COPD x-ray

[patrick2]

I am a 52 yo male. Recently, as part of a Peace Corps medical exam, a routine x-ray was returned with a diagnosis of significant COPD. The results are surprising to the examining PA and physician,and, I might add, to myself.

Although I did smoke lightly in college, I stopped completely 28 years ago. I would describe myself as health addicted having participated in vigorous sports such as cycling and racquetball over the years. I have a balanced diet with supplements and walk between 4-7 miles daily with strength training on alternate days. I engage in hard physical labor without difficulty.

I do not exhibit a single symptom of chronic bronchitis or emphysema. NO SOB, no morning cough, no mucous. The examining physician detected nothing unusual with the stethoscope.

11 years ago in Bolivia I contracted pneumonia which was misdiagnosed initially and which did not respond to medication. Severe coughing lasted for 6 weeks until a second physician prescribed a different course of treatment with success. Since that time I have had only 3 seasonal bouts of flu with any degree of coughing. Last infection was April, 2002.

I know from my own research that x-rays alone cannot be used to diagnose COPD. What could the radiologist have possibly seen? Can anyone suggest an explanation?

[Booby]

I was recently diagnosed with copd, a month or so ago. I have since been treated with a nebulizer, 4 times a day, as well as oxygen to use while i sleep at night. After a month I now have more mucus production than I previously had, and reoccuring chest pain with my coughing spells. I went back to the doctor and he just said i need to have more xrays taken. My questions are, is there anything I can take to subside pain from coughing and also he said that the problem was in my middle lung, what will more x-rays determine?  Thank you very much.

[National Jewish]

The information about your state of health and intense physical activity strongly suggests that you do not have Chronic Obstructive Pulmonary Disease (COPD).  The chest x-ray is an insensitive, non-specific way to make the diagnosis of COPD.  It can be influenced by technique and individual observer bias.  The x-ray of a person with poorly controlled asthma can also mimic the x-ray of a person with COPD.  A pulmonary function test is the best way to evaluate lung function and dispel the diagnosis of COPD.

I strongly recommend that you contact the radiologist and ask him/her, yourself, what led to this interpretation.  If that proves to be unsatisfactory, you should request that the x-ray be sent to another radiologist, of your choice, for a second opinion or simply have another chest x-ray taken.

[Ellis7]

CXR is not a reliable way to diagnose COPD. See:
http://www.pulmonologychannel.com/copd/diagnosis.shtml
Excerpt:
"Chest x-ray is an imprecise method of diagnosis of COPD. It is only consistently abnormal in severe cases and should be performed in the initial evaluation to exclude other lung diseases. Findings characteristic of COPD in chest x-ray are hyperinflated lungs with flattened diaphragm, hyperlucent lungs (chest film shows greater than normal film blackening from increased transmission of x-rays), and central pulmonary artery enlargement. Bullae, areas of destroyed lung tissue that create large dilated air sacs, may be seen as well. "

[starion]

Doctor friends have told me that x-rays are lots of "shadows & light," and can be easily misread (particularly if the person reading it isn't a pulmonary radiologist).  For a better evaluation, I would strongly recommend you have a lung function test, called a spirometry.  This will help determine the condition of your lungs, and be much more authoratative then the x-ray.  If the spirometry results are inconclusive, further lung testing such as a pulmonary function test and/or high resolution chest CT may be useful.
Good luck!
Aloha,
Starion