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Archive: Dr. Tom 122
Posted April 7, 2008

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



Is Pain a Symptom of Lung Cancer?
Q. My husband had been having pain under his right shoulder blade for about a month. He went to a chiropractor. She took x-rays and found an area on the right lung. She suggested he follow up with his Dr. We went to his Dr, she took more chest x-rays and now is scheduling a CT scan.

What are the chances that the pain is associated with the lung problem and how likely could it be cancer? He has smoked for 36 years. The scan is scheduled for tomorrow.


A. Dear Debra, Chest pain can be caused by cancer. Wait for the results of the CT scan. If abnormal, see a pulmonologist.

Dr. Tom


Connection Between Smoking and Lung Cancer
Q. I am a 44 year-old female. I recently quit smoking and have to go for a pulmonary test. I am scared and can only think that it is emphysema. My doctor listened to my lungs and said there is no wheezing and that I was fairly healthy.

I feel sob all the time, but am very active. What do you think?


A. Dear Reegan, You should get spirometry to see if the harmful effects of smoking have reduced your lung function.

Dr. Tom


Is My Oxygen Saturation Within the Normal Range?
Q. I am 51 years old, not over weight and a long time smoker. I have been diagnosed with mild COPD but my oxygen level was only 68% when I had the spirometry tests done. What does this mean?


A. Dear Rudy, An oxygen saturation of 68% is quite low. Be sure this value is correct.

Dr. Tom


Effect of Other Disease and Environmental Factors on My COPD
I am 43 and was diagnosed with emphysema last year, somewhat out of the blue...subsequently I have developed chronic sinusitis and GERD.

My question is two fold, do you think the sinusitis and GERD will make my emphysema progress more rapidly, and do you think this is something I should worry about in relation to my small children.

As of late, my son complains of his "lungs" hurting when he runs, and he does run slower and less than other kids his age. He is 6. I guess my concern is that my condition was aggravated by environmental factors and he was exposed as well.


A. Dear Deborah, Sinusitis and GERD can aggravate emphysema.
This would not explain your son's symptoms, of course. Your son should see he pediatrician for an explanation.

Dr. Tom


Husband Worried about Prognosis Given in the 1960’s
My 53 year old husband had asthma since he was born (a 7 month preemie). He's also had pneumonia six times throughout his life. He keeps telling me he won't live beyond 55 because that's what he was told in his teens (1960's). Is this so? Yes, his lungs are scarred, but otherwise he's in good health, uses albuterol when needed and is physically fit.

Should he consult with another lung Dr.? I know the mind-body connection is important, and he doesn't have a death wish, but he won't budge from what he was told as a teenager. Can you advise?


A. Dear Denise, I see no reason for your husband to be so pessimistic. He should have his lung function measured by spirometry to see where he stands. He should probably be seeing a pulmonologist.

Dr. Tom


Medical Abbreviations
Q. What does it mean by R/O PTB?


A. Dear Frankie, I have no idea. Ask the person that used this word salad.

Dr. Tom


Is Pain Under the Rib Cage a Sign of Lung Problems?
Q. If there were a problem with your lungs would you be having problems under the rib cage? My father is having problems in that area, and shortness of breath and pain.

A. Dear Debra, Lung disease can cause symptoms under the rib cage. You need a diagnosis from an expert such as a pulmonologist.

Dr. Tom


How Do I Know If I Am Having An Allergic Reaction To My Inhaler?
How do I know if I am having an allergic reaction to my inhaler?
Here is the situation...

Was on Asmanex for three weeks. Chest became really tight for a few days. Then the tightness went away and I had really bad heartburn.

Doc told me to stop meds and keep taking my rescue inhaler. The same thing is happening with the rescue inhaler.

I was having really bad heartburn for months. Had an upper scope done and it came back negative.

Now I do not know if it is the inhaler or the upper digestive. Any thoughts?


A. Dear Jamie, Paradoxical reactions to inhaled bronchoactive drugs are rare, but do occur. Better sort this out with the help of your doctor.

Dr. Tom


Questions about Pulmonary Function Test (PFT) Results
I have smoked for around 30 years around seven a day sometimes up to nine but no more and have stopped six months ago.

I don’t understand my results and don’t know whom to ask. I will give you a quick low down .I was experiencing shortness of breath intermittently but was having a bit of a stressful time at home so thought nothing of it and put it down to nerves. In the end I went to my doctor and he did a spirometry which they said was good better in fact than was predicted. I was eventually sent for tests at the hospital for a VQ scan (in case it was a PE) it was normal or at least they didn’t tell me any different and also a PFT including the one where you sit in that glass box thing.

When my doctor got the results he said they had diagnosed me with emphysema but said that he thought the 63% bit was a misprint and that I had asthma as I did not have any other symptoms e.g. cough wheezing etc and the Symbicort and salbutamol he gave me worked so well.

There are a few things I don’t understand Is it asthma or emphysema or is it both or is it neither? Apart from the shortness of breath when I am speaking as opposed to exerting myself I have no other symptoms. I am so confused.


P.S. I would appreciate any info on my results Thank-you so much.

Pred LL* Pred UL** Act1 %Pred
FEV1 (L) 2.67 3.91 3.00 91
FVC (L) 3.12 4.53 4.72 124
FEV1 % FVC (%) 63.49
FEF 50 (L/s) 2.51 6.12 2.12 49
VC (L) 3.26 4.64 4.72 119
RV (L) 1.55 2.70 4.15 195
TLC (L) 5.23 7.21 8.87 143
RV % TLC (%) 27.08 46.20 46.79 128


A. Dear Withie Most of your excessive numbers are normal. I cannot make a diagnosis in your case, which is your doctor’s responsibility.

Dr. Tom
* Lower Limits
** Upper Limits


Is Moving Because of COPD a Wise Move?
I'm currently living in Georgia and considering moving to California or Arizona. I have COPD and am wondering which state would be better for my condition.


A. Dear David, It probably makes no difference. Avoid high altitude.

Dr. Tom


Does Pulmicort have Side-Effects that are Harmful to the Eyes?
I recently had a family insist that their 12 month child use a mask while delivering Pulmicort via nebulizer, as opposed to a "blow by" treatment using aerosol tubing for delivery. Their reason was that Pulmicort causes problems in the eye.

Are you aware of any contraindications of Pulmicort and eyes? I have heard that there is pupil dilation with Atrovent administration, but not with Pulmicort. (of course, given the choice, a mask treatment is preferred for increased medication delivery.) However, this child was kicking and screaming with the mask.

What are your thoughts of ocular contraindications with Pulmicort? Also, do you recommend wiping the face off after Pulmicort delivery, and/or wiping after all aerosolized medications?


A. Dear Karen, I am not aware of any immediate eye complications to Pulmicort use. There is a small risk of cataracts in adults.

Dr. Tom


Baffled by PFT Results
Dear Dr. Tom, I do know that I want to start by thanking you for all your help. You are a godsend for many people that are not getting understandable explanations from their physicians. I think mine gives me more credit than maybe he should for understanding what he is talking about. Basically, I am baffled by my PFT results. Could you please help me interpret these numbers? They are so different from the others that I have seen on your website. Some of these numbers seem too high. Thank you in advance for any help you can give me. I am 49, female, 5' 10.5". So, here goes:

PFT results
FVC Pre Drug Reported 5.27
Predicted 4.03
Post Drug Reported 5.21
% change -1
FEV1 Pre D. Reported 3.58
Predicted 3.07
Post Drug. Reported 3.84
% change 7
Pre d. reported 67.85
Predicted 76.17
Post D. Reported 73.81
% change 9
FEF 25-75%
Pre drug reported 1.97
Predicted 3.28
Post D. Predicted 2.96
% change 50
Room air oxygen saturation 100% at sea level


A. Dear Ali, Your lung functions are near normal, and the use of a bronchodilator causes some reversibility of flow. Forget the FEF 25-75% values, which are often misleading. You also transfer gas across your lungs normally.

Dr. Tom


Very Depressed about New COPD Diagnosis
Just diagnosed at 41 with moderate COPD (spirometry). I have two young children and I am devastated. I had a lung collapse five years ago, but continued to smoke as I was told it really wasn't from smoking. VATs surgery and pleurodesis I have quit now eight weeks ago.

I watched my mother die of this in January and I am so afraid. I do not want to ever be on oxygen and feel that from all the research I have done that I will be. I plan to get antidepressants because at this stage I no longer wish to live. Like I said I saw how horrendous it was with my Mom. Not to mention an embarrassment to my children to have a mom on oxygen at this age.

I have no shortness of breath since quitting, and no more cough. I thought that was a good sign until I read that it doesn't matter in terms of the COPD even if these things are better the disease is still progressing.

I am so angry at myself, and so very depressed. I gave my two weeks notice at my job. My husband is angry with me, for not wanting to live and doesn't believe me when I tell him all the data that says I will be on oxygen probably by 50 yrs old. And, I will probably not be a candidate for any surgery due to my pleurodesis.

I am so sad. What is the best antidepressant for people like me? Thank you for listening.


A. Dear Marion, Just face the fact that you will have some limitations in the future. There should be no embarrassment about oxygen. You may not need it for a long time yet, if ever.

Maintain a high attitude of hopefulness, which is much more effective than any antidepressant. I almost never use antidepressants in my practice.

Dr. Tom


Can Enlarged Spleen Effect Breathing?
I have a spleen three times its size and I am having a hard time breathing. Could my spleen be the culprit?


A. Dear Heather, No.

Dr. Tom


Is Pain a Year After Pulmonary Infarcts Normal?
Q. About a year ago I was diagnosed with a DVT (deep vein thrombosis), multiple pulmonary embolisms and pulmonary infarcts. I went through six months of Coumadin treatment and the issue is now considered by my doctors to be resolved.
But I still have residual pain in my lungs sometimes. And I guess I'm just trying to find out if this is normal, have other people you've come across have experienced this as well. I've figured out the patterns to it: When I'm outside in damp, cold air it hurts. When my immune system is already compromised — such as trying to fight off a cold or infection — it hurts. When I'm emotionally distressed it hurts. It usually hurts in the biggest "chunk" of dead space I was told I had... at the bottom of my right lung towards the back. It vibrates and hurts sort of sharply when I breathe deeply, like it did before I went through treatment. One day when I went out into the rain the day after I'd been sick, I got sharp pains throughout... like all the previously affected areas were acting up in protest. Twisting, sitting hunched over, or laying in certain positions aggravates it.

I tried to find evidence of others going through this sort of thing on the internet, but couldn't. Can you help?


A. Dear Gina, I do not believe that your symptoms are due to the previous pulmonary emboli. Get an explanation for your symptoms from your doctor.

Dr. Tom


Are Shaking Hands a Side effect of Symicort?
Dear Dr. Tom, My Mom has adult-onset asthma, but had bronchitis in her younger adult years. She has been taking Symbicort through a pump or puffer but has a severe side effect of shaky hands. Is there anything she can do/take to counteract the shaky hands? She's been taking Symbicort since 2007.


A. Dear Angie, One of the components of Symbicort can cause tremor. This is a nuisance, but not harmful to your body. You will learn to adjust to it.

Dr. Tom


How Dangerous is Amiodarone HCL
Q. How dangerous is Amiodarone HCL, I have read so many not good things about this drug. Thank-you


A. Dear Phyllis, It has a number of dangers, some serious. Better discuss these with your doctor.

Dr. Tom


EDTA Chelation Therapy
There is a large NIH clinical trial underway to assess the efficacy of EDTA to remove calcification from coronary arteries. Do you have an opinion as to this treatment for calcification in the lungs?


A. Dear Wayne, Yes, and my opinion is that this will not take calcium out of the lungs.

Dr. Tom


Chronic Illnesses and Life Expectancy
My Dad has severe emphysema and is on 24 hour oxygen. He also has heart failure, diabetes and thyroid disease. His hands go numb and his feet are nearly always cold. What do you think his life expectancy is?


A. Dear Katie, He will live as long as his body and determination will allow. Ask God for help.

Dr. Tom


Recovering for 17 Months in the Hospital after Lung Reduction Surgery
Dr. Tom I have COPD I have died two times heart stopped. But something keeps bring me back.

I am on oxygen all the time but I do not need it a lot of times I do not use it at night. When I move around that’s when I need oxygen.

I have had a lung reduction on my right side. I do not know if it worked. I was in the hospital for 17 months so I had to learn how to walk all over again

So what do you think is left for me and what stage do you think I am at Thank you for your time.


A. Dear Bob, God brought you back for some reason. Look for the sign. Live each day for its precious value. You, like me, are in "overtime".



Flying with Oxygen
My husband was just diagnosed with pulmonary fibrosis and is taking prednisone and oxygen. Is it safe for him to fly? We are thinking about taking a vacation and the flight will be about five hours.


A. Dear Annie, If you need oxygen at sea level, you will need it in the cabin altitude too. Get some oxygen measurements at rest and exercise with a simple oximeter.

Dr. Tom


How Often Should Spirometry Be Repeated and What are Normal Blood Gas Results?
My 75 year old mother is on two liters of oxygen 24 hours. She had a lung function test in October. Her respiratory physician has recently requested a second one. My mother finds this test particularly uncomfortable (with the nose clip). How often do you think this test is necessary? Also, what is considered 'normal' for the arterial gas test?


A. Dear Rose, The frequency of doing spirometry depends on why you do it in the first place. Once airflow obstruction is detected, it is useful to repeat spirometry after starting drugs to note their effect. Otherwise they are done if you are planning major surgery, or something unusual. Nose clips are not needed.

Normal blood gasses are P02 of 70-90 at sea level and PCO2 of 40-44mmhg.

Dr. Tom


Switching Respiratory Medications
With all the new respiratory care medications available today is there a time a patient would want to switch to a different med to see if they have better results? Of course if you weren't having favorable results with your current medications you would try something else, but what if you are okay with your present medications and you just wanted to see if a new med was better?

Robert RRT

A. Dear Robert RRT, Perfect is the enemy of "pretty good". I would stay with the old medications if you are comfortable with them. Remember new drugs have new side effects.

Dr. Tom


How Should Professional Painters Protect Their Lungs?
I wish to ask a question regarding my husband. He is a professional painter and has been exposed to various fumes, dust and sanding particles. He has allergic rhinitis that causes him problems with bad coughing when he has the flu or catches a virus.

What we want to know is there anything he can do to keep his lungs healthier, and less susceptible to harm? I was thinking vitamins and such?


A. Dear Maria, There is not harm in antioxidant vitamins. Almost all painters smoke. This should be stopped if your husband smokes.

Dr. Tom


Questions about Pulmonary Embolisms (PE)
I am 47 and have two young children (9 and 10) so I need to be healthy and energetic.

Two years ago in March (this month), I had seven pulmonary embolisms. I survived but there is a severe pain around my right side where the largest PE lodged. My internist took me off heparin last June.

I am frightened because I don't know what caused the PE's. I had minor pelvic surgery six months previous. I am particularly at risk from the PE's or can I be healed completely

I was diagnosed with severe pneumonia two weeks ago, given an antibiotic and today had another x-ray. The doctor said everything was the same (fluid) which is good because the x-rays lag in response to healing. Are there any precautions or worries that I should have now? She changed my antibiotics and gave me a one prescription for an inhaler Advair. She said to take an over the counter cough suppressant. What about the diagnosis about the pneumonia and x-rays?

Have you ever heard about the pain that persists after PE's? I am terrified of dying because of the Heath Ledger story of mixing medications codeine/phenergin + methodone for pain + antibiotic. I would love to be off the pain meds. I can't find any diagnosis for the pain. I was in and out of the hospital a few times before the pain was controlled.


A. Dear Abby, You should be checked for familial factors that increase the risk for PE. I cannot interpret your chest x-ray report from what you tell me. Ask your doctor. Pain rarely persists after PE.

Dr. Tom


Can You Safely Take Coumadin and Celebrex Together?
Can you take Celebrex for arthritis when you are still on Coumadin?


A. Dear Mary, Yes, your doctor may need to adjust the Coumadin dose.

Dr. Tom


Incidence of Lung Cancer Among Smokers
What about a 63 year-old who smokes and the doctor has found a spot on his lung, what are the chances that it's cancer?


A. Dear Lisa, About 10% across the board. But in such a person as you describe it is 100% or zero per cent. He needs to have a CT Scan to see if the nodule is calcified and to note its other characteristics. If it is not calcified it needs to be followed and if it grows, it needs to be removed.

Dr. Tom


Lost Medication Insurance, What Will Happen if I Quit Taking Lung Medications?
. I was diagnosed with COPD/asthma about six years ago. I have since lost my health/meds insurance. I cannot afford to buy these meds any longer. My doctor's office has stopped doing the patient assistant program for lots of his patients. I cannot find an advocate to help with this, what can I do about this. What can happen if I stop taking my Advair diskus and other lung medications?? Thank you for your time sir.


A. Dear Evelyn, You may or may not miss them. Check in on a Medicaid program.

Dr. Tom


What can be Done to Treat Emphysema?
Hi Dr tom, In reading your answers to questions you mentioned a lot could be done to reverse emphysema. Could you elaborate? I was diagnosed with emphysema a year ago and have found very little encouraging news.


A. Dear Deborah, I have not written about reversing emphysema. It can be stopped in its development or slowed by smoking cessation. A rare type called alpha one, has replacement therapy, which may alter the progress of disease.

Dr. Tom


Could it be Tuberculosis?
At first I think this is just another hoax or advertisement who just want to take some money from the user of your site thanks a lot Dr. Tom.

My son is a healthy 12 year old boy and we're wondering why all of a sudden he loses weight. He is very active actually and we can't actually see if he is really ill or not. So we see our family doctor and suggested to have an x-ray.

We haven't consulted her yet and we want you to be the first to diagnose the result of the chest x-ray if he really has tuberculosis or any sort and the best remedy for it or the dos and don'ts for him if ever. There are fibrotic densities seen at the right upper lobe, heart is not enlarge, diaphragm and the rest of the visualized thoracic structures are unremarkable, impression: consider PTB of undetermined activity, right upper lung. Thanks again and GOD BLESS you always.


A. Dear Frankie, I cannot make any conclusions about an x-ray report alone. If TB, it is easy to treat. I wonder why TB is the prime concern here. You need a diagnosis and then a doctor who knows what to do about it.

Dr. Tom


Wheezing after a Nebulizer Treatment
Why is it that sometimes after a patient has a nebulizer treatment they are audibly wheezing more than before the treatment, yet they say their breathing "feels better"?


A. Dear RRT, They probably mobilize secretions and move them into the large airways where they are easy to hear.

Dr. Tom


Can you have COPD Without Coughing and Wheezing?
I have COPD and I stopped smoking over three years ago. I don’t cough, I don’t wheeze, but I am just very short winded. If I have COPD why don’t I cough?


A. Dear Jo, Cough is only one symptom of COPD. Most smokers lose their cough when they stop smoking.

Dr. Tom


Can a Breathing Tube Puncture the Lung?
Can a breathing tube be responsible for the collapse of a lung? I think my mom got her lung punctured by the breathing tube, which led her to go into a coma and she eventually died. Is this at all possible?


A. Dear Sally, Yes it is possible. There should be x-ray evidence of misplacement of a breathing tube, or a chest tube.

Dr. Tom


Hyperextension Emphysema
What is hyperextenison emphysema?


A. Dear Sean, This is not a term I use. Maybe you mean hyperinflation, which is not an accurate way to grade emphysema.

Dr. Tom


Q. I am 32 years old and have smoked for over 20 years, recently I found out I was pregnant and cut back from smoking a pack a day to 5-6. About five weeks ago I noticed small spots of blood in my phlegm in the morning. I was sick when it started, eventually the cold seemed to have gone away then I had swollen glands for another couple of days.

I saw my physician about three weeks ago and she told me as long as it was small amounts of blood and not all blood not to worry. She wouldn’t order a chest x ray because I am pregnant (although I did have one about a year and a half ago and it was normal).

This is going on week six and I am scared. I am overwhelmed by the pregnancy, the thought of quitting smoking and the blood in the phlegm, the blood only occurs in the first half of the day and only two or three times, then its gone the rest of the night. Any advise for me.


A. Dear Amy, See a pulmonologist. You need an explanation for the blood, which is not normal, even in small amounts. Your fetus can be shielded when you get a chest x-ray.

You should not smoke at all during pregnancy.

Dr. Tom


Can Methotrexate Cause Calcified Granulomas
I have been diagnosed with an auto-immune arthritis. I am being treated with Methotrexate for more than a year now. I had a chest x-ray recently and was told that I have calcified granuloma lung disease in my right mid lung, can this condition be the result of Methotrexate or is it associated with RA or another form of Arthritis.

I am scheduled for another x-ray in 10 weeks. I smoked when I was young but I have not smoked since 1991. I fear that I maybe developing lung cancer.


A. Dear Linda, The calcified granulomas are not from methotrexate and are harmless. Forget them.

Dr. Tom


What do my Husbands Spirometry Results Mean?
My husband's spirometery reads:
FVC=130, FEV1=110
DLCO/VA 75. Can you interpret?


A. Dear Kim, These numbers are all normal or in the normal range. Your doctor should have interpreted these for you.

Dr. Tom


Weight Training and COPD
I am aware that Pulmonary Rehabilitation in general will help people with COPD have a better quality of life. My question is specifically about weight training. Does adding muscle in any way help decrease the oxygen needed? Say with a weight trainer versus a non-weight trainer?

A. Dear Melissa, Adding muscle does not decrease oxygen needs. It increases oxygen for function, but this is good for health.

Dr. Tom


Anesthesia and COPD
Q. I have COPD and have now been diagnosed with breast cancer. My last PFT reports (post bronchodilator inhaler) were FVC = 120%, FEV1 = 68% and FEV1/FVC = 46%.

I'm scheduled for a lumpectomy and radiation therapy at the end of April and am concerned about the type of anesthesia. I have an appointment with my pulmonary specialist a week or so before surgery, but am hoping that you can give me your thoughts.


A. Dear Karen, Discuss these results with your pulmonologist who knows you best. Your results are pretty good.

Dr. Tom


2024 American Association for Respiratory Care