asthma or chronic bronchitis?

[cooperins]

I am 54 years old and had a recent terrible, long lasting bout with the flu recently. It turned into bronchitis

I've had bronchtis before but never like this with high fevers and sweats,  breathlessness and longevity.

My PFT results were:

FVC    111% of predicted
FEV1   102% of predicted
FEV1/FVC 67% (predicted 73%)
FEF25-75% 67% of predicted  
DLCO/VA  103% of predicted

Bronchodiolator given and

FVC improved by 4%
FEV1 improved by 8%
FEF25-25% improved by 16%

I smoked but not heavily for last 10 years (2 or 3 a day).  Entire smoking history was put at about 12 pack years for PFT test. Have quit entirely

I had a lot of clear mucous production for several weeks after the lungs settled down and was put on Combivent and Flovent.

After PFT was told had  asthma and "minimal small airways obstruction"

A CAT scan showed  no air trapping or evidence of emphysema.  Radiologist said my small airway passages  appeared normal.

My question -- is it  likely that I have some form asthma as opposed to chronic bronchitis?

I read on one site that if the FEV1 and FVC are or exceed normal, then the FEV1/FVC test is not relevant. Also the Iowa Virtual Hospital site says that the finding of obstruction may not be warranted if the only abnormal test result is the FEF25-25%. I've consistenly ran 2 miles a day for nearly 40 years, and I wonder whether that explains to some degree the FEV1 and FVC values exceeding the predicted.

Any thoughts?

Thanks

[Jcontact]

I have similar results except I have a low diffusion capacity. I was negative for methacholine challenge and scratch tests for allegies in addition. I have a 25% increase in FEV25-75, but a couple of months ago, they decided to eliminate that test at the Paris conference.

Last year I saw three different Docs and got 3 different opinions. One thought Simple Chronic Bronchitis. He stated it doesn't deteriorate into COPD, but I would never feel well. Nothing he could do. The next one thought Cough varient asthma and the 3rd guy seemed to think I was doing it for attention. You would think it would be easier to get a diagnosis.

What I do know is that asthma meds help me. Singulair and ICS or Intal in particular. From what I read, it is possible that early CoPD could respond to these drugs, but since I have been afflicted for almost 10 years I would have thought if I were going to move to the next phase, I would have done it by now.

I have now added Chronic Sinusitis to my list and recently had surgery to correct that. The reason I thought that was significant was due to the Mayo Mold theory of Chronic Sinusitis which they have now applied to bronchial asthma.

http://www.mayo.edu/research/crpad/trial_126.html

This is what I am watching because my problem started in a flooded house. I think I should be tested for at this point is Pulmonary infiltration with eosinophilia, based on work done by Hargreave of Hamilton, Ontario, but I'll never get my insurance company to cooperate.

Well, if you figure out anything, post back. It is a mystery.

[ccctalks]

Hi - What is 'Pulmonary infiltration with eosinophilia'?

[Jcontact]

Leukotrienes, mast cells, and eosinophils contribute to inflammation in asthma but in CoPD neutrophil concentrations are what characterize the disease. There is a small group of patients with Chronic Cough which has the eosinophilic inflammation in the bronchial tree with normal spirometry and no evidence of airway hyper-responsiveness, now named Chronic eosinophilic bronchitis. In other words, Eosinophilic bronchitis was diagnosed when the patient had normal spirometric values, normal peak expiratory flow variability, no airway hyper-responsiveness and sputum eosinophilia. The patient should respond to asthma anti-inflamatory meds like Singulair, Intal, ICS.

http://home.columbus.rr.com/allen/eosinophilic_lung_diseases.htm

[Jcontact]

Here is a link to a Medline abstract from Thorax you may find more helpful.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11828051&dopt=Abstract

[cooperins]

Hi all,

Thanks jcontact for your reponse.  I have nothing new to report except that the doc now calls it "asthamtic bronchitis".  He wants me to saty on flovent twice a day and combivent as needed and each time before I run check back in with him in 6 months.  Additionally, I did respond, acutely so, to the allergen for cats. The allergist doc in looking at my numbers opined that he thought the thing would eventually resolve itself.  Don't have any cats but tons in my neighborhood and all over my yard, etc.  Also about a month before I crashed in to this last round of air stopping flu/bronchitis, took in a couch which a friend gave me and it had had cats all over it for years.  So we'll see if unloading it and really cleaing the house does any good.

Like you, I have heard or read different placement theories -- not COPD, "borderline COPD", athletic lung, etc., No one told me I was just trying to get attention  -- that's got to be kinda unique.  The bottom line is that I still have phlegm in the morning even after quiting smoking, so there's something going on, But this too comes and goes, which may be allergies. I am thinking or just taking a two week vacation along the sea shore and camping out to see if that improves it.

Thanks again for your response.  

Jim