asthma?

[dhp]

I developed SOB after 9 weeks of the highest possible oral dose of terbutaline for pre-term labor. A pulmonologist did methacholine challenge with a dx of mild asthma secondary to my GERD/hiatal hernia (confirmed by GI scope). My baseline FEV1 and FVC were above predicted, and FEF 25-75% and PEF a bit below. It took 6 vials to have a result and even then I didn't feel SOB. He never said that caffeine or recent illness could affect the test, so the accuracy of the result is iffy. I have panic disorder/hypochondria and got a PFM to differentiate between panic attack and asthma attack. I have no PF variability from morning, afternoon, evening, before and after bronchodilator, inside or outside, or before and after strenuous exercise; absolutely no change beyond about 5 points ever. I've never SOB when sick, even with bronchitis. I've never had any wheezing at all or nocturnal symptoms. I do tend to clear my throat alot as the GERD makes me hoarse, but I don't cough. I live and work with animals, as I have all my life, and have no personal or family history of asthma. Since getting my anxiety under control, I am on no medicine and am questioning the accuracy of the asthma dx. Actually, fear of asthma has been one of the biggest contributors to the anxiety/panic all of these years. I'm not even sure I've ever had an actual asthma attack, but I've had plenty of panic attacks. Can I have asthma with no peak flow variations, no nocturnal symptoms, no triggers, no exacerbations when sick, no cough and no wheezing? Could the terbutaline have been a factor in setting all of this off?

[National Jewish]

This is a very reasonable, yet difficult question.  The diagnosis of asthma is made by demonstrating approximately 15% reversibility of the airways.  This can be either with medicine or spontaneous after an attack or challenge.  The standard definitions do not even mention symptoms, in most cases.

From what you have described, you may have very mild airway hyperreactivity.  This was triggered by unknown causes.  It leaves you with relatively normal airways reactivity.  This is not measurable during the course of the day with peak flow variation, no symptoms and just about a perfectly healthy lifestyle!!!!

Someone may label this as asthma.  It is certainly not very evident from the facts you have described such as not needing medicine, having no limitations in your life, and having easily demonstrable airway obstruction.  I am not sure if there is a reason to be alarmed.  I would highly recommend discussing this further with your doctor.  Be sure you understand what he/she thinks is going on.  Also determine if there is anything you need to do in the future.  Most doctors would not recommend using a peak flow meter daily since you have no symptoms, obstruction or need for medicines.