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Respiratory Disorders (Expert Forum)
Stage and Severity of Chronic Obstructive Pulmonary Disease
Answered by
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Stage and Severity of Chronic Obstructive Pulmonary Disease
by Phdeee, Jun 22, 2006 12:00AM
My brother, John, was recently diagnosed with COPD. He is 65 years old, 6’2”, 260 lbs (40 pounds overweight). Though previously athletic, during the last 4 years, he has led a relatively sedentary lifestyle. John smoked 1-2 packs of Lucky Strikes daily from about 15-30 years of age. He also smoked marijuana (about ˝-1 “joint” per day) until about a year ago. He has now stopped smoking completely.
Presently, John experiences shortness of breath when he walks short distances or attempts any exercise. He feels normal when sitting. His recent tests (6/06) include:
1.Echocardiogram: mild elevation of pulmonary artery systolic pressure @49mmHg.
2. Spirometry: FVC=76%PRED, FEV1=91%PRED, FEV1/FVC=82. FEF 25-75% changed by 22%,interpreted as a mild response to bronchodilator
3. Lung volumes: VC=76%PRED, TLC=93%PRED, RV=114%PRED
4. Severe decrease in diffusing capacity = 44% PRED
5. Arterial Blood Gases: PC02=38.4mmHg, PO2=82mmHg, 96%Saturation
We are trying to determine the Stage and Severity of John’s COPD. I’ve read that the standard for Staging has primarily been Spirometry. Since my brother’s Spirometry Readings (as well as Lung Volumes & Arterial Gases) seem within normal limits, how should we interpret the severe decrease in diffusing capacity? Is it typical or unusual to have all normal lung test results except for diffusion capacity? Should we expect the other numbers to fall soon? Does he have severe COPD? How does a person with this type of profile of lung tests typically progress, i.e. what can we expect in the coming months and years?
Presently, John experiences shortness of breath when he walks short distances or attempts any exercise. He feels normal when sitting. His recent tests (6/06) include:
1.Echocardiogram: mild elevation of pulmonary artery systolic pressure @49mmHg.
2. Spirometry: FVC=76%PRED, FEV1=91%PRED, FEV1/FVC=82. FEF 25-75% changed by 22%,interpreted as a mild response to bronchodilator
3. Lung volumes: VC=76%PRED, TLC=93%PRED, RV=114%PRED
4. Severe decrease in diffusing capacity = 44% PRED
5. Arterial Blood Gases: PC02=38.4mmHg, PO2=82mmHg, 96%Saturation
We are trying to determine the Stage and Severity of John’s COPD. I’ve read that the standard for Staging has primarily been Spirometry. Since my brother’s Spirometry Readings (as well as Lung Volumes & Arterial Gases) seem within normal limits, how should we interpret the severe decrease in diffusing capacity? Is it typical or unusual to have all normal lung test results except for diffusion capacity? Should we expect the other numbers to fall soon? Does he have severe COPD? How does a person with this type of profile of lung tests typically progress, i.e. what can we expect in the coming months and years?
Doctor's Answer
by National Jewish, Jun 28, 2006 12:00AM
, Jun 28, 2006 12:00AM
These spirometry values do not show significant chronic obstructive pulmonary disease (COPD). The total lung capacity (TLC) and residual volume (RV) are compatible with COPD. However the forced expiratory volume after 1 second (FEV1) and forced expiratory volume after 1 second/forced vital capacity (FEV1/FVC) ratio do not show enough airway obstruction to cause shortness of breath as severe as you are describing. In essence, your brother’s spirometry results do not explain his shortness of breath. Being over weight and out of shape due to a sedentary lifestyle would be a more likely explanation. The FEV1/FVC ratio is more compatible with restrictive lung disease. Restriction refers to a decrease in the size of usable lung.
The decreased diffusion capacity is puzzling. However it could be seen with a lung problem other than COPD. Interstitial lung disease is a possibility, which occasionally occurs with a normal or almost normal x-ray. The first step would be to repeat it to check its accuracy.
The decreased diffusing capacity and elevated pulmonary artery systolic pressure raise the question of recurrent blood clots in an artery of the lungs, called pulmonary emboli. You might want to ask his doctors about that possibility.
The decreased diffusion capacity is puzzling. However it could be seen with a lung problem other than COPD. Interstitial lung disease is a possibility, which occasionally occurs with a normal or almost normal x-ray. The first step would be to repeat it to check its accuracy.
The decreased diffusing capacity and elevated pulmonary artery systolic pressure raise the question of recurrent blood clots in an artery of the lungs, called pulmonary emboli. You might want to ask his doctors about that possibility.
Member Comments (1)
by sasele, Apr 12, 2008 04:04PM
A related discussion, difference between mild and moderate and severe was started.
by Gita714, Oct 13, 2009 04:44PM
A related discussion, MS PATIENT WITH COPD was started.
