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Sarcoidosis

Sarcoidosis - Pulmonary Function Test

09/27/2011

Question:

I have had Stage IV Sarcoidosis since 1994. But all my Pulmonary Function Tests are within normal range. The report reads "Normal spirometry, a decrease in residual volume." In 1994 it was determined I had Sarcoidosis by biospy, ACE Levels, etc. I have per CT Thorax W/O Contrast "Extensive fibrotic scarring with traction brochiectasis in the right upper lobe with associated volume loss. Findings are felt to represent sequelae of sarcoidosis. Scattered reticular-nodular interstitial densities in both lungs likely representing sequelae of sarcoidosis." Also XR Chest 2 Views PA + Lateral - "Asymmetric upper lobe predominant brochiolar wall thickening and cylindrical bronchiectasis, right greater than left, with posterior conglomerae masses on lateral radiograph. Tenting of the left diaphragm-volume loss. Rightward deviation of trachea due to RUL firbrosis."

Also, my heart has moved toward the center of my chest because of my lungs. I have 3 tiny leaky heart valves (I don`t know if this means anything). And of have acid refux

I quite my job in 2009 because of chest pains, I stay very tired, short of breath, and my ankles hurt. I have dyspnea on exertion.

I have taken a Six-Minute Walk Test and my oxygen dropped to 80. I may have to go on an oxygen tank.

If my CT Thorax, and Chest XR looks so bad why do I have normal breathing test?

My pulmonary doctor retired and my new pulmonary doctor does not really answer my questions. I`m a 56 years old female. This year I have applied for disability but I`m wondering am I really disabled. I`m not on any steriods.

Thanks in advance for answering my questions.

Answer:

Dear Madam- Keep in mind that the range of "normal" for pulmonary function tests is based upon rather large population studies. If you happened to have larger than average lung capacity prior to the onset of your lung disease, say 120% of predicted "normal" values, and now have 80% of predicted "normal" values, you still fall in the "normal range" despite a very large drop in absolute lung capacity.

Clearly, you have lost some lung capacity based upon the radiographic (chest x-ray and CT scan) results. The drop in oxygen levels during exertion indicates that you have limited pulmonary reserve. That is, when your body's oxygen demands increase (during exercise) the lungs are unable to exchange oxygen quickly enough to keep up.

Thus, you do have significant loss of lung function in terms of the lungs' ability to exchange gases, such as oxygen. The criteria for establishing "disability" due to lung disease are more complicated than can be summarized here. You would have to discuss this evaluation with your new lung doctor.

For more information:

Go to the Sarcoidosis health topic, where you can:

Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University