Pulmonary TB or COPD?

Question

Hello Doctor. It's been a while since I've been here, but you all answer some very serious questions that some of our doctors refuse to, or just don't take the time to. Thanks to all of you for (sometimes) lessening our anxieties. Here's my question to you...

I've be told that I have COPD, but I was previously diagnosed with the exposure to TB. I was on the INH and a supplement (it escapes my mind right now). I took these on two separate occasions, because at the beginning I wasn't fully aware of the ramifications of not finishing the entire theray.

It's been sooo long since I've had an x-ray (my doc says that I don't need one). Meanwhile my breathing is getting worst. It's a sheer nightmare for me. I feel that I may be nearing my death.

Could my so-called COPD really be Pulmonary TB, and exactly what is Pulm. TB anyway. I couldn't find a concrete definition of it on this site.

Also, when I was first diagnosed with TB, the doctor that I had then, was kind enough to show me my x-ray and point out a spot that was on my lung.

I'm HIV+, since 1993. Never been put on meds (just for 5 days though). That'a a different story. Last cd4 563. vl 18,ooo.

Please tell me whats the difference between COPD and Pul. TB. And is not taking meds (doctor's choice) enabling me to suffer more from my respiratory ailment. I know all that talk about the numbers being okay and waiting, but can't one wait too long.

Sorry my question/s is a bit long, but I stay depressed often times, and suspicious of what's going on with my health care.

Thank you for your good work.

Answer

It sounds like you were diagnosed as having been exposed to (infected with) TB, but not of having active tuberculous disease of the lung. The difference between the infected and diseased states is kind of like the difference between having HIV infection and AIDS: HIV is the infected state, and AIDS is the disease state where the HIV infection has done serious damage to your immune system. The infected-but-not-yet-diseased-state is called being "PPD+"; PPD is the name of the skin test that is used to diagnose TB infection. If you had had active pulmonary TB in the past, you would have received several drugs at once, just like we use combination therapy for HIV. Instead, what you got (INH plus vitamin B6) was preventive therapy to control the amount of TB germs in your lungs so that you would not get TB in the future.

If you are having breathing difficulties now, it may well be the COPD. In addition to a chest X-ray to make sure that there is no active infection in your lungs, you may need "pulmonary function tests" to define the extent of your COPD and what medicines might work best for improving your breathing. Good luck!