Emphysema in nonsmoker?

[nagdeo]

I am a 44 year old female, lifelong nonsmoker.  I have a normal A1A level with PiMM phenotype.  I do not have any occupational risk factors for COPD, and I do not live, work or socialize in smoky environments.  Both of my parents smoked when I was growing up, and I was exposed to significant environmental tobacco smoke until my late 20s.  My symptoms are chronic cough (nonproductive unless I have an infection or am recovering from one, and then I have abundant and difficult-to-expel mucous), shortness of breath (especially upon exertion), tight chest, and fatigue.  No wheezing.

My PFT shows a moderate obstructive ventilatory defect (FEV1 52% of predicted, FVC/FEV1% 66% predicted, FEF 25-75% 24% predicted with poor response to bronchodilator challenge), air trapping and hyperinflation (TLC 119% predicted, RV 194% predicted, FRC 134% predicted), and low diffusion capacity (corrected DLCO and DLCO/VA both 68% predicted). My doctor says this pattern is consistent with emphysema.  I am looking for other explanations since I seem to be at such low risk for emphysema. Would bronchiectatis be consistent with these sypmtoms and PFT pattern.  Any other suggestions?  Thank you.

[starion]

Hi!  I'm a 45 year old female, life-long nonsmoker, also with normal A1A & phenotype, with NO occupational risk factors for COPD, no exposure THROUGHOUT MY LIFE to lung irritants, but mild intermittent asthma since early childhood.
My PFT similarly shows significant air trapping, FEV1 of between 30% and low 40%s (depending on the test), as well as virtually no bronchodilator response.  My diffusion capacity ranges from a low of 38% to a high or 70%, with most readings in the low 60s.  I was diagnosed at age 42, when I kept waking every night unable to breathe.
Since you hare having the cough, what measures are being taken to identify the cause of the cough?  Have you been evaluated for gastric reflux?  Allergies?  Both can cause chronic cough and contribute to reduced lung function--also properly treating the cause m-a-y help INCREASE your lung function, to make it nearer to "normal."  Also, a good exercise program (approved by your doctor) may help improve overall conditioning and reduce your fatigue.
Has a high resolution spiral chest CT been performed to help confirm or reject a diagnosis of emphsyema?  This was helpful in my case to confirm that I do indeed have severe emphysema, severe asthma, as well as possibly bronchiolitis, though I had virtually NO risk factors for either emphysema or bronchiolitis.
It IS very unusual for folks as young as you and I, with few/no risk factors to be diagnosed with moderate to severe emphysema, and you may wish to get a second opinion at a large medical center with an excellent reputation, such as National Jewish or similar institution.

US News has an annual list of Best Hospitals sorted under various catagories at: www.usnews.com/usnews/nycu/health/hosptl/tophosp.htm When one gets to that site click on "respiratory disorders."

Sorry, I'm unfamiliar with the symptoms of bronchiectasis, since that is not one of my diagnoses.  I'm sure the LungLine nurse will be able to comment much more knowledgeably than I.

Best of luck!
Aloha,
Starion