Second Opinion on Asthma Diagnosis

[Carolina03]

Hi, doc.Thank you for your valuable time.

I'm 38, non-smoker. Two years ago, I had undiagnosed asthma during my third pregnancy. (I'm a former runner who was reduced to bedrest at that time). Postpartum, I was diagnosed with "mild obstructive ventilatory defect w/ improvement after bronchodilators," and prescribed Advair 100/50 x2 daily.

I've had chronic left-sided chest pain since the pregnancy, and was diagnosed w/ "endothelial dysfunction," per a cardiac provocation cath. I'm taking Lisinopril and Inspra daily, and nitro rarely as needed. A recent echo revealed that the right side of my heart is mildly dilated. (We're all hoping that a year from now, the results will be different).    

Below is my most recent PFT for your interpretation and recommendations, if any. Besides a general reading, could you please explain the significance of the low FRC N2 value? What is the significance of the higher-than-predicted values? Thanks again.  

FVC 3.88 (105%PRED) 2% change after Rx
FEV1 3.40 (117%PRED) -0% change after Rx
FEV1/FVC 88%
FEF25-75% 3.99 (121%PRED) -3% change after Rx
FEF50% 4.57 (116%PRED) -1% change after Rx
PEF 7.42 (116%PRED) -6% change after Rx

TLC 6.02 (114%PRED)
RV 2.13 (123%PRED)
RV/TLC 35%
FRC N2 (Liters) 2.50 (79%PRED)
VC 3.88 (105%PRED)

DLCO 21.0 (104%PRED)
DLCO/VA (mL/mHg/min/L 4.04 (90%PRED)
VA 5.20 (102%PRED)

[National Jewish]

Predicted pulmonary function values are mean averages that fall on a bell-shaped curve.  Normal values lie below and above the listed "normal values".  Your pulmonary function measurements, for the most part, are higher than normal but well within predicted values.

The FRC N2 value is of no significance.

[EROS]

There is no asthma here! I suggest a histamine challenge to make sure.

Eros.

[EROS]

In obstructive defects (asthma etc) the FRC is increased, the higher than normal values are a positive.

E.

[HappyNeige]

Thought I'd share a few points here.

1. Asthma can be aggravated by pregnancy.  A couple of years ago when you had 'obstructive ventilatory defect with improvement after bronchodilator', you probably did have pregnancy-related asthma.  However, given the most recent lung function test results, there is no evidence of airflow limitation (obstruction) and therefore I agree with Eros that asthma is quite unlikely.

2. Regarding the values above 100% predicted, there should not be too much concern over those numbers.  The reference values are taken from people of the same age, height and gender as you and numbers above 100%, for the most part, mean that you score better than the average reference population.  Now, there are certain things that are abnormal when it is above 120% like residual volume (RV) but that does not seem to be the case here.

3. FRC N2 is functional residual capacity measured by nitrogen washout technique.  You scored just a tad lower but I bet it was because your ERV (expiratory reserve volume) was low.  Low ERV is usually associated with increased abdominal content, like truncal obesity, pregnancy and ascites; and not from lung/chest wall disorders.

4. I'm not certain how they came to the diagnosis of 'endothelial dysfunction' by cardiac catheterization.  Did they mention a blockage or a plague on the report?  Or did they deduce the endothelial dysfunction from impaired blood flow in certain arteries?

5. You did mention chest pain and dilated right side of the heart.  Did the echo report mention anything about your estimated pulmonary artery pressure being elevated?  One thing to make sure you do NOT have is pulmonary hypertension, espeically when you are a female in her 30's with chest pain and dilated right side of the heart.

Good luck,
HappyNeige...

[Carolina03]

Thank you for your comments.

I didn't think it looked like asthma either. That's why I'm perplexed.

My cardiologist diagnosed endothelial dysfunction, or a coronary flow deficit of 2.4 after using a provocation agent that constricted my arteries and recreated the chest pain. (I was a NIH WISE study patient).  

Pulmonary hypertension has been mentioned as a possible cause of the RV dilation, but my cardio wants to wait-and-see if the medications help before ordering a right-heart cath. (My insurance will not pay for two caths in one year).

Thanks again, I appreciate your valuable insight.

C

[Carolina03]

P.S. For the nurse or doctor, I'm not overweight (or pregnant).

If my PFT values are excellent and my asthma's under control, then can I stop taking the Advair? Isn't Advair a beta-agonist, and therefore not the best med for someone w/ a heart condition?

Thanks.

[missmellie]

I WAS DIAGNOSED WITH ASTHMA WHEN I WAS PREGNANT, I TOOK ADVAIR ALBUTEROL ETC WITH NO RELIEVE.  I FINALLY HAVE BEEN DIAGNOSED WITH VCD VOCAL CORD DYSFUNCTION, WHICH CAN COPY ASTHMA, MANY PEOPLE EVERY DAY ARE IN THE EMERGENCY ROOM WHO CAN'T BREATH GET ANY AIR IN WHO ARE DIAGNOSED WITH ASTHMA OR WHO HAVE ANXIETY.  IT IS A VERY REAL CONDITION THAT NEEDS TO INVESTIGATED BY YOUR DOCTOR IF YOU ARE STILL HAVING SYMPTOMS AND THE INHALERS HAVE NO AFFECT.  I WOULD  STOP THE AVAIR IT COULD BE DOING MORE HARM THAN GOOD, THIS I WAS TOLD BY A DOCTOR RECENTLY, ONE THING THAT I DID DO WHEN AFTER A MONTH THEY DID NOT WORK I STOPPED THEM, SOMETHIMES IT IS BETTER TO LISTEN TO WHAT YOUR  BODY, YOURSELF TELLS YOU THAN THE DOCTORS. I HAVE SEEN CARDIOLOGISTS TO INVESTIGATE A HEART CONDITION LIKE YOU WHEN I WAS PREGNANT AND WAS PUT ON MEDICINES THAT I KNOW NOW THAT I DID NOT NEED.