Normal loss of lung capacity?

[Jim2005]

I am currently in the military and have been having trouble with my run times, stairs, daily chest cramps, etc over the last year. Back in 1997 at 36 years old, (169lbs, 71 in), I did a Pulmonary functions test with the following results:FVC-5.77, FEV 0.5-4.23, FEV 1.0-5.09, FEV 3.0-5.42,PEF-11.94L/S, FEF 25-75% 7.20L/S, FEF75-85%-2.08L/S, FEF25% 11.35L/S, FEF50%-8.08L/S, FEF75% 3.43L/S AND FEF.2-1.2 9.44L/S.  After having the problems with running, stairs, getting winded easy, I did several more tests in the last few months. MRI and x-rays turned out normal. In July I had the following Pulmonary test results (43, 170lbs, 71 in): FVC-4.30, FEV 0.5-3.04, FEV1.0-3.66, FEV3.0 4.05, FEF-11.02, FIF25%-4.52, FIF50%-6.23, FIF75%-4.99, FIF25-75%-5.42. I have been referred to an off-military facility and they want to do a lung biopsy. All the Pulmonary Specialists agree that this is a pretty major shift. I have lived or worked in various nasty areas to include five years in the shipyards, numerous aircraft crash investigations, associated chemicals and fibers in the aircraft industry, and a year living with a 30 by 25 foot Rockwool pile 10 feet away.  I have had my share of possible exposures. The question is, does this look like a major shift in my lung capacity and is it a good idea to do the biopsy with its associated risks? I turned 44 this last month and wonder if maybe I am just getting old? I am also heading back to Iraq in the near future and want to make sure that my health can handle another year in that environment. Any feedback would be most appreciated.

[National Jewish]

This is a markedly accelerated loss of pulmonary function.  It is greatly in excess of the normal loss of lung function associated with aging.  This is not, "just getting old".  Assuming the test results are accurate, you do have progressive, clinically significant lung disease.  It is imperative that the problem be found so that treatment can be started.

CT scanning is preferable to MRI for the evaluation of diffuse lung disease.   I am not surprised that the chest x-ray might be "normal" but would be very surprised if a CT scan were interpreted as normal.

The recommendation of a lung biopsy is sound.  Compared to an open lung biopsy, a video-assisted thoracoscopic (VATS) lung biopsy is a less invasive surgical procedure.  The lung and surrounding tissues are examined through a scope with a small video camera at one end of a flexible tube.  This scope is placed through a small incision between the ribs into the chest.  During this procedure tiny pieces of lung tissue can be taken for further testing.  It would be appropriate for you to request a second opinion prior to undergoing a lung biopsy.

[EROS]

You could always get a High Res CT which has a very high hit rate for restrictive lung disease. Lung biopsy by VATS is not as invasive and recovery time is quick. A good site to post on where some have experience of lung biopsy is

http://www.cheshire-med.com/forums/cldforum.html

Good luck.

[Jim2005]

Thanks for the response. Do the test numbers seem that abnormal to you or could they be normal for a guy just getting older? I'm told they are not good by some, but I'm still not sure what would be considered "normal loss". I have read that a rule of thumb is about 20-30 ml a year after 35. If that is true, 24% loss between 1997 and today seems pretty high. Any other advise or possible considerations?
Thanks.

[EROS]

Jim,
I am not an health professional but have been knocking around lung sites for some time now! The decrease is significant. If I were you I would have the biopsy by VATs if possible for peace of mind if nothing else.
Eros.

[EROS]

Jim,
My guess is you are concerned about ILD or IPF please see the site below, there is an article re whether to biopsy or not in their newsletter.

http://www.pilotforipf.org/newsletters.php

Hope this helps + good luck.

E.

[Jim2005]

Thanks for the site. That probably hit the nail right on the head. I'll be talking to the Doc's on the 10th about the biopsy, I think it's a good idea knowing my "life's" track record. Thanks again for all the help. I'll let you know how things turn out.

[EROS]

I wish you the best Jim, good luck and I hope it all works out.
Let me know how it goes.

Eros.

[2tan]

I wish you luck on your testing,I am not a medical professional.have you been tested for Alpha 1 Antitrypsin Deficiency?This would tell you if you have a genetic form of emphysima. It is a simple blood test. I believe it is extremely underdiagnosed.

[Jim2005]

Biopsy complete. Seems like I have some heavy scar tissue and a good case of Bronchiolitis. Sacks are good but the small airways going to them have been damaged. Possibly a combination of exposures from the first Gulf War, second tour in Iraq or aviation chemicals or places throughout my career. Doing the antibiotics for a 90 day trial, but they said most likely I wouldn't see any or much improvement.  Good thing I started with strong lungs! Just hope it does not become progressive in nature. I guess it was a good thing I did the biopsy prior to deploying again. Never thought this would be anything I would have to worry about. Thanks for your input and take care.
Regards.