Mild Gas Exchange Dysfunction: Symptoms, Tests, and Next Steps

Q: Mild Gas Exchange Dysfunction: Symptoms, Tests, and Next Steps

Hello： 1. <br>The X-ray did not indicate fibrosis, and with normal Total Lung Capacity (TLC), there should be no ventilation issues caused by fibrosis. <br>The echocardiogram showed no signs of pulmonary hypertension, so there are currently no concerns regarding the aforementione

Mild gas exchange dysfunction?

Hello, Doctor.
I have been experiencing severe dry cough since around 2008, with each episode lasting 1-2 months.
I visited an ENT specialist and took medication, but it was ineffective.
Since the symptoms would resolve on their own, I did not seek medical attention during subsequent episodes.
Around 2014, I began to cough up clear phlegm.
After undergoing pulmonary function tests at a chest medicine department, I was diagnosed with asthma.
I also had blood tests at the rheumatology and immunology department, which showed an IgE level of 1000.
I then started intermittently using inhaled corticosteroids, immunosuppressants, and Montelukast.

In early 2018, after jogging and showering, I suddenly experienced shortness of breath.
Since then, I have found it easier to become breathless during exercise.
An echocardiogram at the same hospital indicated enlargement of the left atrium and right ventricle, with mild regurgitation of the mitral, tricuspid, and pulmonary valves.
I subsequently started taking antihypertensive medication; my usual blood pressure was around 160/100, which decreased to about 130-140/80 after starting medication, occasionally dropping to 120/80, but changing medications did not alter this pattern.

At the end of 2019, I began to have persistent phlegm production (mostly clear, but with visible white strands).
In April 2020, I had another echocardiogram, which indicated normal heart size.
In November, after taking a long shower, I felt short of breath, and for the next few days, I experienced occasional pain in the left chest area and found it easier to become breathless while walking.
After resting for a few days, the symptoms improved, but I noticed I was more easily breathless during brisk walking.
Below are the pulmonary function and echocardiogram reports from the past few years:
2018 (Hospital): LV-D: 55, LV-S: 36, LVS: 12, LVPW: 10, LA: 42, AO: 29, RV: 30, PAP: 25, LVEF: 63%
2020 (Hospital): LV-D: 56, LV-S: 33, LVS: 11, LVPW: 9, LA: 38, AO: 33, RV: 23, PAP: 28, LVEF: 72%
2016 (Hospital): FEV1/FVC: 76%, FEV1: 92%, TLC: 133%
2018 (Hospital): FEV1/FVC: 80%, FEV1: 108.3%, TLC: 126.5%, X-ray: Mild thickening of the tracheal wall
2019 (Hospital): FEV1/FVC: 81.2%, FEV1: 109.2%, TLC: 124.9%
2020/12 (Hospital): FEV1/FVC: 77%, FEV1: 106%, PEF: 104%, TLC: 105%, RV: 17%, VC: 116%, DLCO: (30.2) 84%, DLCO/VA: (4.33) 78%, VA: (6.98) 104%.
The report states: normal ventilation function, negative bronchodilator response, mild gas exchange dysfunction.
I would like to ask:
1.
Although the "TLC" in the pulmonary function report is within the normal range, it seems to have decreased significantly compared to previous tests.
Does this have any special significance?
2.
Does a "negative bronchodilator response" indicate that I do not have asthma?
3.
When I followed up at the chest medicine department, the doctor only mentioned that my lung function was normal and advised me to continue using inhaled corticosteroids and Montelukast, and prescribed expectorants and cough medicine, without mentioning the "mild gas exchange dysfunction." I found online that this could indicate serious diseases, and I am worried about conditions like pulmonary fibrosis or pulmonary hypertension.
Is it possible for this to return to normal? What should I do now?
4.
I have heard that cardiac and pulmonary functions can affect each other, but it seems that the doctors I visited did not inquire about my conditions in other specialties, which concerns me.
I currently have regular follow-ups with chest medicine, cardiology, and rheumatology.
What information should I provide to the different specialists?
I am a 34-year-old male, 184 cm tall, weighing 114 kg, and I work as a legal officer.
I resigned last year due to work stress and health issues, and I often sit for long periods with little exercise.
I have been checked by a metabolic specialist who indicated that I have excessive secretion of stress hormones.
Additionally, I have issues with gastroesophageal reflux, hypertensive heart disease, hyperlipidemia, and high triglycerides.
What should I do now? Thank you for your guidance!

Eric, 30~39 year old female. Ask Date: 2021/01/23

Dr. Yang Wenda reply Pulmonology

Hello: 1.
The X-ray did not indicate fibrosis, and with normal Total Lung Capacity (TLC), there should be no ventilation issues caused by fibrosis.
The echocardiogram showed no signs of pulmonary hypertension, so there are currently no concerns regarding the aforementioned issues; please do not worry.
2.
Your symptoms are more indicative of an allergic constitution, where exposure to cold air or allergens may trigger intermittent asthma attacks.
By the time you undergo pulmonary function tests at the hospital, your condition may have returned to normal.
It is recommended to have a follow-up with a pulmonologist and consider the use of inhaled corticosteroids (or possibly adding a long-acting bronchodilator).

Reply Date: 2021/01/23

More Info

Understanding mild gas exchange dysfunction can be quite complex, especially given your medical history and the various symptoms you've experienced over the years. Let's break down your concerns and questions systematically.

1. TLC (Total Lung Capacity) and Its Implications: You mentioned that your TLC values have shown a significant decrease compared to previous tests, even though they remain within the normal range. A decline in TLC can indicate a restrictive lung disease, where the lungs cannot fully expand. This could be due to various factors, including obesity, which you mentioned is a concern for you. Excess weight can restrict lung expansion and lead to decreased lung volumes. It’s essential to discuss this trend with your pulmonologist, as they may want to investigate further to rule out any underlying conditions.

2. Bronchodilator Response: The negative response to the bronchodilator test suggests that your airways do not significantly react to bronchodilators, which is often a characteristic of asthma. However, it does not entirely rule out asthma, as some patients may still have asthma-like symptoms without a significant bronchodilator response. It’s crucial to consider your symptoms in conjunction with the test results. If you experience wheezing, shortness of breath, or chest tightness, it may still be worth discussing asthma management strategies with your healthcare provider.

3. Mild Gas Exchange Dysfunction: The report indicating mild gas exchange dysfunction can indeed be concerning, as it may suggest issues such as pulmonary fibrosis or pulmonary hypertension. However, it’s important to note that mild dysfunction does not necessarily indicate a severe disease. Factors like obesity, sedentary lifestyle, and even anxiety can contribute to respiratory symptoms and gas exchange abnormalities. To address your concerns, it would be wise to follow up with your pulmonologist for further evaluation, which may include imaging studies or additional pulmonary function tests to assess the extent of any dysfunction and to rule out serious conditions.

4. Interconnectedness of Cardiac and Pulmonary Health: You are correct in noting that cardiac and pulmonary functions are closely linked. Conditions affecting one can impact the other. Given your history of heart issues, including left atrial and right ventricular enlargement, it’s vital to ensure that both your heart and lungs are being monitored. When visiting different specialists, it’s beneficial to provide them with a comprehensive overview of your medical history, including any medications you are taking, recent test results, and symptoms you are experiencing. This will help them understand your overall health better and make informed decisions regarding your care.

5. Lifestyle Modifications: Considering your weight and sedentary lifestyle, incorporating regular physical activity can significantly improve both your lung and heart health. Even moderate exercise, such as walking, can enhance your cardiovascular fitness and help with weight management. Additionally, addressing your stress levels through relaxation techniques or counseling may also benefit your overall health.

6. Regular Follow-ups: Since you are already seeing specialists in pulmonology, cardiology, and rheumatology, maintaining regular follow-ups is crucial. Ensure that all your doctors are aware of your complete medical history and any changes in your symptoms. This collaborative approach can help in managing your conditions more effectively.

In summary, while your symptoms and test results may seem alarming, many factors can contribute to mild gas exchange dysfunction. Regular monitoring, lifestyle changes, and open communication with your healthcare providers will be key in managing your health moving forward. If you have any further questions or concerns, don’t hesitate to reach out to your healthcare team for clarification and support.

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