Can Emphysema be wrong diagnosis?

[Duchess47]

My 58 year old sister smoked for many years before quitting 3 years ago.  One year after quitting she was diagnosed with emphysema based on a chest exray and pulmonary function test. Each year since she stopped she has had a follow up with pulmonologist and a PFT.  Each year her numbers on the PFT have improved.  The tech. giving the test says he has never seen anyone whoses numbers improve with each passing year.  Is it possible that she doesn't have emphysema?  What test can she have to confirm whether or not she does have it?

[National Jewish]

This is entirely possible and is good news.  It means that she might have more chronic bronchitis or asthma than emphysema.  Whereas the emphysema is a reflection of irreversible lung damage, the other two have varying degrees of reversibility.  It is possible that she does not have emphysema.  Two ways to tell are:  1) a CT scan of the lungs and, 2) more complex pulmonary function tests that include a diffusion capacity and are done before and after the inhalation of a bronchodilator medicine.

[jo43]

I am only speaking from my experience. - I am 43, and 4 months ago I had a chest x-ray which showed "over-inflated lungs" and "air trapping". I could feel the air move across my chest each morning when I got up, so I knew it was there.

On the basis of that, my GP say yep, this is the very beginnings of emphysema. Being a smoker, (I had just given up the previous week!) I believed him. I have since found out that a CXR is a fairly crude tool for diagnosing emphysema, unless its fairly moderate to advanced. I also had some PFT's done and blew the machine off the table. This didn't make sense.

In the end I had a CT which gives a much mroe detailed picture than a CXR, but obviously, the patient is exposed to much more radiation. Perhaps your sister might like to go this route. I don't know much about the American health system - I am from Australia, and insurance seems to be more of an issue for you guys than us (if you are from the U.S.) I read where someone chose not to have a CT because their insurance iddn't cover it.

Anywyay, from my understanding, emphysema doesn't get better but one can delay the progress of it by avoiding smoking and irritating fumes, diet, exercise and all the healthy things. So it may be worthwhile your sister pursuing some morel investigtation to determine the true extent of her "emphysema"
All the best anyway.

[Duchess47]

Thank you for you reply.  Did the CT reveal that you do in fact have emphysema?

[jo43]

Well, that wasn't too bright of me - to say a CT is much more diagnostic, and then forget to give my own result. My CT in fact was completely normal. The respiratory specialist I saw later, said that because I am of a small build, and am a runner, my lungs are just "big", and that i took a very deep breath when I had the CXR. He also said that sometimes radiologist "over-read" the x-ray to try and cover their butt for any abnormalities that might be. The air trapping is apparently caused by shallow breathing - I don't expel air well, but can exhale a full volume.

[Duchess47]

O.K., but she did  have a CTSCAN.  What exactly would be on a CTSCAN that confirms emphysema.  If whe was just maintaining her PFT numbers that would be one thing, but she has actually imnproved each time.  Should she request another CTSCAN?
Thank you.

[jo43]

Hmmm , the CT (to the best of my understanding) would reveal emphysema if it was there, because the air trapping shows up as a different colour in the pictures and I think you can see alveolar dmaage on a CT film. The CT gives a slice view rather than the flat x-ray picture - so much more detail is on a CT. If the CT was normal, I do not believe your sister has emphysema, especially as you say, your sisters numbers are improving every year. Perhaps it may pay to get a second opinion - but a CT is usually accurate

[Duchess47]

Tnak you once again for your reply.  It is very odd, but the pulmonologist confirmed that CTSCAN revealed emphysema AND her PFT has also improved each time.  Good news, even though very strange.

[PhysBrit]

Is your sister taking steroids to treat her condition? It may be that she has emphysema as well as another condition. The other condition may be improving with the meds she is on.