Hi guys,
I'm a 37 year old male who has recently been dx'd with chronic asthma. I've never had an asthma attack. It's just there slowly eating at my lung function. The lung function decrease was first noticed when I was about 28 yrs old.

I was told by a local small town pulmo that I had COPD even though I have never smoked and don't have A1AD. I decided to go to the University of Alabama in Birmingham and see a doc there. He says it's asthma. CT scan was normal and so were chest x-rays. My full PFT showed a 13% increase in FEV1 with Albuterol.

Was first put on Advair 250. After a month, my spiro results showed a small decline in lung function(59%). Was then put on Advair 500. A month later showed no improvement. Was then put on Advair 500, Singulair and a burst of prednisone. Two months later showed no improvement. I'm back to taking the Advair 250/50 and Singulair and Prevecid(2/day). Hopefully, I'll get some change for the better.

I guess my next step is to go back to taking allergy shots in hopes for improvement.

I guess I'm fairly well controlled because my FEV1 isn't going down anymore. However, it isn't going up either. Do any of you guys have any words of encouragement? I know some of you are on a lot more meds than I am. I'd just like to know I'm not the only one not improving.

thanks
ken

Don't want to sound too pessimistic but thats a lot of steroids and there has been no improvement. It could be irreversible damage or commonly 'airway remodeling' associated with asthma. Unfortunately this could have been prevented earlier in life using corticosteroids at an early age. Studies have shown this. Any optimistic people out there?

Don't want to sound too pessimistic but thats a lot of steroids and there has been no improvement. It could be irreversible damage or commonly 'airway remodeling' associated with asthma. Unfortunately this could have been prevented earlier in life using corticosteroids at an early age. Studies have shown this. Any optimistic people out there?

That's what I'm afraid of too. It gets really frustrating when you realize the first pulmo just gave me an albuterol inhaler and sent me on my merry way. He just said to come back if it got worse. He had full PFT results right there in front of him (including the 13% increase) and still made no efforts to improve my lung function. He was just so baffled that I didn't smoke but "had COPD" according to his beliefs. He didn't order a CT scan or anything. If he had, maybe he would have seen that the results were normal and then dx'd the asthma. It was only last year that I decided to seek better health because I was using that inhaler twice a day.

That's what I'm afraid of too. It gets really frustrating when you realize the first pulmo just gave me an albuterol inhaler and sent me on my merry way. He just said to come back if it got worse. He had full PFT results right there in front of him (including the 13% increase) and still made no efforts to improve my lung function. He was just so baffled that I didn't smoke but "had COPD" according to his beliefs. He didn't order a CT scan or anything. If he had, maybe he would have seen that the results were normal and then dx'd the asthma. It was only last year that I decided to seek better health because I was using that inhaler twice a day.
Mad Scientist,
What are your daily symptoms? Do you remember your numbers on your Pft? I haven't shown a lot of improvement either with my Advair 100/50. Maybe I need to up it, but my allergist just said to add Flovent if I felt I needed it. I don't really have daily symptoms, only occasionally. But still I worry that my FEF (small airways) is only about 40% of normal. She didn't seem that concerned , though. My dad had emphysema and smoked , but I have never smoked, I still worry about COPD. I have had that test for inherited emphysema, but it was normal. I have started exercising more and really working my lungs. Thats what my doctor recommended. I have noticed that I can jog a little more without getting winded than I used to. I also have GERD and am overweight. All my weight is around the middle and sometimes is hard to breath after a heavy meal. I know losing weight would help me.I am really interested in natural ways to help my lungs. I hate taking meds! Oh, and I also take a Yoga class and some of the exercises I do really seems to open up the lungs and show you how to breathe properly. Good luck!

Mad Scientist,
What are your daily symptoms? Do you remember your numbers on your Pft? I haven't shown a lot of improvement either with my Advair 100/50. Maybe I need to up it, but my allergist just said to add Flovent if I felt I needed it. I don't really have daily symptoms, only occasionally. But still I worry that my FEF (small airways) is only about 40% of normal. She didn't seem that concerned , though. My dad had emphysema and smoked , but I have never smoked, I still worry about COPD. I have had that test for inherited emphysema, but it was normal. I have started exercising more and really working my lungs. Thats what my doctor recommended. I have noticed that I can jog a little more without getting winded than I used to. I also have GERD and am overweight. All my weight is around the middle and sometimes is hard to breath after a heavy meal. I know losing weight would help me.I am really interested in natural ways to help my lungs. I hate taking meds! Oh, and I also take a Yoga class and some of the exercises I do really seems to open up the lungs and show you how to breathe properly. Good luck!

Howitt I was considering yoga classes to take while it seems like my asthma has taken a break and decided to be nice to me for a little bit=)..or at least until the dreaded pollen season hits=(. Either way I thought that could help strengthen my lungs..how have you found it? Is it it really helping you breathe easier? Does it help decrease coughing also? Or does any of the stuff leave you with late reaction..?

Mad Scientist,
What are your daily symptoms? Do you remember your numbers on your Pft? I haven't shown a lot of improvement either with my Advair 100/50. Maybe I need to up it, but my allergist just said to add Flovent if I felt I needed it. I don't really have daily symptoms, only occasionally. But still I worry that my FEF (small airways) is only about 40% of normal. She didn't seem that concerned , though. My dad had emphysema and smoked , but I have never smoked, I still worry about COPD. I have had that test for inherited emphysema, but it was normal. I have started exercising more and really working my lungs. Thats what my doctor recommended. I have noticed that I can jog a little more without getting winded than I used to. I also have GERD and am overweight. All my weight is around the middle and sometimes is hard to breath after a heavy meal. I know losing weight would help me.I am really interested in natural ways to help my lungs. I hate taking meds! Oh, and I also take a Yoga class and some of the exercises I do really seems to open up the lungs and show you how to breathe properly. Good luck!

Howitt, sounds like we're a lot alike. My symptoms are primarily shortness of breath upon excertion. I used to have a cough all the time until the Advair came along. I can sometimes hear a wheeze also.

I DO have all my spiro results for the past 10 years. I don't have the "full PFT" results with me but I do have the ones from the spirometry tests. My FEF is 38%.

Howitt, sounds like we're a lot alike. My symptoms are primarily shortness of breath upon excertion. I used to have a cough all the time until the Advair came along. I can sometimes hear a wheeze also.

I DO have all my spiro results for the past 10 years. I don't have the "full PFT" results with me but I do have the ones from the spirometry tests. My FEF is 38%.

When you say you have shortness of breath upon exertion, do you mean just getting up and walking or do you mean jogging, walking fast uphill, etc? I have noticed that since I have been exercising, I can do more which is encouraging. I don't get out of breath quite as much. I still can't run a mile or anything, but that is my goal. I do have some allergies, but mainly in the spring and fall. If I use my nasal spray like I should, it helps a lot. I haven't coughed much since I use Advair. I used to get bad coughs every winter that would linger, but this last year I have stayed cough-free even though my son and husband still got the flu. So even though my FEF number is low, I am really not that limited in my quality of life. I just don't want this to get any worse. And to the poster that was asking about Yoga, I haven't been going to classes that regularly. It is once a week, but I have missed some. However, I have learned certain poses I can do at home. You mentioned being good to yourself, it is really a treat to go to class, relaxing and meditative. Its not a class where you push yourself at all. I really enjoy it. One thing we do that really seems to open me up is to sit on one of those big exercise balls and then lay back and kind of wrap your back around it with arms at your sides. Its kind of like doing a back bend with the ball's help! It makes my back feel good, too. I would recommend it to anyone.
Cindy

When you say you have shortness of breath upon exertion, do you mean just getting up and walking or do you mean jogging, walking fast uphill, etc? I have noticed that since I have been exercising, I can do more which is encouraging. I don't get out of breath quite as much. I still can't run a mile or anything, but that is my goal. I do have some allergies, but mainly in the spring and fall. If I use my nasal spray like I should, it helps a lot. I haven't coughed much since I use Advair. I used to get bad coughs every winter that would linger, but this last year I have stayed cough-free even though my son and husband still got the flu. So even though my FEF number is low, I am really not that limited in my quality of life. I just don't want this to get any worse. And to the poster that was asking about Yoga, I haven't been going to classes that regularly. It is once a week, but I have missed some. However, I have learned certain poses I can do at home. You mentioned being good to yourself, it is really a treat to go to class, relaxing and meditative. Its not a class where you push yourself at all. I really enjoy it. One thing we do that really seems to open me up is to sit on one of those big exercise balls and then lay back and kind of wrap your back around it with arms at your sides. Its kind of like doing a back bend with the ball's help! It makes my back feel good, too. I would recommend it to anyone.
Cindy

Oh, Ken, by the way, do you have a peak flow meter and what is your number there? Mine is always good, 450 to 500. That has always confused me. I asked my doctor why my peak flow is so good and my other numbers aren't, and she said, you probably are athletic and have a lot of muscle strength in that area, which I laughed (I am not athletic at all!) I wonder how much variance there is in machines and doctors. I had a PFT done at the hospital almost 2 years ago and I was normal in all areas. This was 2 months after a trip to the allergist and there machine showed I was abnormal. So I went from abnormal, normal, to abnormal again. Its just kind of strange. I guess what I'm saying is how accurate are the machines they use?

When you say you have shortness of breath upon exertion, do you mean just getting up and walking or do you mean jogging, walking fast uphill, etc? I have noticed that since I have been exercising, I can do more which is encouraging. I don't get out of breath quite as much. I still can't run a mile or anything, but that is my goal. I do have some allergies, but mainly in the spring and fall. If I use my nasal spray like I should, it helps a lot. I haven't coughed much since I use Advair. I used to get bad coughs every winter that would linger, but this last year I have stayed cough-free even though my son and husband still got the flu. So even though my FEF number is low, I am really not that limited in my quality of life. I just don't want this to get any worse. And to the poster that was asking about Yoga, I haven't been going to classes that regularly. It is once a week, but I have missed some. However, I have learned certain poses I can do at home. You mentioned being good to yourself, it is really a treat to go to class, relaxing and meditative. Its not a class where you push yourself at all. I really enjoy it. One thing we do that really seems to open me up is to sit on one of those big exercise balls and then lay back and kind of wrap your back around it with arms at your sides. Its kind of like doing a back bend with the ball's help! It makes my back feel good, too. I would recommend it to anyone.
Cindy

Howitt,
My shortness of breath manifests while walking uphill, walking fast on a level surface (Not bad shortness but I breathe heavier), and definitely climbing stairs. Normal getting up and walking around is not a problem. In the past, I have become SOB while putting on my clothes. However, that doesn't happen now that I'm on Advair.

Again, our similarities are close. My quality of life is ok too but I don't want this to get any worse because it could then start to have an effect. Like you, I also had a parent die from lung disease. My mother had Bronchietesis since she was a child which progressed to emphysema. She had never smoked. Her brother died at the age of 35 with the same disease. So I too fear the COPD possibility even though the inherited test and the CT scans don't show anything.

I have a peak flow meter that also measures FEV1. The peak flow on my meter is usually around 340-370. The FEV1 readings have been fairly close to what the docs machines have been showing until this last vist. This last time, I was showing an FEV1 of 2.74 and his test showed something like 2.56. However, this translated to only a 2 or 3% difference between the FEV1 results. Haven't looked at how the peak flows compared yet.

As for your tests jumping from normal to abnormal to normal again, we again have a litlle something in common. Mine has gone from light obstruction to moderate and back to light then back to worse than the previoius moderate then back to moderate. That was one of the key things my pulmo said was really indicative of asthma.

I am also heavy around the middle and I'm trying to lose weight. That will surely help a lot. Running is out of the question. I haven't run since I was in ROTC training in high school.

madsci

Howitt,
My shortness of breath manifests while walking uphill, walking fast on a level surface (Not bad shortness but I breathe heavier), and definitely climbing stairs. Normal getting up and walking around is not a problem. In the past, I have become SOB while putting on my clothes. However, that doesn't happen now that I'm on Advair.

Again, our similarities are close. My quality of life is ok too but I don't want this to get any worse because it could then start to have an effect. Like you, I also had a parent die from lung disease. My mother had Bronchietesis since she was a child which progressed to emphysema. She had never smoked. Her brother died at the age of 35 with the same disease. So I too fear the COPD possibility even though the inherited test and the CT scans don't show anything.

I have a peak flow meter that also measures FEV1. The peak flow on my meter is usually around 340-370. The FEV1 readings have been fairly close to what the docs machines have been showing until this last vist. This last time, I was showing an FEV1 of 2.74 and his test showed something like 2.56. However, this translated to only a 2 or 3% difference between the FEV1 results. Haven't looked at how the peak flows compared yet.

As for your tests jumping from normal to abnormal to normal again, we again have a litlle something in common. Mine has gone from light obstruction to moderate and back to light then back to worse than the previoius moderate then back to moderate. That was one of the key things my pulmo said was really indicative of asthma.

I am also heavy around the middle and I'm trying to lose weight. That will surely help a lot. Running is out of the question. I haven't run since I was in ROTC training in high school.

madsci

When I say "run" I mean a light jog. I try to maintain that for 2 or 3 minutes (about 4 mph) and then go back to walking. It's running to me since I have never been a runner. I monitor my heart rate and my heart rate goes up too much to maintain that speed (I guess until I get in better shape). I know there is an inherited emphysema, but what about the bronchietasis (msp?) that your mother and brother had? Is it inherited? I have never heard of it.
GOOD NEWS! If we have asthma (and I feel sure we do) it can be controlled. It is reversable in most cases. I think it just takes time to get the medications that really work for you and to take them long term. Hopefully, you have a doctor who is taking an aggressive approach, unlike before. You say you have had improvement since Advair, that is encouraging. Don't let this get you down. I have in the past and it kind of took over my life for awhile. I didn't do myself any good and especially my family. I have recently started the South Beach Diet. I feel so much better when I cut the carbs! I intend to get rid of this middle tire and I know I will feel better. Try not to worry, I will be praying for you! :angel:

Howitt,

Here is a blurb about bronchiectasis:


Bronchiectasis
Bronchiectasis (pronounced bron-kee-ek'-tas-is) is a disorder of the airways within the lungs. Inflammation and infections cause damage to the airways with alteration in the lining layer of the airways. The airways become distorted and enlarged. Enlargement can be uniform or irregular. Mucus can collect in the airways and is difficult to clear because of the damage to the normal ways the airways clear the mucus. This can lead to episodes of infection. Early diagnosis and treatment of bronchiectasis and the infections that occur are very important. You may be born with bronchiectasis, or you may acquire it as an adult or child through one or more of the following ways:

Inadvertent inhalation of oral or stomach material into your lungs, causing chronic airway inflammation. Severe gastroesophageal reflux (heartburn) which occurs when the valve or sphincter connecting your esophagus and stomach is too relaxed; may allow a backward flow of stomach contents to enter your lungs and irritate the airways. Impaired ability to swallow may also cause saliva or food to enter the lungs.
Having another chronic lung condition, such as cystic fibrosis, allergic aspergillosis, tuberculosis, other mycobacteria diseases such as MAI, whooping cough (pertussis), or an immune deficiency disease or severe or repeated episodes pneumonia.
Disorders that affect the function of the cilia (small hairs that line the airways).
Obstruction in your airways because of a growth or tumor.
Kartagener's Syndrome, a rare inherited disease that combines bronchiectasis, loss of ability to clear mucus and chronic sinusitis.



Development of Bronchiectasis
First, inflammation to the walls of the airway occurs from any mechanism (listed in the previous section). The inflammation causes injury to the airways. The resulting loss of the normal defenses of the respiratory tract leads to the loss of ability to clear mucus, making the airways susceptible to infections. Repeated lung infections can cause worsening of the damage to the airway walls.



What are the symptoms?
Symptoms of bronchiectasis include a cough with raising mucus from the lungs. With infections the mucus may be discolored and foul smelling, sometimes containing blood. Fatigue, weight loss, shortness of breath and abnormal chest sounds can occur. Occasionally people with bronchiectasis also have chronic sinusitis that requires further evaluation since bronchiectasis and sinusitis may be due to other diseases. If bronchiectasis is not treated, you may experience increasing shortness of breath, rounding at the tips of the fingers (clubbing) from chronic lung infection and possibly heart failure.

It is not hereditary but is caused by repeated lung infections. My mother and her brother both died as a reult of the heart failure associated with the disease. In her last few years, she couldn't even register on the spirometer.

I appreciate the prayers and I'll try to remember you in mine tonight as well.

thanks
madsci

Correct me if I'm wrong, but don't the lungs repair themselves eventually? For example, I heard that if you quit smoking, eventually your lungs get better. I wonder if you take Advair or similar meds for a few years, that there will be an improvement.

I know how you feel, I was diagnosed when I was 18 and my albuterol inhaler was my only form of medication for about 5 years. I puffed on that thing every few hours. I started seeing a pulminologist when I was 28. Now at 34, and taking lots of preventative meds, I feel pretty good overall. Except for the flare ups, when I get colds/viruses. My numbers are always really good when I go in, and years ago, they used to be horrible. So maybe the meds just need time to work.

You should find that if you work out just a little bit every day, you will start to build up endurance. Even if you start with a goal of 5 minutes per day, you will be able to build on that.

Couple of Q's Monacks:

What preventative meds r u on (steroids?)?

If so, do u notice that ur getting colds more often now???

To answer ur question: no. Lungs don't completely reverse damage done to them. If u quit smoking there is obviously going to be some improvement but they will never regain full capacity. Smoking (and asthma) produce lots of oxidants in the lungs which damage them over time leading to what can be thought of as pre-mature ageing of the lung. Its one of those horrible facts of life. Can u answer my Q's though coz Im interested in this stuff. Be honest!

Couple of Q's Monacks:

What preventative meds r u on (steroids?)?

If so, do u notice that ur getting colds more often now???

To answer ur question: no. Lungs don't completely reverse damage done to them. If u quit smoking there is obviously going to be some improvement but they will never regain full capacity. Smoking (and asthma) produce lots of oxidants in the lungs which damage them over time leading to what can be thought of as pre-mature ageing of the lung. Its one of those horrible facts of life. Can u answer my Q's though coz Im interested in this stuff. Be honest!

Just thought i'd throw in my insight 2 your questions..
Since I've been on Advair(a lil less than a year now) I've had bronchitis 3 times, pneumonia, several colds..
I do believe steroids weaken the immune system in any form. The first time I took prednisone, a day after finishing it I got bronchitis. I didn't take care of it and a week later it was pneumonia.
I've never been sick that much in one year..

Actually, yes, I've had a perpetual cold since September. But I've always been sickly and I am at the peditrician's office every couple of weeks with my sick kids, so I am constantly picking up germs. So I can't say for sure if its worse with the meds. I did ask, my dr about it, and he said the meds should be making my immune system stronger, but I have my suspicions....

I am currently taking Advair 500/50, Atrovent inhaler, Singulair, and Allegra, as well as blood pressure medicine and high cholesterol medicine.

Overall, asthma wise, I feel good though. I sued to suck on my albuterol inhaler every couple of hours and used to wheeze and be out of breath all the time. I don't really have those problems anymore, unless I have bronchitis. Granted I am congested alot, but I don't experience the panicky "I can't breathe" spells very often anymore. So I just assumed that my lungs had gotten better. But I am sure that they are damaged and not like a normal person's.

I am really glad though that I found this board. I've gotten alot of useful information and it helps to read that other people have the same types of problems. It seems like people that don't have the disease really don't get it, and I get frustrated sometimes explaining it to people and answering their dumb questions. My husband included; he is not very understanding sometimes.....

Seems like my lungs do better in the summer and winter vs. spring and fall. I can reach 450 in the summer. In the spring and fall it ranges around 250-320. I been asthmatic all my life, but feel i have been well managed for 20yrs. Except when i recently got this terrible virus. It was the worst cold/flu i think i ever had as a asthmatic. It was puzzling. I couldn't breathe half the day. Tried every asthma medicine and techinique known to mankind. It just needed to runs its course. Which scared me, because i felt cocky that my severe asthma attack days were over.
I have friends that have had asthma bad for year and then found out that something in there house was triggering a allergy/asthma attack. Some found out after years of smoking that they were allergic to smoking. Did you say you got allergy tested?
good luck,
Jane

Seems like my lungs do better in the summer and winter vs. spring and fall. I can reach 450 in the summer. In the spring and fall it ranges around 250-320. I been asthmatic all my life, but feel i have been well managed for 20yrs. Except when i recently got this terrible virus. It was the worst cold/flu i think i ever had as a asthmatic. It was puzzling. I couldn't breathe half the day. Tried every asthma medicine and techinique known to mankind. It just needed to runs its course. Which scared me, because i felt cocky that my severe asthma attack days were over.
I have friends that have had asthma bad for year and then found out that something in there house was triggering a allergy/asthma attack. Some found out after years of smoking that they were allergic to smoking. Did you say you got allergy tested?
good luck,
Jane

Your asthma days are NOT over. You should be taking preventative meds daily. You should get a yearly flu shot and also the pneumonia shot. People die thinking they've overcomed asthema. IE: friends smoking with asthma KNOW the smoking is an irritant and are in deniel. There also very stupid.
Blueblaze

Seems like my lungs do better in the summer and winter vs. spring and fall. I can reach 450 in the summer. In the spring and fall it ranges around 250-320. I been asthmatic all my life, but feel i have been well managed for 20yrs.

If you're only getting 250-300 at any time of the year then u should be on preventers! I always laugh when I look back at the time I had grown out of my asthma but I was still on extremely high steroid doses of 2000 mcg a day along with regular albuterol. My peak flows were 650! One of the doctors finally realised I was being over medicated for years and took me off them. He said I had super-human lungs! Just thought I'd add that story. 500-600 is what well controlled asthmatics should be striving for.

If you're only getting 250-300 at any time of the year then u should be on preventers! I always laugh when I look back at the time I had grown out of my asthma but I was still on extremely high steroid doses of 2000 mcg a day along with regular albuterol. My peak flows were 650! One of the doctors finally realised I was being over medicated for years and took me off them. He said I had super-human lungs! Just thought I'd add that story. 500-600 is what well controlled asthmatics should be striving for.

500-600? wow! that is high!
i'm usually lucky if I can hit 400..usually can't without being on singulair(i've been taken off of it kinda)..without it i'm usually 280 in the morning before meds then about 350 in the afternoon when i'm doing alright.
kinda funny b/c i'm supposed 2 be in the hospital under 300 & at 350 & under i'm supposed 2 do neb treatments of Xopenex. or so my PCP says.. pulmonologist I saw thinks I don't even have asthma bad enough 2 be on meds.
once I hit 450 and I was like dancing around the room..haha...though i'm supposed 2 be hitting 500..
though i'm getting better. in january 250 was a number I could only dream of hitting.
lol how do some peak flow meters go up 2 like 850..does anyone ever actually hit that high? just wondering..haha..850 is crazy 2 think about..

Actually I just had a look at my medical records and I was actually hitting 750-800 frequently in the latter years before they started weaning me off steroids! No definitely, to live a normal life u should be getting at least 450-500. I presume u don't excersize very much as it would be quite impossible with your peak flows!