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Archive: Dr. Tom 71
Posted July 19, 2006

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


Congestive Heart Failure and Using Oxygen During Sleeping Hours

Q. Please explain the benefits of nocturnal oxygen therapy in relation to congestive heart failure. Thanks, been a fan for years.


A. Dear Tom, Many people with congestive heart failure have an oxygen deficit during sleep. It is sometimes due to irregular breathing, and often from lung congestion. Giving oxygen to correct the deficiency helps relieve strain on the heart. It is good practice.

Dr. Tom

Physical Symptoms with Ventilator Changes

Q. When PEEP (Positive End Expiratory Pressure) to 8-10 from 5 what is the average time frame to see improvement in oxygen saturation, or to see a decline in blood pressure And if there is a drop in blood pressure (BP), what is the average time frame for blood pressure to return to baseline once peep returned to original setting of 5?


A. Dear Jess, There is no simple answer to your question. It depends on the underlying illness, and individual cardiovascular responses. Usually the time for BP responses to such changes in end expiratory, if any, are in minutes.

Dr. Tom

Fast Track Transtracheal Oyxgen

Q. Dear Tom, I have read the clinician's directions for a Fast Track TTO (Transtracheal Oxygen). It seems to have advantages over and above the modified Seldinger method TTO normally offered by my HMO. They will not "do" the Fast track TTO, but said they could do a "mini-trach" as in a "pediatric" trach. They say this is so similar as to be almost the same.

My question "Is there a clear advantage of the Fast Track TTO method over and above the mini-or "pediatric" trache for TTO purposes. I exercise at very high flow rates...15 Liters. If the Fast Track is superior to the others I may have to try to go "outside" my HMO, which of course will be expensive.


A. Dear Lyn, I am well aware of your athletic accomplishments, using high flow oxygen, here in Colorado. Congratulations once again.

Either method of placing the transtracheal prosthesis, will work, and they are indeed similar. The important thing is to have the procedure done by someone with lots of experience.

Dr. Tom

Atypical Pneumonia Recovery Time

Q. I had a headache on May 19, followed by high fever, rapid heart beat and difficulty in breathing. The doctors started me on amoxicillin which didn’t do much good and another doctor prescribed Avelox.

By then my breathing got pretty bad and I was rushed to the hospital on May 28th as I almost lost consciousness from lack of oxygen. All the blood reports showed perfect and normal, but the chest x-ray showed a patch in the right middle lobe. The doctors said it was the blood report being normal and no cold or cough symptoms that camouflaged their diagnosis and it took so long for them to diagnose it as atypical pneumonia. I was started on erythromycin syrup and Rocephin through IV. When I was discharged from the hospital, I was given Keflex for another 2 weeks.

I feel better now and x-rays show that 90 percent of the patch has cleared up. How long will it take for me to feel completely normal and back to my old self? What is the care and period of house arrest rest I must take! I have not carried my youngest child for so long as the general advice is do not lift weight. I can't wait to get back my health. I feel better but I keep reading about relapse that can come by not taking the exact rest. I am not able to understand what exactly is atypical pneumonia recovery time and why. How long before my breathing will be perfect and normal.


A. Dear Laila, The recovery time varies, but in general is a few weeks, at most. It depends a lot on your previous lung function. There is no evidence that rest will shorten the recovery period. Assume full activity as soon as you are comfortable doing so.

Dr. Tom

How Should You Wash a Nebulizer Cup?

Q. Dear Dr. Tom, I recently asked a question about whether bacteria can grow in a totally dry environment? If yes, does this include pseudomonas and MRSA (Methicillin Resistant Staphylococcus Aureus is a type of bacteria that is resistant to certain antibiotics)? I wanted to elaborate further my reason for asking is important to me because I was told by my child’ s pulmonologist that when cleaning the nebulizer cup I should make sure it is totally dry before using it again, he then stated "bacteria cannot survive in a dry environment." There is an argument to this effect by his home health nurses who want to just rinse the cup and use it again before it dries.

When I tell them what his doctor has stated they say the doctor is wrong. Are the nurses just being lazy, and is the doctor correct? Personally, I believe the doctor.


A. Dear Jona, Bacteria survive better in a wet environment than a dry one. Often rinsing with dilute vinegar is advised, and I believe this is a good idea. Drying does not take long in air, after the excess moisture is shaken out of the nebulizer.

Dr. Tom

Improving Breathing and Voice:

Q. I had a tracheotomy in 1998 and now I would like some help with my breathing and improve my speech as I find it very hard to even walk up a hill. I Have tried an inhaler and I found it helps a little with my breathing but only last for a very short time. I was hoping you would be able to help me with some ways to improve my breathing and voice with out an operation. I also smoke.


A. Dear Ady, I assume the tracheostomy was a temporary procedure and the trach is healed. Sometimes there are scars around the opening, or in the air passage itself. You should have this checked.

Dr. Tom

Been Around Second-Hand Smoke, Should I Be Worried About CT Scan Results

Q. Dear Dr. Tom, In 2005, I was admitted to the ER for pain in between my shoulder blades (I wanted to rule out a blood clot). However, I did not think I was having a heart attack. My report states that I had a nonspecific right middle lobe, less than 4 mm. pulmonary nodule. I am not a smoker, but married one and have been around second hand smoke for many, many years. I am 57.

My father had lung cancer twice. His first lung cancer started out like this. Should I be worried? My report states that if I had no smoking history, I should have no follow up CT done. What do you think?


A. Dear Meta, In view of your family history of lung cancer, I would suggest a follow up in six months. The risk of lung cancer to you is low, but not zero, particularly with exposure to second hand smoke.

Dr. Tom

Need ‘Plain English’ Explanation

Q. Dr. Tom, I hurt in my chest all of the time, not sure what is hurting. My question is how can I tell whether it is my lungs or my heart or my stomach. I have COPD and my blood oxygen is 56 my breathing test showed that my breathing is 22%. Tell me in plain English what this mean. Help me please to understand.


A. Dear Lynne, Your blood oxygen is low and near the range when supplemental oxygen is helpful, if it remains in this range. It may go lower with exercise. Your breathing capacity is in the range where you work hard to breath. This may cause some chest muscular pain. Usually, chest pain is not a major symptom of advanced COPD.

Dr. Tom

Treatment for Alpha-1 Antitrypsin Deficiency

Q. A good friend has been diagnosed recently with Alpha 1 disease. Can you provide any insight into the treatment? He receives weekly infusions, however he seems to be deteriorating.


A. Dear Jane, Weekly infusions of the material missing in Alpha one disease may slow the rate of loss of lung function and improve prognosis and quality of life. Your friend must be going to a pulmonologist for these infusions and may need some additional medications.

Dr. Tom

Likelihood of Developing Lung Problems Like Mum

Q. My mum died aged 57 of emphysema after she died I found out she had only one good lung from age 18 through pneumonia and also developed asthma. I have worried myself, sick thinking, will I end up the same, although I have never had pneumonia or asthma.

I am 47 years old with no breathing problems. I had a chest x-ray 2 years ago, which everything was normal and I exercise,

I know I should stop smoking but a long history of anxiety has made this very difficult. I have Graves disease and once the thyroid is normal I am being prescribed zyban.

What I would like to know is; if my mum suffered with pneumonia when 18 and only had one healthy lung then got asthma then emphysema and died at 57 what is the likelihood of the same happening to me?


A. Dear Bev, You will not have the same problems as your mother. But it would still be best if you can stop smoking. You may be able to do this with Zyban or other medications. Good luck!

Dr. Tom

What Does Lung Age Mean?

Q. I had PFT's (Pulmonary Function Tests) done today and it said that my lung age of small airways is 88 year old. I am 45. What does this mean?


A. Dear Nancy, Lung age is the age at which your present lung function would be normal. But lung age should not be based on tests for "small airways function". Lung age should be based on FEV1 or FEV1 percent of normal for your height and age. Ask your doctor what your FEV1 (forced expired volume in one second) is and what percent of normal. Let me and the readers know. You may be surprised that your lungs are not so "old".

Dr. Tom

Heart and Lung Problems, Could They be Related?

Q. I did a breathing test and have been diagnosed with small airway disease. What is this?

I have trouble breathing if I walk or climb a few stairs. My chest also hurts. Sometimes at night I wake up trying to catch my breath. I also had a chest x-ray and it came back as unremarkable except for mild biapical plueral thickening which is somewhat nodular.

I also had a left heart catheterization performed as the result of an abnormal stress test, which showed mild diffused hypokinesia of all segments of the left ventricle with an estimated ejection fraction of 40-50%. Also found were trace mitral regurgitation and left ventricular diastolic dysfunction. Also, Left anterior descending coronary artery showed a generic 50% lesion and the Left circumflex coronary artery showed a generic 50% lesion.

Could these be related to my breathing problems? My doctor told me not to worry that all is OK. My mother died from breast cancer and my dad from a heart attack after having 6 by passes done. Thanks.


A. Dear Kathy, Heart and lung diseases are commonly related. Smoking and inflammation of the vessels of the lung and heart are probably the reason. So called ‘tests’ of "small airways disease", unless done in a research laboratory, are commonly misleading, and often wrong. Your heart tests do show some loss of function, but you can be normal and have a good long life with these abnormalities. Be sure to avoid tobacco smoke, exercise and eat well with lots of antioxidants. Remember to live every day with zest.

Dr. Tom

2024 American Association for Respiratory Care