Who is good at reading Spirometry results?

I haven't been on here in a long time, just been happily using my cpap every night with no issues for over 7 years now. This is a little off-topic, but there are some pretty knowledgable people on here for anything breathing related. I've been dealing the last few years with a worsening chronic cough that got really bad this winter, and finally made an appointment with an allergy and asthma specialist 2 months ago after momentarily blacking out in traffic during an intense coughing fit. That was a bit scary! He did a basic spirometry (I don't have a copy) and said I definitely have moderate asthma. The only number I remember for sure was the FVC was at 65% of expected. I also had a bad sinus infection. So, he prescribed a heavy round of oral prednisone, a 3 week antibiotic, 2puffs twice daily of Dulera 200/5, and a rescue inhaler. I immediately saw a huge improvement, stopped coughing, lost the congestion, etc. I think that was due to the heavy prednisone. After the prednisone round ran out I noticed a little congestion and coughing returned, but not bad. Then, 3 days after the antibiotic ran out the cough and sinus stuff came back with a vengeance. So, returned to same doctor (no pft this visit) and he did another antibiotic round as the sinus infection was still there. Two weeks later I returned for a follow up this past Wednesday. On this visit he looked very perplexed as he studied the spirometry results, then said things weren't where he'd hoped. So, he added a second daily steroid inhaler, and said to come back in 2 months. This time I asked the receptionist for a copy of the spirometry report:


The first thing I noticed when I got home was the auto generated diagnosis of "moderate restriction. Post bronchodilator test not improved." At that point I spent a bunch of time online reading up on how to interpret spirometry results. Basically, the info I found showed my results as being exactly as expected for restrictive lung disease, and not really that indicative of asthma since there was so little change after 2 months of heavy asthma controller medication? Do any of you experts at this pulmonary stuff agree?

So, I wish the doctor had been more informative this last visit. He did make a weird comment about leading a normal life if these numbers weren't able to improve. So, after looking into the spirometry results and restrictive lung diseases, etc, I am getting a little freaked about what this could be. I've been around welding and metal fabrication for the last 25 or more years, the last 6 teaching arc welding in a shop with dis functional ventilation, and pairing that with the spirometry doesn't look encouraging! It seems to me like I should have been referred to a pulmonologist with those last results to further determine the reason for the restriction? I've never been to one, even for the sleep apnea, so I guess I have multiple reasons to go see one!

Any experience with this stuff out there? Looking for suggestions, such as what questions to ask the doctor...

Thank you

I'm not familiar with the spirometry, but, If it were me I would get a chest x-ray and an appointment with a pulmonologist.

Yes, a specialist is definitely in order.

Hi Jaybee!

It sounds like your doctor is following you up in two weeks, so I think take the course of treatment advised, and then go see them armed with questions you want answering.

I think it would be a really good idea to formulate the questions you want answering before hand, then write then down as its easy to forget them while in a consultation.

Ask him/her to go through the spirometry with you and explain what FVC, FEV1 and the ratio between the two mean, and what your personal results mean in relation to your lung health.

Also bring up your concerns, and ask about his comment about "leading a normal life" - don't be afraid to tell him/her that their statement worried you!

The last thing to ask about would be ways to improve your lung function via lifestyle modification, for example help with stopping smoking if you do currently.

Please let us know how it goes when you have your follow up, and please try not to freak out, keep with the medications you have been given and hopefully in a couple of weeks you will get the answers you need.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827098/

I have surprise they did not do Lung Diffusion.

Thanks for the input everyone!

The follow up visit is in 2 months, not 2 weeks, at which time another spirometry will be done.

I have never smoked a single cigarette in my life, am healthy, and active. I have never been a full time welder, but have used welding at every workplace. My last job was as a welding instructor at a technical college. The fume hoods were basically useless and had no airflow. I have looked up a lot of welding related issues, but most seem to present as obstructive problems not restrictive. Or, might be more accurate to say the acute or early stages of them are all obstructive where the long term damage might be restrictive. I did leave that job partially to get away from the poor air quality there.

After getting home and figuring out the spirometry report I am really surprised there has not been mention of so chest X-ray or further tests to figure out what is causing the restriction.

Thanks again

Does your insurance allow a second opinion, or for you to go directly to a specialist?

You might call the DR, and ask who he would recommend for a 2nd opinion. Do not assume that he will be insulted, or you will piss him off. If he is open to the idea, you will have a recommendation of who to see. It is better than starting the search from scratch. My DRs has actually recommended a 2nd opinion for me when he was getting stuck. But that is one reason I like him.

BUT

If you do not want to ask, I would still get an apt with a specialist. Even if it is just for a 2nd opinion. It may take a few weeks to get in, but better to get started now.

I can go to specialists without a referral; in fact I did that to get to the allergist in the first place. My physician left his practice due to the group he was with playing ugly with insurance. The local medical group that runs everything gets upset with insurance companies on a regular basis and drops major companies for months at a time to get thier way. Last time he got disgusted and left. There is some kind of contract issue, and he has not resurfaced as an independent yet. I have been waiting as I like him, but in meantime don't have a pcp. When the cough and sinus stuff came up this winter I simply went to the local urgent care that is part of the same medical group. Because of that they have all my records on central database, and my insurance covers urgent care at $35 copay versus $30 for pcp or specialist. First visit was told upi, light antibiotic and light prednisone dose but no change. Back 2 weeks later was told it definitely wasn't asthma (no pft testing) but to try a brief run (5 days) of singulair, but no change. I gave up and called allergist at that point.

I do not know how second opinions work. But, I think just going to pulmonologist would not count as second opinion?

I am going to call the allergist's office with some questions this week. I just feel like I'm being a hypochondriac based on how little alarm he conveyed versus what I'm reading online!

Thanks everyone!

Since it drives me nuts to find threads on forums where people posed a question and then never followed it up, I guess I will update this a bit.

I finally found my old physician; he's having an office built near me but in the meantime working out of one about 40 miles away. So, I started with a routine physical with him, and took the spirometry results in. He actually downplayed the overall numbers saying they weren't that bad. But, he also said he couldn't figure out how the allergist was claiming asthma from them. (the two tests were essentially identical, with a month and a half of the heaviest dose of Dulera taken between the tests. Also, the bronchodilator made negligible changes in both tests) So, he ordered a chest X-ray just to take a look. Yesterday I heard back on it - there is a "concerning" opacity behind the heart. The nurse read me the radiologist report, but I was driving and can not remember the medical jargon - though it contained the word "concerning". Then she said the doc's interpretation was opacity behind heart. He at first assumed pneumonia, but then reviewed my recent history (antibiotics all of Feb and half of March) and changed his mind. Also, seems like I'd be feeling a bit less good if it were pneumonia?!?! So, they are supposed to call me today to schedule a CT scan... This is not re-assuring news....

Thanks for following up, Jay. Keep us posted. I'm glad you didn't wait 2 months for the follow-up. I hope things go well.

Glad you are getting further testing done. Because of my history with an unresolving pneumonia leading to a diagnosis of ILD, I'm very interested in seeing where this takes you. Good luck with all this.

Sorry to hear of your woes. I will also affirm that you need to see a pulmonologist, as an asthma patient myself. I had a hideous cough for years before finally doing so myself. My internist went through several rounds of antibiotics and steriods like you mention for a productive cough that left me close to passing out several times. GERD was the culprit in that case, so you may wish to inquire about that. All it took was Nexium and the cough was gone. Not saying it is the same, but an option.

jaybee72 wrote:But, he also said he couldn't figure out how the allergist was claiming asthma from them.

Easy,

These people buy these cheap spirometers



with automatic interpretation and haven't the slightest idea what they're looking at although

Physician’s Responsibility

The IQmark Digital Spirometer can provide test interpretations if the user enables the Auto Interpretation feature. These interpretations are for the exclusive use of licensed physicians or personnel under their direct supervision. The suggested interpretation and the numerical and graphical results should be examined with respect to the patient’s overall clinical condition. Final analysis should always be determined and verified by a physician.

Spirometry is an effort dependent test. Proper administration of the test is the physician’s responsibility, as is making a diagnosis, obtaining expert opinions on the results, and implementing the correct treatment, if indicated.

Not for nothing, but a CPFT with diffusion:

The diffusing capacity of lung for carbon monoxide (DLCO) is reduced in all patients with intrinsic lung disorders, and the severity of the reduction does not correlate well with the stage of the disease. The DLCO is the most sensitive parameter, and findings may be abnormal even when the lung volumes are preserved. A normal DLCO value excludes intrinsic lung disease and indicates a chest wall, pleural, or neuromuscular cause of restrictive lung disease.

which simply means "something preventing from taking a deep breath" vs "something in the lung itself".

Flow-volume loops could also have offered significant information, however, either/both of those results would have simply have brought you to radiology quicker.

jaybee72 wrote:Since it drives me nuts to find threads on forums where people posed a question and then never followed it up, I guess I will update this a bit.

I finally found my old physician; he's having an office built near me but in the meantime working out of one about 40 miles away. So, I started with a routine physical with him, and took the spirometry results in. He actually downplayed the overall numbers saying they weren't that bad. But, he also said he couldn't figure out how the allergist was claiming asthma from them. (the two tests were essentially identical, with a month and a half of the heaviest dose of Dulera taken between the tests. Also, the bronchodilator made negligible changes in both tests) So, he ordered a chest X-ray just to take a look. Yesterday I heard back on it - there is a "concerning" opacity behind the heart. The nurse read me the radiologist report, but I was driving and can not remember the medical jargon - though it contained the word "concerning". Then she said the doc's interpretation was opacity behind heart. He at first assumed pneumonia, but then reviewed my recent history (antibiotics all of Feb and half of March) and changed his mind. Also, seems like I'd be feeling a bit less good if it were pneumonia?!?! So, they are supposed to call me today to schedule a CT scan... This is not re-assuring news....

Are you still coughing? I had pneumonia last year and two rounds of oral antibiotics didn't cure it. It just got worse. I finally ended up in hospital on intravenous antibiotics which did cure it. I also had a spirometry test after my pneumonia cleared up because they saw something weird in my CT scan. (I had a CT scan after I went to the ER very sort of breath--that is when I got admitted to hospital and got the intravenous antibiotics). I spent quite a bit of time reading on the internet about how to interpret the spirometry tests and was going to post a comment about this. I wrote quite a long post, then when I went to click "submit" it asked for a captcha and my post disappeared .

I was going to say that from what I know (which isn't much) your spirometry tests don't suggest asthma or any obstructive lung problem. I also don't understand why the first doc you saw didn't send you for a chest xray. A chest xray seems to be quick and cheap compared to a spirometry test. Even in Canada, where they are very cheap about everthing, I got sent for chest xrays several times when I had a cough. I have never smoked, either. In the end, after my pneumonia cleared, I had another CT scan and saw a pulminologist who said my lungs seem ok and what ever weird thing was in the first CT scan (possibly ild) was gone. (It was this pulminoligist who told me to get a sleep study which is how I ended up at this forum)

I second the suggestion for seeing a pulmonologist, if your PCP comes up with a blank. The lack of change post-bronchodilator seems to me (not a health care provider, but worked in an asthma research clinic for 4 years) to rule out asthma. Please follow up with the PCP and take notes on what is said.