COPD and normal PFT: confusion

[lily1234]

I am 39 y/o female and have been diagnosed with asthma for almost 20 years.  I had my lower left lung removed when I was 21 due to an abcessed bonchiectasis.  I am a runner.  Lately my asthma has been causing me more frequent difficulty.  I went into respiratory distress in Feb. (a first for me) and have been having more frequent asthma exacerbations requiring longer regimens of prednisone (my worst enemy...bone loss).  I am continually on asthma meds to keep things at bay (advair 500/50, spiriva, asmanex, xoponex, etc.)

Recently I went for a chest x-ray (a pre-op requirement for a hip repairment surgery) which stated that I have copd due to asthma and the clips from  the lobectomy are protruding into the hilum (there was a comparison to a previous chest x-ray this past Feb.)  In addition, I went for a PFT while taking prednisone for over 2 weeks (another acute asthma exacerbation), which revealed that I am above predicted values and have essentially normal lung function.  But there was mild acute respiratory alkalosis, (I am assuming the latter is from the asthma exacerbation?)

What does this mean?   Did the prednisone inflate the results, thus arguing reversibility of the obstruction? and does this rule out copd?  Is it possible to have copd with normal lung function?   If not copd, what is going on with the chest x-ray?  Do I need to be concerned about the clips protruding into the hilum area?

I appreciate any insight you can give.
lily1234

[rockymtmomma]

A related discussion, Running woth COPD was started.

[National Jewish Health]

You and your doctor should search carefully for external, environmental precipitants of your asthma attacks.  Also your doctor should check your lungs for recurrent bronchiectasis and a condition called allergic bronchopulmonary mycosis (ABPM).

Next, you should confirm that the spirometry truly did show normal lung function.  If it did, that is great news.  And, yes, the prednisone could have played a role in bringing your lung function into the normal range.  It would also be important to compare these recent results to previous spirometric results that reflected your personal best.  Also, truly normal PFTs are not compatible with the diagnosis of clinically significant chronic obstructive pulmonary disease (COPD).  Chest x-ray diagnosis of COPD is rather unreliable and the PFTs are a much better indicator of its presence or absence.  The suggestion of COPD is often made on the base of hyperinflation of one's lung and can be erroneous for sub-optimally controlled asthma can also cause hyperinflation.  Respiratory alkalosis, if the only abnormality, simply indicates that you may have been hyperventilating at the time the blood was drawn possibly due to pain.

A CT scan of your lungs would help determine if the "protruding clips" pose a threat or should be ignored.  Consultation with a lung specialist, also know as a pulmonologist, could go a long way to resolving your questions and concerns.

Good luck.

[mpbosnia1]

I have been diagnosed with asthma for about two years now.  I am 44 and a runner as well.  I have always been very athletic.  It came a shock for me when they diagnosed me with asthma so late in my life.  I was put on long term advair.  I have been on it for about 1.5 years.  I am concerned about it skewing the results of my PFT as well.  I took myself off the advair for about a week now.  I am going to the doctor to get retested.  I had bronchitis about 2 years ago when this all started.  After that they said it was asthma.  I believe I have something going on in my bronchioles that cant be seen on xray.  My pft is above average only due to the medication I am on.  A mri is the way to see it all. I dont buy the asthma diagnosis.  I know something is wrong.  Permanent lung damage can result of undiagnosed bronchitis.  I was on the steroids for 1 year.  It worked and then it stopped.  I dont recommend coming off the advair though.  The initial 3 days I had horrible congestion and wheezing that albuterol could not relieve.  Funny doesnt sound like asthma if the albuterol doesnt help.  I dont have productive coughs anymore after stopping the advair.  It seems the advair was making the mucous come up like crazy.  I am seeing a doctor in a couple of days to get a pft without the advair.