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Have stage 4 emphysema. Experiencing back pain and tightness in chest. Any thoughts?

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Practicing since : 2003
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I have stage 4 Emphysema. Recently I have experience a pain in my lower back, especially at night. I first go to sleep OK but wake up to have a loo stop and find that the ache causes discomfort in going back to sleep. I also have a tight feeling in my chest and a pressure feeling below my breastbone, which I assume is hperinflation pressing down on my diaphragm. Lastly I also experience a ache in my upper back which I also attribute to hyperinflation placing stress on my breathing muscles. Any thoughts?
Posted Tue, 19 Mar 2013 in Lung and Chest disorders
Answered by Dr. Gyanshankar Mishra 1 hour later
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. You seem to have been diagnosed with stage 4 Emphysema i.e very severe COPD.

2. In such a scenario as ponted out by you due to great extent of severity of the lung disease i.e more hyperinflation, air trapping and bronchoconstriction, some chest discomfort has to be there.

3. Also if oral steroids have been started, medicine related side effects may be present.

4. You need to get yourself evaluated in detail with a pulmonologist. Pulmonary function tests at regular intervals need to be performed and your medications including inhalers need to be titrated accordingly.

5. Get your ABG(evidence of hypoxemia then LTOT (Long term oxygen therapy may be required). Also a 2 d echo needs to be done to rule out pulmonary hypertension which is most of the times associated stage 4 disease.

6. Do start antacid medication like tb. pantoprazole 40 mg in the morning in consultation with your doctor.

7. Get 5 yearly pneumococcal vaccination and annual flu vaccination.

8. If avaialble you may join a Pulmonary rehabilitation programme in consultation with your phycician.

9. Simple analkgesic like tb. paracetamol can be taken for pain relief and if required you may consult an orhtopedician for the back ache.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.


Dr. Gyanshankar Mishra
Consultant Pulmonologist
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