Alarming Change in My Spirometry - Dr. Please Comment (Thanks!)

[LowMac]

Slightly less than two years ago (late Feb 2002), I had spirometer test -- the very high-tech kind in which you actually sit inside the testing machine. During the first test they did not administer a bronchodilator and took my readings simply as they occurred naturally. The test showed no evidence of obstructive or restrictive lung disease but it was noted that mild upper airway disease seemed evident (basically - asthma).

I had the 2nd spirometer test done just a couple of days ago and my FEV1 dropped from "85%" of predicted, to "69%". My FVC dropped from "82% of predicted, to "71%. With my PEF being a little higher than on the first test, two years ago, the Dr. is saying it could be restrictive lung disease.

The reason this purported drop in my lung function seems so very strange is because my symptoms have not changed and if I had something like pulmonary fibrosis, I should be going down hill rapidly (not happening). I do still have asthma symptoms but for example, I can walk a mile on a walking path, in 25 minutes, without getting out of breath (slightly more breaths afterward, but sloe steady ones).

Everything I have read about COPD, does not state such rapid lung decline in such a short time (the test said my lungs were at "age 85" and I'm just about to turn age 51) ! The PA who did the test, which this time was a handheld machine, had me to do the same breathing maneuvers as I did with the test of 2 years ago and I cooperated completely and with the same effort (straining to get the last air out of my lungs with each of the 3 tries).

QUESTIONS: I do not have lung pain, my shortness of breath does not occur at rest or with walking -- so how in the world could I have lung function of an 85 year old? Wouldn't I know this myself, if this was the case (wouldn't my symptoms correlate with such a finding)??  

[David Tinkelman, M.D.]

My first thought would be to question the validity of the test done (a couple days), subsequent to the one done in February 2012 that showed no evidence of obstructive or restrictive lung disease.

The alleged values are consistent with restrictive lung disease but, given that your “symptoms have not changed” and you can still “walk a mile in 25 minutes” without “getting out of breath”. these results are suspicious, as you note.  You are correct in assuming that, given a change in measured breathing capacity of this magnitude, you would be symptomatic.

The pulmonologist will probably want to repeat the spirometry, get a chest X-ray and carefully examine your lungs.  Until then, I suggest that you not lose any sleep over these results.

Good luck

[LowMac]

I had my PFTs (Pulmonary Function Tests) yesterday -- 01/30/2014, and the results were quite better than the tests done by my PCP (Primary Care Physician).

This was the pulmonologists interpretation of my more extensive testing:

"Very minimal obstruction. Normal TLC. Normal DLCO. Normal airway resistance. No significant bronchodilator response."

I did have somewhat low readings on some of the tests ("FVC 75%" and "FEV1 80%).

He pointed out that my normal FEV1/FVC %, was at "80%" Pre-Bronch and "83%" Post Bronch, which was at "102%" and "106%" of normal values and a marker that is strongly considered.

While I did have some low values, the most important results showed only "very mild obstruction", which was a relief to me.

Thanks,
LowMac

[LowMac]

Thank you Dr. Tinkelman,

My PCP made me a pulmonologist referral, which I coincidentally will be going to, tomorrow 01/30/2014. In the mean time, the pulmonologist ordered chest X-ray, which showed no cardio-pulmonary findings and was "unremarkable".

I will give another short update, once the new spirometry is done.

Thanks again,
Low-Mac