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Archive: Dr. Tom 86
Posted November 28, 2006

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



Albuterol and Lowering Serum Potassium Levels
Q. How much albuterol should be given to lower serum potassium levels and what would be a good reference to find this information?


A. Dear Daphne, It depends on the potassium level and other factors. Generally, the albuterol is administered by nebulizer for more than one dose, until there is evidence of lowering of the serum potassium level. Albuterol does not take potassium out of the body like a resin in the GI tract. It transiently shifts the potassium into cells.

Dr. Tom


Have Asthma and Smoke
Q. I have asthma, since I was born, I am a smoker and missed more elementary school then attended, but asthma has always been controlled. I only had problems if had severe reaction- nuts, sesame etc.
Have had a bad productive cough for almost three months, put on steroid, antibiotic twice, and still have chronic cough with light brownish red spotted phlegm, had chest x-ray, told clear and tested for TB (with a new hospital position) all clear- any suggestions?


A. Dear Jeannie, Yes. Stop smoking immediately. Don't be stupid.

Dr. Tom


What Does a Diagnosis of COPD Mean?
Q. I have recently been diagnosed with COPD.  What is it and how does it progress?


A. Dear Violet, COPD is an airflow obstructive disease closely related to smoking. It encompasses chronic bronchitis, emphysema and asthmatic bronchitis. It is progressive at various rates. It is evaluated by spirometry and treated with smoking cessation, bronchodilators and inhaled corticosteroids in selected patients. It is best managed by a pulmonologist.

Dr. Tom


Training Material for Tracheostomy and Ventilator Care
Q. Dr. Tom, Do you know of resources for free training materials for Trach and Vent care?


A. Dear Kristy, There are training models for this, but I do not know of any free material.

Dr. Tom


Have a Very Low DLCO But Doctor Says I am Fine, I Have a Family History of Interstitial Fibrosis
Q. Dear Dr. Tom - I am very confused. I have never smoked. I have a very low DLCO (46%) and FEV 25% is low but the rest of the PFT is normal.
CT scans show bibasilar scarring in my lungs that has increased over time. The most recent CT scan found a small irregular density in the right mid-lung field and minimal bibasilar atelectatic changes. Pulmonary vasculature is at the upper limits of normal.
I have had chest pain and heaviness with shortness of breath on any exertion for three years now and the doctors keep telling me I'm fine. We also have a history of interstitial fibrosis in the family. Should I seek a 4th opinion? This is further complicated by the fact that I have Lupus and Myasthenia Gravis. Please help.


A. Dear Teri, Your lung function is quite compromised. You should see a pulmonologist. Obviously, you are not "fine". Get a diagnosis and proper treatment.

Dr. Tom


Can You Become Dependant on the CPAP Machine?
Q. I have been diagnosed with CHF, sleep apnea and hypoxia.  I am on oxygen around the clock and sleep with a CPAP machine.  The more I use the CPAP machine I have noticed I am dizzy when I come off of it and I don't feel like I am getting enough oxygen unless I am on it.  It seems I am getting more dependent on it. 
Is this how it is supposed to be?  I was told I should need less oxygen and this is not happening.


A. Dear Pam, You do not state the reason that you need CPAP. It is not addicting, but can be very necessary during sleep. You should see a pulmonologist who is also a sleep specialist since you feel that you are not responding well.

Dr. Tom


Will Oxygen Therapy Help Me?
Q. I have one by-pass for five stents and four more stents and end-stages diabetes and two heart attacks and 3 mild strokes. I take much medicine, insulin shots since 1986. All my Dr’s tells me I will not be here much longer.
I get short of breath when I walk to check the mail and when I get to go to the stores shopping etc. Do you think oxygen therapy will help me?
I am 55 and they put the oxygen on me at the hospital every time I am in there. I have been in there 11 times the last two years.
I will go again soon. I feel another blockage in my heart. The diabetes and cholesterol is bad too. The sugar is running 400 and we can’t get the cells to recognize the insulin.
Please let me know what you think. I ask one Dr and he said they need a reading on a test, but he never orders it. Do I need to ask my heart Drs.?


A. Dear Lynda, Get your doctor to do simple oximetry that will tell the oxygen level in your blood. If low, oxygen may be helpful. Keep a positive attitude.

Dr. Tom

How Can You Tell When You’re in End-Stage COPD/?
Q. How can you tell if your in end stage of COPD, and what are the signs to look for?


A. Dear Linda, I do not like the term "end stage COPD". It usually refers to older patients with severe airflow obstruction as judged by spirometry. Many with so-called "end stage" disease live comfortable and productive lives for many years. Sometimes they outlive their doctors.

Dr. Tom


What Questions Should I Ask the Pulmonogist?
Q. My mother-in-law, 79 years old, had surgery over the summer for pneumothorax. She just finished a 10-week pulmonary rehabilitation program and now has been told she needs oxygen 24/7. I am going with her to a pulmonologist in a few weeks and I would like to know what questions I should ask regarding her follow-up. Can you give me any advice?


A. Dear Edna, Ask all the questions that come to your mind. Ask them simply and expect straight answers.

Dr. Tom


Have Breast Cancer; Could this Matastasize to the Lungs?
Q. I have recently been diagnosed with breast cancer, no lymph node involvement, but a recent CT of my chest showed decreased volume on the right with plueral thickening, I am not a smoker and do not have asthma.  Could this metastasize to my lung?


A. Dear Deborah, Breast cancer can metastasize to the lungs. There are a number of x-ray manifestations of metastasis, including nodules, fluid and pleural thickening. Your doctor will have to interpret your results.

Dr. Tom


Perform Only the Respiratory Therapy That Works and Abandon Therapy That is Not Beneficial
Q. Dr. Tom, I have the RRT, CPFT and RDCS credentials having worked 28 yrs in the medical field.
Nebulized medications seem to have little or no benefit to patients on ventilators. The literature states less than 3-5 % actually reaches airways that may do some good. Why do we continue with this when there is such little benefit? This seems to be true with CPT therapy. Literature states very little clearance when optimal conditions and technique are met so the consensus is it doesn't benefit the patient and sometimes causes harm to the patient if done incorrectly.
Respiratory therapy should abandon any therapy that is not beneficial to the patients. Remember IPPB? Proven to be of no benefit so it was finally abandon after many years and costing the healthcare system lots of money. I am hearing a resurgence of IPPB in some hospitals. We should stick with the things that work and abandon the things that don't.


A. Dear Mike, I agree with you. Do what works for the patient! The problem is that there are individual responses to various treatments, so generalization is not so easy.
I recommended the IPPB study. Yet it is possible for IPPB to help selected patients. Here is where your experience comes in.

Dr. Tom


Worried About Mother’s Pains in Chest
Q. Dear Dr. Tom, I am writing to you in regards to my mother who will be 56 on December 1. My mother has smoked cigarettes (about a pack a day) for more years than I can remember.  Recently, she was here at my house for a visit and had cold like symptoms.  She took a cough drop in the middle of the night to help control the tickle in her throat and the coughing only to find out she was allergic to the menthol in the cough drop.  I ended up having to take her to the emergency room the next day because she said she felt like she was having a "heart attack." 
She described her symptoms as she "could not breathe" and had severe pain in her lower chest area down by the lower rib cage.  The emergency room took her back fairly quickly and they gave her two albuterol nebulizer treatments, cough syrup with codeine and phenergan because she was allergic to the codeine (to prevent her from vomiting). 
Her chest x-rays showed no sign of broken ribs, pneumonia or anything else noticeable. There was no wheezing, like with an asthmatic patient but the doctor and nurses described “tightness" to her lungs.
The nurse gave her a huge lecture about how the pain/tightness she was feeling in her rib area, as she describes it, was most likely from the beginning onset of lung disease where her muscles are tired so other muscles are being used to help her breathe.  I don't know if this is true or not.  They released her and prescribed her some prednisone pills and an albuterol inhaler.
What I do know is that my mom went home and saw her primary care doctor (military medicine/retired) and the doctor sent her to do a breathing test. The breathing test made her heart do some "hiccups" during the testing but the doc found nothing to explain the pain/tightness she is feeling in her lower lung/rib area.  She has been using a heat pad, which she says gives her some very limited relief but no explanation as to what is causing the pain.
The doctor really made my mother mad because he said he was going to give her a referral to a psychiatrist if he couldn't find anything to explain her pain.  Now, how does seeing a shrink make your chest pain go away? All it did was make my mom mad. 
In your opinion, what could be causing this?  Is there another test that perhaps could find out if this is the beginning of lung disease?


A. Dear Barbara, It sound like your mother has some reason other than anxiety to explain her sudden chest pain and tightness in her chest. She should see either a cardiologist or pulmonologist for a diagnosis. NOT a psychiatrist!

Dr. Tom


Have to Remind Myself to Breathe
Q. I find myself not breathing all the time.  I have to remind myself to breathe.  I even get dizzy because of this.  Is there a name for this?


A. Dear Pam, You probably have hyperventilation. If your feelings go away when you exercise, this is the answer, and a way to deal with your symptoms.

Dr. Tom


Husband’s Lungs Have Not Returned to ‘Normal’ Functioning After Bypass Surgery
Q. My husband had a quadruple bypass operation in January.  His heart is functioning fine, but his lungs have not recovered.  He is very breathless and cannot do very much at all without getting extremely tired.  He had a CT Scan, which showed considerable bilateral thickening of the lining of the lungs. 
A lung surgeon had a look at it and said an operation would have more risks than benefits and he would advise continuing with conventional treatment because improvement could follow in time.  It was still early days.  To us this seems like being condemned to a slow and lingering death. Any light at the end of the tunnel?


A. Dear Elisbeth, Yes, the pleural reaction should gradually resolve.

Dr. Tom


Stopping Advair?
Q. I have been using Advair for a month now and the coughing has reduced drastically. How do I stop Advair? Should I wean off? If so, how? 


A. Dear Smith, You can just stop it and see if your symptoms return. If they do, you may need Advair for maintenance therapy.   
You did not state the diagnosis that caused Advair to be prescribed originally. Be sure you have a solid diagnosis such as asthma to justify the continued use of this expensive product.

Dr. Tom


Spot on Lung
Q. What does a spot on your lung indicate?


A. Dear Crystal, It all depends on the size and characteristics of the spot, and whether or not it is growing. It can represent a benign or a malignant process.

Dr. Tom


What Should We Do to Help Father’s Lung Condition?
Q. Dear Doctor, I am responsible for the care of my dear 83-year-old father who is currently living in an Assisted Living Facility. Dad has Alzheimer ’s disease and moderate dementia as a result of the disease. Otherwise his physical health has been good over the years.
Recently, Dad developed what seemed as an upper respiratory infection, although he had no fever and all of his blood tests were all quite normal. His breathing still sounds somewhat congested at times.
In treating the respiratory infection Dad had a Chest X-Ray followed by a CT Scan with IV Contrast. The results showed “a 7 mm density in the right upper lung field, which could represent an area of scarring or small noncalcified granuloma. In addition, there is some more linear density in the right mid lung field; however there is a nodular appearance as well. The areas measure approximately 3 cm in length x 1 cm in greatest thickness and two in number. There is some stranding density in the right lung base, probably the result of scarring and chronic ateletasis and the result of chronic elevation of the right hemi diaphragm.
It was recommended that we should repeat the CT Scan in 3-4 months to exclude the possibility of neoplasm.
1) Would you also recommend that a PET Scan would be advisable at this time to offer a better definition as to what is happening?
2) Are there any other tests you might consider to determine why my fathers lungs continue to sound somewhat congested after three weeks of treatment on antibiotics?
I’ll greatly appreciate your best advice.


A. Dear Bob, This should be a decision made by you and your doctor. Many would not pursue the diagnosis of malignancy further, because the treatment has many burdens.  
I did not get the impression that your father was suffering from these lung lesions. They may be slow growing processes, and accordingly, not a threat to your father's future. May be best to just leave the radiologic findings alone, rather that get more tests, that would stress your father.

Dr. Tom


Side-Effect of Medications
Q. Dr. Tom, My mom is a depression patient for which Dr. have prescribed a medicine named Libotryp DS. Besides that she is taking Molan 30 for acidity and Asomex it’s for high BP. She has been taking these medicines for the last two years and now she is facing many problems like problems in breathing, dry mouth, dizziness, constipation to agitation and tremors. Can you please help me whether she should continue her medicines or not?


A. Dear, Ankita, I am not familiar with these medications, so I cannot advise you. These drugs are not used very often in my field of pulmonology.

Dr. Tom


19. Treatment Sequence for Multiple Treatments
Q. Is there any thing published on the order of doing treatments, for patients that are on multiple therapies like a CF child?
In our clinic we have chosen the following sequence. If the patient is not on that therapy they skip it and move on to the next.
1. Bronchodilator
2. 7% Hypertonic Saline
3. Pulmozyme
4. Airway Clearance
5. Tobi/ Colistin
6. Inhaled Corticosteroid


A. Dear Gary, I do not often use "cook book medicine". The procedures you talk about are all useful in CF in various combinations. I cannot suggest a protocol to fit all patients.

Dr. Tom


What are Clinical Findings?
Q. Received results from CT indicating a "sub centimeter nodular density in right lower lobe, noncalcified.  Assuming clinical findings are benign, consider follow-up in three months."  Where do I get "clinical findings" and should I wait three months?


A. Dear Jean, “Clinical findings” just mean the patient’s symptoms and signs of illness. Not very appropriate for this report, in my opinion.

Dr. Tom


Is Burning and Irritation Part of COPD?
Q. In the past have written a couple of questions, my doctor says I have 55% of lung function. Lately I have burning and irritation. Is that part of COPD? I have been taking Spiriva and Albuterol inhalers, but the burning and irritation persists. 


A. Dear Teresa, Burning is not a common symptom of COPD.

Dr. Tom


Do You Know Anything About Investigative Drug That Helps Damaged Lung Tissue to Regrow
Q. Dear Tom, I was reading recently about a new drug that may actually help damaged lung tissue regrow. It’s currently under trial on Alpha-1 patients at Birmingham University hospital in England. Professor Robert Stockley is leading the trial.
Apparently the drug targets the receptors that help lung alveoli to grow. The researchers themselves have said that they are in completely new territory with this drug and that it is the closest anyone has ever been to a cure for emphysema! It has apparently worked on animals and has also passed the safety test on humans. The trial is due to last one year. It started April of this year.
The new drug came about after scientists made a study of what makes babies lungs develop when in the womb. Again Vitamin A seems to be involved. (Retinoic acid, which seemed to work on mice with emphysema but does not seem to be working on humans was also a derivative of Vitamin A. Anyway, this drug seems to be something new although still based on a molecule of Vitamin A. I was wondering if you knew or heard anything about this possible new wonder drug?


A. Dear Sean, I have not heard of this investigational drug. As you state, retinoids, did not work in humans, but there may be some related drugs that are worth a try.

Dr. Tom


I Would Like Your Opinion on my CT Scan.
Q. I was a smoker for 45 years and have been on Chantix (smoking cessation) for the past five weeks and am doing very well and hope to continue. I wanted to get an exam by a Pulmonary Specialist to determine a medical starting point of my stop smoking.
I had a PFT and a chest X-Ray and they showed I have chronic bronchitis but no COPD, etc. I just had a CT Scan performed as well and these are the results: CT Chest w/o IV Contrast Findings: Spiral scanning through chest using 5mm slice thickness w/o IV contrast demonstrates coronary arterial calcifications. No pneumothorax or pleural effusion. No destructive osseous lesion. No enlarged mediastinal, hilar, axillary lymph nodes.
3mm nodule in the lingula, seen on image 40. There is a mild pleural thickening posteriorly at the left base. Lungs otherwise clear. 2.3 cm benign cyst in left mid kidney.
Impression: There is a tiny lingular nodule, for which a follow-up CT of the chest in six months is recommended. Mild thickening of the left basilar pleura. Small benign left renal cyst.
Could you please comment on the results and proposed follow-up?


A. Dear Donald, The tiny nodule is most likely benign. The renal cyst is certainly benign. A follow up of the tiny nodule in six months is a reasonable approach. The pleural thickening is most likely a result of an inflammatory process in the past, and requires no follow-up, but it will also be seen if you get another CT.

Dr. Tom


Venous Blood for pH Disorders
Q. Is it acceptable to use venous blood instead of arterial for pH values? The pH value being used for acid/base readings with acid/base disorders.


A. Dear Eric, No. It bears no relationship to arterial pH, in most situations.

Dr. Tom

Heavy Feeling in Chest Goes Away with Deep Breathing
Q. I smoked off and on for 12 years. My most recent quit came as I felt a cold coming and that is a great time to get rid of them. It started, as what I thought would be a chest cold, but it did not ever really get that far. That was 7 months ago.
I went to a GP and described the feeling in the middle of my chest as heavy, maybe tight sometimes, sort of like heartburn other times. I also experience a SOB with little activity or after a large meal. Today, it is still there. A sort of odd feeling in the esophagus and with a little movement, I have to inhale deep and fast. Sometimes I have to deep breath at rest. I did not then and do not now cough or produce any phlegm.
These were my complaints at the GP's office and it is the same today. This seems to go away if I continue activity. It is as if my lungs need to 'warm up' and then things seem O.K. Shortly after resting after the activity, it returns.
The GP did the spirometry test my oxygen level was at 97% and he told me that for my age (37) height, weight etc., that he would not worry about it. All other chart measurements were well within normal range.
It is six months later and it is the same. What could this be? Is it time to go to a specialist? Does the increased activity and the deep breathing problem disappearing sound like anything known? Am I just that far out of shape?
BTW, I am still smoke free. Never again!


A. Dear Steve, Great that you stopped smoking. I cannot guess the cause of your symptoms. Better see a pulmonologist if concerned.

Dr. Tom


Retirement Home is Going Smoke-Free, Need Help for  Residents to Stop Smoking
Q. I am a service coordinator in a retirement home which is planning to go 100% smoke free by January of 2008. At this time residents can smoke in their apartments. We have had one smoking cessation program which was conducted weekly by an employee of the local health department.  A small group of very faithful smokers attempting to quit attended the weekly session which convened for one hour every week for six months. Participants cut back, but to my knowledge no one quit smoking. 

We have limited funds, but would truly like to help our residents prepare for the day when they can no longer smoke inside the building.  Many are cooperative and would like to quit.  What would be the best kind of program you could suggest for us, and what would be the average length of time for that program to work.  Thank you for your time.


A. Dear Marsha,There is no magic program. A commitment to quit, and choice of a quit date is key. The new drug Chantix, a nicotine receptor blocker is a help. Good luck.

Dr. Tom


Could Chest Tightness and Shortness of Breath Be Linked to Sjogren’s Syndrome and/or Fibromyalgia?
Q. Dr. Tom, Over the past seven years I have been to all kinds of doctors to include a pulmonologist that later sent me on to a rheumatologist and from there they diagnosed me with Sjogren’s Syndrome and fibromyalgia.  I took the treatment from them now for three years but I still experience the chest tightness, shortness of breath and the feeling of my lungs being squeezed and it causes a lot of pain.

I go to my regular MD, just about every six to eight weeks and they take a x-ray of my chest and call it pleurisy or sometimes bronchitis. I have had enough x-rays and taken enough antibiotics for most people’s lifetime.

My concern is not only does this come on every other month, but it also affects my larynx by altering my voice.  Their concern is that it is in my voice box now.  But I am mostly concerned with why do I keep getting pleurisy and or bronchitis?  My chest hurts to look down or turn my head.

Do you have any suggestions to see if it is linked with my lungs?  I just know how my body feels and they tell me that fibromyalgia cannot be in the lungs, but what I feel is on the outside of the lungs.


A. Dear Cindy, Your fibromyalgia and pleurisy and dry eyes, may be part of a "mixed connective disease" process. "Mixed connective disease” is a mixture of symptoms of some or all of the collagen diseases such as; scleroderma, rheumatoid arthritis and/or lupus. When some aspects of these disease states are all that manifest, doctors, use the mixed connective disease designation this with your doctors.

Dr. Tom


After a Three Week Hospitalization I Have Needed Oxygen 24/7
Q. I have severe emphysema (FEV1=24) and on oxygen 24/7 for two years.  I am also an Alpha (SZ) and on weekly infusion replacement therapy. I have not had any further loss in lung function since replacement therapy, nine months ago.

I attend pulmonary rehab two times per week.  My question to you is why the sudden need for oxygen?  I was placed on oxygen after a three week hospitalization wherein I had been intubated for 13 days. 

My daughter had me transferred to another hospital where they began to wean me from the respirator.  I was completely unaware of everything until the weaning began.  I remember going to the hospital that night by ambulance and going into the emergency room for difficulty breathing.  I woke up three weeks later. 

I was unable to walk, could barely write, etc.  My daughter states that the staff, at the first hospital, told her that I had pneumonia and while in the hospital on respirator, I got another bout of pneumonia.

I just don't understand why this one event would cause the need for the oxygen I now am on.  I have tried functioning around the house without my oxygen on and within the first 10 minutes, I am breathing very heavily and put the oxygen on and within a minute I am fine.  Thanks for any information you might offer. 


A. Dear Cindy, The chest infection may have just been enough to cause more lung damage on top of your alpha one emphysema, so that now oxygenation is impaired. Don't hesitate to use the oxygen to be able to function and enjoy life. Why try to struggle without it?

Dr. Tom


Doctor Says Not to Worry But Husband is Getting Weaker.
Q. My husband has been ill since before Labor Day. He was in the hospital has had three different treatment of antibiotics has a inhaler. 

But he is still weak losing weight coughing taking meds for the cough and cannot keep any food down.  He has lost 14 lbs in about a three week time period he has had two CT Scans one says they found sixmm nodule right lower lobe what does that mean? He can not get a straight answer from his doctor she says don’t worry, but he is getting weaker. 

What should we do?  She is a pulmonary doctor, should she not know? Can you help me please I’ am worried my husband has never been sick ever he just turned 40 and has never smoked.


A. Dear Debi,   Better get an answer from this doctor fast, or get a new doctor. There has to be an explanation for this weakness. I cannot speculate what it is.

Dr. Tom


Risk of Lung Cancer and Smoking
Q. How much greater risk are former heavy smokers at for developing lung cancer; 50% greater risk, for example, than people who never smoked?


A. Dear Deborah, It depends on when you started to smoke, how much, and whether or not you  have airflow obstruction as measured by spirometry. Even former smokers have a much higher risk of lung cancer than non smokers.

Dr. Tom


I am An Ex-Smoker, How Should I Be Screened for Lung Cancer?
Q. Hi. I am 47 and smoked for 27 years quite heavily, but quit 10 years ago. 
Just this year, I asked an internist if I could have a yearly chest x-ray as screening for lung cancer.  He agreed reluctantly saying chest x-rays are not really proven to increase cure rate in lung cancer. 

However, my question is to you is:  Is a yearly chest x-ray an adequate way to screen for lung cancer?  In other words, will a chest x-ray show early lung cancers, catching them soon enough to be treated and cured? Or is a CT (spiral) necessary? Hopefully not because my doctor would never order this, particularly because I have no symptoms to speak of.  Thanks for the info.


A. Dear Deborah, A chest x-ray is not sensitive enough. CT is the only way to go. You are at risk and I suggest yearly CT scans. There is new evidence that the cure rate of very early lung cancer diagnosed by CT is about 85% at 10 years. Much better than with lung cancer diagnosed by standard chest x-rays.

Dr. Tom


Had a Spirometry at Health Fair; Should I See a Doctor?
Q. I had a spirometry done at a health fair. My readings were: FVC 69%, FEV1 55%, FEF or PEF 3.85. oxygen sat. 94, heart rate 77. 

I'm a smoker with a smoker’s cough and cough of junk in the a.m.. In my early 50's, 10-15 lbs overweight. Those that did the test wouldn't say outright if I need to see my doctor. Does this need to be checked?


A. Dear Donna, You do need to see a doctor for a firm diagnosis, and stop all smoking for sure. The spirometry can be repeated to see if the results are confirmed. Dr. Tom 


What is Formoterol Fumarate and How Does It Work?
Q. What is the formoterol fumarate in Foradil that it takes away all head stuffiness I've had in my years with COPD and gives me hours of successful and comfortable breathing?  I have been on the Foradil for one and a half months; formerly I used the Advair which was never as effective. I am on oxygen 24/7. 


A. Dear Doris, Formoterol is a quick acting beta agonist bronchodilator that is also long lasting. Great that you respond so well to it.

Dr. Tom


What are the Chances of Lung cancer
Q. I am 41 year-old male who recently had a CT Scan with oral and IV contrast. After the scan the tech ask the radiologist to look at it. Now to ease my mind his impressions are as follows; "There is a 3mm ovoid noncalcified nodule about the anterior lateral aspect of the middle lobe of the right lung which may be due to noncalcified granuloma. a follow up CT Scan may be considered in six months to evaluate stability." I have not been able to sleep worrying about this. What are the chances it is cancer.


A. Dear Doug, The chances of this being lung cancer are small, but not zero. You did not report on your smoking. Get a follow up in six months, and avoid all tobacco smoke.

Dr. Tom


Does Your Chest Circumference Increase With Lung Disease?
Q. There is a question about chest circumference.  In general someone without lung disease as you age does your chest circumference grow?


A. Dear Jackie,  It may increase in states of marked emphysema. 

Dr. Tom


Doctor Ordered Expensive Medication for Asthma, Any Ideas?
Q. Dr. Tom, I have asthma and my doctor recommends Advair which is very expensive.  Any suggestions on patient assistance for this drug?


A. Dear Susan, Advair is expensive,but effective. The components, serevent and fluticasone are less expensive when given alone.I understand that the serevent component may not be available. A short active beta agonist such as albuterol with the fluticasone, would also be an alternative.  Other anti asthma drugs are less expensive, such as theophylline, and old drug that is seldom used, but may be effective in mild asthma. There are other possibilities.

Dr. Tom


Life of Mucomyst After Opening
Q. I heard that Mucomyst was only good for treatments for 72 hours, how true is this?


A. Dear Tim,  I don't know. Consult the package insert.

Dr. Tom


Had Flu for Two Weeks but Continue to Bring Up Mucus
Q. Hi Tom, Last year while in Columbia and Panama I got a real bad flu which lasted for well over a week or two and has now cleared.  However ever since then I have been bringing up clear muscus and getting chest pain sometimes although this appear to be more related to stress and a lack of sleep then anything else. 

Unfortunately I am still in Latin America and still have the same problem, visiting doctors is a waste of time here and I have tried antibiotics to clear it.  It may be an allergy, I do seem to sneeze a lot and although this started after having this flu it also coincided with my arrival in hot countries, could you advise.


A. Dear Pedro, This post flu cough with mucus can linger on for six weeks or more. You could also be having superimposed allergies.

Dr. Tom


Follow-up: Continue to Lose Lung Function
Q. Hello Dr Tom I wrote to you back in June 2006 Dr. Tom 67- Lost 11% of Lung Function in One Year.

It’s been 5 months since then and I recently had another lung function test this one revealed FEV1 of 47%, FEV1/FVC 56%, FEF25-75 20%, low DLCO and TLCO 240% I am still loosing my lung function my pulmonologist did a bronchoscopy that came back clear he has diagnosed me with severe obstructive ventilatory defect emphysema with no improvement with bronchodilator, and said I am a rapid decliner. My follow up is to have a lung function test and x-ray every three months to monitor me, I am not due to see him until December.

The phone call we had was so short could you please explain what a rapid decliner is? I am now 40 years old 161cms tall, weight 77.0 kg, BMI 29.5. Reading a small amount of information on the internet it says rapid decliners have a poor prognosis, how many years are taken with rapid decline? One doctor told me five years as a prognosis, would this be about right? My chest x-ray and CT scans still come back clear this gives me hope; if it isn’t showing -it isn’t that bad is my theory he,he,he

Any information and advice would be greatly appreciated from you, thank-you once again for all you do here on your site God bless you.


A. Dear Leah, Your FEV1 is quite low for your age. Have you been tested for alpha one defficiency? The FEF 25-75% is misleading and the TLCO does not make sense. Normal loss of FEV1 is about 30cc per year over at least five years. Rapid decliners may lose 80-100cc or more. You really need to check out alpha one, and of course avoid all smoke.

Dr.  Tom


Question from June 2006
Q. I was diagnosed with COPD a year ago my FEV1 was 64% and my report read moderate obstructive ventilatory defect, gas transfer mildly reduced consistent with lung parenchymal and or/pulmonary vascular dysfunction.

At that stage I was a smoker of 60 cigarettes a day, I have weaned myself slowly smoking now only six cigarettes a day I had a lung function test this past Tuesday and my FEV1 is 53% my report reads severe obstructive ventilatory defect please note CoHb4.1% unable to obtain TLCO patient could not hold breath for duration of test.

I understand I need to stop smoking all together and I am going to, but should my lung function decline this fast? I know we all loose lung function as we age but to loose 11% in one year is this normal? My pulmonologist has said there is not much I can do apart from totally stopping smoking and be careful of aerosol cans etc.

 I am really scared if I loose this much lung function it wont be more than three years and I wont have any please can you explain the normal amount we are suppose to loose? 


A. Dear Leah, The amount you lose each year depends on your height, age and sex, but it is far less that 11%. I doubt if you have really lost this much. Do completely stop smoking now and have your lung function measured again in about six months. You may be surprised that your lung function is not dropping as fast.

Dr. Tom


Influenza Pandemic
Q. In the influenza outbreak of 1918, there were no ventilators of sufficient quality, nor were any in widespread use.  Considering both the pharmacological and technological innovations since that time, what has been the specific cause of mortality in the 150 H5N1 (Asian) flu deaths?  Considering that Asian countries may have had a lack of technology in the regions where the virus spread, will the West fare better when the presumed pandemic occurs?


A. Dear Brady, The cause of death has been respiratory failure, as judged by the reports. We do have bette facilities to treat respiratory failure in this country and elsewhere, but the risk of death will still be high in the severe cases requiring life saving care,and these are the patients that will help to spread the disease, if it occurs in a pandemic. So far, there is no evidence of human to human transer. The clustering in families suggests a common source of the bird flu.

Dr. Tom


Congestion and Stuffiness  
Q. I have had a stuffy nose and have to clear my throat especially when I lean back on a chair.  If I exercise and do floor exercises I seem to get some congestion and cough a bit.  I had a test done and my doctor said I had some response to whatever they have you breathe in and she said I have asthma, most likely exercise induced.

What does exercise induced asthma mean and what can you do for it.  She had me try some prescription nose inhalers and also a breath inhaler and I didn't really see a difference when using them, except feeling too over medicated.

I exercise five days a week and get breathless some days after doing the stair-stepper for 10-15 minutes, but not always.  This is like climbing 70 floors according to the machine. 

I am 58 years old.  My biggest complaint is the feeling like I have to clear my throat a lot.  Any suggestions.  I haven't taken any medication for two months and the symptoms are pretty much the same.  I did get a cold last winter when we flew a lot and never totally got rid of these symptoms.  Any suggestions.

A. Dear Deb, An old drug known as cromolyn, or Intal, is very effective in preventing exercise induced asthma. It has essentially no side effects. Exercise induced asthma, is asthma, triggered by exercising, and also sometimes by other things such as exposure to cold dry air. I am not sure this label explains you throat clearing symptoms.

Dr. Tom


Worried about Father Who Has Emphysema and Continues to Smoke
Q. My father has emphysema and still smokes two packs of cigarettes a day.  He's supposed to be on O2 continuously but does not follow that advice.  His saturations at his Dr's office run in the mid to high 60's.  He falls asleep a lot lately while sitting up or doing anything really.  What will happen when his body simply isn't receiving enough O2?  He has an obvious blue tint to him, especially around his lips and mouth.


A. Dear Gina, His emphysema will progress. He should take his oxygen and not smoke. I recognize that tobacco is a terrible additiction. He may need a stop smoking aid such as the new drug Chantix. Ask your doctor.

Dr. Tom


Mother Has Lung Mass the Size of Golf Ball
Q. Dr. Tom, My Mother is a 76 years old. She moved to Colorado from Mississippi five-6 yrs. ago and for at least three years she has been on oxygen. 2 LPM at  rest and 4 LPM upon exertion. We are currently looking for her a good pulmonary Dr.

She has had a CT scan and two PET scans in the past 1-1/2 years.  She had breast cancer, Dec 2004, and the doctors thought my Mother had lung cancer around Feb. of 2005.  She does have a mass the size of a golf ball but her current doctor is just checking to see if it gets bigger every six months. No biopsies have been made. The last test he said there was no change in size.

This Sunday at dinner we were eating and I noticed bubbles coming out of her mouth, she holds her hands to her chest a lot and puts pressure there and said it helps.  I took her to the restroom and she eventually vomits a bit of food.  I asked her how often does this happen and she says four-five times week.

Her current family Dr. is no longer accepting Medicare and I need to find a good senior family Dr. and pulmonary. Her family doctor told her she has a deviated septum and that she is not getting 1/2 he O2.  I'm worried about surgery for her.

They are also talking about TransTrachael O2 for her.  We are not having much luck at a good place for her to have any one really tell her what the procedure is and if she is a good candidate for it.  Rose Med. Center no longer has their pulmonary rehab exercise program and if she has the trans trach O2 therapy she will need a good rehab program. 

I was a certified respiratory therapist YEARS ago and am in a new field now so I know only a tiny bit about the surgery and am more concern of the mass in here CT scan and her eating problems.  Hopefully you can help direct me so I can help Mom. 


A. Dear Hallie, There are many good pulmonologists in Denver. You might want to try National Jewish Hospital which as an excellent pulmonary rehabilitation program. The golf ball size mass needs a diagnosis now and not in six months.

Dr. Tom


Herbal Remedies and Pulmonary Fibrosis
Q. I have PF.  To help control it, I'm on a lot of medication.  I'd like to take some herbal remedies, e.g., herbal teas for the immune system and others that sooth my throat and help me sleep at night but don't know if they will interfere with the medication.  Do you think herbal products will interfere with my medications?


A. Dear W. I do not think so. Give them a try.

Dr. Tom


Could Medication Be Causing Dry Mouth and Lost Sleep
Q. Dear Dr. Tom for the past few weeks I have not been able to sleep. I also have been having a terrible dry mouth and it keeps me up at night. I feel like my mouth is stuffed with cotton. I am taking Combivent Cozaar, Glipizide and Avandia. I have been taking this for quite some time. Do you know what can cause this it seems to have come on all at once just three weeks ago? What can I do to get rid of it? Do you think these meds can cause the dry mouth?
The pharmacy recommended Oral Balance gel is that safe to use? Can you recommend something for me? Can you please help me out? Thank you so much.
yours truly Marie  god bless you


A. Dear Marie, I cannot guess the cause of the sudden dry mouth. Combivent could be contributing. I do not know about the other medications. Taking an oral mouth gel for relief makes sense.

Dr. Tom


Lung Volume Reduction Surgery or Transplant for Alpha-1
Q. Hi Dr Tom, I was diagnosed with advanced COPD, Alpha-1, 1 three years a go and now I am being assessed for double LVRS surgery or transplant, I am 47. I have been having very bad burning sensations in my back both sides. Do you know what causes this?  I am not on oxygen therapy at the moment.  I get very dizzy with terrible hot sweats day and night - which just come on frequently.


A. Dear Marion, I do not know what causes these symptoms. I doubt if they are from emphysema or alpha one defficiency.

Dr. Tom


What Do You Think of Xolair for Asthma Treatment?
Q. I have had severe asthma since I was 21; I am now 59.  I've been having a lot more trouble lately, but all my pulmonologist says is that he's tried nearly everything on me.  Now he wants to try Xolair, a bi-weekly injection.
The information on the internet says that it hasn't been very successful in asthmatics who take cortisone internally (as I have for 30 years).  What do you know about this drug and how safe is it?


A. Dear Nancy, The drug is safe and expensive. It can work in patient who require steroids. I think it is worth a try.

Dr. Tom


Noncompliant When it Comes to Large Doses of Prednisone
Q. Dear Dr. Tom,  Every time I have a problem with my COPD, whether it is a slight cough or just feeling bad, my pulmonologist immediately prescribes large doses of prednisone, (which I refuse to take), and antibiotics.  I am on 10mg prednisone, alternate day therapy plus an inhaled steroid and do not do well on larger doses.
My disease is severe, 6 to 8 lpm O2 on exertion, 3 lpm at rest.
Is it common practice for pulmonologist’s to matter of factly order large doses of prednisone without so much as a thought to the patient's response to this powerful drug?  I have become a noncompliant patient when it comes to steroids, and I don't like feeling this way.


A. Dear Clare, Large doses of predinisone for colds and ordinary chest infectiions is not usually done. I think you are wise to follow your feelings that these doses are too much for you.

Dr. Tom


Can You Wear Oxygen During a PET Scan?
Q. My Mother-in Law has COPD. She is on five liters of oxygen 24 hours a day. She recently had a CT Scan that showed an enlarged aortopulmonary ( node adjacent to the lateral aspect of the root of the aorta in the aortopulmonary  window. It has grown in the last six months from 0.4 X 0.3 to 1.8 X 1.6. There were also “coarse linear densities seen in the right middle lobe as well as the lower lobe. The radiologist’s suggests a PET Scan for assessing the mediastinal adenopathy.
My question is; can a person on oxygen receive a PET Scan? She could not go the required 30 minutes, or more, without it. Second, in a life long heavy smoker with COPD is this enlarged node more likely to be cancer or just some bacterial infection of some sort? What other tests would you recommend?


A. Dear Liz, She can take the oxygen. The node has a fairly high chance of being a cancer, rather than an infection. It needs to be checked our.

Dr. Tom


I am a Cancer Survivor, Should I be Concerned About Growth of Lung Nodule?
Q. I was diagnosed in 2002 with stage III colon cancer and underwent surgery/chemo. Last December (2005) a very small 2-3mm solitary lung nodule was found during a CT scan. We have been following the nodule with serial CT scans and over the past nine months the nodule has steadily grown to 6-7mm. The nodule is classified as "indeterminate". Even with the growth it has been recommended that the only thing we do at this time is to re-scan again in three months. Apparently this is due to the small size of the nodule.

Given my cancer history - does this sound reasonable? Should I consider a biopsy or resection? I am 44 and in otherwise good health.


A. Dear Jennifer, I think that with definite growth, a tissue diagnosis is needed now.

Dr. Tom


2024 American Association for Respiratory Care