacity is normal but residual volume is reduced. Diffusion capacity is mildly reduced when corrected for hemoglobin. Increased Airway resistance.
DLCO is 20.4
RV is 0.46
RV/TLC is 11
TLC is 4.28
Can you please clarify my above question I have PF.


A. Dear Irene, I can understand why you find your results confusing. It is possible that pulmonary fibrosis is present but it would be mild. I suggest consulting a pulmonologist.

Dr. Tom

Can Vicodin Cause Mucus Build Up?
Can this drug cause mucus buildup in my lungs at night while I'm sleeping?


A. Dear Jerome, I do not believe that the Vicodin is the cause of nighttime mucus buildup. Mucus flow is reduced during sleep and increases with daily activity. Thus you will bring up more mucus in the mornings, particularly after you have breakfast and get active.

Dr. Tom

Have Not Felt Right Since Eleven Mile Race in September
Q. I ran an eleven-mile race at the end of September and think I had a slight asthma attack. I have never been diagnosed with asthma, I have not felt right since that race.
I went to a Cardiologist who did an EKG, Stress Test, everything imaginable and only came up with a heart murmur.
I then went to the doctor for my lungs. She only gave me the hand held breath test and prescribed a nasal spray as I have a back drip and Albuterol.
I then had another attack where I felt like I could not breathe, went to the urgent care they x-rayed my chest and said my lungs were hyper-inflated and suggested I keep taking the albuterol.
I have not been running since I have hard time breathing. I am 47 years old, have run my whole life and exercised at the gym at least 4 days a week. Will my lungs eventually go back to their normal state? I cannot sleep at night.


A. Dear Joanne, If you now have exercise induced asthma, it should be prevented by the prior use of albuterol.

Dr. Tom

Bullous Emphysema
Q. My lungs were fine prior to my silicone implants, One year later, I'm diagnosed with bullous emphysema. Do you think it could have just looked like it seeing that I can breathe fine?

Do patients with bullous emphysema have breathing problems?


A. Dear Jodi I do not believe that silicone implants have anything to do with bullous emphysema. I doubt the x-ray interpretation. I suggest getting spirometry to see if your lung function is normal.

Dr. Tom

Clubbing of Fingers
Q. I am Kholood, a respiratory care student.
I wonder, what is the etiology of digital clubbing?


A. Dear Kholood, There are many, many causes. Better look this up in a textbook.

Dr Tom

Continue to Have Pain Nine Months After Pneumonia
Q. I am a 41-year-old female. Last year at this time I had pneumonia for 2 months, but finally got it treated with antibiotics and I got better. But it took 3 additional months for a little pain in my lower left lung to go away.
However, last month--9 months after the pneumonia went away-- the lower left lung pain returned. It is very mild and I only feel it when I breathe deeply. Might it be the cold air of winter affecting a spot that never healed on my lung?
Thank you for your help. I have no health insurance -- that's why it took me 2 months to finally go in for treatment last year. I would like your opinion to know if this is anything to be concerned about.


A. Dear Licia, I would not be concerned. You probably still have some irritation from the lining of the lung adjacent to where the pneumonia was located.

Dr. Tom

Medications for Bronchiectasis
Q. I have written to you before about my 75 year-old mother, who is on 24 hour 2 liters of oxygen. She is taking 250 Advair twice a day.
Up until a week ago she was also using Spiriva. The respiratory doctor took her off the Spiriva since there was not much difference in her air intake. She is now using Atrovent.
Any opinion on these inhalers? Also, I have read that a 'new' medication, specifically targeted at patients with bronchiectasis in a 'stage 4.' Do you have any knowledge in regards to this medication and when it will be available?


A. Dear Rose, Spiriva is a longer acting drug than Atrovent. It does some of the same things, but is more expensive. It is well tolerated. It is designed to retard the loss of lung function over time, and growing evidence suggests it can do this, at least in selected patients. I do not know anything about a new bronchiectasis drug.

Dr. Tom

Need Help with Medical Terminology
Q. What does this mean? "the aorta is tortuous”. Also what is "fibrosis or subsegmental atelectasis at the bases?


A. Dear Teresa, A tortuous aorta is just an elongation and "unwinding of the aorta" and is common in older people. Subsegmental atelectasis of the bases just means that the patient did not take a very deep breath during spirometry testing.

Dr. Tom

Can My Testing Result Help to Predict Longevity
Q. I am 59 year old and have been diagnosed as having Severe COPD approximately 5 years ago. I am prednisone dependent and my most recent PFT shows my FEV1 as 29%. My oxygen saturation is borderline, 92% at rest 90% slight ambulation.
I know these are only numbers but can I realistically look forward to being here in another 5 years?


A. Dear Dennis, Yes. Five or more years. Remember to live these precious years and not be preoccupied by predictions.

Dr. Tom

Dealing with the After Effects of House Fire
Q. My 79 year old grandmother was in a house fire 11/26/06 along with my two nieces—one 4 years old and the other 8 (who died). Also, my mother was 60, and she just passed from the fire this Memorial Day.
Both my grandmother and mother were on a ventilator then had a tracheotomy. My grandmother came home this May on the oxygen machine for a few months. After awhile, she started wheezing and coughing non stop. She took x-rays and was diagnosed by the ENT (ear, nose, throat) with tracheal Stenosis.
He said he recommends surgery but no laser; or she will have to have a tracheostomy for the rest of her life. She can't sleep at night and every time she eats she coughs for hours, especially at night. I don't know if this is related but she's also constipated a lot. Any Thoughts.


A. Dear China, Your doctors are in a far better position to know what is best for her, than I. They have the advantage of looking directly at the tissue around the tracheotomy and other key factors.

Dr. Tom

Question about Upcoming Surgery
Q. In April I went to my primary doctor, complaining of severe discomfort in my upper right back (between my spine and my shoulder blade). It was so severe that often I could not get out of chair or roll out of bed without the sharp pain being very severe. She gave me Elavil and said it was probably a pulled muscle. I took the Elavil for a month, but found no relief, so didn't continue it.
Now, 8 months later, I mentioned this to my general surgeon (who is going to do a gall bladder surgery and hernia repair on me next month), so he did a chest x-ray. At this time, the pain is worse when I sneeze or if I inhale deeply.
Chest x-ray showed nothing significant, although he says my right lung is hyper expanded, which might be a symptom of emphysema. I have never taken a puff, nor worked around chemicals or toxic conditions. I'm a 60 year old healthy female who has a bad pain in my back when I breathe deeply and sneeze.
Should I take the Elavil again, or seek a diagnosis? Is it safe to have the planned surgery in January? What do you think this could be?


A. Dear Adcox, I believe you need a diagnosis to explain why you have such pain. It has features of a nerve root compression, i.e. one of the major nerves that comes out of your spine where there are discs. I do not believe that Elavil will help this.
I cannot give you any advice about surgery. This should be decided between you and your doctor. Forget the hyperinflation of your lung. It does not mean anything specific.

Dr. Tom

Questions about Atelectasis
Q. I recently had a follow up chest x-ray after the first one showed that I had a moderate amount of atelectasis in my left lung and the doctor said that it showed a pleural density in my left lateral thoracic wall. I don’t really understand what this is and need some answers. Hope you can help.
The atelectasis is better and the first x-ray did mention something about the pleural density but said that it was clear and in the second x-ray they said it was much clearer and that I need a CT Scan. Should I be worried? My family history is full of lung cancer should I be worried?


A. Dear Shannon, Do not be worried, but in view of your family history, you should have a CT Scan to see if the atelectasis has cleared and there are no abnormal shadows.

Dr. Tom

What are Normal Ranges for Spirometry
Q. I am taking a pulmonary function test tomorrow and I would like to know what "normal" breathing levels would be for someone who is 5'9" and 160lbs.


A. Dear Stephanie, There are charts or formulae that give the normal levels based on age, sex and height. Ask the technician what is normal for you and get your results in absolute numbers and as a percent of predicted.
Only pay attention to FEV1, and FVC. The other numbers that are sometimes reported are often misleading.

Dr. Tom

What are the Symptoms of Sleep Apnea?
Q. My husband snores, is always tired and suffers from terrible headaches. I was looking at the information on the Sona Pillow. Although I am not sure this would be of help, it does list all his symptom (except headaches) on their website. Could you tell me more about sleep apnea and are headaches a possible symptom?


A. Dear Sue, Sleep apnea has many causes and manifestations. Your husband's symptoms may well be due to sleep apnea. You will need a sleep study to establish a diagnosis.

Dr. Tom

Recently Diagnosed with COPD (Emphysema)
Q. I have been a heavy smoker for 30 years. I have also traveled extensively in Africa. A month ago I was diagnosed with severe emphysema and coyly suggested that, if I was lucky I would live for five years.... I am now 65.
Over the years I have always requested chest x-rays which have always been normal, even two months ago. Recently I had a bout of what appeared to be whooping cough, my doctor's vague assessment.
I insisted on a breathing test which resulted in unpleasant results: 98%blood oxygen (good), lung capacity 47%(bad). I immediately stopped smoking.
I seem to have no dramatic effects since the 'whooping cough' has disappeared and the only exercise negative is if I run for the bus. I am a city walker and gardener.
I am assuming that the diagnosis is correct; my question is why didn't my doctor recommend the breathing test earlier 9-15 years ago. At the end I insisted upon it) which might have given me more time. On the other hand I feel extraordinarily well and since I gave up smoking 3 weeks ago the cough has disappeared. Interesting stuff:
I'm accepting of emphysema, but I do think that the whooping cough element should be considered.
In addition, on one of my work visits to Southern Africa, I became severely ill with a bladder infection and fever and was not able to see a doctor for three days because of the isolation.
After this my colleagues commented on a continuous cough, which was always referred to as THE AFRICAN COUGH, all of which was reported to my doctor.

Ms. Morgan

A. Dear Ms. Morgan, Sounds like you have adapted to your degree of emphysema well. Keep active and never smoke again. I cannot explain to you why doctors are not up on all the treatments for COPD. Stay well.

Dr. Tom

Is there an Association Between Drug Use and Emphysema?
Q. I have bronchiectasis and emphysema and was wondering if a humidifier would help with clearing the lungs. I do percussion therapy but thought a humidifier, especially in the cold dry winter, might also help loosen things up.
My lung function showed somewhere around 80, whatever that means. My doctor said it wasn't horrible but it wasn't great.
I am 41 years old. My doc also stated that I might have gotten the emphysema from a 17-year bout with heroin addiction. Is that possible? I have been clean now for years but he said it was probably drug-induced emphysema.


A. Dear Michael, I do not believe that the emphysema was caused by heroin addiction. You are young and must protect your health. Stay away from all smoking.

Dr. Tom

Are Cough Suppressants Okay at Bedtime
Q. My father is 87 years of age. He has a chest cold that causes him to cough. He is bringing up phlegm when he coughs.
Should I give him a cough suppressant at night when he goes to bed? Thank you in advance for the information.


A. Dear Jerolyn, No. If he has mucus accumulation, he needs to cough it up.

Dr. Tom

What is an Azygos Fissure?
Q. My son age 14 years had been coughing too much lately, but now improved after two months. I had a chest X-ray done in his report everything came out normal with the exception of Azygos Fissure (incidental finding). I so worried about it need to know what can be done now onwards to prevent any thing else.


A. Dear Ishrat, This is a normal variant of lung development. It has no risk to him at all.

Dr. Tom

Mom has COPD at Age 48
Q. My mother has had C.O.P.D for two years. She finally told me last night. I have a twin sister and we're still teenagers and want to know how long our mom will be around. Will it kill her in a matter of days, months, or years? She is 48 and I want her to be around to see my kids. Could she? She has never smoked but has it.


A. Dear Nickie, Her longevity will be due, in part, to what level of lung damage she has now.
Most patients with COPD live well into their 70’s. About 15% of COPD patients have never smoked.
Sometimes this runs in families. If so a simple test for what is known as Alpha One, will tell if this is the reason. I suggest you discuss this with your doctor.

Dr. Tom

More Information about Alpha-One:

What Role Does Height Play in Spirometry Results?
Q. Dear Tom, Thank you for answering my last question about my spirometry results.
Come to find out the nurse messed up my height, she put me at 52 inches instead of 62 inches. I did call the nurse back and try to explain but she brushed it off and told me there was no big difference in my results.
Now my question is would there be a difference in the height being that its almost a foot difference. I am a 31 year-old female, 168 lbs , and 62 inches tall .
I am thinking that the predicted would be different just don’t know if it would be higher or lower ? Here are my results again,
FVC 3.19 PRED% 148 , PRED 2.14
FEV1 1.22, %PRED 60 ,PRED 1.97 ,
FEV1% 38 , %PRED 41 , PRED 93


A. Dear Nichole, Height makes a big difference. Taller patients have higher normal values. I do not understand the way your numbers are displayed, but they appear to show a moderate degree of airflow obstruction as presented.

Dr. Tom

Am I Taking Too Much Medicine?
Q. My doctor has me on Asmanex, Advair, and also Spiriva. Is this too much?


A. Dear Gail, No. But there are some similarities between Asmanex and Advair. These drugs work well together, and should be taken according to your doctor’s prescription.

Dr. Tom

Side-Effects of Advair
Q. Hi Dr. Tom, Could achy joints and achy bone feelings be a side effect of Advair? I have been on it on and off for about a year for emphysema


A. Dear Deborah, These are not common side effects of Advair but anything is possible.

Dr. Tom

Pleurisy Question
Q. How many times can you get pleurisy?


A. Dear Shekia, There is no limit.

Dr. Tom

Collegiate Runner Having Trouble With Asthma
Q. I have asthma exacerbated by distance running. I have tried about five different medications and none of them have helped to bring my lung function numbers up to a normal level (they are below a normal level).
What do you think is the next route of treatment? I am only 21 years old and very frustrated with this because I am a collegiate competitive distance runner. Please help!!


A. Dear Kristi, You should see an asthma specialist for more advice. You should be able to prevent exercise induced asthma with medications taken before exercise.

Dr. Tom

Worried About Brother’s Medical Reports
Q. Recently my brother went for Diagnosis (CT SCAN, MICROBIOLOGY). After consulting with doctor, he said there is nothing to worry except some observations for which he needs medication.
His CT Chest plain and contrast report read as below:
Multiple mediastinal and hilar nodes noted. The largest nodes in prevascular region measures 1.4 X 1.3 cms. Mild necrosis noted. No calcification. Right lower lobe anterolateral segment infiltrates noted. Rest of lungs are normal. The mediastinal vascular structures are normal. Trachea and major bronchi are normal. Lung vascularity is normal. Both pleurae are normal. No e/o effusion. The rib cage is normal. Cardia is normal. Esophagus is normal.
IMPRESSION: CT image morphology is in favor of * Multiple mediastinal and hilar lymph nodes with right lower lobe small are infiltrates - Infective, possible KOCH's.
His Blood for Mycobacterium Tuberculosis PCR report read as below;
Nature of specimen: Whole blood - EDTA
Nature of Investigation: Mycobacterium tuberculosis DNA
Method: Polymerase chain reaction (RT PCR)
Angiotensin converting enzyme (ACE): 52 U/L.
TB lgA: 150 S.U.
TB lgG: 90 S.U.
TB lgM: 0.66
Request you to kindly let me know your thoughts on above diagnosis reports and any suggestions.


A. Dear Kiran, These results need to be interpreted by your pulmonologist. I would have to speculate too much to say anything, except that you should follow and expert's advice in follow-up.

Dr. Tom

Daytime and Nighttime Oxygen Saturation Checks
Q. I am 54 years old and was diagnosed with mild COPD. My resting saturations are 93%. Should I have my saturations checked while sleeping?


A. Dear Ernie, This would be a good idea. Daytime saturations may not reflect the level of oxygenation during sleep.

Dr. Tom

Worried By Pleurisy
Q. Hi Tom, It’s me again (38 year-old male, an ex- social binge smoker, quit in 2003), I have just been to my doctor with the fourth case of Pleurisy this year. I have had this 7 times in 2 yrs.
He tells me I have a dry pleurisy. I am in pretty bad pain again and have aches pains + chills. I had 2 x CT's in 2004 and 2005 for this same reason. I have a dry cough during the day + productive in the morning, my FEV1 is >100% and my FVC/FEV1 is 76.
This pleurisy is a concern, I had a look on a medical website and there was 16 causes for this, outside the viral ones the rest were serious conditions. My doctor tells me my case is not viral.
The thing that gets me is that it says pleurisy is a symptom not a cause and this has not been answered. I have had no significant exposure to asbestos apart from working for a few days with some suspended ceiling tiles 18 years ago. (I am not even sure they contained asbestos)
I also had a normal CXR 6 months ago, what would you suggest as the best course of action, does this need investigation to establish the cause.

My doc prescribed low dose Volatrol for 3 months and my usual Symbicort for my mild asthma and simple chronic bronchitis.


A. Dear Conn, It is true that pleurisy can be considered a symptom, but it has a disease that causes this symptom. I cannot do any better than your doctor in making a firm diagnosis. It may still be viral, but I suggest seeing another expert for still another opinion.

Dr. Tom

Thoughts About Room Humidifiers
Q. Is the use of a central humidifier recommended for COPD patients? Any negative comment re: bacteria?


A. Dear Irwin, What do you mean by a central humidifier? I cannot answer your question without more information.

Dr. Tom

Does Hyperinflated Lungs Shown on Chest X-Ray Mean COPD?
Q. I had a chest x-ray done for pre op (for a minor procedure, ob/gyn) and it came back as "Lungs Hyperinflated but clear. Impression: COPD."
How can this be? I am a 50 yr old female, 110 lbs and run 3 miles every other day. I never run out of breath, never smoked, never lived with a smoker. This diagnosis has to be a mistake?


A. Dear Tina, You are correct. A chest x-ray showing hyperinflation is not diagnostic of COPD. Get spirometry to measure your lung function if you are concerned.

Dr. Tom

After CT Scan a PET Scan was Ordered
Q. Dear Dr. Tom: I've had a nodule on the left node of the lung and have had threee CT scans. The latest one showed no change in the nodule, however, it did indicate a soft tissue lesion in the right lower lobe and doctor has ordered a PET scan - What can I expect? Is this serious?


A. Dear Helene, You will have to wait to see what the PET scan shows, and to get your doctor's opinion about it.

Dr. Tom

Q. My skin is breaking out around the nose, mouth and ears since wearing nasal cannulas. Any advice? website states there are hypoallergenic cannulas. Other than being latex-free, what does that mean, and what specific manufacturer's products are "hypo-allergenic"?


A. Dear Jeff, Sorry, but I do not know the brand names. Ask your supplier.

Dr. Tom

Nighttime Coughing
Q. I smoke, and cough in my sleep what does that mean?


A. Dear Tammy, You are accumulating mucus when you sleep. This is from the daytime smoking. Stop all smoking and the cough will stop.

Dr. Tom

Questions about Asthma and Methacholine Challenge
Q. I am a 35 year-old woman, who does not smoke, is not overweight, and has no history of allergies (other than to cats, which I avoid at all cost).
About two years ago I started having a problem with shortness of breath, as though I cannot fill my lungs. I assumed it was due to stress, or exertion, or what have you. I essentially made excuses for it. However, it has progressed, and in recent months, has been joined by an occasional dry cough, intermittent pain in my chest when trying to breathe, a tightness or heaviness in my chest, difficulty talking (when short of breath), and the shortness of breath is not only (hours) daily, but no longer requires any exertion to start an episode.
I went to a pulmonologist who felt that it was likely that I had an adult onset intrinsic asthma. He scheduled me for a lung function test. Although I do not remember all of the results off hand, I was told that my highest lung capacity result without any medication was 65% of the expected level, and that after they administered the inhaler treatment (albuterol – 4 puffs) my lung capacity was elevated to 74% of the expected result.
On the final page the test results it stated that I had a Restrictive Lung problem. The Technician said that the doctor would be calling me to inform me of the medication he would be prescribing me because I definitely had asthma. That is not the call I received from the Doctor.
After receiving the results, the doctor has scheduled me for a Methacholine challenge test, and a chest x-ray. Obviously that made me rather curious, so I looked up information on Pulmonary Function Tests and asthma. I found that asthma is an Obstructive, not restrictive problem.
Here are my questions:
1. Can the (computerized) Pulmonary Function test issue a result of Restrictive, and still have the diagnosis be asthma?
2. If not, is it most likely that my Pulmonologist is doing the Methacholine challenge test to actually rule out Asthma, not as another type of Asthma test, as I had originally assumed?
3. If he is no longer looking for asthma, what are the alternatives, given the symptoms, and progressive nature of the problem?
I apologize for the length of my email, and thank you for any insight you are able to offer.


A. Dear Erin, Asthma is an obstructive disease. I see no reason to do a methacholine test to exclude asthma.
You need to see a pulmonologist who specializes in restrictive lung diseases. It is entirely possible that you have an early stage inflammatory process, leading to restriction, and there may be some very effective treatment for it.

Dr. Tom

Oxygen Concentrator as Opposed to a Liquid Oxygen System
Q. We started with an Oxygen Concentrator used only nightly. It’s a heat generator and noisy. Now trying liquid oxygen.
My wife does not like it because it cuts off when she lays down at nights. She wants to go back to the concentrator which will now have to be on 24/7; constantly running in a small room with poor air circulation. Electrically that sounds dangerous and especially as an oxygen generator; not to mention what the electric bill would look like.
Please comment.

Mr. Brown

A. Dear Mr. Brown, There is no reason for a liquid system to cut off during nighttime use. Use the flow directly from the home reservoir.

There are quiet concentrators that use little electricity, such as the Eclipse, that uses about 40-50 watts only and is quiet and generates little heat.

Dr. Tom

Muscle Cramping During Exercise
Q. I have COPD, don't take O2, and am 65 years old. I quit smoking 5+ months ago. My FEV1 has been at 33% at last spirometry.
I've been using the treadmill regularly. I've had muscle cramps/pain for a few months now, and getting worse. Could it be a possibility that my muscles are starving for O2 and causing pain?


A. Dear Jack, This is possible, but it is more likely that the cramping is due to increased muscle use. I suggest you monitor your oxygen saturation with an oximeter during exercise to settle the issue.

Dr. Tom

Very Concerned about Living in a Dusty House
Q. Hello, I am a teenage student. When I wake up in the morning, my lungs ache. I have a mild stuffy nose, and I have neck and back pain as well. Our house is so, so dusty. We have dust on our ceiling fans, all over the floor, and on top of that, we have two dogs in a very small house of a family of four, and they shed hair like crazy. I'm aware that we are constantly breathing that in, and have tried several times to get my mom to buy an air purifier, but she just won't.
I'm 15 and I have a younger brother at the age of 5. He tells me that his neck really hurts in the morning, and he always has a stuffy nose. He also has asthma. I've been wondering if this could be linked to our honestly...disgusting house filled with dust, germs, dog hair, and who knows what else.
I just wanted someone to clarify my problem, if it really is what I'm thinking. Can breathing filthy air be linked not only to lung problems, but back and neck pain as well? What can do to help my little brother and me, I am merely a teenager? My Mom thinks I'm just being paranoid about the whole thing, but I really am concerned about my health. What should I do?


A. Dear Zoey, Your dusty home can be causing lung problems. It is possible to get neck pain if you are doing a lot of coughing. Start cleaning your house yourself, i.e. vacuum, dust, etc. Maybe she will get the message.

Dr. Tom

What is a Non-Calcified Node?
Q. I have over the past 3 yrs been having bouts of bronchitis, maybe twice a year, treated with Biaxin 500 TID. Being a nurse, and having a doctor that has not found anything that has helped my wheezing that I have every once in awhile I suggested a chest x-ray, they found a spot, so was therefore given a CT Scan without contrast (allergic to iodine and shellfish) anyway it showed a non-calcified, 7X10mm round smooth well demarcated nodule in my L middle lung.
What is your advice? Should I do what he suggested, watching it with CT Scans for growth? However; I’m concerned about it not being non-calcified, would a PET scan be of any help or should I get another pulmonologist’s advise?
I hate to be pushy, but having some medical knowledge keeps me in a panic state all the time. Any advice would help. Thank you so much. Oh and I live in Illinois so wondering if this could be histoplasmosis infection? Or just what are your thoughts on the whole thing together?


Dear Melinda, This is most likely histoplasmosis. But I would get a follow-up lung scan in about four months. Not a PET Scan, yet. You never mentioned smoking, or family history, which would increase the level of concern, but the odds are still a benign lesion, such as histoplasmosis.

Dr. Tom

Symptoms of Carbon Monoxide Poisoning
Q. I work for Cherokee Nation EMS. Last winter we had an emergency call to an equipment rental facility for CO poisoning. We had 5 patients, of which only one presented with frothy sputum. She was pregnant at the time of exposure. From what I have read this symptom is seen quite often in the presence of CO poisoning.
Can you explain the pathology of CO poisoning causing pulmonary edema, why we would see it in some and not all exposures even if the carboxyhemoglobin levels are higher in patients that do not have this symptom?


A. Dear David, CO poisoning replaces the oxygen in the blood and starves the tissue of energy producing oxygenation. The lungs can get directly damaged from the CO and leak pulmonary edema fluid. All people are not equally susceptible, and there may be local factors within the building, such as cracks that leak air, that may alter the CO level.

Dr. Tom

Have Pain When Taking a Deep Breath
Q. Hi, I was just wondering what you would recommend I do for this. I have been diagnosed with bronchitis about 3 or 4 times in the past year and a half and also have had pleurisy. Now I have had these really sharp, and random, pains (Sharp/Stabbing) to the left of my right shoulder blade and on the top part of my chest (on the right side).
After I get these pains it also hurts for me to inhale deeply and I have to stop myself when I yawn. I also cannot laugh for long periods of time because it makes me have coughing fits.
I have seen a respiratory specialist and they did tests for autoimmune diseases, they have done chest x-rays; an ECHO on my heart, and asthma testing and everything keeps coming back negative. The pains are getting worse and the only thing that my doctor suggested is that I stay out of smoke.
I would really like to know what is causing this and make the pains go away. What do you suggest?


A. Dear Megan, I agree that staying out of all smoke may help. Something is irritating your air passages and lung lining.

Dr. Tom

Worried about Results from CT Scans and Recent Changes in Health
Q. I have high cancer rate in my family. For the last year and a half I have had chest pain in my upper left side. In the last four years I have had either bronchitis or pneumonia, I have had a raspy voice in the mornings along with 33 pounds of weight loss in the last two months. I do not exercise since my past six back surgeries have caused problems.
I was getting a ct pelvic scan, which showed a small lesion in my upper left lung. My doctor didn't think much of it-called it scaring from infection such as pneumonia so he wanted to check my heart from the chest pain-long story short found; enlarged left ventricle and enlarged left atrium- nothing to worry about.
As precaution they decided to do CT scan of chest- everything showed up normal except now a large lesion was found in my lower right lobe of my lung. Doctor said it is large but is from scaring- trauma, infection, etc.
My worry is how does he know it is benign; I have had all these problems including the weight loss and chest pain. Why didn't they see the lower right 4 months ago when they did the pelvic scan and seen the left lesion? He keeps say could be acid reflex, I keep saying I went through that with another doctor who prescribed meds for that and it didn't change anything. I am confused and worried. What do you think?


A. Dear R.J., I can understand your confusion. The large mass needs to be explained, such as by biopsy.

Dr. Tom

2024 American Association for Respiratory Care