Cough and Pulmonary Tests

[IsThereAnAnswer]

Until seven weeks ago, I smoked for 25 yrs (pack/day). I have had a dry cough for about 5 yrs, mostly at night and eventually in the morning also. No breathlessnes but always hoarse and clearing my throat. I have hiatal hernia.

In 2002 I had PFT tests done at Mayo Clinic in 2002. FVC 107%, FEV1  93%  FEV1/FVC  71.4. DLCO 77% adj. Methacholine caused 28% decline in FEV1. Post BD FEV1 2.08 (73%).

At Mayo endoscopy also diagnosed allergic rhinitis and significant chronic laryngitis.

Seven weeks ago during a bad cold, I woke up unable to breathe in. I never had anything like that happen. The ER, diagnosed bronchitis with an asthma attack. The nebulizers did not help much. The IV steriods help and I went home.( Best PEFR at the ER was 320.) I quit smoking that day. My cough stopped completely 4 days later.

My GP's office did a spirometry test two days later even though I was pretty sick and had to stop several times for coughing. The nurse did he test twice. My FVC showed 90%, my FEV1 showed 75% and my FEV1/FVC was 69. PEFR was 324. My GP gave me the same peak flow meter and said to start measuring daily. The PEFR eventually went from 320 to 350 to 370 to 400 over the next few weeks. The average now is about 385.

I went to a pulmonologist at Cleveland Clinic. He took my history, ordered an Xray and new PFT tests (not be scheduled until  the end of December). He suspects mild COPD since I don't have symptoms of atopy. I am on no medicines.

I am worried about the "asthma" diagnosed by the ER, especially without BD relief and the significant difference in my spirometry tests since 2002. I have read about VCD and wonder it explains my visit to the ER?  Also can being so sick in the second test cause a mistaken result in the FEV1 even though my PEFR has improved so much? If I have VCD, can that affect the FEV1 measurement?

Thank you so much.

[National Jewish Health]

The most recent pulmonary function tests (PFTs), performed shortly after an episode of bronchitis with bronchospasm, at a time when you were still "pretty sick" do not provide a valid comparison with the 2002 spirometric results.  PFTs measurement should be used for such comparison, only when your lungs are and have for some time been in a steady state.  While you may have lost pulmonary function over a 5 year period, the recent PFTs cannot confirm that.

Don't worry about the asthma diagnosis.  Bronchospasm can occur with chronic obstructive pulmonary disease (COPD), especially with infection, and need not be a reflection of asthma.

Vocal cord dysfunction (VCD) is characterized, for the most part, by obstruction to inspiration; not to expiration and thus not characterized by a reduction in FEV1.  It can occur without or with asthma.  Peak flow measurements may differ significantly from the FEV1.  Peak flows are a good way to monitor asthma control but are not a good measure of overall airway function or disease severity, whether asthma or COPD.

Even if the recent PFTs value approximates your baseline lung function, at this time, they still indicate fairly good pulmonary function.  You are lucky in this regard, after 25 years of smoking to still have good lung function.  You can preserve it, if you never smoke again.

[hardware2]

Your first order of business should be to quit smoking right now. With a hiatal hernia it is very possible that you have some form of acid reflux as well. The reflux could be causing the rhinitis/sinusitus and also damaging your lungs via aspiration. I went out and got and paid for an EBT CT scan of my lungs and am glad I did. The scan clearly showed emphysema but no cancer. Sooner rather than later, doctors will be recommending those scans to help better identify lung cancer at an earlier stage than likely with a regular x-ray. You are obviously proactive in your care as one can tell by your going to Mayo and the Cleveland Clinic. I too go to Mayo and they charge the same as the local places around here. I took the old joke - "What do they call the guy (or girl) who finished last in his or her class at medical school?"  (answer..."Doctor"). I'm pretty sure Mayo and the Cleveland Clinic don't have too many last place finishers in their ranks. National Jewish is #1 in pulmonary though. Good luck.