Breathing Treatments for Kids
Q. I am an RT working in the ER of a community hospital. My question concerns the different breathing treatments used to treat acute pediatric lung inflammation situations. Every second is precious when treating babies/pediatric patients. I want to keep as up-to-date as possible on the best treatments available.

Do you have any information on using heliox (helium and oxygen mixture) to deliver breathing medication to these little tykes instead of the usual methods of using humidified oxygen or air?

Susan

A. Dear Susan, I do not treat babies these days. Heliox is a low-density gas that has helped with the ventilation of small and large patients that have severe airway obstructions, usually of the major upper airways. It moves down the air passages easier than oxygen, which is more dense. 

Better ask a pediatric pulmonologist for more current details.

Dr. Tom

 

Is Carboxyhemoglobin Important for Determining Need for Oxygen
Q. Do you consider COHb (carboxyhemoglobin; carbon monoxide combines with hemoglobin to form carboxyhemoglobin) values in the 3-6% range to be of significance when checking people for oxygen need?

Larry

A. Dear Larry, Yes, for one thing, these levels indicate that the patient is still smoking. Smoking cessation should be the first priority. Also 4-6% of the hemoglobin is taken up by carbon monoxide that is tightly bound to hemoglobin, thus replacing some oxygen carrying “space.”

Dr. Tom

 

Role of Respiratory Therapist in Cancer Care
Q. I have to do a talk on the respiratory therapist and the cancer patient. Other than nebulizer treatments and oxygen, what is the role of the therapist and the cancer patients?

Are there any web sites and or literature that I can refer to? I have tried the Internet and have not gotten much.

Jennifer

A. Dear Jennifer, There is a lot written about end of life care in cancer patients that involve oxygen and mechanical ventilation. I don't know of any web sites.

The principles are comfort of the patient and maintenance of the person's dignity. Another principle is avoiding the futile extension of death with a mechanical ventilator. The time comes when ventilators should be discontinued and the patient given sedation to assist the transition from life to death.

Some confuse this with “assisted suicide” or even euthanasia. This is NOT correct. Removing mechanical ventilation with sedation is appropriate care for many and necessary to reduce suffering.

Jennifer, I would also like to suggest reading the two RESPIRATORY CARE Journal issues regarding palliative care:

RESPIRATORY CARE Journal Consensus Conference on Palliative Care
November 2000, Volume 45 Number 11
December 2000, Volume 45 Number 12

Dr. Tom

 

Can Using Spiriva Decrease the Need for Home Oxygen?
Q. Great website, very informative. Quick question—do COPD sufferers with a history of home O2 usage need to continue the O2 once they are on Spiriva?

Carl

A. Dear Carl, It depends on the patient. Spiriva may open up enough airways to allow for better oxygen transport, thus making supplemental oxygen unnecessary. This does not happen often. Needs to be checked with pulse oximetry. 

Dr. Tom

 

Joint Commission on Accreditation of Health Organizations
Q. Are there any JCAHO initiatives directly for respiratory care?

Joan

A. Dear Joan, I have not read the latest guidelines or initiatives. They change from time to time. JCAHO deals mostly with quality issues of care, and not specific care for individual patient.

Dr. Tom

 

Wife is Concerned About Husband’s Coughing
Q. My husband coughs after every meal. It has been happening for the past six months.

He has a history of working around carcinogens (ex. asbestos) and does have occupational testing every six months. I have told him it could be as simple as GERD (Gastroesophageal Reflux Disease)

He is only 47 years old and I love him dearly. I think he needs to see his MD about this but he is putting it off. Do I have a valid concern?

Caroline

A. Dear Caroline, Yes, chronic cough always deserves an explanation. There are many causes. You need a diagnosis.

Dr. Tom

 

Having Pain After a Lobectomy. Is it Scar Tissue?
Q. Two years ago I had a lobectomy (surgical removal of the lobe of the lung) of my left lung because of non-small cell cancer. Although my cancer was removed I did not have any chemo or radiation.

I still have pain. Could it be scar tissue? What can I do, if anything? My oncologist is not concerned?

Please help because I am getting disgusted and tired of being ignored and tired of the pain.

I guess I should be glad I am alive. I am also a non-smoker, another puzzling question.

Donna

A. Dear Donna, You probably have incisional pain from rib damage or removal. Sometimes the partly removed rib regenerates for a time and then the pain subsides. Takes about a year in some cases.

Your oncologist is not concerned, because he does not feel the pain. You need some mild pain medications, until this resolves, which it will. About 15% of women with lung cancer are non-smokers. Good that yours was found and removed.

Dr. Tom

 

Where Can I Get Enjoying Life with COPD?
Q. This is not your typical question!  We would like to have all our students, in the Disease Management, Rehab and Extended Care course, buy and read a copy of the small blue book you and Louise Nett RN RRT FAARC wrote Enjoying Life with COPD. 

Our bookstore is working hard to get copies but has already warned us that the copies may be limited.  Do you have any inside information on where these books may be more accessible for our bookstore to purchase?

Thanks so much for the service you are providing our patients - and our therapists too!

Helen MA, RRT, FAARC

A. Dear Helen, The book is out of print. Have you tried Amazon.com? I may be able to find a copy in the storeroom if you are not successful. Let me know. I will try to help you find a copy if all else fails. 

Glad you are so interested in the topic.

Dr. Tom

                

Pulse Oximeter Readings
Q. Why are pulse oximeter readings different when sitting down versus lying down?

Jeff

A. Dear Jeff, Oxygenation may be changed by various positions. The reason is the matching of the airflow and the blood flow in the lungs. Lying down may elevate the diaphragm, if the abdominal contents are large and compress the lungs, thus reducing the airflow to the lower parts of the lung. Blood flow through these regions does not get oxygen and this mixes with the rest of the blood flow in the lungs, resulting in lower saturation levels while relining.

There are other rare conditions where oxygenation is greater while lying down compared with standing.

Dr. Tom

 

Nebulizer for Tracheotomy Patients
Q. In your opinion, what is the best way to provide nebulizer treatments to a patient with a tracheotomy? Please provide diagram if possible.  Thank you for your input.

Roberta

A. Dear Roberta, Nebulized moisture is delivered via the large bore tubing that attaches to a trach collar. For nebulized bronchodilators, the nebulizer is either put in line and powered by a separate gas source or a meter dose inhaler can be placed in a “T” adapter and actuated with each breath.
Can't draw this for you on the screen, but you will know what I mean.

Dr. Tom

 

Need Help in Understanding my Pulmonary Function Test (PFT)
Q. I had a recent PFT (pulmonary function test) and my allergies were bothering me at the time. The RRT (Registered Respiratory Therapist) said the tests were not good.

How can you tell what the actual lung function is from the PFT's? I'm not sure how to read the FEV1 with the headings. Which one is the important one? 

FEV1 (ref) is 2.04 - (CI) 2.04,
Pre Measurement: 0.88 Pre %Ref: 43 
Post Measurement: 0.95 Post %Ref: 46

The report does say that the FEV 1 changed only by 8%, which is insignificant response to bronchodilator.

I have had emphysema which was classified as severe for past 11 years...had been a smoker and quit 11 years ago...also had been working with heavy duty chemicals.  Thanks for your help with my questions.

Dot

A. Dear Dot, I don't understand your numbers.

If your FEV1 is 2.02 that his good. But 0.88 rising to 0.95 liters per second also sounds like a low FEV1 and a small response to bronchodilator. This would be an 8% increase.

The important numbers from spirometry are the FVC, is total volume blown out and the FEV1, which is exhaled in the first second. Then repeat after bronchodilator and see the rise in both the FVC and FEV1. Hope this is clear. 

Dr. Tom

                         

What is Pulmonary Fibrosis?
Q. My father was diagnosed with pulmonary fibrosis.  Can you explain in simple terms what this is?  And do you know anything about stem cell injections for PF?

Melinda

A. Dear Melinda, Pulmonary fibrosis is a dense scar within the alveoli of the lungs. There are many forms of pulmonary fibrosis. Some are reversible with medications and others are not.

Stem cell research has not been used in pulmonary fibrosis, except in basic research situations. It is not for use in human forms of pulmonary fibrosis. 

Dr. Tom

 

Question About Nodule on CT Scan
Q. I received my chest CT scan recently at a V.A. hospital. I was told my CT shows emphysema.  The chest nodule may possible show infection. Does that mean I may possibly have cancer?

Sharon

A. Dear Sharon, This nodule may go away if it is caused by infection and properly treated. If it remains and is large enough, or grows on follow-up, it should be biopsied or removed surgically, because it may be curable cancer.

Dr. Tom