Disease progression and travel

[quiet171]

I was diagnosed with beginnings of emphesema in '98. '01 I was diagnosed w/very severe COPD.Last testing in April '08: FVC 2.61 pre/2.89 post;FEV1 1.05/1.17;FEV1/FVC 40/40;FEV6 2.18/2.38;FEV1/FEV6 2.18/2.38;FEF25-75% .34/.36;FEF25% .82/.95t;FEF50% .37/.43;FEF75% .17/.16;PEF 4.74/4.62; FIVC 2.87/3.08; TLC 6.96 L;VC 3.33 L;IC 1.85 L; FRC PL 5.06 L; ERV 1.44 L; RV 3.63 L; RV/TLC 52%; Vtg 5.71 L; DLCO 11.8; DL Adj 11.6; DLCO/VA 2.29; VA 5.09 L; EVC 3.13 L; Raw Total 3.71 L/sec; Raw 2.50 L/sec; Gaw .401 L/sec; sRaw 14.26; sGaw .070; Perfusion lung scan: diffuse non-uniformity uptake throughout both lungs w/o wedge or segmental defects; anteriorly left lung has 44%  right 56% uptake.  Posteriorly left lung 37% uptake right 63%. The LPO study 30% uptake in left uper lobe,70% left lower lobe.  RPO study right upper lobe to have 12%, right middle lobe 12%, right lower lobe 76%; Total geometric mean: left 41%;right 59%;Low normal left ventricular systolic function, visually estimated ejection fraction 50-55%; Mild septal dysynergy noted; Normal right ventricular size and function; Interatrial septum appears intact; Mildly dilated IVC; Unable to quantify tricuspid regurgitant jet or determine PA systolic pressure due to lack of adequate TR jet; LV diastolic diameter base 4.5cm; LV systolic diameter base 2.9cm; IVS diastolic thickness .7cm; LVPW diastolic thickness .7cm; LA area 4Cview 13.7cm2; LA area 3C view 12.8cm2;LA Systolic Diameter Apic 4.8cm; LA Volume 31.2cm2; LA volume index 18.9cm3/m;AV peak velocity 147 cm/s; AV peak gradient 8.7mmHg; Mitral E point velocity 74.4cm/s. Does this seem like normal progression of the disease with treatment of Spireva, Advair, Albuterol and oxygen during sleeping? I won't be able to see a pulmonologist until September but I live in Minnesota and my son is getting married in Colorado.  Will I need more oxygen when I go to Colorado and will I need oxygen when I fly or would it be better to drive?

[National Jewish Health]

Your PFT results and perfusion lung scans are consistent with the diagnosis of physiologically severe/very severe COPD.  A more expansive view of disease severity would also take into account, functional incapacitation (severity of shortness of breath with exertion and degree of difficulty performing the activities of daily living.)

The Echocardiogram results are actually encouraging; specifically the normal right ventricular size and function that  suggests that you probably do not have significant pulmonary hypertension and the estimated normal LV ejection fraction.  You would need to speak to the cardiologist who interpreted the ECHO regarding the implications of the other findings.

You ask, “ does this seem like normal progression of the disease with treatment …..”?  Without knowledge of your 2001 PFT results, it is not possible to judge progression.  But, if you truly did have “very severe COPD” at that time that would suggest that, if anything, progression has been relatively slow.

Whether you will need supplemental oxygen in Colorado, depends on your levels of arterial oxygen saturation and/or the (partial) pressure of arterial oxygen, while breathing ambient air without supplemental oxygen.  The average arterial oxygen saturation in Denver is around 92-94% and the average arterial oxygen pressure 65-70 mm Hg.  Many large medical centers are able to check these arterial values with an individual breathing air that contains roughly the amount of oxygen, present in the Denver.  You should check with the Pulmonologist’s staff about this.

Commercial airliners are pressured to the equivalent of an altitude of 7,000-8,500 feet.  If you have recently been comfortable on a commercial plane for 3-4 hours or more, that would be a sign that your blood oxygenation in Denver at 5,280 feet might be acceptable, but I would not rely on that alone.  Also, if you plan so spend time at 7,000-9,000 feet in Colorado, the chance that you will need oxygen is much higher.  If you want to be safe, you will want to be tested, as above.

And, yes, slowly driving to Colorado would allow time for your body (including your lungs and heart) to begin to adjust to high altitude.  To make a significant adjustment to altitude would require a trip from sea level to Denver, to take 5-7 days.

Hope this helps.

Good luck