Tuesday, September 30, 2014
COPD (Chronic Obstructive Pulmonary Disease)
Asthma and emphysema
I am a 51 yo Female, 124 lbs, non smoker and before Sept 08 been in perfect health. Then started having SOB with chest pain. Full cardiac work-up negative and pulmonary function testing results borderline with metacholine challenge fall of 40% after 3 doses. In Feb. 09 I was dx`s with mild emphysema in both upper lobes by CT scan. Pulmonologist has no idea why I have both these conditions. I put a radon detector in our home and had AAT testing, both negative. I take symbicort,singular, use rescue inhaler still daily, and my use of nebulized albuterol has decreased. Also, did a 4 wk stent of prednisone. Do you have any idea what is happening to me,any other testing I should have, or ideas on what to do? Family history of lung CA, my father, his sister, their father, father`s other sister chronic bronchitis, all were smokers. I am afraid they are missing something and I will continue to get worse. Thank you very much for any reply.
Thank you for visiting NetWellness and for your question. On this site, NetWellness experts try to answer general questions about health. Only a health professional performing a thorough clinical exam is able to evaluate your symptoms and discuss your case specifically. There are a couple of points that you raise that can be discussed, though.
The first is the notion of emphysema in a nonsmoker. Cigarette smoking is by far the most common cause of emphysema, but there are others. Chronic exposure to other particles such as fumes, chemicals, and dust can cause lung disease. A1AT deficiency is an inherited defect that can cause early emphysema in smokers and nonsmokers. It is very likely that there are other genetic causes that have not yet been described. Chronic malnutrition, connective tissue disorders, HIV, and drug use are other known causes of emphysema.
The second point is that you appear to have a positive methacholine challenge test. It is possible that you have difficult-to-control asthma or a complication of asthma. Most patients with asthma, though, are controlled on an inhaled steroid. However, you could have an allergic component of your lung disease that is not being controlled.
The third point is in regards to testing. When it is difficult to determine the cause of shortness of breath, a cardio-pulmonary exercise test can be helpful. This test is similar to a stress test with additional information about breathing that is obtained.
If you still have questions and uncertainty about your disease, a second opinion can be helpful.
Michael E Ezzie, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University