Can CPAP cause COPD?

[Catnapper]

I recently had a chest x-ray as prep for surgery. I received the copy yesterday and here is a quote:
The lungs are hyperexpanded and the diaphragm is flattened. Increased AP diameter of the chest and attenuation of the peripheral vasculature are also seen, findings consistent with moderately severe COPD.

I had a chest x-ray 2 and a half years ago, and a CT scan 1 and a half year ago, and both were "unremarkable". About a month after the CT scan I started CPAP. I have never been a smoker, and I don't live with a smoker. I was asthmatic until I was 9 years old and it disappeared. I have never been injured or in a situation that would risk damage to my lungs such as a fire or in a lab accident. I don't have chronic bronchitis, and have only had one cold or virus since being on CPAP and that was last January.

What could have happened to make this change? I don't know much about COPD, but I guess I better start checking. I feel fine. Would I have symptoms with moderately severe COPD?

My sleep doctor is a pulmo, and he has never indicated any worry. My last sleep test was the end of September. Would the sleep test have shown indications of COPD as well as the sleep apnea?

[DreamDiver]

This article would suggest that CPAP is actually beneficial to those with COPD.
http://www.aafp.org/afp/20010815/603.html

This abstract about a study where CPAP was compared to Negative Air Pressure machines (the invasive kind that go down your throat) in patients with COPD. It was found that the non-invasive positive pressure ventilation (xPAP) was easier on recuperation than negative pressure ventilation. Hospitals in general are using less negative pressure and more positive pressure.
http://www.emedicine.com/med/topic3371.htm

To me, these links suggest that it depends on what will work best in any particular situation, but that xPAP therapy should actually augment rather than hinder concurrent COPD therapy.

[deerslayer]

thankyou diver for posting the link for the family physician,really enjoyed it!seeing your avatar gives me the urge to dive again. have been on 2 peter hughes trips,etc.but have not dove in 7 years. am considering a shallow reef dive in feb. when in ixtapa. can't just sit back & wither away

[Snoredog]

go by where you had the x-ray taken, tell them you need to borrow it, ask that the "findings" report from the Radiologist be included in the folder with the X-ray.

Then ask your pulmo about it, they DO make mistakes reading X-rays, MRI's and CT scans, your Pulmo should be able to tell you if you have COPD. They could have also gotten your film mixed up with someone else, if you don't have COPD, just think about the patient that does and just got a all clear from your x-ray.

You can also take it to another doctor for a 2nd opinion, just keep the X-ray and findings, if you have another x-ray later you can compare it to the first.

[DME Daddy]

I know cpap patients that have been on high pressures for twenty years and are going strong. I have never seen any scientific evidence that positive airway pressure causes COPD. We do use cpap to help COPD patients on occasions, usually with favorable results.

[DreamDiver]

Catnapper,

In some instances, COPD could be viewed as the doctorese-politically-correct way to suggest 'heavy/chronic smoker' without actually saying it. Are you 'fresh-air challenged?' Further, even if you don't smoke, you won't be able to pin COPD on CPAP, nor lay suit for iatrogenically-induced COPD due to CPAP. Unless your doctor told you to work in a cigar bar for your health, it just isn't going to happen.

If you're a smoker (or have been a chronic smoker), it's more likely that smoking is the main cause of your COPD. If anything, according to that article above, CPAP is more likely to have staved off some of the symptoms of COPD. First, CPAP machines generally use an air filter, screening out air pollutants, and second they saturate your blood 02 to healthier levels - even people with COPD.

If you were thinking that maybe high pressure was blowing your lungs out of proportion like a balloon losing it's elasticity, this is also unlikely. At a pressure high enough to do that, your mask would be hovering around on your face like an air-hockey puck, leaking all over the place. It would be too uncomfortable for you to even wear it. Aerophagia would probably occur first. Your ear-drums would be more likely to go second - and I'm not sure a sleep doctor would prescribe for you a pressure high enough to even do that.

It makes me curious though: has anyone here who hasn't had chronic ear problems before CPAP had an ear drum blow-out by CPAP?

[jsmythe]

Catnapper, you said you had an x-ray done, did they also do a Spirometry test or a lung function test?

I really don't see how they can tell you this without doing other tests on you and only looking at the x-ray if you have never had bronchitis or pneumonia. Your asthma may have done a little damage, I don't know that much about asthma. I agree with the others, get a second opinion.

About 7 years ago I was diagnosed with COPD. Was not a pleasant experience to be told this. I have worked in a hair salon for 28 years breathing chemical fumes of all sorts, worked in a furniture factory breathing wood dust ( I was a hand-sander and paint sprayer-no masks to wear). Yes, I am a smoker, but all the doctors told me that all the years that I had bouts with severe bronchitis and pneumonia and my jobs that I had contributed to the COPD. The bronchitis and pneumonia left scar tissue in my lungs. Smoking just made it worse, not cause it. But the bright side is, CPAP has helped me a great deal. I can breathe so freely at night with it, whereas in the daytime, it is very difficult sometimes. I was on oxygen for several years and when I was put on CPAP, the doctor said he did not think that I needed the oxygen with the cpap machine. So, IMHO, no I will never believe that CPAP causes COPD, it helps us that have it breathe a lot easier.

[Catnapper]

Thanks for the responses.

I repeat that I am not and have never been a smoker. I don't cough except when I have a cold, and haven't had but that one cold since using cpap.

I don't know how I could go from "unremarkable" chest x-rays and CT scans to moderately severe COPD in such a short time without any other trauma to my lungs. Wouldn't I have symptoms? I do get short of breath if I exercise too hard or something like that because I am overweight and out of shape, but I can ride my exercise bike for 20 minutes or so without difficulty several times a week. My biggest problem with exercise is that I have tendonitis around my kneecaps, probably an after effect of bilateral total knee replacement. That hurts.

I will definitely go see the pulmo about this. The report does say "consistent with COPD". Is that a diagnosis? I had no other lung tests, as this was just to prep for surgery, not for a lung problem.

Would cpap use hyperexpand the lungs and flatten the diaphragm? I know the tech told me to take a deep breath and hold it. Maybe my lungs have gotten expanded by pushing against cpap while exhaling.

[Julie]

Get a second opinion!

[bman]

I have seen this once before and it is not that common. I suspect it may be reversible. This happened in a person with no smoking history or any other causes that may cause the coad appearance in the X-rays ie same as your case and in the onset of a short period of time like after using cpap. Spirometry was not used to see whetther the breathing pattern is consistent with COAD.

I wondered in your case whether a cpap with exhalation relief like bipap etc would make your breathing easier. You can always do a follow up CXR and I think it will probably be back to normal in the future. I am not aware of a prospective double blinded studies on the effects of cpap causing CXR changes. Well, it is probably not immportant. I would prefer to breath well than to worry about a hyperexpanded lung.

[wabmorgan]

I don't see how CPAP use could cause COPD. However, although smoking is the number 1 cause, there are other causes as well.

[Slinky]

You might also ask your anesthesiologist about this when you see him pre-op.

And to easy your mind, do as you mentioned and see a pulmonologist. Whilst you are waiting for that pulmo appointment your family doctor can schedule a Pulmonary Function test. If your sleep doctor was a pulmonlogist you could also try questioning him.

Frankly, the only effect I'm aware of of CPAP on COPD is that it can help COPDers breathe and sleep much better!

[Catnapper]

I went to see the sleep/pulmo doctor today. He told me that the only way to diagnose COPD is with the Pulmonary Function Test. He said there is no correlation between the results of a chest x-ray and COPD.

So he wrote a prescription for me to have the test at my convenience. He apparently did not think there was any urgency.

After I have the test, I will know.

[ozij]

That's good, Joannie. Keep us posted.

O.

[yamdigger]

The respitory technician at the vendor where I bought my cpap says that setting the cpap pressure too high can cause central apnea. This is probably why sleep docs don't like patients setting the pressure on their own machines.