COPD

[giffords]

Im 44 yrs old. smoked 1 pack per day from 20-30. Had to quit mostly because I was short of breath. Have had a productive cough pretty much since I quit. I work out often, but noticed myself a little more sob playing basketball than others my age. When i quit smoking at 30 had pfts, because of sob and it showed moderate obstructive disease.
In march of this year 2009 I went to bed and my wife asked why I was short of breath and I said I just ran up the stairs. That night I woke up short of breath and have had problems breathing for last 6 months. Extreme sob. Had a catscan and negative. Had two pfts one was completely normal and the other showed minimal obstructive disease and the pulmonologist said he still thought it was normal.
I had to quit my job, because i became too sob. I now asked my dr to order and ABG. The only thing is some days are horrible and some days I feel pretty good all day long. any input would be appreciated

[Davy9]

I suggest that they look more at the heart and the vascular system in the lungs. A normal PFT with such exquisite SOB points to the heart or the match between the blood and the ventilation in the lungs. Pulmonary hypertension or chronic micro-embolisms can cause this.

[giffords]

davy9,

Thanks for your input. Im pretty much lost at this point. Im actually a nurse and feel like im losing my mind. I went to temple Lung center and they did my second pft and that showed the minimal obstructive disease, but the Dr stated " that was computer generated diagnosis, but I think its normal"
I have had atrial septal defect with repair, but just had echo and it looks good. Normal LV function.
I have discussed pulmonary HTN with my doctor, but will look into further. Any other advice would be great!

[Davy9]

Have they done a diffusing capacity for carbon monoxide (DLCO) with your PFT's? V/Q scans? PFT and metabolic study under load (stress test)? They can indirectly assess pulmonary hypertension with one of the imaging studies (I don't recall which one).

[giffords]

Im not sure if they have done this I will check into. I just had my abg done, and it looks good, i dont feel good today, but it looks ok dont know if you know the numbers but ph7.41 pco2 40.8'
po 2 90 bicarb 25.4 sat 97.5 thanks again for any help John

[Davy9]

On the surface the ABG looks in the realm of Okay. But you do not state the heart rate or resp rate and so on. The O2 is a tad low for a resting ABG for someone your age and normal PFT's.

You must be familiar with pulse oximeters. You need to conduct a simple exercise assessment using one. Start off at rest and get a good set of baseline values. Then walk down the hallway and monitor the changes.

For what you describe you require a thorough work-up. For what it might be worth you are young enough for consideration for a lung transplant in the worst case scenario. But you do need a clear diagnosis/prognosis.

[giffords]

davy

where you talking about my po2 or my sat being tad low?

[Davy9]

I was referring to the O2 tension not the hemoglobin saturation. O2 sats are accurate but you really need to understand the hemoglobin O2 dissociation curve to interpret them properly. You reach 90% sat in the low to mid 80's of O2 tension (torr) and do not hit 100% sat until about 400 torr. But once your sat is in the 80's it will drop very fast if the PaO2 (torr) drops just a little bit further. It works that way so that the hemoglobin can easily pick up O2 in the lungs and then release it to the tissues.