Recent onset SOB; PFT shows restrictive process?

[tiancheng]

Hi:

30 yr old Asian Male, 5'10'', 190 lbs, otherwise healthy, diagnosed with childhood asthma. Asthma returned in 2/2006. Treated with Asmanex and albuterol. Since 2006, asthma flares-up during change of seasons (October through March). Asmanex daily and albuterol as needed during flare-ups. History of Asmanex usage as follows: (2006 - 2 months; 2007; 3 months; 2008 - 5 months; 2009 - 7 months). The last two years I experienced chest tightness/breathlessness within a week after going off the asmanex. Since stopping the Asmanex in 5/2009, I have continued chest tightness/breathlessness that manifests 2-3 times a week for 3 hours or more. Since 5/2009, my PEF is usually between 600-650 with FEV1 between 3.20-3.50. At time, I also experience "crackling" of my neck/shoulder bones upon a full inspiration. When I was on the Asmanex, I almost felt like someone was breathing for me. Now, I have to constantly monitor my breath to make sure that I do not experience SOB. I also experience SOB under stress, in anticipation of a confrontation or with lack of sleep. I have never experienced these symptoms before for such an extended period of time.

I have three questions. First, what explains the symptoms I exhibit now, which I have never exhibited before? Could it be linked to the use of the Asmanex and/or adrenal suppression?

Second, what are the diagnostic tests recommended to rule out the differential diagnoses?

Three, does my PFT show any restrictive process? First value is pre-bronchodilator. Second value is post.

FVC      87/86
FEV1    86/88
FEV1/FVC  100/103
FEV25-75   68/74
PEF          109/113
FIV1/FIVC   73/80
FIVC           83/83
MVV           44
TLC             87
VC              87
RV              84
RV/TLC       93
FRC            82
ERV            69
IC               90
VE             277
DLC0         105
Dl Adj         105
DLCO/VA    120
VA              85
(although not posted, my resistance values were between 94% and 104%)

Thank you for your time.

[National Jewish Health]

It is apparent that your breathing difficulty has increased in the last year.  That is not uncommon in asthma.  It can happen without any obvious reason, such as an infection.  It seems like your airways are more hyper-reactive now then they were a few years ago.

Here are some answers to your questions.

1.  You really do not present with any typical symptoms of adrenal suppression from what you have described.  It is difficult to tell you more about the cause of the "crackling" sound you feel or hear.  A good physical examination may shed more light on that.  It is doubtful that this is related to the Asmanex.

2.  The most likely cause of what you are experiencing is an increase in the inflammation in your lungs from your asthma.  It is reasonable to have a chest x-ray to make sure there are no obvious problems going on in your lungs.  If, after this comes back normal, you are still concerned seeing a Pulmonologist is a good idea.

3.  I assume that you have presented the percent predicted values for your PFT results.  These are basically pretty good.  Having normal FVC and FEV1 is a good sign you do not have restrictive disease.


Seeing a specialist may give you more answers and peace of mind.

[tiancheng]

also - non-smoker; swim 2x a week w/o noticeable difficulty breathing