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Q. I am a 32-year-old non-smoker, but in spirometry test the FEV is low. Why?

Answered by
Dr. Zubayeralam
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 12, 2021

Hello doctor,

I am a 32-year-old male and not a smoker. Recently I had trouble breathing and felt mucus stuck in my throat that I constantly had to clear up. My breathing problems come and go. Usually, it lasts for days then goes away. They do not get worse with exercise. The symptoms started at the end of the last year, and they are on and off. I went to a pulmonologist, and I had spirometry done that showed unfavorable results with FEV in the 70 range done the test three times and one time after taking an inhaler, which did not significantly improve the results of spirometry. I have been redirected to do a chest X-ray and come back after two weeks. I still have trouble breathing and would like to consult the X-ray result, as it really stresses me out what it might be. I am taking Beto ZK 25 half tablet for tachycardia for many years.

#

Hi,

Welcome to icliniq.com.

I can understand your concern. According to your statement, you have suffered from breathing difficulties and feeling mucus stuck in the throat.

If your FEV 1 (forced expiratory volume) values are lower than average (average predicted values are more than 80%), suggest the presence of COPD (chronic obstructive pulmonary disorder) or another condition that is causing breathing difficulties. But FVC (forced vital capacity), FEV1 to FVC ratio values are needed for the determination of the pattern of lung diseases, whether it is a restrictive pattern or obstructive pattern.

Cigarette smoking is the main cause of COPD or chronic obstructive pulmonary disease, but besides smoking, it may result from exposure to other inhaled irritants like asbestos, silica, coal, etc., due to environmental or occupational hazards. Even some genetic factors are also responsible for developing COPD, like cystic fibrosis.

According to your chest X-ray film that is provided here (attachments removed to protect the patient's identity), it seems to me that the chest X-ray film is normal and showing no abnormalities. HRCT (high-resonance computed tomography) of the chest is the standard gold test for COPD.

FEV1 is usually improved by greater than 15% after taking inhaled bronchodilators or steroids in case of bronchial asthma. So, in the reversibility test, if your FEV1 is improved greater than 15% after inhaled bronchodilators or steroids, then the result suggests that you are most probably suffering from bronchial asthma rather than COPD. But, if no improvement occurs, then it is most probably COPD.

As your predicted FEV1 values in the 70 range, so it indicates mild abnormal reports. So, it would help if you underwent some investigations like HRCT of the chest, ECHO (echocardiogram), etc., to find out the underlying etiology for your present sufferings and then treat them accordingly.

In the meantime, you can take Levosalbutamol, antihistamines, leukotriene receptor antagonists like Montelukast, Doxofylline, etc., to subside your present sufferings.

I hope this was helpful.

Hi doctor,

Thank you.

It helped relieve some of the stress I have been feeling while waiting to see my regular doctor, and glad that the X-ray shows no abnormalities.

#

Hi,

Welcome back to icliniq.com.

As I have already mentioned, you should undergo HRCT of Chest, ECHO to exclude the causes. Again, FVC, FEV1 to FVC ratio along with FEV1 are needed to determine the pattern of lung diseases like obstructive or restrictive type.

Please get back if you have further doubts.

Hi doctor,

Thank you.

I have managed to take pictures of the spirometry tests I have had. I am attaching the pictures. Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

As far I understand to look into your pulmonary function test (attachments removed to protect the patient's identity) before inhaled bronchodilators like Salbutamol, your FEV1 was 75% (below average), FVC was 100%, and FEV1 to FVC ratio was 64% (below the normal predicted value). Again, after inhaled bronchodilators, FEV1 was 79%, FVC was 98%, and FEV1 to FVC ratio was 68%.

FVC or expiratory forced vital capacity's normal value are 80-120%, the average predicted value of FEV1 or forced expiratory volume in one second are above 80%, and the ratio FEV1 to FVC is between 70% and 80% in normal adults. A value less than 70% indicates airflow limitation and the possibility of COPD.

As your FEV1 was below normal, FVC normal, and the ratio FEV1 to FVC below normal, so you have a respiratory disease pattern in the obstructive type.

In the case of obstructive respiratory diseases, to determine whether it is asthma or COPD, a reversibility test was done, and FEV1 was not improved more than 15%, your obstructive disease pattern is most probably COPD.

To confirm COPD, a chest X-ray (posteroanterior) view was done, but at the initial stage of COPD, no radiological changes may not be found on the chest X-ray. So, HRCT is the gold standard test for detecting COPD.

I hope this was helpful.

Hi doctor,

Thank you.

I am just really confused. I am really young. I have never smoked. I do not have a cough. No one in the family has ever had lung issues or COPD. Is it possible the spirometry was not done correctly and interfered with the result? I am sorry for all these questions, but COPD is a very tough diagnosis. I will, of course, do the HRCT as instructed. Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Do not be upset. Spirometry is meaningless if it is done incorrectly, and the resulting misdiagnosis is a cause for concern. In the case of spirometry, each test has an approximately 5% false-positive rate.

As I have already mentioned that spirometry may be done incorrectly, and results will be different. I have already mentioned the different steps of your pulmonary function tests and chest X-ray P/A view with an interpretation according to your investigation reports. I think you can undergo the HRCT of the chest to exclude any respiratory causes. HRCT of the chest will confirm everything. If nothing is found in your HRCT of the chest, then you can do repeat your pulmonary function tests for your mental satisfaction. If nothing is found in the HRCT of the chest, then it will confirm that you are free from COPD or other conditions that can cause respiratory difficulties.

As a whole, nothing has been confirmed yet, as you have suspected, so you have undergone some investigations according to your doctor's advice. But, it is important to remember in mind that nothing has been confirmed yet. So, do not be worried at all at this moment before confirming anything.

I hope this was helpful.


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