FVC Test Results

[azt219]

On 12/4/2023 at 4:22 PM, Neeranam said:

I wanted a 2nd opinion so went to the local govt hospital and got another test. 

 

See the doctor next month. Here's the results. 

I don't know if it's better or worse. 

 

 

 

It's basically the same as your last one, from your post in Feb.

 

I think Sheryl misread the last one.

 

Your FEV1/FVC is only at 65.9% which is very slightly below normal, your %predicted is 86% which means you're about 15% off normal currently.

 

The suggested clincal picture is that you have some sort of obstructive lung disease from your results.  The most common causes are Asthma and COPD.  Do you have a smoke history?  There are certainly other causes and if you're a non smoker, it's definitley worth investigating further, sometime it's very benign things like bronchiectasis caused by infections, but sometimes it can be more serious things like aspergillus, immune deficiency, or sarcoidosis as another poster suggested.  There's a lot it can be, and depending on how you're feeling, might warrent further investigation.  

 

I wouldn't fret too much right now, even at 86% %pred, it's only very mild disease.  If you smoke, the advice would be to stop smoking, as it will only get worse, and it will get to the point you require oxygen at home if you continue smoking heavily (that is if it is the cause of this)

[Sheryl]

As aboive, the results -- if they can be relied upon -- suggest mild  obstructive lung condition but would need to be interpreted together with your clinical picture and history (which, if memory serves, includes a long bout of COVID?)

 

It has been my experience that these tests are often poorly administered in Thailand  )(incorrect/inadequate instructions etc) leading to results often being not so reliable.

 

If you are really troubled by persistant or worsening respiratory symptoms you should invest in a trip up to Siriraj, Hua Hin is not the place to try to investigate this

[Neeranam]

8 minutes ago, azt219 said:

 

It's basically the same as your last one, from your post in Feb.

 

 

 

The suggested clincal picture is that you have some sort of obstructive lung disease from your results.  The most common causes are Asthma and COPD.  Do you have a smoke history?  There are certainly other causes and if you're a non smoker, it's definitley worth investigating further, sometime it's very benign things like bronchiectasis caused by infections, but sometimes it can be more serious things like aspergillus, immune deficiency, or sarcoidosis as another poster suggested.  There's a lot it can be, and depending on how you're feeling, might warrent further investigation.  

 

I wouldn't fret too much right now, even at 86% %pred, it's only very mild disease.  If you smoke, the advice would be to stop smoking, as it will only get worse, and it will get to the point you require oxygen at home if you continue smoking heavily (that is if it is the cause of this)

Thanks very much for explaining that!

 

I quit smoking 10 years ago; I was heavy from about 19-39. 

I found I couldn't breathe so well after Covid and the first doc I saw gave me Serotide 50/500.

He thought is was asthma but said I'd need a special test to find out for sure. Then, a few months later, when the spirometer test had no increase after the  ventolin, he said emphasema. I run 20 km a week so found this odd and went to another hospital. I see the specialist next month. 

I had asthma, seemingly, when I was a baby but never again, leading a sporty life. 

 

Thanks again. 

 

 

[Neeranam]

3 minutes ago, Sheryl said:

If you are really troubled by persistant or worsening respiratory symptoms you should invest in a trip up to Siriraj, Hua Hin is not the place to try to investigate this

Thanks Sheryl, I'll keep that in mind. 

I actually have no real breathing issues right now, unless I stop the serotide I take, which I tapered myself from 50/500 to 25/125 as I felt I didn't need the higher dose. Tried to go down to 25/50 but didn't feel right. 

[azt219]

5 minutes ago, Neeranam said:

Thanks very much for explaining that!

 

I quit smoking 10 years ago; I was heavy from about 19-39. 

I found I couldn't breathe so well after Covid and the first doc I saw gave me Serotide 50/500.

He thought is was asthma but said I'd need a special test to find out for sure. Then, a few months later, when the spirometer test had no increase after the  ventolin, he said emphasema. I run 20 km a week so found this odd and went to another hospital. I see the specialist next month. 

I had asthma, seemingly, when I was a baby but never again, leading a sporty life. 

 

Thanks again. 

 

 

 

You need to calculate your smoking pack years.  If you smoked 1 pack a day for 10 years, then you'd have 10 pack years.  

 

If your pack years is less than 10, then it's less likely COPD.

 

Given you had this after COVID, it's very likely COVID related lung changes.  CT might help to assess and get clearer pictures of the extent of damage to your lungs from COVID, but I suspect treatment won't change, which is what you're already on, the inhalers - some kind of salbutamol and/or steroid inhaler. 

 

Sherly is also absolutley correct, these lung function tests are completley user dependent, it requires you to follow the instructions of the test, so if you didn't the results would be massively misleading.  The worry here might be communication between you and the test administrator as they would have to tell you the instructions in what may have been broken English or in Thai, and you might not have been able to follow as correctly as possible.  

 

emphysema could certainly explain the lung function test results you show, but odd to jump to that given your condition isn't so severe based on your tests, still possible but I'd expect worse results.  but your doc is not wrong re: CT. if you had emphysema then doing a CT will either diagnose it or rule it out since it will be faily visitble on the scan.  

 

my hunch is that this is likely COVID related, but a thorough doctor (absoluetley depends on their experience and confidence, as well as how you present when you see them) may request further investigations to rule out autoimmune diseases or other immune conditions, that could cause this picture, and a CT certainly isn't a bad call I would argue.  

[Neeranam]

38 minutes ago, azt219 said:

Given you had this after COVID, it's very likely COVID related lung changes.  CT might help to assess and get clearer pictures of the extent of damage to your lungs from COVID, but I suspect treatment won't change, which is what you're already on, the inhalers - some kind of salbutamol and/or steroid inhaler. 

Is there any chance it is reversible?

Could the vaccines have anything to do with it? Astraz/Moderna

[gerrybpattaya]

On 2/2/2023 at 11:56 AM, Sheryl said:

 

I have severe COPD and live in Pattaya, I completely agree with your views and have found that both COPD specialists leave a lot to be desired. I 

recently had my medication changed with has virtually destroyed me but my doctor refuses to change to another option. My neext step will be to make an appointment at Banfrumgrad Hospital who have real specialists.

 

Your results  are all normal as far as I can tell.  Even the results in the 70 - 86% range are well above thresholds for diagnosing pulmonary disease to the best of my knowledge. But I am most definitely not an expert.

 

I suggest you not  continue with either this doctor or this hospital.  Small private hospitals upcountry in no way have the level of expertise found in Bangkok even if affiliated with a Bangkok based chain. In fact, unless in Chiang Mai or maybe Pattaya, I generally advise people away from private hospitals in the provinces.

 

Since all this started after you had COVID, the effects of COVID are indeed the likely explanation. After effects of COVID are many and varied and still not well understood. Fortunately most improve with time as it sounds like yours have done.

 

Since you have no breathing issues now and can even run 5 km, swim etc without difficulty I think the only real issue is whether and how you can now safely come off the inhaler.  Note that this has to be done through a gradual tapering, not suddenly as that can trigger problems with more than your breathing.

 

I suggest you come up to Thonburi and see one of this pulmonologists there:

 

https://www.siphhospital.com/en/medical-services/doctor-biography?id=68

 

Same doctor can also be seen at Thonburi Hospital on Tuesday evenings and Saturday mornings

https://www.thonburihospital.com/searchdoctor

 

 

 

 

 

[Sheryl]

On 12/7/2023 at 6:37 PM, Neeranam said:

Is there any chance it is reversible?

Could the vaccines have anything to do with it? Astraz/Moderna

Impossible to say re reversability given lack of clear diagnosis. But it does not sound severe nor  like  you are very limited by the problem at present? While CT  scan etc may shed more light they are nor likely  to smalter management. 

 

The vaccines had nothing to do with it. The COVID and your smoking history likely do.