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Archive: Dr. Tom 141

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

Endotracheal Lavage

Q. I saw your note from 2006; do you still believe, there is no harm in using normal saline for endotracheal lavage? I use this procedure daily, and advance the catheter first if possible, however, when protein builds up, I still instill saline to promote effective removal. Am I causing harm?

Scott BS, RRT

A. Dear Scott BS, RRT,

You are not causing harm to be lavaging with normal saline.

Dr. Tom

Dad Won't Stop Smoking

Q. My husband has bad COPD and was in the hospital for a couple of weeks last year. He is a very heavy smoker and will not stop; he is 63 years old.

He has to get cataracts removed from both eyes; he went blind nearly over night with all the steroids.

The doctor has told me he has a short time to live. His lungs are so bad. It is no good talking to him, what can we do?


A. Dear Nora,

HE is the one who has to decide to break the addiction of smoking. I suggest going to a smoking cessation clinic or expert. It is important to his survival.

The cataracts are easily removed.

Dr. Tom

I Cough, Even with Asthma Medication

Q. In August of last year I was diagnosed with pneumonia. Then the last week of November I was admitted to the hospital due to chest pain. My doctor said I had an allergic reaction to the antibiotic medication. It was also noted that I had pneumonitis

My sputum tests were negative. However, from time to time I have cough. 

During the last week of December, I found out that I have asthma. I was given an inhaler and medicines for my cough.

I returned to my doctor because I was so worried about my condition. According to her, my chest is clear and healthy, to date I am still using my inhaler but my cough is still persistent.

Early this morning, I had a blood stained phlegm but the rest of the day there was none. What do you think my condition is? I am so worried. I hope you could help me with this. Thank you. More power. GOD bless.


A. Dear Jem,

The bloodstaining is due to excessive coughing. See a pulmonologist for better control of your asthma. There are alternative drugs.

Dr. Tom

Could Inhaled Toast Crumbs Cause Voice Changes?

Q. After inhaling crumbs while eating toast I suffered a coughing spell for at least 10 minutes. Since that time, 30 hours, I feel like I have something caught in my throat and my voice sounds peculiar. Almost like I have a cold, which I don't. My voice is raspy and when I take a deep breath I cough. Could this be related to the toast crumb inhalation?


A. Dear Diana,

No, but it maybe from the damage of excessive coughing. This should resolve quickly. Otherwise see an otolaryngologist.

Dr. Tom

Dry Mouth Side Effect of Medication

Q. I just finished an antibiotic that was making my mouth dry. Made it hard to eat and swallow sometimes from it being dry. How long will my mouth be dry now that I am off of the meds?


A. Dear Chris,

The dryness will subside gradually, in a week or two.

Dr. Tom

Lung Age

Q. I recently took a Spirometry test, which said that I breathe like a 73 year old but I'm 39. I'm still waiting for the doctor to let me know results but I would like to know what this means.


A. Dear Barbara,

This means that your lungs have lost function to that of a 73 year-old person of the same sex and size. If you are smoking, you MUST quit.

Dr. Tom

Recovery Time for Acute Respiratory Distress Syndrome (ARDS)

Q. I am 52-year-old non-smoker. I have been out of the hospital for five weeks from ARDS. I use minimal O2 with activity. How long is ARDS recovery?


A. Dear Kathy,

Maximum improvement from the insult of ADRDS may be six months to a year. Don’t get discouraged.

Dr. Tom

Dr. Wants Dad to Continue with Medication that Dries Up His Phlegm

Q. My dad is 84, has COPD due to heavy smoking, for over 50 years. He has not smoked for over 10 years yet he is constantly coughing up whitish/grayish phlegm.

About a year ago the doctor put him on Spiriva and Symbicort. He stayed on Spiriva for about two months during which time he was constantly coughing but unable to bring up any phlegm. He would get really bad headaches from coughing.

He stopped Spirvia and now he still coughs but is able to bring up the phlegm. He did try again to take the Spiriva and the same thing happened.

I feel it is due to the anticholergenic effects of the medicine. His doctor wants him to go back on the medicine. He lives in Ireland.

I would greatly value your expert opinion.


A. Dear Kathryn,

It is likely that the Spiriva is the cause of dry mucus. Your doctor should pick an alternative that is not an anticholinergic.

Dr. Tom

Side Effects of Smoking During Pregnancy

Q. Would my daughter's nearsightedness be a result of my ex-wife smoking during her pregnancy?


A. Dear Garry,

Probably not.

Dr. Tom

Oxygen Bars

Q. Are there any advantages to using a commercial “oxygen bar”? A lady I work with just bought one and is very excited about using it. What are the pros and cons of using an oxygen bar?


A. Dear Carla,

These are a joke intermingled with fraud. Save your money.

Dr. Tom

Quit Smoking and Worried about Phlegm Production

Q. I am 23 years old. I have never been a habitual smoker, but I have smoked after works a lot of nights and socially drunk for about four years, while in college.

I recently quit smoking. After about six days, I don't have much of any cravings and don't plan to smoke again. I feel fine.

This morning I hacked up some phlegm with a little bit of light blood in it. I made myself dispel a little more phlegm, which had an even lighter amount, then none and none the rest of the day.

Do you think it is serious? I noticed a small amount of dried blood in my nose this morning, too. Maybe post nasal drip or an infection? But do you think it sounds serious?


A. Dear Paul,

This is not serious. The phlegm will gradually subside. The small amount of blood with coughing is not a concern.

Dr. Tom

Symptoms Continue Two Months after Collapsed Lung

Q. My lung completely collapsed approximately two months ago and I ended up spending a week in the hospital. Ever since I was released I have been coughing (nothing comes up) and have a hard time breathing, especially in this cold weather. 

I have had an x-ray and my pulmonary doctor said the results are clear. He then put me on steroids and two inhalers. I am still coughing and have a shortness of breath. Is this common after having a collapsed lung? Will it go away? I don't understand what is going on!


A. Dear Bobbie,

You should not still be coughing from a re expanded lung that was previously collapsed. I think you need a pulmonary consultation to explain it. You may need bronchoscopy.

Dr. Tom

Worried about Wheeze

Q. I am 39 years old and 10 months ago I gave birth. I quit smoking when I got pregnant; I was a social smoker for about 15 odd years primarily on the weekend. Friday nights, we would smoke a pack in the evening—then nothing the rest of the week.

I have read that “binge” smoking is worse for you than a pack a day smoker, is this true?

I had a CT Scan three years ago for a chronic cough, which was clear and was put on allergy medications, which helped the cough but I have a wheeze, very slight, but I can hear it every evening when I am laying down, primarily on my right side. The inhalers or the medications my doctor gave me do not alleviate the wheeze. I am very concerned about the wheeze.

What should I do? Should I be concerned about this wheeze?


A. Dear Alexandra,

The wheeze is more likely to be asthma than anything else. Binge smoking is bad, but so is all smoking. I suggest seeing a pulmonologist for a diagnosis and treatment. You should not just let these symptoms nag at you.

Dr. Tom

Questions about the Hubbly Bubbly

Q. My girlfriend smoked a hubbly bubbly at a party and she thinks it's harmless.

I told her I don't approve, because to me all smoking is harmful no matter what form. I don't know much about it and I was hoping you could give me some facts about it.

I noticed that after her first puff she went for more and more. Not knowing what's in there it seemed very addictive to me.

Thanks for your time.


A. Dear R.,

I don't know what a “hubbly bubbly” is, but it is probably pot. It is stupid to smoke anything, particularly when you don't even know what it is.

Dr. Tom

Mixing Brovana with Other Drugs

Q. Can I mix Brovana & Pulmicort?

Can I mix Brovana & Symbicort?

Can I mix Brovana and Asmanex?


A. Dear Michael,

As far as I know these drugs are all compatible with each other.

Dr. Tom

What about the Hypoxic Drive?

Q. I'm interested in the correlation of COPD/FIO2 concentration and “drive to breathe”. A point that is always repeated over and over to students in the healthcare field. What is “too much” oxygen? 

There are institutions that administer one-hour continuous, nebulizers that are run off of wall O2, to clients with COPD exacerbations and no “drive is lost”. Any advice, on current literature?


A. Dear Richard,

This “hypoxic drive” issue drives me nuts. The hypoxic drive comes in to play on ascent to altitude. We proved years ago that giving low flow nasal oxygen does not change it. Too much oxygen is more than you need to correct for the oxygen deficit.

Dr. Tom

How Does Methotrexate Help Sarcoidosis?

Q. My mother has been diagnosed with sarcoidosis and her doctor is weaning her off of prednisone but has now placed her on Methotrexrate and Lipitor due to her high bad cholesterol.

She has developed diabetes and high blood pressure as a result of the prednisone. 

She does not know much about Methotrexrate and needs to know why they have switched her to this particular drug. Will it affect her already existing conditions (high blood pressure and diabetes) and will it further affect her kidney functioning? What are the side effects of this drug, and how can it possibly benefit her?


A. Dear Vanessa,

Read the warnings that come with the Methotrexate prescription. This drug may be useful in sarcoidosis, but you should be seeing a pulmonologist with experience with it. It is a pretty safe drug.

Dr. Tom

Questions about Wheezing

Q. What's the difference between asthma and bronchitis? How do you know if I have either one?

I went to the emergency room last year for feeling shortness of breath, cough, wheezing and they told me I had chronic bronchitis and gave me an inhaler and antibiotics.

But ever since sometimes I wheeze and take my inhaler to calm my 'wheeziness'. Is there a way to get rid of it, am I going to be like this for the rest of my life?

I was pregnant this year and felt shortness of breath and wheezing and had to take the inhaler; will my baby have the same problem later in life?


A. Dear Yuri,

Asthma is a kind of bronchitis. There are many other causes. The bronchodilators and inhaled steroids are used for asthma and related asthmatic bronchitis, which is a combination term used on purpose, to be nonspecific.

Dr. Tom

Worried about Father who is on a Ventilator

Q. My dad, who is 74 years old, had suddenly gone breathless, and is on artificial ventilation for the past 15 days. After two days of hospitalization, he was diagnosed with pneumonia in his left lung and treated with antibiotics.

Since it did not subside, doctor started anti-fungal, however the culture report was sterile. He showed improvement, and left lung got completely cleared. Doctors were slowly reducing the mode of ventilator and he was fine.

After 10 days, they performed tracheostomy, and then two days after that he went very bad; the x-ray showed right lung pneumonia. He is still on ventilator, fully conscious.

This pneumonia looks like a ventilator-associated pneumonia (VAP). Now the x-ray is slightly improving, but today they tried stepping down the ventilator to spontaneous mode and my dad could not stand it. The doctors say that his muscle power is very weak.

Dear doctor, please suggest to me what could be done to save my dad, who is completely conscious. Expecting your kind response.


A. Dear Parseetha,

He should be able to be gradually weaned, in spite of the complications that he has already suffered. I suggest looking for a facility that specializes in weaning such patients, such as the Kindred group of hospitals.

Dr. Tom

Seems Like Too Much Medications

Q. My uncle is an asthma sufferer and is on a lot of medication. I would like to know should he be taken these medicines? Advair, allopurinol, Avapro, Proventil inhaler, Nasonex, fexofenadine, Spiriva, low dose aspirin.

Does mixing all these medicines cause lung breakdowns and make breathing hard at some point?

Mr. B

A. Dear Mr. B.,

You will have to ask the doctor who prescribed these medications about their appropriateness. They make sense for some situations.

Dr. Tom

2024 American Association for Respiratory Care