Q: I am 44 years old and have scoliosis and one lung collapsed three years back. From December to January, I had a bad cough. The pulmonologist told me I had neglected the cough and had almost destroyed the other lung too. With medication and inhalers I could go back to my routine, except that too much exertion made me breathless. This year the cold was so severe, my lung just gave up and i was hospitalised for type II respiratory failure. I am out of hospital now and on home oxygen during the night. I have gone back to work, but any extra exertion like walking up even a slightly inclined slope makes me breathless. Added to the cold, I have also a posture problem due to the scoliosis. My lower back feels quite painful. How can I prevent osteoporosis and how can I make my lung stronger?

A:Unfortunately, restrictive lung disease with severe scoliosis does cause chronic respiratory failure and dependency on oxygen. Indeed, sometimes a permanent tracheostomy is necessary to make breathing easier. Bone wasting may occur, and calcium {1-1.5 grams a day} with Vitamin D are advised. Any form of tolerable exercise is helpful, and the assistance of a physiotherapist should be sought to plan a suitable regimen. Of interest is the finding that methtylphenidate (Ritalin) can stimulate the respiratory center of the brain and improve the depth of breathing, thereby discouraging the deterioration that is bound to slowly occur in this condition. Early and appropriate use of antibiotics is very important should an infectious exacerbation occur.