Contact Us
Ask Dr. Tom Lung Diseases Medication Tests Healthy Living Finding Care Stop Smoking
Home > Ask Dr. Tom > Archive > Dr. Tom 129

Archive: Dr. Tom 129

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



What are the Symptoms of Bronchitis?
Q. The doctor says I have bronchitis, but I don’t cough. Culd it be something else?

A. Dear Carlos,
Bronchitis is always characterized by cough. Ask your doctor again about the diagnosis. You did not tell us any of your symptoms.
Dr. Tom

Do I have COPD or Asthma?
Q. I have been extremely out of breath for just over six months now when I walk up stairs, etc. When I get severely out of breath my jaw aches and my heartbeat is rapid. I had a chest x-ray which showed hyperinflated lungs. This was followed up with a spirometry test, which showed my lung age at 35, but I am 36; what does this mean?

Doctor has diagnosed COPD but gave me no treatment plan. Asthma inhalers don’t seem to help. Kind regards and many thanks.

A. Dear Simon,
You must not have COPD since the lung test showed normal for age. I suggest you see a pulmonologist for diagnosis and treatment. You should not have to suffer these symptoms. Dr. Tom

VATS Bullectomy Pleurodesis
Q. My younger brother, who is 21, is having a VATS bullectomy pleurodesis. What is this please?

A. Dear Richie,
It is a surgical procedure done via a scope inserted through a small incision, that allows the surgeon to take off local areas of lung that are abnormal and irritate the area to avoid future air leaks of the lung, known medically as pneumothorax.
Dr. Tom

Multiple Problems With No Answers
Q. My husband has a complicated case and I am extremely frustrated on where to go from here. He is a bone marrow transplant recipient, (ankylosing spondylitis, scoliosis) he has radiation therapy damage to his lungs and he is a former smoker.

Currently he is experiencing rapid weight loss, fatigue and major issues with shortness of breath. His O2 saturations are in the upper 90s. His PFTs show mild obstruction. His symptoms do not seem to fit his test results. However, he cannot breathe at all.

One doctor believes the primary problem is Graft vs Host disease, another believes it is COPD, another believes the ankylosing spondylitis is causing most of the issues, and yet another thinks his scoliosis is causing chest wall problems.

He is on a variety of medications…steroids, immunosuppresants, inhalers, anti-fungal, antibiotic, Singulair, etc. Nothing is helping. 

We go from doctor to doctor and are getting nowhere fast, yet he is deteriorating rapidly. Any suggestions are deeply appreciated.

A. Dear Mica,
I suggest going to a center that deals with extremely complex problems like you describe. Probably the best is the National Jewish Center in Denver. I know the doctors there and they are excellent.
Dr. Tom

How Long Does It Take to Recover from Pneumonia?
Q. I had a severe case of pneumonia. I had very few symptoms of pneumonia (only chest pain and breathing difficulties—I never had a cold, sore throat, cough, or fever) so I am concerned that I will relapse and not notice. My doctor said the x-rays are clear and the CT scan is almost back to normal. I have been off antibiotics for four weeks.

I still have green phlegm that I cough up daily, particularly in the morning. The doctor said that coughing up phlegm after pneumonia is “normal,” but how long can it last before I should become concerned?

A. Dear Linda,
Your course of slow resolution is not unusual for severe pneumonia. Your x-rays are showing clearing. I believe you will gradually return to normal over the next few weeks.
Dr. Tom

What Does Lung Scarring Mean?
Q. The doctor told me that my lungs are scarred, so I asked the doctor if he could tell me how this happened. He told me that maybe it was from a cold. I told him that he was wrong; I think that I was exposed to asbestos dust because I worked down at ground zero.

A. Dear Joey,
You could be right. I suggest seeing a pulmonologist for diagnosis and treatment.
Dr. Tom

Could I Have Gone from Mild to Moderate COPD in a Year?
Q. Last year a PFT test showed that I have a mild COPD with the following result:

FEV1/FVC ratio 68% (normal is > 70%)
FEV1 2.91, 81% predicted.

This year's PFT test shows moderate COPD with a drop of 240 to 300 ml of FVC and FEV1.

Could I lose this much in one year and move from mild to moderate when I stopped smoking two years ago?

A. Dear Has,
It is possible, but unlikely that this is all COPD. There may be a component of asthma. I suggest seeing a pulmonologist.
Dr. Tom

How to Stop Smoking
Q. I have smoked for 35 years, and over the past couple of years have started smoking about two packs a day. I have quit several times but always start back smoking. I am scared. I want to quit but do not seem to have the will power and now I am afraid the pain I am feeling is something bad. What test should I have done and do you have any suggestions for a successful quit smoking program? I live in North Carolina. Can you recommend a good doctor to see on the east coast of North Carolina?

A. Dear Anita,
There are many strategies used in smoking cessation and some over-the-counter and prescription drugs that help in quitting. I suggest looking for a specialist in smoking cessation in one of the major medical centers of North Carolina, such as Duke, or the University of North Carolina.
Dr. Tom

Recommended Follow-Up on Calcified Nodule
Q. A couple weeks ago I had a gall-bladder attack and ended up having about five tests done, one being a chest x-ray. The chest x-ray showed what they called a button. Next I had a CT scan and it showed a calcified nodule. I was told I needed to repeat the scan in three months.

After reading up on calcified nodules I was under the impression these were not harmful. If this is true why do I need a follow-up? What are they looking for on the next scan?

A. Dear AC,
Calcified nodules are always benign and do not need follow-up.
Dr. Tom

Can You Give a Lung for a Transplant? 
Q. My husband has nodules in his lungs supposedly from his cancer that he has in his leg but they have never tested them to see if they were cancerous or not. We were just wondering if worse comes to worst would it be safe for him to get a lung transplant and if I could possibly give him one?

If so would we both have a really good chance of being able to live how we did before and do all the same things that we did?

A. Dear Stacey,
A diagnosis of the nodules is necessary before any consideration of transplantation can be entertained. You cannot donate a lung to your husband.
Dr. Tom

Could it be a Side Effect of the Antibiotic?
Q. I am getting over pneumonia in the right lung, and after two weeks of ciprofloxacin tablets my face is sore and bleeds when I shave. Can you help.

A. Dear Robert, 
Maybe. I do not think the ciprofloxacin is the cause of bleeding while shaving.
Dr. Tom

Shortness of Breath and Coughing Two Years after Lung Collapse
Q. Hello. I had spontaneous pneumothorax in 2005. I have been coughing for past two years with no apparent reason. I have shortness of breath that disappears usually after an hour of coughing, When mucus is finally out, it's easier to breathe, but I still need to clear my throat. I went to a second doctor already and I have been told that I have severe allergies. None of the medicine seems to work. Can this be related to my blebs disease?

A. Dear Rafal, 
 I do not believe that your cough and mucus is related to your bleb disease. I suggest you be checked for asthma.
Dr. Tom

Life Expectancy and Advanced Emphysema
Q. What life expectancy can be had for a 62-year-old with very advanced emphysema, 26% lung function and a BMI of 19 and who stopped a two-pack-a-day 40-year habit, two years ago.

A. Dear Carter,
It is very hard to predict life expectancy in anyone with COPD. I would guess, that you can look forward to 10 years or more. The most important thing is to enjoy life, day by day.
Dr. Tom

Should I Go Back to the Doctor?
Q. I was recently diagnosed with a fractured rib (10th rib on the right side). The x-ray also showed some irritation (or something like that) to the pleura around my lungs. I recently had to lift some heavy objects due to a flood and have physically overdone it the last few days. I am worried that the pleura could be damaged further as I am in more pain than prior to diagnosis. What symptoms should I look for before I go to the doctor again?

A. Dear Brittney,
It is more likely that you have simple muscle strain. I would wait a week or so before seeing a doctor, unless the pain is too severe.
Dr. Tom

Should I See a Pulmonologist?
Q. I am 26 years old. I quit smoking four months ago; I smoked for eight years, 1/2 pack per day. About a year ago, I inhaled fumes for about 30 seconds of car a/c refrigerant (R134a). Almost immediately I felt woozy and had intense pain in my chest and trouble breathing. I read up on the chemical, and they said that it displaces air in the lungs if breathed in. The intense pain continued for one week. I’ve also had sharp stabs of pain in my chest three times a week for the first few months.

Though the pain is a lot better now and I don’t have the sharp pains, I still have some chest tightness and difficulty breathing since then, and also still have pain in my lower left chest, mainly under my lowest left rib. Also, in the same spot as the pain, my whole lowest left rib has become increasingly raised up, from the center to the side. If you feel it, you can definitely notice a mountain-like bump in the difference of height between the xiphoid process and the beginning of the left rib.

I went to the clinic and the doctor said it sounds like a problem with my diaphragm. I had x-rays done six months ago and the report said nothing was unusual. This week I got a contrast chest CT scan, and the results say—“Symmetric biapical parenchymal scarring and bullous formation is observed." Is the scarring and bullous formation noteworthy? Is this serious enough to see a pulmonologist?

A. Dear Serge,
Scarring and bullous formation may or may not be important. I suggest you see a pulmonologist and get a diagnosis, based on more information, such as your lung function.
Dr. Tom

Progress in the Treatment or Cure for COPD
Q. This is an important question so I hope you have the time to address it. All over the world there is research into COPD; in the U.S. the University of Pittsburgh came up with solid proof that COPD is an autoimmune disease, and they are experimenting with cyclosporine to assist COPD sufferers.

How close, Dr. Tom, are we from a real breakthrough to really help people with this disease, instead of continuing with medications that only mask the symptoms. How many years, would you say, we are from really getting a solid grip on this disease? Now a cure may be a long way off , but so many are saying that some real breakthroughs are just around the corner in regards to finding some meds that may not cure the disease but will halt its progression. What say YOU!!! Thanks.

A. Dear Philip,
There is a frantic search going on for drugs that will stop the process of COPD. Many mechanisms seem to be involved, so there are a number of therapeutic targets. I do not believe COPD is simply an autoimmune disease, and I would be amazed if cyclosporine would affect it, but this is the reason for controlled clinical trials.
Dr. Tom

What does Biapical Changes Mean?
Q. I was recently told I have chronic changes to the lung apices. The impression states findings appear to represent chronic biapical change. Exactly what does this mean?

A. Dear Nina,
This usually means shadows that result from some remote inflammatory process. If you are concerned, see a pulmonologist, and get your lung function measured.
Dr. Tom

Feel Sliding Under Rib Cage
Q. I have always been active and involved with sports. Less than two years ago I ran a half marathon without stopping. A little at a time, the breathing got worse. Just 14 months ago I did a weekend adventure where I biked, hiked, canoed, played golf, no problems.

Not long after that, I started having trouble catching my breath more and more. I also had a heart palpitation, which I had checked out at a physical and stress test and everything was fine.

Call this coincidence, but I felt something moving on my right side under the rib cage. This occurred when rolling out of bed, into bed, went on for weeks. Finally it went away, but the poor breathing continued.

I went to an allergist and got diagnosed with allergic asthma. The problem is, I’ve taken asthma medicine but am still lousy off and on. Now this has affected my exercise because I’m paranoid and feeling worse due to the lack of exercise.

My question: Is it coincidence that I felt this “sliding” under the ribcage and my breathing and everything else got worse not long after, including the palpations? I had a chest-x-ray and nothing there.

A. Dear Jim,
I do not know the cause of the “sliding” feeling. You should not have to suffer from shortness of breath. I suggest seeing another doctor, such as a pulmonologist to explain this and get proper treatment started.
Dr. Tom

Is Coughing a Symptom of Sleep Apnea?
Q. The pulmonary specialist (who has done blood test, sinus scan, lung scan and sleep study) said I have sleep apnea and that could be causing my slight shortness of breath and coughing Other than that, he finds nothing wrong. Where do I go from here? Any thoughts?

A. Dear Mary,
In sleep apnea, one often awakens with a feeling of suffocation and sometimes coughing. This should not persist through the waking hours. But reflux is a common cause of cough. I suggest getting treatment for this.
Dr. Tom

Follow-Up on Straight Back Syndrome and Asthma Difficulties
Q. You answered my question about straight back syndrome by saying that it doesn’t affect asthma. I have always, though, had difficult-to-control asthma in spite of good breathing tests. I also have really bad allergies, which I can control. All chest xrays and scans are normal.

I take Pulmicort, Foradil, theophylline, Singulair, Beconase, Astelin. I have had allergy shots as well as Xolair; neither of these helped much.

Can you think of any possible reason that I have so many asthma difficulties? At times it’s fine but goes out of control often, especially during high pollen counts. My last allergist did not believe me when I had asthma attacks since breathing tests were good.

A. Dear Susan,
Asthma is a very complex disease, or group of diseases. You are on a lot of medications that should control most asthma. Of course it is common to have asthma attacks and still have normal lung function between attacks. Maybe you should see another asthma expert to help you manage your complex problem.
Dr. Tom

Oxygen Saturation and Need for Oxygen
Q. My doctor ordered an O2 saturation check a week ago, I slept with it on all night. She called me today to tell me it dropped below 88 sometimes. She was going to have an oxygen supply company contact me tomorrow. What does this mean? She really didn’t say anymore.

A. Dear Robin, 
You need her to explain how often you had low saturations and how low they went. Just starting oxygen for an occasional drop in sleep saturation is not appropriate, in my opinion.
Dr. Tom

Can Pleural Scarring be Caused by Sleep Apnea?
Q. Can stable pleural-parenchymal scarring cause sleep apnea?

A. Dear Richard, 
Possibly, if there is aspiration of gastrointestinal contents during sleep and periods of apnea. This should be checked out by a pulmonologist or gastroenterologist, or both.
Dr. Tom

Is it COPD or Asthma?
Q. My PFT results: severe obstruction and no restriction with significant improvement postbronchodilator therapy. Diffusion capacity is within normal limits.

FVC pre drug 87% predicted
FVC post drug 13 % improvement

FEV1 < 50% pre drug
FEV1   60% post drug improvement

FEV1/FVC pre drug <58
FEV1/FVC post drug 42% improvement.

Is this asthma? I have no cough and walk approximately two miles per day.

I have an appointment with a pulmonary doctor for the first time and want to be informed.

A. Dear Pat,
It could be both. You have a definite reversible component suggesting asthma. Discuss this with your pulmonologist.
Dr. Tom

Weaning off of Oxygen
Q. I am 25 years old and have respiratory insufficiency due to a brain stem tumor when I was 3. I recently had a very bad case of pneumonia, got a tracheostomy and am at home on oxygen 24/7. My doctor said that we can talk about weaning me off of it once these constant tracheostomy infections clear up.

Is there any harm in going off and on oxygen for 1–2 hours at a time if I feel o.k. Thank you in advance for your response.

A. Dear Marian, You should monitor your oxygenation with a simple oximeter during periods when you are off oxygen. For that matter, you should also monitor your oxygenation while active too, and adjust the flow if necessary. Discuss this with your doctor.
Dr. Tom

Concerned about Oxygen Therapy and Medications
Q. My father has severe emphysema bullous no air in right lung and bullous pushing left lung up into a corner -- not a well man.

My question is: He has been put on 8lpm of O2 through a Venticaire mask, 35%. Is this not a high lpm of oxygen to be on? Will he not retain CO2 ?

My second question is that he is also on Spiriva and ipratropium and tons of other stuff. I will send you a list if needed could you get back to me asap.

A. Dear Lois,
Do not worry about CO2 retention. This is a very rare happening in stable patients. A venti mask does not deliver high concentrations of oxygen. As you state, only 35%.

I wonder why this is being used. Nasal canulae are much more pleasant and do not cause CO2 retention, as some health workers wrongly fear.

 It is not wise to use both Spiriva, (i.e. tiotropium) and ipratropium together. They do similar things and the ipratropium may reduce the effectiveness of Spiriva. Discuss this with your doctor.  
Dr. Tom

 What is a Dry Drowning?
Q. I received an e-mail from a friend regarding a child that died from “dry drowning.” The child had been swimming earlier in the day. As an RRT, what should be symptoms and/or events that would alert one to dry drowning?

A. Dear Bobbie,
Dry drowning simply refers to the fact that severe spasm of the voice box occurs during drowning and thus the lungs are not full of water, as is commonly believed.
Dr. Tom

14 MM Node
Q. I had a chest x-ray, showing a nodular appearing density anteriorly at the level of the diaphragm, measuring 14mm. Would you explain this condition?

A. Dear Wade,
Your doctor will have to explain the significance to you. If not calcified, it needs identification at this size. Maybe it could be followed looking for growth for about three months. Whether or not this is wise, or an immediate biopsy done, depends on your general health and other considerations that are not known to me by your simple question. Dr. Tom

I Really Need Help, My Father’s has Multiple Problems
Q. My father got chest x-ray and had these findings... subsegmental atelectasis (on both lung bases), tortuous aorta, marginal sized heart, diaphragm and sulci are normal bony thorax is unremarkable. Could you please explain this result to me?

I am worried on atelectasis and aorta, my father also had findings on EKG right bundle block, left anterior hemiblock and bifascicular block, normal sinus rhythm please I really need help, Yes, he was a smoker for many years.

A. Dear Gaby,
Your doctor should explain these findings. I do not know enough about your father to be very specific. It is certain that he has electrical conduction problems with his heart. Ask about the need for a pacemaker.
Dr. Tom

Cough Following Surgery
Q. I am 47 tears old and have stage IIIA lung cancer. I have had chemo plus radiation, an upper right lobectomy and more chemo. The operation was April 14. Shortly afterwards, I developed a cough that is still present -- not as bad, but still there. Could it be from the cancer (apparently it’s gone) or from the lobectomy? Is it normal?

A. Dear Antonella,
It is most likely that the cough is due to the irradiation. I am sure you are being checked for cancer recurrence. I wish you well.
Dr. Tom

Nebulizer Treatment with Patients on Oxygen
Q. What is the right way to give a nebulizer treatment to a patient on oxygen (nasal cannula for example)? Do you give it with the oxygen? Do you increase the oxygen while on the nebulizer treatment and if so why is that?

A. Dear G.G.,  
The nebulizer can be powered by either the oxygen or a separate pump. It makes no difference. You do not need to change the regular nasal oxygen flow no matter which method of powering the nebulizer that you use.
Dr Tom

Shortness of Breath and Asthma
Q. I do have asthma but lately I am short of breath just bringing out the garbage can. This doesn’t seem normal. Is it?

A. Dear Linda,
You should see a doctor if you are concerned. I cannot make a diagnosis from such a simple question.
Dr. Tom

2024 American Association for Respiratory Care