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Experiencing shortness of breath and coughing. On asthma medications. CT results show bilateral air trapping and "mild bronchomalacia. Suggest

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I am a 30 year old female who has been experiencing shortness of breath and coughing for last 14 months both at rest and after exercise. First sought treatment in ER 12 months ago where tests showed normal chest Xray. Then had echo cardiogram done that came back normal. Over last 12 months multiple in office spirometry & peak flow tests have come back normal, & I've showed no positive improvement after bronchodialator administration during those spirometries. I was put on asthma medications anyways by family doctor (Flovent, albuterol before exercise) but did not see improvement.

Dr finally had full PFT & chest CT workup done at large teaching hospital last week. PFTs showed normal spirometry, but low TLC (4.84), ERV (0.48) & DLCO (18.6) measures. I did not respond signficantly to Methacholine challenge to indicate asthma. CT results reported significant bilateral air trapping and "mild bronchomalacia of the right mainstem bronchus and both lower lobe rhonchi XXXXXXX

Family doctor says despite results of PFT tests, evidence of air trapping on CT means I have asthma & "not to worry" about the bronchomalacia. Recommendation is I simply need to treat with stronger asthma meds. Does this diagnosis seem right? Should I be concerned about bronchomalacia as online research suggests it is rare in adults? Should I simply up asthma meds as family doctor suggests or seek consultation of pulminoligist?
Posted Mon, 8 Jul 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. Since the CT has shown evidence of air trapping, the continuation of inhaled therapy is justified.

2. Also hypothyroidism independetly adversely affects the pulmonary functions. So keep the thyroid in control.

3. A Pulmonologist opinion should be sought and an opinion regarding bronchoscopy can be taken in view of CT finding suggestive of bronchomalacia.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Experiencing shortness of breath and coughing. On asthma medications. CT results show bilateral air trapping and "mild bronchomalacia. Suggest 14 hours later
Dr Mishra:

Thank you for your answer. I have a few follow-up questions:

1.) Are there any particular class of asthma medications or inhaled therapy that are considered more effective at eliminating air trapping? (EG Flovent vs Singular vs Symbicort?)


2.) I am in particularly concerned about the low DLCO and TLC numbers as this does not seem typical of normal asthma findings. Are these low measurements likely due to the air trapping or should I be concerned there is something other than simply asthma involved?

3.) Also would like a little more information on understanding a finding of bronchchomalacia on a CT as can sound serious, but am hopig it is not. Are mild cases usually sought to be addressed through treatment or is a finding like this something that an individual can have chronically with little adverse affect? As an adult is it likely the bronchomalacia is something that I've had chronically for years or is it a new development? My understanding from the literature is that developing bronchomalacia is rare as an adult so am trying to determine if it may be a congenital defect I have had since birth just never discovred/asymptomatic until now?

Thank you in advance for your response.
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up.

1. Normally a combination inhaler like symbicort is prescribed in most asthma cases.Therapy depends on pulmonary functions. Oral bronchodilators and other medications are added as and when required on individual basis.

2. As said , DLCO decrease with other parameters in pft is associated with hypothyroidism. Also in current or ex smokers (active or passive smoking) , the pft may be decreased. Air trapping on ct means that bronchodilator on asthma medications need to be started.

3. Bronchomalacia is normally a chronic process. But the diagnosis can be confirmed on bronchoscopy. It is a risk factor for air trapping and seems to be an incidental finding in your case.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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