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

 

 

Hyper-Inflated, Hyper-Expanded Lung
Q. What does it mean if your chest x-ray comes back that you have hyper expanded lung fields.

Marte

A. Dear Marte, It just means you can take a very deep breath, and have a lot of air in your chest. It does not tell how well you empty your lungs. It is NOT a lung function test. It is sometimes mistaken for emphysema.

Dr. Tom 

Have Recurring Lung Problems; What Questions Should I ask My New Pulmonologist? 
Q. Dear Dr. Tom, I am 35 years old and five years ago I had postpartum cardiomyopathy.  It was very bad.

After going to the doctors for six weeks, I got to the point where I could not lay down and had a horrible cough. I passed out in the hallway and was rushed to the hospital. It took two weeks for them to find out what I had.  I was in full congestive heart failure with an ejection fraction of 15%. The left side of my heart was three times its normal size and I had two large blood clots in my heart; they never came out of my heart because it was too weak to pump them out.

Prior to finding this out, I had a lung biopsy sent to the CDC and my lungs were drained slightly by a needle inserted into my back. I had a very grim prognosis and stayed in the hospital for 32 days.

I fully recovered one year later, after blood thinners and heart medicine. I have been off all medicine for four years now. Two weeks ago I was not feeling well and went to bed. I awoke at 1:00 am with a horrible pain no my left side in between my ribs.  I was dizzy, vomited and my friend called an ambulance. By the time I got to the hospital, I was coughing up water.

The doctor did chest x- rays and diagnosed me with pneumonia. He sent me home with Levaquin. I got a little better, but the pain in my ribs would not go away. I am an active person and stayed in bed for 12 days.

In between that time I went to the ER twice. A repeat x-ray was done and the doctor said the pneumonia was still there. He also mentioned casually that I have pretty good scarring where the pain is, which happens to be where the pneumonia is. I was not aware of any scarring whatsoever in my lungs.  He said the pneumonia is irritating the scar tissue, which in turn is causing the pain. It has been three weeks now and I still have the pain. I take ibuprofen, Cipro, Doxycycline and Vicodan every day.  The pain is more severe when I hiccup, belch, or try to take a deep breath.

I insisted that they refer me to a pulmonologist they feel that it is unnecessary, but did.  I have an appointment the 26th of this month.

WHAT DO YOU THINK IT IS? What questions should I ask the Doctor? I have a feeling its not good and I am very uneasy about it.

Debie

Dear Debie, It sounds like irritation of your pleura, i.e. the lining of the lung between the lung and the chest wall. Discuss this possibility with your doctor. If it is from pneumonia, it should now be clearing. You must insist on a diagnosis. There are many possibilities.

Dr. Tom

*More information on the pleura

Is It Safe to Take Medications Together?
Q. Recently I had a lung function test and my doctor told me that my lungs are 55%. My question is that he has prescribed Flovent, Spiriva, and Foradil to be taken together.
Once a day for Spiriva Twice a day for the Foradil and Flovent

Can you tell me if it is safe to take all these three medications together?

Terri

A. Dear Terri, Yes, these medications are all compatible with each other, and are commonly taken the way they are prescribed for you.

Dr. Tom

Three Month Cough and Weight Loss, Should Friend be Worried?
Q. A friend has had a cough for three months and losing weight. Should she be worried?

Becky

A. Dear Becky, Yes. See a  pulmonologist. There are many possibilities and your friend needs a diagnosis and appropriate treatment. 

Dr. Tom

Thinking of Moving Dad to Help his Emphysema  
My 79 year-old Dad has emphysema, and has recently been put on oxygen.  We live in the Tampa Bay area of Florida, where it is very humid. My family and I are considering a move to the Asheville NC area.  We would like to propose for my parents to move with us, because I am concerned that the climate is not the best for him here in Florida. 

My question is, is the climate in North Carolina any better for his condition, and are there any "best places to live" with his condition?

Anna Marie

A. Dear Anna Marie There is no "best place" for emphysema, but better at low altitude. I think the altitude in Asheville is about 2500 feet. I do not believe it has any better climate.

Dr. Tom          

Worried about Brother's Emphysema Diagnosis and Lung Function Decline
Q. I have a question relating to emphysema. My 34-year-old brother recently had a CT scan of his lungs, which to his horror showed mild emphysema.

He does not have Alpha-1 Deficiency and has quit smoking. His spirometry was described as being "as near to normal as can be" except for a "slight obstructive component that is completely reversible" His FEV1 was 100%. As you might understand, my family is all extremely worried about him.

Anyway my question is this. How quickly do you think his lung function will decline in the future? I have heard that normal age-related decline is about 25-30ml a year and that it can get up to 100 ml. a year in people with emphysema who continue to smoke. How many ml. a year do people with mild lung damage like my brother but who stop smoking usually lose? Even a rough indication would be a great help.

Sharon

A. Dear Sharon, Most smokers who are losing FEV1 at an accelerated rate, have a slower decline on quitting. Sometimes near the normal rate. Stopping smoking is key to preserving lung function.

Dr. Tom

 Have Respiratory Muscle Weakness, How can I Improve my Lung Function
Q. I have a myopathy with proximal and respiratory muscle weakness. I had some PFT's done that showed a MVV of 31%, MIP 25 % and MEP 21%. I know those numbers are really low. The other PFTs show mild restrictive pattern.

Is there anything I can do to increase these numbers (MVV, MIP and MEP)? I know my pulmonologist told me to avoid colds, etc since already having weakened muscles could turn into something more serious.

I have air hunger and dyspnea with exertion and with lying flat.

Linda

A. Dear Linda,0 You can help maintain your remaining muscular strength by exercising as much as possible, or using a resistance training device.

Dr. Tom

Wishing You Well
Q. I wrote to you a number of months ago regarding my COPD. I read your website whenever I think about it. I am busy living each day and enjoying my 8 year-old daughter. I was saddened to read today that you are sick. You are quite a guy to do this website for everyone else. Handsome too (you look like my father :-)) I hope every day is the best it can be for you and I hope you have many of them.

RH.

A. Dear RH, Thanks for caring. Every day is precious.

Dr. Tom

Peak Flow Meters in Emergency Rooms
Q. With which cases should peak flow meters be used in the Emergency Room?

Respiratory Care Department

A. Dear Respiratory Care Department, Peak flow is not nearly as good as simple spirometry, but better than nothing for unexplained dyspnea, such as with asthma attacks or exacerbations of COPD. 

Dr. Tom               

Son has had Cough for Four Months
Q. My son is 8 years old and he has had a chronic dry cough for approximately four months, following a cold.  After numerous visits to his pediatrician we were referred to an allergist. 

It was determined that he does not have any allergies. He had sinus and chest x-rays done.  He was treated for a sinus infection with Omnicef for three weeks.  His chest x-ray showed "hyperinflation."  Repeat x-rays showed that the sinus infection had cleared but the chest x-ray remained the same.

I am very concerned that I have not been able to determine what is still causing his cough. Is it anything serious?   Any information would be greatly appreciated.  Thank you for your time.

Marilyn

A. Dear Marilyn, You need a diagnosis of the cough. Better see a pediatric pulmonologist. He may need bronchoscopy to rule out a foreign body in the air passages. 

Dr. Tom

Mother has Platelet Disease and is Short of Breath
Q. My mother was diagnosed with ITP (Idiopathic Thrombocytopenic Purpura) at the end of June and since then she was in the hospital for three weeks and they removed her spleen but her platelets still remain below 10,000.  The doctors have put her on Prednisone and Imuran. 
The past week she is really having a hard time breathing and the doctor just seems to ignore it.  Today she saw the doctor and he sent her for a chest x-ray.  The x-ray did not show anything but they decided to keep her at the hospital to find out why she is short of breath.  Can you give me any insight into what possibly could be causing the shortness of breath? 

Joan

A. Dear Joan, There are many possibilities. They should be able to make a diagnosis in the hospital. Be sure she sees a pulmonologist.

Dr. Tom

Could Lung Surfactant Help those with COPD and Asthma?           
Q. Dear Dr. Tom, Would the use of a lung surfactant help individuals with COPD/asthma and/or emphysema? We take steroids  (orally or inhaled) to reduce inflammation.  I have read that in cases of acute respiratory disease, a lung surfactant may be used for inflammation.
Do you think it would be helpful to take supplements of phosphatidylcholine for inflammation, as it is one of the lipids in our body's lung surfactant?

Cindy

A. Dear Cindy, No. There is no study that shows that surfactant works in these conditions.

Dr. Tom

Husband Hospitalized for Shortness of Breath but all Tests are Normal 
Q. My husband has recently been hospitalized for SOB that he had for a week, X-rays, blood work, echocardiogram, lung scan and pulmonary function test, ALL NORMAL!!

He was fine for about six days and with the last four days has escalated. He has to go for a stress test and sleep study. When he can't breathe he gets very anxious, which his doctor seems to think is the problem. It's not.

He can just be sitting watching TV and gets very SOB, then after a while he will get anxious. Do you know of anything else that should be checked? A nurse friend of his said to check the kidneys as a few years ago he had a Hydrocele and then got Sepsis.

Linda

A. Dear Linda, If your husband’s shortness of breath goes away while exercising, mildly such as in walking, it is most likely due to anxiety. If it does not go away, keep trying to find a pulmonologist who can explain his symptoms.

Dr. Tom