Tal Klatchko, D.O.

Pulmonary & Critical Care
Roper-St. Francis Hospital
Charleston, South Carolina


1) I have been coughing for months. What could be causing my cough?
2) How do I know if I need oxygen for my lung disease?
3) How can I quit smoking?
4) How do I know if my prior smoking damaged my lungs?
5) Can Pollution injure my lungs?
6) Should I obtain a flu shot this year?
7) Dr. Klatchko’s name is followed by the initials “D.O.” What is a D.O.?



1) I have been coughing for months. What could be causing my cough?
Chronic (long-term) coughing very rarely improves with antibiotics alone. The most common causes of a persistent cough are posterior nasal drainage, asthma and gastro-esophageal reflux.

Posterior nasal drainage results from mucous and fluid draining backwards into the throat and onto the vocal cords. Patients with this problem usually experience a tickle or irritation in the back of the throat. They may also notice sinus pressure or pain and a stuffy nose. Persistent nasal drainage may result from allergies, viruses or environmental irritants. Doctors commonly treat the problem using nasal sprays to decrease inflammation as well as decongestants for drying out the mucous membranes of the nose. Your doctor may also evaluate you for any allergies or other environmental irritants.
Unrecognized asthma also commonly causes a persistent cough. Asthma effects almost five percent of the US population and causes intermittent inflammation of the bronchial tubes in response to exercise, allergies, viruses or other triggers. Patients with mild asthma often complain of a dry cough, noisy breathing and shortness of breath. If your cough is from mild asthma, your doctor can easily treat the problem with a variety of inhaled medications.

Acid reflux from the stomach into the esophagus and windpipe may also cause persistent coughing. These patients sometimes complain of heartburn or indigestion after eating. They also sometimes complain of a foul taste in the mouth, but in some cases cough will be the only symptom. Your doctor can also easily correct this condition by using medications to reduce the acid production from your stomach.
Other less common conditions causing persistent coughing include lung tumors, regurgitation of food particles into the windpipe and a variety of rare lung diseases. The vast majority of these problems can be detected with a routine chest x-ray.

If your coughing persists, you should call your physician and discuss these different possibilities. Your doctor will probably recommend an x-ray and one or two additional tests to diagnosis the actual cause of your cough.
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2) How do I know if I need oxygen for my lung disease?
Many patients with lung disease require oxygen. A famous study done in England about 15 years ago proved patients with low arterial oxygen levels lived longer by using oxygen at night. This famous study used needle punctures of the artery in the wrist to measure the blood oxygen level. The technology for measuring the oxygen level in the blood has improved over the past two decades and healthcare professionals no longer need to puncture the artery to measure the blood oxygen level. We now measure oxygen levels using a painless finger probe.

Most experts now recommend oxygen for any patients with a finger probe oxygen
measurement of less than 89%. If your oxygen saturation (level) is less than 89% at rest, you should wear the oxygen as much as possible. If your oxygen level only drops with exercise, you only need oxygen with walking and sleep.

Medicare pays for oxygen in those patients who qualify. If you only require oxygen at night, the doctor will probably prescribe a concentrator. A concentrator is a machine weighing about 30 pounds and standing around three feet high. The patient places the concentrator near the bed and connects a small tube from the concentrator to the nose. If you need oxygen during the day, your doctor will order portable oxygen in addition to a concentrator.

Portable oxygen comes in several forms. Durable equipment companies may provide compressed oxygen in large green cylinders. These cylinders weigh five to ten pounds each and provide around two to three hours of oxygen. I personally recommend one of the newer liquid oxygen systems. The most up-to-date liquid system provides a portable tank weighing around a pound and a half, which can easily be placed over the shoulder and lasts for up to eight hours.
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3) How can I quit smoking?
Cigarette abuse remains a major health problem in the United States. Smoking increases the risk of suffering a stroke, developing lung or bladder cancer and experiencing a heart attack. Smoking also worsens osteoporosis and peptic ulcer disease. Quitting cigarettes ranks high as one of the key things Americans can do to improve their health and longevity.

Most experts now recommend selecting a “quit date” and completely abstaining from tobacco use after the set date. Studies demonstrate greater success with this “cold turkey” method as compared with gradual reduction in cigarette use over time. People may seek support through group counseling or encouragement from their physicians and family members. Many programs also employ hypnosis to help improve determination. Medical studies have shown mixed results concerning hypnosis as an aide to smoking cessation. Some studies showed a benefit from hypnosis and other studies demonstrated no advantage.

Cigarettes contain an addictive drug called nicotine. Nicotine acts as a stimulant in our bodies similar to caffeine or amphetamines. When a person stops smoking, he or she may experience symptoms of withdrawal, including anxiety, irritability, palpitations, weight gain or difficulty sleeping. The average person gains about 10 pounds after giving up cigarettes. The symptoms of irritability and anxiety generally peak around three (3) to five (5) days after the last cigarette, but cravings and some mood changes may persist for months.

Pharmacies sell several nicotine replacement therapies, which help alleviate the symptoms of nicotine withdrawal. Nicotine replacement therapies provide a small quantity of nicotine through a patch applied to the skin, chewing gum, nasal spray or hand held inhalers resembling plastic cigarettes. Doctors currently believe all these types of nicotine replacement therapy are equally effective and no one method stands out at this time.

Some physicians may also recommend pills for smoking cessation. Chantix (Varenicline) and Zyban (Bupropion) are the two popular prescription drugs which help the adults to get rid of smoking routine. Chantix helps reduce nicotine craving and withdrawal effects in smokers. Zyban has been approved as both an antidepressant which mainly treat a condition called major depressive disorder and as an aid to patients who want to quit smoking. Medical studies showed greater success rates with these medications in comparison to placebos (“sugar pills”). Keep in mind there are no panaceas. No matter what pills, nicotine replacement therapies or support groups a person employs, quitting cigarettes is not easy. It requires determination, persistence and good old-fashion will power.
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4) How do I know if my prior smoking damaged my lungs?
Smoking damages the lungs in several different ways. Smoking may cause chronic irritation in the bronchial tubes resulting in wheezing, coughing and phlegm production. Doctors call this type of inflammation chronic bronchitis. Cigarettes also may destroy the tiny air sacks in our lungs called alveoli. These alveoli normally extract oxygen from ambient air we inhale. The destruction of these alveoli prevents the lungs from deflating normally and limits the ability to exhale. Doctors call this form of injury emphysema. Although some smokers may suffer from only one of these types of injury, the majority experiences a combination of chronic bronchitis and emphysema. Doctors call this combination of problems chronic obstructive airway disease or COPD.

Lung tissue does not regenerate and smoking related damage to the lung is often permanent. The sooner a person stops smoking, the less likely permanent lung damage will occur. Lung specialists use Pulmonary Function Testing to determine if a person suffered any injury from prior smoking as well as for measuring the severity of injury. Pulmonary function testing is simple and can usually be performed in the office of a lung specialist. The testing involves several parts. First the patient exhales into a tube attached to a computer to measure the force of exhalation. Next, the technician will assist the patient with several easy maneuvers to measure the size of the lungs and the ability of the lungs to extract oxygen from the surrounding air. A thorough evaluation of the lungs also requires a chest x-ray. The x-ray will detect any pneumonias, collapsed lungs, or cancer.

If you smoked previously, do everything you can to quit now. If you need to know if any injury has already occurred, ask your doctor to arrange for a chest x-ray and pulmonary function testing.
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5) Can Pollution injure my lungs?
Pollution can injure lung tissue. Autopsy studies show the lungs of urban dwellers from highly industrial areas contain higher levels of soot and black pigmentation than the lungs of people from rural areas. Pathologists call this black soot imbedded in the cells lining the tiny air sacks of the lungs anthracosis. Exposure to high levels of pollution over a long period of time also increases a person’s risk of developing emphysema or lung cancer later in life.

Pollution does more than just effect statistics. Air contamination may adversely affect our breathing on a day-to-day basis. Patients with chronic bronchitis or asthma often complain of more wheezing and shortness of breath when the air quality is poor. Sudden exposure to large amounts of smoke or exhaust fumes can also aggravate existing lung disease.

Air contamination in the work place can also cause lung disease. Lung specialists often describe a syndrome called occupational asthma. This syndrome occurs when patients experience wheezing and difficulty breathing only in the work place. Their symptoms improve on weekends and during vacation. The inorganic irritants found in smoke, chemical solvents, cleaning solutions, oils, or dust particles initiate a cycle of inflammation and narrowing of the bronchial tubes. The symptoms worsen in the work environment with exposure to these contaminates and abate during vacations or time away from work. Physicians usually find this problem difficult to treat without decreasing the amount of air contamination and patients often need to change their work environment.

If you want to know if air pollution damaged your lungs, you should schedule an appointment with your doctor. He or she will most probably recommend a chest x-ray and breathing tests called Pulmonary Function Tests.
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6) Should I obtain a flu shot this year?
Influenza is a viral illness infecting patients during the late fall and winter months. Influenza or the “flu” causes muscle aches, fevers, runny nose and coughing. The illness usually subsides after seven to ten days in otherwise healthy adults. Unfortunately, in elderly individuals or patients with underlying diseases of the heart or lungs, influenza may progress to pneumonia resulting in a long disabling illness or even death.
Most authorities recommend people at increased risk receive a flu shot annually in October or November. The vaccine does not guarantee complete protection from the flu, but most authorities estimate a 70 –80% reduction in influenza through use of the vaccine. Those people who do contract the flu even after taking the vaccine usually experience less severe symptoms.

Current recommendations suggest anyone over the age of sixty receive a flu shot. Most authorities also recommend a flu shot for anyone suffering from a chronic lung or heart disease including emphysema, chronic bronchitis, heart failure or asthma. Healthcare workers including nurses, doctors and medical office personnel should also receive flu shots, as should pregnant women in their second and third trimesters of pregnancy and residents of chronic care facilities such as nursing homes.

The flu shot may cause local soreness at the injection site or even a mild episode of muscle aches. Rarely, patients may experience a severe allergic reaction to a flu shot. For this reason, the center for disease control recommends against giving the flu shot to any patient who experienced a previous allergic reaction to the vaccine. Authorities also recommend against taking the flu shot if you have any history of allergies to eggs since the vaccine is prepared through the use of eggs. Patients who recently suffered from a neurological disease called guillian-barre syndrome should also avoid taking the flu shot, as should patients with severely compromised immune systems.

Scientists recently developed a new intranasal vaccine against influenza in the form of a nasal spray. The initial studies with this vaccine showed promise and in 2003, the FDA approved the intranasal preparation for children over the age of five and adults under the age of fifty.
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7) Dr. Klatchko’s name is followed by the initials “D.O.” What is a D.O.?
If you’re like most people, you’ve been going to the doctor ever since you were born, and perhaps were not aware whether you were seeing a D.O. (Osteopathic Physician) or an M.D. (Allopathic Physician). You may not even be aware that there are these two types of complete physicians in the United States.

The fact is both D.O.s and M.D.s are complete physicians. They are both licensed to perform surgery and prescribe medication in all 50 states.

Is there any difference between these two kinds of doctors? Yes. And no.

  • Applicants to both D.O. and M.D. colleges typically have a four-year undergraduate degree with an emphasis on science courses.
  • Both D.O.s and M.D.s complete four years of basic medical education.
  • After medical school, both D.O.s and M.D.s can choose to practice in a specialty area of medicine — such as psychiatry, surgery, or obstetrics — after completing a residency program (typically two to six years of additional training).
  • Both D.O.s and M.D.s must pass considerable state licensing examinations.
  • D.O.s and M.D.s both practice in fully accredited and licensed hospitals and medical centers.
  • D.O.s comprise a separate, yet equal branch of American medical care.
  • Together, D.O.s and M.D.s enhance the state of care available in America.

However, it’s the ways that D.O.s and M.D.s are different that can bring an extra dimension to your family’s healthcare.

  • Osteopathic medical schools emphasize training students to be primary care physicians.
  • D.O.s practice a “whole person” approach to medicine. Instead of just treating specific symptoms or illnesses, they regard your body as an integrated whole.
  • Osteopathic physicians focus on preventive health care.
  • D.O.s receive extra training in the musculoskeletal system-your body’s interconnected system of nerves, muscles and bones that make up two-thirds of your body mass. This training provides osteopathic physicians with a better understanding of the ways that an illness or injury in one part of your body can affect another.
  • Osteopathic manipulative treatment (OMT) is incorporated into the training and practice of osteopathic physicians. With OMT, osteopathic physicians use their hands to diagnose illness and injury and to encourage your body’s natural tendency toward good health. By combining all other available medical options with OMT, D.O.s offer their patients the most comprehensive care available in medicine today.

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