Asthma or COPD

[JJW1234]

I'm 40 years old.  I have had asthma since childhood - mild (occasional salbutamol) until about 10 years ago, then a little worse.  Preventer inhaler as well as occasional ventolin - very rarely had symptoms.  I smoked socially from age 20 (3-4 cigarettes each day - not underestimating!) until about 9 months ago - no further smoking.

My breathing has become a little more difficult, is so for most of the time, and is worst in the morning.  My inhalers help but most weeks I have a slight breathing difficulty most of the time. Some weeks, my chest feels completely clear.  I can't pin down any differences in circumstance/lifestyle about these weeks except vacations.  No wheezing, no heavy sputum - occasional coughs.

I've had some tests.  Blood oxygen normal/good (98% but can't remember 98% of what!).  Peak Flow usually 650+ (550 when I'm having an asthma period).  Spirometry gave a figure of 82% (blow out in 1 second - cant recall the tech term).  Improved about 7% with salbutamol.  Suspect I did better than this a few years back.  Had a scan (big white donut thing) - normal.  Cholestorol normal/good.

Apart from this, I'm not unfit - I do sports, jog 5k 4 days a week.

I'm trying to find out if this is a) uncontrolled asthma and/or b) lungs settling down after stopping smoking and/or c)  early signs of COPD.

I'm also looking for suggestions as to what to do next.  I'm fairly worried about this.  Even wondering whether it's stress causing the concern.

Thanks for the help.

J

[National Jewish Health]

Asthma is inherently a chronic disease and its natural course is to vary in severity, over time, over weeks, months, years or even decades.  Many times an external cause (chronic infection, allergens or irritants) can be identified as the cause of the worsening but not infrequently no specific cause is found, and the worsening is attributable to the natural history of the disease.  I assume that your more recent symptoms are secondary to fluctuation in the obstruction to airflow that characterizes asthma.  But, there could be other causes, lung conditions that could be superimposed on your lifelong asthma.

Your blood oxygen level of 98% is normal.  The figure is based on the amount of oxygen your blood is carrying, in comparison to the physiologic maximum it is capable of carrying, 100%.  The FEV1 (“blow out in one second”) value is 82% of the predicted value for a person of your age, gender and height.  It is borderline low and the improvement with salbutamol, consistent with the diagnosis of asthma.

The normal lung scan (CT or MRI) you had effectively rules out lung diseases, other than asthma, and that means that it is highly unlikely that you would have early COPD.  

Your decision to stop smoking is very wise and you would do well to never take up smoking again, or place yourself in an environment (work or home) where your would be chronically exposed to passive cigarette smoke or any other occupational irritants.  Basically, you should strive to breathe clean air all the time.  You refer to “lungs settling down after smoking”.  Physiologic changes do occur with smoking cessation, the most common of these being a transient period, of as much as a year, during which you might experience an increase in mucous production, associated with increased cough.  If severe enough this could result in periodic shortness of breath.

What to do next?

You should confirm with your doctor that the tests do not, even remotely, suggest, any other diagnosis (in particular, recurrent clots to the lungs, called pulmonary emboli) and then work together to achieve optimum asthma therapy with a long-acting bronchodilator and an inhaled corticosteroid.



Good luck

[wannasing]

I forgot to mention -- in case it helps -- I smoked socially for 20 years too, and have always had asthma symptoms around allergens, chiefly cats.

[wannasing]

Hi -- I'm 45, and I've had similar doubts since I've taken such a long time to recover from acute bronchitis I got last fall.  I sometimes have periods of what I'd call "heavy-chestedness," brought on by stress and fatigue, but unlike you, I am coughing up a little sputum (something I never did before I got sick).  I am told that this is not inconsistent with a diagnosis of asthma, and like you (I think) my numbers are good. I am currently taking Symbicort, Singulair, and Flonase, and most days am able to exercise and go about my daily business (full-time working mom).

First, what does your doctor say?  If you don't trust his/her opinion, get another one.  Second, if you have atopic (allergic) asthma, allergies can change, so you might want to get an IgE blood test done to see if you're now sensitive to dust mites, etc.  Drainage from sinus allergies and infection can cause asthmatic symptoms, too. Third, you did not mention your gender, but judging from your peak flow I would guess you're a male.  If you were female, hormonal changes that occur pushing into the forties make lungs more vulnerable to everything, including inflammation.  A lot of women experience asthma exacerbation in their forties  -- I don't know whether men have similar issues due to age. Definitely, stress (which affects hormones in both men and women) can be a factor.  And don't forget GERD, which can provoke asthma symptoms, and is something that middle-aged people get.

Asthma symptoms can change throughout your life with circumstances, diet, air quality, age  -- a variety of factors.  If your doctor thinks more or different medication could help you, try and see how it goes.  My doctors do not think I have COPD and I have decided that until my spirometry figures regularly slip into the "permanent obstruction" range I'm not going to assume that I do.  Easier said than done, of course, but until you have someone do a more thorough investigation of what is causing your symptoms, obsessing about your breathing can make it worse (of course, if you have a serious attack, go to the hospital!)

[JJW1234]

Thanks Doc, Wannasing, much appreciated.  Great advice - gives me something to talk to my doctor about.  Best wishes.