37 yr old male, former smoker for about 13 years approx.1/2 pack per day. Quit about 2 mo’s ago & after 3 wks I started feeling SOB w/ barely a cough (just urge to). First thought it was anxiety but then started to check it out.Have had a chest xray,CT of chest(showed minimal scarring in rt apex), EKG, Echo, blood tests-all normal.I did a PFT test w/ the following results pre & post bd in % terms- FVC-117/119, FEV1-114/117, FEV1/FVC-81/82, FEF25-75-103/110, FEF78-85-112/118, TLC–119, VC-117, RV/TLC 29 (pred was 29). The DLCO isn't listed but on graph it appears to be 120%. The flow loop seemed normal but was not as constant (looked like a step function in parts).The only low #'s were - FEF25 (not FEF25-75) - 76/92 +21%, MVV-75/78.My pulm Dr diagnosed me w/ mild asthma & noted that there was no significant change w/ the BD. Gave me advair 100/50 & rescue inhaler. I have been using for about 2 weeks & am not noticing any real change. He said the PFT could be normal or could be mild obstruction. Asthma is in my family but I am skeptical since I am a former smoker & the meds aren’t really helping.I bought a Oximeter & peak flow meter & the oxi usually reads f97-99 & the PFM I can blow about 650. Read online about people being SOB after they quit smoking, mostly due to the reemergence of cilia in the lungs & their attempt to rid the lungs of mucus built up there from smoking. Considering that this may be what I am dealing with I began to follow some remedies suggested online (mucinex, tea, steam room, cough up mucus,etc.). Not sure it is working & although I am able to bring up plenty of mucus (light yellow not dark) I am not sure its from my chest or my throat since I have Post nasal drip. Chest feels dry. Still SOB w/light cough and heavy feeling in chest. Q's - does PFT indicate mild asthma/copd/nothing? If so what are the indicators?What is FEF25 and what does it indicate? Is COPD/Emph possible w/my scores? Are my PFT #'s too high? Where do I go from here?Thx
The Nicotine Withdrawal Syndrome encompasses a variety of symptoms, the most common of which, specified by the DSM-IV-TR* are listed below. It is not at all uncommon to experience a variety of other symptoms, following smoking cessation, some of those secondary to nicotine withdrawal but others secondary to alteration in cilial function and increased mucous production, by the normally present (temporarily over-active) mucous glands, embedded in the airways.
Your physician is correct in stating that your PFT’s are WNL. Note, there is a wide range of predicted normal values and your results are at the high end of “predicted.” It is conceivable that, with the passage of time and cessation of increased mucous production, your measured pulmonary function may even improve slightly.
As for your specific questions:
Q's - does PFT indicate mild asthma/copd/nothing? If so what are the indicators? What is FEF25 and what does it indicate? Is COPD/Emph possible w/my scores? Are my PFT #'s too high? Where do I go from here
The PFT’s are normal and not indicative of asthma or COPD. The FEF 25 (the forced expiratory flow rate during the first ¼ of total exhalation) is a minor measurement and, when taken alone, of no clinical significance. Your PFT results are inconsistent with the diagnosis of COPD. Of all the measurements, only the TLC (total lung capacity) and the RV/TLC can be abnormal, when “too high.” Your values are WNL.
Where do you go from here? You go on to a life lived with normal, healthy lungs; one lived with no further testing of your lungs, of any type. Further testing would only be a waste of time and money.
The primary message is that you have made an excellent decision to stop smoking and should not be alarmed by what are, almost certainly to be, transient signs and symptoms.
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