Hi All, I've just been for my spirometry and it was different and new to me... took some effort lol, first the reversibility part was not added. Then after I called them and ensured that I needed it apparently the consultant added it on which was great!!! However, once I'd finished the test I was told it was just not needed as this was only done I they couldn'tget the readings and in my case we got all the readings needed, therefore wouldn't be done?? I did about 4 different tests and 3/4 goes on each! She said id done well on the test as in performing them, she couldn't see anything urgent on there either... should I still be worried or?? Is this likely not to be asthma related or copd?? I have to call in a few week's to get the results but I'm just asking to see if any one knows anything? Should I have asked the nurse anything while I was there...
Spirometry but nurse said no reversib... - Lung Conditions C...
Spirometry but nurse said no reversibility needed
I really cant answer your question Ami40 - you have been told that there doesnt seem to be a problem. If your tests hadnt indicated any level of asthma or copd then its not likely a reversibility second test would be needed as there would be nothing to reverse!
However Im not sure about what you were told re reversibility testing though as they seem to be saying that a reversibility test would only be needed to confirm the first test if that wasnt clear, which is not why it is done. I too would be a bit confused by that.
Ask if you can have a copy of the test results and then if after speaking to them you are still not happy, call the BLF helpline whose number I forget but someone will come on with it. Their nurses are kind and well informed and used to people being anxious about their conditions. Hopefully they will be able to reassure you.
Hi 02 Trees, thanks for the response. I haven't been told that there doesn't seem to be a problem though? Just that the I can get the results in due course from Consultant. Would the technician have said if there was an issue or she could notice anything there and then? She just said id done well in performing the test and that there was nothing 'urgent'. Should I have pushed for more info... I was a little dazed after the test so just waited to get out and get some fresh air etc lol!
Re reversibility i think she said that it wasn't needed due to there were no 'tightness' in the airways, that needed unblocking etc and that they had got the results which were needed? Indicating even if I took inhalers it would not really make a difference? Is this wrong?
Well of course I cant say Ami40 but if you are being told the airways aren't "tight" that does suggest you dont have asthma. Your peak flow result sounds like it was ok and that's the asthma test. Im saying this as an asthma veteran!
So again I would say, ask for a copy of the results - you're entitled to them - and call the BLF helpline. Sorry I cant help more.
No thank you that's great I understand, i did ask for copy of results but apparently they can't give them out in case they get lost? DPA and all that, i think they can be added on to my medical records though! So will get a copy that way! I'm guessing that's what it sounds like too, not asthma, so should I keep taking my ICS which is Clenil just for asthma? As it may not be doing anything etc? And now the more worrying thing is is it copd which is worse?!
The technicians aren't in a position to give you any detail on the results which is why you were only told what you were. They are, however, sufficiently trained to read the results to know if they have produced a satisfactory result for the consultant to look at which will also be why you were told that there was no need to take your inhaler and do more tests. This is just my interpretation of what you have said.The results of the tests go to the consultant who will interpret them and then tell you his findings. As frustrating as this may be, this is normal practice.
Yes I totally get this and thank you, I'm just concerned should I be taking my ICS Clenil which is just for asthma, if its not that? Which it seems like not as she said it won't make any difference etc? Oh heck, just have to be patient for results now... I just hope its not copd which I worse?!
I would continue with the clenil until you are told otherwise. Hope it's not too long before your appointment with the consultant.
Glad you got your tests done. Generally, reversibility is only done when there is obstruction specifically on spirometry - if there’s no obstruction, it can’t be reversed. That said, without knowing exactly what tests you’ve done, it’s difficult to know what data they have and what it can tell them. A full panel of pulmonary function tests done at a hospital is different to just having plain spirometry, and if you did a few different types of test, then it sounds like you had full PFT, so they may have not needed to do reversibility with the additional data they obtained via other tests.
Regarding the clenil, unless told otherwise, keep taking it. The active ingredient - beclomethasone - is used in both asthma and COPD. The only difference is in asthma it’s often used as an individual component steroid inhaler like clenil, whereas in inhalers intended for COPD, it usually has a long acting reliever drug in the same inhaler, but the steroid does exactly the same thing whether it’s as a stand-alone ICS or part of a combined inhaler. There’s no difference to the steroid effect or the benefit, and there are people with COPD that struggle to find a combined inhaler that suits, so they routinely use a separate ICS.
Thank you so much Charlie, you have explained this well! Yes I had a full PFT and I specifically requested a reversibility and it was added on by the consultant, so I'm guessing if there was a need for it, then it would have happened? I also wasn't needed to do the 6 min walk? Is that normal too?
If there is no obstruction, can that mean there's no copd? There doesn't seem to be asthma... so this may be something completely different etc? I know your not medically qualified so don't worry won't take any response as gospel etc!
Yes, I'll keep taking the clenil but hopefully will know soon enough, because if its not either then I shouldn't even be taking inhalers?! And what damage is it doing of I don't need it??
But then its finding out what it is? As its definitely not just in my head... could this be to do with breathing patterns disorder etc...
It's just the waiting game now...
So, you can’t have COPD without obstruction. It’s as simple as that. Even with really good fev1 and fvc, you would still have obstruction showing in the fev1/fvc ratio figure. You can have asthma with normal spirometry if it’s mild and you had no symptoms at all at or around the time of testing, because the obstruction in asthma is only present when the airways are narrowed. Or if you’re well managed on medication with little to no symptoms at all, including the use of inhaled steroids. That’s talking specifically about asthma in relation to spirometry, though, not full PFT. I don’t actually know what shows during PFT - if anything - in relation to asthma if someone is asymptomatic at the time of testing. I now know what I’ll be doing this afternoon 😂 With regards to the exercise tolerance test (the walking test), again, without knowing which tests you did have it’s difficult to comment, but generally they would only do that if they felt (or tests showed) it was relevant and necessary.
It’s a more unusual finding because the conditions are more uncommon, but pulmonary function testing (including spirometry) also helps diagnose restrictive respiratory issues. These are most generally lung conditions that fall under the heading of interstitial lung diseases, but restriction can also happen for non-respiratory reasons, including obesity. Restrictive conditions are not an area of specific interest in my case, but I have read around them a little bit. My understanding is that, although some people will have an abnormal fvc, all three of the ‘primary’ readings looked at with spirometry can sometimes be normal in ILDs. By comparison and as explained before, in obstructive conditions, even if fev1 and fvc are normal, the ratio won’t be. For picking up ILD/restrictive conditions, looking at the total lung capacity and gas transfer during testing is much more useful, and full PFT usually covers that. It would show in a reduction in the total lung volume recorded, and values known as DLCO (aka TLCO), and also the KCO. These relate to how well the lungs are transferring various gases including carbon monoxide. However, if there was evidence of restriction, I would anticipate they would get in touch you with pretty quickly for a ct scan as they would want to establish what type of ILD you have. All of that said, I would also stress that full pulmonary function testing is not something they only do if they’re suspecting an ILD, it is something quite frequently done in patients where they want to make sure they’re not missing anything, and with the impact covid has had on diagnostic testing, full pft is probably the quickest and easiest way to comprehensively assess someone for any lung disease at present. Equally, a request for a CT scan in coming weeks would not be a reason to immediately panic, as CT is useful in most respiratory conditions, including to rule respiratory conditions out.
Unfortunately, the bottom line is you need to wait for a follow up or feedback on the PFT results. The good news is that if you have an obstructive condition, that will be obvious and they should be able to advise on treatment going forward. Restriction will also be apparent, and if they’ve found that, then it’ll most likely be a CT scan next to try and determine which one and starting you on appropriate treatments. If the testing was normal, that will tell you it’s dysfunctional breathing at the root, and you can look at ‘retraining’ your brain and body with regards to that. Respiratory physios and physiologists can support with DB where required, although availability on the NHS depends on the hospital you’re under and local provision. I wouldn’t personally be concerned about unnecessary use of an ICS at the moment - obviously it’s not ideal to take something you don’t need, but the odds of it causing problems is extremely small. Whilst everyone is different, it may be a little bit reassuring to know my daughter was completely unnecessarily taking inhaled steroids for about 6 years, sometimes at extremely high doses, and it hasn’t caused her any harm. That doesn’t mean I was best pleased when we found out, though, so I do understand your concern.
Have you had a date for a follow up with the consultant?
Thanks Charlie,
Taking all the above into account, does that mean because she's said that reversibility is not needed, which must be due to no obstruction/tightness (she specifically said there's none that's why not needed), or can you think of any other reasons why she may have said not needed? Therefore, to this its unlikely that there's no COPD or Asthma? Or maybe Asthma only but mild and wasn't showing due to no narrowing etc? Is this correct?
Would there be fev1/fvc ratio figures without reversibility etc? This was a full PFT with gas tests and quite a few tests tbh, so I'm guessing it should show on there?
What kind of ILD/Restrictive conditions do you mean? I'm a little overweight but not too much tbh, I think I've been putting on more weight when since started on inhalers... when I first got suspected pneumonia roughly 2 yes now, I think I was given some steroid tablets and these resulted in gaining weight since then never been able to shift it...
Yes, I'll just have to wait for the results and see if they want me for a CT scan like you said.
I will be very shocked if its DB issue, can this cause SOB and other issues?
OK thats great to know that the ICS won't really cause much damage, I'm not really on a high dose tbh... I take 2 puffs on a morning and just 1 on a night of Clenil Modulite 100 mcg (checked with Asthma nurse and she said its OK to do this).
Yes, I'm sorry to hear about your daughter, I'd be livid too!
No date was given for follow up, but technician said consultant would have results overnight? But to call the Dr's secretary in a few week's? Which coming to think about it is a bit strange why it should take that long... unless she meant days and not weeks lol
My understanding is that if she explicitly said there is no obstruction, that would fully explain no BDR being done. You can’t reverse something that’s not there to start with. If there was definitely no obstruction, that rules out COPD, but it wouldn’t rule out mild asthma, as long as you had no symptoms at the time of testing. If you were having symptoms as you were doing it and still had no obstruction, that would also make asthma if not a definite no, then pretty unlikely. Ratio is a principle part of spirometry - you can’t do the test without obtaining that figure, and they wouldn’t be able to tell you whether you were obstructed or not without it.
Obstructive diseases impair someone’s ability to exhale fully, restrictive ones impair the ability to fully expand the lungs. ILD is an umbrella term encompassing a large number of different lung conditions, many of which are restrictive. They can be idiopathic in nature (meaning we don’t know the cause), or caused by exposure to certain substances like asbestos, the use of some medications, or as a consequence of other underlying diagnoses, particularly autoimmune or connective tissue diseases. They range from conditions that can sometimes spontaneously reverse and be recovered from after a period of time, through to progressive conditions where the prognosis is quite poor. There are a few members here with various ILD diagnoses, the most common one probably being idiopathic pulmonary fibrosis (IPF). Sarcoidosis is another more common form of ILD, but all ILDs are rare overall - my understanding is you’re probably talking about a total of tens of thousands of patients in the U.K for all ILDs combined. The IPF patient registry at the end of 2019 contained less than 2500 patients at that time diagnosed with the disease.
The general rule of thumb across all the specialties we deal with seems to be to allow an absolute minimum of two weeks for test results to reach and be assessed by the consultant, and/or be fed back to the GP. As to whether or not DB could cause sob, the short answer is yes, absolutely. It can also occasionally, in certain circumstances, lead to low oxygen levels as was the case with my teen, but the NHS recognises a whole host of symptoms that are attributable to breathing pattern dysfunction, including breathlessness, dizziness, palpitations, pins and needles, gastro upset, back and neck pain, fatigue, and difficulty concentrating. It’s also not always obvious, either: it took a formal test in a lab to be able to recognise my daughter’s issue, and she attends arguably one of the top 5 respiratory hospitals in the world. Everyone there knows about and is trained to recognise DB, including the physios etc., but it isn’t always easy to spot. In Bod’s case, she has very high levels of generalised anxiety as a result of being high functioning autistic, but she also had a really bad spell of chest health where she spent almost 5 out of 12 months in hospital with infections and pneumonia. Her particular pattern of unhelpful breathing is what your body is forced to do when you have a really bad chest infection: the working theory is that she became accustomed to breathing like that when she was unwell to the point it became habitual even once she was more stable again, and prone to worsening in line with fluctuations in her stress and anxiety levels. It’s believed that about 30% of adult patients with asthma also have some degree of DB, so there can be a link with underlying chest disease. It’s not always either or.
Hi Charlie, the technician said that there's no 'tightness' in the airways so was able to get a reading of whatever was needed without the reversibility aspect? I'm guessing that's what she meant as she said there would be no point doing it as it would give the same readings? Can this be taken as there's no obstruction?
I don't think I was having symptoms while I was doing the test. I was a little out of breath but that's due to doing all the tests and the process of them... she had said I'd done well in performing the tests but not let any more info then that tbh...apart from saying there's nothing urgent she could see... I wish I'd have probed a little further but I was anxious before I went in to the test, as its new and this inhaler makes me like that tbh...
Yes, I understand what you mean by ILDs now, will have to wait and see and find the out what the results show.
It may well be DB issue, I have breathlessness, dizziness, back and occasional chest ache, my back aches and chest only aches occasionally, my ribs ache from the back, so its difficult to explain etc... I feel like when I exhale it feels a little muffled and very occasionally just a slight wheeze. This started from my ribs aching at the front and now it's just really at my back on either side of spine. I do have GAD but I think this is heightened by thinking I can't breathe at times and also inhalers!
Oh, I'm really sorry to hear about what your daughters been through and hope she's on the mend now👍
Can I ask if there's any specific questions you ask the consultant if you was me?
I'm very grateful for all the information/advice and your time that you have given me too, so my deepest thanks for that too 🙏😉
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