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Moderate-stage COPD or moderate obstruction from COPD?

I am hoping for a medical pro to help translate some LFT results, as the lung function test consult from the Pulmonology nurse practitioner was pretty splash-and-dash. The clinic was about 1.5 hours behind schedule and the visit was under 10 minutes. The provider sped through the results ("Oh, you didn't know you had COPD?") then handed over some printed material on COPD, some instructions on Rx and OTC meds, and was off. There is no additional appointment for another 6 months.

The NP's message was moderate-COPD without signs of emphysema ("good") but with lung hyperinflation ("want to see that reduce").

But the NP didn't seem to do any specific COPD stage assessment. Definitely not BODE stage testing (e.g., walking test) and perhaps GOLD staging, but the FEV and FVC are all above 100% of reference values, so that seems like it would point to mild COPD (and just moderate obstruction)? There doesn't seem to be an underlying disease diagnosis or desire to determine one. The patient, my spouse, is young and has no cough or a bit of post-nasal phlegm but nothing major, Chest X-ray was clear. An echocardiogram showed some minor stuff but nothing significant. No hospitalizations or exacerbation type events. She'd been feeling the shortness of breath and such for about 9-12 months prior to diagnosis.

Demographics: 40 yo female, caucasian, 42.61 BMI (I'm unsure if the history suggests possible obesity hyperventilation syndrome, but no arterial blood gas has been performed and I don't think HCO3 has been performed with recent blood panels to screen for that). Family history of COPD (mother) and 20-25 pack-years of smoking (quit 5 years ago), second-hand smoke exposure as a child, seasonal allergies, no diagnosis of asthma but was prescribed an inhaler a number of years ago. We live at a higher altitude (about Denver height).

Sorry to lean on the folks digitally. We have asked to be added to one of the pulmonology clinic's MD cancellation waitlist but it doesn't sound promising in terms of getting seen any-month soon. This is quite a scary diagnosis to absorb with so little information and with SO being just 40 years old. The only thing she was told about progression and prognosis was "don't look at mortality data on the internet."

Symptoms/Related Issues: Shortness of breath, especially in mornings and after climbing stairs or walking on an incline (does walk, treadmill, or other exercise daily). Sought medical help after months of poor sleep in addition to SOB and overnight pulse oximetry showed hundreds of desaturation events (over 30 per hour). Was put on 2L overnight oxygen during diagnostic testing and remains given LFT results (has a hard time with the oxygen due to stuffy nose)

LFT Results:

FVC: 5.68 liters pre-inhaler of albuterol (131% of reference level); 5.52 liters post-inhaler (127% of reference value)
FEV1: 3.69 liters/105% reference pre-inhaler, 3.69L/105% ref post-inhaler
FEV1/FCV: 65% pre-inhaler, 67% post-inhaler (ergo, moderate obstruction/COPD)
FEF25-75%: 2.10 L/sec (47% ref) pre-inhaler, 2.27L (51% ref) post-inhaler
PEF: 8.31 L/sec (114% ref) pre-inhaler, 8.80L/sec (120% ref) post-inhaler
FET100%: 12sec pre-inhaler, 11.45sec. post-inhaler
FIF50%: 1.32 L/sec pre-inhaler, 1.72L/sec post-inhaler (this one was the only big inhaler change at 31% increase)

TLC: 7.08L (123% reference)
VC: 5.68L (131%)
FRC PL: 3.85 (130%)
ERV: 2.44L (212%!)
RV: 1.40L (78%)
RV/TLC: 20%

DLCO: 22.5 (88% of reference value)
DL Adj: 20.7 (81% ref)
DLCO/VA: 4.20 (84% ref)
DL/VA Adj: 3.86 (77% ref)
VA: 5.37L (96% ref)
IVC: 4.21L (108% ref)

Raw: 2.84 (93% ref)
Gaw: 0.352 (108% ref)
Vtg (Raw): 3.70
Raw f: 65 BPM

In addition to clarity about current state, the other questions are the common ones - what might this mean for progression, life expectancy, etc.? After spending a lot of time reading through journal articles and abstracts, one thing that seems pretty clear is that there are very few longitudinal or retrospective studies or literature reviews about COPD groups under age 65.
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973741 tn?1342342773
ugh, been awhile since you posted this.  Splash a dash, ha ha.  love that phrasing but MAN is that annoying. What has transpired since.  I'll check back for your response.
Helpful - 0
The pulmonology NP got super irritated at me for asking about the relevance of FEV1 to staging, admonished us for consulting Dr. Google. Talked about how they use the "Gold standard" - which she felt is clearly not anything I'd know about. She spoke about using best practices from the American Thoracic Society. She pointed at the LFT results where it says moderate obstruction and admonished us a bit more before generally talking more about her/their expertise and how we should not use the web for information. I literally had the GOLD and AFT (and BODE) frameworks in a folder in my lap). She "had never heard anything like" the rather significant reaction my partner had to the inhaler she prescribed and seems to doubt that it was what really caused her to go to the ER two weeks prior. She said we could always reach her even though we had tried through phone and online charting several times before and after the ER visit. (The reaction spouse had was common and serious enough that Walgreens literally sent us a special mailer to us about it). She then prescribed a new inhaler that isn't the type for what GOLD and ATS actually recommend for her stage. THe NP has not graded her at all but I had enough help on the COPD Foundation forum that I think we know she is Level I, grade B at this point. She also misinterpreted/misread resutls from an overnight pulseox study. Sigh.

Anyway, she had more recent LFT for an unrelated surgery and has seen some mild improvement and we'll be switching insurance and providers October 15.
Annnnnddddd…. Got a new pulmonologist due to insurance change. He looked at her prior PFTs and said something about “…if you even have COPD” and ordered another PFT. Her FEV1 was was at 70 this time and new Doc said that rise doesn’t happen with COPD. He thinks it’s maybe a certain type of asthma that can not get picked up by pre-/post-brochiodialator spirometry. Anyway, incredibly happy for this news and even more angry at the NP who misdiagnosed and aggressively admonished us for asking questions about her determination of moderate COPD.
Wonderful news! It does pay to get that second opinion. I wish I could be so lucky.
It was wonderful news!  Thank you for the kind words.
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