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pulmonary function test/bronchoscopy
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pulmonary function test/bronchoscopy

i had pulmonary function test done which i have some queries:
1. my PEF25-75% is low. the computer print out says ?small airway obstruction. What does that mean? what will cause small airway obstruction? i have progressive difficulty breathing and hemoptysis for 3 years. any interpretation of this PEF result in relation to my symptoms?

2. the DLCO bit.. i was told that a certain type of gas is breathe in, hold for 10sec, then released inorder to calculate the efficiency exchange of oxygen or sth like that. The problem is, when i did the first time, because of some technical error (i sort of let some gas leaked out from mouthpiece), i was asked to do a second time. But since i have already breathed in  the 'gas' during the first time, having this second time done immediately with more 'gas' breathed in (ie not starting with 'zero'), will the result be inaccurate? If not accurate, how long should i wait before doing a repeat if needed?

3. Is bronchoscopy better tolerable with nasal entry or oral entry? or not at all? what about comparing to gastroscope? has anyone done both? which is more tolerable or with worse experience?
God bless everyone. I'm having one done and is very worried about what the doctors will find. bleeding source from cancer? <sigh> :(
Thanks for any advice.

-Zoe :(
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1. The FEF25-75% is an unreliable measurement of small airway function.  This measurement and the FEF200-1200 show marked variability in healthy people and are not helpful in detecting disease in an individual person.  Ignore this part of the pulmonary function tests.
2. The gas that is used to measure DLCO is rapidly expelled.  The test can accurately be repeated within 1 to 2 minutes.
3. Bronchoscopy is better tolerated with nasal entry.  In general, bronchoscopy is better tolerated than the gastroscope.

Three years is a long time to have hemoptysis.  You should have the bronchoscopy.  If your chest x-ray is normal, it is unlikely that your hemoptysis is from cancer.  After 3 years cancer would show up on a chest x-ray.

Good luck.
9 Comments
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Avatar_n_tn
Hi!
I've had a flexible bronchoscopy under VERY MILD sedation (as mild as possible, at my request).  They inserted the VERY thin probe through my nostril (really just like a plastic-coated wire), after my nostril had been numbed with lidocaine gel.  My throat had also been numbed by gargling with the same gel.  The procedure was very fast (under 20 minutse) & absolutely painless, under the skilled hands of my favorite, very experienced pulmonologist.  The anesthesia was wonderful and patted my hand in comfort.  As part of the procedure, they took biopsy samples, did a lavage & suctioning to check for bacteria, and also did brushings to check for bacteria as well.  

Depending on what is needed by the doctors, there is a more invasive rigid bronchoscopy, which requires more sedation.

You should ask your doctors to explain the pros & cons of each procedure, so you can make an intelligent and informed choice.

As far as the spirometry, please ask your doctor to explain it in light of YOUR total history and conditions.  

Aloha,
Starion
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Avatar_n_tn
The PEF25-75 (Peak Expiratory Flow Rate within 25-75% of your FVC) is an indication of small airways disease. The most common type is Asthma.

The gas you breath is is a very small dose of carbon monoxide. CO tends to bind to hemoglobin 10 times greater than oxygen. What this test does is, it measures the ability of diffuse through your lung tissue. A known concentration of CO is inhaled. After a 10 sec breath hold, you blow back into the machine. The machine then calculates how much CO is missing. If there is very little CO detected by the machine, that means your lungs absorbed it all! Hence, You have a great diffusion capacity. If the machine detetcs high concentrations of the CO, that means your lungs do not absorb gasses very well. There are several diseases and ailments that can cause poor diffusion of the lungs.

When you inhale CO with this test, it tends to stick a round for a bit. Unfortunately, the first test was botched and a second test was allowed. this mean you inhaled a SECOND dose of the CO. Its safe...VERY SAFE to breath this is small quantities...but it may skew the results a tad. We normally like to wait 20-30 minutes between DLCO tests if an error was made. Its also imperative that the patient NOT SMOKE 3 hours before the test. Cigarettes have CO in them!

The brochoscopy entry should be determined by the physician. There are several things to take into account with each entry (ie bleeding, gag reflex, risk of vomiting, tolerance to sedation, etc) The most common "outpatient" route is through the nares (nostrils) The doc will numb up your nose with a very strong anesthetic. The bronchoscope is then inserted into the nare (with lubrication) and advanced. There is less gagging this route, however some bleeding may occur because it can sometimes be a tight fit.

As far as a colonoscopy goes.....they are completely different. We're talking about the other end hunny. (not my speacilty!)

Hope this helps!

-Andy, RRT, CPFT
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Avatar_n_tn
In agreement with AndyRRT the FEF25-75 is indicative of smaller airway obstruction that MAY me associated with people who have asthma.
However, with respect to my colleague mentioned above, CO (carbon monoxide) has an affinity for hemoglobin over 200 times that of oxygen, not 10 times as you mentioned above. Just a footnote. Take care and be well...
                                         J.C.I. BS, RRT
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Avatar_n_tn
I had a brochoscopy through the mouth under light sedation and it went well - I hardly noticed it - however I also had a gastropscopy under sedation and kicked nurses and docs away, they couldn't get it done.  Some say a gastra is easier done while fully awake.  

Regards
J
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Avatar_n_tn
Thanks all for the advice! It's very helpful and informative indeed.
what other causes might contribute to small airway disease (decreased PEF25-75%) apart from the common asthma?

-Zoe
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Avatar_n_tn
Doh!

Little typo my RT friend. In all actuality, hemoglobin has an affinity for carbon monoxide that is 210 times its affinity for oxygen. YOU'RE OFF BY 10! (heh-heh)

The more I read my posts, the more embarassed I get. I'll try and be more careful and proof read more often....my appologies.

-Andy
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Avatar_n_tn
Just spoke with Bob Kacmarek, the afinity can be as much as 230-270 times greater! (Holey chowdah)


-Andy
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Avatar_n_tn
I was referencing good ol' Dr. Bob when I mentioned that number. Tell him all is well at the University of Cincinnati and we say HI to he and Dean Hess...be well!
                                            
                                       J.C.I. BS, RRT
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