Do I have emphysema,or other lung illness?

[Despereaux]

Thank you in advance,

I'm a 36 yr/ 75 kilo female. 4 yrs. of mild/mod high BP. Taking Deralin & Atacand. Have anxiety/ panic taking xanax. Also have bad GERD. On Somac 40mg twice daily. Smoked from 16-28 years old 10-20 cigarettes a day. I have been smoke free since 28. I also have ferretin problem as my iron stores are real low according to blood tests,possibly due to menses.

Job requires alot of talking. Been slightly SOB when talking alot for a 5 years. No limitations on exercise. I am not really that fit either. I traveled overseas and came back home, and immediately had serious SOB and yawning to catch breath with sighing. My GP said it was my anxiety. 1 year later I still can't breath and  had PFT's and they came back as the following,

FEV1 (predicted) 3.01 (observed) 3.54 %117
FVC 3.47 4.08 %117
FEV/FVC 82 87 %106
PEFR 6.89 7.53 %109
PEFR 25-75 3.76 4.09 %109
FEF 25% 6 7.32 %122
FEF 50% 4.30 5.20 %121
FEF 75% 1.94 2.05 %106

Lung volumes
SVC 3.74 4.31 %124
IC 2.29 2.98 %130
FRC 2.75 2.51 %92
ERV 1.19 1.33 %112
RV 1.56 1.18 %76
TLC 5.10 5.49 %108
RV/TLC 31 22 %71

DLCO 26.86 16.16 %60
KCO 5.66 2.95 %52
VA 5.10 5.47 %107

Clinical interpretation,
spirometry/Flow Volume -normal
Lung volume/Normal
Histamine/Negative
Gas diffusion/ Moderate Reduction

Conclusion
Isolated Moderate Reduction in Diffusion

Normal lung CT, Normal lung  x-ray, Cardiac/Pulmanary angiogram and doppler of legs showed no blood clots.Heart also appears normal. Physical exam normal. Next I am going in for an echo of heart.

My question is looking at my PFT's what can it be? Does it look like Emphysema? If so what stage? I feel like I am going to suffocate. I have the same SOB standing and sitting, sometimes lying down makes me feel more comfortable. I have no allergies except for hayfever. Never had asthma. I know my Gerd is real bad and I am working on fixing that,but the GP feels that Gerd does not affect my SOB.

Thank you for your help.

[National Jewish Health]

Given the normality, if not hyper-normality, of your pulmonary function results, I question the validity of the report of a moderate-markedly reduced diffusion capacity; I would put no credence in it.  Especially so in light of the allegedly normal CT Scan of your lungs and the normal pulmonary angiogram.  

You mention “a ferretin problem …as my iron stores are low”.  If you have any degree of iron deficiency anemia this could account for a falsely low diffusion capacity, if the measurement is not corrected for your actual hemoglobin.  You should discuss this with your doctor.  

You also mention anxiety/panic, yawning and sighing.  These symptoms are common with the hyperventilation syndrome and there is a strong association between panic disorder and hyperventilation.  I suspect that your respiratory symptoms are secondary to panic disorder and not to any physical derangement of your heart or lungs.  Some persons with panic disorder have a better response to the anti-depressant, sertraline (Zoloft) than to Xanax.  This might be worth a trial and you should discuss this option with your doctor.

Finally you consider engaging in regular exercise, such as rapid walking.  This, alone, can have a salutary effect on a person’s perception of his/her breathing.

The good news is that, due in part to your decision to stop smoking, there is absolutely no evidence to suggest the diagnosis of emphysema and you can get on with your life without that concern.

Good luck

[Afyil]

I wish I could take CT scans, could only afford Spirometry and Diffusion hardly, couldnt ask for CT, so just living with hellish curiosity, (without insurance)

[Despereaux]

Also would like to add that I did an experiment yesterday. I walked for 17 minutes and some up-hills. Did not require to stop to catch my breath. I was SOB when I started and SOB when I finished almost about the same. My CT scan said no evidence of institial or alveolar disease.