asthma or emphysema?
Question:
– Hide quoted text — Show quoted text -> > I spent much of last year battling ear infections, a strep infection > > and numerous sinus infections. Aside from the sinus thing, I’ve been > > feeling very run-down, little energy, and have noticed episodes of > > SOB. Nothing life threatening, but very noticeable. I’ve been a smoker > > on and off for 15 years (I’m 33) and decided that this year would be > > the year to quit, scheduled (and had) a physical last week, gave blood > > for tests and took a pulmonary function test. > > The results of the PFT are as follows: > > FVC pre:3.88 (106%), post: 4.12 (112%), (6% change) > > FEV1 pre: 2.93 (93%), post: 3.23 (103%), (10% change) > > FEV1/FVC pre: .75 (88%), post: .78 (92%), (4% change) > > PEFR: pre:4.51 (67%), post: 8.03 (119%), (78% change) > > FEV25-75 pre: 2.48 (54%), post: 2.87 (63%), (16% change) > > TLC: 4.80 (81%) > > RV: .96 (50%) > > DLCO: 14.23 (49%) > > DLCO/VA: 2.62 (46%) > > I know that determining whether this is asthma or emphysema (or both) > > can be quite difficult. How do you know for certain which one it is? > > Can anybody give me some insight as to what these results suggest? I > > was not able to see my regular doctor as he will be out of town until > > the end of next week. I did see another doctor, though, to ask some > > questions about the PFT, and he said that he believes that I suffer > > from chronic sinusitis and that the PFT suggests mild asthma. (What in > > the PFT specifically would suggest asthma and NOT emphysema?) I am > > scheduled to meet with my regular doctor in a week and a half or so, > > but any help/advice you can give me now would be greatly appreciated! > The pattern on the PFT’s suggests obstruction. This is evident by the normal > large airways (FEV1, PEFR) and the greater than 20% drop in medium to small > airways (FEF 25-75). When grading COPD (chronic obstructive lung disease > a.k.a. emphysema) which is a fixed obstructive defect, usually from smoking > (85% of the time), an FEV1 of less than 1 is called severe, 1-2 moderate, > and greater than 2 mild. This may have been what he meant when he termed it > mild. This nomenclature is for grading COPD and I am not sure it applies to > asthma because the "severity" of the asthma will depend more on how > hyper-reactive the airways are and how much spasming you have. The low > diffusing capacity (DLCO – how well gasses get across the lung to the blood) > implies that a lot of lung is not functioning. If it is asthma it is not > mild for this to get that bad. > By definition COPD is a fixed obstructive defect and asthma is reversible. > The fact that you show less than a 20% improvement after the dilator > suggests a fixed defect and emphysema. The only problem with labeling you > with this is that you are very young for smoking related emphysema. Even > heavy smokers who start young do not normally develop COPD until their 40’s > or more commonly 50’s or 60’s. There are two other possibilities. One is > that your asthma is just so out of control (possibly due to the smoking) > that the bronchospasm was not relieved by one dose of dilator. > If his sinusitis is severe enough, it can exacerbate asthma to the point > that one dose of bronchodilator won’t work either. And of course, > sinusitis + smoking together can really interfere with the > bronchodilator’s doing its job. > — > Steven D. Litvintchouk
I want to make sure I understand. Are you saying that the sinusitis could have an affect on my DLCO level? Either way, I realize that quitting smoking is not an option, but rather, a MUST.
Response:
– Hide quoted text — Show quoted text -> > > I spent much of last year battling ear infections, a strep infection > > > and numerous sinus infections. Aside from the sinus thing, I’ve been > > > feeling very run-down, little energy, and have noticed episodes of > > > SOB. Nothing life threatening, but very noticeable. I’ve been a smoker > > > on and off for 15 years (I’m 33) and decided that this year would be > > > the year to quit, scheduled (and had) a physical last week, gave blood > > > for tests and took a pulmonary function test. > > > The results of the PFT are as follows: > > > FVC pre:3.88 (106%), post: 4.12 (112%), (6% change) > > > FEV1 pre: 2.93 (93%), post: 3.23 (103%), (10% change) > > > FEV1/FVC pre: .75 (88%), post: .78 (92%), (4% change) > > > PEFR: pre:4.51 (67%), post: 8.03 (119%), (78% change) > > > FEV25-75 pre: 2.48 (54%), post: 2.87 (63%), (16% change) > > > TLC: 4.80 (81%) > > > RV: .96 (50%) > > > DLCO: 14.23 (49%) > > > DLCO/VA: 2.62 (46%) > > > I know that determining whether this is asthma or emphysema (or both) > > > can be quite difficult. How do you know for certain which one it is? > > > Can anybody give me some insight as to what these results suggest? I > > > was not able to see my regular doctor as he will be out of town until > > > the end of next week. I did see another doctor, though, to ask some > > > questions about the PFT, and he said that he believes that I suffer > > > from chronic sinusitis and that the PFT suggests mild asthma. (What in > > > the PFT specifically would suggest asthma and NOT emphysema?) I am > > > scheduled to meet with my regular doctor in a week and a half or so, > > > but any help/advice you can give me now would be greatly appreciated! > > The pattern on the PFT’s suggests obstruction. This is evident by the > normal > > large airways (FEV1, PEFR) and the greater than 20% drop in medium to > small > > airways (FEF 25-75). When grading COPD (chronic obstructive lung disease > > a.k.a. emphysema) which is a fixed obstructive defect, usually from > smoking > > (85% of the time), an FEV1 of less than 1 is called severe, 1-2 > moderate, > > and greater than 2 mild. This may have been what he meant when he termed > it > > mild. This nomenclature is for grading COPD and I am not sure it applies > to > > asthma because the "severity" of the asthma will depend more on how > > hyper-reactive the airways are and how much spasming you have. The low > > diffusing capacity (DLCO – how well gasses get across the lung to the > blood) > > implies that a lot of lung is not functioning. If it is asthma it is not > > mild for this to get that bad. > > By definition COPD is a fixed obstructive defect and asthma is > reversible. > > The fact that you show less than a 20% improvement after the dilator > > suggests a fixed defect and emphysema. The only problem with labeling > you > > with this is that you are very young for smoking related emphysema. Even > > heavy smokers who start young do not normally develop COPD until their > 40’s > > or more commonly 50’s or 60’s. There are two other possibilities. One is > > that your asthma is just so out of control (possibly due to the smoking) > > that the bronchospasm was not relieved by one dose of dilator. > If his sinusitis is severe enough, it can exacerbate asthma to the point > that one dose of bronchodilator won’t work either. And of course, > sinusitis + smoking together can really interfere with the > bronchodilator’s doing its job. > — > Steven D. Litvintchouk > I want to make sure I understand. Are you saying that the sinusitis could > have an affect on my DLCO level? Either way, I realize that quitting smoking > is not an option, but rather, a MUST.
Response:
I spent much of last year battling ear infections, a strep infection and numerous sinus infections. Aside from the sinus thing, I’ve been feeling very run-down, little energy, and have noticed episodes of SOB. Nothing life threatening, but very noticeable. I’ve been a smoker on and off for 15 years (I’m 33) and decided that this year would be the year to quit, scheduled (and had) a physical last week, gave blood for tests and took a pulmonary function test. The results of the PFT are as follows: FVC pre:3.88 (106%), post: 4.12 (112%), (6% change) FEV1 pre: 2.93 (93%), post: 3.23 (103%), (10% change) FEV1/FVC pre: .75 (88%), post: .78 (92%), (4% change) PEFR: pre:4.51 (67%), post: 8.03 (119%), (78% change) FEV25-75 pre: 2.48 (54%), post: 2.87 (63%), (16% change) TLC: 4.80 (81%) RV: .96 (50%) DLCO: 14.23 (49%) DLCO/VA: 2.62 (46%) I know that determining whether this is asthma or emphysema (or both) can be quite difficult. How do you know for certain which one it is? Can anybody give me some insight as to what these results suggest? I was not able to see my regular doctor as he will be out of town until the end of next week. I did see another doctor, though, to ask some questions about the PFT, and he said that he believes that I suffer from chronic sinusitis and that the PFT suggests mild asthma. (What in the PFT specifically would suggest asthma and NOT emphysema?) I am scheduled to meet with my regular doctor in a week and a half or so, but any help/advice you can give me now would be greatly appreciated!
Response:
– Hide quoted text — Show quoted text -> I spent much of last year battling ear infections, a strep infection > and numerous sinus infections. Aside from the sinus thing, I’ve been > feeling very run-down, little energy, and have noticed episodes of > SOB. Nothing life threatening, but very noticeable. I’ve been a smoker > on and off for 15 years (I’m 33) and decided that this year would be > the year to quit, scheduled (and had) a physical last week, gave blood > for tests and took a pulmonary function test. > The results of the PFT are as follows: > FVC pre:3.88 (106%), post: 4.12 (112%), (6% change) > FEV1 pre: 2.93 (93%), post: 3.23 (103%), (10% change) > FEV1/FVC pre: .75 (88%), post: .78 (92%), (4% change) > PEFR: pre:4.51 (67%), post: 8.03 (119%), (78% change) > FEV25-75 pre: 2.48 (54%), post: 2.87 (63%), (16% change) > TLC: 4.80 (81%) > RV: .96 (50%) > DLCO: 14.23 (49%) > DLCO/VA: 2.62 (46%) > I know that determining whether this is asthma or emphysema (or both) > can be quite difficult. How do you know for certain which one it is? > Can anybody give me some insight as to what these results suggest? I > was not able to see my regular doctor as he will be out of town until > the end of next week. I did see another doctor, though, to ask some > questions about the PFT, and he said that he believes that I suffer > from chronic sinusitis and that the PFT suggests mild asthma. (What in > the PFT specifically would suggest asthma and NOT emphysema?) I am > scheduled to meet with my regular doctor in a week and a half or so, > but any help/advice you can give me now would be greatly appreciated!
The pattern on the PFT’s suggests obstruction. This is evident by the normal large airways (FEV1, PEFR) and the greater than 20% drop in medium to small airways (FEF 25-75). When grading COPD (chronic obstructive lung disease a.k.a. emphysema) which is a fixed obstructive defect, usually from smoking (85% of the time), an FEV1 of less than 1 is called severe, 1-2 moderate, and greater than 2 mild. This may have been what he meant when he termed it mild. This nomenclature is for grading COPD and I am not sure it applies to asthma because the "severity" of the asthma will depend more on how hyper-reactive the airways are and how much spasming you have. The low diffusing capacity (DLCO – how well gasses get across the lung to the blood) implies that a lot of lung is not functioning. If it is asthma it is not mild for this to get that bad. By definition COPD is a fixed obstructive defect and asthma is reversible. The fact that you show less than a 20% improvement after the dilator suggests a fixed defect and emphysema. The only problem with labeling you with this is that you are very young for smoking related emphysema. Even heavy smokers who start young do not normally develop COPD until their 40’s or more commonly 50’s or 60’s. There are two other possibilities. One is that your asthma is just so out of control (possibly due to the smoking) that the bronchospasm was not relieved by one dose of dilator. The other (much less likely) is that you have another reason to have emphysema besides smoking such as alpha-1 antitrypsin deficiency. No matter what the diagnosis the first step is to quit smoking. There are no possibilities that will not result in a rapid decline in pulmonary function if you continue to smoke. The next step is probably to aggressively treat the asthma and any related triggering factors (allergies/sinus, reflux, smoking) and then repeat the test. If your lung function does not improve (including the DLCO) and true emphysema is suspected then a search for the more unusual causes of it is in order as I don’t think your smoking history would be sufficient to explain it. The chronic infections could be true infections or reflect allergies and could be associated as a trigger for the asthma or possibly suggest other diagnoses such as immune deficiencies (like HIV, immunoglobulin deficiency, immotile cilia syndrome, or others), autoimmune diseases (sarcoid, Wegener’s granulomatosis), chronic reflux and aspiration, cystic fibrosis, or other problems. What other testing needs to be done will depend strongly on how you respond to smoking cessation and aggressive treatment of your asthma and allergies. I assume a chest x-ray has already been done and was normal. — CBI, MD
Response:
- Hide quoted text — Show quoted text -> I spent much of last year battling ear infections, a strep infection > and numerous sinus infections. Aside from the sinus thing, I’ve been > feeling very run-down, little energy, and have noticed episodes of > SOB. Nothing life threatening, but very noticeable. I’ve been a smoker > on and off for 15 years (I’m 33) and decided that this year would be > the year to quit, scheduled (and had) a physical last week, gave blood > for tests and took a pulmonary function test. > The results of the PFT are as follows: > FVC pre:3.88 (106%), post: 4.12 (112%), (6% change) > FEV1 pre: 2.93 (93%), post: 3.23 (103%), (10% change) > FEV1/FVC pre: .75 (88%), post: .78 (92%), (4% change) > PEFR: pre:4.51 (67%), post: 8.03 (119%), (78% change) > FEV25-75 pre: 2.48 (54%), post: 2.87 (63%), (16% change) > TLC: 4.80 (81%) > RV: .96 (50%) > DLCO: 14.23 (49%) > DLCO/VA: 2.62 (46%) > I know that determining whether this is asthma or emphysema (or both) > can be quite difficult. How do you know for certain which one it is? > Can anybody give me some insight as to what these results suggest? I > was not able to see my regular doctor as he will be out of town until > the end of next week. I did see another doctor, though, to ask some > questions about the PFT, and he said that he believes that I suffer > from chronic sinusitis and that the PFT suggests mild asthma. (What in > the PFT specifically would suggest asthma and NOT emphysema?) I am > scheduled to meet with my regular doctor in a week and a half or so, > but any help/advice you can give me now would be greatly appreciated! > The pattern on the PFT’s suggests obstruction. This is evident by the normal > large airways (FEV1, PEFR) and the greater than 20% drop in medium to small > airways (FEF 25-75). When grading COPD (chronic obstructive lung disease > a.k.a. emphysema) which is a fixed obstructive defect, usually from smoking > (85% of the time), an FEV1 of less than 1 is called severe, 1-2 moderate, > and greater than 2 mild. This may have been what he meant when he termed it > mild. This nomenclature is for grading COPD and I am not sure it applies to > asthma because the "severity" of the asthma will depend more on how > hyper-reactive the airways are and how much spasming you have. The low > diffusing capacity (DLCO – how well gasses get across the lung to the blood) > implies that a lot of lung is not functioning. If it is asthma it is not > mild for this to get that bad. > By definition COPD is a fixed obstructive defect and asthma is reversible. > The fact that you show less than a 20% improvement after the dilator > suggests a fixed defect and emphysema. The only problem with labeling you > with this is that you are very young for smoking related emphysema. Even > heavy smokers who start young do not normally develop COPD until their 40’s > or more commonly 50’s or 60’s. There are two other possibilities. One is > that your asthma is just so out of control (possibly due to the smoking) > that the bronchospasm was not relieved by one dose of dilator.
If his sinusitis is severe enough, it can exacerbate asthma to the point that one dose of bronchodilator won’t work either. And of course, sinusitis + smoking together can really interfere with the bronchodilator’s doing its job. — Steven D. Litvintchouk
Response:
- Hide quoted text — Show quoted text —— Original Message —– Newsgroups: alt.support.asthma Sent: Friday, March 22, 2002 11:04 PM > The pattern on the PFT’s suggests obstruction. This is evident by the normal > large airways (FEV1, PEFR) and the greater than 20% drop in medium to small > airways (FEF 25-75). When grading COPD (chronic obstructive lung disease > a.k.a. emphysema) which is a fixed obstructive defect, usually from smoking > (85% of the time), an FEV1 of less than 1 is called severe, 1-2 moderate, > and greater than 2 mild. This may have been what he meant when he termed it > mild. This nomenclature is for grading COPD and I am not sure it applies to > asthma because the "severity" of the asthma will depend more on how > hyper-reactive the airways are and how much spasming you have. The low > diffusing capacity (DLCO – how well gasses get across the lung to the blood) > implies that a lot of lung is not functioning. If it is asthma it is not > mild for this to get that bad. > By definition COPD is a fixed obstructive defect and asthma is reversible. > The fact that you show less than a 20% improvement after the dilator > suggests a fixed defect and emphysema. The only problem with labeling you > with this is that you are very young for smoking related emphysema. Even > heavy smokers who start young do not normally develop COPD until their 40’s > or more commonly 50’s or 60’s. There are two other possibilities. One is > that your asthma is just so out of control (possibly due to the smoking) > that the bronchospasm was not relieved by one dose of dilator. The other > (much less likely) is that you have another reason to have emphysema besides > smoking such as alpha-1 antitrypsin deficiency. > No matter what the diagnosis the first step is to quit smoking. There are no > possibilities that will not result in a rapid decline in pulmonary function > if you continue to smoke. The next step is probably to aggressively treat > the asthma and any related triggering factors (allergies/sinus, reflux, > smoking) and then repeat the test. If your lung function does not improve > (including the DLCO) and true emphysema is suspected then a search for the > more unusual causes of it is in order as I don’t think your smoking history > would be sufficient to explain it. > The chronic infections could be true infections or reflect allergies and > could be associated as a trigger for the asthma or possibly suggest other > diagnoses such as immune deficiencies (like HIV, immunoglobulin deficiency, > immotile cilia syndrome, or others), autoimmune diseases (sarcoid, Wegener’s > granulomatosis), chronic reflux and aspiration, cystic fibrosis, or other > problems. What other testing needs to be done will depend strongly on how > you respond to smoking cessation and aggressive treatment of your asthma and > allergies. I assume a chest x-ray has already been done and was normal. > — > CBI, MD Wow. You’ve given me quite a lot to think about. All of it scary. The doctor I saw (not the regular doctor) did not think a chest x-ray was necessary at the time and advised holding off on it until I can see my regular doctor, leaving that decision up to him. I now plan to insist on one. He also put me on Albuterol, Flonase, Afrin (for 5 days only) and Allegra, and sent to me down for a sinus cavity x-ray. (I haven’t gotten the results back yet.) As far as the smoking goes, I signed up for a smoking cessation class, but the next round of classes doesn’t start until April 9th. I don’t think I can (or should) wait that long to stop smoking, so it looks as if I’m going to have to do this cold turkey. Always a pleasant experience, but I guess when you’re looking at possibly battling emphysema, stressing about putting down the smokes seems pretty small in comparison. Thank you for your help.
Response:
> Right. And from what I’ve read and seen all the hypnosis, patches and > snake oil in the world really doesn’t do anything but help you > psychologically and make someone else rich.
Well, all I can say to that is that some of us could use the help psychologically speaking while quitting. Whatever floats your boat and all that. > BTW, I quit cold turkey (no aids) in ‘95 and my wife did last year. > Been there, done that.
Good for you! I mean that sincerely. So, without the use of any smoking cessation aids, how did you cope?
Response:
>In a sense, we all have emphysema.
This is what my pulmologist told me. He further stated that if we lived long enough we would all die from emphysema due to the polluntants in the air.
Response:
The same company manufacturers them and they are both the same drug. I went to an inservice from their sales rep. The reason the name is different is that many health insurance companies do not cover drugs to stop smoking. You really need to take it more than a day before you can say it wasn’t for you. There are some side effects but they usually go away after
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