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Respiratory Disorders (Expert Forum)
Conflicting Diagnoses - Asthma or COPD?
Answered by
CO
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Conflicting Diagnoses - Asthma or COPD?
by gtmomof4, Sep 18, 2007 12:34PM
I am a 45 y/o female. 5’11” & 158. I smoked ½ a pack for 17 years off and on and quit 6 years ago. I had been experiencing shortness of breath and extreme fatigue for quite some time before going to a family practitioner. Xray showed hyperinflation w/relatively flat diaphragms. Spirometry results:
FVC 116%
FEV1 90%
%FEV1 81%
FEF25%-75% 37%
PEF 71%
A month of being on Advair 250/50, follow-up spirometry results:
FVC 102%
FEV1 96%
%FEV1 98%
FEF25%-75% 76%
PEF 94%
He said obstruction was due to COPD.
After 6 months on Advair, I saw a pulmonologist for 2nd opinion. Spirometry results:
FVC 112% TLC 90%
FEV1 112% RV 47%
%FEV1 103% VC 112%
FEF25%-75% 90% DLCO 98%
PEF 135% DLCO/VA 88%
Pulmonologist adamantly stated that it is not copd, that I most likely have mild asthma. He has ordered xray, blood work & Methacholine challenge.
Even on medication, I still periodically get shortness of breath. If I miss more than 1 dose of advair, the coughing comes back and my peak flow levels drop 10-15%. If I use albuteral inhaler, I do not feel a quick relief as I would expect to if this was asthma. No mucous production, but I do have constant post nasal drip. What is your opinon? Thank you.
FVC 116%
FEV1 90%
%FEV1 81%
FEF25%-75% 37%
PEF 71%
A month of being on Advair 250/50, follow-up spirometry results:
FVC 102%
FEV1 96%
%FEV1 98%
FEF25%-75% 76%
PEF 94%
He said obstruction was due to COPD.
After 6 months on Advair, I saw a pulmonologist for 2nd opinion. Spirometry results:
FVC 112% TLC 90%
FEV1 112% RV 47%
%FEV1 103% VC 112%
FEF25%-75% 90% DLCO 98%
PEF 135% DLCO/VA 88%
Pulmonologist adamantly stated that it is not copd, that I most likely have mild asthma. He has ordered xray, blood work & Methacholine challenge.
Even on medication, I still periodically get shortness of breath. If I miss more than 1 dose of advair, the coughing comes back and my peak flow levels drop 10-15%. If I use albuteral inhaler, I do not feel a quick relief as I would expect to if this was asthma. No mucous production, but I do have constant post nasal drip. What is your opinon? Thank you.
Doctor's Answer
by National Jewish Health, Sep 28, 2007 11:00AM
, Sep 28, 2007 11:00AM
The marked increase in your FEV1, to a predicted normal level of 112%, strongly suggests the diagnosis of asthma, as does the normal TLC and near normal DLCO. The DLCO is usually elevated with asthma, but yours may be slightly reduced due to the cigarette smoking. The hyperinflation with a relatively flat diaphragm could have been in association with air trapping, at the time, due to asthma. An x-ray now might look more normal.
If you do have asthma, with a positive methacholine challenge, you should stay with optimum Advair™ Diskus® (fluticasone propionate and salmeterol) Inhalation Powder therapy, for relief. Give careful consideration to everything in your home and work environment, seeking to discover an irritant or allergen that might be causing your asthma.
No good answer for the relatively limp response to albuterol.
If you do have asthma, with a positive methacholine challenge, you should stay with optimum Advair™ Diskus® (fluticasone propionate and salmeterol) Inhalation Powder therapy, for relief. Give careful consideration to everything in your home and work environment, seeking to discover an irritant or allergen that might be causing your asthma.
No good answer for the relatively limp response to albuterol.
First test: FVC 4.69, FEV1 2.99, %FEV1 63.75, FEV25%-75% 1.35, PEF 4.96
Second test: FVC 4.27, FEV1 3.29, %FEV1 77.04, FEV25%-75% 2.84, PEF 7.02
Third test: FVC 4.73, FEV1 3.67, %FEV1 78, FEV25%-75% 3.10, PEF 9.43, TLC 5.81, RV 19, VC 4.73, DLCO 30.6, DLCO/VA 4.79
Thank you.