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    What do these spirometry results indicate?

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Posted on Fri, 7 Jul 2017 in Lung and Chest disorders
Question: I am wondering if asthma typically involves restrictive or obstructive airway problems, and if the following spirometry data is indicative of asthma, COPD, or some other breathing difficulty condition: (1) 11/02/2016. FEV1/FVC 0.55, FEV1 50% predicted; (2) 12/16/2016. FEV1/FVC 0.66, FEV1 72% predicted; (3) 01/09/2017. FEV1/FVC 0.64, FEV1 83% predicted; (4) 05/16/2017. FEV1/FVC 65.2 (best values from all loops), FEV1 73% predicted.

(I can attach the spirometry reports for the first three entries if need be.)
doctor
Answered by Dr. Jnikolla 49 minutes later
Brief Answer:
Obstruction probably

Detailed Answer:
Hello and thank you for asking in HCM

I can understand your concern

All of the Spirometry tests you have provide shows obstruction of the airways.

For evaluating if this is asthma,COPD or other the Spirometry yest should be done before and after inhaling bronchodilatator (usually Albuterol ).
If the result after Albuterol is improved more than 12 % or more than 200 ml air it is more probably to be Asthma,if not than we can say it is COPD.
However the clinical picture of the patient is important too.
We might have Asthma and COPD (overlap syndrome ) in the same patient too (asthmatic patient who smokes over 40 years of age)

So defining Spirometry results needs a lot of data.
Regarding tyour data in my opinion it os Bronchial Asthma.
You can attach the results too

Take care and feel free to ask me again

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jnikolla 4 hours later
Dr. Jolanda thank you I'm very glad to hear from you.

I attached a file for spirometry data as mentioned. Of note, I was not able to do a complete pulmonary function test because my obstructive airway maladies prevented me from inhaling deep enough to complete the test. So I am not sure I will be able to do such tests as you suggest.

Also of note, below are some labs ordered by a rheumatologist. Notice the first two entries, which are usually characteristic of Wegener's granulomatosis, which absolutely manifest as obstructive airway problems. I do not however have a history of recurrent hemoptysis, hematuria or epistaxis, and CT imaging of chest shows no respiratory system abnormality, radiologically speaking.

Myeloperoxidase antibodies: 1.9; H (< 1.0 = no antibody detected)

Proteinase-3 antibodies: 1.9; H ((< 1.0 = no antibody detected)

Complement, Total (CH50): > 60 U/mL; H (standard range 31-60 U/mL)

DNA (DS) antibody: 5 IU/mL; H (< or = 4 negative; 5-9 indeterminate; 10 = positive)

Chromatin AB: 1.1 IU/mL; POS AI (< 1.0 NEG AI)

ANA CHOICE ABS CASCADING RFX: positive (standard range: negative)
doctor
Answered by Dr. Jnikolla 5 hours later
Brief Answer:
Poor effort

Detailed Answer:
Hi there

I saw the results and it seems to me that it is an obstruction even that your effort has been poor.

The blood tests comes for Wegener too.You will be probably treated by rheumatologist and you will repeat Spirometry after 3 months again ti see if there is difference between them.

Take care

Dr.Jolanda


Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Jnikolla 19 hours later
Thank you Dr. Jolanda.

My providers don't want me doing steroidal inhalers because of underlying infection What effective non-steroidal options are there for (a) rescue inhaler management and (b) long-term management of obstructive breathing problems?
doctor
Answered by Dr. Jnikolla 5 hours later
Brief Answer:
bronchodilatators

Detailed Answer:
Hi there

Despite steroids you can take long acting bronchodilatators like Formoterol combined with anticholinergic agents like Atrovent inhalers

However in asthma steroids are the first line therapy.

Please discuss rwith your doctor for the above

Take care

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Jnikolla 3 days later
Dr. Jolanda my PCP did a pre- and post-bronchodilator yesterday on me with an albuterol sulfate rescue inhaler. Post-bronchodilator results showed virtually no improvement in lung function. Based on this information and the foregoing spirometry information I provided you in this conversation, would you think my breathing problems point more towards COPD than asthma?
doctor
Answered by Dr. Jnikolla 7 minutes later
Brief Answer:
if persist bronchoconstriction yes

Detailed Answer:
Hi again

Yes if the Spirometry test after Albuterol has no improvement and if persists the bronchoconstriction yes we can say it might be COPD.

But is very important the clinical picture of the patient ,if he smokes or not.

Usually in young ages COPD is due to emzymatic genetic deficit .

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jnikolla 11 hours later
Dr. Jolanda you are fielding a lot of my questions. I am going to give you value in high ratings for giving me value in information. :)

I do not smoke but I am exposed to secondhand smoke sometimes and have a history of toxic mold exposures. Would the enzymatic genetic deficit you refer to in the young be as regards glutathione? I have a GTSP 1 enzyme genetic mutation, which has to do with glutathione-s-transferase production. This enzyme activity is located within the brain and lungs. Glutathione deficiencies can result in asthma and breathing problems, and people with such deficiencies sometimes reap benefit nebulizing glutathione, which I have interest in trying.
doctor
Answered by Dr. Jnikolla 38 minutes later
Brief Answer:
AAT deficiency

Detailed Answer:
Hi there

I meant alpha 1 anti tripsine deficit that might be tha cause of COPD in a patient 40 years old.

You can try glutathione nebuliser and probably might help you


Wishes

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Dr. Jnikolla

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