Could I have COPD?

Hello Dr. Mahler – Could I have COPD?

I have been thinking about COPD, but not sure all of the symptoms. I am a 41 year old woman and I suffered a PE in September of this year. There were four blood clots present in my lungs. The doctors wanted to go in and perform the clot busting surgery but decided against it. Since then I have had to be on a constant flow of oxygen. I cannot do more than 3 minutes of exercise. I sleep a lot and I am tired all the time. The doctors are perplexed and are trying to regroup until February 2016 and then bring me back in. I have never been a smoker but was born with underdeveloped lungs. I am overweight and there is a history of Pulmonary Embolisms in my family. With the oxygen my O2 is at 96 and without the oxygen it is at 73%.

Thank you for any information that you can provide me.

Chakula in Charlotte, NC

Dear Chakula:

Sorry to hear of your ongoing problems.

The two main symptoms of COPD are shortness of breath and cough. At your age of 41 years, it is unusual for you to have COPD, especially since you have not smoked. Do you have any history of inhaling irritants (like dust, fumes, smoke, & fibers) in the air at work or at home? COPD is diagnosed by a simple breathing test called spirometry (see figure below).

Diagram of spirometry to diagnose COPD.

Diagram of person breathing out hard and fast into a machine. This test is used to diagnose COPD.

If you doctors have not ordered this breathing test, I suggest that you ask about such testing.

As you probably know, pulmonary embolism develops from “blood clots” in the legs, mainly in the thighs (see figure below). The blood clot breaks away from the vein and travels to the blood vessels of the lungs (called pulmonary arteries). This can cause shortness of breath, chest pain, and possibly coughing up blood.

Blood clot in leg can break off and travel to the blood vessels in the lungs

Blood clot in leg can break off and travel to the blood vessels in the lungs

Are you taking anticoagulant medication to prevent more “clots” from forming? With your family history of pulmonary embolism, and as you had a a blood clot at an early age, it is likely that you have a genetic factor contributing to blood clots forming. I suggest that you ask your doctors about being tested for various genetic causes for “blood clots,” including Factor V Leiden, a genetic disorder.

In some individuals who have pulmonary embolism, the inner lining of the blood vessels of the lungs can develop thickening and “webs” that reduce or block blood flow. If severe enough, this may also cause an increase in the pressure in the blood vessels of the lungs (called pulmonary hypertension). Both changes in the inner lining of the blood vessels and pulmonary hypertension can lead to a low oxygen level as you are experiencing.

If I saw you in my practice , I would order breathing tests including diffusing capacity to help explain the low oxygen saturation with walking and an echocardiogram (ultrasound of the heart) to test for pulmonary hypertension. Also, I would order blood tests or refer you to a hematologist (a specialist in blood clotting) to evaluate for a possible genetic problem in blood clotting.

I hope that this information is helpful. Try to stay as active as possible. Walk, then stop to catch your breath, and then resume walking again. I realize that this may be hard for you, but it is important for your overall health. Keep this up with a goal of 15 – 20 minutes of actual walking.

Best wishes,

Donald A. Mahler, M.D.