Frequently Asked Questions About COPD

Dr. Barry Make is the Director of the Emphysema Program and Pulmonary Rehabilitation at National Jewish. Dr. Make's major interest is clinical research in the pathophysiology and management of patients with chronic obstructive pulmonary disease (COPD - emphysema and chronic bronchitis). He also has extensive experience in the management of long-term ventilator-assisted individuals. Dr. Make evaluates and manages outpatients with COPD and other pulmonary disorders at the National Jewish Medical and Research Center. Learn how Dr. Make answers some frequently asked questions about COPD and other chronic lung diseases.

Scroll down the page, or click below to see questions and answers about COPD and other chronic lung diseases for each category:

Anatomy and Physiology

Question: What lines the inner wall of the bronchus?

Barry Make, MD-- The bronchi are the air passages that branch into the lungs from the trachea. Bronchi have a layer of cells, but all the cells are not the same. Some cells produce mucus. Others have little hairs, called cilia, which beat the mucus up toward the mouth to help get rid of it. The mucus traps foreign particles and the cilia carry them out of the lungs as part of the bodies’ defense mechanism.

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Health, Wellness, and Prevention

Question: What can an older ex-smoker (who gave up smoking entirely 35 years ago) and who now has early-stage emphysema do to help herself?

Barry Make, MD-- Stopping cigarette smoking is great and you need to be congratulated for that. That should have been a shake of your hand, not my head. Preventing infections with flu shots and pneumonia shots will help keep you healthy. Stay away from others who smoke and second-hand smoke. Medications may be helpful in preventing worsening as well - bronchodilators to keep your lung passages open for example. You may also want to consider pulmonary rehab.

It might be helpful to think about what signs should lead you to call your doctor right away. When people with COPD get worse, we call this an "exacerbation." This is marked by a change in one or more of the following: increase in shortness of breath, increase in cough or sputum production, a change in sputum color to more yellow, green or brown. If you have these symptoms for a day or more, then you should call your doctor. You may need an antibiotic and / or a steroid pill to help your symptoms and prevent you from getting worse.

Barry Make, MD-- It is not easy to stop smoking. But stopping smoking slows down the progression of lung disease, even if the disease is advanced. So smoking cessation is our first step in anyone who has lung disease. The most effective smoking cessation methods include nicotine replacement (patches or gum are most commonly used), Zyban (an oral medicine to reduce craving) along with counseling with a healthcare professional including regular visits.

Question: I have severe COPD but I feel good most of the time and can do anything I want until I catch a cold and then I end up in the hospital. Is there something I can do to prevent this?

Barry Make, MD -- There are some things that can help prevent infections. You should get a flu shot every year. A pneumonia shot is also available and is good for about 6 years. Keep your hands clean. In addition, we sometimes see people who develop frequent infections who are also using nebulizers for delivery of their lung medications. Nebulizers can be associated with more frequent exacerbations. It is also important to treat these exacerbations quickly and appropriately. LUNG LINE has more information on these topics; call 1-800-222-LUNG (5864) at National Jewish.

Question: I am 53 and severe COPD. I feel good most of the time but get infections and end up hospitalized. Is it my immune system?

Barry Make, MD-- If you are using a nebulizer, there are some steps to help prevent infections in your lungs. We tell our patients to rinse the nebulizer cup after each use, shake it out, and then re-attach the cup to the nebulizer. Turn on the compressor and leave it on until the nebulizer is totally dry and free of any droplets of water. Also, disinfect it in a vinegar and water solution regularly.

Question: I have severe COPD but do really well on a day-to-day basis. The real problem I have is infection, which lands me in the hospital. Is there a way I can reduce these?

Barry Make, MD -- There are several things to think about in your case that may be worth considering. First, you should get a flu shot every fall and a pneumonia shot once every 5-6 years. Make sure you don't have problems swallowing or with reflux from your stomach (commonly called heartburn or hiatal hernia). Make sure you take your regular bronchodilators regularly. Your doctor might consider adding an inhaled corticosteroid to prevent your worsenings. Stay away from irritating things in the air, particularly cigarette smoke. And consider asking your doctor about stopping your nebulizer if you are using one and replacing it with "puffers."

Barry Make, MD-- You know that about 25% of people in the US smoke cigarettes. However, only less than 25% of smokers develop COPD or emphysema. You may know someone who has smoked for 25 years at 3 packs a day and has no lung problems and another person who has smoked only 15 years and one pack a day and is disabled because of their lung disease. What makes us all different and causes some of us to develop lung problems from cigarettes is our genes. Some people are more susceptible because of their genetic make-up. We are currently looking for people with smoking-related lung disease who have brothers and sisters who also smoke. By doing a blood test, we hope to identify the genes associated with smoking-related lung disease and eventually find out why the disease develops and find new and more effective treatments and preventions.

Question: Are certain parts of the country better/worse for someone with severe asthma?

Barry Make, MD-- We don't recommend any areas of the country to live for people with asthma. One should preferably live in a clean air environment and not in an area of heavy air pollution. Also, because people react differently to climates and weather conditions, there are no recommendations for areas that are better for asthma. In addition, people with allergies tend to have problems with allergies in different areas.

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Relationships with Other Conditions

Question: I believe most COPD patients are probably older. My son, now 4, has bronchiolitis obliterans, brought on by RSV when he was near his first birthday. Do you know of any support groups for parents of young children with COPD or bronchiolitis obliterans, in particular?

Barry Make, MD-- This disease is not COPD, but does share some of the features of this disease. Bronchiolitis obliterans is a disease of the small air passages in the lungs (the bronchioles) which become inflamed and then scarred and narrowed. It may occur after severe viral infections. This disease is less common than COPD and asthma and thus there are not likely to be any support groups for this disease. However, check with your local hospital, pulmonary physicians and lung association and ask them if there are any support groups for parents of children with asthma or cystic fibrosis, two more common lung diseases which usually have support groups for patients and families.

Question: Will you be speaking at all about RADS? (Reactive Airways Dysfunction Syndrome)

Barry Make, MD-- RADS also shares some of the features of COPD, but I will not be speaking about that. RADS is due to an environmental exposure which leads to a disorder of the lungs very much like asthma. A pulmonary physician or, an occupational medicine physician with expertise in pulmonary disease may be helpful. National Jewish has a group of physicians specializing in occupational pulmonary disease.

Question: Does nephrosis affect chronic asthma or vice versa?

Barry Make, MD-- Nephrosis refers to a disease of the kidneys. In general, patients with asthma do not get kidney disease. But some kidney diseases are caused by medications so make sure to tell your doctor about all the medications you are on currently and all the medications you have ever taken. In fact, this is good for all of us to remember to tell our doctors about all our medications.

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Symptoms and Diagnosis

Question: Is having pain in the lung typical of COPD?

Barry Make, MD -- Chronic lung pain is not commonly associated with COPD. However, pain can come from the wall of the chest and not directly from the lungs - this in fact can be seen in COPD. Pain in the chest can come from coughing very hard and straining the muscles of the chest. Pain in the chest can be due to a rib fracture from coughing hard. Pain in the back of the chest can come from osteoporosis, or thinning of the bones. Check with your doctor to find out the cause of your pain.

Question: I've had adult-onset asthma (chronic & severe) for approximately thirty-five years. I've been to some of the best doctors in Houston, TX; Temple, TX; and Denver, CO (National Jewish). So, as you'd expect, I'm taking the recommended dosages of the latest medications. My chronic excessive mucus is a major concern. I am unable to stop a cough when the mucus begins to block my airways. I cough very deeply and it is very hard to free my airways from the mucus. At times, my cough severely hurts my ribs and causes a lack of bladder and stool control. What can be done to stop this excessive amount of mucus? I take Robitussin DM when I tire of coughing. Although I have chronic sinus problems and have had sinus surgery, I have very little drainage. I feel that this is not the problem.

Barry Make, MD-- Well, this is the type of question that is very hard to answer. The problem with the computer is that I can't see you to evaluate you in person. And since you have already asked this question of a lot of doctors, I can only give you a very general answer. Some issues to think about: it is often difficult for people to recognize that their cough and mucus is coming from their nose; they get sensitized to this chronic problem. Some medications may make this worse - including nebulizers, guaifenesin. Swallowing can cause food to go into the lungs causing more mucus. Asthma causes cough and phlegm. So, you need to make sure your doctors hear your problem and address it directly so you have all the answers.

Question: I have chronic shortness of breath and sinusitis. My medicine is not working. What should I do?

Barry Make, MD-- Unfortunately, this general question is hard to answer so you need to check with your doctor. There seem to be two separate questions here. Sinusitis does not usually cause shortness of breath but does cause drainage from the nose and often to the back of the throat and may cause intermittent sinus infections. It can be associated with asthma as well. So, you need to find out why you are short of breath and if your sinuses are or are not related to your lungs.

Question: I am age 60 and have had asthma since about age two. It has been pretty much under control since the 8th grade, although I am still getting allergy shots for dust & cats and also take Flovent and Serevent daily. Several years ago I had a flare-up due to a big exposure to dust and cats etc. and went to an urgent care place which administered oxygen and prescribed a steroid for several days. I actually felt good for a few days until I got back on the daily inhalers. Last summer, I tried a clinic that administers oxygen externally to be absorbed by the skin and that seemed to help a little. However, doctors that I go to seem to be fixated on prescribing nasal sprays and even Prozac (which has tended to be present each time that I've had a flare-up in recent years.) For the last week I've been coughing a lot and sometimes coughing up phlegm. For the prior week my sinuses were congested for much of the week. Two weeks ago I went into my allergist for a routine annual checkup and he gave me samples of Rhinocort and Astelin to try because I've been complaining for years about a coating in my upper lungs or trachea that did not respond to coughing but would produce a little phlegm when I "cleared my throat". I had had most of my nasal drainage under control with NasalCrom. My chest x-rays show enlarged lungs typical of asthmatics and some nodules that supposedly are typical of Ohioans. I have heard no doctor say that I have COPD but I think my symptoms might fit. Whatever it might be called, do you suppose that I might get some real relief by taking some sort of fungicide tablets and getting regular inhalations of oxygen?

Barry Make, MD-- This is a very long and complicated question about lifelong asthma and a recent increase in symptoms. First, if you are experiencing new or increased symptoms you need to check with your doctor to find the cause and get appropriate treatment. I know many patients just wait until their next appointment, but you at least need to call your doctor on the phone and tell him about these symptoms and get treatment if necessary. Patients who have long-standing asthma can develop permanent changes in their lungs that look like COPD and they then do not respond as well to medications. Breathing tests, a chest x-ray and a chest CT scan may be helpful in sorting this out. Fungicide tablets, the over-the-counter type, do not, as far as we know, offer any benefits. Prescription fungicide tablets are only used when there is a documented fungus infection. Oxygen is not absorbed through the skin, only through the lungs.

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Treatments and Medications

Question: What is a sputum examination?

Barry Make, MD -- Sputum is the material one coughs up and out of the mouth. It may come from the lungs or possibly from the sinuses. Sputum is produced in the air passages of the lungs and is part of the bodies natural defense mechanism. Many kinds of sputum examinations are possible and look for potential organisms that might need to be treated such astuberculosis and tuberculosis-like bacteria, fungi, etc. Also a sputum examination can be done looking for abnormal cells that might indicate a lung cancer.

Question: Do nebulizers make aerosolized medications?

Barry Make, MD-- Nebulizers refers to the equipment to take a liquid medication and put it into an aerosol which can then be inhaled into the lungs. The equipment includes some sort of "compressor" which provides a source of power or pressurized air, and a nebulizer cup that holds the medication. When forced out of the cup by compressed air, the medication forms tiny droplets that can be inhaled and easily absorbed in the lungs. Medications that are commonly nebulized include bronchodilators to help open the air passages and antibiotics to treat some types of lung infections.

Question: Do metered-dose inhalers contain chlorofluorocarbons and, do they deplete the ozone?

Barry Make, MD -- Metered-dose inhalers are "puffers" which hold a medication that can be inhaled into the lungs. Traditionally, these delivery devices do contain fluorocarbons that can harm the environment. Newer medications for the lungs are now becoming more widely available either in metered-dose inhalers which do not have fluorocarbons or which have medication in a powder form which also do not have fluorocarbons. Your doctor should know which agents are available and what new ones are coming on the market. LUNG LINE also knows about the available medication delivery systems; 1-800-222-LUNG (5864) at National Jewish.

Barry Make, MD-- Another common question is how to take an inhaled medication with a metered-dose inhaler. The proper technique is not easy! Remember to shake the canister first. Then hold the canister about 2 to 3 fingers away from your open mouth - many people put it right in their mouth which is not correct even though the package insert has a picture of this technique. Then take a slow breath in, too fast a breath in will not get the medication in to your lungs as well as a slow breath. Then hold the medication in your lungs for a count of ten and exhale slowly. Remember to only take one puff of medication on each breath. If you have trouble with this technique, a "spacer" may be helpful. Spacers are devices which can help you get the most medication to your lungs and reduce the amount deposited on the back of the throat. LUNG LINE at 1-800-222-LUNG (5864) has written descriptions of this technique.

Question: How do nonsteroidal anti-inflammatory medications work?

Barry Make, MD -- Nonsteroidal anti-inflammatory medications reduce irritation, or inflammation. They may be used for arthritis to help lessen irritation in the joints and thus reduce pain and swelling. They are not commonly used to treat lung diseases.

Question: I am currently on oxygen for exercise and sleep. I can see in the future that likely I will be on oxygen throughout the day. I expect at that time, my daily activities outside my home will shut down, because I doubt if I can accept being in public with a hose hanging on my face. Would transtracheal oxygen be a valid consideration for me? Or is the risk too much?

Barry Make, MD-- Your concern is very common. The medical facts are that we all need oxygen to survive - every living thing, even the fish in the sea use oxygen, which is dissolved in seawater. In patients with COPD whose oxygen level is below a certain value, oxygen indeed prolongs life. So, although I understand the issues about being seen in public with oxygen, it is medically necessary and if you explain this to people you meet they will not be bothered by it. I have seen many times where young children, naive by their age, will come up and ask a patient on oxygen to explain the therapy. Children, and adults, do better when they have the most and best information.

By the way,although you have not asked yet, I would like to tell you about medical research on COPD. I think it is important to understand the way that new treatments get tested. Medications, devices, even surgery, are tested in clinical trials. Subjects with lung disease like COPD, are needed to find out whether new treatments work. At National Jewish, we are continually testing new treatments for COPD and asthma and many other lung diseases. Often, physicians in your local community will also be testing new treatments. So, keep an eye open for such opportunities.

Question: I am a 64 yr. old female recently diagnosed with COPD. I have been taking Serevent, Combivent, Pulmicort and Flonase for almost 2 months & am still experiencing periodic bouts of shortness of breath. Do you have any suggestions to combat this? Are there breathing exercises and or medications that I'm not already taking?

Barry Make, MD-- The first approach to treating COPD is to use medications like the ones you are on to open up the air passages and thereby reduce shortness of breath and improve your capacity for activities. However, they do not completely eliminate these symptoms. The next step (in addition to medications) if you continue to have symptoms is to ask your doctor about pulmonary rehabilitation - a comprehensive program of exercise and education that can help to reduce shortness of breath and improve quality of life. LUNG LINE at National Jewish has more information they can send you about pulmonary rehabilitation; 1-800-222-LUNG (5864).

Question: What is the best postural drainage position for the middle segment of the lung?

Barry Make, MD-- Postural drainage is a technique where the patient lies with the affected area up. This allows secretions from that part of the lung to drain down and more centrally to the larger air passages and then get coughed up more easily. The middle segment of the right side is actually both toward the side and the front of the lungs. So the best position is to lie on the left side, with the left side on the mattress.

Question: Dr. Make, Have you seen any significant improvement with the use of Xopenex with end-stage COPD as compared to albuterol?"

Barry Make, MD -- Xopenex is a new bronchodilator medication - it helps open the air passages. It is very similar to albuterol, just a minor chemical change. It has the same beneficial effects as albuterol with fewer side effects. It can be used in patients with COPD. Remember, however, that any medication in COPD is unlikely to totally and completely eliminate all the symptoms once the disease has progressed. That's why pulmonary rehabilitation is so important. It is the next step toward improvement and will help you live with the disease.

Barry Make, MD-- Another new treatment that is potentially beneficial for people with COPD is lung volume reduction surgery. In this surgery, the worst portions of both lungs are removed. Many patients have improvements in shortness of breath. However, not all patients benefit. National Jewish is a major center in the National Emphysema Treatment Trial, an NIH and Medicare funded study to find out more about lung volume reduction surgery, if it works, in whom it is effective, and how long the benefits last. All patients who meet the study criteria also have pulmonary rehabilitation after extensive tests to tell us about their lungs and heart.

Question: My wife has chronic asthma for over 50 years and I have three questions: 1. She gets bronchitis and never seems to recover from it by taking antibiotics and prednisone. Is there a possibility she has a fungal infection as well? If so, what is the treatment protocol for it. 2. She uses Pulmicort, Serevent and other prescribed meds to control her asthma. Are there newer meds that would be more helpful? 3. She gets 1/2 flu vaccine as she is allergic to eggs. Is this better than relying on Relenza or other new meds to help when she has the flu virus? If so, are there other meds to be considered?

Barry Make, MD--First, there are many causes for episodes of bronchitis, including viruses, bacteria, fungi, environmental air pollution, and asthma. So the cause needs to be determined. In addition, some people have trouble swallowing and food or liquids can get into the lungs causing bronchitis. And, we see a lot of people on nebulizers who get frequent bronchitis and some times stopping the nebulizer helps. The second part of the question is newer medications for asthma. There are newer pills, leukotriene antagonists, which help some people with asthma and you did not list that medication. Other medications are under study. The third part of the question is flu shots. Certainly people who are allergic to eggs should in general avoid flu shots. However, most people who can eat eggs are able to take a flu shot (speak with your own physician about this). Obviously, it is better to prevent the flu with a flu shot than trying to help the illness with the newer or even the older pill type of medications.

Question: -- I am interested in obtaining any information about an inhaled drug "Spiriva". My husband has COPD and uses Oxygen as well as a nebulizer with Ipratropium Bromicle 0.02% Solution 4xdaily. We are always interested in new medications that may aid his quality of life.

Barry Make, MD-- Spiriva is a relatively new medication, in the same class as Atrovent. However, it is administered by an inhaler once a day and appears to be more effective than Atrovent. This medication was developed for people with COPD and is available in the US.

Question: Can you explain the significance some of the abbreviations that appear on a spirometry printout? (E.g., "FVC" and "...25%-75%".)

Barry Make, MD-- FVC refers to the forced vital capacity and that is the deepest breath a person can inhale or exhale. FEV1 is the amount of air that a person can exhale in one second after completely filling his/her lungs. The FEV1/FVC ratio is the value of the FEV1 expressed as a percentage of the forced vital capacity. That is, the percent of the deepest breath a person can inhale that he/she can blow out in one second. The FEV1 is the most common measure of obstruction to airflow as can be seen with asthma and COPD.

Question: I have had COPD (emphysema) for the past 20+ years and each year my lung capacity decreases. Weather changes are increasingly harder to deal with and exercise becomes harder. I have had the top lobe of the right lung removed and have had bypass surgery on 7 arteries. I have heard there may be several new meds on the market in other countries that may bring relief and possibly improve the lung functions. If there are, and if there are new exercises recommended, please advise.

Barry Make, MD-- There are no real breakthrough medications for COPD available anywhere else in the world just now. Check with your doctor to review your current medications, or visit a pulmonary specialist to do this. Vitamin A is being investigated as a possible way to improve lung function, but results won't be available for several years. Regular exercise should be a lifelong habit to keep you and your lungs healthy. Walking, treadmill, or cycling are the minimum exercises. Healthcare professionals in a pulmonary rehabilitation program can individualize these and other exercises for you. Weather changes are hard for everyone. Air pollution is another factor making your lungs worse. We are studying the effects of air pollution on COPD patients in Denver over the winter to find out more about how much air pollution is a problem and how it affects people's lungs - the study is funded by the Environmental Protection Agency which sets standards for air quality in the US.

Question: I have COPD. I exercise and use my medications daily. I am now on Combivent Inhaler in addition to Serevent and Azmacort. If I should need a fast acting inhaler, what should I use: Combivent or albuterol? I also use these (Combivent) or albuterol in my nebulizer when I am having shortness of breath problems in humid situations, ozone problems, small particulate problems, or when I have an infection. Please give me some advice as to what is the proper meds to use in each situation.

Barry Make, MD-- You need to check with your doctor. One of the issues is that Serevent and Combivent contain medications of the same class. Serevent and the albuterol in the Combivent are both beta agonist bronchodilators and can thus increase your chances of side effects if you are using both on a regular basis. Both Combivent and albuterol can be used for quick relief, but I am concerned you might be on too much medication. In a lot of patients with COPD, overuse of medications is common. Rather than taking more medications when you are short of breath, try sitting down, relaxing and doing your pursed lips breathing (breathe in through your nose and then out slowly through lightly pursed lips) - this is likely to be as effective than taking more medications at such times.

Question: Hello. I was diagnosed with pulmonary hypertension (restricted lung condition) and cor pulmanal in 1991 and have been using oxygen since Aug. 1991. Last year Atelectisis was discovered and I was put on IPPB treatments. Now that the atelectisis seems to have disappeared I am wondering if I should continue to do the treatments. My Pulmonary specialist says he does not think that they will help me but if I wish to continue them, they will not hurt me. Just recently I have had to up my oxygen rate from 1/2 at rest and 3/4 with activity to 1 at rest and 1 ½ with activity. I only use Vancenase AQ. No other drugs. I am a 48 year old white female. I weigh 183 lbs. I also use a Bi-pap machine with 3 liters of oxygen at night. This has been my lifesaver. Are you able the give me any suggestions?

Barry Make, MD-- Atelectesis is not very common in pulmonary hypertension. IPPB may be helpful to continue, but not mandatory. The way to adjust your oxygen is to ask your doctor or oxygen company to check the oxygen in your finger (oxygen saturation) while you are sitting and walking and adjust your oxygen flow so the saturation stays about 90%. It is not appropriate to adjust your oxygen only based on how short of breath you are. Do you know why you are using BiPAP? Your oxygen level should also be checked at night.

Question: I was diagnosed with emphysema in 1978. At that time, I was not experiencing any difficulties. The disease has progressed to a point where I am now considered 100% disabled by the VA. I am presently taking Slo-Bid, 300mg, three times a day; Proventil, three inhalations, three times a day; Atrovent, three inhalations, three times per day; and Azmocort, six inhalations, twice each day. The doctors I see tell me that I am maxed out on medication that is designed to help COPD patients. I am not on oxygen. Through the years, I have searched for something that would help ease the symptoms of COPD; Particularly, the frequent episodes of shortness of breath. Many asthma and emphysema sufferers have advised me to see a Dr. Carrillo at the Carrillo Clinic in Mexicalli, Mexico. They say he has a medication, which is nothing short of a miracle. I was impressed by the number of people who say they have been helped by the medication prescribed by Dr. Carrillo. However, when I search for doctors or other health professionals who are knowledgeable about the Carrillo Clinic, I can find none. Or, at least, that is what they are telling me. With the numbers of COPD sufferers telling me that they are returning to the clinic each year for help, I find it hard to believe that no health professional is aware of the clinic or the medication that Dr. Carrillo prescribes for the relief of COPD symptoms. The only reference I have been able to locate is an article published in the July 1992 issue of the Journal of Allergy and Clinical Immunology which states that each of the proprietary pills contain approximately 3.5 to 4.2 mg of triamcinolone. The article suggests that since the dosage is inconsistent and the medication unregulated, there should be some caution exercised. My question is; If Dr. Carrillo has been successful (and the numbers seem to indicate that he has been) in reliving the symptoms of COPD through the use of triamicionolone, why are no health professionals in the US using it or, at least, investigating the results of its use?

Barry Make, MD-- In general, when you are seeking new treatments, there are some things to ask your doctor. You have a right to the answers to these questions. First, what exactly is the nature and type of treatment? What are the side effects or adverse effects that have been seen and how often do they occur? What are the short-term and also long-term benefits and outcomes? What data has been collected and has it been presented at a scientific meeting or published in a medical journal? More specifically, triamcinolone is a steroid. Steroid pills are not effective for most patients with emphysema and have a lot of long-term adverse effects. A carefully performed trial of this is warranted but objective measures of lung function along with your symptoms are required to assess whether the oral steroid pill has been of benefit. Breathing tests and a medial history and physical examination should be performed before and two weeks after the medication trial. Best of luck.

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Possible Side Effects of Medications

Question: I take a number of asthma drugs including Flovent 220 4 puffs a day. I have what I will describe as anxiety more like vertigo. I used to be able to endure it – even when I was at heights. But now, even driving on minor hills can trigger a response. Could my drugs cause or increase such side affects?

Barry Make, MD-- Vertigo is probably not related to your asthma or medications, but may be associated with hyperventilation - breathing too fast because of anxiety. So, your doctor needs to help you sort this out.

Question: My husband uses Combivent for severe COPD and has quite good results. One of the very difficult side effects is that it causes severe flushing--like hot flashes, but no fever, no perspiration. This is also true of nebulizers. Since he must use them this side effect is quite debilitating and alarming. Does anyone have a solution to this problem? The Dr. and the pharmaceutical company (who are quite aware of the problem) have no answers. This was intermittent at first, but now goes on most of the day. Can anyone help?

Barry Make, MD-- Beta-agonist bronchodilators, like albuterol which is one of the components of Combivent, can be associated with increased heart rate and palpitations. It sounds like this is causing the problem. The amount of the medication being taken may be a problem. These effects are more common with higher doses (more than 2 puffs at a time or more than 2 puffs every 4-6 hours). Spacers, mentioned before, reduce the amount of medication from the puffer (metered-dose inhaler) that is deposited on the back of the throat and may reduce these problems. Xopenex, mentioned before in one of the questions and answers, has less side effects and might be worth trying. Another suggestion is to use Atrovent only and not the albuterol. Combivent has both albuterol and Atrovent.

Question: asked by email: My wife has severe COPD along with pulmonary hypertension. Could one of her medications cause tremors? She is on 4 liters of liquid oxygen continuously and cuts down to three at night. Could it be albuterol?

Barry Make, MD-- Albuterol can also cause tremors for some people (see above). In addition, someone who has severe COPD may have muscle weakness and experience tremors with activity. It is important to check with her doctor about the oxygen liter flow during the day and at night. Many people need to have their oxygen increased at night when breathing is typically more shallow and the oxygen level is correspondingly lower.

Barry Make, MD-- Thank you all for your questions and for participating in this chat.

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