Dr. Harsha D. S
Pulmonology (Asthma Doctors)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Do my spirometry results tell you anything? Are they below normal? I am a male 5.74 ft, 182.98 lb, 39 years old. I sometimes have shortness of breath.
Hello,
Welcome to icliniq.com. Post-bronchodilator forced expiratory volume (FEV)1/FVC (forced vital capacity) is less than 70. FEV 1 is more than 80 (attachment removed to protect patient identity). No reversibility indicative of asthma in the post-study. It seems to suggest mild COPD (chronic obstructive pulmonary disease). It also correlates with your symptoms. Were you or are you a smoker? It would be better if I could have the image of the actual spirometry report.
Patient's Query
Thank you doctor,
I have attached the image. Unfortunately, I smoked about a pack a day from the age of 16 to 23. Now I am 39.
Hello,
Welcome back to icliniq.com. I have gone through the report. It is suggestive of mild chronic obstructive pulmonary disease (COPD) as I explained in my previous answer. That is presuming the test has been done appropriately as per standard protocol. However, 39 years is very young to have COPD. I would suggest you get evaluated by a pulmonologist there since I do not have the luxury of examining you in person. I would also suggest further evaluation including a chest X-ray. There is a possibility that it may be asthma. If spirometry has not been performed as per protocol we may get wrong results as it is an effort dependent test. Asthma is associated with episodes of chest tightness and wheeze. Usually, patients have other allergies like skin and nasal allergy. Another possibility is eosinophilia. It can also present with similar symptoms and spirometry results. I would strongly suggest a personal consultation and examination by a pulmonologist there. Investigations to be done are chest X-ray, serum IgE, absolute eosinophil count. Differential diagnosis include COPD, asthma, eosinophilia.
Patient's Query
Thank you doctor, You are very good. I have some additional questions now please: 1. Attached an X-ray I had done about three weeks ago because I went to the emergency from feeling dizzy and shortness of breath. They diagnosed me with bronchitis, but the pulmonologist yesterday said I did not have it and X-ray looked fine. 2. I was diagnosed with sinusitis about six years ago. About two times per year I get a bad case of it, and I think it could be due to change in weather or pollen. We have the allergy test in one week. 3. How many % points could the test be wrong? For example, I am still recovering from flu and chest infection since almost two months ago. It seems I cannot get the last part of this chest infection out of my body (which is what caused me to go to an emergency three weeks ago). Could the spirometry test be wrong by 10 % because of this?
Hello,
Welcome back to icliniq.com. 1. Your X-ray appears fine to me. 2. Get the allergy evaluation. 3. Difficult to say in %. If the test has been performed correctly, in a reliable machine, it has to be right more than 95 percent of the time. 4. Further evaluation by HRCT (high-resolution computed tomography) thorax may be needed if your pulmonologist deems necessary.
Patient's Query
Thank you doctor,
Two more questions: 1. If I am still recovering from this chest infection, could that effect forced expiratory volume (FEV)1 and FEV1/FVC (forced vital capacity) % ratio? Now I am 80 and 68 when I feel healthy, could these numbers go up to 90 and .80 or is it impossible to go up so high? 2. I still feel like I have some kind of chest infection or something that I cannot cough out, do you think this could be the problem and not chronic obstructive pulmonary disease (COPD)?
Hello,
Welcome back to icliniq.com. 1. Taking so long to recover from chest infection is highly unusual. Infections do not change spirometry values. If it is asthma, by taking appropriate treatment your lung functions can become normal. 2. In my opinion, if your symptoms are still persistent, you will need further evaluation to rule out asthma or chronic obstructive pulmonary disease (COPD). Testing for eosinophil count, serum IgE, heart evaluation and possibly high resolution computed tomography (HRCT) of the chest may be needed. Your pulmonologist there may be the better judge. Please keep in mind my suggestions are based on your spirometry report and symptoms. A repeat spirometry, once your symptoms have improved, is also recommended.
Patient's Query
Thank you doctor,
I just got back from my follow up appointment. My pulmonologist had me take Symbicort (once in the morning, once at night) for a week and had me come back in for testing. I have attached the results. Forced expiratory volume (FEV)1 has gone up from 80 % to 82 %, Forced vital capacity (FVC) has gone up from 90 % to 95 %, and peak expiratory flow (PEF) has also gone up from 77 % to 89 %. FEV1/FVC ratio has gone down though from 68 % to 66 %. She says she thinks it is not chronic obstructive pulmonary disease (COPD) because my FEV1 is above 80 %. However, my FEV1/FVC ratio is so low, I thought anything below 70 % is classified as COPD? She wants me to continue using Symbicort for a month and then come back again for another spirometry test, she also asked me to do some bloodwork. Do you think it is COPD? If not what can it be?
Hello,
Welcome back to icliniq.com. I have two possibilities in mind. One is bronchial asthma. The test done here is not a proper bronchodilator reversibility test. Try to get a proper spirometry with a bronchodilator reversibility test done. That means your Symbicort (Budesonide, Formoterol fumarate dihydrate) should be withheld 12 hours before the test. Perform spirometry once. 400 micrograms of Salbutamol has to be administered through an inhaler and spirometry repeated after 15 to 30 minutes after the inhaler. The second possibility is a variant of chronic obstructive pulmonary disease (COPD) called alpha one antitrypsin deficiency. It can be seen in younger individuals. That will require testing for alpha one antitrypsin levels. In my opinion, you should undergo spirometry with bronchodilator reversibility test. If asthma is ruled out by this test for alpha one antitrypsin levels and get a high-resolution computed tomography (CT) scan of the chest.
Patient's Query
Thank you doctor, 1. The first image I have attached is my first spirometry test. Have I done the bronchial asthma test you are referring to there? (I used an inhaler on that one and retested 10 minutes later). 2. Is it in any way possible my low numbers are caused by gastroesophageal reflux (GERD) or the sickness I had? Prior to the sickness, I did not feel shortness of breath at all. 3. Will my forced expiratory volume (FEV)1 ever go up to 85 % or 90 % or is that impossible?
Hello,
Welcome back to icliniq.com. 1. Yes, the first test is the one I referred to. It does not show features of asthma. Assuming it was done properly, it favors mild chronic obstructive pulmonary disease (COPD). 2. GERD (gastroesophageal reflux disease) or infections do not cause any reduction in forced expiratory volume (FEV)1/FVC (forced vital capacity) ratio. They do not cause results like this on spirometry. 3. FEV1 may go up only in cases of asthma where reversibility of airway obstruction is present. In COPD it will not go up. But recent studies have suggested that if the ratio is between 0.6 to 0.7 as in your case it may be due to biological variations and repeat testing at a later date is desirable. So, if you are getting improvement in your symptoms on taking Symbicort, we can repeat spirometry and check after one month as your pulmonologist has suggested. If still, the ratio is less than 70, then I would suggest evaluation as I mentioned in my previous answer. Serum alpha one antitrypsin levels and high resolution computed tomography (HRCT) of the chest. In your case, as you have quitted smoking early, it was a good decision since quitting smoking will slow the decline in lung function caused by it before.
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Pulmonology (Asthma Doctors)
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