Bob Penhallow,RCP, Licensed Respiratory Care PractitionerThese are the questions and answers from our first two forums. Look through them, your answer may be here. Bob took a new job and we haven't heard from him since late spring 2000.
I just found out that I have COPD. Could you please let me know what this is. I am really scared. I don't know if this going to kill me or not. Please answer me soon. Gordon.
(later entry) I am a 49 year old man who started with problems with my lungs about 1 1/2 years ago. My problem started with what I though was a chest cold. For two weeks I took over the counter medication. After about a month I was still quite congested. I decided to see my family Dr. and he put me on a decongestion cough medicine and a antibiotic medication. I took that for about two weeks. Still I was not getting better. My chest was really congested and I could not stop coughing. I would bring up lots of flem. This went on for about three months more.
Finally my Dr. decided to send me for a Lung function test. This test indicated that my lung capacity was at 72 %. My family Dr. put me on ventilin and started treating me for asthma. I again took this for another month. My congestion was not getting better. My family Dr. sent me to a lung specialist and he put me through another series of lung function test. One was for asthma. I was put on cortizone for 10 days and then went through the lung function test. My results after 10 days went to 62%. I got worst instead of better. This apparently ruled out asthma.
The Specialist told me I had C.O.P.D. I didn't know what that was. He said that smokers normally get C.O.P.D. Well I have never smoked so I found this hard to accept. I have been exposed to second hand smoke over my life time but have never smoked. The specialist told me there was nothing he could do to help me.
Now this is whare I am at in my life. My family Dr. is trying to do what he can using asthma medication to try to treat what he thinks I have. He has made a referal to another specialist in a larger city where there are better facilities. Here is what has happened in my life that could be a cause for my problem. At my place of employment we moved into another location which was an old building that was renovated with new up to date offices. I started my problems three months after moving into this location. The office area is ventialated by a close loop ventilation system. We depend on this system to supply our office area with air. There is no window that opens to outside air. The humity level this wnter was 18% most of the winter. I have a humidifier in my office and it puts 11 liters of water in the air every 24 hours. The humity level never went over 22%. The building was an old warehouse that had hundreds and hundreds of birds making their nest there for 75 years. This was an unheated and unventilated building over these years. The building was renovated and a spray insulation was applied over years and years of bird droppings. I am wondering if this could be causing my lung problems?
I am at a crossroad in my life whare my lungs are at 60% capacity, I am not in bad shape. I walk in the evenings, I bowl, I cross country ski and never slow down. My energy level is low but I keep on going. I cough all the time, bring up flem all the time and am still very congested. What in your opinion could be causing my lung problems. I am getting no answers from the local medical profession and am very fustrated. Tell me what I have to do. What question can I ask with my Dr.? Please help me with this as I do not know what else to do. Thank you, Gordon
Gordon, Bob Penhallow here, Linda's resident respiratory therapist for this site. Having a lung function of 72% is relatively normal.But going down to 62% in 10 days is suspect.There is a possibility that your effort wasn't as good as your first. Remember this test is VERY effort dependent. Did they do a Methacholine challenge with one of the breathing tests? This is a test to rule out asthma. I don't know where you live, but you mentioned bird droppings. The first thing that comes to mind, and has GOT to be confirmed and dx by your doc, is a fungal disease. Histoplasmosis, etc. Found by xray and blood testing. Very treatable. Spores of fungi are all around us and more so in different areas of the country. Also! Does your family have a history of lung disease at an early age? If this is the case, then there is chance of Alpha 1 Antitrypsin disease, although I think your lung function would have been much worse. Again, finding this out is just a matter of a simple blood test. Ask your doc about the fungal possibility. All that can come out of that is that you don't have it. At least you will know. And that is what is important here. Finding out! And that may be frustrating at times but you need to vigilant in finding out and asking MANY questions. I need to go to work, now, but I will think about this some more and get back to you, Gordon.
Hope this helped and come back. BobPÊ
My husband has emphysema & takes the following medications: Varapamil, 180mg, 1/day; Ventolin,17g,4/day; Atrovent,4/daily; Vancerli, 2/daily (these are 2 puffs each time). Also uses nebulizer 2-4 times daily. He has no energy & problems sleeps (has restless leg syndrome). Uses oxygen as needed (most of time) Oxygen level in low 90's. Could he be overdosing on some of these medications causing his lack of energy & rls. He's also overweight and getting almost no exercise as the weight makes him shorter of breath. The test a doctors show he has 26% of breathing output. May not have explained very well. Thanks for any answers you can give. Ethel
Dear Ethel, Bob Penhallow, RCP, here, Linda's resident resp.therapist for this site. Sounds like your husband is severely deconditioned beyond his COPD. Get him into a pulmonary rehab program at one of your local or regional hospitals, ASAP!!!!!!!! There they should be able to consul him in every facet of disease management, that should include a dietary consultation, if not, get one on your own, he NEEDS to lose weight, but needs to learn HOW to breathe and exercise first! Ask his doctor about this as SOON AS YOU CAN! If he is taking his albuterol QID (4 x day) via metered dose inhaler AND taking the same medication via a nebulizer as well, QID, then this is NOT particularly a good thing. This is NOT good for the heart, and I see that he is already on Verapamil for his heart. He also may NOT be taking his inhalers correctly, thus, he is NOT getting the full effect from the medication. He NEEDS to start exercising NOW! Have him start out VERY, VERY, slowly. Walk to the mailbox, or some short distance that he can also walk back to the house with minimum SOB. Have him do this a few times a day, to his tolerance. Have him do pursed lips breathing (check out Linda's breathing techniques area). Have him cut down on the processed carbohydrates like, pasta, bread, white rice, cookies, etc. Increase the vegetables and SOME fruit. Have him drink AT least 64 ozs of water/day, unless he retains water and/or his doctor has him on restriction. If so, then his doc should have him on lasix or similar med. so make sure you consult his doc on this one, because water is key to the body especially the lungs, for the removal and hydration of mucus. Again, get him into a rehab program. If you can't find one, come back here and let me know where you live (city or area only)and I will give you the closest one. A program like this will give him a greater knowledge base about his disease and how and why to take medications, etc, and also should increase his exercise tolerance while being monitored by licensed personnel. Of course, HE HAS to WANT to be helped! His complience to this process is paramount. COPD is a disease that in most cases, responds to rehab, therefore quality of life is improved. Remember, you have GOT to crawl before you can walk, and this applies to those that have let COPD completely take over there lives. He CAN learn how to "walk" again and have a life that is enjoyable and productive, it's CERTAINLY worth the try! Hope I helped in some way, Ethel. Hope this helped and come back. BobPÊ
Please help me understand this diesease. They told my father today that he had only 30% of his lung left. What does this mean. How long does he have? Justalit.
COPD is a very serious disease but it is not an immediate death sentence even if diagnosed as severe or end stage. Many know that they have it for a number of years before it significantly affects their quality of life and they become concerned that "someone" must do something. When that occurs, one finds that medical assistance runs from fantastic to useless. What doesn't change, is that the degree of acceptance and degree to which the COPD patient becomes involved in their care will greatly affect the quality of life and ability to cope with the disease. Otherwise I'd go with your father on his next check up if allowed. Have the doctor discuss the problems and needs.
Hope this helped and come back. BobPÊ
I have asthma, but I wonder if I might have a mild case of COPD. SometimesI have the same symptoms as COPD. Is this possible? Thank you. Pinky
Pinky, Bob P here,Linda's Resident Respiratory Therapist. Asthma "symptoms"are very prevalent with people that have adult lung disease (COPD).Your airways may be very reactive to many stimuli like pollen,smoke, perfumes, etc, and they may cause the airways to shutdownand you may wheeze and such. U may have what I call "legitimate"asthma or But to know exactly what u have, it is IMPERATIVE thatU have a COMPLETE Pulmonary Function Test, and I can't stressthis enough. Talk to your doctor about this and about your exactdiagnosis. Have him or her review the results with U and don'ttake no for an answer! Knowledge is everything!
Hope this helped and come backto let me know how things went. BobPÊ
Is this right? If you have alveolithat are hyperinflasted you can't get 02 in. If you have Emphysemayou can't get the c02 out. Are both these copd? Is the treatmentthe same? How do you find out which one you have? Does it makeany difference? Thank you.
Thewhole thing about emphysema is that air can get in but can't getout, like a one-way valve, it's the airway that does this, andthis is why PLB is so very important to do, for intra-bronchialpressure (think of u holding a hose and watering your garden,a steady stream of water is coming out. Now u squeeze the endso only a trickle is coming out. What do U feel from the hosein back of the hand that is squeezing? The hose is bulging, right!Well, your airways act the same way with PLB.) Anyway, the alveolikeep getting bigger and bigger and weaker and weaker and finallytear apart. Remember a group of alveoli share a common wall soit deteriorates until the whole thing is one big giant nothing.Also when air gets into an alveolus there may not be any circulatorymechanism for the O2 to be transported. Like a dried up riverbed. The reverse can happen also. This is called a V/Q mismatch.The V is for ventilation and the Q (both with a dot over them)is for circulation. But I want to tell U that there may be partsof your alveolar architecture that are OK alveoli, just not beingused, ( it's like use it or lose it, for a while anyway) likewhen people have thoracic or abdominal surgery. Some alveoli arenot used due to inadequate breathing volume so they become basicallydormant, this is called atelectasis and can be remedied to a certainextent with increased activity and breathing exercises, especiallywith a device they call an Incentive Spiro meter. This is a devicewith a ball or cylinder that when U breathe in deeper the ball,or whatever will go up thereby encouraging U to breathe deeper.But U have to be careful not to over do this. Lastly, yes peoplewith emphysema, cannot get CO2 out, and this is the problem thatI mentioned above. But if U remember and are compliant with pursedlips breathing, this problem can be abated to some degree. Onlyproblem is that U have to remember to it whenever U need it andnot to pant and this is tough! Hope I helped, BobPÊ
Is cramping ofthe feet and hands do to any medication we might be taking forCOPD? Also the dry skin. Is this a sign of old age or COPD? Iam 68 have had LVRS but still on o2. Thanks again. Peg
BobP here, Linda's resident respiratory therapist here. Peg's question.There is a slight possibility of muscle cramps due to albuterol,which is just one of the side effects of this drug. Also prednisoneand the inhaled equivalents; azmacort, aerobid, flovent, vanceril,etc have as side effects, muscle WEAKNESS. But she should, underher doctors care and guidance, check her potassium level (havean "electrolyte" panel done, it's a simple blood test),this can cause muscle cramps; and she should be drinking, as muchwater, (64 oz. or MORE), ALL DAY, as she can or as her doctorhas allowed and this is VERY important to do everyday withoutfail! This will nourish the whole body and keep it hydrated. Andas a side bar, ask her to use ONLY water soluble hand lotion likeKeri, and not Vaseline Intensive Care, types. The water solubletype will absorb into the skin before evaporating unlike the Vaselinetypes, which main ingredients are wax & petroleum. Your friend ,Bob Penhallow, RCP, resident respiratory therapistÊ
NEW INFORMATION:BobP here, Linda's resident respiratory therapist here. This justout! A new bronchodilator is on the market and I think U all shouldknow, if U don't already! Its called, LEVALBUTEROL, brand nameXopenex (say: Zo-pen-ex) from Sepracor, INC. It is a Beta2-adrenergic,like albuterol (Ventolin, Proventil and their generics from Warrick,etal). But it only contains the R-isomer (isomers - those chemicalsubstances that have the same molecular formula but have differentchemical and physical properties). Albuterol has BOTH the R &S isomers. It is the R- isomer that is the one that is responsiblefor the bronchodilation of the smooth muscles of the airways,the S- isomer does not bind to the Beta2 adenoreceptors. I knowthis may be "gobbly gook" to some, but just sit backand enjoy and learn. The indications for this drug are for REVERSIBLEbronchospasm in moderate asthma and COPD! Yes, it is very similarto albuterol but may be tolerated better. Please consult yourphysician! It is available in unit dose vials of 3 ml(cc), containing,0.63 mg levalbuterol & normal saline. The recommended dosageis three times a day (TID) every 6-8 hrs., by nebulizer only,at the time of this notice. Yes, that means, no metered dose inhaler,yet! It is for patients, 12 yrs old and older! Please consultyour MD for adverse effects, but they are very similar to albuterol.By the way, for those of U that use a nebulizer unit (like Pulmoaide,etc) U might try getting the PARI LC Jet nebulizer unit to usewith your compressor unit! These are covered by Medicare now,and last for 6 months. They are SO superior to other nebulizersand do such a tremendous job. It may take a little, to a lot longerto get through a "treatment," but they nebulize everylittle particle, so that U get the treatment that U deserve, andNEED! AgainI am glad to give U this info, but as always, please consult yourphysician as to this drug and nebulizer! OK? Bob Penhallow, RCP,resident respiratory therapistÊ
Dear Synthy, Bob P here. Justthought of a couple of things. First, u are 49y/o, right? WhenU see your physician, ask him to test U for Alpha 1 -Antitrypsin(AAT). This is the genetic form of emphysema. Now I dont wantU to get alarmed at ALL! It is just a simple blood test and willtell U a lot. If its negative then U know THAT, if it is positive,then there is treatment for this. U just need to know and rulethis out. The hallmark is your age, especially if U have had abreathing problem for most of your 40's. It is the lack of a protein,Alpha 1-Proteinase Inhibitor (that guards against the elastaseenzyme, (which likes to destroy good lung tissue, thinking itis guarding against those enemies that attack your lungs). Theprocess of knowing about your lung situation, as I have said manytimes, is a strong offense! Knowing all that U can about yourlungs is strengh! To know is to understand what to expect andreslove! To be able to talk to your MD in a knowledgeable way!To know what he/she is saying to U and what to ask! But I begof U, NOT to get worried at all! OK? Some MDs are reluctant toorder this test, because they seem to think it is so "outthere" that it is not necessary. AAT affects 1 in 46 emphysematicpatients! If U are one, U need to know, period. So just ask yourMD to order this. Insist! Second, have U heard of the drug, Zyban?Its a drug that has been an anti-anxiety, anti-depressive underthe name of Wellbutrin (generic: bupropion HCL). Well when peoplehad been taking this drug for anxiety disorders and smoked, theyfound that those people stopped smoking. So they did some studiesand it seems that there is something about this certain drug,as opposed to others in this catagory, such as Xanax, BusPar,Ativan, Valium, that has an effect to cause people to NOT havethe urge to smoke or at least lessen the urge! It has been usedwith my smoke cessation program pts. for a year now and it isso very successful that I recommend everyone serious to stop smokingto ask their MD to prescribe! Some MDs are again reluctant toprescribe because they think that anti-depressants reduce the"drive" to breathe well. This is not entirely true,if dosed properly! It is a safe drug, if U look at the side effectsand don't necessarily look to the "seizure disorder"one. Of course if U have a history of seizures then this drugis NOT for U! But in the last year, not ONE person has complainedof anything but occasional insomnia and mild other side-effectsthat do not affect their lives in anyway! It can be used in conjuntionwith the nicotine patch, inhaler and gum! It seems to work, soask your MD about this also. Go with health in your life and peace inyour heart! Bob Penhallow, RCP, resident respiratory therapistÊ
How can I notsmoke when I go into a panic situation?
DearSynthy, Bob P here. Why do u smoke to begin with? Most likelyto reward yourself, something to do with your hands, it physically"calms" u down, etc. All of these things can be doneby doing something else! When U feel panic or depression, justtake a walk or do something else to delay the urge! And DO IT!Dont wait. Just leave and walk outside a little! Remember something.The urge for a cigarette WILL go away, whether U have a cigaretteor not! If someone tied U to a chair, (and I am not advocatingthis for real..LOL) u would have an urge in probably 7-10 minsand if no cigarettes where available to u, the urge would justpass! Think about all the cigarettes in the day that U smoke thatU really didn't like, but U did it out of habit. Yes, nicotineis a most highly addictive substance and it is THE toughest ofall substances to "kick"! But just try to take a walk,change your habits that are connected to smoking, ie: talkingon the phone, driving, having your morning coffee, cocktails atnite,etc, do some other exercise, just divert yourself in someway! Get a kids coloring book and place it by the phone and whenu get a call,just start coloring or doodle! It does take diligenceand constant vigilance! Just take it one step at a time! Justknowing when and WHY u light up, and taking a sec to realize whatU are doing to your lungs is a big step to quiting. But firsttry to do what I said when u feel panic! Just leave the scene!One of the best things to do, and U can do this anywhere and anytime,is Pursed Lips breathing. Just take in a moderately deep breaththrough your nose, and exhaling through pursed lips (this is puckeringyour lips like U would to whistle) and make the exhalation atleast twice as long as U inhaled! Practice this! If u have troublewith this, get a candle, light it and sit in front of it at leastan arms length away and do the pursed lips breathing toward thecandle and make the candle light flicker but not go out! Thisprcedure is not only a good substitute for smoking but is goodfor your lungs, and one of the best relaxation techniques knownto man! Just practice, practice! Just try some of these Synthy.That is all U can do, is just TRY, and u will be taking one ofthe biggest steps of your life and FOR your life! Hope I helpedin some way! Hope I helped in some way. Go with health in your life and peace in your heart! Bob Penhallow, RCP, resident respiratory therapis
This is the end of question and answer at this time. I will add the rest on a second page at a later time
