PFT Evaluation...looking for advice and scared

[bjack2955]

I am 37 years old and have had asthma all my life (non smoker). I have typically managed by asthma through albuterol and Advair off and on. I am very active and exercise at least 5 times a week (mostly running). I have ran a couple of half marathons and felt like my asthma was under control (although I do find myself using my albuterol more than I should). However, starting in October 2013, I started to feel extremely short of breath with some wheezing. It felt like it started overnight with no triggers. I thought it was a mild flareup due to winter season and my regular dx gave me a Prednisone pack. With flareups like this in the past, a Prednisone pack typically did the trick. This time it did not. I finally went to a pulmonologist who ordered me a PFT as I had not had one in a number of years. The results were not good. Pulmo said I had very poorly managed asthma and results showed a moderate to severe asthma classification. I am copying and pasting my results to see if anyone has insight into my numbers. I know the pulmo was very focused on the FEV1 being so low against predicted and the RV% of 131 showing significant air trapping. My biggest concern is comments that he made that there is a condition called "post infection bronchiolitis" which is an irreversable narrowing of the airways. However, based on my research, you typically would see some sort of infection like fever, cough, etc that would then lead to something like this. I never had that. I am just worried that this shortness of breath may never go away and my FEV may never get to normal. The positive is that I had a pretty good reaction to the nebulizer as shown in the 16% increase in FEV. Any thoughts from anyone out there on the below results?

FEV1 2.59
FEV1% 55
FVC 4.24
FVC% 72
FEV1/FVC 61.08
FEV1/FVC EXP 80.42
RESPONSE TO BRONCHODILATOR +8% FVC, +16% FEV1
TLC 7.27
TLC% 90
RV 2.87
RV% 131
VC 4.40
VC% 75
DLCO 50.94
DLCO% 161

[David Tinkelman, M.D.]

I hope that your pulmonologist did not actually say that you, “had poorly managed asthma” with the implication that your doctor was remiss.  But he/she has raised the question of what we call fixed or irreversible airways obstruction, for which there are a number of causes (including bronchiolitis) in the context of long-standing asthma.  More information may be required before further speculation on what has transpired in your lungs since October and this may require a CT Scan or a lung biopsy.

I am encouraged by the bronchodilator response of a 16% increase in FEV1.  I suggest you simply ask your pulmonologist what should be the next step in further attempts to establish a diagnosis and initiate disease specific pharmacotherapy.

Should he/she, for any reason, prefer to not proceed with further diagnostic measures, I recommend that you consider seeking a 2nd opinion at one of three institutions staffed by physicians with a special interest and expertise in your type of airway obstruction:  Dr. Richard Martin at National Jewish Health in Denver, Colorado (my institution) or Dr. Sally Wenzel at the University of Pittsburgh Medical Center or Dr. Monica Kraft at Duke University Medical Center.  

Good luck

[bjack2955]

any help?