Medicine Interacting with Other Medicines
Q. I have COPD due to childhood asthma and pneumonia
five times as a child. My chest x-ray shows small
lung size and lung and bronchial scar tissue. I
am a 61-year-old female. I do not have asthma attacks
or lung fluids and have not been a smoker. I have
tachycardia, resting pulse between 90 and 100 when
not on ZIAC. My cardiologist could not determine
a cause for the high pulse rate. My current medications
are Adviar Diskus 250/50 and ZIAC (Bisoprolol/HCTZ
) 10/6.25mg one tab per day.
I understand the beta-receptors and beta antagonists
in the two medicines I take cancel the benefits
of the Advair. Since starting ZIAC my resting pulse
is 70-75 but my breathing quality has diminished.
Would switching from Advair to SPIRIVA and staying
on ZIAC be something that I might benefit from?
Will the ZIAC and SPIRIVA benefits cancel each other
A. Dear Sandy, This will have to be determined
by your doctor. ZIAC contains a beta-blocker,
but it will not oppose Spiriva, as Spiriva is not
a beta stimulator, it is an anticholinergic.
Sleep Apnea and Asthma
Q. I am 39 years old, am not overweight, and have
been diagnosed with sleep apnea. I currently
use a CPAP at night, which I would describe as being
moderately effective. I also have allergies,
and have been taking allergy shots for a year and
a half now, which have reduced the severity of many
of my allergic symptoms.
How much is known about any connection between
environmental allergies and sleep apnea? I
also feel shortness of breath during the daytime,
though an asthma test has not shown me to have it.
Is it common for sleep apnea to cause daytime shortness
A . Dear Keith, Not much is known about environment
allergens and sleep apnea. If the allergens are
causing nasal irritation, this can be contributing
to upper airway obstruction and thus sleep apnea.
Sleep apnea is not directly related to shortness
of breath while awake.
Lung Treatment for Sickle Cell Anemia Patients
Q. Do you have any advice on the effectiveness
of using EZ-PAP vs. IPPB for pediatric sickle cell
A. Dear Dee, Sorry, I have no specific information.
However, if the EZ-PAP, or similar devices, can
avoid nighttime oxygen reductions this could help
sickle cell anemia.
Positive Methacholine Challenge
Q. I've asked a couple of questions in the past,
and have another thought for you. I'm the guy that's
been worried about silicosis over the past
I had a methacholine challenge at St. Luke's yesterday,
and after the first dose of methacholine, I had
a 48% change in my lung function. After the test,
I had an appointment with my pulmonary doctor who
said I definitely have asthma and put me on pulmicort.
Any reason to doubt this diagnosis? He said
it was a very dramatic result and a very easy diagnosis
for him. Sound right to you?
A. Dear David, Yes, right on. This is confirmatory
of asthma, and this is not related to silicosis.
Medications and Hair Loss
Q. I am having hair loss and don't know what is
causing it. I take Glipozide and Avandia for sugar
diabetes and Cozaar for high blood pressure and
Combivent. At first I thought it was the Zetia causing
it so we discontinued that, but I am still having
hair loss. Please, Dr. Tom, what do you think is
causing it? If I just find out, maybe I can change
A. Dear Marie, I do not know any connections between
the medications you are taking and hair loss.
Is "Rest" Beneficial for Bronchiectasis
Q. My question is in relation to bronchiectasis
patients - regarding the subject of "rest".
We all know that certain parts of the body need
rest to heal properly after an injury. But
what about the lungs... is 'rest' a required
component in the healing process of a lung?
For example: if a bronchiectasis patient has a
full-blown episode (fever, coughing, congestion,
etc), would a bare minimum of physical activity
be beneficial, or would it not matter?
A. Dear Paul, Rest each day is a necessity.
Exercise does not worsen bronchiectasis. It is important
to stay active.
Annual Update Concerning Lung Condition
Q. You answered a question for me a year or so
ago. I've been diagnosed with moderate restrictive
lung disease, caused by scarring from an old lung
issue, and traction bronchiectasis from repeated
bouts of bronchitis.
As an aside, I started taking effervescent Acetylcysteine
from Germany a year and a half ago. I went from
two bouts of bronchitis a year, to once in the last
two years. Strictly anecdotal, I know.
Anyway, in my newest round of PFT's (Pulmonary
Function Tests) my TLC (Total Lung Capacity, the
volume of air in the lung at the end of a maximal
inspiration) had actually increased from 58%
to 64%, the FEV1/FVC ratio was unchanged, but the
DLCO (Diffusing Capacity) went from 60% to 48%.
FRC (Functional Residual Capacity, the volume of
air in the lung at the end of normal expiration)
and RV (Residual Volume, the volume of gas remaining
in the lung at the end of a maxima l expiration)
were both greatly increased. Hard to believe because
I feel the best I have in two years. Of course I'm
waiting for my pulmonologist's take, but thought
I would ask you as well.
A. Dear Armand, This is good news. The small drop
in the diffusion test is not alarming, and it still
represents good gas exchange function. The elevated
RV and FRC are also not of great concern.
I believe there is increasing evidence that oral
acetylcysteine can be helpful in your particular
type of restrictive lung disease. Stay healthy.
Consequence of Giving "Too" Much Oxygen
Q. Is it true that if you give the patient too
much O2 that it will increase the CO2 in the body
causing less respirations and just put the patient
to sleep, permanently?
A. Dear JT, No. This is a very common misconception.
When CO2 goes up with high concentrations of oxygen,
it is NOT from a decreased drive to breath. You
do not achieve high oxygen concentrations from nasal
Difference Between Bronchiectasis and Chronic
Q. What is the difference between Bronchiectasis
and Chronic Bronchitis?
A. Dear Sandy, They are both chronic inflammatory
processes of the linings of the air passages. There
is deformity and destruction of the large air passages
in bronchiectasis. Bacterial infection is a far
more common problem in bronchiectasis than it is
in chronic bronchitis.
Can Granulomas be a Cyst or Adhesions?
Q. I have severe allergies, which have been verified
through many allergy tests. During this time
of year they are especially bad and my breathing
becomes strained. I lose my breath when going
up stairs and always feel as if they are struggling
a bit for air.
I have had the methacholine challenge and do not
have asthma. I have been taking allergy shots once
a week for 7 months, and have had no improvement;
in fact I think it is getting worse.
I have had two chest x-rays and they shows multiple
granulomas on my lungs. I have a long history
with adhesions and had a hysterectomy at 32 years
old, (after many other surgeries for adhesions).
I have also had a long history with polyps and cysts.
Had gall bladder out- filled with polyps, had multiple
cysts on ovaries, cyst in sinus etc.
My concern is with my lungs and allergies.
Are granulomas something to worry about? Do
they get worse with time? Could the x-ray
be wrong, and actually be adhesions or cysts and
not granulomas. Thank you for any information!
I see my doctor frequently and they seem to think
it isn't a big deal. I just wanted the re-assurance.
A. Dear Christine, Granulomas in the lung
are commonly healed and of no significance. They
do not relate to cysts or adhesions. Some active
granulomas are present in certain allergic
reactions on the lung surface, but these allergic
processes are not the same as the common granulomas
seen on chest x-rays.
Worried about Husband's CT Scan
Q. My husband had a chest X-ray. The doctor said
that there were spots and he had a CT scan. When
the doctor read the scan he said he had thickening
and the spots were due to his smoking.
I'm still concerned about this, my husband has
a smoker's cough and has smoked for many years.
I want him to see a lung doctor for a second opinion
just to make sure; is this a good idea? His MD just
seemed so vague in his reason for the thickening
A. Dear Stacey, This all sounds vague. So-called
spots are usually benign, but those that show change
are suspicious of lung cancer. Better see a pulmonologist.
Brother and Sister Have Asthma, What are
Q. I have not being diagnosed with asthma yet;
I did however use an albuterol inhaler for about
a month. My brother has being recently diagnosed
with asthma; my sister had being asthmatic
since ninth grade. Is it possible for me to have
asthma but not yet diagnosed? Could I be the one
who has asthma as well? My family goes to the
same doctor. How do I change my family physician?
I am 22 years old last time I went to the doctor
was in 2004 for a cough.
A. Dear Eric, Since your brother and sister both
have asthma, you are also at risk of developing
it. But this is not certain. If concerned, you should
see an asthma specialist, either a pulmonologist
or an allergist.
Update from Craig
Q. Thanks for your last reply (asthma, silicosis
worries). You had asked me to provide you with the
results of my methacholine challenge. After just
one dose of the methacholine (doctor said they do
as many as 4 doses to determine sensitivity) and
retesting PFT's, I had a 48% decrease in lung
They diagnosed me with asthma and gave me Pulmicort-
two puffs, twice daily. I've been taking it for
a week now, at least I think I'm taking it- I really
can't tell if I'm inhaling anything or not, although
I've followed directions.
I haven't had any real change in how I feel in
the past week. I have some upper abdominal aching/pain
that I've had off and on for a few months sort of
on my sides. Not sure if that's related or not.
Seems to be.
Anyway, let me know what you think about the diagnosis,
and if indeed Pulmicort seems the way to go. I've
heard it can take up to a month for it to fully
work. Thanks as always for your time and attention.
A. Dear Craig, Your methacholine challenge is confirmatory
of asthma. Pulmicort is an anti inflammatory drug
that will take some time to work. It does not treat
bronchospasm, and you may need a bronchodilator,
such as albuterol for symptoms. Pulmicort is a controller
of asthma, and albuterol a symptom reliever.