Normal FEV1 , Normal FVC , Reduced FEV1/FVC - but Dr insists its NOT COPD

[gopalansree]

FEV1/FVC reduced- but Pulmonologist insist it is not COPD .

I am a 35 Year old male , who has never smoked .

Has a regular work out routine.

I had an appointment with my pulmonogist as a follow up to a a CT scan I had taken as part of my immigration physical.

The CT scan was to rule out any active TB infection - and the CT scan ruled so - indicating my lungs were allright.

I just wanted to get this confirmed with my pulmo , hence the appt.

Since this was my first time , I was asked to do spirometry and PFT .

I am worried abt the numbers I see on my test results ...

FVC 111%

FEV1 90%

FEV1/FVC 67%

FEF25-75% 53% -

all of these post bronchi dialtor admin.

My TLC , RV , RV/TLC , DLCO are all normal.

I am worried that the reduced FEV1/FVC may indicate COPD.

But the Dr was quite confident that it was not .

In fact he even did not diagnose me for Asthma.

He ruled out Emphysema and also chronic bronchitis .

His interpretation was this :

No Obstructive pulmonary impairment. Mid flows slightly decreased. Flow volume loops indicate a variable intra thoracic airways obstruction. Lung volumes by nitrogen washout show no abnormality . The DLCO is normal.

I have no symptoms for Chronic Bronchitis - that is productive cough for at least 3 months in the past two years . I do get some cold infections a few times in a year . Mucous for a week and dry cough for 3 weeks after and then I am fine.

He said I wouldnt need any further follow ups . Question : 1) Can COPD really be ruled out ? 2) Do I need a follow up on the variable intra thoracic airways obstruction part ?

[hypercat54]

Hi I can't comment on the 2nd bit but in order to have copd your lung function (FEV1) has to be under 80%. Anything over this is just considered a variation of the norm. x

[gopalansree in reply to hypercat54]

Hi Hypercat - thank u for the response . But what bothers me is that i see numerous online literature out there that says according to GOLD standard fev1/fvc <= 70 and Fev1 >= 80 is considered mild COPD . I get depressed that this is only a slippery slope - cause COPD only progresses for the worst and can neither be cured nor arrested in place.

[DJstag in reply to gopalansree]

Hi,

Yes you are right, the GOLD 2018 guidelines state for diagnosis a spirometry result of FEV1/FVC of less than 0.70 is required. FEV1 is used only to determine severity (not confirmation of diagnosis as is commonly belived) and can be greater than 80% (it could even be 100%)

The fact you say you are fairly symptom free, is probably why COPD hasn't been diagnosed. Symptoms are required for diagnosis.

I would get a second opinion if you can.

Regards

Mikey

[hypercat54 in reply to gopalansree]

The important figure is your FEV1 which you said is 90% not 80%? A lung function of 90% is considered a variation of the norm. You will live a long and healthy life yet so please stop worrying so much.

Even if you had copd it rarely progresses quickly. I was diagnosed mild 10 years ago and it has hardly progressed at all. There are many on here with a lung function below 50% who still have a very good quality of life and aren't planning to go anywhere for many years yet. x

[jackdup]

Your FE1/FVC is below 70% because your FVC is 111% which is generally not an issue. You didn’t post your actual FEV1 or FVC so I can’t calculate what your FEV1/FVC would be if your FVC was 100% instead of 111% but it would definitely increase the FEV1/FVC, but can’t say for sure if it would be over the 70%. The FEV1/FVC being below 70% is more of an issue or concern when it is because your FEV1 is reduced rather than your FVC increased as it is in your case. It is possible you have mild COPD based solely on the numbers you posted above but of course I am not a doctor so my opinions and assumptions don’t mean much when you have been to a pulmonologist who has examined you and reviewed your test results and given his diagnosis. While those numbers can be indicative of COPD, the numbers can also be explained without you having COPD as well and as a specialist has come to the conclusion you don’t have COPD I think you should take comfort in that.

[Healthy24680 in reply to jackdup]

Hi I also have high FVc 118% pred, my actual fev 1 is 3.95 while the predicted is 4.15 so I have 95% ratio , my actual FVC 5.71 L and predicted 5.08 and ratio was 112.5 comparing to predicted FVC . Can it have different explanation rather than COPD. I also have no symptoms

[jackdup in reply to Healthy24680]

If you have no symptoms why did you have a spirometry or pulmonary function test?

First I am not a doctor nor do I have any medical background so can only say it would seem possible you do not have a lung disease, but if doctors have examined you, listened to your lungs and perhaps did x-rays or CT scans or MRI than they would be able to make a diagnosis. There are several lung diseases and the only one I am familiar with is COPD so offering and explanation as to what other explanation could account for your test results I can't say. Your FEV1% is only slightly reduced and from my understanding that could still fit within the normal range. It is my understating the predicted value is the average of a number of people of the same age, same height, same gender and same ethnicity without lung disease so as it is an average some people will be above the average and some below so being at 95% I would suspect could still fit within the normal range, however you may have other test results that I am not aware of that do confirm COPD. Have you seen a specialist and have they confirmed that you have COPD?

[Healthy24680 in reply to jackdup]

hi , was having the urge to clear my throat and some sputum but just few times a day. They did the test and X-ray and physical exam. Physical and x ray showed nothing wrong

[jackdup in reply to Healthy24680]

From what I understand the lungs produce about a litre of mucus everyday that just makes it way into your throat and you swallow it without even knowing so it would seem possible at times your throat senses the mucus and you attempt to clear your throat. I would suspect sometimes your mucus may be a bit thicker for one reason or another, perhaps it is clearing some pollutants like dust for example and then it becomes more apparent in your throat and you attempt to clear it. It probably wouldn’t hurt to drink a bit more water which would help thin the mucus unless yoiu already drink a sufficient amount.

[Healthy24680 in reply to jackdup]

It can be , I was told before this can be as result of GERD which I have. Thanks

[Lazarus]

I agree with the previous posts. with an FVC of 111% and other good figures, it sounds as if you are worrying unnecessarily. The ratio figure could be expected to be lower with a high-value FVC. (your FVC result is 11% BETTER than normal.) COPD just means Ongoing lung obstruction - and if you are a smoker or work in an asbestos factory then it will likely progress downwards. However, it isn't curable so a diagnosis of COPD won't be a great help to you. But you sound quite healthy by comparison to some of us. I suggest you try to find out what is causing the "variable intrathoracic airways obstruction" from a 2nd opinion and start worrying if you get down to 40 or 50 %. I manage ok with FEVC1/FVC at around 20% - but I don't recommend it. Good luck anyway.

[Healthy24680]

Hi I have FVC 118% , FEV1 95% and FEV1/FVC 68.5 % - specialist gave me mild COPD diagnose based on that and the lab technician wrote small airways disease based on number of mid numbers 25/75 which is similar to urs 55%. Then the same doctor wrote air trapping and slight hyperinflation and put me on inhalers while the second specialist saw the report and told me I don’t have hyperinflation and air trapping cuz the ratio of Risidual volum / total lung is normal .. took me off inhalers.... so confusing , interested to know the outcome of your search

[Fennella02 in reply to Healthy24680]

My 25/75 is at 45% and my diagnosis includes air trapping from Small Airways Disease. I have inhalers etc and am quite symptomatic. Although my FEV1 is 62%, my FEV1/FVC is 91% so I don't officially have copd but am treated as though I do.

[Healthy24680 in reply to Fennella02]

May I ask what are your symptoms and were you a smoker ?

[Fennella02 in reply to Healthy24680]

Well, I’m 50, female, slim and active but I have Lupus/UCTD which is the likely cause of the chest inflammation so my resp consultant treats my symptoms rather than the cause. I’ve never smoked. Symptoms are breathlessness upon exertion & also when sitting. A cough that is productive but not huge amounts of mucous & other yuck. My peak flow is low at 250 but I can still outwalk most people! I can’t, however, go any faster than a walk and it’s not for want of trying - small airways make up a large % of airways overall & mine don’t work well. I also get terrible pleuritic pain several times a year but I don’t think that affects my airways. Not sure if this is any help at all . . .

[docmel]

What is yours resting heart rate?

[Healthy24680 in reply to docmel]

Low fifties almost 52 but sometimes is around 46. Does it mean something to Lung function ?

[docmel]

Well yes and no usually if you have issues with the lungs it’s affects the heart. Usually with an increased heart rate as in my case my first symptoms of my issues was a sustained heart rate at rest of 120 plus beats per minute and shortness of breath. Always remember we are each uniquely different and all this is information may not ever pertain to you.