Lung Issues: Insights on Tracheostomy and Fibrosis

Pulmonary disease issues

Hello, Dr.
Jian:
1.
I underwent a tracheostomy in the intensive care unit of a teaching hospital during the New Year holiday in 2003 due to an emergency.
I was on a ventilator for a whole month, then transferred to another ventilator unit where I stayed for seven months before being discharged for rehabilitation.
A month later, I was readmitted to the ventilator unit, and after another month, the tracheostomy tube was removed, allowing me to cough up phlegm on my own and speak with difficulty.
However, the doctors indicated that my lungs had developed fibrosis, and the residual tracheostomy site could heal on its own within one to two months.
After being discharged, I returned for regular check-ups and was prescribed expectorants for persistent phlegm.
For the asthma triggered by lung fibrosis, I was given inhaled medications for relief, which were not significantly effective, and I still needed to rest in a lying position.
I inquired about when the residual tracheostomy site would heal on its own, but the answer was still one to two months.
Since there was no definitive answer, I stopped attending outpatient visits due to the long distance and the burden of taxi fares.
Nearly two years have passed, and the tracheostomy site has shrunk to the size of a mung bean, but I still produce phlegm when coughing, speaking, or eating, and my speech is breathy and hoarse.
Can you tell me if this tracheostomy site can heal on its own, and how much longer it might take? Is it possible to seek surgical closure at another hospital?
2.
I always produce phlegm while eating, and sometimes I notice rice grains and vegetable remnants in the phlegm.
Could it be that my esophagus has developed a fistula? Otherwise, since the trachea and esophagus are separate, how could food particles appear in my phlegm?
3.
I experience shortness of breath with minimal exertion, which was not present before my illness.
Is this a common symptom for all patients with lung fibrosis?
4.
Has my condition progressed to typical "chronic obstructive pulmonary disease (COPD)?" Can it be cured with continued outpatient treatment, or has it become a lifelong disability? Can I request surgical removal of the fibrotic tissue?
5.
Occasionally, I notice blood streaks in my phlegm, which disappear after a day or two.
Is this a sign of a serious condition?
6.
My weight has dropped from 49 kg before my illness to 40 kg and has not returned to normal for a long time, although my appetite is still good.
What could be the reason for this?
I would appreciate your brief responses to these questions.
Thank you.

tpy, 60~69 year old female. Ask Date: 2005/06/03

Dr. Jian Linzhen reply Pulmonology

1.
Some tracheostomy stomas may heal spontaneously while others may not, and they do not require suturing.

2.
Suspect tracheoesophageal fistula.

3.
Pulmonary fibrosis leads to decreased lung function.

4.
Surgical resection is not necessary, but rehabilitation should be continued.

5.
It is not severe and may be due to tracheitis.

6.
Decreased lung function due to pulmonary fibrosis and muscle deconditioning can both affect body weight.

Reply Date: 2005/06/03

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your lung issues, particularly in relation to your history of tracheostomy and lung fibrosis. I understand that you have several concerns, and I will address each of them to provide clarity and guidance.

1. Healing of the Tracheostomy Site: The healing of a tracheostomy site can vary significantly from person to person. Typically, small tracheostomy openings can close on their own within a few weeks to months, depending on factors such as the size of the opening, your overall health, and any underlying conditions. Since you mentioned that the opening has shrunk significantly but is still present after nearly two years, it may be beneficial to consult with an otolaryngologist (ENT specialist) or a thoracic surgeon. They can evaluate the site and determine if surgical intervention is necessary to close the opening, especially if it continues to cause issues with speech and airflow.

2. Presence of Food Particles in Sputum: The presence of food particles in your sputum is concerning and may indicate a potential issue with the esophagus or a fistula (an abnormal connection) between the trachea and esophagus. Normally, the trachea and esophagus are separate structures, and food should not enter the trachea. I recommend that you seek a thorough evaluation, possibly including imaging studies or an endoscopy, to rule out any complications.

3. Shortness of Breath with Minimal Activity: Experiencing shortness of breath with minimal exertion is common in patients with lung fibrosis. This condition leads to scarring of lung tissue, which can significantly impair lung function and gas exchange. While not all patients with lung fibrosis will experience the same level of exertion-related breathlessness, it is a common symptom. Rehabilitation and pulmonary therapy may help improve your endurance and quality of life.

4. Chronic Obstructive Pulmonary Disease (COPD): Given your history and symptoms, it is possible that your condition may overlap with COPD, particularly if you have a history of smoking or exposure to lung irritants. However, lung fibrosis and COPD are distinct conditions. While COPD is characterized by airflow limitation, lung fibrosis involves scarring of lung tissue. Unfortunately, lung fibrosis is generally considered irreversible, and while treatments can help manage symptoms, they may not lead to a complete cure. Surgical options, such as lung volume reduction surgery, may be considered in select cases, but this would require a thorough evaluation by a specialist.

5. Hemoptysis (Coughing Up Blood): The occasional presence of blood in your sputum can be alarming. While it may not always indicate a severe condition, it should not be ignored. Causes can range from minor issues, such as irritation or infection, to more serious concerns, such as lung cancer or pulmonary embolism. It is crucial to report this symptom to your healthcare provider for further investigation.

6. Weight Loss and Appetite: Unintentional weight loss, especially in the context of chronic illness, can be multifactorial. It may be related to decreased appetite, increased energy expenditure due to breathing difficulties, or other underlying health issues. It is essential to discuss this with your healthcare provider, as they may recommend nutritional support or other interventions to help manage your weight.

In summary, I encourage you to seek follow-up care with specialists who can provide a comprehensive evaluation of your lung condition and address your concerns about the tracheostomy site, potential esophageal issues, and overall lung health. Regular monitoring and appropriate interventions can significantly improve your quality of life and manage your symptoms effectively.

Best wishes for your health and recovery.

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