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Have hypertension, asthma, anemia and mild COPD. Looking for proper diagnosis

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Posted on Tue, 11 Dec 2012
Question: I am 45 year old never smoke, second hand smoker all my life, my preexisting conditions are hypertension, asthma and anemia; recently diagnosed with mild copd. born premature 3 pounds in need of immediately patent duct arterial surgery but was done at age 9, doctors think I born with another heart condition in addition to the patent duct, always suffer dyspnea, recurrent respiratory infection, kind of blue/purple lips and anemia before and after surgery, was diagnosed with asthma 3 years ago; again doctors think my asthma was overlook by doctors because they were concentrated in my heart problem when I was a kid. Finding in recent testing:
Echo findings; mild mitral, aortic, tricuspid and pulmonic regurgitation. Mild elevated PA (RV) systolic pressure of 35.mild reduced cusp mobility aortic valve.
Chest CT Scan findings: nonbullous pulmonary hyperinflation )
Spirometry findings: severe airway obstruction with low vital capacity and lung age >84. Based on the study the patient has mild chronic obstructive lung disease
PFT findings: mild expiratory airflow obstruction, definite bronchodilator response is not present and mild decrease in DLCO which does not correct for alveolar volume.
I am concern about my lung age of >84, the XXXXXXX of all my mild heart problems and pulmonary elevated systolic pressure and my high blood pressure with my now diagnosed mild copd; and if the DLCO findings indicates emphysema and if nonbullous pulmonary hyperinflation is have pulmonary hypertention?
doctor
Answered by Dr. Santosh Kondekar (8 hours later)
Hi,
Thanks for writing to us.
Yes, it is likely that you do have pulmonary hypertension that may be almost irreversible at this age.
Given your current complaints, all issues including pulmonary hypertension… copd… DLCO… failure to bronchodilator are almost irreversible and will need regular lifelong therapy with repeated antibiotics, inhalation therapies with ipratropium and significant activity restriction.
Even now there is a lot to improve your quality of life depending on what exact symptoms you are suffering from…
Echo findings do not mean much in the background of cardiac issues.
I hope this helps curtail your anxiety… I will be most pleased to help you further if any more concerns.
Thank you.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Santosh Kondekar (10 hours later)
I am confuse about few things you mention;my choronological age is 45 but muy lung age is >84 how irrelevant is my lung age in copd; copd diseases are emphysema and chronic bronchitis since dlco only decrease in emphysema you didn't tell me if that means I have emphysema you also mention "Echo findings do not mean much in the background of cardiac issues" I don't know what your sentences means.
doctor
Answered by Dr. Santosh Kondekar (15 hours later)
Hi,
here is a verbatim explanation

I am confuse about few things you mention;my choronological age is 45 but muy lung age is >84
---that means your lungs have been weakened ahead of time and they are under functioning.. irreversibly to some extent. So with age gap of this much, its just a statement. There is no way to calculate age of lung. For ease may be you can understand this better if I say.. half of your lung capacity/function is now no more available.

How irrelevant is my lung age in COPD; COPD includes emphysema and chronic bronchitis. Often these coexist in varying proportions. Age irrelevance means.. if i say lung age is 70 or 80.. it doesn't have a much difference as its just an approximate statement. Once you have COPD, lungs are damaged irreversibly. What age you call it may not mean anything. What is relevant is .. how much oxygenation they are able to maintain and how much stress lungs may be able to tolerate. This can be loosely assessed by spirometry, oxygen saturation and rate of breathing at rest.


Since DlCO only decreases in emphysema you didn't tell me if that means I have emphysema-It does mean some degree of emphysema does coexist. i would suggest that instead of falling in medical nomenclature which is overlapping and ambiguous at times; you should be more concerned for day to day quality of life and the restriction of activities and medicines recommended if any. You may make arrangements for an oxygen service for home use in case of emergencies. your current quality of life decides how susceptible you may be for further worsening. Since these issues have not occurred not overnight; and they have developed over 3-4 decades; your body functions are likely to be well adapted to the level of damage and you may be at ease than other COPD/emphysema patients who develop the issue only late in life.

"Echo findings do not mean much in the background of cardiac issues" : Mild findings on echo are likely to be present as a part of cardiac work overload ( due to the issue with the lungs and the heart) since decades and are inadvertent with such cardiac disease by this age. So additional therapy for same may not benefit much and hence finding another abnormality like this doesnt mean much severe issues.

Thanks.
I hope that I have addressed your concerns. Feel free to ask for details. do not panic .. stress, anxiety and worry all are risk factors for COPDs.

Above answer was peer-reviewed by : Dr. Aparna Kohli
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Answered by
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Dr. Santosh Kondekar

Pediatrician

Practicing since :1997

Answered : 379 Questions

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Have hypertension, asthma, anemia and mild COPD. Looking for proper diagnosis

Hi,
Thanks for writing to us.
Yes, it is likely that you do have pulmonary hypertension that may be almost irreversible at this age.
Given your current complaints, all issues including pulmonary hypertension… copd… DLCO… failure to bronchodilator are almost irreversible and will need regular lifelong therapy with repeated antibiotics, inhalation therapies with ipratropium and significant activity restriction.
Even now there is a lot to improve your quality of life depending on what exact symptoms you are suffering from…
Echo findings do not mean much in the background of cardiac issues.
I hope this helps curtail your anxiety… I will be most pleased to help you further if any more concerns.
Thank you.