Does My Stethoscope Lie?

February 10, 2013 I enjoy teaching.  That is what my web site is all about.  I teach patients and doctors alike.  One of my favorite topics to teach about is asthma.  When I am teaching physicians, I like to start off by asking the question “Does your stethoscope lie?”  The answer is a resounding yes! 

Case in point - Patient “A” is a 32 year old who comes into the office for his annual physical.  Patient “A” states he is doing great, off all his asthma medication and enjoying his life.  I exam patient “A” and listen to his lungs.  His exam is 100% normal.  Because I teach about asthma and am experienced with spirometry (an objective measure of lung function), I order a test.  The spirometry results were remarkably abnormal! Despite my patient’s attestation to being normal and my own physical exam, patient “A” flunked his lung function test in a big way.  Patient “A” is now back on his maintenance medication and doing well.  Patients are often not aware of problems they have.  This is especially true when it comes to asthma and chronic obstructive lung disease (COPD). 

Patients, especially smokers, often lose tiny amounts of lung function over long periods of time.  The cumulative result is that they do less and less and never notice how little they are actually capable of doing.  Often, a smoker denies coughing.  His loving spouse then pokes him in the ribs and proclaims “you cough all the time.”  The smoker’s response is “that’s my normal cough”.  Sometimes abnormalities occur so often that they become normal. 

Adding to the diagnostic dilemma is the fact that my stethoscope may lie.  Breath sounds may appear completely normal in a patient with severe lung disease.  The moral of the story is that spirometry is an essential part of a thorough lung exam.  If you have a diagnosis of asthma or COPD, you should have a spirometric exam at least once a year.  If you ever smoked, you should have a baseline study.  If you have recurrent episodes of bronchitis, you should be tested.  Talk to your doctor about a lung function test.  The life you save may be your own. www.livewellthy.org