Low FEF25%/75%

[WindsweptRissa]

Hi,

I have had asthma since childhood (now 45) and a productive cough for 6 years. This summer I had a chest infection which I had trouble getting rid of followed by some issues with fungus in my sputum (which seems to have gone now as last sputum gets was clear). Currently waiting for appointment at the hospital initially with general medicine but will hopefully be referred to a chest specialist (I live in Shetland so you have to be seen by general medicine first before you get referred to a specialist in Aberdeen). Hopefully then I’ll find out what is causing the cough, asthma or something else. In the meantime X-ray was normal and I’ve just had spirometry. Everything was normal on my spirometry apart from my FEF25/%75% which was low (sorry don’t know the actual numbers). In fact my lung volume and peak flow were better than normal. The person who did my spirometry said that this could indicate and issue with my small airways. But I’ve no idea if this is an asthma issue or something else. Has anyone else had similar results (normal spirometry but with low FEF25%/75%)?

[Kristicats]

Sorry don’t understand your scores /% I think respiratory drs usually go by the Fev1 percentage to determine the stage of COPD and to tell the difference between asthma and COPD.

[WindsweptRissa in reply to Kristicats]

The FEF25%/75 is the middle part of your breath (I.e. after 25% of your breath has been exhaled and before 75% of your breath has been exhaled. There is no problem with what I can exhale at the beginning of the test or with my overall volume but my air flow is slower than normal in the middle part of my exhalation.

[Hidden]

Hi WindsweptRissa, how awful that you have to go through a rigmarole with people who probably have no idea about your condition before you can get to those who do. As you have lifelong asthma and a productive cough for six years, this raises a flag for me that the asthma may have led to bronchiectasis, which is quite common. Bronchiectasis is a different condition to either of those under the copd umbrella, and, unless you are a smoker, you are quite young to have developed these. Bronchiectasis can only be diagnosed by ct scan and needs the ongoing care of a bronchiectasis specialist so that it can be managed and further lung damage prevented. Do mention this to all of the medics that you see, at least to get it ruled out. Good luck, I hope that you get to the bottom of it all and the correct ongoing treatment and support.

[WindsweptRissa in reply to Hidden]

Yes, they certainly make you jump through several hoops before you actually get to see someone who may be able to give you the answers. Been back and forth to the GP many times over the past few years and hardly ever the same person as we rely on a rota of several doctors plus locums. The cough gets dismissed as probably an asthma thing, but then you go for your asthma check up with the nurse and when filling in the part about frequency of symptoms she refuses to put down daily symptoms because she says a chesty cough isn’t really an asthma thing. It’s rather frustrating. If it is an asthma thing then that means my asthma isn’t adequately controlled and if it isn’t an asthma sypmtom then I need to know what it is so I can be on the right treatment. I have mentioned Bronchiectasis - ended up doing a bit of googling to find out about the possibilities, it seemed to fit so told the GP that’s what I thought it could be. I’m just hoping I won’t have any trouble getting referred to the lung specialist from general medicine and it won’t take too long (my appointment with general medicine has been rescheduled twice so far).

[Hidden in reply to WindsweptRissa]

Yes good luck. Do let us know how you get on.

[soulsaver]

Are you a(n ex)smoker? How many per day? Is there contaminants in what you do for a living - smoking fish/keep poultry etc?

A low flow rate in the Fev25-75 does indicate a possible small airways issue. It could be related to life long asthma; maybe a smoking or other contaminant related deterioration; or just the physiology of your lungs.

[WindsweptRissa in reply to soulsaver]

No, never smoked and not exposed to anything like that. My mother has had lifelong asthma and was diagnosed with chronic bronchitis/COPD over a decade ago, but has never smoked though. Maybe I’ve just inherited her dodgy lungs.

I was exposed to asbestos a few years ago, but I doubt it would have been enough to cause problems - when the council removed our old boiler they just sawed off the flue pipe just below the ceiling, leaving a pile of dust for me to sweep up. Took me ages to get the council to do something about the bit of pipe left sticking out and the hole in the kitchen ceiling. When they finally sent someone round he said he couldn’t touch it because it was asbestos. Then took even longer for them to send a specialist round to remove it.

[Fennella02]

Hi. I have a low fef 25/75 - currently 41% but has been sliding each year. I don't have copd not asthma. My consultant calls it Small Airways Disease/Bronchiolitis. The treatment is the same as for the larger airways but it's harder to get the inhaled medication to where its actually needed. I cough a lot with mine and can often be very breathless.

Let us know what happens next. X

[WindsweptRissa in reply to Fennella02]

Thanks. If you don’t mind me asking, how did you get diagnosed?

[Fennella02 in reply to WindsweptRissa]

For several years, my condition was trivialised - if your fev1 and fvc are good then they’re not always too concerned. I have a longstanding diagnosis of lupus so lung problems can be a feature. I’ve researched a bit on SAD - enough to find that there isn’t a great deal of info out there!

Diagnosis has ‘evolved’ over the years with repeated PFT’s and spirometry. They don’t get too excited about it because inhalers are the mainstay of treatment. I’ve read that fine mist inhalers are best but Spiolto was the only suitable one for me and I was allergic 🙁.

Hope this helps a bit. I have had to really persist with my consultant or he would have discharged me back to my GP.

[WindsweptRissa in reply to Fennella02]

Yeah, I had spirometry 3 years ago and as the FEV1 and FVC were better than normal I was told my lungs were perfectly healthy. Apparently sounding like a 60 a day smoker when you cough despite never smoking is nothing to be concerned about lol.

[Fennella02 in reply to WindsweptRissa]

Yes, I’m with you there! At my appt last week, my consultant did admit that only part of the picture comes from the test results, the rest is how it affects us individually. I keep getting ‘natural ageing’ thrown at me but I’m 51, non smoker, under 8st and botch up miles with my dogs each day so I don’t accept that my bronchioles are so much older than the rest of me!