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

 

Should I Be Worried about a “Mild Case of Emphysema”?

Q. I have a mild case of emphysema found on x-ray after a roaring case of bronchitis. I also had a lung test done where you sit in a glass enclosure and do different types breathing. My number was 126, in fact the technician that gave me the test even asked me why they had sent me to him because he couldn't find anything wrong with my breathing.

My family doctor (internal medicine) told me to stop taking the Advair Diskus 250/50, that a walk-in doctor put me on (my family doctor was on vacation that week). After a 6-month check-up My doctor said that 126 was normal breathing and I should not take the Adair medicine when I didn't need it.

My question: Should I be worried about the emphysema getting worse, even though I don't smoke or hang around people that do? I am 65 and haven't smoked for 25 years.

Roger

A. Dear Roger, You must not have emphysema, because you have had lung function tests that are reported to be normal. I do not know what 126 refers to, however.

In any case a chest x-ray is not accurate in the diagnosis of early emphysema and this should be known by radiologists. I would follow your doctor's advice and stop the Advair, for which there seems to be no indication.

Dr. Tom

Going “Cold Turkey” with Prednisone

Q. What will happen if I stop taking prednisone 20mg. cold turkey?

Rebecca

A. Dear Rebecca, It depends what you are taking it for, and for how long. If you have been receiving it for only a short time, i.e. less than a month, for something that is easily controlled, prednisone can be simply stopped and not tapered.

Dr. Tom

Father has Spots on Lung, Worried about Lung Cancer

Q. My father has been diagnosed with blood cancer and he is getting treatment for it, he got his first cycle of chemotherapy done. During his recovery period, he was having fever daily and they performed a CT Scan of his chest and found spots in one of his lungs, which the doctors think is some kind of fungus.

Is it possible that a person who is undergoing treatment for blood cancer can have lung cancer too or is it just an infection in his lungs. I'm worried about this situation. Please reply to this question.

Radhika

A. Dear Radhika, The spots are most likely to be a complication of the chemotherapy. Follow your doctor's advice.

Dr. Tom

Therapist Driven Protocols

Q. I would like to write a paper for a class I am taking on therapists-driven protocols at U.S. hospitals. How can I find out which hospitals have implemented therapist-driven protocols for their respiratory therapists?

Charles

A. Dear Charles, Some hospitals have adopted therapist driven protocols, but I do not know which ones or what protocols. In general, I am not a great fan of protocols. It is hard to write protocols that cover all patient situations.

Dr. Tom

Blood Gases and Oximtery Readings

Q. My mother-in-law is suffering from pulmonary fibrosis for the past three years. She has a CO2 retention problem apart from breathlessness. She uses a BiPAP machine (Bi-Level Positive Airway Pressure is a technique that is often used to treat sleep apnea and/or to provide airway support with a face mask rather than tracheal tube that is attached to a mechanical ventilator) with O2 for five hours a day.

Her pulse oxymeter reads 93 at rest. Is it sufficient? How does the oxymeter reading correlate with ABG? She finds the ABG too painful, so we don't subject her to it.

Indira

A. Dear Indira, The pulse oxymeter correlates well with oxygen measures from arterial blood gasses. An oxymeter does not measure CO2.

Dr. Tom

How to Control a Large Amount of Oxygen Tubing?

A. I need a product that can control the large amount of O2 tubing trailing around the floor.  Who can I go to for help? Thanks so much.

Irene

A. Dear Irene; A number of attempts have been made to put oxygen tubing on a spool that can retract. I am not sure that any such product exists. Shorter lengths of delivery tubing such as 25ft , may help. One of the many advantages of ambulatory, i.e. "wearable oxgyen" is the lack of tubing on the floor. Lots of people have tripped or stumbled as a result of the oxygen tubing and suffered injuries.

Dr. Tom

Questions about Bacteria

Q. Can bacteria survive in a totally dry environment? If so, what types of bacteria, and does this include Pseudomonas and MRSA (Methicillin-Resistant Staphylococcus Aureus is a type of bacteria that is resistant to certain antibiotics)?

Jona

A. Dear Jona, Many bacteria can survive in a dry environment for a time, some more than others. Resistant Staph Aureus, and Pseudomonas species are particularly troublesome.

Dr. Tom

Sleep Study Protocols

Q. I'm a RRT (Registered Respiratory Therapist) in a rural community and I've been specializing in patient education for sleep apnea.  What method of screening at home do you prefer to screen patients at home for sleep apnea? 

Is a downloadable pulse oximeter helpful in screening and thus encouraging patient's to go in for the full sleep study?  I was asked by several subacute and rehab facilities to come up with a protocol for screening their patient's for sleep apnea. 

Thank you, Joyce, RRT

A. Dear Joyce, In general, a nighttime record of oxygen saturation can be used as a crude screening test for sleep apnea. It is not very accurate, but it tells about the levels of oxygen, which is an important measure in patients suspected of sleep apnea. When normal throughout the night, sleep apnea is not common. But when low, this simple monitoring does not determine the cause.

Dr. Tom

9.  Worried about Cousin who has Acute Respiratory Distress Syndrome (ARDS)

Q. My question is in regards to fluid in the lungs. My cousin was recently in the hospital when she was overdosed. This caused her to aspirate. The aspiration eventually went into her lungs causing her to develop ARDS (is a life-threatening condition that causes lung swelling and fluid build up in the air sacs). She is on life support as we speak and the doctors have stated to us that there is nothing they can do for her condition because her lungs are not responding.   

I would like to know is a patient who is thought to have pneumonia be positioned flat on their backs? If there is another position? Can you please let me know? Because it is my belief if a person is having trouble with breathing they would be propped up in a sitting position to breath more easily. If I am wrong please let me know?

Are their other treatments available for her condition that we are not being informed of?

Can she receive a lung transplant and can this save her life?

I am very worried for my cousin who has never had any problems with her lungs and all of a sudden her lungs have completely shut down. The doctors have also informed us of the ARDS spreading to her other organs can this happen? My cousin is 21years old. Does she have a chance at a normal life, which includes childbirth?

Rosa

A. Dear Rosa, ARDS can resolve over time with proper care and patient life support. Since your cousin is young, she has a good chance to recover. If she develops associated kidney failure, which is common, she can receive dialysis. Placing patient in the face down position can help with oxygenation.

A remarkable recovery can occur even in dismal situations. Do not ever give up. It may take weeks or months for recovery.

Dr. Tom

*** Sherry, this a follow-up question from last week, please link

10. Follow-Up on Spirometry Test ( Dr. Tom 68 follow up)

Q. Dr Tom, Thanks for being so nice. The spirometer test was done with a very wide tube in my mouth (I wear dentures so it was a problem getting a good solid clasp around the mouthpiece. My results were poor but improved a lot when given inhalers, therefore I was given Bricanyl, and Spiriva. If my lung capacity is 25-30% (FEV1), how come I can put in a very full day at work without gasping for air? I am not on O2 and I am not taking any meds with steroids.

Phil

A. Dear Phil, Some patients have remarkable adjustments to severe lung damage. Keep working and enjoy life.

Dr. Tom

11. Calcifications Found on X-Ray

Q. I recently had an x-ray and they found a calcium deposit under my lung. I am 59 years old. They didn't tell me what causes this or what it may cause down the pike. Could you please help me with some information about this what causes it and if it will lead to anything else? Thank you Norma

A. Dear Norma, Calcium deposits are usually due to healed infections. They are not dangerous. You can forget about the calcium.

Dr. Tom

12. Continue to have Pleurisy Pain ( Dr. Tom 62 follow up )

Q. Dear Tom, I wrote again a number of weeks ago regarding my condition (whatever it is) and a diagnosis of Non Viral Pleurisy. You said you never heard of it!

This is unusual, this Doctor is supposed to be practicing modern medicine for 20 years. He had me convinced but your opinion is with no doubt correct. I have not managed to find this diagnosis on the web either.

Anyway the pleurisy pain is back, I am also having stiff joints in the mornings for the last two years. I had a work up for lupus and was declared normal.

Given this pleurisy is going on over two years and I am an ex smoker with childhood asthma and normal PFT's, Methacholine, CT etc.; apart from a glitch in my 75-25 flows (70% predicted).

My main symptoms regarding my lungs are inability to get a deep breath and a morning cough and mucus throughout the day.

What do you think I should do now? I am tired with this and feel I am wasting my doctors time as I don’t seem to be getting worse.

Thanks again, Conn

A. Dear Conn, There many causes of pleurisy. The term non viral, doesn't mean much. Some chronic pleurisy may occur in arthritis states. You say you have been tested for lupus. Also get tests for rheumatoid arthritis.

Dr. Tom