Emphysema of Lungs

Dear Ask The Doctor:  I
 
Hi. I'm a 59 year old male. Eleven years ago, I had a left lung upper lobectomy for lung cancer - adenocarcinoma. Nil chemotherapy, nil radiotherapy. Lucky lad that I am, I have had good health since. (I'm well enough to work in a manula labour job cleaning swimming pools).Other features of the situation were that I have had bullous cysts in both lungs, probably all of my life. In the post-op pathology childhood tubercular scarring was found, so I suppose I'm lucky in a multiple sense. As a result of a recent chest infection, I have had an x-ray revealing "non specific pleural parenchymal opacifications in the left and lower zones. Most of these changes do look to be longstanding and of chronic nature" ..."the emphysematous bullae in the left lower zone was present previously, but the cystic change in the left mid-zone has evolved since the previous chest x-ray". (two years ago) My other lung remains clear. My heart is apparently fine, and my blood pressure always comes in at 120 over 80. As a result I'll be having a CT scan in a couple of days. The reason I am asking this question is that it is possible that I may be confronted with medical decisions in the near future, and I'd prefer to be armed with some knowledge prior to the scary place where bad news may be confirmed and I have to make decisions... My question is this - since I am prejudiced against the notion of chemotherapy, if there is a new tumour shown by the CT scan, is left pneumonectomy an option, and would this present any reasonable prospect of mid term survival? I should add that since the infection, a combination of ibuprofen, erythromycin and bromhexine hydochloride has enabled me to clear some of the mucus that was previously not shifting, and as a result I'm pretty well off pain killers again as the pain and breathing difficulty has subsided by about 50%. (I'm thinking that the non-clearance of all that nasty stuff wasn't helping.) Thanks in advance for your opinion. Rob Brittan Sydney Australia
 

Dear Patient:  I understand your concern about your lung condition. Certainly your lung seems to be compromised according to your recent X ray, especially when changes are noticed compared to a previous X ray.
As you may already know, emphysema causes inflammation within the fragile walls of the alveoli. This can destroy some of the walls and elastic fibers, which allows small airways to collapse when you exhale, impairing airflow out of your lungs. This condition predisposes to infections that might destroy the inner walls of your lung. I cannot tell you if there is a new tumor or not, this can only be suspected after your CT scan is done and then confirmed with a biopsy. I am sure that your doctor will need to evaluate your lung function and according to that would suggest you the best choice for the treatment.
The treatment can vary depending once again in your lung function and compromise. Medications to help you breathe better and antibiotics to combat any source of infection might be used up to lung reduction surgery in which compromised part of your lungs might be removed. I wish you the best.
 

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