Severe Chronic Cough
Q. I have had a severe cough with clear mucous I can't bring it up all the time. My doctor gave me Alavert-D (antihistamine and decongestant) and DY-G100-100MG/5ML LIQ but it isn't working I smoke over a pack a day. But I never coughed before. This has been going on for almost a year what do you think it is. 

Sheila

A. Dear Sheila, Better get an answer from a pulmonologist. Start with a chest x-ray and spirometry to test your pulmonary function (the health of your lungs). There are many possibilities, including chronic bronchitis, lung cancer, and on and on. I cannot tell from what you tell me.

Dr. Tom

 

What Effect do Allergies have on Breathing?
Q. I have written before and you have been kind enough to answer my questions. 

I have emphysema and asthma.  No chronic bronchitis.  I rarely cough.  Anyway, I have a skin condition that itches and my doctor, prescribed me Hydroxyzine HCL (antihistamine), 10mg, along with some creams, to help relieve the itch. What it did was clear up my allergies. 

I have suffered horrific allergies since 1991.  In doing so, my ability to breath has improved almost 100%.  Some days I wake up and forget to use my inhalers, I feel that good.  I do use them, as it wouldn't be very smart otherwise.  I use my nebulizer much less now.  I can walk up-hill with little or no SOB (shortness of breath). 

My question, can clearing up allergies improve one's breathing?  I've been feeling good for almost 1 1/2 months now.  Thank you very much for your help. .

Pat

A. Dear Pat, Yes, allergies can be involved in asthma. Avoiding allergens can help.

Dr. Tom

 

Concerned about Mum’s Chest X-Ray
Q. My mother who is 62 had a bad pain in her right side and went to the doctor, who did a chest x-ray.  When the result came back, it said that she had hyperinflated lung fields consistent with COPD and a small nodule, which was a granuloma in the upper right lobe. 

Mum is a life long non smoker, her husband and kids don't smoke either. Her parents smoked but she stopped living with them 40 years ago. She doesn't wheeze or cough or get bronchitis.  We are very concerned - what could have caused the hyperinflation or COPD?

Kris

A. Dear Kris, Hyperinflation on a chest x-ray, just indicates that the patient can take a big breath. It does not measure lung function and by itself, does not mean much.  

If the nodule is calcified, it is indeed a granuloma. If not, it needs follow-up. Lung cancer is not common in non smokers, but does occur, particularly in women.

Dr. Tom

 

Best Location for Someone who has Severe Emphysema
Q. In April 2005, my husband was diagnosed with severe emphysema. We live in NJ and wanted to know what type of climate/state would be better for him than NJ?

Joyce

A. Dear Joyce, There is no ideal climate. In general a warm, dry climate is preferred by many, and at a low altitude. Examples are New Mexico, Texas and Arizona, but not in the mountains.

Dr. Tom

 

Registered Respiratory Therapist has a Few Questions 
Q. I am a Homecare RRT (Registered Respiratory Therapist) and I have 2 questions for you:

1. In your guide to prescribing LTOT you mention increasing flow by 1 liter during exercise and sleep. Do COPD and Pulmonary Fibrosis patients often experience nocturnal destaturation (decreased oxygen saturations during sleep) and are the mechanism of destaturation due to perfusion changes in the lung? Is this how I should maintain all my patients from now on?
2. A few of my patients receiving LTOT (long term oxygen therapy) complain of nasal drip. What is the possible cause, also, what is the connection between Pulmonary Fibrosis and rhinorrhea (medical term for a runny nose).

Gerry

A. Dear Gerry, The extra one liter at sleep is empirical, not based on good science. Hypoxemia (low levels of oxygen in the blood) is usually worse during sleep due to the mismatching of ventilation and perfusion and reduced respiratory center activity.

Rhinorrhea may be due to nasal irritation from the oxygen flow. Rhinorrhea, is not a symptom of interstitial fibrosis.

Dr. Tom

 

Awakens from Sleep Starved for Air
Q. I have pulmonary sarcoidosis (a disease of unknown cause in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues) and possible tonsil involvement because I have had atypical enlargement of one tonsil for over a year, shortly after being diagnosed with sarcoidosis.

However, I have a general question, I have a problem with sleep where I stop breathing and due to this I get a shock throughout my body that wakes me up starving for air. This happens every night and shortly after going to sleep (10-20 minutes into sleep) so I can only assume that sleep apnea is not the cause, as all literature I've ever read states that sleep apnea occurs in REM sleep (Rapid Eye Movement sleep is associated with dreaming and paralysis of body muscles, except for the eye and diaphragm muscles), and I do not snore.

What are other possibilities for the cause? Could sarcoidosis granulomas inflammation in the tonsils or larynx or somewhere else in that area cause this to happen?

Jeremy

A. Dear Jeremy,  Sleep apnea can occur at any time, but usually during REM sleep. You could have some upper airway obstruction from sarcoidosis that is causing your problem. I suggest a formal sleep apnea study.

Dr. Tom

 

Question about Granulomas
Q. Is there any connection between mild persistent asthma and development of a lung granuloma?  What about a history of pneumonia?  Can pleuritis (pleurisy is an inflammation of the pleura, the lining of the lungs, with subsequent pain) cause scarring in the base of a lung?  Thank you.

Robin

A. Dear Robin, Asthma and granulomas are not related. Pleural inflammation may leave a scar.

Dr. Tom

 

Effect of High Concentration of Oxygen on COPD Patients
Q. Dr. Tom, What will be the effect of giving a high concentration of oxygen to a COPD patient? Thanks.

Aida

A. Dear Aida, Probably not much, but there is no point in giving more oxygen than needed.

Dr. Tom

 

Teaching Pursed Lip Breathing during Exercise
Q. My career is changing from acute care to pulmonary rehabilitation, and I need to educate myself on pulmonary patients and rehabilitation.

I have been able to get quite a bit of information off the Internet and different websites but one thing I am having problems understanding is purse lip breathing with exercise, for example with Thera-Bands (synthetic rubber bands used in exercising), do you breathe in through your nose when pulling the band out and blowing out through your mouth when pulling band together? Is this correct and where can I find more information on this?

KC Klinger, RRT

A. Dear KC, Textbooks on pulmonary rehabilitation can help you. I suggest one of Hodgkin and Connor's editions. Pursed lips breathing involves exhaling slowly against the lips that are partly closed as in whistling.

Dr. Tom

 

Increased Mucus and Shortness of Breath Since Medication Change
Q. I have bullous emphysema and asthma. The doctor prescribed Spiriva in place of Atrovent.  Coincidently or because of the change, I now cough up much more mucous and have a greater shortness of breath after very little exertion.

I am tempted to get off the Spiriva and go back on Atrovent but with more doses of Atrovent.

What would you recommend? Could the shortness of breath be related to the Spiriva? One of the possible side effects listed for Spiriva is difficulty breathing.

Leo

A. Dear Leo, Spiriva and Atrovent work through essentially the same mechanism. If you were better with Atrovent, I suggest returning to it, and taking it three or four times a day.

Dr. Tom

 

“Breath Building” Devises  for People with Emphysema
Q. Does the Volyne Breath Builder have any advantages for an Emphysema patient for exercise? Thanks so much for your time and help    

Dot

A. Dear Dot, I do not know about this device. It is probably an unnecessary gadget. I suggest normal walking and pursed lips breathing (see graphic above).

Dr. Tom

 

What Happens if Bullae are not Surgically Removed?
Q. I have severe bullous emphysema and prefer no invasive surgeries or procedures at this point in my illness. What happens if I don’t get them removed? I already have many problems breathing, even trying to finish a sentence I have to stop and catch my breath.

Jeff

A. Dear Jeff, They will remain the same. There are some new valves under study that aim to reduce the volume of these bullae, but these studies are only done in major medical centers.

Dr. Tom

 

Son had Multiple Lung Problems and Mom is Concerned about Pain and Tenderness around Chest Tube Wound
Q. Dr. Tom, My son had a serious accident one and a half years ago. It was a high-speed car accident resulting in multiple injuries. He coded on 3 occasions. He had pnuemothorax (a collection of air or gas in the space surrounding the lungs, the pleural cavity) and hemothorax (a collection of blood in the space between the chest wall and the lung, the pleural cavity) and of course ARDS (Adult Respiratory Distress Syndrome is a life-threatening condition in which inflammation of the lungs and accumulation of fluid in the air sacs, called alveoli, that leads to low blood oxygen levels). He had chest tubes on either side and was on a vent (mechanical ventilator) for 3 weeks.

Just recently he started complaining that he has pain and tenderness right around the site of the old chest tube wound (chest tube is a surgical inserted hollow, flexible drainage tube that is placed between the ribs and into the space between the inner lining and the outer lining of the lung,  the pleural space, in order to drain blood, fluid, or air and allow full expansion of the lung). It feels somewhat sucken in around the site. He says it feels like a bruise and it is very tender to touch. Since the accident I tend to be a little hyper about him but should I make him see someone about this? He is 20 and thinks mom is a bit nutty about taking care of him.

Beverly

A. Dear Beverly, It is hard for me to tell what this is by the description. Since the accident is that far in the past, I suggest you do have him see his surgeon or a pulmonologist to determine the cause.  

Don’t apologize for being a caring mom. You both have been through a lot, and a sense of some anxiety is normal.

Dr. Tom

 

Want to Understand Pulmonary Function Test (PFT) Results  
Q. Hello DR Tom, I'm a candidate for NYC (New York City) Fire Department. I'm 31 and for the last year and a half I have exercise 3 times a week. I smoked very little when I was a younger.

The results of my PFT were:

FVC ACTUAL	3.52/87%
FEV-0.5 ACTUAL	1.68/64%
FEV-1 ACTUAL	2.31/70%
FEV-3 ACTUAL	3.12/80%

The fire dept. asked that everything be at 80%.

I was an athlete all my life and never had asthma. I’m concerned because I really want the job but I can’t seem to breathe the out (exhale) all of the air that I breathe in (inhale) and the doctor said that I might have a mild obstruction in my lungs, but said that my lungs where in good shape.

Please help me understand.

Anthony

A. Dear Anthony, The only numbers that have clinical meaning are the FVC and FEV1. You are close to normal. I do not think you have anything to be concerned about.

Dr. Tom

 

Could the Medication for My Heart Condition cause Shortness of Breath?
Q. I was discharged from the hospital with acute bronchitis & atelectasis (the collapse of part or all of a lung by blockage of the air passages or by very shallow breathing) which I understand to be is collapse of lung tissue, yet the report with the X-ray states “no acute pulmonary abnormality is identified”.

Question- I am on Amiodarone for Atrial Fibrillation (abnormal rhythm of the heart) and I'm experiencing all bad identifiable effects such as shortness of breath, severe gastric reflux, tremors and now atelectasis.  Should I pursue this lung problem as a possible effect from the Amadarone?

William

A. Dear William, Yes. Amiodarone can cause serious lung reactions. Better get lung function tests.

Dr. Tom

 

Are There any Medications that I Should Not Take Before a PFT?
Q. I have a pulmonary function test in March for disability I take 80mg of prednisone a day (and it's killing me) and 200mg Zoloft a day should I take this medication before the test? 

William

A. Dear William, Stopping these drugs just before the pulmonary function tests, presumably spirometry, will not effect the results. Why are you taking such a high dose of prednisone?

Dr. Tom

 

Lung Problems After Multiple Rounds of Drugs
Q. Dr. Tom, I have a problem that has gone on for 6 months now; chest congestion, cough, fever and hard time breathing.  Had X-rays and a CT-Scan.  All clear.

The only diagnosis I have been given is bronchitis. I have had 3 rounds of different antibiotic, 4 rounds of Prednisone and none of it has helped. The doctor even said he was confused with this.  It just will not get any better  - suggestions?

Sharon

A. Dear Sharon, Get a doctor to do spirometry to test your lung function. Chest x-rays and CT Scans do not tell how well your lungs are functioning. Your doctor should know this.

Dr. Tom