"your lungs are clear"

[runcyclexcski]

After reading this forum for a month now (thank you all for the comments and for the great support!), it appears that many asthmatics (myself included) who have a solid diagnosis of asthma, are often told in the AE something along the lines of "your lungs are clear" (after X-rays, listening to the lungs etc). I also now read that people with long covid often hear the same thing ("I can't breathe, but the MD tells me my lungs are clear, what do I do?").

Can airway constriction be detected by X-rays? What is this "clear" statement supposed to mean in the doctor language -- to assure the person that they do not have something more serious than asthma (although the patient came specifically for asthma), that the person is not in an imminent danger of dying from asthma, or is this meant to hint to the patient that it's "all in the head, it's anxiety, its muscle-skeletal" and pack up and leave already ("we need your bed for someone else")? Can one's lungs be "clear" (whatever the sensitivity of X-ray is) while the person is in distress due to tightened airways?

From a layman standpoint, if I think of my lungs as a system of sacks and small pipes, and the bronchi as the main pipes. I.e. the lungs are "clear", but the air cannot get in/out b.c. the pipes are blocked.

[twinkly29]

In my experience they generally mean no infection (sounds of it when listening or visible on x-rays), and no wheeze but also good air movement, so air moving both in and out - the air movement is important especially for those who don't wheeze as just "no wheeze* isn't helpful when you don't wheeze. But if they're saying lungs are clear generally then lungs sound good and air is moving ok. They're not saying someone doesn't have asthma, just that at that moment the lungs sound ok.

[runcyclexcski in reply to twinkly29]

Thank you Twinky. Infection sounds like a good explanation (although if one has no fever or persistent cough, not sure why they bothered... I know how pneumonia feels like ).

When they said that to me last time, it took me passing out at the AE to get nebulizer and steroids (which made me feel better in 30 min -- the nebs I mean). So to me the "lungs are clear" statement sounded like a justification for not bothering with any treatment.

[twinkly29 in reply to runcyclexcski]

Maybe on that occasion after all there's always that chance but it doesn't mean that every time that is said means it's an excuse

[jodew]

I’ve had many ‘your chest is clear’ moments. One in particular was whilst in resus with a loud, very distinctive sound of infective phlegm going round my airways, struggling for breath, high temperature etc. Though I was told ‘you have a chest infection’ But your lungs are clear’....though my airways were clearly super tight and swollen, due to the effect this very obvious chest infection had on my respiratory system, so I’m guessing it means that it means no pneumonia?

[twinkly29 in reply to jodew]

It could well have done in that instance as not all chest infections show on a chest x-ray but bacterial pneumonia would, so that would make sense.

It's such a vague phrase though, or can be, and can mean all sorts (so unhelpful really!) It's also difficult because we can feel as you did, all very real and hideous, but air movement etc can still be good - so they could still have meant that. Many a time I've had similar, thankfully with a doctor or team who did actually acknowledge that air movement in/out sounding ok didn't actually mean that I was ok giving the symptoms I could feel. Not sure if that makes sense - I guess what I'm trying to say is that yes we can still feel as you did and lungs sounding ok doesn't mean we are.

[Hevtrev]

I took my daughter (18 months old at the time) to the docs a few times with crackles on her chest and unusual breathing. Each time told fine her lungs are clear as day. Each time I thought to myself....something is not right. It bugged me.

Anywho ... She ended up in hospital not long after for sucking in at neck and very fast breathing.

She's been diagnosed now and has her inhaler.

The doc said to me every time he listened to her lungs her asthma wasn't flaring so her lungs did sound clear. Why it took months of appts and eventually a hospital visit to diagnose.

[runcyclexcski in reply to Hevtrev]

Thank you for sharing Hevtrev.. I hope you can find a better doctor who would listen (if only for 15 min at a time) rather than being dismissive. I wonder if all they can hear is the large airways resonating, whereas if the inflammation is in the lower airways they have no clue.