LOCATION: Outpatient, Hospital PATIENT: Nancy Plume SURGEON: Gregory Dawson, M

LOCATION: Outpatient, Hospital PATIENT: Nancy Plume SURGEON: Gregory Dawson, M.D. PREOPERATIVE.DIAGNOSES: Dyspnea and has productive cough. POSTOPERATIVE DIAGNOSIS: Same. INDICATIONS: Dyspnea and productive cough PROCEDURE PERFORMED: Pulmonary function study INTERPRETATION: 1. The flow volume loop basically has normal configuration with inspiratory limb and minimally reduced flow rates but they are probably still within normal range. 2. No significant change after bronchodilator. 3. Plethysmographic lung volumes are normal without evidence of hyperinflation. 4. Single breath lung volumes are also normal without evidence of hyperinflation. 5. No significant dynamic airway collapse (air trapping). 6. Transfer factor is actually super-normal at 121% of predicted which can be seen with pulmonary hemorrhage, polycythemia, mild asthma or mild congestive heart failure. 7. Pre-bronchodilator flow rates have a pattern consistent with minimal chronic obstructive pulmonary disease/emphysema, mostly “peripheral airway dysfunction”. 8. Post-bronchodilator values show no significant change and the same conclusion can be reached. 9. The MVV is normal, both pre and post bronchodilator. Between that and the abnormal FEV-1 I expect normal exercise tolerance. 10. Airway resistance is normal. OVERALL IMPRESSION: The patient has probably mild chronic obstructive pulmonary disease/emphysema with peripheral airway changes that could be consistent with the patient’s body habitus as she is 5’6″ and 325 lbs. The super-normal DLCO, however, suggests an underlying problem. Please see above. Clinical correlation would definitely be necessary.