Help with sprirometry results

[TLB261]

I am a 41 year old white female. I was diagnosed with exercise-induced asthma about ten years ago and have used albuterol for that.

In August, I felt like my chest was tight much of the time so my family doctor put me on Symbicort. I didn't feel like it was helping so I was sent to a pulmonologist in November. The results of the spirometry are here:

http://tinypic.com/r/2wqde2b/6

The results of the chest X-ray are here:

http://tinypic.com/r/2gxeihj/6

The pulmonologist wants me to repeat the spirometry at the end of January. He said that if it doesn't improve, he will send me for a CT scan. Until then, I am using Advair daily.

My questions:

--why did my lung function get worse after the albuterol?
--if this is restrictive disease, is advair worth it?
--what do the chest x-ray findings mean? What are prominent markings?
--could allergies play any role in this? Just had a very positive RAST test for dust mites. I suspect I am also allergic to other things.  
--how scared should I be right now? I have two toddlers and the thought of not being healthy for them is too much.

Many thanks in advance.

TB

[TLB261]

Thanks again, Jenn. The visit was fairly reassuring. He gave me the option of going for a CAT scan now or waiting until we repeat the pulmonary function tests. I decided to wait after he pulled my chest xrays and we could see for ourselves that nothing has changed in a year. If my tests don't improve next month, we'll go from there.

[Jenn12546]

I saw that as well, your TLC is at 67% of predicted values for your height and gender. That is probably why he might be thinking restrictive disease. People with emphysema actually have a larger TLC because of over inflation due to not being able to exhale all of the air out of the lungs. On xray, the lungs look hyper inflated.
I am not sure what to make of the markings in your chest, that is why a CT scan is needed to see what they mean and what they are. More testing may be done depending on the results.
I am very glad you are seeing your pulmo. I would write down all of your questions and bring them with you. I do this with my appts because I always forget to mention something and have to call the office.
Good luck and hang in there...I know how hard it is to wait.
Jenn

[TLB261]

Thanks, Jenn, for the insight and for taking the time to respond. I have been so anxious about this that I haven't been able to eat anything. I called and made an appointment for tomorrow so I can discuss the results with the pulmonologist again. I was just there on Monday, but I don't feel like I knew enough to ask the right questions. Of course, now that I've looked restrictive lung disease up, I'm completely frightened.

What do you make of the lower than predicted total lung capacity? That is the one thing that he said concerned him most. Do the "prominent markings" on the chest xray mean anything to you.

[Jenn12546]

First of all, what has the doctor said about your spirometry's and such? I am not a doctor so please bear with me, just a nurse who has had her fair share of PFT's and other tests. Your numbers don't look too bad, maybe a mildly restrictive process. FEV1 is usually considered normal if they are >80%, same with FVC. At least that is my understanding. Your FEV1/FVC ratio is >100%, so that rules out obstructive disease, perhaps you have a restrictive process. Your small airways (the FEF 25-75%) look great, usually with asthma they are decreased. As far as your numbers getting worse after the albuterol, believe it or not, some people actually become bronchospastic with that med. Did you feel tighter after the nebulizer?
I think it would be a good plan to get that CT scan, it gives a better detailed picture of your lungs.
I wish I could help more,
Jenn