One Third of Lung Function

[little_weed]

Finally, after months of waiting for the full results of ct scans with PFT's, I have the startling information that I have lost two thirds of my lung function!!!

My pulmonary specialialist doesn't "do" staging for emphysema, and will not be drawn on a prognosis, because at this stage they cannot measure the rate of decline.

My FEV1 indicated maybe mild to moderate, but the ct scans showed "significant emphysema", and whilst he says that the FEV1 is good, the Volume/Diffusion/Gas transfer etc show the actual extent of the emphysema in the upper lobes, and that I am working on one third capacity.

I am being referred for possible LVRS, which is usually done at a worse stage, but he thinks the time to do it is now.

Can anyone give me any info on what they think my staging would be if given one? Severe or Very Severe??!! Or am I still "moderate" as I had been led to believe early on in the year.

Every bit of research I have done has been in terms of "staged" emphysema, so cannot quite get my head around
33 and 1/3 % lung function, with a FEV1 of 84% predicted!

[sally1055]

A related discussion, 41 % lung capacity was started.

[little_weed]

Hi, thanks for your post.
I have included the relevant figures in my previous post. I have also put the question up in the COPD general forum, but I also wanted the M.D's opinion on this forum, which has been very helpful.

I have spent the last year researching PFT's, COPD and in particular emphysema, and know a fair bit about the numbers.

I also read a lot of research articles, and have come across the anomalies and contradictions with hyperinflation and upper lobe emphysema, and the spirometry results.
I seem to fall into this category. The CT images are important to take into consideration with the PFT data.

Any input would be appreciated, thanks.

[little_weed]

Thank you for your reply.
It is the inconsistency of the data which prompted me to ask the question. Your reply was both informative and intelligent, for which I thank you.
I am posting the following results for your information

Diffusion/gas transfer
                  Predicted       Observed        Observed            Observed
                                     Pre (absolute)    Pre (% pred)       Pre (SR)
Tlco (Hb)       8.78              2.94                   33.54                -4.99
Tlco                8.78              2.97                   33.85                -4.96
Va                  5.63              5.67                 100.83                 ----
Kco (Hb)       1.56              0.52                   33.27                  ----
Kco                1.56              0.52                   33.57                 ----

Standardized residuals (SRs): +/-1 SR contain 90% of the reference population.
Severity scale for SRs: mild: 1.64 to 3.0 moderate 3.0 to 4.0 severe >4.0


Lung Volumes (Helium Dilution)
                  Predicted       Observed        Observed            Observed
                                     Pre (absolute)    Pre (% pred)        Pre (SR)

He-VC(L)        3.38          3.84                  113.72              1.10
He-FRC(L)      2.93          4.95                  169.02              4.04
He- RV(L)       2.00          2.98                  149.42              2.82
He-TLC(L)      5.63          6.82                  121.22              1.99
He-IC(L)          2.01          1.54                   76.58.               ----
He-ERV(L)      0.93          1.97                  210.92               ----
RV/TLC(%)    37.33        43.71                117.09              1.09


It is the above gas transfer results which I think, show the damage my doctor refers to,along with the ct images, when he says that I have lost two thirds of my lung function.

My spirometry results included the following results:

                     Predicted       Observed               Observed            Observed
                                          Pre (absolute)       Pre (% pred)          Pre (SR)
FEV1(L)               2.88               2.43                     84.22                -1.20
FVC{L)                 3.37               4.11                   121.94                 1.22
FEV1/FVC(%)     78.83            59.09                     74.96                 -3.03

The ct images showed the extensive damage to the upper lobes, which looked diffuse.

I am being referred to one of the best pulmonary hospitals in the UK, but that could be many months away.

Many thanks again.

[David Tinkelman, M.D.]

There appears to be some inconsistency with your data.  Most notably is the declaration that you “have lost two thirds of my lung function” but have an “FEV1 of 84% of predicted.”  While there is not always a good correlation between the amount of emphysematous lung and the reduction of airflow, as measured by the FEV1, it would be most unusual to have lost 2/3 of one’s lung function and still have normal airflow (FEV1 84% predicted). You should ask the pulmonary specialist for an explanation

Your request that the severity of your COPD be staged is reasonable and this could be done in accordance with internationally accepted standards, in either of two Guidelines for the Management of COPD:  the GOLD standards or the ATS/ERS standards.  Your lung doctor would be familiar with these standards.  You should understand, however, that severity as judged by these standards, is not a criterion for operability.

The NETT study findings and subsequent observations established  the criteria used today, for patient selection as being good candidates for surgery.  Patients  are selected according to the morphology of emphysema (upperlobe predominant versus other patterns; localized vs. diffuse), physiologic severity(FEV1, DLCO, Ppa), the patient’s fitness (6-minute/shuttle walk,), the patient’s perception/expectation regarding quality of life, and the presence of important co-morbidities such as coronary artery disease, pulmonary hypertension, sputum production, or ongoing tobacco abuse.

Your pattern of primarily upper lobe emphysema is considered to be the optimal pattern for LVRS.  But this finding alone, without  the following  symptoms, is not an indication for surgery:  in addition to the X-ray and CT Scan findings, there should be: abnormal PFT’s and low blood oxygen levels (at rest and with exercise), shortness of breath with exertion and low baseline exercise capacity  . Persons with these characteristics are those most likely to achieve the greatest benefit from LVRS.

LVRS should be considered for patients only after they have received maximal medical therapy and have undergone pulmonary rehabilitation. Furthermore, a chest CT and cardiopulmonary exercise testing measuring maximum work load are required to determine if a patient is likely to benefit from the procedure. Once these objectives are fulfilled, LVRS can be offered to patients who have upper lobe predominant disease, as the procedure has been shown to improve symptoms, quality of life, exercise capacity, and lung function in this group.

Be advised, LVRS is risky and, in some instances lung function, symptoms and/or quality of life may worsen rather than improve.

My recommendation is that you seek a seek a 2nd opinion from a pulmonary specialist who has had much experience with COPD and this procedure and, if LVRS is ultimately deemed to be indicated, that the surgery be done by a surgeon with extensive experience at a major medical center.  You have the right to request a report of the outcomes of previous surgery (of this type) performed by the surgeon chosen to do your surgery.  And remember, there is no hurry to make this decision.

Good luck

[Between]

I was wondering what your other numbers are? Such as your fev1/fvc and fvc and also tlc and dlco. All the numbers come together. The fev1 you posted is good. I know all the numbers along with your ct scan and clinical exam go together.