Overinflated lungs and Chronic airflow limitation

[Knightowl]

I had a chest x-ray and it states that my lungs were overinflated due to chronic airflow limitation.  But a Spirometry test for Asthma has shown my results okay.  DLCO total was 72% of the predicted. Is the x-ray wrong according to these other test results as the spirometry doesn't suggest airflow problems.  A saline challenge test made me cough and gave chest tightness and I couldn't inhale deep enough to give enough good results for this test to be finished. Any comments would be nice to stop me wondering as my doctor doesn't give me many details.  Thank you for your time.

[National Jewish]

The chest x-ray may be showing that your lungs are just slightly overinflated.  Since the radiologist sees this as being more inflated than usual the chest x-ray report notes overinflated lungs.  It is the interpretation that is an “over read” rather than the chest x-ray being wrong.  Remember that the radiologist sees only your chest x-ray without the opportunity to see you to find out what symptoms you are having.  So the radiologist wants to be sure to point out everything to the doctor who knows what symptoms are causing you to seek his help.

Your airflows on the spirometry test for asthma may be low, but still within the normal range.  So the spirometry report notes normal airflows.  If you have had spirometry testing done in the past, it would be helpful to compare them with your most recent results.  It can be more helpful to compare your results over time rather than comparing your results to the normal range.

Your DLCO is low at 72% of predicted.  The cough and chest tightness that you had in response to the saline challenge was a predictable response.  Generally inhaling saline is used to help a person cough up sputum for further testing.  Your other test results may be near normal or just beyond the normal range.  A pulmonologist would be the type of specialist to give a more detailed explanation of your test results, identify if you have a lung problem and what would be the best treatment.

[nmc]

Hi knighowl:
The spirometry test is pretty accurate and a result showing 72% of the predicted value suggests there is some degree of airway obstruction. What result did you obtain after administering the bronchodilator spray? Regarding the inflated lung fields, my experience from having both is that the x-ray is not as accurate as the CT scan for determining this.

[Knightowl]

Thanks for your reply.  I don't know what the result of that was.  But I looked at the computer screen and the graph looked like it had gone to a higher curve after taking the Ventolin.  However after it I sat in the chair and got all shakey and the chest tightness didn't go away for ages.  It didn't automatically relieve it.  When I see the specialist in ten days will ask him about it.   Ventolin is terrinle causing bad shakes....  Is Ventolin meant to make Asthmatic's breathe better?  The saline test nearly choked me and made me want to 'bring something up'. NOt sure if it was from the stomach or lungs... Caused me to cough a bit.  But if I breathe in deep with the steam in the shower it does the same.  I'm not good with steam or vapour mists as the saline mist.  Any comments on this???  Thanks

[Knightowl]

PS: My DLCO was 72% you said that if the Spirometry is 72%  But the DLCO test is a different one.  Do you know anything on this one??

[CINDY4]

The DLCO, is your diffusing capacity, showing how well you exchange your oxygen and carbon dioxide, I believe.  I know this is a very important number, and there is usually more concern for this being low than other numbers on spirometry, at least that has been my experience.

[nmc]

Hi again knightowl:
Sorry, I misunderstand what the 72% was referring to. I'm not sure what a DLCO of 72% means (because I think the value depends on your total lung capacity), but as the previous poster indicated, DLCO refers to how well oxygen is diffused from the alveoli to the capillaries. If your doctor indicated your value was within normal limits, this particular test suggests you have no interstitial disease. As for inflated lung fields, I still think the CT scan is the best diagnostic tool for determining this.

[nmc]

Forgot to mention the saline test. I've also had this test and my understanding is it helps loosen any nasty stuff in your lungs so it can be coughed up and analyzed. My chest also felt "tight" afterwards, but this feeling did not last long (maybe a day). I use Albuterol, which also causes "shakiness", so I imagine this is a typical reaction to most bronchodilators. Sorry I can't be more help.

[Ellis7]

The normal range for DLCO is 75-125%, according to this link:
http://www.meddean.luc.edu/lumen/MedEd/MEDICINE/skills/pft/les1text.htm
"Diffusion capacity uncorrected
Patient is asked to take a deep breath of air containing known concentration of carbon monoxide and to hold it for 10 seconds. The terminal (alveolar air) portion of expiration is collected to measure CO concentration. Diffusion capacity is then calculated using a complex formula. The normal range is 75-125% predicted."

[Knightowl]

Thanks everyone very much for your comments.  The DLCO is a complicated thing.  So basically it means??  Something like the oxygen is not taking over the carbon monoxide, which has been taken in, quick enough??  Only a guess.  Actually I can't remember having to hold my breath for 10 seconds.  I think she just made me breathe normally.  I wonder how much different it would be if I held my breath?  Maybe I did hold it can't remember.   Anyway according to the x-ray there was trapped air in the lungs.  Does a DLCO result of 72% show 'trapped air'?  Is all too complicated. When I see the lung specialist hopefully he'll explain it.  See him in one week.  Still helps to have an idea of what's going on before then so can ask him questions.  My problem is now and then after getting out of bed and moving and walking down the street I feel completely as though I'm choking and on every breath want to cough and feels bad like I want to bring something up  nothing comes up though.  I get weak throughout the body also and have to stop walking.  'Sometimes is associated with low abdominal pain and pressure which also stops me walking.  If I try to keep going I collapse.  After lying down and resting for up to an hour it seems to pass but still feel like choking..  At the time when this was happening a lot a doctor did a bronchoscopy and said that he found inflammation in the bronchial tubes and there was gastric acid refluxing into the lung.  Has anyone had this happen on Broncoscopy??  Eg: is this a normal thing that happens during this test.  I had drank nothing at all since the previous night about 12 hours.  Don't know why I refluxed.  Is hard when things like this happen and you don't know what's going on.  Helps to know if it is Asthma or what ever then you can do something to help the problem.  Maybe I have a lot of mucus trapped that is trying to come up and gives me the coughing and choking feeling.  At times during the night I have woken to feel acid up in my throat.    What problems do you all have eg: Asthma or whatever? I've heard that dairy products are bad for Asthmatics as create mucus.  But then I read that inflammation in the bronchial tubes causes mucus.  Which story is right??  Or does inflammation cause it and dairy products aggravates the already made mucus. I pass a lot of white mucus out of my bowel.  It has to be coming from somewhere??  Any ideas of this mucus problem.  As too much mucus could hinder breathing..   Regards to you all and all the best in coping with your various problems.

[Concerned lady]

It sounds like you will have some very good questions for the Pulmonologist! I hope you can also get your gastric reflux under full control, by finding out what all your underlying causes of your reflux are, and, by effectively treating these underlying causes.

My husband and I found (after being diagnosed at Nat'l Jewish), that gastric reflux was a major cause of our breathing problems (VCD/Vocal Cord Dysfunction).

We also have to treat our sinus problems. We continue to treat both our reflux & sinus problems, daily (as maintenance) and this has kept us free of breathing problems for several years, now.

Sincerely, Concerned lady
<a href=http://cantbreathesuspectvcd.com>http://cantbreathesuspectvcd.com</a>