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Discussion:
Lung capacity
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Today I saw my "new" pulmonologist. Tried to get the "stats" out of him re: my lung function tests, etc. but the most he would say is my lung function is at 49 percent and he heard some crackles in the lower left lung. My pulse ox was at 92.

He did not say to stay on the co2 24/7. He put me on Spiriva and Advair both. Said the reason I felt better on Flovent was because Spiriva alone was not addressing the asthma component and said the reason I had a bad reaction to Advair when I tried it before was because it was in powder form and as this is an HFA inhaler it should work fine. He also said to stay on the Combivent as a rescue (though I thought when doing Spiriva one did not do Combivent)....oh, it is so confusing! But I will try them again! He did say he wanted to get the sleep apnea addressed immediately.

He is very nice and seems very good...I guess I am just tired of fighting this battle.

Anyway, an inquiring mind would like to know...just how bad is 49 percent, anyway? Obviously it is less than half one's lung capacity, but I don't feel that bad. My heart tests came back normal. Today I mopped the floor and wasn't out of breath once. Usually I wear my oxygen when doing chores but today I forgot and felt fine.

I tried googling for an answer but didn't get anywhere, though I did see an article that said Viagra was promising for some sort of lung disease! LOL.... What a wonderful way to feel better!
Posted on 11/28/07, 12:59 am
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Reply #1 - 11/28/07  10:41am
" Stages of COPD

The basic "standard" for evaluating the severity of COPD has primarily been spirometry, also known as the Pulminary Function Test (PFT).

However, functional dyspnea, body mass index (BMI), and FEV1 from Spirometry, when evaluated collectively, offer better insight into outcomes such as survival. Most times, the spirometry results are the only referenced statistics.

Spirometric Classification
The normal lung function, when measured with Spirometry, diminishes approximately 5% every 10 years after age 35 years old. Therefore, it is rare for a person over 35 to have a 100% In addition, the normal values for the FVC and FEV (2 of the measurements in a pulmonary function test) vary depending on age, height, sex and race. The numbers are higher for:

35 years old vs 65 years old
Taller than shorter builds
Men than women
Caucasian than most other races.

The number used (FEV1) is a percent of the average expected of someone of your height, age, sex and race. It is expressed as a percent of predicted. Any number over 80% is considered normal

STAGE

Symptoms
Pulmonary Function Tests (PFT) with an FEV1 result of:

STAGE I
mild
Often minimal shortness of breath with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal
> 80% of predicted

STAGE II
moderate
Often moderate or severe shortness of breath on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation
50-80% of predicted

STAGE III
severe
more severe shortness of breath, with or without cough, sputum or dyspnea - often with repeated exacerbations which usually impact quality of life, reduced exercise capacity, fatigue
30 50% of predicted

STAGE IV
very severe
appreciably impaired quality of life due to shortness of breath - possible exacerbations which may even be life threatening at times
Less than 30% of predicted --
or less than 50% with chronic
respiratory failure


The above chart is based in part on the Global Initiative for Chronic Obstructive Lung Disease. "
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Reply #2 - 11/28/07  10:45am
" i found this on line about lung function,
Stage 0
Lung function is determined to be within normal levels, however the patient is experiencing symptoms of cough and excessive sputum. Stage 0 is considered to be the "at risk" stage, which may only require elimination of potential risk factors.

Stage 1
When measured with a spirometer, the Forced Expiratory Volume in one second (FEV1) is greater than or equal to 50 percent of typical lung function in a healthy adult. This means the patient can expire at least 50 percent of the air in his or her lungs in one second. During this stage, patients may be experiencing severe breathlessness, however the impact on the person's quality of life is minimal. Stage 1 is considered to be a "mild" stage.
Mild COPD can be treated with short acting inhaled beta-agonists such as albuterol, or a combination inhalant containing anticholinergics and beta-agonists

Stage 2
Lung function, as measured with a spirometer, indicates the FEV1 to be between 35 and 49 percent of normal lung function. During this stage, patients experience a significant impact on his or her quality of life. Stage 2 is considered to be a "moderate" stage.
Moderate COPD can be treated with one or more bronchodilators or inhaled anticholinergics. If the COPD symptoms haven't subsided and pulmonary function tests continue to fluctuate, an inhaled corticosteroid may be prescribed.


Stage 3
FEV1 lung function is less than 35 percent of normal lung function. The patient's quality of life is impacted profoundly, and the disease may be life-threatening. Stage 3 is considered to be a "severe" stage.
Severe COPD can be treated with one or more bronchodilators, inhaled glucocorticosteroids, and inhaled anticholinergics. Although, theophylline may be added to the therapy if beta-agonists and anticholinergics have not suppressed the COPD symptoms. Oxygen and mucus thinners, such as guaifenasic may also be prescribed when COPD is severe. "
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Reply #3 - 11/28/07  12:29pm
" You are doing better than me.
My last test showed an FEV1 at 36%. This is severe to end stage according to my pulmonary doc. Reading the posts here; I guess I am a hair way from life threatening. "
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Reply #4 - 11/28/07  3:08pm
" Zenna, you're posts are so helpful. Thank you for doing the research. I'm at Stage 2, even though my last FEV1 was at 72. I'm sure my pulmonologist is considering other factors, too. When I'm having an exacerbation, I'm supposed to take 1200 mgs of Guaifenisin (Mucinex) twice a day, to help thin the mucus so I can cough it up easier.

Joni, the Flovent is an inhaled corticosteroid, and should lessen the need for fast acting rescue meds. It should also slow down the progression of the disease. I use Pulmicort in my nebulizer, which is a similar med.

I asked my doctor a few weeks ago about applying for disability. He said that here in Wisconsin they wouldn't consider anything above 50% lung capacity, unless there were other factors.

My husband has sleep apnea. He wears a C-PAP to bed every night. (I jokingly tell him I'm sleeping with Darth Vader!) It has helped him tremendously, and I would think that your days would go much better if you're getting enough O2 at night.

Love and hugs, Sue "
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Reply #5 - 11/28/07  5:02pm
" i might add to this post remember we are all different,someone can do very well with 50% lung function whilst others do bad the above i beleave is a rough example.i do no that the more you know about this illness and the more you look after yourself by excersing and no smoking can make life a whole lot better, take youe vit c and zinc . i also found that echinacea id very good and stopping the colds we catch that can be life threatening for us. i also take wheat grass oat grass and barley grass it tastes fowl but it helps me alot. it stops all that coughing up we find ourselfs doing.well for me it helps. "
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Reply #6 - 11/29/07  10:11pm
" what a great post! we need to have copies of the numbers and stages! what ARE the normal ranges for the finger oxygen measurer? you know the thing they put on your finger to measure your oxygen? "
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Reply #7 - 11/30/07  7:54am
" The first thing you need to remember is that the oxygen saturation provided by an oximeter does NOT have the accuracy of an arterial blood gas (ABG, a test done on blood usually taken from an artery in your wrist). However, oximeter readings are a lot less difficult (and less painful!) to obtain, are great for providing trends, and are certainly a lot less expensive.
Several things can affect the accuracy of the reading that you get with a finger oximeter including some nail polishes, (especially blue, green, black or metallic ones), poor circulation, and having had a cigarette in the past few hours. If you smoke, don't waste your time and money buying an oximeter! The oximeter can't tell the difference between the oxygen (O2) in your blood, and the carbon monoxide (CO), thus giving you a falsely high indication of the adequacy of the amount of oxygen circulating in your blood if you have been smoking!
Your oximeter will give you a heart rate as well as an oxygen saturation. Don't get the two confused.
A normal saturation, at sea level, is about 98%. Many patients with COPD will have an oximetry reading in the mid or low 90's, but that is fine. People without pulmonary disease also have low oximeter readings when they go to altitude. In Denver (5,000 ft. altitude) a normal saturation is about 90%.
You should have an oximetry reading above 88% but don't worry if it jumps around and briefly drops below that. It can be due to your activity or circulation, a bent finger or arm, cold hands, or even due to holding your breath rather than exhaling with effort. Consistently having levels drop below 88% is of concern and should be reported to your physician.
Most physicians prefer that you maintain an oximetry reading of at least 90%, keeping it between 90-94%. The preferred level depends on your individual condition and the type of pulmonary problem that you have. This is where you turn to your pulmonary physician for advice specific to you. Remember, each of you is an individual with different needs.
If you are observant, you will find that pacing yourself helps keep your oxygen level up.
You'll probably find that your oximetry readings will be high, even "normal", when you are sitting, and that they will drop with activity. If you are really smart, you will find that your breathing pattern can make a significant difference in your oximetry levels.
Those of you with restrictive disease will find that your oxygen saturations may plummet with activity if you don't carefully pace yourself and practice good breathing techniques.
If you have COPD, when you breathe slowly, breathe out longer than you breathe in, and use pursed lip breathing (PLB) it can sometimes make the difference between a normal and an abnormal oximetry reading. If you have a form of restrictive disease, you may need to try different breathing techniques to see what works best for you. Slowing your breathing helps, and using PLB usually helps.
If you are doing good pursed lip breathing you should be able to increase your oxygen saturation numbers while you are doing the PLB. The lower your saturation, the easier it is to "blow those numbers up". The closer your saturation is to normal, the better your technique needs to be in order to increase your saturation numbers. There are lots of patients with low oxygen saturations who are able to increase their saturations all the way up to 93% with good PLB technique. We've seen some super stars get all the way up to 98%, much higher than the saturations they have on 2 lpm of oxygen!
WARNING! If you work too hard at your breathing techniques, you will see that you actually lower your saturations! So, relax and don't be an over achiever! "
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Reply #8 - 11/30/07  9:44pm
" I take Atrovent instead of Spiriva, because Sririva caused pain in my eyes , and the two can not be taken together. I also take
advair, and Xopenex as a recue inhaler. I am on a B-pap machine, it has made a big difference. "

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