Asthma/PFT

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Question
QUESTION: hi i am 31 Year old male former smoker i have stopped for 2 years now i deal with acid reflux and post nasel and was wondering what you think of my PFT test i took 1 week ago i have never had asthma or anything like that no cough just cronic throat clearing i had a lung xray and was told my lungs look great.i was told by 1 theripist that it looks like beggining stage of CoPD and by another that they didnt see anything glaring but was under 100%.
i can walk just fine and do 25 min on the exercise bike with no problem other then fatigue.
Thank you Justin

Spirometry

FVC Liters Ref=6.15,Pre Meas=4.95,Pre%Ref=81,Post Meas=4.96 Post%Ref=81,Post change 0
Fev1 Liters Ref=4.96,Pre Meas=3.88,Pre%ref=78,Post meas=4.00,Post%Ref=81,post chg=3
Fev1/Fvc % Ref=81,Pre meas=78,post Meas=81
FeF25-75%L/sec Ref=4.85,Pre meas=3.67,Pre%Ref=76,Post Meas=4.04,Post%Ref=83,Post%Chg=10
PeF L/Sec PreMeas=7.85,PostMeas=7.11,PostChg= -10
Fet100% Sec PreMeas=6.60,PostMeas=6.57 PostChg= -0

Lung Volumes

Vc Liters Ref=6.15,PreMeas=5.18,Pre%Ref=84
TLC Liters Ref=7.95,PreMeas=6.90,Pre%Ref=87
RV Liters Ref=1.93,PreMeas=1.72,Pre%Ref=89
Rv/TLC% Ref=24,PreMeas=25
FRC PL Liters Ref=4.00,PreMeas2.45,Pre%Ref=61
Ic Liters Ref=4.06,PreMeas=4.45,Pre%Ref=110
Raw cmH20/L/Sec Ref 1.09

Diffusion

DLco Ml/mmhg/min Ref=46.3,PreMeas=35.6,Pre%Ref=77
DL Adj mL/mmHg/min Ref=46.3 PreMeas=33.1 Pre%ref=72
Va Liters PreMeas=6.11
DLCO/Va mL/mHg/min/L Ref=6.03,PreMeas=5.83 Pre%Ref=97
DL/VA AdjmL/mHg/min/L PreMeas=5.43
IVC Liters PreMeas=4.69

ANSWER: Hi Justin,

First, I want to congratulate you on quitting smoking!

It does appear to be early stages of COPD. What is interesting is that you have been fortunate enough to have it discovered this early.

From the age of 25, when your lungs are fully grown, a non-smoker will lose ~ 10-20% of lung volume by the age of 55. In a person with the genetic profile that is tied to COPD, the decrease is significantly greater, possibly up to a 60-80% decrease by this age. The great news for you is, that the day you stopped smoking, the rate of decline goes back to that of a non-smoker, with the exception of the tissue that was damaged, is now gone from use. You no longer are inhaling 4000+ chemicals that were destroying the tissue. Keep in mind that second-hand smoke will have the same effect as smoking on you, so you need to stay away from that environment the best you can.

If you are in an aerobic exercise regimen, you may find greater energy reserves building that may reduce your discomfort.

I have another concern, do you work in an environment that exposes you to chemicals that also may contribute to the problem? There are occupations where this is common, and proper breathing gear needs to be worn to protect you.

Hope this helps!

Sincerely, and best wishes!

Marc

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

QUESTION: so how long would you think i ahve until it gets worse? i was told that it was on the Boarder line. do you think it can be reveresed or that post nasle drip/acid reflux or not had been up but for about an hour could have lowered my lung function,my lung Xray i had not to long ago Dr said my lungs Looked amazing my echos all came back normal i have no problems on the exersise bike i go for 25 mins with no problem i mean alittle tired sweety and alittle out of breath but im ok im not gasping for air or anything.

Answer
Hi Justin,

Have you been evaluated for allergies? The post-nasal drip would be irritating your throat, triggering coughing. I'd be interested to see if you had improvement with using either a steroid nasal spray on a daily basis to knock down the inflammation and runniness. If it helps, but not completely, there is a new combo steroid/antihistamine spray called Dymista with enhanced action to dry up the sinuses. To save money, they have a discount card where you would not pay more than $35 per fill. ( https://www.activatethecard.com/6502/welcome.html )

Regarding the reflux, are you a caffeine drinker (coffee, tea, colas, energy drinks)? THese have a great impact on causing reflux. Even chocolate has this effect. When you get the reflux, it irritates the lining of the esophagus. The nerves of the esophagus also run to the lungs, so if the nerves are irritated, is causes the muscles in the lungs to contract, making breathing tighter, as well as increasing cough. Needless, to say, if you are a caffeine consumer, go decaf, and after a few weeks of tissue healing, you'll begin to notice an improvement.

Taking these steps, and the ones I mentioned earlier, it should be years before the airway issues begin to appear. If you maintain a good aerobic exercise program, that will increase the benefit even further.

Hope this helps!

Sincerely,

Marc

Asthma

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Marc Rubin, RPh Asthma Educator

Expertise

I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.

Experience

Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

Organizations
American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

Publications
AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

Education/Credentials
BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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