Is Singulair Safe for Babies?
Q. My four month-old son has a cold that causes him to cough
and the doctor has prescribed Montelukast Sodium. I have seen a big improvement
just after one dosage but cannot find anything on the net that says it is ok
for his age. Is this medicine suitable for a baby of four months?
A. Dear Gabriel,
Monteleukast (Singulair) has been approved for children age
12 months and older but it has been safely used off-label in several research
studies to treat infants as young as one or two months of age with bronchiolitis (generally
Many medications have not been specifically approved for
infants and young children but can be used safely and often effectively in the
very young. It sounds like this worked well for your son and that is good news.
Oxygen for Preterm Baby
Q. Dear Doctor,
May I ask how much oxygen is a preterm baby (35 weeks 1.790
Kg) getting if the he/she is receiving 0.025 LPM of pure oxygen in one
minute if the baby is breathing 40-60 breaths per minute?
A. Dear Roel,
I love questions like this! There are two good answers.
When I am teaching students, it gives me the opportunity to
build equations to calculate the fraction of inspired oxygen (FIO2) based on
tidal volume (about 7 mL/Kg) and respiratory rate giving minute ventilation,
then taking into account dead space and how this changes with increasing
respiratory rate, and ambient air (0.21 oxygen) entrainment we can derive a
rough approximation of the inspired oxygen. Whew! But this is great for
The second answer is really the correct answer–it doesn't
matter. Babies will have changing airway surface area, minute ventilation, and
dead space so what we try to do is give the least amount of oxygen necessary to
keep the oxygen saturation greater than 90%. Give just the amount of oxygen
that it takes and you will support that infant. Beware that if the baby's
oxygen requirement to maintain saturation is going up, this probably means
Is There a "Safe" Way to Smoke Marijuana?
Q. I recently had a partial lung collapse (approximately four
centimeters). I was given a chest tube, and sent home within two days. My lung
feels okay right now with no issues since the chest tube.
I was a smoker of three years, but quit cold turkey when
this happened. I am a chronic marijuana smoker of five years, and have plans to
decrease the amount of marijuana I smoke, but not completely stop. I’m
wondering if this is a bad idea. I don’t plan on smoking very much, or taking
large deep inhales. And possibly smoking marijuana with a vaporizer, which I’ve
been told would be the best idea. But my health is my number one priority.
A. Dear Jay,
There is no safe way to smoke pot. Don’t be silly. Give
What Stimulates You To Breathe?
Q. What is the stimulus to breathe for the patient with
severe COPD? I always thought it was a low PaO2 level but now I’m not sure. I
was told it was a high PCO2 level?
A. Dear Sandy,
There are multiple drives to breathe, which are CO2, oxygen
level, muscular effort and many more. This is not a simple subject.
Maximum Oxygen Level on Room Air
Q. What would cause a PaO2 of 200 on room air?
A. Dear Linda,
Should I Worry About Lung Scarring?
Q. I recently had a chest x-ray as a routine prior to my
hysterectomy. It came back as abnormal and my doctor asked if I had been sick
with a cold or pneumonia, I had not. She then ordered a CT Scan, which revealed
that I had lung scarring and to follow-up with a Pulmonologist.
Could you please tell me what does this lung scarring mean,
and should I be worried?
A. Dear Terri,
It just means that at one time there was inflammation. There
are many causes for this. I would pay no more attention to these x-ray
findings, unless you get symptoms such as progressive shortness of breath
or chronic cough.
Very Fit but Lungs Feel Stiff
Q. Hi Dr. Tom, thank you very much for this ‘service’, if I
can call it that. Access to a person with your knowledge is so appreciated.
I have just come back from a two-hour walk across rough
terrain with my dogs! I feel fantastic. I eat well, I'm not over weight… and
I suppose I should add that I love life! I am very active.
Here is my question: I am a forty-eight year old
man. I gave up smoking when I was thirty-three. The thing is, when I push
myself in any sort of activity, I get a sort of ‘wooden’ feeling in my lungs. It
is as if they will not expand!! Also, where I walk is normally mountain regions
and yet I do not ‘feel’ the fresh air… I labor to breathe (but seem to be
able to ‘out-walk’ all the others!).
Thanks again for access to your knowledge base…
I hope this mail finds you all in the very best of health.
A. Dear Noel,
I cannot explain your unusual lung symptoms. You sound very
healthy and should remain so.
Teaching Tracheostomy Care
Q. I am a nursing instructor at an Associate degree program.
We are preparing to teach tracheostomy care. There is debate on the prevalence
of non-disposable inner cannulas.
Can you provide any insight into the prevalence of
non-disposable inner cannulas. Should we should teach our students trach care
with a disposable inner cannula only or do you think non-disposable inner cannulas
are still fairly common?
We live in an isolated area, so it is hard to tell what the
national trend is. Any insight would be great.
A. Dear Karla,
I have not done ICU care for a number of years. I do not
know the current status of disposable vs. nondisposable cannulae.
Q. Are there any current issues or research on byssinosis?
If so, where could I find information?
A. Dear Jennifer,
Read a textbook or chapter in a general pulmonary book, on
byssinosis. It is a pneumoconiosis caused by cotton products.
Chronic Interstitial Changes
Q. I recently had a chest x-ray after reporting to my
allergist that I had mild wheezing on exhalation and shortness of breath on
The x-ray showed that I have mild chronic interstitial lung
changes, as well as mild spleen enlargement. The allergist suggested I consult
a GP about both. Should I be concerned?
My family history includes COPD and lupus, and I do not
A. Dear Elaine,
I think these findings require an explanation. I can think
of many possibilities. I suggest consulting with a pulmonologist.
RESPIRATORY CARE Journal and Peer Review
Q. I have had many doctors tell me that our RESPIRATORY CARE
magazine is not peer reviewed; is this true? If so what does it mean to be peer
A. Dear Christopher,
RESPIRATORY CARE is the science Journal of the American
Association for Respiratory Care. An important aspect of the scientific process
is peer review. Following the peer review process, the editor has the
manuscript reviewed by experts (peers) who advise the editor about whether the
paper should be published or rejected. The peer review process also provides
feedback to the author about how the paper can be improved, or to support the
recommendation to reject the paper.
The majority of papers submitted to RESPIRATORY CARE are
peer-reviewed, and most of those are returned to the authors for revision
before they are acceptable. Some papers submitted to RESPIRATORY CARE do not
pass the rigors of peer review and are rejected. This serves as a measure of
quality control in that only papers of acceptable quality are published.
RESPIRATORY CARE is the premier journal of its subject matter and it is
recognized worldwide. This has been recognized by inclusion of RESPIRATORY CARE
in PubMed (Index Medicus) and the ISI's Web of Science.
Dr. Dean, Editor of RESPIRATORY CARE
Questions about Bronchiectasis
Q. Hi. I am 33 years old. About five years ago I was
diagnosed with bronchiectasis
in my lower left lobe. I end up being on antibiotics six to seven times a year
to control infection (often I catch a cold from one of my children and it goes
straight to my chest).
Do you know of any treatment that is more effective to help
control Bronchiectasis, than constant use of antibiotics?
My doctor keeps saying there is nothing else to do. But I
have to wonder, that at my early age, I have to deal with this for the rest of
my life. I am on an inhaler, but I don’t really find that it makes a lot of
difference. Will this new inhaler Spiriva help for bronchiectasis?
And what do you think of the possibility of a lobectomy?
Also is bronchiectasis considered a COPD? Thanks for your help!
A. Dear Susan,
If the bronchiectasis is really limited to one lobe, which
is distinctly possible, a lobectomy can be amazingly effective. Pursue this
possibility with your pulmonologist. A CT will tell about the localization of
Spiriva is okay, but won’t change the basic pathology. Using
antibiotics frequently for diffuse disease is safe and effective.
Is It Better to Keep Active if I Can Still Do My Job?
Q. First: I was diagnosed with COPD, severe. Second: I
deliver home heating oil, (dragging the hose to peoples' homes to fill with
diesel fuel) in Pennsylvania.
The pulmonologist diagnosed this after making me walk
(extremely fast, almost a jog) down the hallway and back 4 times. I was not
short of breath, but my O2 level dropped. He stated I should be on O2 and quit
work, apply for disability. Right, who can live a year without income?
Anyway, question is, if I can do my job, wouldn’t it be
better to keep active, Instead of quitting, worrying about an income and paying
bills, and going on O2 (which my insurance will not pay for).
A. Dear Pam,
I agree with you that if you can do your job without oxygen
and undue distress that you should keep right on working.
Strange Feeling in Lung Since Quitting Smoking
Q. Hey, I've been a smoker of weed for the last six years or
so with a short break here and there. I've just stopped for good and I've
noticed in my right upper lung it has a odd feeling to it and it has a sharp
acute pain (in one little spot) and only comes as I do heavy activities.
I've noticed my right upper lung just feels a little different from my other
Is this in my head, or is it after effects of smoking and my
body is trying to do something, or is it something worse? Any reply will be
greatly appreciated thank you for reading this.
A. Dear Matthew,
These strange sensations on stopping pot are hard to explain.
They will subside. You will remain well.
Lungs Look Like a Smoker's Lungs but Have Never Smoked
Q. I was told during an echocardiogram that my lungs look
like a smoker’s but I have never smoked and don’t live with a smoker. What else
could cause this?
A. Dear Donnamarie,
A misinterpretation. You cannot identify a smoker's lung
from an electrocardiogram.
Q. Dear Dr.Tom,
I’m 35 and scared. Do I have asthma or COPD and will these
breathing flare-ups ever stop or only get worse?
As a child I had bronchitis quit a few times and pneumonia
once. I had no problems with breathing just bad allergies until about four
years ago. I moved to a wet colder climate with a lot of plants and redwood
trees and had my first SOB incident which sent me to the emergency room.
I finally have a referral to see Pulmonologist because I
have had poorly controlled asthma (or maybe it is COPD) for about three years
now. I am fine for weeks at a time and then something sets me off but I don't
know what. I live with cats that I'm allergic too but usually this past time it
was cold wet weather and the time before that a bad cold/flu.
I’m scared. Could it be COPD? I smoked around 10 cigarettes
daily for 15 years with regular quits of up to six months before this. I quit
for good when this all started.
I like albuterol, it helps a lot, but I tend to use it a
little compulsively and go through it quickly. Sometimes I take prednisone with
a bad flare-up but I won't take Advair etc daily because I think they prevent
me from losing weight. (I am 10-20 pounds overweight but normal BMI range).
I have bad breathing at night and a nonproductive cough that
makes my head hurt when I'm having a flare-up but not at other times. When this
happens I just can't get enough air.
Sad and wheezing, Carolina
A. Dear Carolina,
It seems most likely that you have asthma and need both
bronchodilator and inhaled steroids for it. You will not gain weight on inhaled
steroids any more than oral steroids.
Acapella Breathing Device
Q. How does the acapella breathing device work?
A. Dear Bobbi,
It sets up high frequency vibrations that tend to promote
mucus flow. I have not been impressed with it.