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Dr. Andrew Rynne

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Should I be concerned about restrictive lung function?

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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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Posted on Tue, 15 Jan 2013 in Lung and Chest disorders
Question: Dear Docor.
Please guide for future for Restrictive Lung Function,
does this is a serious concern in long term,.

Reports of Lung Function tests with sleep study are enclosed.
doctor
Answered by Dr. Gyanshankar Mishra 2 days later
Hi,
Thanks for posting the query on XXXXXXX After going through your reports (Your evaluation reports are of 2010), I would like to comment the following:

1. Your PFT results: Your DLCO (Diffusing capacity) corrected for alveolar volume and hemoglobin is normal. Hence the restriction defect on lung volumes and spirometry is due to the chest wall i.e. obesity (your BMI is >40).

2. Your sleep study result is suggestive of obstructive sleep apnea and you should continue on auto cpap device.

3. You seem to be suffering from obesity, diabetes, systemic hypertension, hypothyroidism & obstructive sleep apnea. This is a part of metabolic syndrome or syndrome Z. Please continue all your medications regularly. Also do get your your lipid profile done and a stress test done to rule out early IHD.

4. The ABG report time is mentioned as 1.31 pm. I would suggest you to do an early morning ABG. Your oxygen saturation in ABG is low i.e. you are hypoxemic.

5. At present you haven't mentioned any symptoms. The most important aspect of management would be weight control )life style modification through diet and exercises) . Obesity is reason for restrictive defect on Lung function test. Since PaCO2 on ABG is normal obesity hypoventilation syndrome does not seem to be a strong possibility , however a recent and early morning ABG is recommended. Also a repeat sleep study may be done to evaluate the response of CPAP therapy. In consultation with your physician you may consider even surgical options in the form of bariatric surgery but being diabetic, risk benefit ratio will have to be evaluated.

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.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Gyanshankar Mishra 2 days later
Dear Dr XXXXXXX
My present symptoms are-
All day tired and feeling sleepy with confusion, whereas in past I was doing very well in my daily routine and in profession.
Warmness in hands and some times they got red, pink colour of skin appeared around chest even on minor rubbing and disappear
Pedal edema, pain in lower abd area, pains allover like left arm, elbow, shoulder, right side with stiffness.
All days feeling some irritation in throat like cold symptoms and wax is coming from both ears almost on daily bases which is not normal.
After using of CPAP for 7-8 hours even feeling sleepness and taking sleep 2-3 hours, sleep always very XXXXXXX
On occasions pain in center part of head appears and goes.headache on frontal head appeared this may be due to central heating system in homes here in Canada. Gums are feeling that getting down ward /upwards thus teeth looks longer than previous and itiching pain is feeling with some bleeding while brush. My DHEAS was low, hemoglobin was also low. ESR was always high from 20 to 48 during last three years,dipstick haematuria is always there, under cystoscopy urologist noticed large stricture in bulbous urethera but he is not ready to evaluate further.
In Echo and carotid there is some changes. parotid u/s is also enclosed.
doctor
Answered by Dr. Gyanshankar Mishra 7 hours later
Hi,
Thanks for the follow up query. After going through the follow up query, I would like to comment the following:

1. The reappearance of the sleep symptoms make a repeat sleep titration study important for the assessment of your cpap pressure requirements. Most probably that would have increased.

2. Irritation in throat is sometimes seen in long term use of cpap therapy. If expectoration production is there then a short course of antibiotics may be taken in guidance with your doctor. Also please do clean the humidifier of your cpap device to prevent such infections.

3. Warm hands, pedal edema and tiredeness may also be contributed to the hypothyroidism.

4. Most important advise at this stage is weight reduction. Please follow lifestyle modification, dietary changes, physiotherapy and if reuired medical interventions for your weight reduction.

5. You may also consult an ENT specialist for any surgical intervention if possible or required to reduce the upper airway crowding (A high mallampati score on clinical evaluation denotes this). Also do get a repeat evaluation from a pulmonologist and endocrinologist at this stage.

6. Regarding hematuria and stricture urethra, I suggest that you consult your urologist regarding the further management of the same. An ultrasound of the abdomen / cystourethrogram may reveal the etiology. Alternatively a radio isotope renal scan can also be done for renal functions. Hematuria needs further evaluatiion.

7. Your HbA1c is slightly on the higher normal side and a better control of diabetes will benefit you.

8. Parotid ultrasound indicates non specific inflammation. Viral infections subside on their own. But it is advisable to get a dental opinion and rule out any infection like mumps if present.

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.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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