Early stage COPD or Emphysema or just uncontrolled asthma

[Ohmygod]

Current situation: 34 yo male, previous mild controlled asthma from childhood, smoked socially since 17, 20/40 a week for last 9/10 years, no exposure to pollutants, have not smoked in last 4 months, currently experiencing breathlessness / feeling of obstruction at rest, on excersize (can excersize well on Ventolin), coughing daily ( somethines deep rooted and harsh), phlegm daily 2 x thimbles clear and frothy Have a rattle at times in chest (after vigirous excersize) which is relieved by cough. Preventers make me worse, (breathe poorly, feel hyper ventilated)) tried Advair, Symbicort, Singulair and Becotide, all work for one week and then I'm tight chested again.

Pulmologist did following tests
Spirometry: All normal Methacoline and EIA less than 10% reduction resolved with ventolin. Minor obstruction noted which was reversed with ventolin. Chest CT: Normal, Blood Tests: Everything fine, oxygen, red bloodcells count etc. ECG: Fine with stress test fine.

I also saw a Rheumothologist and Cardiologist who all gave me a clean bill of health. My Pulmologist tells me there is no area / heading he can put me into / under not even asthmatic.

1. Is there a chance I might have early stage COPD or Emphysema which does not show on PFT or CT
2. Is the fact my symptoms are made worse by inhalers, daily cough and phlegm a sign of early stage COPD or an intolerance to inhalers
3. Is there a case for a broncoscopy
4. Why do different inhalers relieve for one week and then stop
5. Do you think I should go it alone without inhalers

Thanks for your help!

[Lou7]

A related discussion, testing needed to check out respiratory disorder was started.

[National Jewish]

In the healthy lung there are small hair-like projections called cilia that clean the lungs by moving mucus up and out.  Smoking paralyzes this cleaning system.  When you quit smoking your lungs began to recover from the inflammation caused by 17 years of smoking abuse.  Most likely this inflammation is causing your symptoms.  Coughing up phlegm daily is a good sign.  It shows that this cleaning system is working again.  When you were smoking this phlegm would just stay in your lungs.  As long as you quit smoking before there has been permanent damage to your lungs then you will get better as the cleaning system cleans your lungs.  This may take up to a year after you stop smoking.  Congratulations on your wise decision to stop smoking!  You may want to look at our Quit Smoking Topic Center at http://www.nationaljewish.org/topic/smoking_cessation.html for ways to help you stick with your wise decision to smoke no more.  Also check with your doctor for other quit smoking resources in your area.

Your history suggests that you are recovering from smoking along with having asthma.  However with all these normal tests, it is practically guaranteed that you do not have a significant heart or lung problem.  There is almost no chance that you have early stage chronic obstructive pulmonary disease (COPD) or emphysema, which does not show on pulmonary function test (PFT) or CT scan.

Your daily cough with phlegm is neither a sign of early stage COPD or intolerance to the inhalers.  Instead it is a good sign that the inhalers are helping you to clear the phlegm that would otherwise stay in your lungs.  Your symptoms are a nuisance but should eventually resolve as your lungs recover from smoking.

There is no case for bronchoscopy.  There is no logical explanation of why different inhalers give you relief for one week and then stop.  You should definitely go it alone without the inhalers.

Aerobic exercise done on a regular basis conditions the entire body so that the muscles are working as efficiently as possible.  This allows the breathing muscles to use the least amount of energy to move air in and out of the lungs.  Over time this helps to lessen breathlessness.

[Ohmygod]

Thanks for your reply; just to investigate further:

A "bit" of Chronic Bronchitis, I have had no re-curring chest infections with green mucus typical of Bronchitis. If it is this do you think it will reslove over time since I have stopped smoking or is the damage done..

Do you think I should see my GP/Pulmo re a course of oral steroids/meds to halt / maintain this condition.

My pulmo does not classify this as Chronic Bronchitis, should I seek a second opinion.

If it is Chronic and on-going how long till emphysema (Now non smoker with a good excersize regime + balanced diet)

Why does Sybicort 200(Formoterol and Budesonide)make me feel tight chested unable to breathe and Symbicort 100 makes me a little better but not 100%, should I be on something else?

Do you feel the Bueytko method is an option

I'm worried...its a lonley station!!

[AndyRRT]

1.) No - PFT's don't lie. CT's don't lie.

2.) No - Its not common for inhalers to make matters worse unless you are allergic to the medication. (which is also very uncommon) Because you are inhaling an aerosol, sometimes that can be a bit irritatiing to the airways and coughing will follow. This is usually indicative of bronchospastic airways or hyperreactive airways.

3.) Probably not. But this would be upto your pulmonologist. Do you cough up blood tinged secretions?

4.) In some cases with inhalers (and it depends on which ones you are using) they stop working because the brochospasm is over. The Albuterol inhalers have taken care of that. What they don't take care of is the inflamatory response. Steroidal meds can treat that, but they usually dont kick in for about a week or so.

5.) If you are feeling wheezy and get relief from your albuterol inhaler, I would not discontinue using it. To me, it sounds like you have a bit of chronic bronchitis.

Andy, RRT, CPFT