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

 

 

Husband Coughs and Clears His Throat Constantly
Q. Hello, My husband is 45 and in over all good physical and mental health.  He developed a cough that won't go away.  He feels a tickle in the back of his throat and he has to cough, and/or clear his throat.  He coughs and clears constantly. 

The only time he has relief is when he lies down for an extended period of time.  He can lie down in the afternoon after work for about 45 minutes, and the cough seems to lessen.  When he wakes up after a night of sleep, he does not cough at all.  Within five minutes after getting out of bed, he begins to cough.

Besides his primary Dr., he has seen an allergist, pulmonologist, ENT, gastroenterologist, and neurologist.  All of them have been unable to figure out the problem.

He was told he has mild GERD and has tried about four acid reflux medicines that don't stop the cough, and he doesn't have any heartburn, however, his vocal chords are a little inflamed. He changed his diet for three months and removed all spicy foods, soda, and alcohol, but it didn’t make a difference. He had and EGD (esophagogastroduodenoscopy) that showed a hiatal hernia, but the doctor said not to be concerned about that. He had a bronchoscopy that came back normal.

He has been given Prednisone, asthma inhalers (but he doesn't have asthma and never has had it) and they even tried an anxiety medicine (but he isn't depressed or anxious).

Nicole

A. Dear Nicole, Your husband has seen the necessary specialists and has had appropriate studies. I suggest trying acid suppression more vigorously, with drugs chosen by a pulmonologist or gastroenterologist.  He should be able to get free of the cough. You never mention smoking in your question, but I assume this is not a problem.

Dr. Tom 

 

Scared Into Quitting
Q. Hi Dr. Tom, I am frantically searching for an answer to a result of a CT Scan that I had done recently. It was done due to a pre-operative (hysterectomy) chest x-ray that showed a shadow. The CT Scan revealed a non-calcified granuloma in the left lung base, it stated tiny and incidental. It also showed a diaphragmatic hernia and early stages of emphysema.

I am 49 years old female and in the process of quitting.  This woke me up. I am doing fairly well with it so far. I am a pack a day smoker and I have only been smoking two cigarettes a day. I will definitely will be a nonsmoker after my surgery. I am quitting no matter what. This scared me enough. I am currently using nicorette gum and it is helping. I have to beat this habit and I will.

Please tell me that this non-calcified granuloma is nothing to be concerned about. Oh it was suggested that I do a repeat of the CT Scan in six months. I am scared. Any info would be so greatly appreciated. 

Lucinda

A. Dear Lucinda, You must quit all smoking to protect your lungs. The small nodule is almost certainly a granuloma, but it would be prudent to check on any change such as growth in six months or so. Stay healthy.

Dr. Tom

 

Son has Continual Problems with Lung Health
A. Dear Tom, My youngest has involved health issues. At age thirteen he had varicella pneumonia, slipped into DIC and really had a rough time of it. He almost died - but didn't. He is now 23.

This winter he has been troubled with pneumonia most of the winter. We just got home from the hospital from a scary weekend following a hypoxic event. Each time he has gotten his lungs x-rayed, half of the diagnosticians say he has pneumonia and half say he doesn't. They give him antibiotics and send him home.

He clears up and then has a reoccurrence. This has been going on since January. Something is wrong here. Something is being missed. I strongly believe he needs further evaluation. With each diagnosis the best label they give him is interstitial pneumonia. My question to you; can you recommend a really good pulmonologist for us to take him to?

Betsy

Q. Dear Betsy, I recommended a referral to the National Jewish Center in Denver. He may have some immune deficiency that makes him prone to recurrent pneumonia.

Dr. Tom

 

Lung Problems and Still Smoking
Q. Dr. Tom, I am a 28 year-old female who is not the most healthy I have already had a complete hysterectomy and other issues. I was told  two years ago, by three different doctors, I have the starting stages of emphysema. This was very hard to believe considering my age and now everyday is constant battle to breathe. The breathing machine tests that I have taken many times the doctors don’t give me the percentages on those but they say I have got the lung capacity of a 50 year old. Also when I have x-rays of my lungs everyone always says my lungs are “very long”. Is this common in emphysema. 

Both parents have emphysema. I also smoke two packs a day. Also have the wheezing cough with and without productivity and increased shortness of breath. Do you think it is possible for these doctors to be right and if so what steps do I need to take to get this under control so I don’t die before my children are marrie?.

Kristen

A. Dear Kristen, You must stop smoking. It is likely that you have a familial form of emphysema. I strongly suggest a simple blood test for alpha one deficiency. If this deficiency is found, there is good replacement therapy that should be started now by an experienced pulmonologist.

Dr. Tom

For more information: Alpha One Foundation:  https://www.alphaone.org/

 

Low Diffusion Capacity
Q. Can the military med board me for DLCO level of 50%?

Joseph

A. Dear Joseph, I do not know what the their criteria are. Of greater importance is the cause of the diffusion deficit and treatment. See a pulmonologist.

Dr. Tom

 

Cold Air Causes Shortness of Breath
Q. I get shortness of breath when the room temperature is cold why?

Jack

A. Dear Jack, Sudden exposure to cold air, which may also be dry, may be irritating to some people.

Dr. Tom

 

Living at a Higher Altitude and COPD
Q. I have COPD and sleep apnea.  I only have to use oxygen when I sleep with my CPAP.  I breathe really good when we camp by the Pacific Ocean in Southern California.  I also have no trouble when we vacation in Prescott, AZ (5,000 ft altitude). 

We're planning to move -- would it be healthy for me in Prescott -- I can't afford a home on the Coast.  Or would I be healthier inland, but still the West Coast, or somewhere else? 

Christine

A. Dear Christine, You would be better to avoid the altitude, since you apparently need oxygen at sea level. There is no point in stressing your heart by adding an additional burden of altitude.

Dr. Tom

 

Taking a Long Time to Recover from Bronchitis
Q. Hi Dr Tom. Hope all is well with you. Over the last number of years I have been great. No coughing, rarely short of breath, going to work and working out on the treadmill. I had been great until January 2008 when I caught bronchitis. I have had it ever since. In April I got influenza A, which was like being run over by a Sherman tank.

I am slowly getting back on my feet and have started working out again but this is my fear. With bronchitis and influenza I am hoping my lungs are not permanently scarred. I am shorter of breath,  and have had this very raspy cough ( non -productive), or very little phlegm.

I am still not feeling 100% and by 4 p.m. I seem to be very tired. Every day improved slightly but I am asking you if it takes a while to feel 100% better after influenza A. Will this cough now ever go away. Thanks Dr Tom and take care of yourself. We need you.

Philip

A. Dear Phillip, Influenza causes a severe damage of the lining of the airways. The cough that results may take months to clear, but it will. Keep active and fit.

Dr. Tom

 

Oxygen Prescriptions
Q. Why is it bad to increase oxygen flow without a prescription and what are the things that can happen if you do?

James

A. Dear James, It is not bad to increase oxygen flow without a prescription to deal with episodes of worsening shortness of breath. You should get an oxyimeter and check that you are keeping your blood saturated with oxygen, and not excessively so, such as above 96%, which sometimes has consequences.

Dr. Tom

 

Is All This Medication Necessary?
Q. Dear Dr. Tom:  My 75 year-old mother is on 2L oxygen 24 hours a day.  She is currently taking both Advair and Spirvira.  I was told they are both long-lasting inhalers.  Is it really necessary to take both long-lasting inhalers as well as Atrovent?   We will also discuss this with the respiratory doctor at the end of June. Thank you for your continued assistance.

Rose

A. Dear Rose, Advair and Spiriva are complementary and are commonly used together. Atrovent has actions like Spiriva and should not be used with it. Discuss this with your prescribing doctior.

Dr. Tom

 

Possible Lung Damage from Volunteering during September 11th
Q. My CT scan of chest report included: "minimal vascular ectasia but no significant vascular calcifications identified".

Does this mean one vessel with dilatation or more, somewhere in chest?  Otherwise, there was "minimal scarring in both lung bases, more so on left" which we assume it is the result from 9-11 NYC volunteering.

Lora

A. Dear Lora, This may or may not be related to the dust and other toxic exposures of 9/11. The findings are minimal and should not be causing concern. 

Dr. Tom

 

Husband has History of Tuberculosis
Q. My husband had a cough and fever. He went to doctor and he gave antibiotics now his cough is gone. But he had a scar in his upper left chest x-ray, the doctor took sputum and blood for testing cancer and TB they did these test three times, all sputum test negative.

My husband had TB when he was just one year old and again had a TB attack some 8 years ago. Now he is now 33 years old. His mother remembered that he had a TB scar in his x-ray; she saying nothing to worry about it is normal. But the doctor is suggesting a bronchoscopy of lungs; since all test negative doctor is saying it must be large chance for infection...his weight is increased. Should we go on with this??? What really could it be? Please suggest.

Hima

A. Dear Hima, I fail to see a compelling reason for a bronchoscopy with stable chest x-rays and sputum tests that are negative for TB organisms.

Dr. Tom

 

Mother Thinks that Increasing Oxygen will Help Her but Doctor Says No
Q. I have a question I am hoping you can answer. My Mom is 81 with COPD and heart problems to go with it. A couple weeks ago she began started sleeping longer hours, just about all day and most of the night.

She has her oxygen up to 2.5 liters and does the nebulizer six times a day, double doses. The last few days she is having a hard time breathing and wants her oxygen turned up thinking this will help, but her doctor said no.  Does this mean her time is coming soon.

Please can you help me with this answer, all I want to do is try to make her comfortable as possible.

Debbie

A. Dear Debbie, The increased oxygen flow is not dangerous and should be allowed as a comfort measure.  It is hard to predict how long one will live with advanced lung and heart disease. Your mother has already lived a longer than average lifetime.

Dr. Tom

 

Finished Antibiotics and Steroids but Still Have Bad Cough and No Sputum
Q. Dr. Tom I was diagnosed with COPD in 2004. My PFT is at 30%, but I still basically get along fine. I am on Spiriva and Symbicort. My pulmonologist has suggested twice that I need to get on a lung transplant list and I would never even consider it.

Two and 1/2 weeks ago I got a scratchy throat and woke up at 4am took a Duraflu. I felt terrible all day till the evening then I felt fine. I continued with Duraflu and went on a trip to the doctor and coughed my head off the whole time with lots of green sputum. I went to my allergist got a steroid shot and five days of Avelox I am finished with Avelox.

I now have a constant gravely gross cough and no sputum I am now worried what should I do?

Sugar

A. Dear Sugar, You will have to follow your doctor's advice on this. You probably still have a lot of inflammation that is causing the cough.

Dr Tom

 

Wegners Disease Prognosis
Q. What are the chance of some one dieing from Wegners disease?

Sarah

A. Dear Sarah, The prognosis depends on the extent of lung and other organ involvement such as the kidneys and the response to therapy. Survival is greatly improved in the modern era. You should see a rheumatologist or pulmonologist or both for management of this complex disease.

Dr. Tom

 

Medicare Reimbursement and Pulmonary Rehabilitation
Q. Dr. Tom, Is it true that a FEV1/FVC ratios of less than 75% is used to diagnosis COPD? What is the % criteria used for COPD patients to obtain paid Medicare for Pulmonary Rehabilitation?

Mari

A. Dear Mari, This ratio is commonly used as the first indicator of COPD. It tends to over diagnose the disease. I do not know anything about Medicare criteria or reimbursement. So far, there is no Medicare approval for pulmonary rehabilitation, but there should be. 

Dr. Tom

 

Do Not Want a CT Scan Due to the Radiation Exposure
Q. Dr. Tom, Very much need your help – do not want to do a CT scan because of high radiation.

I’m 35 years old, went to PCP with concerns about air hunger. Chest X-ray spot on the X-ray at the base of the right lung, this spot is visible only on the frontal x-ray and NOT on the lateral view.

Got referred to a pulmonologist for further investigation– lung function tests showed everything is OK! Asked his clinic’s radiologist to review the X-ray – he said that this spot was possibly a granuloma.

My pulmonologist is recommending a CT scan because he says that they are not able to see calcification and CT scan will give them a better idea if in the lung, calcified and indeed granuloma and not something worse. Never smoked. No cough. Had pneumonia at 13. Rarely get sick. Ten years ago had fibroadenoma of the right breast removed. Can this be showing on the x-ray?

Daria

A. Dear Daria, Your risk of lung cancer is very low. I do not see a compelling reason for a CT Scan. One follow-up would be reasonable. The shadow has nothing to do with the fibroadenoma of your right breast that was removed.

Dr.Tom

 

Newly Diagnosed with Sarcoidosis
Q. I have just been told that I have sarcoidosis. On my chest CT they found that I have multiple nodules in my lungs. Also they said that I have a 2cc nodule against my heart and one at the base of my throat. Also they said they cannot rule out neoplastic etiology. I am a 48 year-old white female I never smoked, drank or did drugs. Can you please tell me what I did to get this?

Cheryl

A. Dear Cheryl, The cause of sarcoidosis is unknown. It is generally not a serious problem. The overall prognosis is good. You should see a pulmonologist about possible treatment if you have symptoms or abnormal lung function.

Dr. Tom

 

Home Evaluation for those with Lung Disease
Q. Is it necessary to have a doctor’s order, for a health care professional, to go in to an oxygen patient’s home to do a patient evaluation? (breath sounds, heart rate, respiratory rate)?

Kisha

A. Dear Kisha, Yes, this is usually the requirement, when reimbursement is an issue.

Dr. Tom