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Archive: Dr. Tom 144

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

Can Doctors Tell if Someone Has Been Smoking?

Q. My cousin is a COPD patient and is on oxygen 24/7. She said that she is not smoking and I believe she is. To try to get her to at least quit for a little while I told her that her doctor would be able to tell if she had a cigarette in the last two weeks, and maybe that way she would realize that if she could put them down for two weeks she could do without for good.

Is there such a test or a way for a doctor to tell if she had smoked within the last two weeks?


A. Dear Susan,

Yes, thiocyanate levels remain elevated, as do nicotine levels for several days on stopping smoking. CO clears in hours.

Dr. Tom

Question about Treatment for Interstitial Lung Disease

Q. My mother has interstitial lung disease (ILD). Is it true that there is no treatment for it, and if not what should I do? How can I go for a lung transplant, is it possible to get a transplant in India?


A. Dear Preeti,

There are several forms of ILD, some are treatable and others not. You would have to go to a transplant center; I suggest Bombay University as a starter.

Dr. Tom

Mucus Plugs

Q. I’m a 28 year old man. I had asthma when I was a child. I have had mild dyspnea for a year and I also cough up green/brown mucus plugs regularly. Those plugs are strange because they have small flecks inside. I’m really worried because I also had some episode of blood-streaked sputum.


A. Dear Luciano,

This material you are coughing up may be dried asthma mucus. It may be associated with some blood streaking.

Dr. Tom

Sister is Ill with Lung Disease and Cancer

Q. My sister is in her final stages of emphysema, she had lung cancer and beat that, but now the doctor said she needs to get her affairs in order. She is also DNR (do not resuscitate). What is her prognosis?

We have cancer running rapid thru the family my mother, sister and this sister and also lost a niece last month to liver cancer and have another niece with non-Hodgkin lymphoma.


A. Dear Linda,

Only her doctor can give her an accurate prognosis. I do not have enough information, but obviously her life will be shortened.

Dr. Tom

Treatment for Idiopathic Pulmonary Fibrosis

Q. Are there any medicines in the near future that will work on stopping idiopathic pulmonary fibrosis?


A. Dear Joseph,

There are many under study, but no certain effective drug yet. Keep hoping.

Dr. Tom

Life Expectancy and COPD

Q. I read on your site that COPD patients have a life expectancy of 10 years. I was diagnosed more than ten years ago but still manage to go to rehabilitation once or twice a week. I must admit that I require oxygen more as the years go by. My oxygen level at rest is 90%-94%. I feel that I still have at least another five years. I am 67 years old.


A. Dear C.,

You are probably correct. Enjoy the life that remains for you. It is a gift.

Dr. Tom

Taking Ambien and While Using Oxygen

Q. Is there a danger of taking Ambien while on oxygen?


A. Dear Joanne,

No, unless the Amibien dose is very high.

Dr. Tom

Shortness of Breath for Seven Months

Q. I’ve had a bad cough along with phlegm and shortness of breath everyday for the past seven months. I have no medical insurance, which is why I haven’t gone to the doctors. I also suffer from back pain in my lung area.

If I go to the doctors can anything be done to reverse my symptoms or at least some of them?


A. Dear R.,

This all depends on your diagnosis. I suggest seeking care through some volunteer clinic. Your problem may be easy to solve.

Dr. Tom

Brother Has to Continue to Have His Lungs Drained

Q. My brother started getting strange symptoms last November, his lungs keep filling with fluid and he has to go to the hospital every few weeks to have his lungs drained of two-three liters of fluid each time.

They ruled out pneumonia, asbestos exposure, but took biopsies to check for cancer; he is very exhausted and worn out and hasn’t worked in four months. The doctors can’t figure out why the fluid keeps coming back—any ideas?


A. Dear Mike,

A hidden cancer or heart failure are the best possibilities. Your doctor should be able to make a diagnosis.

Dr. Tom

Should a Benign Tumor be Removed?

Q. I am 65 years old and have COPD. I take Spiriva, work, stopped smoking at 45. When I was 30 had two spontaneous pneumothorax and they repaired the blebs.

I have a benign tumor at lower lobe of my lung, which has not grown for a couple of years, but now it has grown a little.

They want to take the tumor out, but with it goes 25% of lung due to location of tumor and scar tissue. If I let it grow, for 12 months, would it affect my breathing, and cause infection and pneumonia?

If it were anywhere else they could easily remove it, they have CyberKnife at Saint Francis in Hartford. I have gotten two opinions, but I need another one.


A. Dear Dan,

A growing tumor should be removed in most cases. Usually this can be done without sacrifice of much surrounding lung tissue.

Dr. Tom

Steps for Follow-Up

Q. I have a spiculated nodule in the left upper lobe. My lungs show extensive emphysematous change.

My question is directed at determining the next step toward diagnosis. What about biopsy? How serious would it be if a biopsy resulted in an air leak or collapse? Should I consider surgery when it is not clear that there is cancer? Please comment on the next best step I should take.


A. Dear Carol,

A spiculated nodule, assuming calcification, is almost always benign and needs no treatment.

You did not specify a calcific spiculation, however. If you are talking about a non-rounded lesion with tiny shadows arising from it that are not calcified; that is a completely different matter. Your doctor can tell you in an instant, which one you are dealing with.

Dr. Tom

Childhood Asthma

Q. My grandson had a bout of RSV at 14 months old. Is he condemned to get asthma?


A. Dear Linda,


Dr. Tom

Follow-Up on Life Expectancy and COPD

Q. You have indicated that a person diagnosed with COPD can live UP to ten years. That is disheartening, as I have mild COPD in the form of emphysema. I am not on an inhaler or oxygen and I still play doubles in tennis. I can’t believe I’ll be dead in 10 years! I am currently 61 years old - was diagnosed last year.


A. Dear Nino,

In your case, you will live a lot longer than the ten year average. The ten year life expectancy, I quoted in the previous question was for moderately advanced COPD.

Dr. Tom

2024 American Association for Respiratory Care