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Archive: Dr. Tom 17
Posted April 19th, 2005

Progress of Emphysema 
Why does emphysema continue to progress even after you get rid of the cause or the irritant?  And how fast in ml (on average) does your lung FEV1 go down, in a male with emphysema?


A. Dear Ringbo, Good question. Stopping smoking slows the progress of emphysema, but sometimes progression is due to age-related rate of decline. Normal average size men and women lose about 25-30cc of FEV1 per year as a normal consequence of aging. This is due to reduced elasticity of the lungs, and thus, less force by the lungs to empty like a rubber balloon, that deflates, after it is blown up. In smokers with emphysema, the loss is about 75-100 cc per year

Some of the inflammation in small airways smolders on in some, and some dropping out of lung sacs, i.e. emphysema, occurs even after irritants are avoided. But it is far slower than if smoking or other exposures continue. 

Dr. Tom                    


Questions About Nebulizers, Medicine, and Oxygen
Good day Dr. Tom. I have 4 questions for you. Hope you could send me your answer as soon as possible.


Dear Joel,

Q.1. Here in UK we nebulize patients by using compressed air and we set it to 6 to 8 liters per minute. What are the advantages and disadvantagse of using this compared to a compressor-driven device like a Pulmo-Aide?

A.There is no difference between using the compressor pump on a Pulmo-Aide, and using compressed air or oxygen to run a nebulizer.

Q.2. Is it true that Iprotropium Bromide can cause glaucoma?

A. Iprotropium can increase the pressure with the eyes and worsen glaucoma. This is rare.

Q.3. Can we put Salbutamol in an ultrasonic nebulizer or is an ultrasonic nebulizer (a nebulizer that produces finer aerosol particles) only for normal saline just to loosen mucus?

A. You can use Salbutamol in an ultrasonic nebulizer.

Q.4. If you are giving 100% oxygen, can you give it for more than 24 hours?

A. 100% oxygen by nasal cannula at 2 liters per minute is diluted by the air you breathe. Thus the percentage of oxygen you breathe is about 24-30%. You can do this for years. But if you are talking about being in a chamber with 100% oxygen at sea level, toxicity begins in about 24 hours. This is bad for the lungs.

Dr. Tom


Postural Drainage for Neonates
I need any and all information you can get me about postural drainage and percussion of the neonate. I am working for a unit manager of labor and delivery who doesn’t know what it is and has never heard of it. I know, scary. Anyway, she has requested information and I am trying to get it to her. Thanks for your help. 


A. Dear Marty, Postural drainage just means putting the baby head down on the belly, for a while. Commonly gentle clapping of the back is done to encourage the drainage of secretions in the lungs.

For additional information see the American Association for Respiratory Care’s Clinical Practice Guideline for Postural Drainage Therapy. The guideline has an extensive list of references and bibliography.

Dr. Tom


Trouble Breathing
Hello, This is very good site. I have a question for Dr Tom. I have a breathing problem. I can breathe normally when I am busy. For example, while walking my breathing does not bother me. (FYI) I smoked as a young adult.

I had tests at the hospital. The results were very good and the doctor said I have psychogenic dyspnea. He says I am abnormally aware of my breathing. I was on Xanax for three weeks but now I am on nothing.

My breathing feels labored at rest and is stopping me from sleeping. I feel short of breath at rest but can cope with exercise well. My breathing is making me anxious constantly and my quality of life is poor. My doctor has said they might try a drug they give amputees to make them forget about their missing limb, he reckons this might switch off this attention to my breathing.

I feel that I am on my own on with this and have met a psychologist who was no help. What advice can you give me to help me overcome this affliction?

Lorenzo, Milan, Italy

A. Dear Lorenzo, I agree with your doctor that your problem can be termed “psychogenic”. However what you feel in your breathing is real. You are actually breathing more than necessary, and your body says, “slow down”.

You might try yoga or other control of your breathing. This should give you relief. Be glad that your lungs are normal.

Dr. Tom


Home Oximeter Use
What is the correct position to be in when taking oximeter (a machine that measures your oxygenation) readings, sitting or lying down? Or is either one OK? I question because when you are in the hospital or ER you are lying down when they check.


A. Dear Jeff, An oximeter can be used sitting, standing, walking and lying down. It tells you about oxgyenation of your blood in all situations. Sometimes it is lower while lying flat, because you may breathe less deeply in this position.

Dr. Tom


Working Out With Weights
I have worked with COPD clients for 15 years in rehabilitation.  I have some clients lift weights 3 - 4 lbs for 5 different reps no more than 12 each.  My question is that a P.T. recommended that I should have them lift 6 - 7 lbs 5 reps 5 times.  If I did that most of the clients will be too exhausted to do any other activity.  What do you think?


A. Dear Vickie, I believe the lower weight and more frequent exercise is better. Your patients should develop a comfortable routine for upper exercise training and do this for about 10 minutes with each arm twice a day for maximum strength training. 

Dr. Tom


Quit Smoking
I am 21 years of age and was recently at the doctor and diagnosed with Bronchitis. I have since quit smoking (2 weeks) and have continued to cough up brown (sometimes small specs of red) phlegm. But considerably less than when I was smoking. Is this most likely associated with the bronchitis or would you recommend going back to the doctor for a follow up? 

Also I sometimes have pains in my back around where my lungs are but I believe that to be most likely muscle related from coughing.

Also I went to the doctor for chest pains about six months ago and had a chest x-ray and the doctor said it was fine. Your insight is appreciated!!


A. Dear David, It may take a month or two for the coughing to subside. A cough itself is irritating to the lungs. But just be patient and it will go away. Congratulations on stopping smoking. At your young age, you have probably added 10 years to your life!

Dr. Tom


Air Pollution
I am a student at Fresno City College in Fresno, CA, and I am writing a cause/effect paper about what causes air pollution, and the health effects of air pollution on humans.  If you could answer these questions I would greatly appreciate it.


Dear Chris,

Q.1:  What are some short-term effects of ground level ozone or air pollution all together?

A. Short term effects are lung irritation and cough in some persons. Depends on the person and the level of pollution.

Q.2:  What are the long-term effects of air pollution on the average person?

A. Long term exposure may lead to chronic bronchitis, particularly in smokers, but also in some nonsmokers.

Q.3:  Do you know the type of disease associated with the effects of air pollution?

A. The most certain diseases are chronic bronchitis, emphysema and lung cancer. In each case the air pollution is a contributing cause and not directly cause and effect.

Dr. Tom


Rheumatoid Arthritis and Oxygen?
Would I benefit from oxygen therapy? I’m a 42 year-old woman with   I severe Rheumatoid Arthritis (RA). I was diagnosed with RA 10 years of  age. I was sent to a pulmonary specialist when I complained of chest pains and shortness of breath. 

MY DLCO’s (the lungs diffusing capacity) range from 65%-70% when I’m feeling good. 

My pulse rate is what concerns me.  Resting pulse rate (sitting) rarely drops below 100 beats per minute. Frequently it goes up to 120 with little or no exertion. My O2 saturation rates are usually above 95%.


A. Dear Wanda, Oxygen will not help you if your oxygen saturation is already 95%. But I assume this is at rest. If your oxygen saturation falls below 88% on walking, oxygen may be helpful to your condition.

Dr. Tom


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