Expert: Marc Rubin, RPh Asthma Educator - 12/18/2010

Question
QUESTION: Hi Marc, I live in a large city, no pets at home, no Rx meds, never smoked and avoided smoky places, 120 lb F.  I was referred to a pulmonologist after a chest XR for abdominal pain and spasms on the left side of chest, under bottom of left ribs, that go around the side to my back (sort of through me) The chest XR was ordered for "crackles" in Nov 2010 with report of lungs slightly hyperinflated with mild flattening of diaphram with Impression:  Chronic COPD versus active airway disease. Last Jan I had a chest XR for chest pressure/tightness/dry cough, at an urgent care clinic and the doctor said my lungs were significantly hyperinflated.  He said if he had not seen me bfore seeing the XR he would have thought I was a person with COPD. Also at that time I had a gallium scan (re: a kidney question) and the report was prominent gallium activity in both lung hila.  I had a stress test at that time and it mentioned trace pulmonic regurgitation and mild ticuspid valve regurgitation.  (Had ablation for WPW heart syndrome a couple of years ago.)  What would the CT be called? I wonder if it would provide info about what is causing the abdominal pain that I've had for 3 years.  I did a simple breathing test recently and then my chest and lungs hurt for several hours afterward. The doctor said maybe I have asthma but I don't think I wheeze.  In fact, when I exercise I always feel much better.  I like to sleep with a small pillow on my chest because it feels better to keep my chest warm.    Are these types of things noted on the reports something that most people over 50 might typically have? Thank you!  Susie

ANSWER: Hi Susie,

What is your occupation/work environment?
What town do you live in?
Home environment: apartment or single family/old construction or newer/basement?

I'm looking at the potential of occupational asthma. Chronic asthma can lead to COPD.

Looking forward to hearing back from you.

Sincerely,

Marc


---------- FOLLOW-UP ----------

QUESTION: Hello, Marc-- I wonder if I should have mentioned that I had an adrenal lesion/adenoma finding a couple of years ago 12mmx11mm I think.  It's on the left side (along with my little kidney stone) and sore abdomen/back.  Does that have anything to do with asthma or lungs?  Had a slightly high cortisol level recently and low serum uric acid 0.8.  Thanks, Susie

ANSWER: Hi Susie,

The higher cortisol level would actually result in lower lung inflammation most likely resulting in reduced symptoms. Was the lesion left alone pending followup to observe changes?

I'll assume the kidney stone issue is resolved at this point in time. If it was collected, did they tell you the chemical makeup?

I see you sent another note.....

Marc

---------- FOLLOW-UP ----------

QUESTION: Hi Marc,  I was told that the lesion meant nothing.  I don't think anyone was thinking it needed watching.  The stone was mid-kidney and first noted at 2.2 mm in 2008 and a year later 2009 it was 4.0mm.  Last June it was checked and it was 5.5 mm.  I have been taking calcium citrate for about 6 months.  The stone was checked again a couple of weeks ago and it is 2.5 mm now, a very nice surprise.  I have thought that this was causing my abdominal/flank/back discomfort.  The doctor said that as it disintegrates it could be causing some symptoms.  So I don't know the chemical makeup. They said it might have been a result of infection from my chronic UTIs from 2007-Aug 2010.  This is the longest I've gone without a UTI since 2006, really.  I was told the Vit D deficiency probably started about 2007, diag in Sep 2008. What is that cT test called for lungs?  Lung CT?  I'm supposed to be NPO 4 hrs prior.  Thanks again,  Susie

Answer
Hi Susie,

First, a lung CT is a more sophisticated x-ray than the typical scan. Images appear in greater detail, and generally in color in order to make it easier to identify abnormalities. It appears that your physicians are being very thorough in trying to find the underlying issues taking place.

One thing that concerns me though. You have had a number of unrelated illnesses, the wondrous benefits of aging. Has it ever been brought up that the hyperinflation may be due to anxiety disorder secondary to your prior medical history? The reason I say this your lack of symptoms during exercise, which may be a psychological distraction from your other medical issues. When you worry, anxiety may result in rapid, shallow breathing leading to the hyperinflation. If this has not been discussed, run this though past your physician.

Let me know how things turn out.

Have a Merry Christmas, and a happy healthier New Year!

Sincerely,

Marc