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Question about Pulmonary Function Tests


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#1 Stef

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Posted 26 February 2009 - 02:51 AM

Hi Everyone!

I had a question about pulmonary function tests (PFT's) which has been puzzling me, and wonder if anyone has an answer.

I'm familiar with PFT testing (I've been asthmatic my entire life), but I'm wondering if anyone knows if PFT results in an asthmatic patient would be able to differentiate between asthmatic problems and other problems (as in scleroderma or lupus changes in the lungs)?

I take two medications daily (Advair Diskus and Singulair) to help control my asthma (which is typically moderate to severe), but have had issues the last 3 to 4 months or so. I've been experiencing shortness of breath that feels different from my asthma issues, and at times have sharp pains when I breathe deeply around the left side of my chest (around my heart). I'm not running a fever (I thought of pleurisy, too!), but I can't shake the uneasy feeling I have that my lungs seem different. I had a chest x-ray in December which was clear (I actually had bronchitis and was treated at the time).

I see my regular rheumatologist today (and yes, for those of you that remember, unfortunately I am stuck seeing the same doctor I wrote a post about last month detailing how bad the appointment was!). I saw the specialist in Pittsburgh, but he is to be seen on a consult basis, which means I have to find a new rheumatologist, and unfortunately, there's not many around my immediate area. I hope this doctor listens to me this time.

Please let me know if anyone knows in depth information about PFT.

Thanks so much!

Stef

#2 Shelley Ensz

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Posted 26 February 2009 - 03:41 AM

Hi Stef,

I'll be sending good wishes away for your rheumatologist appointment today. I hope it goes better for you than last time.

Please keep in mind I have no medical training at all and verify everything I say with a reliable medical source. As I understand it, when they suspect (or as in your case, know) a patient may have asthma, they do the PFT with an inhaled bronchodilator challenge. They take readings first, then the inhaler, then more readings. That helps them sort out whether (and to what extent) any impairment is due to asthma or other issues.

Generally speaking, they might ask you to skip your asthma medications the day of your test. However, at my husband's last PFT (he has severe COPD with asthma and emphysema) they said they could no longer request (or perhaps it was "require"?) that. My impression was that may be for reasons of legal culpability. But you can see how, if you have asthma, and you take meds right before the PFT, it's probably not going to show any significant difference with the bronchodilator, so they could conceivably say you don't have any evidence of asthma on the PFT, either.

But the answer is yes, they can pretty much tell the difference between asthma and other causes with a PFT, if they also do the bronchodilator challenge. For my husband, when he was initially diagnosed, they also put him on a high dose of prednisone for just one month, to see how much lung function would be restored with it. I believe that also gives them some idea of the extent that asthma could be influencing his breathing (but perhaps it was the emphysema angle; I'm not certain.)

Scleroderma lung involvement (pulmonary fibrosis) is also visible in other tests such as CAT scans. In my case, fibrosis shows up clearly on x-ray, but in mild or initial stages it often does not show up on x-ray. But, if your x-ray in December was clear, that is good, and that alone qualifies you to do one fling at the Sclero Happy Dance today. Hopefully your rheumatologist appointment goes okay, giving you the chance to do two whirls on the dance floor. Be sure to take your asthma medications first!
Warm Hugs,

Shelley Ensz
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International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099

The most important thing in the world to know about scleroderma is sclero.org.

#3 fortson

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Posted 26 February 2009 - 08:45 AM

Hi
I'm new to post but have been lurking for more than a year. Anyway, I recently had a PFT and the tech was able to tell me that from the readings I had an obstructive problem which would include things like asthma or COPD while any shortness of breath would be related to a restrictive problem.

So the answer to your question is that they can tell the difference between asthma and sclero related problems and this was before they gave me the inhaler. Hope this helps
Cindy

#4 janey

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Posted 26 February 2009 - 09:03 AM

Cindy,
Welcome! Glad to see that after lurking you decided to show yourself. :) We're glad you joined us. So have you met with you doctor to discuss the results of your pft? Do you have a diagnosis of sclero? May I suggest that you start a new post and introduce yourself. We'd all love to know you better.

Stef - As both Cindy and Shelley have said, yes to your question. They don't even do the inhaler with me any more because the before and after were always the same. My pulmonary doctor said that sclero caused lung problems aren't affected by the albuerol (bronchodilator).

So how did your appointment go with your rheumatologist?

Big Hugs,
Janey Willis
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International Scleroderma Network (ISN)

#5 debonair susie

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Posted 26 February 2009 - 10:13 AM

Hi Cindy,

I too, would like to welcome you here! Like Janey said, I'm glad you've posted at last!
Usually, once a person posts, they're much more comfortable and find they post more often and get pretty good response from the other folks from this community!

I hope that you can get answers to your satisfaction. Both Shelley and Janey provided great suggestions for you.

Let us know how you are doing, okay?
Special Hugs,

Susie Kraft
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International Scleroderma Network (ISN)

#6 JustME

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Posted 26 February 2009 - 11:36 AM

Have you had an echocardiogram yet? If not that should be the first thing you do. You have all the same symptoms I did and they finally diagnosed me with pulmonary hypertension (PH) which is related to scleroderma. I'm not saying this is what you have but you need to rule it out. It took me 2 years to get a doctor to listen to me.

#7 Stef

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Posted 27 February 2009 - 07:36 AM

Thank you for all the wonderful information!
I saw my Rheumatologist yesterday, and the appointment was MUCH better! I started our appointment by being very open and addressing his behavior from the last appointment...and he was genuinely apologetic!
My meds were adjusted. My Prednisone was doubled to 20mg daily, I'm to remain on the Plaquenil (200mg twice daily), and will now begin taking Methotrexate once weekly (3 pills the first week, then 6 each week after). I must have labwork done every 2 weeks while on the medicine as I have some underlying Liver issues.
I had a chest x-ray yesterday, as the Dr felt I may have Pleurisy. He also wants me to schedule an Echocardiogram next week to make sure everything is ok, as I've had these sharp pains in my chest and some minor swelling of my lower legs and abdomen. I was also given a prescription for a mild diuretic to help with the swelling.
I should be having PFTs done sometime soon once we see whether or not the chest x-ray shows anything.
Thanks, again, everyone!

- Stef

#8 debonair susie

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Posted 01 March 2009 - 11:52 AM

Thanks Stef, for sharing your news!

We always like to read good news!

I'm glad you spoke with your dr and really happy he apologized to you. Maybe he was just having a rough day?
At any rate, what a great thing for him to do... Hopefully, this leads to a great dr/patient relationship.

I hope that the medication doses work well for you and that you are able to notice positive results. I'm also glad to read that they'll be carefully monitoring you with labs.

Please let us know how your echo turns out, as well as when you'll be having your PFT.

This IS all good, hopefully gaining alot of insight into what's going on with you.
Special Hugs,

Susie Kraft
ISN Support Specialist
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International Scleroderma Network (ISN)