Lung Function Tests Results

[li10up]

On Monday I had my lung function tests performed and then met with the pulmonologist. He talked a lot about the nodule in my lung and showed me my PET scan images and then talked about the tests I had done earlier. I thought I understood what he was saying but now I have a question about something. He said something about 70 or 70% being borderline obstruction something-or-other and I was at 69 or 69%...I'm not sure which. Can anyone explain what he was talking about? He said he could give me an Rx for an inhaler that I could try to see if it helped with my breathing during exercise but then said that maybe I should just wait and see how things went. So that's what we decided...wait and see. Should I have tried the inhaler?

[Possegal]

i'm guessing you don't remember any terms that the dr used? which is totally normal especially if the words are foreign to you. i'm guessing he is telling you that your FEV1/FVC is at 69%?? and 70% or lower is considered obstructive airway disease. i can explain what the two numbers are specifically if you need me to. i'm guessing you don't have a copy of the report. i've found myself asking for copies of everything with my sister lately. did you take the PFTs before and then after using an inhaler? which would tell you if that significantly changed the numbers? i used to teach spirometry to my pharmacy students (not fun, as most folks when told to breathe normally hyperventilated and a few passed out on me), but i digress. do you have exercise induced asthma? an inhaler really helps with that and it isn't a bad thing to have one handy in case you need it. but if your dr thinks just going as is and seeing how you do, with i presume follow-up as needed, then that is probably the way to go.

[li10up]

i'm guessing you don't remember any terms that the dr used? which is totally normal especially if the words are foreign to you. i'm guessing he is telling you that your FEV1/FVC is at 69%?? and 70% or lower is considered obstructive airway disease. i can explain what the two numbers are specifically if you need me to. i'm guessing you don't have a copy of the report. i've found myself asking for copies of everything with my sister lately. did you take the PFTs before and then after using an inhaler? which would tell you if that significantly changed the numbers? i used to teach spirometry to my pharmacy students (not fun, as most folks when told to breathe normally hyperventilated and a few passed out on me), but i digress. do you have exercise induced asthma? an inhaler really helps with that and it isn't a bad thing to have one handy in case you need it. but if your dr thinks just going as is and seeing how you do, with i presume follow-up as needed, then that is probably the way to go.

I got confused with the numbers he was throwing at me but what you said sounds right to me. Yes, it would be great if you could explain what those numbers mean. He did not give me a copy of the report. I should have asked for one. I could get it if I needed to. No I did not us an inhaler at all during the PFT. He said I "may" have exercise induced asthma but he thinks that with the "worry" of the nodule that I should just wait and call him if I continue to have problems. When riding my airway seems to fill with mucous and I feel like I'm breathing through a straw...but I don't have any wheezing. Then afterward, when I get home, I seem to cough off and on for an hour or two. I also started coughing a little bit near the end of the PFT tests. What are your thoughts on this? Thanks so much for replying.

[maillotpois]

I'm still confused - what IS the nodule and is it supposed to stay there?

[li10up]

According to my doc the only way to KNOW what the nodule is is to do a biopsy. He doesn't think that is a good idea since the PET scan indicates that it is benign. However, there is still a small chance that it could be malignant so that is why they need to follow up with CT scans over the next two years to make sure it doesn't grow. If it increases in size then something will have to be done...if it doesn't I should be good to go. He said it could be something left from a case of walking pneumonia when I was younger (don't think I ever had this), something I was born with, or any other number of things. They just don't know without doing a biopsy...and a lung biopsy isn't a small matter.

I've learned a lot over the last few months.

[maillotpois]

But is the nodule impeding your lung function?

[li10up]

But is the nodule impeding your lung function?

No, he does not think it is impeding my lung function.

[Possegal]

i had a dr who i really liked who would help me through my asthma episodes who told me once "you know as well as i do, all that wheezes is not asthma, and all that is asthma does not wheeze".

i'm a coughing asthmatic myself, with cold weather and viruses being my two worst triggers, then exercise (worse obviously with cold air) and smoke. i don't wheeze, but i do notice a sort of constricted sound to my breathing when i run, only when i run though, no other exercise. if that makes sense.

and yes, the only way to truly know about a nodule is to biopsy it. but that is a more intrusive way to look at it than you may need to do. i know this as i've said before, my sister is battling lung cancer right now so i'm right there for all the tests, etc. plus, i work in that field. anyway, usually with a lung nodule (benign ones are usually a result of some sort of infection or inflammatory response) there are characteristics (CT and PET) that indicate it is not cancer and then whether or not the size of it changes over time is indicative of benign vs malignant. yes, they will follow for 2 yrs before saying 'no worries', but if it is a malignancy, it would grow rather fast. so another CT that says, still there and still the same size, will be really good news. plus, the uptake of the nodule on PET tells a lot, and yours clearly did not have the uptake pattern of a malignancy.

i guess that is a lot just to say - i can imagine how scared you are, no one wants to hear there is something in their lungs and no one knows for sure what it is. but it sounds like the dr has done a lot to distinguish if this nodule has any of the characteristics of a malignancy and it doesn't. easy for me to say 'rest easy', but it sounds like you are in good hands. i spend a lot of time reading a board by a lung cancer specialist and i've seen him answer questions to people with a nodule on x-ray and CT and saying these same things to them, and he should know. though i also see the anxiety in these patients and feel tremendous sympathy for them, so you aren't alone if you are feeling anxiouis about it all and still unsettled despite the doctor's assertion that things look fine.

so, the lung tests. when you do them we can get a lot of information. they should have had you do things like breathe in and out normally and then breathe in taking in as much air as you can, exhale normally, exhale all the air you can. from that we get all sorts numbers and the ones that he was talking about to you were
FVC - this is forced vital capacity, it is how much air you can force out of your lungs by exhaling as strongly as you can - here you've inhaled as much as your lungs can hold and now are forcing out all the air that you can (keeping in mind that you can't force it all out, there is always air left in your lungs, this is called residual volume)
FEV1 - forced expiratory volume in 1 second and this number is how much of that air comes out quickly, in the first 1 second.

normal would be that you can force out 70% or more of that volume of air you forced in, within the first second. a lower percentage would be indicative of some sort of obstructive or restrictive disease and other numbers, i believe, would eliminate one or the other. and sounds like your dr has said it is an obstructive disease like asthma.

i wouldn't discount the ability of the stress over all of this to wreak some havoc on your feeling of shortness of breath. sounds like your gameplan is a good one. i may go ahead and get an inhaler and then do the experiment myself, similar exercises with and without a puff beforehand, see if i feel any differently while working out. but i'm a lab rat at heart, and always happy to be my own N of 1 in an experiment.

the nodule could be impeding some lung function, depending on its location and size. but it doesn't sound like the dr thinks that or he wouldnt' be suggesting exercise-induced asthma as the diagnosis. but i don't know for sure. nor would i begin to diagnosis on the net since i'm not an MD or a pulmonologist, just a phd pharmacology research scientist who happens to know more than i'd like about lung masses and who spent a few years teaching spirometry (though i'm way rusty on explaining those things). and i see while doing my lengthy writing you answered what i thought, that the dr doesn't think this is impeding anything. i'm guessing you were having some shortness of breath problems and went to get it checked out and the nodule was found while working you up for why you were having SOB?? am i right? this is one of the arguments in the community against the idea of routine scans to check for lung cancer, similar to a mammogram. you will find way too many benign nodules that will put patients through tremendous anxiety and possibly very intrusive follow-up tests, just to be told never mind, you are fine. i'm sure you can speak to that anxiety better than i can! and while i do really understand the logic behind not doing routine screening, i also hope to God there is something developed soon that helps us screen and catch lung cancer in its early stages, since the fast majority of LC patients find the cancer when it is either locally advanced or metastatic, and that is not when you want to catch it.

[li10up]

possegal, that was a lot of very good information. You also said a lot of the same things my doc said so it seems you are very well informed in this area. Thank you so much for you input. I don't feel like I have stressed much at all about the nodule...it's more like I was just trying to educate myself about it as much as possible. But I know nothing really about PFTs and what the results mean. You helped clear that up. Do you think getting something like OTC Primatine Mist would help me determine if an inhaler would help with the breathing difficulties I'm getting while riding - or should I just call him and ask for an Rx? This all started when I started getting chest pains after a backpacking trip to Colorado. The CT scan of my heart showed the nodule in my lungs...that's the only way I found out about it. Otherwise I probably would have never known. I probably would have chalked up the breathing issues to just being "out of shape" ...even though riding should be getting easier not harder as time goes on.

[Possegal]

i've picked up a few things with all my learning, i suppose. and sadly a few more out of necessity as i sometimes feel my sister's life depends on it. which i know is too much pressure to put on myself, but that's my style.


i'd recommend getting a script from the doc. he'll likely give you albuterol which is a more selective drug than epinephrine, which is what primatene mist is. they both have efficacy at beta-2 receptors, which when activated will dilate your bronchioles and open up your air passage. but epinephrine hits all the sympathatic nervous system recpetors which means it has a lot more effects. not that the albuterol doesn't have some activity at other receptors, nothing is truly selective. but with albuterol, most people will feel a lot less of the effects you would see with epi. i say most because there are always people who don't fit the norm. the person who says that pain killers make them wired not sleepy, that sort of thing. epi will increase heart rate, and i looked back at your other posts and saw that that was one of the issues at one point, so i don't think that would be advisable. but i would call the pulmonologist and see what he says, but i think he'd rather you have albuterol.

i saw also that you had some heartburn issues, did you get scoped to see if you had GERD? it is weird how GERD and asthma and post-nasal drip are all rather intermingled. that coughing thing can be due to GERD as well as asthma, GERD can make it feel like you have post nasal drip. heartburn sure causes pain in the chest. just tossing that out there, may be worth having that looked at, not all patients with GERD have consistent heartburn. just sort of free-thinking here. there is nothing worse than having symptoms that no one can seem to explain.

and again, not an MD here, a lowly old PhD (with a judge for a brother who i'm sure would insist i put in a disclaimer)

[li10up]

possegal, I'm very sorry to hear about your sister. I hope things go well for her. My husband is a cancer patient so I have some idea of what you and she are going through. I appreciate all the info you have given me. Don't worry...I'm not the type to try to hold anyone else responsible for my decisions...just looking for info.

About the GERD...I'm very much aware of the heartburn and the chest pain caused by it. But the other chest pain I'm experiencing doesn't seem at all like heartburn to me. For one thing many times it is not in the center of my chest but off to the left a bit. I'm not sure if I should pursue this any more because it is a lot less frequent than it was when I first experienced it. I'm just tired of all the dr. appointments.

[RoadRaven]

...if it doesn't I should be good to go.

This is the line I am focusing on. This sounds really good.
This is where I will "send" when I think of you, li, and this is what I trust will be confirmed with no growth in the next two years.

Aroha from Aotearoa

[li10up]

RoadRaven-thank you. I believe that positive thinking is very important. I fully believe that in two years I will be given the "thumbs-up" sign.