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Archive: Dr. Tom 124

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



Father has Idiopathic Pulmonary Fibrosis, What Can I do to Keep Him Comfortable?
Q. My 90 year-old father was recently diagnosed (based on symptoms and a chest x-ray, no lung biopsy was done) with idiopathic pulmonary fibrosis and has started O2 therapy at 3 lpm.  At rest, his O2 saturation is good--in the mid to upper 90s; but if he walks at all--even from the bedroom to the den--that exertion will cause his level to go down to 78-82%.

I was also told that a dry cough is common with IPF, but he has a frequent and very productive cough (no color, no blood, but lots of it.)  IPF is a horrific disease; I'm just checking to make sure I'm doing enough to keep him comfortable and wonder if I should be looking into something else in addition. Thank you so much for your help.


A. Dear Nancy, You are doing the right thing to give oxygen. I cannot give specific advice about treatment for any patient however, I usually recommend a course of corticosteroids, in cases of intractable cough as a trial. Your doctor should decide whether this is wise, but in your father's case, you are looking for comfort and not cure of disease.

Dr. Tom


Lung Damage and Second Hand Smoke
Q. I am a nonsmoker, but I have been working in a smoking bar as a bartender for the past year. Each morning I now wake up with phlegm in my throat perhaps acting as a protective mucus barrier?

I want to know how badly I am damaging my body with second-hand smoke four-days a week/ eight hours a day. Please enlighten me. Thanks.


A. Dear Lyndi, The damage is significant, but not as bad as if you smoked yourself. This is why smoke free bars, restaurants and  workplaces are so critical for lung health.

Dr. Tom


Can Pain Be a Sign of a Lung Mass?
Q. Can pain starting in the neck radiating down the back toward the upper right lobe be associated with a possible lung mass?


A. Dear Michelle, This is a possibility. Have you had a consultation with your doctor and necessary chest x-rays to look further into this?

Dr. Tom


Signs and Symptoms of Worsening of COPD
Q. If you have emphysema how can you tell if you're getting worse, outside of doctor’s visits?


A. Dear Deborah, It is wise to have spirometry periodically to check on progress and responses to therapy. Otherwise your symptom of shortness of breath is the best indicator that you have. Stay as active as possible.

Dr. Tom


Decline in Pulmonary Function Tests
Q. Hi Dr. Tom: I am a 47 year-old female and was diagnosed with COPD about two years ago. I stopped smoking at that point.

Until last month I had frequent PFT's and they were always right around
FVC = 89%,
FEV1 = 73%,
FEV1/FVC = 83%.
Last month, and on follow-up last week, my PFT readings declined to FVC = 89%
FEV1 = 68%
FEV1/FVC = 78%
My doctor wrote in the chart that this was a rapid decline, and surely at this rate it would drop very low soon. But then on follow-up he said it was 'normal variability.' Now I know statistics, but it seems unusual that about seven readings were the same and then the last three were 5% lower and this would be just variability. It has dropped and it makes me nervous.

I'm not smoking nor around smoke or anything I can think of that would continue to damage my lungs. I've been thinking about seeing someone else for a second opinion. What do you think could be happening?

Thanks! Your Q&A with people with lung problems is very admirable!


A. Dear Joni, The differences are not great; there are day to day variations. I would not be alarmed about this apparent drop in function, which is small. You are wise to avoid all smoke. Stay healthy.

Dr. Tom


Could I be Allergic to Propellant in Inhaler?
Q. I have a very allergic family but had no asthma; that is, until I was overcome by gasoline fumes. Now exposure to second hand smoke, perfume, exhaust, high ozone, change in weather pressure, certain cleaning solutions, aerosol sprays all set off sudden severe asthma attacks with wheezing, but some doctors say I have "silent chest syndrome". 

I began getting worse with asthma the use of inhalers such as albuterol instead of better, funny thing is nebulized albuterol works well. I presumed this meant the gas propellant in the inhaler was aggravating my asthma. Some doctors say this is not possible. What do you think?

What do you think? Is this a multiple chemical sensitivity issue?


A. Dear Linda, I do not know for sure what this is. It sounds like a vocal cord or upper airway problem, and not asthma. I suggest seeing a pulmonologist who can look at your vocal cords and airways using a scope.

Dr. Tom


Practice of Prescribing Multiple Steroid Inhaled Medications
Q. What do you think of the practice of prescribing two steroid inhalers for people with moderate to severe emphysema?  The pulmonologist I work with in upstate NY order Flovent  MDI (2 puffs), or QVAR, and Advair BID.  I can't find any literature supporting this. 


A. Dear Mary, There is no reason to use two inhaled corticosteroids together.

Dr. Tom


Impact of Facial/Dental Structure on Pulmonary Function Tests (PFT)
Q. I have had emphysema for four years. My FEV 1 went from 51% to 40% over this past year. 

I had just had maxillofacial surgery to remove three molar implants three weeks prior to my PFT. Hence, half of the maxillary teeth are missing. Do you think the radical change in the oral cavity could have impacted the significant drop in the FEV 1? 

I'm involved in pulmonary rehab two times a week and the RTs haven't seen a significant decline over the past year.


A. Dear Sondra, I do not believe your maxillofacial surgery is the reason for the drop in lung function.

Dr. Tom


Can One Test be Positive and the Other Negative? Follow-up question
Q. Last time I asked about abnormal degenerate cells in sputum from the lungs.  We have seen our specialist who has ordered a second test of the lung sputum from the trach.  He told us that the second test is clear and shows no degenerate cells.  Is this possible to be there one time and not the other?  Thanks for your help.


A. Dear Linda, It is possible for the degenerative cells to resolve, such as in stopping smoking. Sometimes the variation is due to the depth of coughing and the success in raising the sputum that contains the cells.

Dr. Tom


Order of Taking Medication
Q. When I use my albuterol and Spiriva, which one would be used first?


A. Dear Anna, It makes no difference which order you use. 

Dr. Tom


Short of Breath after Hodgkin’s Lymphoma Treatment
Q. I had bleomycin for Hodgkin’s lymphoma.  My DCLO is 73% and I am a non-smoker. I get short of breath often, worse with stairs and exertion. Is there anything I can do to improve my lungs (scar on CT scan) and improve my breathing?  Thank you.


A. Dear Jeannie, You probably have some scarring from the bleomycin. I suggest enrolling in a pulmonary rehabilitation program to improve your exercise tolerance.

Dr. Tom


Discussion about Nebulizer via Mouthpiece or Mask
Q. Hi Dr. Tom, I have been a therapist for twenty years.  At the moment in our department we have quite a few new therapists along with many who have been in the field for a long time.  One of our discussions has been about the efficacy of the small volume nebulizer using mouthpiece or mask. There are differing opinions and differing reasons. 

What is your opinion and can you recommend any studies that might have been done?   


A. Dear Sally, What is your question? Both are used for nebulization and I know of no comparison studies.

Dr. Tom


Leg Cramps and Seretide
Q. I am a COPD sufferer, 85 years old. Could Seretide be the culprit for my getting frequent leg cramps?

Mr. Patel

A. Dear Mr. Patel, This is a possibility. I suggest you stop the Seretide for a few days and see if it makes a difference.

Dr. Tom


Normal Oxygen Saturation Levels
Q. I have low oxygen saturation, usually from 88 to 92%. I have had extensive testing and there is no medical reason other than my weight.  Occasionally I am down to 85% so I am motivated to get these readings within acceptable levels.  Should I exercise without oxygen to improve those readings? 


A. Dear Ken, No. Exercise with oxygen. Your goal should be to lose weight and you will expend more calories by exercising more on oxygen.

Dr. Tom


What is Carbon Dioxide Retention?
Q. What is CO2 Retention?


A. Dear Irina, It is an elevation of the normal level of carbon dioxide in the arterial blood.  When it occurs slowly in advanced COPD it is not harmful and may improve the efficiency of CO2 removal.

Dr. Tom


What is Minimal Ground Glass Opacification and Honeycombing?
Q. Good Morning Dr Tom, First, thank you for any info you can provide. It's a dreary, dark weekend and my latest CAT scan report arrived in yesterday's mail. I thought you might be able to answer a question before I speak to my (wonderful) rheumatologist tomorrow. Here goes, I have systemic scleroderma (ten years) and the report mentions, evidence of honeycombing and minimal ground glass English, please :)


A. Dear Elizabeth, These are descriptions of abnormal shadows related to your scleroderma. The honeycombing suggests scarring and the ground glass active inflammation. Discuss this with your rheumatologist.

Dr. Tom


Pulmonary Tuberculosis and Lung Scarring?
Q. I had pulmonary tuberculosis, minimal on the lower left lobe, in 2005 and it was treated. I asked my pulmonologist about it she said that the scar will be permanent.  Is there a possible solution to get rid of a lung scar or is there any medicine that could help me get rid of it?

I need to have a clear x-ray result for employment purposes. I am afraid the company won’t hire me because of it. Although my doctor issued a med cert stating that I am already treated and physically fit to work.

I am so worried about it because I’m planning to land a job in a cruise ship and a fast food chain. Looking forward on your reply.


A. Dear Dorothy, The scar from the healed tuberculosis will not go away. You will have to rely on the statement of your doctor that you have been adequately treated. Most reasonable people will accept this explanation.

Dr. Tom


What Could Cause a the Bad Smell in Oxygen Device
Q. My dad has been diagnosed with pulmonary fibrosis (PF) and is using a Helios unit for oxygen.  He insists that he has a bad smell when he uses the oxygen, and that it is making him feel extremely sick.  We have tried different types of tubing, but don't know what else to do.  Is this from the PF, or could it be the oxygen? 


A. Dear Becky, I have no idea where the smell comes from. It is not the oxygen, which has no odor.

Dr. Tom


Questions about Revatio and Idiopathic Pulmonary Fibrosis (IPF)
Q. I am a 75 year-old male.  I was diagnosed with emphysema eight years ago and IPF three years ago.  Although I have had a stent inserted in my right coronary artery the same year I was diagnosed with emphysema. My cardiologist tells me that my heart is in good shape.  I lifted heavy free weights three nights a week for two hours up until 10 years ago, and feel sure that that recreation insured a strong ticker. 

Now my pulmonologist is strongly recommending that I have a right heart cath to determine if my pressure is high enough to warrant my taking Revatio.  Her recommendation is due to the fact that my last two echocardiograms have indicated fluctuating pressure. 

My cardiologist said he didn't think the cath was necessary, but would perform it if I wanted him to.  Even if the pressure was sufficient. After researching the side-effects I am extremely reluctant to take the Revatio. I already have glaucoma, reasonably controlled and dry eyes caused by one of the emphysema drugs, and I am really not interested in going blind.  Do you have any experience and/or references in regard to the use of Revatio?


A. Dear Fred, Revatio is a very useful oral drug in pulmonary hypertension. It has few side effects in the low dosage that are used in pulmonary hypertension. It is the same drug as Viagra, used for other purposes. I would follow your doctor's advice about taking it.

Dr. Tom


Surgical Rick and Low FEV1
Q. I have been having nodules on my lungs monitored for two years. Last week they noticed it had gotten larger, about 3/4" in diameter and scheduled me for a PET scan. When this first came up my pulmonary doctor told me if they were cancerous that I would not survive surgery.

My FEV1 is 17% and has been for five years, however, I am not on oxygen as sitting and standing I get O2 readings in the mid nineties. I do drop in the 80's or lower sometimes on doing most anything. But if I sit down within a minute or two it is back in the mid 90's. I never remain short of breath.

Has this been your experience that people with severe emphysema and that low of a reading cannot survive lung surgery.


A. Dear Joe,  Most people with advanced COPD  and lung cancer can stand the surgery. Often this can be done via a scope. Good luck.

Dr. Tom


Coughing for Four Months
Q. Dr. Tom, I moved on January 3rd, and was living in an apartment where I felt like I had allergic troubles - wheezing after sitting on the carpet, constant productive cough, etc. I have no shortness of breath now, and no wheezing. 

In March, I was diagnosed with Bronchitis, and did a 10-day antibiotic course - felt better.  I've since moved out of the apartment, but now I have morning and night phlegm production - thick and yellowish, chunky.  I've had occasional "flakes" in the phlegm, but not major.  Could this be a remnant of the allergies / bronchitis?  It's now May, so I've had on and off phlegm and productive cough for going on 4+ months.  Is it normal for there to be lingering phlegm / productive cough after being treated for bronchitis and "well" for a month plus? Thanks in advance for your response.


A. Dear Kevin, There are many causes of persistent cough and phlegm production. A common and very treatable one is asthma. I suggest seeing a pulmonologist.

Dr. Tom


COPD Medication
Q. What medicine has least side effects and best results for COPD?


A. Dear Tom, It depends on the patient. Amongst those with generally low side effects are Spiriva and Atrovent. They are similar drugs and are not taken together. Many other drugs are well tolerated. 

Dr. Tom


Lung Pain
Q. Dr. Tom, I would like to get your opinion: my background is a 49-year old female with a history of smoking.  I was hospitalized last August with pneumonia. I then became septic and got Acute Respiratory Distress Syndrome.  I was on a vent for three weeks and chemically paralyzed.  I was in the hospital for a month and am still recuperating. I had two chest tubes while on the vent.

I have pain in my left lung when I deep breathe, yawn, or sneeze, I have had it since I left the hospital.  I have told both my pulmonologist and infectious lung doctor about it; they don't seem too concerned.

 I had a CT in November, a broncosopy in January (which showed nothing) and a round of antibiotics for three months.  My CT showed "Mild pleural thickening. Small bilateral pleural-parenchymal scars versus subsegmental atelectasis."

Do you think my pain could be from scarring? Neither doctor has given me an answer.  Could a portion of my lung still be collapsed? I would just like to know what is causing the pain. 

If I have to live with it the rest of my life that is fine, would just like to know the cause.  I know I was seriously ill and am very thankful to be here.  These doctors saved my life.  Thank you for whatever insight you might have.


A. Dear Patty, The pain may still be due to the inflammation and scarring. There is no major area of collapse. All should improve. You are lucky. Be thankful.

Dr. Tom


Fear of COPD
Q. Dr. Tom, I am 34 years old and have smoked on and off since the age of 16.  I quit smoking during three pregnancies (three years with the last one 12 years ago) and a couple times (one year and one and a half years) in the past nine years.  I've had a smokers cough for many years (constantly clearing my throat).  I caught a bad case of the flu in February and quit smoking.  After getting over the flu, my cough is gone. 

However, I now have a major fear of having COPD, feel that I'm not breathing right, and that I'll die as my mother did (COPD at 46 years, along with drugs and alcohol abuse for 30+ yrs).  Any suggestions or recommendations?


A. Dear Tina, Get spirometry done to see what your lung function is. Consult a pulmonologist if you are abnormal and get checked for a familial form of emphysema, known as alpha one deficiency. 

Dr. Tom


Spirometry Results
Q. My FEV1 - 98% and my FEV6 is 48%.  What does this mean?


A. Dear Reegan, It is not possible to have these two numbers from the same spirometry. I do not have an explanation. I suggest a repeat.

Dr. Tom


Questions to Ask Doctor about Sleep Apnea
Q. My husband has sleep apnea and we are going to see a pulmonologist. He snores a lot and skips breath in his sleep, it’s bad What are the right questions to ask.


A. Dear Shelly, Ask him to explain sleep apnea and how it is diagnosed and treated.

Dr. Tom


Could Medication be the Cause of Bruising?
Q. I have been on Advair 250/50 for about two years, I also take Spirivia. I have leg and feet cramps and if I barely touch anything I bruise (real red bruises on top of skin) very easily.

I cannot find this to be a side effect of Advair but I feel that this is the med that is causing it. Could this cause the bruising?  Which med do you think would cause the bruising? I am 63 yrs. old.


A. Dear Gwyn, These two drugs should not have anything to do with easy bruising. Consult your doctor.

Dr. Tom


2024 American Association for Respiratory Care