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Archive: Dr. Tom 74
PostedAugust 10, 2006

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



Test Results

Q. Dr. Tom, I am 31 years old, an ex smoker of five years and I have been exposed to Silica dust as well as a two year exposure to a house with mold problems.

I had a pulmonary test done today, and was told everything looked normal with the exception that my oxygen intake was at 120 and was predicted to be 100. I was then told that could be bad if I was not releasing enough out of my lungs when exhaling. The number that was assigned to the exhale was 24; mine was 26 meaning that my lungs are retaining a little more oxygen.

I was told this is not a significant difference and that everything still looked good. But I can’t help but wonder if this could be the warning sign of a developing respiratory problem caught in its early stages.


A. Dear Aaron, I don't understand these test results. What does "oxygen intake" mean? It is not a commonly used term in pulmonary medicine. What are your spirometry values and any tests of diffusion or blood gases?

It is possible that this term does refer to diffusion, also known as gas transfer. If this is correct, your results are normal. If I have more information, I can interpret your values.

Dr. Tom

Outgrowing Asthma

Q. Dr. Tom, Regarding an answer you gave (archive Nov. 05) you wrote that maybe the child will "outgrow" his asthma. I was taught that asthma is a chronic disease like any other, and that in fact in may lay dormant for many years but does not go away, and may very well appear latter in life? Your thoughts?


A. Dear Carol, Boys may "outgrow" asthma more commonly than girls, for some unknown reason. It can lay dormant for years, but in boys it often does not return in later life. Sometimes very late in life, it can rear its head again.

Dr. Tom

Squamous Metaplasia

Q. In 04/2004 my dad was seen for coughing up blood. CT showed a spot on RLL that MD diagnosed as 'squamous metaplasia'. This past June another CT showed four or five more spots now on both lungs. I have researched this medical term and have not been able to find the two mentioned together. I've found a definition for 'squamous' and one for 'metaplasia'. Does this really exist?


A. Dear Christy, Squamous metaplasia,in the lungs (and other organs) means a change in the cell type of the lining of the air passages in some places. This is not a malignant change, but may be the first step in a complex process that, later on, could evolve into a malignancy. It often regresses on stopping smoking.

Dr. Tom

PFT Results

FVC 71%
FEV1 59%
FEV1/FVC 65%
FEF25-75 32%
PEF 78%
TLC (74)%
FRC N2 (70)%
RV 69%
VC 79%
Moderate obstructive changes, most likely chronic bronchitis.
My question is with these numbers can you tell the difference between chronic bronchitis and Emphysema and also with the TLC (Total Lung Capacity) being under 80% would this also show a restrictive component, and should I be concerned.
My doctor does not like to discuss the COPD; he doesn't think it is bad enough to worry about although he did prescribe Spiriva. Should I be on any other medications? I do not have shortness of breath. I quit smoking three years ago.


A. Dear Wendy, Spirometry showing obstructive changes does not distinguish between chronic bronchitis and emphysema.

You are correct the values also show a restrictive defect. Your results are not too bad. It is great that you stopped smoking. You may not need the Spiriva.

Dr. Tom

Growth of Lung Nodules

Q. I wrote to you several months ago about three small mm nodules that were found by CT Scan of my chest. I went to the lung doctor and showed him the CT and he said they were very small, smooth, and he would send me for a follow-up like the report to do (three to six months). I was too nervous to wait six months so I went in at four. The Dr. read the report and they got smaller and felt they were fine and nothing to worry about, and I did not need any more follow-ups.

When I found out Dana Reeves had it in August I went back because I sometimes I feel I can’t get a good breath. I do have allergies and sinus. But I get an ache in my upper back, ribs, and shoulder mostly my right. I also have Epstein-Barr (Epstein-Barr virus, frequently referred to as EBV, is a member of the herpes virus family and one of the most common human viruses) and hypothyroid and have had lots of muscle aches in the past and I am high strung.

He said I was fine and can be getting a little asthmatic and he did not want to expose me to all that radiation. He said if I wanted to take another CT, to ease my mind, to wait a year.

It has been a year and a half since my last CT (02-05). He gave me the prescription in April but I was scared to go. I am getting a dry cough mostly for about 10 days, a little phlegm not really and it is clear and a little yellow. I realize my nose is a bit sinusy, but I don’t feel a drip. I cough to clear myself to breathe better.

What is worrying me is it is almost two years and I have this cough and when I cough and breathe in deep my back aches and, mostly my trapezoid muscle. My ribs feel inflamed which I also had before. I don’t cough when I am asleep only during the day.

I am going to the lung doctor. I was never a smoker but I lived with them. Do you think the nodule could have grown? I read that you were supposed to go for follow-ups until two years. I am concerned. Do nodules grow fast? Hope you can help.


A. Dear Angel, Since you are a non-smoker I do not think that the chances of the tiny nodules are enough for youto do another scan. I realize that Dana Reeves was also a nonsmoker, and environmental smoke is a risk. If you do get another scan for reassurance, wait a year is my advice. These small nodules do not explain your symptoms.

Dr. Tom

Pneumonia and Low Oximerty Results

Q. Dr. Tom, My son is now a little over three and a half years old. When he just turned two, he got pneumonia. The emergency room measured his oxygen saturation level at 46~48% using the pulse oximetry. The doctor used two more pulse oximetry to confirm the result, but also did a blood test to confirm those instruments. My son did recovered and appears to be a normal and healthy child. Would there be some hidden long-term damage to his organs and brain that we should look into?


A. Dear Ted, I do not think so. Young children can tolerate transient low oxygen quite well. Assume that he is now normal.

Dr. Tom

Using Lubricant with Oxygen

Q. What lip and nose lubricating products can be used while using supplemental oxygen?


A. Dear Edith, You can use non-oily lubricants, such as KY Jelly.

Dr. Tom

Inhalers and Uncuffed Tracheostomy (Trach) Tube

Q. What are your thoughts on uncuffed trach tube* patients using inhalers (Spiriva, Combivent, Advair)? She had been doing via mouth per the hospital that she was released from.


A. Dear D., I do not know how sufficient pressure could be produced to be able to inhale these medications with an uncuffed tracheostomy tube. It would also require a device to connect the trach tube to the drug delivery devices.

Dr. Tom

*Uncuffedtracheotomy tube; there are several types of tracheostomy (trach) tubes; the cuffed tube has a small soft ballon that helps to hold the trachin place.

CT Report is Confusing

Q. I am very confused on my CT report, my doctor found posterior mediastinal* mass on my lung. In my first report three months ago they called it a lesion, mass, tumor, then a nerve sheath tumor can it first be called all these things and mean the same?

Now they did another scan it hasn't grown though this CT scan also says there is minimal biapical pleural parenchymal scarring. When I looked this up it talks about cancer, can this be caused by any thing else and should I be worried?

My doctor wants to wait another year for another CT. People around me keep telling me I should have a biopsy to be sure because that’s the only for-sure way to know.

Do you think I should wait a year? Also in my first CT they said it has a soft tissue density. Please give me advice am I worried about nothing?


A. Dear Pat, The mass needs to be explained by a biopsy.

A nerve sheath tumor could be malignant, but also benign. The apical scarring indicates some remote inflammation, and is not particularly indicative of cancer.

I think you should not wait a year for a definitive answer. Your worries can be resolved by making a diagnosis.

Dr. Tom

* The mediastium is the part of the chest between the breastbone (sternum) and the spinal column and it contains the esophagus, trachea, heart.

Cough for Over 12 Weeks

Q. Dr. Tom, I am a 34 year old, healthy woman, with a cough of 12 plus weeks. I have been treated with antibiotics, allergy medicine, and tried three weeks of prescription antacid. A chest X-ray was normal. I had a PFT with methacholine challenge (a test that can identify people with “sensitive” airways, often used to diagnosis asthma) and got through all levels with a 17% decrease (I'm told that is not conclusive of anything.).

Any ideas why I still have a wet cough? I am being treated in a military clinic and do not feel they have enough specialties to know what is happening with me. One doctor suggested my neck is getting fat and blocking my airway. I am 5'4" and 161 lbs.


A. Dear Stacey, If, the cough started with a chest infection it will slowly resolve.

If your cough continues, insist on a definitive diagnosis and you should be referred to a pulmonologist. Dr. Tom

High Oxygen Flow Rate

Q. I work at a hospital and it has been said that it does not matter what you set a nasal cannula at 8 liters per minute (l pm) – 10 lpm because the most that that patient will get is 6 lpm

I personally feel the setting should never be above 6 lpm. Can you injure a patient setting it higher than 6 lpm?

I also think that anything over 4 lpm of oxygen should be humidified.


A.Dear Helga, No, but the high flow may be somewhat irritating. Otherwise it will not cause harm.

So called humidifiers, such as bubblers do not add much humidity to theoxygen.

Dr. Tom

May have Inhaled Small Piece of Plastic

Q. I may have inhaled a small piece of probe cover plastic by mouth. How concerned should I be? Would this kind of plastic break down, be expelled or remain in my system? I am a former smoker of 20 years quit six years, age 40.


A. Dear Sara, Plastic will not break down in your lungs. If you are coughing, you should have a bronchoscopy* to look for the piece and remove it. Dr. Tom

* A bronchoscopy is a diagnostic procedure in which your doctor uses a scope (a tube with a camera on the end) to take a look at the inside of the airways and lungs. Lung tissue biopsies can be obtained during a bronchoscopy.

Mother has Severe Shortness of Breath, Surgeon says she May be Too Old for Surgery

Q. My 73 old-year mom had diverticula surgery few years back with temporary colostomy, now with huge hernia. Cosmetically it bothers her, but more importantly- has severe SOB (Shortness of Breath) uses O2 when needed and can’t walk far. The surgeon told her she may be to old for surgery but was cleared by heart doctor. Could repair of hernia help with her SOB?


A. Dear Debbie, It depends on its size and location. I believe you can find a good surgeon that will do the surgery if necessary.

Your mom is not too old, unless she has other things wrong with her. Has her lung function been measured by simple spirometry?If not, I suggest you get this done to help access her risk of surgery.

Dr. Tom

14. What about Air Cleaners?

Q. My husband has COPD and I was thinking about getting an air cleaner but I don’t what type to look at; they have cleaners with Hepa filters and some with no filters that have a “magnetic” grid that you clean yourself. Any thoughts?


A. Dear Nita, So called air cleaners mostly remove dustfrom theair. They are not very effective inpolluted areas.

Dr. Tom

15. Continuous Positive Airway Pressure (CPAP) and Carbon Monoxide Poisoning (CO)

Q. Would CPAP with 100% 02 be an effective therapy for CO poisoning?


A. Dear Ron, Yes, about the same as 100% oxygenwithout CPAP. Hyperbaric oxygen is more effective.

Dr. Tom

16. Blood in Phlegm

Q. Hello Dr Tom, Last October I coughed and when I looked at it, it was phlegm with blood. I could feel the blood rising from my lungs up to my throat causing me to cough, I called the ambulance and they asked whether I had ate anything that had scratched the back of my throat, or swallowed anything awkward, I said, no. It stopped within five minutes and I went back to normal and thought nothing of it.

Then a month later it happened again and lasted for about three minutes. It was like a tickly cough and when I coughed there was blood, not a lot though. I noticed it was always when I came on my period.

This sequence happened for about four months and I have not had a problem since apart from a slight tickly cough, and it seems to be worse when I go to bed, or lie down.

At the time of this happening I did a lot of shouting and screaming and I thought that this was the cause. I haven’t coughed up any blood for at least five months but I get worried and when I worry my chest goes tight and I get a little twinge under my breast bone. Do you think it is anything serious to worry about? I do smoke and I have smoked for at least eight years. I’m a 23-year-old female. Thank you for your help and time.


Dear Michelle, It is possible that you have endometrial implants,i.e. tissue similar to the lining of your uterus, in your air passages. This would explain the coughing of blood during your periods.

This can be diagnosed by bronchoscopy, which involves placing a small tube inside your air passages for direct vision. This procedure is done by a pulmonologist.

Dr. Tom

2024 American Association for Respiratory Care