differing diagnosis of PFT

[MorganGal]

I was recently diagnosed with COPD by a pulmonary specialist based on a FPT performed at a hospital using the full-body enclosed space procedure.
However, due to the circumstances involved with the diagnosis from the doc that ordered this test back in January of 2009, I decided to seek a second opinion. The second doctor, also a pulmonary specialist has given a quite different diagnosis.

The first doctor says I have 'moderate stage" emphysema due to the FEF 25-75% (L/s) spirometry values (which last January were 39% of predicted, with an FEV1 of 2.14 (91% predicted) and FVC of 3.47 which is 122% of predicted. This doctor based his diagnosis on the FEF 25-75% test results, giving me a diagnosis of emphysema.

The second doctor interpreted these results as asthma after seeing my records and test results. She says that my lung Xrays and CT scans didn't show "emphysema"...and that she doesn't pay any attention to the FEF 25-75% values because they aren't a reliable indicator of lung disorder. This doctor is not paying any attention to these results.

So, because I "liked" the second doctor's diagnosis better (who wouldn't prefer to have treatable asthma over emphysema?) I have been seeing her and taking the drugs (inhalers) she has recommended.

However, the most recent spirometry test results (yesterday-August 4) have led me to doubt the wisdom of this doctor's diagnosis. My FVC has gone up to 142% of predicted, the FEV1 has stayed at 91% of predicted, but the most alarming change is that the FEF 25-75% has gone DOWN to 23% of predicted. The FEV1/FVC ratio has gone from 75% of predicted to 65% of predicted.  This "second" doctor says this is a "normal spirometry" and says that my increased breathing difficulty is due to the increased panic attacks and GERD. And that the feeling that my "throat is closing" is probably from acid reflux.

I need help! My primary care physician's assistant (PA) told me I clearly have emphysema AND asthma based on the first PFT.  But why has my spirometry changed so drastically and which of these diagnoses is correct? Is the asthma treatment bad for the small airways and is that why my FVC going up and the FEF 25-75% showing such a drastic decline?

Please advise any way you can. Should I seek a THIRD opinion? What should I do here?
What if the third doctor's opinion is different and my spirometry continues to change in the manner that it seems to be going?

I'm obviously not a doctor, but I do have a science (biology and occupational health and safety) background so I'm not new to physiology and the science behind COPD. I just never realized the PFT results could be interpreted so differently. Can you help me? This is causing a high degree of stress for me and my panic attacks have escalated. Is there something else these doctors should be considering? Could my panic attacks have caused these changes in the spirometry results?
Thanks,
MorganGal

[little_weed]

Take no notice of the FEF 25-75% (L/s) .

It is the FEV1 that is the important reading for assessing your lungs! And yours is pretty damn good!

Well, a few of the other results are important as well, but don't be getting in a panic over your FEF 25-75%. And some results in the Lung Volumes, and Diffusion/Gas Transfer would be  read independently of your Spirometry. My Diffusion results were through the roof, but that is one way they can tell I have Air-trapping i.e ephysema. So bear in mind, one lot of results would be elevated, whilst another lot would be reduced. (I have notes on which, but not with me at the moment)

A diagnosis of emphysema would also be confirmed by CT Scan, and as you have had one, I think you can relax!

Swap?

[little_weed]

Me again!
Copy and Paste the following website address into your browser's search.

It's a website for people with cystic fibrosis, but it really is good for anyone having PFT's to understand what each of the tests are for.

I found the "Long Explanation", at the end, the more useful to understand my PFT's.

It will explain the differences between Fev1 and FEF 25-75% etc etc and all the significances.

http://cystic-l.org/handbook/html/pft_s_explained_for_you.htm

Read it a couple of times to let it sink in - I printed off a copy to keep with my results.

Hope it helps.
x

[allmymarbles]

(1) What symptoms made you have your lungs tested in the first place? Did you have difficulty breathing?

(2) I would first get control of the panic attacks before doing anything else. If you have been taking prednisone or Advair, or any other steroid, this could lead to a disruption of adrenal function that could lead to panic attacks (due to high cortisol). I suffered panic attacks due to Advair. I got off Advair and started taking high doses of vitamin B5 and very small does of DHEA as part of a cure. Until these attacks stopped, at the very first sign of one coming on, I took a very small dose of Xanax to abort it.

Without the panic attacks you will be in a better position to evaluate whatever else is going on.