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