do i have copd

[arlene918]

69 yr old f. chest xray results:  heart normal in size/configeration. Aorta elongated and tortuous. Lungs clear of infiltrates. Minimal scarring/atelectasis noted. Lungs do appear to be hyperinflated. Hemidiaphragms smooth &  costophrenic angles well-outlined. Increase in thoracic kyphosis, scoliosis, osteroporosis & mild/moderate degereative changes in spine. Impression: 1.atherosclerosis 2. Question COPD  3.minimal scarring  4.  kyphoscoliosis 5. Osteroporosis.6. Degenerative arthritis.

Where is atherosclerosis indicated? What does hemidiaphragms & costophrenic mean?  Would xray show indication of chronic broncitis or emphzyma if I had copd?  What does an elongated aorta mean.Primary doctor prescribed inhaler but I dont even know if i have COPD.

[David Tinkelman, M.D.]

Response to your added comments from Dr. Tinkelman, National Jewish Health:

Being overweight and deconditioned are very common causes of shortness of breath with exertion.  That you wheeze, under any circumstance including “laying down”, combined with the other evidence suggestive of possible COPD or asthma (hyperinflation) suggests that you might have either of these conditions.  As previously mentioned, the best way to evaluate this is with pulmonary function testing (Spirometry) and you and your doctor should definitely arrange for this.  If your doctor is unsure about this, the two of you may want to request consultation with a lung specialist.

[arlene918]

Wanted to add that my dr ordered chest xray because I get short of breath on exertion and in very humid weather. I also wheez when I am laying down. I am overweight and thot this could cause my shortness of breath.

[lesley61]

I have had asthma from childhood.  Been diagnosed and treated accordingly.  Outgrew asthma at the age of 17.  Had a bout of pneumonia when I was 23.  Asthma then reappeared and was very severe. Cortisone resistant, Been in hospital one week per every 5 to 8 weeks.  Was started on Methotrexate for asthma 20 mg per week  Pulmison 20 mg per week.  Heart rate increased  I became hypertensive and had pulmonary hypertension.  Medication was not changed and I carried on with Methotrexate and Pulmison (Prednisone).  Then I was prescribed Amediorone for heart prolem.  Did not help.  Was placed other medication for the heart.  Had a Ephysioogyly Study of the Heart which showed that I did not have a problem with my heart.  I did have a murmer and the cardiologist said that I had a leak somewhere and that is why my was racing at 120 bpm at resting. Night time steady 80 bpm and day time anything between 120 and 180 bpm.  I had a pulmonary embolism and more clear radiologic tests were done.  Was told that a portion of my left lung was dead.  No clafriication or explation was given.   Went on with Methotraxate and Pulmison and Amidiorone.  Condition detiorated.  2 years ago I was admitted to hospital for bronchospam.  Sputum tests showed I had hospital borne pneumonia and was discharged 15 minutes later by a specialist physiciation.  Was readmitted 2 days later with hospital  borne infection of the digestive system and hostital borne infection of the lungs, had IV at a different hospital  Had hyperinflation of the lungs and pleural effusion.  Had a series tests and open lung biopsy.  Was told that I had interstitial lung disease because I had Rheumotiod Athritis of the lungs.  I have no problems with my joints and I can lead a normal life.  I am not aware that I am always wheezing and I am short of breathe because I had asthma from an early age.  I have done some investigation of the disease and what always comes up is that Amediorone and methotrexate causes Lung Fibrosis.  I was RF tested and it was negative but my specialist physician denies that medication caused my problem.  Told me to carry on with treatment which he prescribed in September until January and then he would do all the necessary blood work and Xrays.  My previous physician did tests every 4 to 6 weeks.  It has been 3 months and this doctor has no further test e.g liver and kidney function tests or chest Xrays.  I am female and I am 48 years old.   I have two sons aged 26 and 22.  Was happily married for 28 years and am now divorced. LOTS OF STRESS (trying to hide it from my loved ones).l  MY EX- HUSBAND IS LIVING WITH HIS  ONLY SIBLINGS WIFE.  SHE MOVED IN BEFORE I LEFT.  HER ONLY CHILD IS 18 AND MALE.

PLEASE TELL ME THAT I DONT HAVE RHEUMATOID ARTHRISTIS IN MY LUNGS.    IT MEANS I CAN STOP THE METHOTREXATE AND PULMISON AND HAVE THE NORMAL ASTHMA PROBLEMS.

REGARDS
LESLEY
SOUTH AFRICA
JOHANNESBURG

[arlene918]

Thank you for the information. I am going to see a pulmonary doctor.  As far as osteoporosis I have hyperparathyroidism with elevated blood calcium (10.5) and my endo does not want me to take bone builders. I am walking and will do weight at a gym. I am also taking  Vit d 50.000/month because of low vit.d. However I am looking into osteoporosis meds I may be able to take.

[David Tinkelman, M.D.]

I can’t say for certain what is the location of the atherosclerosis but as the aorta is the only blood vessel mentioned, that is probably where it is.  The important question would be, the severity of it and whether there are any symptoms associated with it.  Depending on the location of the atherosclerosis, your doctor could tell you what symptoms might be associated with it.  Rest assured that some atherosclerosis (mild or slight), elongation (lengthening) and tortuosity of the aorta are common at your age and generally and of little or no significance

That your heart size is normal is good news.  The diaphragm is the large muscle that separates the abdominal organs from those in the chest.  There is a right and left sided component, hence the use of the modifier, hemi.  Under normal circumstances, the movement of the two is synchronized.   The diaphragm is the major respiratory muscle of inspiration.

Costophrenic refers to the junction where the diaphragm meets the chest wall, including the ribs.  That the costophrenic angle is well outlined is also good news.  It means there is no abnormal fluid in your chest and suggests that the diaphragm is not abnormally flattened, as is seen with emphysema.

Hyperinflation describes the circumstance that when a person forcefully blows out all the air he can, some air is trapped and the lungs may have more residual air in them than normal.  Hyperinflation is most commonly seen with asthma or COPD and that could be the cause in your case.  The mere presence of some degree of hyperinflation is not the problem.  If it is or is not a problem depends on the degree or severity of the hyperinflation.  When it is severe (most often associated with advanced COPD), the diaphragms have a flattened appearance on X-ray (see preceding paragraph).  The X-ray would not show mild emphysema or chronic bronchitis.

The best way to determine if you have COPD is to have pulmonary function testing (Spirometry) and that often can be done in one’s doctor’s office.

The one thing in this interpretation that is commonly ignored, is #5 Osteoporosis.  Many doctors still assume that osteoporosis is not a serious condition in men.  That’s wrong and the fact that the osteoporosis is of a degree to be recognized on chest X-ray means that, in your case, it is severe enough to warrant treatment, at a minimum with Calcium and Vitamin D but optimally also with drugs given specifically for osteoporosis, a class of drugs referred to as bis-phosphonates.  The pharmacologic approach to osteoporosis should be supplemented by regular weight-bearing exercise, including walking and you are definitely not too old to engage in a regular exercise program.  

If your doctor doesn’t deem the osteoporosis worthy of treatment, you should consult with another doctor.  By taking this action, you may well be able to spare yourself the grief and suffering of a fractured hip, in the years to come.

Good luck