Conflicting Diagnoses - Asthma or COPD?

[gtmomof4]

I am a 45 y/o female. 5’11” & 158. I smoked ½ a pack for 17 years off and on and quit 6 years ago. I had been experiencing shortness of breath and extreme fatigue for quite some time before going to a family practitioner. Xray showed hyperinflation w/relatively flat diaphragms. Spirometry results:
FVC                       116%
FEV1                       90%
%FEV1                    81%
FEF25%-75%           37%
PEF                         71%

A month of being on Advair 250/50, follow-up spirometry results:
FVC                       102%
FEV1                       96%
%FEV1                    98%
FEF25%-75%           76%
PEF                         94%

He said obstruction was due to COPD.

After 6 months on Advair, I saw a pulmonologist for 2nd opinion.  Spirometry results:
FVC                       112%                     TLC       90%
FEV1                     112%                     RV         47%
%FEV1                   103%                    VC        112%
FEF25%-75%           90%                   DLCO       98%
PEF                        135%                DLCO/VA   88%

Pulmonologist adamantly stated that it is not copd, that I most likely have mild asthma.  He has ordered xray, blood work & Methacholine challenge.

Even on medication, I still periodically get shortness of breath.  If I miss more than 1 dose of advair, the coughing comes back and my peak flow levels drop 10-15%.  If I use albuteral inhaler, I do not feel a quick relief as I would expect to if this was asthma. No mucous production, but I do have constant post nasal drip. What is your opinon?  Thank you.  

[National Jewish Health]

The marked increase in your FEV1, to a predicted normal level of 112%, strongly suggests the diagnosis of asthma, as does the normal TLC and near normal DLCO.  The DLCO is usually elevated with asthma, but yours may be slightly reduced due to the cigarette smoking.  The hyperinflation with a relatively flat diaphragm could have been in association with air trapping, at the time, due to asthma.  An x-ray now might look more normal.

If you do have asthma, with a positive methacholine challenge, you should stay with optimum Advair™ Diskus® (fluticasone propionate and salmeterol) Inhalation Powder therapy, for relief.  Give careful consideration to everything in your home and work environment, seeking to discover an irritant or allergen that might be causing your asthma.

No good answer for the relatively limp response to albuterol.

[gtmomof4]

I realize I should have given the exact values of my spriometry instead of percentages.

First test:  FVC 4.69, FEV1 2.99, %FEV1 63.75, FEV25%-75% 1.35, PEF 4.96
Second test:  FVC 4.27, FEV1 3.29, %FEV1 77.04, FEV25%-75% 2.84, PEF 7.02
Third test:  FVC 4.73, FEV1 3.67, %FEV1 78, FEV25%-75% 3.10, PEF 9.43, TLC 5.81, RV 19, VC 4.73, DLCO 30.6, DLCO/VA 4.79

Thank you.