Patient picky about follow-up testing

Dear Dr. Roach: I am a 63-year-old female in very good health. Admittedly, I smoked for 22 pack-years, but that is pretty far in the past. I have had two CT lung scans as a result of a pneumonia diagnosis last fall. The second, a follow-up six months after the first one last December, found a ground-glass attenuation nodule about 1 cm diameter in my upper right lung.

I have also been found to have emphysema and/or COPD, although I suffer no discomfort or symptoms from those.

The pulmonology office requires that I have spirometry testing before I see the specialist, but doesn't this only address the COPD and emphysema issues? I live a very active and athletic life. How would you approach this issue if you were my general care physician? — R.C.

A ground-glass opacity nodule is called that because of its appearance on X-ray or CT scan. They are a specific area of abnormality in the lung, and may represent an area of inflammation, but also may represent early stages in the progression to lung cancer. Because of this, these findings are followed by yearly CT scanning for at least three years. I feel the small risk of radiation is greatly outweighed by the ability to identify a potential lung cancer before it has a chance to spread.

As far as getting spirometry goes, that is indeed to evaluate the emphysema (emphysema is one of the major types of chronic obstructive pulmonary disease). Knowing how severe the disease is has value; however, the fact that you have no symptoms suggests mild disease. I understand you are annoyed that the specialist demands a test that is not relevant to the reason you are referred: If I were your primary care doctor, I'd have a chat with the specialist to see if it were truly necessary.