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Archive: Dr. Tom 31 Alpha-1 Antitrypsin Deficiency (AAT) As I was reading the questions, I noticed a particular one where her mum had died of emphysema at age 57 but had lung problems for probably 30+ years. You are correct that she may have had bronchiectasis because you may have had much more information, but she may also have had AAT Deficiency (a disease that is under diagnosed and misdiagnosed) - especially if she were a smoker. Thank you for all that you do for all of us. Maureen RN, MN A. Dear Maureen, You are correct. I should have mentioned Alpha one deficiency as a possibility. Nice to hear from you. Dr. Tom Last week’s question: Worried about Mother Who is on a Ventilator Do you think it is a good idea that she is given a tracheotomy (is an opening surgically created through the neck into the trachea, windpipe) and then tried to wean off of that. I am just concerned she will get stuck being on the ventilator for life. She is only 53, and has severe emphysema. Smoked up to the day she was taken by ambulance. Can someone’s lungs be that bad by such an early age? Jennifer A. Dear Jennifer, A tracheostomy is more comfortable for the patient that an endotracheal tube (tube placed in the airways through the mouth or nose). It will allow for better suctioning of secretions. It is also a good step in weaning, that may take more than a few days. Advanced emphysema in the 40s and 50s is fairly common. Women are more susceptible to cigarette smoke than men. Your mom can still recover, and be rehabilitated to the point of a good quality of life. Dr. Tom
Trouble Breathing Even with Oxygen I am still on oxygen and have a lot of trouble breathing when moving around. I am overweight, very much so. Is my breathing still from emphysema or osteoporosis or just being overweight? I am over 65 years old and losing weight is a big problem with me. Mary A. Dear Mary, Oxygen often does not relieve shortness of breath. It corrects the oxygen deficit and unburdens your heart, and usually helps with exercise tolerance. But shortness of breath is mostly due to the mechanical abnormalities of the lungs and chest. Overweight, itself, may cause shortness of breath. Keep trying to exercise, by walking at least 30 minutes twice a day. This is good for osteoporosis, and may help you lose weight and exercise more with less shortness of breath. Dr. Tom
Normal Saline Lavage for Ventilator Patients Carol A. Dear Carol, I do not know of any controlled studies comparing saline lavage with water, or mucus dissolving drugs, such as acetylcysteine (antioxidant drug used to thin mucus). The mechanical effect of fluid, instilled and then suctioned is clinically helpful. Dr. Tom
Needs Help with a Difficult Decision I have been told by many, that the life expectancy after lung transplant is 5 years, and that forty some medications are necessary after transplant. These medications come with their own severe problems and side effects. I do not do well with meds and have had adverse reactions to many. I react badly to prednisone at any dose over 15mg alternate day therapy. My FEV1 is <16%, and my Doctor's prognosis is 1 more year, 2 if I'm lucky. I'm 84 yrs & 1 week. :) What are your feelings on transplant? Claire A. Dear Claire, Well, you have already lived 84 years, and will probably live some more without a transplant. Very few patients your age are considered candidates for lung transplantation. There are risks, of course. It is not true that 40 medications are needed in lung transplant patients, but some powerful drugs are needed to help prevent rejection. Dr. Tom
Will a Move to New Mexico Help My Breathing? My question is this, I am thinking of moving to Las Cruces NM where the climate is dryer than here in VA. The sea level is about the same. Do you think this will help my breathing? Thank you very much. Earl A. Dear Earl, It might help, but try it first, before moving your home and leaving your friends. Dr. Tom
Tiny Dots on CT Scan, but No Diagnosis A needle biopsy was done but showed nothing, as dots were too small. Tissue biopsy is planned. Any indication what this may be? Preliminary diagnosis states; milnary type interstitial lung disease. Looked this up and it could be a million things. What do you think the CT scan means? Any possible direction we might look? Any help would be appreciated. Also coughing up blood. Thank you. Pam A. Dear Pam, If you are coughing up blood, you should have bronchoscopy (diagnostic procedure in which a tube with a tiny camera on the end is inserted through the nose or mouth into the lungs). Many "tiny dots" suggest a healed fungus, such as histoplasmosis (a disease caused by the fungus Histoplasma capsulatum, which grows in soil and material contaminated with bat or bird droppings). You do not need any biopsy or treatment for this. Dr. Tom
Follow-up Question on Spirometry My chest x-ray was clear, as were my lungs (no crackles, wheezing, etc.). I should also mention that I haven't been having any symptoms...no shortness of breath, etc., and I walk 2 - 3 miles/day with no problems. I recently went to a pulmonary specialist and had an exam and had the spirometry redone. My spirometry values (the actual values) were almost identical to the previous ones obtained at the free screening. BUT, the percentages were very different. FVC: 88% This was apparently because of the use of a different reference system. HOW DO I KNOW WHICH ONES TO TRUST? The doctor concluded that my lungs were fine, and that I neither had obstructive or restrictive problems. Do you agree with his diagnosis? Thanks again. You have a great site. Suzie A. Dear Suzie, I agree with your doctor. Your lungs are fine. Stay well. Dr. Tom Last Week’s Question: Questions about Spirometry Results I was fairly confident that I didn't have COPD. But was surprised when my results indicated a restrictive process. My best values were: Could my low FVC value be due to my recent smoking? Will it improve on its own with time? Should I have additional tests? Any information will be appreciated - I am very worried. Suzie A. Dear Suzie, Your results are borderline. Not really abnormal. I do not mean to get personal, but the “restriction” could be a matter of weight. If you are not overweight, forgive the suggestion. Dr. Tom
Chronic Bronchitis and Smoking Also, I am still smoking. I know I shouldn’t be, its just I suffer from a lot of stress as well so I find it harder to give up smoking. I am not bringing up any phlegm now but my chest is so sore and I have a bad cough. I keep getting a flu achy feeling. I am worried. Diane A. Dear Diane, I can understand your problem with quitting. Many smokers deal with stress, anxiety and depression by smoking. But your lungs will get worse. Try again. Dr. Tom
Needs Reliable Information about Lung Transplants Now I am starting to have second thoughts because I can't find reliable data about the success rate of patients living with a new lung. What is the normal life expectancy for a successful lung transplant recipient? Buford A. Dear Buford, The survival time for lung transplantation varies tremendously. The problem is lung rejection. On average the survival is about five years. But I have one patient alive 14 years after transplantation of both lungs, and others doing well beyond five years. Dr. Tom
Experiencing Shortness of Breath with Exercise My local doctor performed an examination including spirometry. Every thing was fine and over 100%. FEV/FVC was 77%. FEF75-25 value which was 79% of predicted FEF75 value was way down at 60%. My doctor is saying in the absence of anything else to point to a reason for my symptoms there is reason to suspect that this pattern indicates disease in the small airways. If my spirometry is normal why are these low? If I was coming in for the FEF25 at 90% I would be happier that all is well. Also does the inflammation that causes airway inflammation cause inflammation in other areas, i.e., joints, brain, skin problems. I have seen a rheumatologist (an MD who treats rheumatic illnesses, especially arthritis) and she tells me there is no lupus etc. Jane A. Dear Jane, Forget the FEF 25-75% and FEF 75%. These tests are misleading, and do not necessarily relate to small airways narrowing. Your lung function is good, and this is not the cause of your shortness of breath. Try more conditioning exercises. Dr. Tom
Trouble Sleeping I am on Spiriva and Advair, Atenolol, Glipizide and Insulin. I have difficulty sleeping and Ambien (sleep medication) only lets me sleep a couple of hours. Any suggestions concerning Melatonin? Thanks. Mary A. Dear Mary, Melatonin is very safe. Give it a try. The sustained release preparations are best for a long sleep. Dr. Tom
Inhalers are not Working Anymore Can you suggest other meds to update to? Shelby A. Dear Shelby, There are other alternatives, such as Serevent and Foradil which are beta agonists, like albuterol, but are long acting. Also Spiriva (tiotropium) which acts like your Atrovent, but lasts for 24 hours. They can be taken together. Dr. Tom
Please Help My Mom Her latest follow-up shows that she is beating the cancer, however the radiation and chemo has left her with such breathing difficulties it is draining her will to live. Her trach care has become tremendous with constant suctioning of mucous. We assume the lungs are in the healing process after her radiation. Is there anything we can do to help facilitate the healing and reduce the mucous that is forming so often? She hasn't had a more then 2 hours of consecutive sleep in weeks due to having to suction or mucous plugs forming. She is already on oxygen and humidity all day as well. Feeling very helpless that nobody knows how to help relieve her symptoms. Please Help... A Loving Son! A. Dear Loving Son, I understand the problem and there is no simple answer. The radiation, for the cancer, may well have caused lung inflammation. If so, your doctor may have tried corticosteroids. If not, it might help. Also cough suppressants such as Tessalon Pearls, help some people. Hope it subsides. Dr. Tom
Shortness of Breath She gave me a breathing treatment and said I had COPD and gave me a prescription for Combivent. I saw a Pulmonologist 2 weeks later (for sleep issues) and they did another test with before and after values. My before and (after treatment) values were: FVC =85.37% (90.95%) I am a 44 year old female and smoked for 30 years most of them more than a pack a day. I am also at least 80 lbs overweight. I was told I had “small airway disease” and was given Advair and Spiriva. I haven't really noticed any difference after 3 weeks. What should I do? Should I ask for a CT Scan and blood gas work? I'm trying to educate myself on this disease but one day I get good information and the next day I read bad information. How should I handle this disease? Suzanne A. Dear Suzanne, Your spirometry results are normal. Forget the FEF 25-75%. This test is misleading, and does not necessarily mean small airways disease, like many doctors were taught. Once we get the wrong information in textbooks, it is hard to remove it. Try to exercise more and lose weight. You will feel better. Dr. Tom
Are Medications Causing Pain and Weakness? Thanks for your help. A. Dear Tom, These pains and soreness are not from your medications. They suggest arthritis. Better see a doctor that deals with arthritis, such as an internist, or rheumatologist. Dr. Tom
Grandson has Cystic Fibrosis (CF) and Needs Treatment for Excessive Mucus Tom A. Dear Frank, Mucus is a big problem with CF. He should see a CF specialist. He may need to inhale antibiotics, such as tobramycin, or have anti-inflammatory treatment. Dr. Tom
Trouble Keeping BiPap Mask On I also have asthma and am currently on Advair and albuterol PRN (use as needed). My pulmonologist has put me on a BiPap (a machine that aids with oxygenation and ventilation) at night with 14/4 settings. I am having a terrible time getting used to the BiPap. I can go to sleep with it on but will take it off in about 2 hrs without me even realizing until morning. My BiPap keeps up with how long I wear it and that is how I know I take it off . I don't know what to do about it with me being unaware of when I take it off. Do you have any suggestions? I am at a loss as what to do. Also, do you know if there is any exercises I can do to strengthen my respiratory muscles. It frightens me that this is a progressive type disease and could potentially end up with further decline of my respiratory muscle strength. Thanks for your help. I have enjoyed your site and have found it useful. Have a blessed day. Linda A. Dear Linda, Keeping the BiPap mask on is a challenge. There are different types of masks. You need an experienced respiratory therapist or doctor that deals with BiPap every day to help you. I do not have much personal experience with BiPap. Dr. Tom
Question about Bronchiectasis and Spirometry Results I'm 49 years old, 5ft, weight 128lbs and have never smoked. I did have lung infection all my life since I was very young. Recently I had Lung function test done (Flow test, Test mode "FRONTLINE"). Anyway my test results FEV1 35% Predicted
What is normal and is this something I should be concern? My peak flow usually is about 300 on a good day and on bad days is about 210 -250. Mary A. Dear Mary, These spirometry results are consistent with your immotile ciliary condition. You need aggressive antibiotic treatment for each flare up of lung infection. This is the best way to prevent disease progression. Dr. Tom
Question about Pulmonary Function Test (PFT) Result It appears to be generated from the machine that did the test after analyzing the results. While I am 63 years old it is says my lung age is 98. How is this number derived and what does it mean? I cannot find this term in the books I have read or on the internet. Thank You. Renita A. Dear Renita, Lung age is that age when your measured lung function would be normal. This means that your lung function values are below what is expected for normal persons of your age or sex. Dr. Tom
Worried about Dad’s Illness He has also been told he will not work again. Do you think he will have a good quality of life when he returns home from hospital? Is he going to die from this and if so is there a time frame in which deterioration starts to speed up? Thank you. Siobhan A. Dear Siobhan, It is not possible for me to answer your questions, since I do not have enough information about your dad. Knowing how severe is his COPD by measurements, his oxygen level, and the nature of his heart disease would help. Better ask his pulmonologist about this. If he is not seeing a pulmonologist, get a referral. Dr. Tom
Hate Having a Tracheostomy I had surgery for a trach (tracheotomy is a surgical opening into the trachea, windpipe). The trach mostly fell out after 6 months, so I removed it. I had it out for about a week, then went back to the doctor, who put it right back in, in his office. He then performed surgery to put in a "button" (tube that holds the tracheotomy open). He made the hole too large, and surgically inserted another trach. I HATE having a trach in my neck. My question is: Will this trach be permanent, how can you tell if its permanent, what can I do to prevent it being permanent? I am a 40-year smoker, but am trying to quit. Syilla A. Dear Syilla, Your tracheostomy site, called a stoma or mouth, can heal at any time that the button is removed. I assume that you have no tracheal damage that will require a permanent trach. Your doctor, or a consultant will be better able to decide what is best for you than I can with this limited information. Dr. Tom
Would Mother Benefit from CPAP Many thanks. Tina A. Dear Tina, CPAP can help with sleep apnea, when it is associated with COPD. Dr. Tom
Simple Chronic Bronchitis Is this always diagnosed by History? I have searched the web high and low looking for detailed information on the course of Simple Chronic Bronchitis. Maybe you might post a link when I can find more info on this topic. Thank you for your good work. Matt A. Dear Matt, Simple chronic bronchitis, is diagnosed by history. There is no airflow obstruction with simple chronic bronchitis. It usually is cured by stopping smoking. Dr. Tom
Could Spiriva be the Cause of Spasmodic Cough? Diane A. Dear Diane, Sprivia should reduce coughing. Maybe you are having an unusual reaction. I suggest stopping the Sprivia for a week to see if the cough subsides. If so, then start it again and see if the cough returns. This should settle the issue. Dr. Tom
Can Bush Killer Spray Cause Damage to the Lungs? The thing I am worried about is one day a man was spraying bush killer in the woods next door. My friend did not know about the spray until he came real close to her house and she smelled it. She went to see what he was spraying but by that time she had already been breathing the fumes for about 30 minutes. Later on that day, she said her sinuses got worse, she had a funny taste in her mouth, and eyes were burning, so she bathed real well. The next day her eyes were red and shestill was tasting something bad and not feeling well. She called her doctor and went to see him and told him what happened. He said she had a bad sinus infection and gave her antibiotics for 10 days. Ten days later, she was not better and went back to the doctor. He gave her 10 more days of antibiotics and 20mgs of prednisone for 7 days. She got feeling better but was having to do the nebulizer treatments 4 or 5 times a day to breathe good. What I am wondering is, could the bush killer hurt her lungs and will she never breathe better? Is there anything we can do to find this out? Edna A. Dear Edna, It could be that the spray was irritating. It should not cause permanent damage. Dr. Tom
Are Kidney Cysts Something to Worry About? Henrietta A. Dear Henrietta, Many people have one or more kidney cysts. These are developmental in nature. Not a problem in most cases. When the kidneys are literally full of cysts, called polycystic kidney disease, this is a hereditary disease that often needs treatment. Dr. Tom
What is the Truth About Oxygen? My mother-in-law has been to three doctors, none of which will prescribe oxygen. They say it makes the lungs weak and dependent. Jane A. Dear Jane, Oxygen does not make the lungs weak and dependent. Your doctors should know better. Nighttime oxygen may be correcting an oxygen deficit during sleep. Nighttime oxygen is best prescribed following studies of breathing and oxygenation during sleeping. Dr. Tom
Wife Quit Smoking but Husband Still Worried About Her Overall Health She has no cough but I see her at odd times trying to get a deep breath. A nurse friend of ours recently did office spirometry with a handheld for her and her results were: The thing that concerns me was her FEV1/FVC was hovering between 71 and 72% on different blows. Is this a cause for concern? John A. Dear John, Your wife's lung function is normal. The FEV1/FVC is normally 70%. Good that she quit smoking before any lung damage took place. Dr. Tom
CPT’s (Current Procedural Treatment Codes) Julie A. Dear Julie, I do not have the billing codebook before me, so I cannot answer your question. Dr. Tom
Is Melting Plastic Harmful to Your Lungs? I know the fumes can't be good, but Poison Control said that they weren't toxic. Can you please tell me if I have anything to worry about? Thanks! Melissa A. Dear Melissa, These fumes from hot plastic were probably irritating. This type of casual exposure will not cause problems. Dr. Tom
Are There Psychological Side Effects of COPD She is also very depressed, anxious, and nervous. She has frequent panic attacks. She came out of the hospital today, and four hours later is in the ER. The nurse at the assisted living center said her oxygen was 83%, when the Ambulance came. The hospital is saying she's crazy and is thinking of sending her to a psychiatric nursing home. Aren't her symptoms common for a COPD Patient? Where can I get a better pulmonary doctor? Need help ASAP! Nancy A. Dear Nancy, Psychological problems are common with COPD. These include anxiety, depression, preoccupations with body functions, and sometimes, panic attacks. Pulmonologists usually understand this and these symptoms generally respond to counseling. Panic attacks can be treated with drugs, directed by your doctor. Psychological problems do not cause an oxygen saturation of 83%. This requires treatment. Dr. Tom Is There Anything Else That Can be Done for My Dad? He is on oxygen and has been ruled out as a transplant candidate by just about everybody we have talked to. He also has some damage to his esophagus, so he also coughs almost always. My mother listens to him cough and gag every night. I guess I just want to know if there is anything more that could be done for him, even if it is risky or experimental. On his present course he won't be with us long at all. Have we exhausted our options? He did make a trip to the National Jewish Medical and Research Center in Denver and they told us that the disease was so far advanced that there wasn't much they could do for him, other than put him on oxygen and try to make him more comfortable. Last year he looked and acted normal, today he can barely move. What do we do? We feel utterly helpless, and he is losing what makes his life valuable. Russell A. Dear Russell, I do not have enough information to give you a good answer. He has been to an excellent medical center that understands lung diseases in general. I am sure they tried corticosteroids that are often used in radiation-induced lung and esophageal damage. Other medications can suppress his cough and make him more comfortable. Dr. Tom
Could Parrot be the Cause of Repeating Pneumonia? It came back stronger this year so we decided to work harder to find the cause. We had parrots who died from breathing problems very close to the period when the disease first came out, however, we hadn't had another parrot since then. Do you have an idea for the cause to this chronic disease? Shimi A. Dear Shimi, Parrots can carry an organism that causes pneumonia, and can be the source of allergic reactions in the lungs. But with the parrot out of the house, you will need another explanation for the pneumonias. Dr. Tom
Rapid Decline in Lung Health My 8 year old is worried. And, due to needing insurance for me, my husband didn't get a job he wanted. I had to quit mine in June. Biopsy said: panacinar emphysema - NOT Alpha-1 (Alpha-1 Antitrypsin Deficiency Emphysema also known as "genetic" or "inherited" emphysema) but doctors say they believe it’s genes because my lungs look good other than at the very bottom. I handmade crafts this past Christmas for gifts using spray adhesive and glossy sealers - could that have caused my breathing to go so bad so fast. FEV1 - May 1.1 June .900 Aug .800 Will any natural herbs help? Please give me any information you can—my doctor is stumped. I come from a small family and we are running thin on hope recently. Please help. Vicki A. Dear Vicki, You certainly need an explanation for your complex problem. I would have to have answers to many more questions than space allows, to give you a reasonable answer. If emphysema runs in your family, you may have this and not have the Alpha One abnormality. I doubt if the adhesive material you used at home caused the problem. You should be going to an experienced pulmonologist to help sort this out. Keep in touch and let me know what happens. Dr. Tom
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