Feeling Short Of Breath With Exertion. CT Scan Showed Mild Focal Scarring Lobe. Suggest?

Posted on Mon, 12 Aug 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 12 Aug 2013 Answered on

Wed, 4 Sep 2013 Last reviewed on

Question : i have been feeling short of breath with exertion. i had a ct 2 years ago which showed mild focal scarring upper right lobe. i wore an oximeter on my finger to monitor my oxgen level while sweeping the large back patio. i swept for about 15 minutes. my oxy level started at 98 and went down to 95 . is this normal? my boyfriend who is 53 and smokes did the same. started at 97 and went UP to 99 while sweeping. should the oxy go up or down during exertion? thank you

Answered by Dr. Vivek Chail (5 days later)

Brief Answer:
Oxygen saturation decreases with exercise

Detailed Answer:
Hi XXXXX
Thanks for writing in to us.

Mild focal scarring on CT scan seen in the right upper lobe will not affect your oxygen saturation pressure significantly.

The oximeter reads the oxygen saturation of arterial blood in your finger tips. It depends on the modality of exercise and effort used. Often abbreviated SpO2, oxygen saturation can be measured using pulse oximetry. An accurate measurement depends on several factors, including your body temperature and the amount of light the sensor picks up. With exercise, the oxygen saturation should decrease slightly.

Most healthy people have an average resting oxygen saturation of 95 to 98 percent. A decrease from 99 to 95 is acceptable following exercise. Usually when SpO2 falls to 85, the individual experiences short of breath.

In your partner, the level going up from 97 to 99 is not significant as there could be errors in recording.

Hope your query is answered.
Should there be any further query, please feel free to ask.

Regards
Dr. Vivek

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vivek Chail (34 minutes later)

i thought maybe the mild focal scarring was idiopathic pulmonary fibrosis and therefore that was why my oxygen level dropped when doing things like exercise. i heard scarring of the lung makes you short of breath and kills you. so then more than likely the shortness of breath is my weight and not some deadly disease??

Answered by Dr. Vivek Chail (3 hours later)

Brief Answer:
Clinical evaluation recommended

Detailed Answer:
Hi XXXXX
Thanks for writing in to us with an update.

As you have hypertension and also are in the morbid obesity group, the shortness of breath could stem from cardiac as well. Isolated focal lung scarring may need to be re evaluated by repeating Chest X XXXXXXX and if any suspicious finding is present, a high resolution CT scan of lungs might be necessary.

Idiopathic pulmonary fibrosis is an extreme disease of the lungs and includes the progressive onset of following symptoms:
Dry cough
Shortness of breath, especially during or after physical activity
Lasting tiredness
Weight loss
Enlargement and bulb-like development of the fingertips and nails (a condition called clubbing)
Certain lung functions tests also need to be done before coming to a clinical diagnosis. On imaging there is large scale destruction of lungs in idiopathic pulmonary fibrosis.

In your situation, I would like to examine both, your heart and lungs before arriving at a specific clinical diagnosis.

I re confirm that your weight is more likely to cause shortness of breath than any deadly disease like idiopathic pulmonary fibrosis. Nevertheless, you must get evaluated completely for peace of mind.

Hope your query is answered.
I would be glad to answer any more doubts that you may have.

Wishing you good health
Dr Vivek

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vivek Chail (7 hours later)

my pulmonologist will not give me a ct scan. he says i worry too much. i had a pft already and it showed mild restriction. he said it is because i am over weight. my dad died from pulmonary fibrosis. this is why i use an oxymeter to see how i do when i exercise. i can barely exercise. the atenolol is for tachycardia . i do not have high blood pressure. should i switch pulmonologists? he says the mild focal upper lobe scarring is nothing.

Answered by Dr. Vivek Chail (14 hours later)

Brief Answer:
A repeat chest X XXXXXXX may help

Detailed Answer:
Hi XXXXX
Thanks for writing in with an update.

I am sorry to learn that your father had (?Idiopathic) Pulmonary Fibrosis and hence you have so many questions about the deadly disease. Mild focal upper lobe scarring which is stable for a long time might rule out the possibility of idiopathic pulmonary fibrosis. The other concern is that your weight might also cause the mild restriction in pulmonary function test and also affect blood oxygen saturation levels.

It would be important to know that a new study looking at the genomes of more than 1,500 patients with idiopathic pulmonary fibrosis (IPF) found multiple genetic associations with the disease. The research is still in progress and under clinical evaluation.

As IPF is a disease with no proven straightforward treatment, it becomes all the more difficult to treat. The best management in IPF patients is early detection of the condition and its control by medications with regular follow ups. As you might already be aware, you might also need regular evaluation of your heart as well because of your morbid obesity.

I would suggest that at least an X XXXXXXX of your chest be taken and interpreted for any increase in the mild upper lobe focal scarring during the last two years. If your current pulmonologist is unable to help you out with that, you may approach another doctor.

Hope your query is answered.
Should you have any further query, please feel free to ask.

Wishing you good health.
Dr Vivek

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Shanthi.E