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Respiratory Therapist/Potential COPD diagnosis in a nonsmoker?


I'm 48,female, healthy weight, generally healthy, never smoked, minimal exposure to smokers.  Recently was treated for pneumonia.  Doc tried 2 antibiotics (Zpack and low-dose Levaquin [history of c. difficile infection, so docs don't like to give me much in the way of antibiotics.)  After about 2 weeks, was still very short of breath and found my heart racing with simple movement.  Was admitted to hospital for IV Levaquin and lots of breathing treatments.  Spirometry in the hospital done, with the comment "you should be able to breathe out harder...but then again, you have pneumonia."

Seem to be recovering, if slowly.  Still get short of breath with exertion (was able to do 30 minutes at a walking pace on my elliptical before I got sick, now can't do more than 2 minutes until I am a gasping mess with a 200+ BPM heartrate).  Have a slight cough, get totally exhausted by the end of the day.  Figured this was part of normal pneumonia recovery.

Had a follow up chest x-ray yesterday.  The report reads:  the lungs are hyperinflated with flattening of the diaphragm indicative of COPD.  No acute infiltrates are noted.  So...I read this as the pneumonia has resolved (no acute infiltrates...the pneumonia was in my right lower lobe).  But what's up with the hyperinflation/diaphragm issues?  Could this still be "angry lungs" recovering from pneumonia, or something more? Is it possible to have COPD having never smoked? I'll be following up with my doctor, of course...but would appreciate some thoughts as I formulate questions for my doc.  Thanks.

Hello Mary,

Thank you for entrusting me with your personal health care/medical question. Honestly, this is a tough one to handle, as you are a non-smoker with minimimal exposure. Generally, hyperinflated lungs and a "flat" diaphragm or a flat "costophrenic angle" are part of the gold standard that is used to acurately diagnose early COPD. The diaphragm will not flatten out as a result of the lungs being irritated from pneumonia damage...this flatteneing out is an anatomical change to an organ that occurs over a gradual period of time, and not an acute response to an acute condition such as pneumonia. One thought is to make sure the "technique" of the xray was done properly...if the lungs are not at (depending on many variables) full inspiration or full expiration, sometimes there can be false findings. When in doubt, perhaps the doctor will look at doing a fuller set of pulmonary function tests (PFTs) or a chest CT to gather more info.

I hope this helps.

Larry, RRT  

Respiratory Therapist

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Larry W. Wical, BA-RRT


I CAN answer: ALL questions and queries related to the following topics... - Oxygen - Asthma - COPD - Bronchitis - Emphysema - Pneumonia (Viral/Bacterial) - Tuberculosis (TB) - SARS - Influenza (Flu) - Vaccines - Pulmonary Embolism - Pleural Effusion - Atelectasis - Inhalation injuries (burns, chemicals, etc.) - PFTs - Cardiovascular health - Sleep Apnea - BiPap/CPAP - Ventilators (Respirators) - Aspiration injuries - Thoracic injuries - Lung contusions - Tracheal injuries - Artificial Tracheostomy - Secretions - Prolotherapy/Regenerative Injection Therapy (RIT): A patient's experience/perspective - General health and fitness - Prolotherapy (from a patient's perspective) I CANNOT answer: Questions that vary too far from my primary scope of pulmonary and cardiovascular care and fitness. I promise to be open and honest about my knowledge of submitted topics, and will always openly provide my personal as well as professional feedback as it relates.


Registered Respiratory Therapist (RRT, RCP) since 2005. I have worked primarily in the acute care, critical care, burn care and home care settings.

NBRC - National Board of Respiratory Care AARC - American Association of Respiratory Care

-All About Kids Magazine -The Clermont Sun -Cincy Sports & Fitness Magazine -Many online Fitness and Health blogs and "webazines"

- B.A. in Communication (1997) - A.A.S. in Respiratory Science (2005) - RRT license (state of OH, KY and IN) - Basic Life Saving (BLS) - Advanced Cardiovascular Life Support (ACLS) - Advanced Burn Life Support (ABLS)

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Currently work in the city's largest academic/research hospital.

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