Interpreting spirometry test results

[MaisieGray]

Good morning. I am new here. I recently had a spirometry test due to symptoms of frequent cough, breathlessness, and chest pain/discomfort that goes up into my throat and bizarrely, my ears. I am 40 yrs hypothyroid, and have aortic regurgitation requiring surgery "sooner rather than later", so both a possibility for playing a role in those symptoms. I also have hypertension, essential tremor, spine deterioration and kyphoscoliosis, so I don't know how much my symptoms are affected by the propranolol I take for the tremor, or by the two-plane curvature of my spine. I am 66 yrs old. To get to the point, attending my GP for the test results today, has left him, and definitely me, confused. I've no familiarity with asthma so the key phrases don't roll easily off my tongue, so please bear with me. He looked at one screen and said my result was 102% what it should have been, which seems very much at odds with what might be expected from my symptoms; but he then looked at another which gave a result of only 45% and mentioned small airways. He was initially going to prescribe a 4 X daily use of ventolin but then said it worked in an opposing way to the propranolol so decided against that for now, and instead has asked me to have a reversibility spirometry test to see what effect that has. My apologies for the Janet & John-type description, but can anyone give me a clearer explanation please, of what might be going on re those test results?

[hilary39]

Hi there! Sounds like you have a lot going on and I'm sorry asthma might be heaped on top of it!! It sounds like your FEV1 is normal (the reading that's 102%). That's the measurement of your big airways and how well they're working so that's good. Many asthmatics do have much lower scores for the small airways readings on the spirometry--mine are typically between 50-75% anticipated. Your doctor is probably going to do a few challenges to see how you respond to determine whether you have asthma or another lung condition (or something else entirely).

He might have you do a spirometry before and after using ventolin--if there is improvement than it is probably asthma. He might also do a methocholine challenge to simulate an asthma attack and measure what happens to your airways. The test can be a bit uncomfortable but typically taking ventolin afterward (which they will give you) helps clear up any discomfort.

There are many great websites that explain how spirometry works such as this one healthline.com/health/spiro....

Keep educating yourself and asking us and your doctor(s) questions. It's the best way to make sure you get your asthma under control if that's what this is-

Take care, hope you are breathing better soon.

[MaisieGray in reply to hilary39]

Many thanks hilary39 for your informative reply, and for the link which I'm going to read now. My GP didn't mention the methocholine challenge so thank you for mentioning that too, I will read further on it, and raise it with him. Your help is much appreciated.

[Hidden]

Hi

The issues you describe:

frequent cough, breathlessness, and chest pain/discomfort that goes up into my throat and bizarrely, my ears

Are all symptoms of LPR (silent reflux). This is distinct and separate from GERD or acid reflux.

You should investigate it online to see if it is a possibility.

Cheers

[MaisieGray in reply to Hidden]

Thank you for raising that Hidden . Interesting. I hadn't thought of that as a cause, as hypothyroidism can often result in there being low, rather than high stomach acid, which I assumed might be the case with me and part of my wider IBS issue, although I've never checked it out. But LPR is definitely something to think about and I'll do some further reading as you suggest. Thank you.

[Mogget]

Hi MaisieGray, I’m sorry to hear you’re going through all this. I’m a fellow asthma and hypothyroid sufferer. I’m still unsure whether my thyroid has any impact on breathing issues but my feeling is there is a link. Especially when I’m feeling very tired and ‘heavy’ my chest can be dragged into that too. It’s a shame sometimes that specialists are so stuck in their own fields and don’t always consider the body holistically. I do wonder whether getting on top of my thyroid problems (thyroxine doesn’t solve it all for me) would help with the asthma.

You’ve had some great advice on the spirometry. Mine came out at 113% (I think it; it was above average anyway) last year but I still have a diagnosis of severe asthma and frequent exacerbations. I don’t wheeze but do get tightness and chest pain. I did react to a mannitol challenge (similar to the metacholine one) which helped me get my diagnosis.

Fingers crossed you get to the bottom of things! Ask away - here, GPs and specialists. As tired as we can be we need to advocate as best we can for good treatment!

[MaisieGray in reply to Mogget]

Hi Mogget . Thank you for your response, I'm sorry I missed it yesterday. Sorry to hear that you too are hypo. Yes it would be better if more connections could be made more readily, although I have to say that my Cardio has a far better grasp of thyroid issues than my GPs do. Whether Cardio training by definition includes more focus on the subject or whether he personally has interested himself, I don't know, but it's very useful to say the least. It's interesting that you say your chest drags into you feeling tired and heavy. I can't for the life of me remember if my chest issues started at the time my NHS T3 was withdrawn in 2017, although I think so as I had a chest X-ray that year as well - and if so, would seem to indicate a possibility that there is a connection or trigger there, as my FT3 level nose-dived. There seem to be a number of studies reporting the connection between the two disorders, so you've prompted me to read wider, thank you.

Thank you too, for the reference to the mannitol challenge - more info for me to get a handle on in case my GP needs prompting. Thank you again.

[Mogget in reply to MaisieGray]

That’s very interesting.

I think there is some scientific literature linking hypothyroidism and breathlessness/asthma but would need to dig into it all again.

Interesting about the T3. Why was yours withdrawn? Twitchy GP? I guess as you know thyroxine is just T4 and it’s meant to convert to T3 but there are still so many people in the thyroid community who are unwell on that alone as the argument is that the conversion can be impaired for various reasons (are you part of the Thyroid UK community on HealthUnlocked?). I had once considered investigating NDT which contains T3... something to look into again...

[MaisieGray in reply to Mogget]

Re T3, I was told "someone from the CCG was here, happened to notice you were prescribed T3 and said we had to stop immediately" ..... Unbelievable - he wasn't medically qualified, didn't know me or my health, and it went against the guidelines for withdrawal. I then eventually had a private prescription from my GP and had it dispensed in Germany, and also paid to have genetic DIO2 testing privately, which fortunately (!) gave me an homozygous positive result for a particular SNP. Two appeals later with the support of my Endo, it was reinstated. A few years ago I tried both Naturethroid and ThyroidS NDT for a period, and was no better or worse than being on a T4/T3 combo, so went back to that. If you feel you aren't optimally medicated on mono-T4 and your test results show poor conversion, you perhaps should try NDT. When my T3 was withdrawn, my FT3 fell from top of the reference range to the bottom very quickly, so I have evidence that my particular SNP has a direct effect on my conversion.

[Mogget in reply to MaisieGray]

Thank you for this information; I’m currently learning as much as I can about my thyroid disorder and this is very helpful. I’ve started reading Izabella Wentz’ root cause book. I think addressing my thyroid issues may go some way towards addressing my asthma issues. My whole system is out of whack and I need to treat it all holistically!