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Archive: Dr. Tom 40
Posted November 18th, 2005

Questionable Medication Practice
Q. One of the local pulmonologist is writing a strange order: Dump a capsule of Foradil into a nebulizer with a unit dose of budesonide (home-made Symbacort) and nebulize. I fear this practice results in no bronchodilator delivery and has no basis in the literature.

I also fear this "experimental" therapy, without IRB (Institutional Review Board, assure that, in research involving human subjects, the rights and welfare of the subjects are adequately protected.) approval, could jeopardize the therapist's license.

Your recommendation, please.


A. Dear Tim, You are quite correct. The inert material of the dry powder, or the powder itself, probably inhibits aerosolization (production of an aerosol -- a fine mist or spray containing minute particles). This combination has no scientific standing, by the products selected. It actually is a "new drug", by FDA (Federal Drug Administration) regulations, and accordingly, should only be used as an "investigational new drug," i.e. IND, by FDA requirements.

I believe you should not be forced to use it, and should take it up with you medical staff. Sticking your neck out has risks, but you are right. Go for it!

Dr. Tom


Interpreting PFTs
Q. Dr. Tom, I would like to know how you feel about Respiratory Therapists (RTs) interpreting simple PFTs (Pulmonary Function Tests) for the occupational use of respirators. Do you know where I can find specific guidelines for the interpretation of PFTs for respirator use? Thank you very much.


A. Dear Ric, I believe RTs are qualified to do this. There are OSHA regulations for the use of "respirators," which are not respirators in the usual sense, but tight fitting masks. These require a reasonable ability to ventilate, which is measured by simple spirometric tests, FEV1 and FVC. Ask OSHA for a copy of their requirements.

Dr. Tom


Internist or Pulmonologist to Read PFT?
Q. Can a PFT (Pulmonary Function Tests) be performed and read by an Internist as apposed to a pulmonologist? Where can I further find out the guidelines on this?


A. Dear Juan, Certainly an internist, allergist, pulmonologist, and any one who wants to learn about the interpretation of simple spirometry can do this, just like the interpretation of arterial blood gases results. I do not know a reference on this. Common sense.

Dr. Tom


Pneumonia Immunization Frequency
Q. I'm a 77 year old man and had a pneumonia shot about 5 years ago. Do I need a booster shot?


A. Dear Art, This is debatable. Won't hurt.

Dr. Tom


Wegener’s Granulomatosis
Q. I recently checked your website because I am a Wegener's (an uncommon disease, in which the blood vessels are inflamed.) patient who has been fighting this illness for 4 years now. I have already had two lobes removed because none of my doctors knew what the masses were, as it turn out it was Wegener's.

Now after a short remission I have been told that the Wegener's is back and I have lost another 17% of lung capacity and have to once again look towards chemo as treatment - as I am looking for other treatments I found your website and as I would expect to find certain illnesses I was disappointed to find that Wegener's was not one of them and I was wondering why?


A. Dear Stefanie, Wegener's Granulomatosis, is a complicated disease, usually treated with prednisone anti-inflammatory drug) and cytoxan (anticancer drug). You need an expert to guide your therapy. There are other alternatives.

Dr. Tom


Treatment of Bullae
Q. Hello. I am a 29-year-old female and have Neurofibromatosis (Neurofibromatosis or NF is an inheritable genetic disorder that leads to the development of soft, non-cancerous tumors, neurofibromas, on nerve tissue throughout the body), Epilepsy, and a recent survivor of a rare cancer (1 in 7000). I was told that the cancer was some how connected to the NF however I am not sure it is a rare cancer.

During one of my routine CT scan at Roswell Park Cancer Institute I was told I have bullae (aired filled thin walled space in the lung) on my right apex I have had severe burning pain in my right shoulder now for a while even before they told me the news. I am wondering is there treatment for the pain besides surgery and could the NF play a part in the bullae?


A. Dear Patricia, I doubt if the bullae are the cause of your pain. The pain could be related to your NF.

Dr. Tom


Better Climate of Asthma, Phoenix or San Antonio?
Q. We are living in Phoenix, Az. and are planning on moving to San Antonio, TX. My 11 year-old son has asthma and is not doing very well with it here because of the pollution and dust.

He is on Serevent and Albuterol and we do keep it under control. However we are being told that our move might not be a wise decision, even though I have done my own research and found that the air quality is a whole lot better in San Antonio. What do you know about pollutants in San Antonio verses Phoenix? And what would you recommend, a drier dustier climate or a slightly wetter climate?


A. Dear Stephanie, There are dusts and antigens in all environments. Moving from one area of the country to another, may work for a while, but, often, allergies to new environmental materials may develop. Your son may well "outgrow" his asthma, as he approaches adolescence. Maybe you should stay put and rely on medication to control the asthma, and hope for a remission.

Dr. Tom


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