The COPD Thread

[Chris S]

Seeing as there's a decent concentration of old fuckers awesome vets on here, many of whom have partaken of dubious lifestyle pursuits in the past, or have been dealt a duff hand from DNAJesus, we really should have a thread where we can compare numbers.

I know there are some really old threads here about COPD, and some related to it but actually about other things - but if I wake up some thread from 2008 that had five replies, I'll be subject to muttering from the permanently annoyed.

So, I had my annual review this morning. I've moved to a working class, ex-mining community and the clinics around here have some VERY well attended (and needed) COPD support; I could tell the nurse knew what she was about.

I blew a 540 average - not too shabby for a 183cm tall, 60 year-old with smoking related emphysema in both lungs, and alpha1-antitrypsin deficiency. The nurse is more used to folks who need help walking from their car 15m away; y'know - the blue-lipped brigade. When she said "Do you manage to get much in the way of exercise?" and I replied "I ride my bike about 200km a week, and usually manage a couple of 10000 step days a week", she gave me the "What are you doing here?" look.

Next appointment - this time next year.

[Wowbagger]

That's good news.

I sort-of get a similar feeling when I go to my rheumatology clinics. I suppose the difference is that when it first started, my rheumatoid arthritis really did reduce my quality of life a lot for a couple of years. Now the drugs regime works and I'm mostly OK.

[mrcharly-YHT]

I was diagnosed with COPD some years back - I definitely had trouble breathing, getting to the corner shop and back destroyed me. Would be gasping, lungs heaving, going faint.

Ventolin made it worse.

Cause was tracked down to chronic gastric reflux; the acids were causing serious inflammation in my pharynx. Drugs and diet change sorted it.

Not being able to breath is terrifying.

[numbnuts]

I was diagnosed  with emphysema in 2000 possible  cause smoking and working  as a blacksmith.
The following  year I had a lung  function  test and the nurse told me it was very  good and couldn't  believe  I had  emphysema, a new x-ray was booked, yes emphysema.
I bought an oximeter to see the results while cycling, on very long hills it dropped  to 83 that was the lowest, but the recovery was less than two minutes and most of the time  only one minute.
Told my doctor he but it down to me being  fit for my age.
In 2010 I had to have another  x-ray for asbestoses,  finding - nothing wrong with you all clear with no signs of emphysema.......... I really  don't know who is telling the truth

[caerau]

My mother got told she must have had tuberculosis once a couple of years back as they found a shadow that must have resembled TB damage.


2 years later.  Nope, nothing there.  Never had tuberculosis. 


Lung X-rays may not be 100% reliable methinks.  Better to be safe than sorry though I suppose and check, but the worry - well I guess she was confused rather than worried.

[DrMekon]

What flavour of A1AT do you have? I've got PISZ, which means I'm pretty immunosuppressed. Shitting it about COVID19.

Blowing 700 on the peak flow. Spirometer is broken, but I was blowing FEV1 of 5.27L FVC of 6.74 and a FEV1/FVC ratio of 0.78 earlier this month.

[Chris S]

What flavour of A1AT do you have? I've got PISZ, which means I'm pretty immunosuppressed. Shitting it about COVID19.

Blowing 700 on the peak flow. Spirometer is broken, but I was blowing FEV1 of 5.27L FVC of 6.74 and a FEV1/FVC ratio of 0.78 earlier this month.

MZ, so not so bad - but 25 years of smoking in the past has probably not helped my cause.

ETA: Why do you think being A1AD is immunosuppressant? Unless you're taking immunosuppressing drugs for it or something else, it shouldn't make much difference. Being A1AD just means your lungs get damaged when there's an immune response. How that relates to Covid-19? Well, nobody knows I guess.

[IJL]

I see and review a fair bit of COPD and a few points i thought might be worth mentioning .

I blew a 540 average - not too shabby for a 183cm tall, 60 year-old with smoking related emphysema in both lungs, and alpha1-antitrypsin deficiency. The nurse is more used to folks who need help walking from their car 15m away; y'know - the blue-lipped brigade. When she said "Do you manage to get much in the way of exercise?" and I replied "I ride my bike about 200km a week, and usually manage a couple of 10000 step days a week", she gave me the "What are you doing here?" look.

The 540 sounds like a number i would expect from a peak flow, its not a very useful test in COPD.  Peak flow is quick and easy whereas spirometry takes longer and many people with significant COPD struggle to get useful results.  An annual FEV1 was part of QOF but was dropped last year.

Diagnosis from x-ray is not very accurate
https://erj.ersjournals.com/content/48/suppl_60/PA3936
An xray suggestive of COPD should be followed up by spirometry.

Spirometry can  vary over time, I have seen people whose COPD was diagnosed after poor spirometry results, when the test was repeated 6 months later the spirometry  results are normal.   The original symptoms likely had another cause that was fixed by a healthy dose of time.

If you wanted to monitor your chest and don't mind spending one of these is good and we have several in the practice

https://www.medisave.co.uk/vitalograph-copd6-copd-screening-device-p-8344.html?gclid=Cj0KCQjwu6fzBRC6ARIsAJUwa2SzmdqKztFlniw-2yGKxrwVosr5lqB73cwDnx3YGUmWukwXwmG_fIIaApfVEALw_wcB

The magic number  is 70

a diagnosis of COPD is sometimes made just on history
but an FEV1 and/or FVC / ratio of the two below 70 % (without significant reversibility with salbutamol) is diagnostic

[DrMekon]

I just got a free NuvoAir Smart (old one died) - they are cool. Before I knew I was getting a freebie, I also bought a comtec SP70B

https://www.ebay.co.uk/itm/SP70B-Handheld-Digital-Spirometer-Bluetooth-Lung-Breathing-Diagnostic-Device-/163905868196

You get FEV1 FVC and the important ratio - and it logs to your phone.

[DrMekon]

What flavour of A1AT do you have? I've got PISZ, which means I'm pretty immunosuppressed. Shitting it about COVID19.

Blowing 700 on the peak flow. Spirometer is broken, but I was blowing FEV1 of 5.27L FVC of 6.74 and a FEV1/FVC ratio of 0.78 earlier this month.

MZ, so not so bad - but 25 years of smoking in the past has probably not helped my cause.

ETA: Why do you think being A1AD is immunosuppressant? Unless you're taking immunosuppressing drugs for it or something else, it shouldn't make much difference. Being A1AD just means your lungs get damaged when there's an immune response. How that relates to Covid-19? Well, nobody knows I guess.

It stops your lung immune system functioning properly. It's only your lungs & liver (maybe kidneys) that get screwed. Not a general immune system problem. That's how it was explained to me. I have tried and failed to understand papers I've seen, but I'll ask next time I see my consultant - who I co-supervise a PhD with, so I get special attention

Stuff that looks like it makes sense to people clevererer than me - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237306/

[sojournermike]

Just been recommended to buy a couple of handheld fans for my daughter (asthma) an dmother in law (COPD and asthma) based on research into fan therapy - https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/fan-therapy-in-copd-patients/

Might be interesting/useful in these times.

Hope all are well.

Mike