DEAR READER: Emphysema results from damage to the airways of the lungs, obstructing the flow of air on exhalation. Symptoms are exercise intolerance, loss of appetite, fatigue and shortness of breath. The most common cause for the condition is smoking. Smoke temporarily paralyzes the cilia (microscopic hairs) that line the bronchial tubes. When the effects of smoke become so severe as to interfere with their movement, irritants in the bronchial tubes infiltrate the alveoli (air sacs) and inflame the tissue. This causes the elastic fibers to break down. Once the fibers have been destroyed, a person with emphysema must almost force air out of the lungs when exhaling.

Risk factors include exposure to secondhand smoke, occupational exposure, heredity, age, HIV infection and connective-tissue disorders.
Diagnosis might be accomplished through a chest X-ray, pulmonary-function tests, arterial blood-gas analysis, sputum analysis or though a CT scan.

Treatment involves discontinuing smoking and staying away from people who smoke. As you have discovered, steroid inhalers, bronchodilators and supplemental oxygen help ease symptoms. Antibiotics might be prescribed for respiratory infections. More complex cases and last-resort tactics might require surgery or transplant. On the home front, remedies include breathing from the diaphragm while lying down, deep breathing exercises and exhaling through pursed lips. The act of exhaling through puckered or pursed lips will increase air pressure within the airways. Avoid known irritants such as toxic chemicals, people with respiratory infections and cold air during the winter. This can be accomplished simply by wearing a mask over the mouth and nose, or by keeping the area covered with a scarf when outside. Exercise and eat well. If you are overweight, the body requires more oxygen to function properly, interfering with the process of breathing. Losing weight will work toward making breathing easier. And, above all, avoid smoke.

To provide related information, I am sending you a copy of my Health Report “Pulmonary Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092, or download an order blank from my Web site, www.AskDrGottMD.com. Be sure to mention the title.

I had my blood checked to see if it is too thin, but that test was negative. A thyroid test was slightly low, but I haven’t talked to my doctor about that yet to see if there is a connection. My medications are Spiriva, Albuterol and Armour thyroid. I was previously on Symbicort, but it made my tongue swell and become raw, so I was switched to the Spiriva that doesn’t work as well. I’ve been on the thyroid medication for 50 years and expect to have to take it for the rest of my life.
I really would appreciate your input.

DEAR READER:
Your Spiriva prescription has an uncommon side effect of rash for a very few individuals. If the rash appeared once you made the switch from Symbicort to Spiriva, you have your answer; your leg rash is drug-related. If, however, you had the rash prior to the switch, you must look elsewhere.

Your tongue swelling was an indication you could have had an allergic reaction to the components of the drug and your physician was correct to make the change to Spiriva.

While you sent a photograph of your rash the condition is difficult to diagnose since there are so many possibilities. It could be viral or bacterial in nature, a form of plant dermatitis, Lyme disease, pityriasis, Sjogrens, or other conditions.

I would rule out the Armour thyroid, because you have been on it for so long. The combination of the three drugs, however, could interact and present in the form of unexplained rash. The only true way of determining this is to eliminate one drug at a time to see if the rash disappears. Because of your COPD, I would urge you to speak with your physician or cardiologist before even considering making any changes. In the interim, you should make an appointment with a dermatologist if you haven’t already done so. See him or her while the rash is in full bloom so a diagnosis can be made.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.