Lung overinflation

So I went to the Pulmo a couple days ago and had full PFT's. I posted here a couple times prior.

Anyway, my FEV/FVC was 69, then to 71 post Albuterol. So not much change. FEV1 105%, maybe 108 post. Again not much change. Airway resistance normal. DLCO normal.

But my lung volumes not. TLC, RV, TLC/RV ration all increased. The residual volume (RV) was 318% of predicted. For this reason he checked me for Alpha 1. I am 43, smoked about 10 years, never heavy, but that does not matter now. The final report says minimal obstructive disease with overinflation. I know that FEV looks at the larger airways, so can be unaffected by air trapping like I have. And boy do I. That is a static measurement too. I tend to be hyper aware of my breathing and for a "mild" obstruction, my symptoms don't match up. So I do believe how I breath impacts it. Whether physio or psychological. Maybe both. But when I try and do anything physical, I notice I get more out of breath now than I did even two months ago. I have dyspnea all the time, better since I started Spiriva two days ago. I am six puffs in so far and he said give it a month before I see any difference, if at all. I was on Dulera and Flovent in the past and did nothing. My symptoms were not as bad then. Thats what scares me, how I feel like I am worse. 6 months ago I had normal spiro for the most part, FEV1 always high. Again, that is irrespective of hyperinflation.

So my doc said he didn't see much to be concerned about. Yes volumes high and checked Alpha 1. Said he has been doing so for years and out of thousands maybe a handful were +. Whether I do or not, I have what I have. He told me he would be happy with my results. I asked about meds and he was reluctant, when I pointed out the hyperinflation, he gave me a month sample of Spiriva. Yes I live in America, so samples of expensive medicine a good thing. Since I was on Dulera, Flovent he said no point and I agree. He also said he didn't see much from a cardiopulmonary standpoint for my SOB. Hmmmm. I mean to me hyperinflation means Asthma or Emphysema. I had the former but always from allergies or exercise. Not severe Asthma, but I did smoke, so maybe I damaged the alveoli that way or the latter. I can appreciate his reluctance to slap a dx on me, does not benefit me at all. Doesn't change the management, which is meds if you need them. In theory, I am Gold stage 1, which means mild and Albuterol as needed or a LABA. Spiriva is approved in the US for mod-severe. Tho I know many on here and in america, like myself who are "mild" are taking it. Not too mention studies have shown it to be beneficial early on. We will see. If it can get rid of some of the trapped air and improve my breathing I am all for it.

I mentioned some other things and he told me we can look as hard as I want and he will find something wrong with me eventually. I actually like his style, said if it was serious he would tell me. So I got the sense further testing, like an Echo or VQ scan would be for to evaluate my sob from a cardiac standpoint or maybe small pulmonary emboli. Overall he was not too impressed, aside from the lung volumes.......even then not so much. No CT scan, which is fine, even if I have something on CT like Emphysema, does not change the management. Did the inhaler thing, no help. Though in the past, albuterol did the trick. Not so much now. Supposed to see him in 1 month.

Anyone else on here with "mild" copd, and hyperinflation? I feel like everything about what is going on with me doesn't fit. My age, smoking hx, god FEV1, normal DLCO, normal airway resistance. No cough. I did wheeze but stopped after the Spiriva, Yet my lungs are full of air. Some air trapping yes, but I have a lot. Like I should be much further along. Like much worse function. Not to mention I would expect the DLCO to be low if the emphysema was bad and that those numbers would coincide more with the air trapping.

Of course since I learned of the hyperinflation, my abdomen feels tense and full, but this does not happen overnight. COPD takes awhile to show itself, so now my abd feels that way after seeing the results. But the volume numbers are real.

Confused? So am I.

Best,

Patrick

18 Replies

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  • I am not a doctor, but I am very intrigued by your symptoms. Did it happen quickly? Was there any incident that seemed to trigger the worsening of your condition? i.e. Inhalation of something toxic? Were you in the armed forces in the Middle East?

    This is a very long shot and — PLEASE — take what I am suggesting with a massive pinch of salt. Air-trapping, and massive hyperinflation but not severely down PFTs... Mmmm....

    Maybe a gentle hint about Obliterative Bronchiolitis? This can show itself in air-trapping before there is significant change in PFTs. Sounds like Small Airway Disease, anyway. Look it up and check out what you are feeling.

    So glad you have a doctor that is determined to stick with the problem.

    All the best and let us know how things go.

    K xxx

  • Hi katinka, I read your question about toxic chemicals with interest. I often wonder if my lung problems were made worse when I was prescribed an insecticide lotion for scabies....just before I got pneumonia .

    The lotion turned out to be Lindane....I didn't realise it at the time as it had a Latin name on the bottle.

  • Would love to hear more details about all that. If you can bear to go over it all.

    Love Kate xxx

  • Hello again, Knitter. Just looked up Lindane. Nasty stuff. Have you suspected for a while that it could have caused your pneumonia and subsequent lung problems?

    I am fascinated by all things pulmonary, the rarer and odder the better. You did not put much up on your profile. Are you happy to tell more? I am a duffer at tech stuff but if you would prefer to use PM I will try to respond. As you might realise from my posts I think, only think, (not a clear diagnosis yet) , that I may have Obliterative Bronchiolitis. So I am quite clued up about it. I think, again, only think, that there may be more of it around than doctors realise. One of my hobby horses is doctors who too readily go down the COPD route because it is common, and easier and cheaper for them than scratching their heads.

    Please get back to me if you want to.

    Kate xxxx

  • Well the SOB started in January. I was smoking at the time, had been for about 3 months, hadn't smoked for about 6 months prior. I started getting SOB and I knew something was up the the "fags" were gone. I have continued to have SOB and up until recently a faint expiratory wheeze that I could hear, but that could not be auscultated with a stethoscope. Maybe on forced expiration, but even then not so much. Just this constant feeling of SOB and and up until about two weeks ago, I could lift weights and do some moderate aerobic exercise and to be honest, I didn't feel very breathless, in fact I noticed it less because I expected to be breathless from exercise? Not sure if that makes sense.

    Couple weeks ago things changed, felt like a had more SOB, more fatigue and I would get winded easily. And if I climbed stairs or just getting up from sitting my pulse would shoot up. I am talking like over 100 easy. And I felt like I would wheeze more and like I had this turbulent air, a harshness, with expiration. Like in my throat. I had someone listen to my lungs and they didn't hear anything. Which is not all together uncommon. Often pt's hear it when nobody else does or only with forced expiration.

    Anyway, I was working in Alaska in a remote area and I had to leave 4 days early and see the Pulm, my anxiety was over the top. But it is not in my head. I don't have 311% of predicted RV for nothing. Today I tried to walk up a short hill and I just could not catch my breath. Inhlaed deeply and of course that makes the hyperinflation worse. The Pulm listened to my lungs and said all clear, even on forced expiration. So what gives? That was even before the Spiriva. But I know in Alaska, I felt like crap and left early. No gain as it cost me some serious dough. No cough ever, maybe a week last Jan. no fever. Have not even had a cold all year. Something has to be up.

  • Hmmm... As I say check out the Obliterative Bronchiolitis. I am sure that your doctor will investigate it anyway. He sounds like good sort. Hyperinflation from asthma and to a certain extent with COPD is variable, (with asthma should almost disappear once the spasm has gone.). But with OB it is constant because it is caused by fibrosis not inflammation. Any ideas about toxic inhalation?

    Keep us informed.

    K xx

  • No, other than cigs. I will say after this began, I became super sensitive to any cleaning products and scents. I did some sanding without a mask, very light sanding and my chest became super tight. Same with dust. Originally I thought our new dog was also not helping because I am allergic to animals. Especially cats. Ill for sure do some reading on OB. Thanks.....

  • Hang in there Patrick. It sounds like you have a good doc. Just you keep him on his toes!

  • I will. I do want a Ct scan I think. Even though he does not recommend. Ill wait until Jan if I can because that is when my insurance deductible starts again and I have a feeling I may meet it next year.

  • Hi Patrick, I have COPD/ asthma with hyper inflated lungs....I find the pursed lip breathing helps to get rid of trapped air so fresh can get in.

    Have you looked at Gerald's post today......13 simple strategies .....there is a You tube video on pursed lip breathing and belly breathing as well. Also tips on how to avoid bloating.

    I like David Carbonells breathing videos on You tube too. Also relaxation and meditation helps to reduce tension in my breathing muscles.

    Take care

  • You know I did see it. Ill have a look at it. Hoping between that and Spiriva it will help.

  • I think doc's GP talk a load of Sh## about causes of hyperinflation (1) us trying to breath threw a load of bubbling mucus filled filled lungs Befour any of us are diagnosed is enough to cause bad breathing habits and hyperinflation ( 2 ) then you have trauma PTSD of not being able to breath that causes it's own breathing problems

  • Well this is true. I don't cough, never have when this all began. Maybe a week or two when it began, but Flovent cleared that up. About the only thing it helped. But being aware of every breath, especially of you feel like not enough is getting out is a very real symptom and yes quite distressing.

  • Not a lot of people know Azithromycin inhibits mucus hypersecretion from airway epithelial cells.

    Thats why wonder drug works so well

    Also i was going to do post on Ecigs & Azithromycin

    Ecigs are apost to dry out you lungs to surrpose could say inhibits mucus hypersecretion from airway epithelial cells.

  • Hi have you been tested for asthma as that can cause wheezing and sob? I have asthma and mild copd and some of my symptons are worse than they should be. I find a great breathing exercise to get rid of CO2 is to breathe in quickly (though nose or mouth) to a count of 3, hold it for a few seconds, then breathe out quickly and continue on until you feel empty. You will make some strange noises so it's best to do it alone. x

  • No I have not. I do have allergies, known this for awhile. Always thought I had mild allergic asthma. Far back as I can remember I would need to use my inhaler for allergies, but not very often. Cats, dogs, pollen. Same before exercise. But that changed in Jan when the Albuterol did not clear up the SOB or wheezing, maybe a bit. He doesn't think asthma, neither do I. Makes me wonder though what I ever had. I just don't know anymore to be honest. Only how I feel.

  • Hi again Patrick, have you had any skin tests for allergies at all.

    All three of my asthmatic daughters are allergic to different animals and house dust. Antihistamines help, and one takes Monteleukast tablets.....best to ask your health practioner.

    I have a problem with some bronchodilators...I have to make sure I balance their use with a steroid preventer, otherwise my chest gets tighter. But that's me.

    I hope you find some relief from the new inhaler...best wishes.

  • I do have allergies, and I was tested years ago, and everything popped up. I have been on Monteleukast before. But my main thing is the SOB, and that didn't change on the allergy meds. I also use a nasal spray.

    Thanks. I hope it works as well.

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