Hi:
30 yr old Asian Male, 5'10'', 190 lbs, otherwise healthy, diagnosed with childhood asthma. Asthma returned in 2/2006. Treated with Asmanex and albuterol. Since 2006, asthma flares-up during change of seasons (October through March). Asmanex daily and albuterol as needed during flare-ups. History of Asmanex usage as follows: (2006 - 2 months; 2007; 3 months; 2008 - 5 months; 2009 - 7 months). The last two years I experienced chest tightness/breathlessness within a week after going off the asmanex. Since stopping the Asmanex in 5/2009, I have continued chest tightness/breathlessness that manifests 2-3 times a week for 3 hours or more. Since 5/2009, my PEF is usually between 600-650 with FEV1 between 3.20-3.50. At time, I also experience "crackling" of my neck/shoulder bones upon a full inspiration. When I was on the Asmanex, I almost felt like someone was breathing for me. Now, I have to constantly monitor my breath to make sure that I do not experience SOB. I also experience SOB under stress, in anticipation of a confrontation or with lack of sleep. I have never experienced these symptoms before for such an extended period of time.
I have three questions. First, what explains the symptoms I exhibit now, which I have never exhibited before? Could it be linked to the use of the Asmanex and/or adrenal suppression?
Second, what are the diagnostic tests recommended to rule out the differential diagnoses?
Three, does my PFT show any restrictive process? First value is pre-bronchodilator. Second value is post.
FVC 87/86
FEV1 86/88
FEV1/FVC 100/103
FEV25-75 68/74
PEF 109/113
FIV1/FIVC 73/80
FIVC 83/83
MVV 44
TLC 87
VC 87
RV 84
RV/TLC 93
FRC 82
ERV 69
IC 90
VE 277
DLC0 105
Dl Adj 105
DLCO/VA 120
VA 85
(although not posted, my resistance values were between 94% and 104%)
Thank you for your time.