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Archive: Dr. Tom 117
Posted Februaruy 26, 2008

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



What do Low Lung Volume on Chest X-Ray Mean?
Q. In April 2007, I was diagnosed, by CT scan, with a pulmonary embolism in the lower left lung also a subsegmental atelectasis in the right lower and middle lobes.  On January 10, 2008, I was having some issues with shortness of breath, and episodes of constant/chronic coughing spells, some wheezing, but I am a severe asthmatic. 

The doctor thought I may be experiencing another blood clot, so he ordered a CXR, the only thing it showed was low lung volumes.  How serious is this?  How can it be treated, and will I always have it?


A. Dear Janell, This only means the chest x-ray was taken before you did a maximum deep breath in. Maybe you were limited by pain. This is not serious at all and will resolve.

Dr. Tom


Twenty-Six Year Old Worried About Testicular Cancer
Q. I have been having sharp pain (especially at night) at the inner/lower end of my testicles. I tried seeing doctors, explaining how I feel. I even at times said to them that I might be having testicular cancer to which they disagreed, saying I'm still young (26 years old) to worry about cancer.

I'm now using Hifenac, which belongs to a group of drugs called non-steroidal anti-inflammatory drugs. This drug is not available in USA.

What should I do? Should I go for an x-ray or anything related to being able to vividly see if everything is alright and to know what is giving me pain? I'm so worried because I haven’t had a kid yet. Please help


A. John, You are a perfect age for testicular cancer. A careful palpation of your testicles followed by a CT scan can make or rule out the diagnosis.

Dr. Tom

For More Information about Testicular Cancer:


Help, I’ve Had Persistent Cough Since September
Q. Dr. Tom, I had a cold in September and since then, have had a persistent cough.  But, it was always an unproductive one and sporadic, so I never paid attention to it. 

In October, my nose would get so stuffed up so I couldn't sleep at night.  A doctor told me it was allergies and no to worry.  In January, my coughing became more severe and I noticed I started wheezing.  I felt that I might have bronchitis, something I often had as a child. 

The wheezing scared me one night and I went to the ER who prescribed me an inhaler I didn't want to take.  I went to a doctor after that who said I didn't have bronchitis and gave me Avelox (antibiotic) and Singulair instead.  The Avelox did nothing and the Singulair made my heart race to the point I felt I was having a heart attack.

A third doctor ordered a chest x-ray, which came back negative.  I don't know what to do.  Not a day goes by where I don't cough or wheeze (although very mildly).

 I'm never gasping for air and breath flow is pretty normal.  It's just this chest tightness and wheezing that really disturb me.  I got the inhaler prescription filled just to have something with me on nights where it is so bad and I can't stop coughing. Any advice would be greatly welcomed.


A. Dear Lia, You, most likely have asthma. See a pulmonologsit or allergist and get complete control of the wheeze and cough.

Dr. Tom


Side-Effects of Lung Medicine
Q. I started taking Flovent inhaler about a week ago; last winter I was on Symbicort and I was getting terrible cramps in my feet and sometimes in my hands.  Could these inhalers be the cause?  I have sarcoidosis as well as asthma and emphysema.


A. Dear Marinna, These medications should not be causing cramps of feet and hands.  If they do not subside, see your doctor or another doctor for an explanation.

Dr. Tom


What does CT Scan and Chest X-Ray Results Mean?
Q. Hi Dr. Tom, In January 2008 I had a chest x-ray, done to rule out pneumonia, the results came back a normal x-ray. A week later I told the Dr. there was something wrong as I was getting sicker so he ordered another x-ray. The results came back mild left apical pleural thickening with a possible subcentimer nodule at the left apex laterally. So what does that mean?


A. Dear, Pamela, There is a nodule or there is NOT a nodule. None of this "possible" stuff.

Get a CT Scan to see if a nodule is present and to help determine the characteristics of the nodule and then follow-up, if not calcified, at an interval to be determined by the size of the nodule. 

Apical thickening is due to old inflammation of the upper reaches of the lung; it is actually a healed scar and of no other significance.  

Dr. Tom


Can Certain Occupations Cause Health Concerns for those with COPD?
Q. I have recently been diagnosed with COPD and suffer from SOB with little exertion. I am not on oxygen yet.

I work 40 plus hours a week in a veterinary clinic with exposure to pet dander, forced air heat, and aerosol air sprays for odors. I notice that my breathing is much worse when I'm there. Am I causing faster progression of the COPD by continuing to work there?


A. Dear Sharon, You may be allergic to pet dander. Also the sprays may be irritating.

I suggest getting spirometry to see if you have any measurable loss of lung function before making a decision about leaving the place, in the context of the value of the job to you.

Dr. Tom


I Don’t Understand My Lung Scan Results
Q. The findings on my recent lung scan state. "Findings consistent with biapical emphysematous changes without evidence of an acute pulmonary disease process." What does that mean?

I have been told I will need a lung transplant soon. I use a life vest everyday but am not on oxygen. I smoked for over thirty years but through the use of Chantix and counseling I have been smoke free for over eight months. I also use a variety of inhalers.


A. Dear Theresa, These findings point to old inflammation. You will need an evaluation of your lung function (spirometry) and a consultation before a transplant becomes worthy of discussion.

Dr. Tom


Smoking Damage to the Lungs
Q. I just quit smoking and my doctor says I have some scarring in my lungs. What does that mean for me now and in the future?


A. Dear Tamie, It depends on the amount of damage done, when you stopped. Smoking does cause scarring of small airways. You can tell a lot about your future by getting spirometry done to assess your remaining lung function.

Dr. Tom


I am a Smoker and am Having Pain in the Middle of My Back
Q. I have been a smoker for too many years and I have been having pain in the middle of the right side of my back. I have noticed a little wheezing now and then. I had a chest x-ray recently and all the receptionist told me, was there was a lot of scarring in the lung. Can you tell me what this means?

Should I have a MRI? The pain in my back seems to have subsided some because of the medicine they have prescribed but the ache is always there and I was wondering what advice you could give me?


A. Dear Susan, Lung scarring rarely causes back pain. The scarring needs an explanation. I suggest you see a pulmonologist, since there are many possibilities here.

Dr. Tom


Recommended Tubing Change Schedule for Oxygen Concentrators
Q. I use a concentrator and was told to change the tubing every two weeks and wash with water and vinegar every couple of days or so. Now my supplier only wants to give me the 50' tubing every ninety days. I this safe for my well being?  Thank you for your time


A. Dear Sharon, It is safe, but your supplier should be more generous in replacing the 50' tubing. He is only trying to save more money for his bottom line.

Dr. Tom


Found a Spot on My Lung
Q. I recently went into the doctor to get checked for my heart and everything was fine.

They called me back to ask me to do additional x-rays of my left lung because they detected a spot but wanted to double check to make sure. How concerned should I be? What are the chances this could be an error?


A. Dear John, It needs to be confirmed. Spots can mean many different things. The solitary nodule which, is not calcified, has about a 10% chance of being malignant, depending on many risk factors and modifying conditions. Follow your doctor's advice.

Dr. Tom


Did Smoking or Working Environment Cause COPD?
Q. My mother in law is 58 and has recently been diagnosed with COPD.  She has smoked approximately 15 cigarettes a day since being a teenager.  She has also worked in a care home laundry for the last 15 years in a small room where the only ventilation was from opening the door. 

Could her job have caused the COPD or is it likely to be from smoking.


A. Dear Corinna, It is far more likely that smoking was the cause, rather than any fumes she contacted at the laundry room.

Dr. Tom


What is Paraseptal emphysematous
Q. My sister was just given the following diagnosis - Paraseptal emphysematous changes with biapical bullae. No pulmonary nodule or mass seen. What exactly does this mean?
Thank you for your help.


A. Dear Cindy, This is a description of the tissue or x-ray type that led to this report. As stated, it is not easy for me to say anything more about it.
What does your doctor think?

Dr Tom


I Have a Low FEV1; Do I Have Asthma, COPD, and/or Alpha One Antityripson Defieciency
Q. I am 29 years old. I have 11 pack years of smoking under my belt. I gave up at Christmas, and also smoked joints daily for most of this time.

Is a low FEV1 due to asthma or COPD?

I am a carrier of alpha one antitrypsin deficiency (I am an MZ with 74mg of A1AT). My grandmother died at 72 from emphysema (she was a smoker), and my Dad is 57, smoked until last year, and doesn’t have COPD yet or at least that I know of.

I had spiromety when I was 22 and I had a 65% predicted  FEV1. The specialist told me I had the start of emphysema. Needless to say I was a bit worried. Next year I had a fev1 of 88%. The same doctor then told me I had asthma.

I had my spirometry tested yesterday and FEV1 is 72%, and my FEV1/ FVC is 66%.

Do I have asthma or COPD? Have I really destroyed 28% of my lung capacity in your opinion?

Any advice appreciated. I don’t’ trust the specialist and my own GP doesn’t really seem to have a clue.


A. Dear David, You need to see if the impairment is reversible by bronchodilator drugs. It is most likely asthma, meaning reversibility of the airflow obstruction.

Joints are very damaging to the lungs, so COPD is a possibility.  At  your lung age and with the minor risk factor of a mildly low alpha one test. You must never smoke again, and get treatment for any chest infections that you encounter.

I think it best that you see a pulmonologist who you like and trust.

Dr. Tom

For More Information on Alpha-1 Antitrypsin Deficiency


What is the Recommended Follow-up for Multiple Nodules in Lung
Q. From a CT I have six scattered pulmonary nodules, the largest is 6.5 x 5.0 cm, two small ones, the largest 7.8 x 5.0 mm. Also, biapical pleural-parenchymal scars seen.  I have never smoked.  My doctor wants to do another CT scan in three months. I need to know more now.  Where do I go from here?


A. Dear Nancy, You can't mean 6.5 x 5 cm. These would be huge masses and probably should be biopsied. A follow-up of the other masses is wise, if they are not calcified, but I suspect that you have some wrong information in this question.

Dr. Tom


I Am an Ex-Smoker, Would this Be the Cause of Lung Scarring?
Q. I am a 67 year old female who smoked for 30 years. I have stopped for two years. The doctor did a CT Scan and found some linear scarring in the left lung base. What does this mean?


A. Dear Cindy, This does not mean much. It probably represents old inflammation.  You do have a heavy smoking history, so you should have a follow up in about four to six months.

Dr. Tom


Medication for Excessive Mucus
Q. From last year I have been suffering from excess mucus formation. It had started mainly from common cold, which is cured after taking some medicines. But day and night I suffer from excessive mucus formation. I have taken many medicines common cold relieving tablets all failed.

It is the same during summer as well in winter but it starts heavily as I wake up in the morning. So can you prescribe some really good medicines found in India and which, have no side-effects.


A. Dear Debjit, No. I do not prescribe in this information vehicle, and I do not believe such a drug exists. 

Dr. Tom


Bruised Lung
Q. My boyfriend and I were in a car accident on the 15th. We were heavy smokers before the accident and my boyfriend had a few broken ribs and a bruised lung.

My question to you is; what could smoking do to a bruised lung?

We do not plan to continue smoking but we shared one cigarette to call it quits. I want to make sure that nothing could come from the half a cigarette he had. Let me know a soon as possible.


A. Dear Chelsa, Nothing could possibly come from a half a cigarette. Take this opportunity to resolve that you will never smoke again.

Dr. Tom

For More Information on Stop Smoking:


Q. I went to the ER yesterday for some chest and back pains. They did a chest x-ray and then took me in for a CT Scan. In the scan they discovered a 5 mm nodule on my lung.

I am terrified. I am 49 and have been a smoker for 20+years. I certainly have quit now but I know this nodule was not there about five years ago. I was told to have another CT scan in six months. Doesn't this seem long to wait on this? Thank you in advance.


A. Dear Dawn, This is a pretty standard interval for such a small nodule, but I would take it seriously and have it done as advised.

Dr. Tom


What Can Lessen the Effectiveness of Albuterol?  
Q. Do temperature or altitude have any affect on the effectiveness of albuterol?


A. Dear Avery, Extreme altitude and cold can affect the nebulization process a lot. You should keep the device at body temperature, when adventuring out in the cold, and at altitude.

Dr. Tom


2024 American Association for Respiratory Care