COPD

[Guest]

I have not been feeling well for quite a long time:
for a few years I often felt cold, even in the
warm weather, weak and tired without
much exertion, often felt numbness
in my head and feet.

During the last year I seemed to be catching
colds very easily and could not completely
get rid of them. In March I had a bad cold,
perhaps bronchitis, with fever and pain in
my chest, which was somewhat relieved
by herb inhalations and warm drinks.
I slowly, in about three weeks, felt better, but
some discomfort in the lung area remained and
about two weeks ago started getting worse.
After I spent about two days in the colder
weather I felt sick again: the scratching, itching
pain in my lungs, difficulty taking a
deep breath, sometimes fever, weakness and
numbness I felt before.

This made me go see a pulmonologist who
after examining me, told me that he doesn't
see any problems with my lungs and
that I came to a `wrong department'.
He suggested that possible causes of my chest
pain might be excess of acid in my stomach,
for example. `But since you came in, let us
do a lung function test just in case'.
When I called him on the phone a bit later to
find out the results of the test, he said: `Well
you did come to the right department, the test
shows you have emphysema', but still on my
successive visits he didn't think my present
chest pain is lungs related.

Last week my condition was rapidly worsening,
the pain in chest increased, sometimes I feel
tightness in the chest, a certain `caged in'
feeling, at some moments I was very weak,
the numbness of my head increased and
became more constant, my ankles are swollen
in the evening, my ears get plugged
in as during an air flight, sometimes a little bit
of white or yellowish mucus comes out but
not much.

I am convinced that my present condition is
lung related: it feels much like a bronchitis.

Could you please offer your opinion and
advice?
Could it be that what I feel now is an
acute condition of emphysema I was diagnosed
with?

Thank you.

[Guest]

do you smoke? did you ever smoke? if not, then it would be unusual for you to have emphysema. there are conditions that can cause it besides smoking but they are uncommon. I am not sure what is causing all your symptoms. did the pulmonologist put you on any inhalers? there are some that are good for emphysema and the symptoms you describe. other than contacting your doctors regarding this worsening of your condition, I cannot give you much more advice.
[quote]
I have not been feeling well for quite a long time:
for a few years I often felt cold, even in the
warm weather, weak and tired without
much exertion, often felt numbness
in my head and feet.

During the last year I seemed to be catching
colds very easily and could not completely
get rid of them... [/quote]

[Guest]

No, I don't smoke and never did.
I went to see another pulmonologist to get
a second opinion and he doesn't think I have
emphysema. The first doctor diagnosed
emphysema based on the high RV (residual
volume) of my lung function test. The results
of this test were:

Normal Observed

TLC 6.50 8.28

VC 4.88 4.41

RV 1.66 3.88

FEV 1 3.95 3.71

FEV /VC % 81.8 94.1

PEF 9.30 3.93

02 77.9 89.6

CO2 38.0 41.9

Base Excess -0.90 3.50

O2 saturation 96.9 98.0

(my height is 174 cm or 5'9'', weight 55 kg, or
about 110 lbs)

The second doctor told me that if I had emphysema the oxygen saturation of my
blood would be affected, especially under
physical strain, and FEV1 would not be
as high. He thinks the large RV is due
to some inflammatory process, which is
due to an allergic reaction, and suggested
bronchoscopy.
He could not offer any explanation of my
acute symptoms however.

What do you think about this situation?

[quote] do you smoke. did you ever smoke... [/quote]

[Guest]

Based on what you have written, your only real abnormalities on this test were an elevated total lung capacity, elevated RV and low PEF. While emphysema can cause this, there are other conditions. did they check a diffusing capacity on you during the pulmonary function testing? It would be listed as DLCO and more importantly DLCO/VA? This may help determine if you truly have a form of emphysema. without ever smoking, you would need more tests (usually blood work to start) to help evaluate the cause of the emphysema(if present).
[quote] No, I don't smoke and never did.
I went to see another pulmonologist to get
a second opinion and he doesn't think I have
emphysema... [/quote]

[Guest]

Recently they did measure the diffusing
capacity. It was 72% of the normal.

The Alpha1-Antitrypsin test was normal.

When I asked the pulmonologist what was the
basis for his diagnosis and how sure he is of it.
His reply was: "You have twice the normal amount of air in your lungs, for me there's no
doubt you have emphysema, what else could
it be? On your lung function test RV is 208%
and ITGV is 4.64 l, which is 147% of the normal.
This clearly indicates that you have emphysema
but what could have caused it, is unclear".
He suggested that the possible cause might
be my scoliosis.

Today I had another lung function test with
approximately the same results; the RV went
down from 208% of the normal to 173% after
Atrovent. On this basis the pulmonologist
suggested Tiotropium treatment.

You mentioned there might be other conditions
leading to my symptoms. What are they?
Do you think the test results I mentioned above
indicate emphysema?

In the last few days I was feeling very cold
almost all the time and the discomfort in my
chest worsened. Is it possible that the feeling
of tightness and discomfort is the feeling
of overinflation of my lungs and of the changes
in the airways? Can one feel emphysema in
this way?

I will appreciate any thoughts and suggestions
you might have.

Slava

[quote] Based on what you have written, your only real abnormalities on this test were an elevated total lung capacity, elevated RV and low PEF. While emphysema can cause this, there are other conditions... [/quote]

[Guest]

I am glad the alpha 1 antitrypsin level and diffusing capacity were normal. Having the response to atrovent makes me think obstructive lung disease may be present and that your scoliosis is the likely culprit. Obstructive lung disease can have emphysema but not always. Emphysema is really a breakdown of the area of the lung where oxygen and carbon dioxide go in and out of the body respecitvely. It would be unusual to have significant emphysema with a normal diffusing capacity.

In any case, the tioproprium is a reasonable medication and continued care with a pulmonologist is important.
[quote]
Recently they did measure the diffusing
capacity. It was 72% of the normal... [/quote]