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Archive: Dr. Tom 64
Posted May 29th, 2006

Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

X-Ray Shows Pleural Thickening, Should I be Concerned?

Q. I recently had a chest x-ray and although their impression was “no evidence of acute disease in the chest”, one of their findings was "there is mild apical pleural thickening". Can you please tell me what that means and if there's reason to be concerned? I smoked for 30 years, and quit 2 and a half years ago.


A. Dear Jane, This report is not specific for any diagnosis. It suggests that you had some inflammation in the upper part of your lung in the past.

Dr. Tom

Worried About Nagging Cough and Wheeze

Q. I am a 49 year old female, in good shape, and active. Recently, the past three weeks, I have a nagging dry hacky cough. It wakes me up at times in the middle of the night. I am also occasionally hearing a small wheeze on taking in a deep breath. When I exercise (walking fast on treadmill), I feel like my lungs aren't as healthy. Should I seek medical attention or ride it out?


A. Dear Diane, You did not say if you smoke. If these symptoms last more than two weeks, see a doctor and get spirometry (see National Lung Health Education Program at: https:// ). If you smoke, stop.

Dr. Tom

Lungs Ability to Regenerate after Second Hand Smoke Exposure

Q. I am curious on the lungs capabilities, if any, to regenerate or cleanse itself. If exposed to smoke (second hand in my case) will the lungs, after continued non-exposure to smoke begin to repair, or is the damage that may be there permanent, without treatment?

I'm not experiencing any problems and I've never taken even a puff of any cigarette but was exposed when I was younger and was curious as to its potential long lasting effects?


A. Dear Chad, Most lung injuries from second hand smoke heal after exposure ends. You may want to have spirometry (see National Lung Health Education Program at: https:// ) to see if your lung function is normal.

Dr. Tom

Need Advise on Where to Get Help for Weaning Mother off the Mechanical Ventilator

Q. My mother is 73 years old and has chronic emphysema (diagnosed about 5 years ago). Approximately 1 year ago she fell and broke her hip. In order to perform necessary surgery on her hip the doctors had to intubate (the placement of a tube into the trachea to keep airway open and can be connected to a mechanical ventilator) her and she spent the next two months in the hospital and the facility was making progress with her ventilator weaning.

We were told that she needed to be put in a LTC facility (Long Term Care facility) for further treatment. Once in the facility, all efforts to wean her (from the ventilator) seemed to cease instantly. When we questioned her pulmonologist he simply claimed, "she is not a candidate for weaning.”

As a result, my mother is experiencing a living hell being connected to the ventilator and my family is being destroyed financially. Any advice you can give us would be welcome. Are there facilities in the Rockland County, NY area where we can transfer her to get more aggressive treatment to come off the vent and get her life back?


A. Dear Joseph, Most such patients can be weaned from the ventilator, even after this period. Transfer you mom to a facility that will do the necessary weaning. Kindred Hospitals are good, as are others. She has more than a 50% chance of being weaned. These delays in weaning disturb me greatly.

Dr. Tom

Extra Resources to Finding Quality Care:

Lung Health Online Finding Care
Specific Topics you may find helpful in the YLH Finding Care Sections are:

“Quality Respiratory Care Recognition” Means First Rate Respiratory Care”
The purpose of this program is to help consumers make choices about their health care by recognizing hospitals that promote patient safety by providing access to respiratory therapists to deliver their care. The AARC maintains and publishes a database of long term care facilities that meet a specific set of requirements.

List of Long Term Care Facilities

Medicare's Nursing Home Compare Tool

The primary purpose of this tool is to provide detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.

How to Go About Presenting New Product Ideas and Retain My Intellectual Property Rights?

Q. I've been in working in the HME/RT (Home Medical Equipment/Respiratory Therapy) arena for over 18 years. I have developed some ideas that have not yet been utilized to improve the delivery of portable oxygen to patients in their homes. How can I share my ideas with a manufacturer or potential investor (to see if they are viable), and yet protect my intellectual property rights?

Brian RRT

A. Dear Brian RRT,* You can approach them and ask to sign a nondisclosure agreement. If you have something of value, you may want to patent it with an attorney, or an interested manufacturer could do this for you following the agreement.

Dr. Tom

* Registered Respiratory Therapist

Is Important to Identify Bacteria Type Before Starting an Antibiotic?

Q. At the start of an infection in a bronchiectasis patient, is it important to identify the bacteria before starting antibiotic treatment? Or is it better to start a wide spectrum antibiotic first, then identify if not effective? Which is the best method?


A. Dear Paul, Empiric use of antibiotics is the norm here. There may be more than one organism active in bronchiectasis. Broad-spectrum antibiotics can deal with the most common bacterial invaders in bronchiectasis.

Dr. Tom

Oxygen Needs for Lung Patients who are Flying

Q. Could you explain to me, in detail, how to know if a patient with COPD or any other lung disease who is on supplemental oxygen at home needs more oxygen if they are taking a flight.

Also if you could send me some articles regarding this subject.

P.S. I am a resident.


A. Dear Alan, All passengers will need more oxygen at the 8,000 to 10,000 feet cabin altitude. Look up Dr. Jamie Stoller's article on air travel and the COPD patient's requirement for supplemental oxygen. Dr. Tom

Oxygen and Air Travel. James K Stoller MD. Respir Care 2000;45(2):214-221

Doctor Says I Have Asthma but I Don't Have Asthma Symptoms

Q. I am a 42 year-old male in good health. I just had a physical and mentioned that I have noticed I don't have the lung capacity that I used to when performing aerobic exercise like running and wrestling. My doctor gave me a spirometry test, which he says indicates asthma and the lung condition of a 63 year old.

I don't have any other symptoms like coughing or wheezing and don't experience asthma attacks. I was prescribed albuterol (bronchodilator, rescue drug) and QVAR (inhaled steroid, maintenance/control drug), but I am hesitant to take either because I don't think I really have asthma.

Can a spirometry test show a false reading indicating asthma if one sustains the breath too long rather that exhaling as quickly as possible? What other tests should be done to confirm this diagnosis? Also, what damage can I do to myself if I take QVAR and albuterol and don't really need?


A. Peter If you use the albuterol and QVAR and get spirometry done again, it may show significant improvement. This would confirm the suspicion of asthma.

Dr. Tom

Husband's COPD and General Health is Out of Control and He Continues to Smoke

Q. My husband is 61 years old and has emphysema and COPD, he is on O2 and takes breathing treatments, he still tries to work but he is going on the hospital on a pretty regular basis, once a month and this last time it was two weeks apart.

He still smokes and I can't get him to quit. He has high blood pressure, depression, and now is no longer hungry said if he eats then it's hard for him to breath.

Is the end near? I am so worried about him and I just need to know what to expect will it get worse than what it are ready is.

When he has an attack he can't breathe and he gets real scared and this time his blood O2 saturation was 83. That's the lowest it's been. I just need someone to help me, please.


A. Dear Beth, Your husband is probably heavily addicted to nicotine and smoking. He needs to quit with the aid of a physician and nicotine replacement as well as a drug that helps to deal with depression and nicotine withdrawal. Discuss this with your doctor.

Dr. Tom

Why is a Tracheotomy Needed for Using a Ventilator at Home?

Q. My sister is currently in the hospital from an asthma attack complicated by her emphysema. She had an additional attack in the hospital and can't seem to breathe on her own after two weeks. The doctor mentioned a possible tracheotomy ( an opening surgically created through the neck into the trachea/windpipe ) where she will be on a ventilator at home. I don't understand why she needs a tracheotomy if it is her lungs that are the problem? Could you explain?


A. Dear Shan, The tracheostomy is more comfortable than a tube in the airway. It will allow for eating and talking, and is a better tube for suctioning secretions. She can be weaned from the ventilator in time and the tracheostomy closed, when her lung function improves.

Dr. Tom

Treatment for Lungs Vasculitis

Q. What can be done for vasculitis in the lungs? I am on prednisone 40mg. and 3 liters of oxygen. Pulse oximeter drops from 99% saturation to 86% saturation if oxygen removed. Any suggestions would be helpful.


A. Dear Sally, There are several forms of lung vasculitis. You need a more specific diagnosis. See a pulmonologist. There are other immunosuppressive drugs that can be used.

Dr. Tom

Diaphragm is Paralyzed, Any Chance that I Will Not Need Supplemental Oxygen?

Q . I am currently on oxygen 2 liters. My problem is my diaphragm is paralyzed thus my left lung is 40% and my right 85%. Is there any medication to take other than oxygen to keep my blood oxygen at a safe level, so I do not have to rely on the oxygen 100% of the time?


A. Dear William, No, but the oxygen you use can be portable and you can have a normal life style.

Dr. Tom

2024 American Association for Respiratory Care