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Archive: Dr. Tom 88
Posted December 15, 2006

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



Nebulized Glutathione
Q. Have you any information on results of nebulized glutathione for emphysema?


A. Dear Sam, No. Glutathione is a powerful antioxidant, but I know of no human research on inhaling it.

Dr. Tom


New Drugs Pulmonary Fibrosis?
Q. I have pulmonary fibrosis diagnosed in 2004, still stable. Are there any new drugs to slow down the scarring process?


A. Dear Pam, There is an intense search for such a drug, but as of now, there are no breakthroughs.

Dr. Tom


Lung X-Ray Shows Thickening of Lining. Could Open Heart Surgery Cause it?
Q. My mom had open-heart surgery in 2005.  She recovered without any complications. While at the doctor last week for a sinus infection and cough, she had a chest x-ray done. The x-ray showed some thickening of the lining at the top of her lung. Her doctor thinks it may be from her lungs being collapsed during her open-heart surgery. 
Can this be a reason for this or should we be concerned and following up with a pulmonary specialist? 


A. Dear Lisa, This can be the answer, but usually the scaring is at the base of the lungs. For this reason, I suggest consulting a pulmonologist.

Dr. Tom


Does Combivent Cause Positive Methamphetamines Drug Test Results?
Q. I currently work for Children’s Services and have many clients that I need to drug test. Most of the clients begin to list their current medications AFTER they have submitted a positive drug test for Methamphetamines (Meth).
Is there any information anywhere that states which prescription meds could come up positive for Meth. during a drug test? If not, can Combivent make a drug test positive for Meth? How?


A. Dear Jody, No, not through any mechanism that I can conceive.

Dr. Tom


Can I Expect a Normal Life with Mild Emphysema?
Q. Hi Tom! A CT Scan recently showed mild emphysema on my lungs. My lung function spirometry tests have all been pretty good with my FEV1 averaging around 100% and upwards of predicted. In other words my lung function still seems normal although my last test showed mild but completely reversible obstruction.
I quit smoking two years ago when I was 33. I'm 35 now; I exercise regularly and eat lots of anti-oxidant rich food.            
My question is this--Do you think I can have a normal life span? I know it varies from case to case but if I follow my treatment (Pulmicort and Bricanyl), and avoid all environmental smoke; do you think I can have a normal life span?
I'm only 35 and feel I still have so much living to do. I don’t want to be thinking about death and dying but I'm extremely depressed and worried about my future.


A. Dear Dervla, You can definitely plan to live a normal length of life, i.e. to about 80 years on average for women. It is up to you about the quality of life. Hopefully this answer will help.

Dr. Tom


A Few Questions about Lung Diffusion Capacity Testing
Q. Dear Dr. Tom, I recently did a pulmonary function test, which despite some evidence of minor airway obstruction was essentially normal. However I'm a bit concerned about my diffusion capacity measures. My DLCO was 115% but my DLCO/VA was slightly down at 84%.
I can’t seem to get a satisfying answer from my doctor on this issue. What does it mean to have a slightly reduced DLCO/VA when the actual DLCO is at the upper levels of normal? Is there any significance in this? I suppose I'm also wondering which is the more important value--the DLCO or the DLCO/VA?
I am 36 and smoked for 17 years, quit last year.


A. Dear Dan, Your results for the diffusion test are normal. The DLCO/VA just corrects for the size of your lungs and is within the normal range. Stay well and enjoy life.

Dr. Tom


Is There a Risk of Barotrauma with Chest Physiotherapy on Mechanical Ventilation?
Q. Dear Dr. Tom, I am a respiratory therapist and my question regards an issue raised from the ICU consultant I am working with that didn't crossed my info since school; chest physiotherapy in the form of vibration and percussion, is it applicable for mechanically ventilated patients considering the risk of barotrauma, of course.

A. Dear Athra, The techniques of vibration and gentle percussion do not cause barotrauma in ventilated patients.

Dr. Tom                                   


Weaning from Mechanical Ventilation
Q. Is there any difference between a T-Piece and CPAP+PS (Continuous Positive Airway Pressure + Pressure Support) while weaning chronic pts from mechanical ventilation?


A. Dear Abdulmoshen, Yes. A T-piece is complete separation from the ventilator. CPAP +PS is still doing some of the work of breathing.

Dr. Tom


Painful Rubbing Sound from my Left Side
Q. I am 26 and have had a problem for the past two years now that no one has been able to identify.  I get a strange, sometimes painful rubbing sound in my left side especially when my breathing rate increases.  I workout frequently but can't get my breathing rate up past a quick jog because of this.  It also acts up when I lift heavy objects or walk uphill.  There is an audible sound that resembles a pleural rub, or intestinal movement. 
I have been to a GI and had numerous tests done.  Endoscopy showed a slight hiatal hernia but my GI doctor says that wouldn't cause all the noise or pain.  He recommended a respiratory therapist.  My chest x-ray came back normal and my general practitioner said it had to be the hernia.  Please advise if you have any thoughts about what it could be.


A. Dear Patricia, I do not believe it is the hernia. It is probably a pleural inflammation that does not show up on a regular chest x-ray. Best to ignore it, if you can.

Dr. Tom


Innumerable Tiny Nodules Seen Mostly Upper Lobes
Q. Dr. Tom, Recent CT Scan indicated that I have innumerable tiny nodules seen mostly upper lobes.  These are in the range of 1 to 2mm in size.  Also have an area of abnormality density involving the medial aspects of the right middle lobe and also lingula.  The next paragraph then says "this is thought most likely secondary to acute inflammation / infection of the chronic sequela of prior inflammation or infection.  The distribution of right middle lobe and lingular chronic changes including bronchiectasis has been described in microbacterium avium intracellulare infection.  However, no current bronchiectasis is demonstrated."
I am a 38 year-old former smoker.  Born at six months and had pneumonia eight times in childhood through law school.  Should I be concerned that these nodules are cancer?


A. Dear Lora, No. Whatever infection it was is now healed. It is most likely due to a fungus called histoplasma, which is very common in the Midwest. Forget about it, but keep a copy of your chest x-ray, in case you move, so you will have a comparison if you get another chest x-ray.

Dr. Tom


How Does Percent of Lung Capacity Match-Up with Years of Life
Q. Dear Dr. Tom, I came onto your site by accident one day and I am so glad that I found it.
My friend, of twenty years, was diagnosed back in late May of this year with Emphysema. A month before his diagnosis he was in the hospital with pneumonia and was in ICU for two weeks. I now know, which took me awhile to figure ou,t why he would be diagnosed at such a young age of 42, a deficiency and not to mention his two packs a day habit for twenty or more years.
My question is this, I recently read a question on your post of a person with 40% lung capacity wanting to know how long they might live and your answer was ten or more years if you take care of yourself. My friend when diagnosed last May now has 50% lung capacity maybe little less depending on how much a person loses in a six month period, he no longer smokes.
I apologize for jumping off the track here; I was wondering with 50% lung capacity does my friend have about an equal outlook?


A. Dear Cindy, Probably, or better if he avoids all smoking and secondary smoke. Has he been tested for Alpha One Deficiency? If not, he should.

Dr. Tom


Hammond Crunch
Q. I understand a "Hammond crunch" can indicate pneumomediastinum on pneumopericardium.  Where does one auscultate for this and what does it sound like?
A. Dear Harold, Over the heart. It sounds like "crunch, crunch" with each heart beat.

Dr. Tom


How Harmful is Inhaling Silca?
Q. I've been working at a construction jobsite for the past three weeks.  I am doing a siding job with Hardiplank siding sheets.  These sheets are 4 by 10 feet long and have cut over 150 boards within this three-week period time.  I did not know that these boards contain Silca (with apparently causes cancer and/or Silicosis).  I was cutting with no mask and with a skillsaw in an outside area.  My question being,  how much silica is to much?  Am I at risk? 


A. Dear Dan, Any silica is too much. Since it was outside, the risk of disease is small. You must wear a tight fitting facemask, that is OSHA approved for dusty environments.

Dr. Tom


Advair and Bacterial Pneumonia
Q. I'm a normal healthy 44 year-old woman who has been recently put on Advair for an unknown persistent cough.  After an x-ray and a CBC, I have a bacterial pneumonia.  Is Advair contraindicated with bacterial pneumonia?


A. Dear Ada, No. Your doctor should have a good reason to continue the Advair in the long term. A chronic cough alone may be a manifestation of asthma, but there are other causes. Be sure your doctor has the right diagnosis. 

Dr. Tom

Interested in Becoming a Respiratory Therapist
Q. I'm a Registered Medical Assistant and am interested in Respiratory Therapy. Would a two year program be a good start?


A. Dear Joseph, Yes. But a four-year program with a degree would be better.

Dr. Tom 


Complications of Chemotherapy and then Acute Respiratory Distress Syndrome (ARDS) ; Now Have Nodules
Q. Hi Dr. Tom, Last year was diagnosed with Stage one breast cancer.  Had lumpectomy, chemo, and radiation.  However ran high fevers throughout chemotherapy, which lead to pneumonia then ARDS.  Have no memory or ARDS experience but was intubated about two weeks and had to learn how to walk again and deal with hallucinations. 
This summer six months after ARDS and four months after radiation I had a CT Scan of lungs which showed "sub-centimeter diffuse bilateral nodules" Report also said "Neoplastic process can not be ruled out".  Since then have had PET scan (good!) and another CT Scan (stable)...Next CT is Dec. 28th.
Do you think nodules could be from ARDS or Radiation?  Also, am ex-smoker. Anyway, I am kind of emotional wreck, so afraid of possible metastasis. Thanks in advance for any thoughts on this matter.  I have just discovered this site and think you do a great job. 


A. Dear Frankee, These nodules may be from the ARDS, but this is unlikely. Careful follow up is wise. A "good" PET scan is reassuring.

Dr. Tom


Is the Concern about the Lymph Nodes or the Hyperinflation?
Q. I am a 41 year-old female in good shape I went to the doctor for annual physical and a chest x-ray was done. I was told I had a 1cm density in left lung field. A CT Scan was done and said it most likely reflects prominent vessels. Then went on to say nondiagnostic sized lymph nodes in precarinal region.  Mild hyperinflation of lung fields with biapical fibrotic scarring and subpleural scarring in superior segments of each lower lobe near fissures. No lesions or infiltrates or nodules. Recommend continued close clinical follow up and repeat ct in six months. 
I am aware of scarring is common.  Confused as to why I need another CT.  For the hyperinflation or the lymph nodes?


A. Dear Chickie, Hyperinflation on a chest x-ray, does not mean much. The enlarged lymph nodes may or may not be important. I believe a follow up is wise, to be safe.

Dr. Tom


2024 American Association for Respiratory Care