Asthma and now maybe restrictive disease too?

[luvwinnie]

I have an appt with a pulmonary dr. in three weeks, but would love input from an MD in the meantime.. I was diagnosed with asthma a few years ago. I've been on one puff of Asmanex and albuterol (now Xopenex) as needed, but rarely needed rescue inhalers. Cold weather usually made it worse.  I've only seen my general dr. for my asthma and he isn't very  informative (changing doctors). The last couple of months my "asthma" has felt worse...using inhaler more, feel like there is a band across my chest and like someone stuff cotton in my airway, get out of breath so easily (just talking sometimes!). I'm 41, female, 5'5", 120 lbs. I aslo have autoimmune issues going on (psoriasis, psoriatic arthritis) but they are in remission. I also get migraines. I did take methotrexate for about 4 yrs.
Last week I had  a spirometry test and obtained a copy of results. They say Premed: Inidcates moderate obstruction as well as low vital capacity, possibly from concomitant restrictive defect.
Postmed: Indicates mild restriction

Now to me that means I could have something going on other than asthma. I called my cousin who is an MD and he agreed and said go to a pulmonary dr.

My FVC was 73%....2.52
FEV1  58%   1.66
FEF 25%/75% was 32%    1.04
FIVC 2.94     85%
PEF  4.37     69%
FEV3   2.33   73%

Post med
FVC 2.69
FEV1  2.01
FEF   1.54
FIVC  2.82
PEF  5.23
FEV3  2.54

Thank you.

[National Jewish Health]

First the PFT’s.  The FEV1 is definitely reduced but there is an increase of approximately 20% in the post-med FEV1.  This, with the baseline reduction in FEV1 to 1.66 L. (58%) indicates significant, reversible obstruction to airflow, consistent with the diagnosis of asthma.  The FVC, while reduced is 80% of predicted, post-med, a borderline low predicted value.  An accurate assessment of the degree of reduction of the FVC (if any) would require, 1) comparison with an FVC, obtained during the period prior to the onset of your symptoms; that is, before “the last couple of months”,(ideally values obtained before methotrexate therapy)  and/or 2) a current determination of lung volumes; for example TLC (total lung capacity)

Reduction of the FVC could be on the basis of, 1) restrictive lung disease, for example secondary to autoimmune disease and/or long term methotrexate therapy or, 2) air trapping secondary to obstruction of airflow associated with asthma.

The first step should be to determine how much of your shortness of breath (dyspnea) is, 1) on the basis of asthma, 2) how much on the basis of restrictive lung disease or, 3) how much on the basis of another type of lung disease, an occult lung disease, such as, for example, recurrent clots to the lungs (pulmonary emboli).  In this regard, I would hesitate to attribute your seemingly severe symptoms (“out of breath so easily (just talking sometimes!) to asthma, or at least to asthma alone, when your post bronchodilator FEV1 is 2.01 L. (approx. 70% predicted), and for this reason would favor a diagnostic evaluation to include, 1) complete pulmonary function testing (including Lung Volumes and a Diffusion Capacity), 2) high resolution CT scanning of your lungs, 3) studies to rule out pulmonary emboli and, 4) ABG’s at rest and with exertion.

While it is natural to assume that your shortness of breath is on the basis of asthma, I would really hesitate to proceed on that assumption and, while seeking to optimize your asthma therapy, would hasten to rule out other causes of your symptoms.

I would only add that, while the vast majority of patients with mitral valve prolapse (MVP) are asymptomatic and remain so throughout their lives, MVP can result in severe insufficiency of the mitral valve accompanied by symptoms of chest pain or discomfort, shortness of breath, fatigue and palpitations or any combination of these.  Reevaluation of the MVP would be strongly indicated.

Endometriosis?  Endometriosis can effect the lungs and can produce pleuritic chest pain, fluid in the chest, pneumothorax and/or bloody sputum, but seldom shortness of breath without one or more of the preceding symptoms.   Nevertheless, should abnormalities be seen on the CT Scan of your lungs, thoracic endometriosis should be considered in the differential diagnosis.

Please let us know how things turn-out for you.  I suspect that you have a diagnosable, treatable condition.

Good luck.  

[luvwinnie]

Just wanted to add I also have rosacea, mitral valve prolapse and endometriosis.