COPD CT scan with contrast Vs fev1/fev

[Reach86]

Hi all new here I have been diagnosed with emphysema for around 2 months now from a x-ray then a CT scan with contrast. I have a long wait for spirometry through the NHS so I booked a private one and had it today. it shows my fev1/Fev is 71% which now has me confused as my breathlessness and symptoms don't match up to my score. For example I do one flight of stairs and need to catch my breath or walking normal pace for a few minutes leaves me breathless. Does anyone have any advice on what could be going on? I have also had 3 spontaneous pneumothorax and a pleurodesis done in my very late teens.

Many Thanks

[Ergendl]

Hi, Reach86. Sorry to hear you've had such confusing results. I'm not a doctor so I can only comment from my experience. I have emphysema with asthma overlap. When I took the Pulmonary Rehab course a few months after diagnosis in 2015, the physios helped me realise I had disordered breathing - I was deliberately hyperventilating before a more challenging task like climbing a hill or digging the garden. I started diaphragm singing exercises to get greater control of my breathing and no longer do that now. With other healthy living changes, my results have moved back into the normal range from moderate, I still have my conditions, but they don't affect me as much in day to day activities.

You can look up diaphragm singing exercises on YouTube or check the Asthma Lung website for singing for lung health groups in your area to see if this will help for you. Do ask your GP for a referral to a Pulmonary Rehab course too.

[Reach86 in reply to Ergendl]

Thankyou for your reply and the information and I will take a look at the diaphragm signing.Thanks again

[Superzob]

unfortunately, the FEV1/FVC ratio doesn’t tell you anything about the symptoms you’ll have, only the degree of obstruction. This may become an issue if you’re told that you only have mild COPD and therefore don’t need much treatment. Hopefully you’ll find a medical professional who understands that it is the symptoms that matter and that’s what you need to treat; you’re not treating the test result!

[Reach86 in reply to Superzob]

That's good advice thankyou I have spoken to a nurse and have been advised that sometimes with emphysema it doesn't show as much on a Spiro as it's deeper in the lungs. Also that things might be different as I'm younger than normally diagnosed for copd

[jackdup]

Do you have a copy of your spirometry test results? The number that is a better indicator is the FEV1% of predicted. Even then there are people with lower numbers that do better than those with higher numbers. Some of it depends on how good of condition you are in. If you have always been physically fit and exercise regularly you will more than likely do better than someone who may be out of shape.

[Reach86 in reply to jackdup]

These are my Spiro results wasn't actuall run through what any of it meant

Spiro results

[jackdup in reply to Reach86]

You would certainly never know you have COPD based on these results. Your FEV1% of predcted is 98% and is 4.52. Anything between 3.75 and 5.43 could be considered normal for someone your age, gender and height. The predicted value for you is 4.59 and you are 4.52. It is surprising you are have breathing issues unless there are some other contributing factors. Generally if your FEV1% of predicted is reduced and your FEV1/FVC ratio is below 70 you can be diagnosed with COPD but your ratio is above 70 and your FEV1% of predicted is well within the normal range and only slightly below what would be predicted for someone your age, gender and height. It also mentions your lung age is 38 which means you have lungs that would be expected in a person 38 years of age so if you are around that age it would mean that your lungs appear normal based solely on the spirometry. The CT showed emphysema but would suspect it is quite mild based on the spirometry.

[Reach86 in reply to jackdup]

As I said I'm not sure and it's why I'm so confused as I'm struggling at the moment I did have a pleurodesis in my late teens and have had yearly chest infections since that as well as chest pains etc so maybe that's contributing to it. Also this Spiro was done on a small handheld like thing I dunno if that makes a difference?

[jackdup in reply to Reach86]

It certainly would be confusing. You should ask your doctor whether these other issues you mentioned would or could be contributing to your issues. A handheld spirometry may not be quite as accurate as a full pulmonary function test but should not vary that much i wouldn’t suspect.

[Reach86 in reply to jackdup]

Ok great thanks I did wonder if maybe my diagnosis was wrong but I had my CT double checked and told it's definitely emphysema but I'm going to have a talk and try to find out why

[jackdup in reply to Reach86]

I would definitely be asking more questions as well. If you do have emphysema as I mentioned it would seem to have to be very mild given your spirometry.

[Reach86 in reply to jackdup]

That's what's confusing me because my symptoms don't feel mild. I'm also wondering if the fact I had taken both my inhalers the morning before my spirometry might have changed things?

[jackdup in reply to Reach86]

I have always been told not to take my inhaler for 4 hours prior to a test. One way to differentiate asthma from COPD is if you take an inhaler and your spirometry improves significantly. They will often test you and then have you take your inhaler, wait about 20 minutes and test you again. An inhaler can improve the results a bit if you have COPD but not return it to normal whereas with asthma a significant improvement can be seen. While your inhalers may have improved the results a little but don’t think they could have improved it that much.

[Reach86 in reply to jackdup]

Ok thanks then I guess I'm just gunne be lost until I speak to a professional and try to work out what's going on. I really appreciate the help jackdup

[jackdup in reply to Reach86]

You are welcome, sorry I couldn’t be more helpful. Good luck and let us know how you make out.

[Reach86 in reply to jackdup]

Will do cheers I'm trying not to stress about it but I like knowing what's happening and as I don't it's freaking me out. Thanks again