Mild Emphysema Diagnosis

[KLMcCoy]

Hello.  I am a 39 year old female who smoked for 24 years.  I've been smoke free for 8 days now.  I quit immediately after hearing the mild emphyesema diagnosis.  I should tell you also that I have severe health anxiety and am wondering if I am causing some of the air hunger I am having with this.  My mom (adoptive) had a health scare with her lungs about 4 months ago, but the thoracic surgeon seems sure that it is histoplasmosis.  I started looking up symtoms for lung cancer and immediately gave myself every thing I read.  Shoulder pain, back pain, arm pain, chest wall pain, coughing, shortness of breath, muscle fatigue, etc etc. My family doctor was on vacation for a week so I went to the urgent care to get a chest xray.  The chest xray came back clear and the Dr said that I did not have any form of lung cancer or COPD to save myself the money and not get any expensive work up.  I believed him for a short minute...but then the anxiety kicked in again.  I started looking up how effective chest xrays were at detecting COPD and lung cancer and read that while they can detect lung cancer and COPD both are usually in advanced stages and that a CT scan is a better screen.  So I went to my family doctor and he ordered a CT scan, which only noted mild emphysema.  The family doctor didn't seem too concerned, but wanted me to get a PFT to see if I had asthma. I also have this slight wheezy feeling when I first get up in the morning that goes away after 1 breath.  I've read that could possibly be GERD and the shortness of breath may be related to that.  Anyway, here are the results of my PFT:
FVC                 92.9
FEV 1              90.0
FEV1%FVC      96.2
PEF                 70.1
FEF 25/75        95.8
MEF 75            79.3
MEF 50            100.0
DLCO SB         107.7
DLCO VA         113.1
RV                   112.2
FRCpleth           101.6
TLC                  103.5
VC                    102.0

How severe is the emphesyma?

[David Tinkelman, M.D.]

Your pulmonary function test results, below, are within normal limits.  That means that the values are within the predicted normal range for persons your age and height and that is good news.  It means that, despite having smoked for 24 years, you still have more than enough lung power to engage in the activities of a normal life and that you do not have clinically significant emphysema.  You are lucky.  That is not to say that your lungs have not been damaged by the smoking.  The CT scan confirms that but also confirms that the damage is limited and should not be perceptible to you.  Given that, the presence of any emphysema should serve as a strong warning that you should never again smoke or spend time in an environment where you will regularly breathe-in 2nd hand smoke.

Your doctor is right.  You need not and should not subject yourself to any further testing at this time.  The symptoms you have experienced have nothing to do with the CT-demonstrated emphysema.

You may or may not have asthma.  The “wheezy feeling” is suspicious for that diagnosis but also consistent with bronchitis which, if the case, will likely subside with sustained smoking cessation.  Should you at any time in the future experience unexpected shortness of breath, it would be reasonable for you to be checked for asthma and if demonstrated, seeking treatment for it.

The anxiety you describe seems to be having a negative effect on your quality of life.  I suggest that seek treatment for that.

Consider yourself to have been fortunate to not have sustained serious lung damage from the 24 years of smoking cigarettes.

Please also see my reply to your question in the Respiratory Disease Forum.

Good luck

[KLMcCoy]

Dr Tinkelman,

Thank you for taking the time to respond to both of my posts.  I thought I had posted one in the general forum.  I didn't realize I had posted both in the expert forum.  I greatly appreciate your time.

I am determined to never smoke again.  I have two beautiful little girls who need their mommy active and happy and alive.  The mild emphysema diagnosis scared me worse than anything ever has.  

I've suffered from some form of mental disorder most of my life.  It tends to manifest itself in different ways although health anxiety has always played a huge role.  It seems to be getting worse as I age.  And you are correct in saying that it has a negative impact on the quality of my life.  It's non stop worry and negativity.  I am definitely going to seek treatment.  

Thank you again for your time, advice and expert opinion.  I appreciate it more than you know.