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Archive: Dr. Tom 145

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

Spontaneous Pneumothrax

Q. I’ve recently had a spontaneous pneumothorax, and it was determined it was a congenital bleb at the apex and repaired with pleurodesis. But a week later, there is now a banana-shaped air pocket under the bottom of the same lung. How could this happen?

I’m not a smoker, have had no trauma or injuries in many years. I have an appointment with a pulmonary doctor but would like some answers now.


A. Dear Jan,

You still have a small leak. Discuss this with your pulmonologist.

Dr. Tom

Is Part Time Smoking Bad?

Q. I am taking Sprivia but I still smoke (some times) but don’t smoke full time. Is this harmful?


A. Dear James,

Yes, all smoking is harmful.

Dr. Tom

I Am a Former Smoker and Wonder about My FEV1

Q. I am a 25 year-old male and am 71 inches tall and 160 pounds. I smoked three packs a day for three years and I am wondering how significant a decline in FEV1 I can expect and how much this will affect my cross country running abilities.

I don’t know what my FEV1 was before I began smoking but using a handheld asthma device (Microlife PF 100) I can sometimes get an FEV1 of 4.70L/min when I inhale very deeply, but usually get about 4.4 L/min.

How normal is this and can the handheld "spirometer" be trusted? Is there any possibility that I will regain any of my lost lung function? I had an X-ray done that was normal. What residual health effects can I expect?

Interested Reader

A. Dear Interested Reader,

A hand held spirometer can be accurate. You are obviously pretty normal and can expect a normal life span.

Dr. Tom

Can Exposure to Paints Cause COPD?

Q. Can the exposure of oil paints and pastel paints cause COPD?


A. Dear Angela,

Not unless very excessive exposure, or a family history of hypersensitivity to such paints.

Dr. Tom

Extra Moisture for Your Nose While Using Oxygen

Q. I use oxygen, what can I use in my nose instead of Vaseline?


A. Dear X,

Use a non-petroleum product such as KY jelly.

Dr. Tom

Is Incentive Spirometer a Good Exercise for COPD?

Q. I have COPD and am trying to delay any increase in my breathing problems by going to rehab two to three times a week. Will I benefit by using an incentive spirometer deep breathing exerciser?


A. Dear Cynthia,

No, but it will give you a good way to amuse yourself. Just be active and make measurements about monthly.

Dr. Tom

Recommended Follow-Up for Lung Nodule that has Shrunk

Q. I had a lung nodule that was found about eight months ago, CT Scan. The pulmonologist upon looking at the nodule thought it was related to my Crohn’s disease but couldn’t be sure because it had an irregular border and suggested follow up every three months to monitor stability.

Well, I had my nine month CT Scan and the nodule has shrunk from 1.4 cm down to 8 mm and it had a more faint appearance on the scan.

The Dr. was very pleased but said I still need to complete the follow-up until we reach two year mark.

Should I be relieved or concerned that they still want to follow-up in six to twelve months?


A. Dear Pat,

You should be relieved and do not need the follow-up.

Dr. Tom

Insurance Coverage Turned Down Due To Hyper-Inflated Lungs

Q. An insurance company turned me down for coverage citing "hyper inflated lungs" as the main reason. My physician never mentioned this to me and I was wondering if I should be concerned?


A. Dear Cathy,

No. The insurance company is not up to date. Insist on spirometry.

Dr. Tom

Exercises for Cystic Fibrosis

Q. What kind of exercises can a CHF patient do at home?


A. Dear Sherry,

Any exercise that is comfortable.

Dr. Tom

Father having Hallucination in the Hospital

Q. My dad is in hospital as we speak. He has congestive heart failure and now a nurse tells us, he has COPD. Ever since he has been in hospital he has been hallucinating. What could be causing this? I’m really scared.


A. Dear Lisa,

It could be drugs, or the severity of his disease. Maybe it is sleep deprivation. Be sure he is placed by a window during the day and has darkness at night.

Dr. Tom

Flow Meter for Liquid Oxygen

Q. Where can I find a liter reader for my liquid oxygen? I know there is an item out there that you stick in the tubing to see how much oxygen the reservoir is putting out. It's about the size of a pen and is made of glass. Please help me.


A. Dear Carol,

I will refer your question to Bob McCoy, who is expert in all these technologies. I have one of these flow meters, but it does not have any identification on it.

Dr. Tom

Does Oxygen Increase Dementia?

Q. Dear Dr. Tom,

I apologize for my lack of medical terminology in advance.

My mother is caring for my stepfather who has a host of issues, such as COPD, dementia, eye problems, muscle issues; the whole nine yards.

He has been in and out of the hospital recently with bouts of pneumonia. He has been on oxygen therapy for some time, but lately on it most of the day and night.

One of his daughters heard that too much oxygen will increase his dementia, and my mother wanted to know if this were a fact or fiction. I had always thought that the less oxygen to the brain, the more chances of dementia. Can you please straighten us out… thanks so much for your time.


A. Dear Kim,

There is no way to get too much oxygen to the brain, by use of ordinary oxygen delivery systems. Too much oxygen does not cause dementia; too little oxygen does.

Dr. Tom

Rheumatoid Arthritis and Lung Nodule

Q. Can you give me any information on pulmonary nodules when a person has Rheumatoid Arthritis? Have been periodically checking size of nodules by CT scans as both parents have died from lung cancer. Any info will help

Also, I recently was diagnosed with Asthma and have trouble breathing with increased SOB.


A. Dear Nancy,

Nodules from the rheumatoid process are fairly common, but I would be much more concerned with your family history. I suggest seeing a pulmonologist now and working out a screening schedule.

Dr. Tom

What to Expect with Chronic Bronchitis?

Q. I am 63, just diagnosed with chronic bronchitis. Can I live a good normal life? I am so afraid I will rapidly become worse.


A. Dear Marilyn,

Chronic bronchitis does not necessarily carry a poor prognosis. Get your spirometry measured to check on your lung function. Avoid inhaling all dusts and smoke of any sort.

Dr. Tom

Crystalline Silica

Q. My husband has crystalline silica in his lungs. Should we move to a dryer climate? Will it help?


A. Dear Cindy,

This will make no difference. You should see a pulmonologist for monitoring of the silicosis, which will not have a bad prognosis, as long as the exposure has ended.

Dr. Tom

Optimal Capacity of Small Volume Nebulizers

Q. Dr. Tom,

Here's a respiratory question for you; what is the optimum filling capacity of a small volume nebulizer?


A. Dear Jerry,

It depends on the size of the nebulizer. Check the specs.

Dr. Tom

What Should I Expect from My Visit with the Pulmonologist?

Q. I am 50 years old. My father died at 64 years old from lung cancer. He smoked and I inhaled a lot of his smoke as a child.

After an abnormal chest x-ray I had a CT Scan with contrast, which was also abnormal.

I was told to see a Pulmonologist.

Should I be worried about Lung Cancer?

What should I expect at the Pulmonologist visit? Do you think he will want to do a lung biopsy on the enlarged node?


A. Dear Liz,

Your pulmonologist will likely want to do a lung biopsy by needle, and in view of the risks, I would follow his advice.

Dr. Tom

I Am 43 And Diagnosed with Mild/Moderate COPD

Q. What is the life expectancy of someone like me? I was diagnosed at 43 with mild/moderate COPD, emphysema. I am on Spiriva and Advair. I was hoping my life expectancy would be close to normal.

I read your comments about life expectancy being 10 years or so, and wanted to know if that was for advanced disease, as well as mild. I want to be realistic, and know what to tell my kids.


A. Dear Deborah,

It depends a lot on your spirometry now and whether there is a response to therapy. Your prognosis should be good, or near normal.

Dr. Tom

What Causes a Dry Cough?

Q. I have had severe COPD for 12 years and have never been bothered with the bronchitis or bronchial cough. Recently I have been having a dry cough. What would cause this?


A. Dear Sharon,

There are many causes of dry cough. See a pulmonologist.

Dr. Tom

Spirometry Results

Q. I am 59, will be 60 in July. I quit smoking in January of 2007. I emailed you a year or so ago, but did not have all my numbers.

These numbers are from May of 07.

FVC ref is 3.08, mine is 2.96

FEV1 Ref is 2.51, mine is 1.02 before medicine and 1.22 after which comes to 41% pre and 48% post.

My FEV1/FVC is 43 pre and 41 post.

My DLCO/VA is 70%.

I have lost 60lbs since then as I went on a diet. I am scheduled for a new breathing test in Sept.

Dr. Tom this is scary, can I live 15 years with these numbers? I know you are not God, but please tell me your best guess.

Thank you so much and I know you are not well and appreciate what you do to help us with COPD.


A. Dear Mary,

Not too bad! You can live 15 years with these results if you take good care of yourself.

Dr. Tom

How Can I Protect Myself from Asthma Triggers?

Q. I learned recently that I have asthma. I am 64 years old and I never had asthma as a child. Before I was diagnosed with asthma. I have an inhaler that is for emergency use. Also I have an inhaler that I take twice a day, and Singulair that I take once daily.

I want to go on vacation to India and am wondering how can I limit the pollution, dust, and all the elements that trigger this asthma. Please help me, as I need some advice from you.


A. Dear Tiny,

Trying to avoid dust pollution in India is very difficult. Do your best and enjoy. Try to anticipate attacks and take a preventive short acting inhaler as you would with exercise asthma.

Dr. Tom

How Does Hemoglobin Affect Oxygen Saturation?

Q. Can you explain if having low hemoglobin or high hemoglobin affects the pulse ox reading; can you elaborate on both conditions.


A. Dear Barb,

Hemoglobin does not affect saturation. Consult a physiology textbook.

Dr. Tom

Expected Recovery from a COPD Exacerbation

Q. Dr Tom-I am a 47-year-old male who was diagnosed with COPD in April of 2008. My FEV1 was at 48% and I showed mild hyperinflation of the lungs. I quit smoking the day I was told and my Pulmonologist opted not to put me on any medication at that time.

I worked all summer long feeling pretty good—no breathing issues! In fact I was happy to see my oxygen level stay strong at 98%—I even played tennis! Unfortunately, a few weeks prior to Christmas I was exposed to some paint fumes, wood smoke, and some really strong cat urine odor. One of those exposures sent me in to a tailspin and started an exacerbation.

I had a new spirometry where it showed I dropped 12% points on my fev1 score. My Pulmonologist said he didn’t feel such a large drop in function was typical of COPD. His opinion was that I had irritated my airways and would probably regain the lost function.

It's been three months and I feel worse than ever. My oxygen has gone from a steady 98% to 96%-down as low as 94% when I am half asleep. I am afraid to find out what level I’m at when I am in a deep sleep. I will say I have hope because with just a deep breath I bounce right up to 98%.

I am constantly SOB with a stressed muscle feeling in my diaphragm, a tight chest, and I have a constant bloated feeling in my stomach. I don’t have any mucus secretions but I do have a stressed voice.

The last symptom I can think of is I have a lump feeling in my throat--almost choking. My Pulmonologist has me scheduled for an endoscopy to explore the possibilities of GERD. Although I wouldn’t be surprised if I am experiencing some GERD—I have my doubts that GERD can cause all of my symptoms.

What I’m really looking for is some confirmation that my Pulmonologist is steering me down the right path. I guess if I wanted you to answer any one question it would be as follows: Do you think it's possible to have symptoms like I've described and rebound back to my original status prior to the exacerbation?

Sincerely—Worried Sick!

A. Dear Worried Sick,

Yes, it is possible to make a complete rebound. An endoscopy for GERD is also a good idea.

Dr. Tom

Oxygen Administration During Exercise

Q. I am a physical therapist and I have a patient who is 70 male with severe COPD. He started to tolerate about 20 feet of walking without oxygen, O2 Sat is 98% but he has moderate SOB on exertion in spite of good saturation. Will it help to give him O2 @ 2 liters when his walking to tolerate more walking with standing or sitting rest stops?


A. Dear Antonette,

He will be able to exercise more with oxygen than without it. Give it a try.

Dr. Tom

How to Explain Cancer in Terms One Can Understand

Q. Hi! I’m a nursing student. I just want to ask how can I say to a 10 year old girl what is cancer in words she would understand because her 6 year old brother has leukemia.


A. Dear Greyel,

This is not easy. Explain that lung cancer is caused by smoking and includes cancer cells. That may do.

Dr. Tom

Long Lungs

Q. I am a 41 year old male, don't smoke, drink or drugs. Active, slim build and can hold my breath for 1 min 45 seconds. I have never smoked, no shortness of breath at rest or exercise, do have no productive dry cough in morning during allergy season and suffer postnasal drip and draining.

I recently reviewed some medical reports from a visit to the ER with chest pain in August 2008. They did chest X-rays and I was told I had long lungs and they had to retake one of them. The report states in the impression that I appear to have hyper-inflated lungs although may be secondary to technique and appear to show flattening hemidiaphragms. They never said anything to me in the ER to follow up on it. I am wondering now if I should be worried and follow up. Should I be worried about COPD or can other things cause this?


A. Dear Jim,

No. This report is a common error in people who can take a large breath. Forget about it.

Dr. Tom

My Brother Needs to be Weaned from Ventilator

Q. My brother needs to be weaned off the vent. He is very weak. We live on Long Island, NY. Any good places you know of? We are willing to go anywhere to give him a chance to better his life.


A. Dear Lorraine,

The best places are weaning centers such as the Kindred hospital group. There is one in Denver. There are other options. More than 50% of long-term ventilator patients can be gradually weaned in experienced centers.

Dr. Tom


Q. How can one tell if breathlessness is because of anxiety or biological concern?

I am 45, a nonsmoker although I had smoked sporadically in the past (during crises) then stopped. I sometimes notice my heart is beating fast and it feels like breathlessness when I awake and when I first lie down to go to sleep (occasionally).

My lungs showed clear but I read mild hyper inflated. Would you suggest any other tests? The breathing is good with exercise and when I take pain pills (currently for a pain in back).

Doctors recently found a 3 mm vegetation or thrombus on my mitral valve following a small cerebrovascular accident: (with no deficits except for nominal speech disorder sometimes).

How much can arthlerosclerosis play into breathing and maybe I have it?


A. Dear Marie,

You need spirometry to measure your lung function. Arthlerosclerosis does not cause shortness of breath. The mitral vegetation may need investigation. I suggest consulting a cardiologist.

Dr. Tom

Dad has Lung Problems and Now has a Bad Pain in Back

Q. My Dad has been going to doctors also Veteran's doctors and regular close to home doctors. He has a lot of lung problems. On oxygen 6 lowest 7-8 at high levels. Swells in the feet also but he takes medication for all this.

Well, now he has lower back left side back pain and he can barely walk. All the doctors gave him pain pills and want to take a chest x-ray which has nothing to do with his back. They did rule out kidneys and cancer and bladder and prostate; what else could it be? Thank you for any information.


A. Dear Tony,

There are many things this could be. I suggest consulting a pain specialist.

Dr. Tom

2024 American Association for Respiratory Care