Expert: Marc Rubin, RPh Asthma Educator - 10/5/2009

Question
QUESTION: Hello there

Please help me regarding my spirometry test. I've such a hard time understanding it.

About 5 months ago I had an spirometry test. The result was : PD20FEV1: 0.89 mg/ml .

As I recently felt that my asthma has worsened yesterday I took a new spirometry test. Here is the result :
PD20FEV1: < 1 mg/ml .

Please let me know what has happened exactly? Also I would like you to tell me which kind of asthma do I have right now, and what kind of asthma I used to have 5 months ago? Do I have minor, or average or severe asthma right now? I can scan and show you my complete spirometry graph if needed.

Thank you so much.I really appreciate your help.

Soheil

ANSWER: Hello Soheil,

The actual information you provided applies to a methacholine challenge spirometric test. This is a test to verify if your airways react normally to the irritant chemical, or over-react as in asthma, where they start constricting at a much lower dose. This test is not the same as a straight spirometry test where you are first checked with the spirometer, then given a dose of salbuterol, wait 15 minutes, and repeat the spirometry to see what increase in air volume you inhale, and the percent improvement over the baseline. Based upon age, gender and height, your values are compared against the normal range of expected values for age, gender and height. 80 to 100% of projected values for FEV1 indicates good control, 60 to 79%, poor control, and below 60%, severe.

Asthma is a condition which can vary day to day, and seasonally.

Things that increase the lung inflammation and airways spasms are called "triggers". Some of these triggers are in the environment: pollen from grasses, trees, weeds, molds, air pollution (particulate matter),cigarette smoke, ozone, dust, animal dander, etc. Lung infection triggers are viruses, and a few select bacteria that cause pneumonia. Also, emotions can play a part, such as laughing, crying, and stress.



Within an individual, is a single variation of asthma. But, the degree of illness is what varies, as you described your conditions now as compared to 5 months ago. Severity is based upon: frequency of use of rescue inhaler, number of night time awakenings/month, ability to partake in normal day to day activities, number of days of school or work missed, and spirometry readings (FEV1 and FEV1/FVC ratio).

This response has taken longer than I planned due to creating a severity classification chart in Excel  and PDF format from the latest Expert Panel Guidelines. I just tried to cut and paste it in, but it totally messed up the chart. If you send me a response marked "Private" with your email, I'll send you the chart directly. Let me know if you can read an Excel .xlsx file, or if you have a .pdf reader like Adobe Reader or Foxit Reader.

Also, if you are interested, for no charge I can enroll you in an asthma education course for no charge that is presented as a Powerpoint through your email. It covers the basic of asthma, as well as triggers, device technique, and other tools to help you take control of your illness.

If this interests you, in addition to your email address, I'll also need your birthdate, which becomes your password to enter. Again, this information needs to be sent marked "Private" to protect your privacy.

I hopes this begins to help you.

Looking forward to hearing from you.

Sincerely,

Marc





---------- FOLLOW-UP ----------

QUESTION: Dear Marc

Thanks for the information. Just a quick simple question. When my result was PD20FEV1: 0.89 mg/ml , my doctor said I had a mod-severe asthma. Was she wrong then? She's a university professor in this field also. I would say one of the best doctors in our country.

I am 169 cm tall. 73 Kilograms in terms of weight , and my birth year is 1983. Please let me know if my result is PD20FEV1: 0.89 mg/ml which kind of asthma do I have? Sever , moderate , or mild .

Thanks

Answer
Hi Soheil,

I want you to think of your asthma as a variable condition that can one week be mild, with no symptoms, yet the next week, you may have a severe attack. The level of severity does not define the type of asthma, it defines the level of CONTROL of the condition.

New, in the latest asthma guidelines in the US ( NHLBI Expert Panel #3 Asthma Guidelines, 11/2008), was that we no longer just looked at the degree of IMPAIRMENT (in lay terms: severity), but also introduced the concept of RISK, or the potential to be susceptible to an attack (or in medical terms, an exacerbation). The major benchmark of asthma control is the number of emergency rooms visits in 1 year. You could be a patient that rarely needs rescue medication, yet has had 4 ER visits due to a sudden, intense flare-up. This would be a high risk patient. On the other hand, another patient may be on 2 daily controller medications, yet has not seen the inside of an emergency room in 2 years, thus, a well-controlled, low risk patient. See what I mean.

The critical issue becomes CONTROL. Through education & understanding of your personal triggers, knowing how to anticipate issues, and to properly address trigger exposure, YOU take control of this disease, and can achieve a near-normal quality of life. I state this repeatedly, 15% of Olympic athletes have asthma and win medals. By taking control, the impairment is reduced, and your risk is lowered. The fact that you are reaching out for help is a reflection that you do want to take control and enjoy life. This is terrific.

The PD20FEV1 value you refer to is not a benchmark used over here. Consider that this is a tool your doctor uses to assess where you are in order to better evaluate whether she needs to increase or decrease your medication. It doesn't define you, just helps assess the direction that needs to be taken.

Again, as I indicated in my last response, I'd be happy to provide the free asthma education course to you if you wish. Just let me know.

If you have further questions, please feel free to get back to me.

Sincerely,

Marc