Asthma or some other lung disease?

[DawnV]

I’m a 31 year old woman with two children who has been in fairly good condition in the past. Due to some health problems I have had a hard time doing aerobic exercises mostly. I had overcome some of those, so I started doing light treadmill (2-5 minutes) and discovered I would start yawning, getting light headed, feeling disoriented and muscle tone become a lot less (I’d drop things and generally feel not in control). So, I asked my doctor. Exercise induced asthma. I was given an albuterol inhaler. Then, I was sick and went in with O2 at 83%. Since it was the second time they put me on prednisone that month, they prescribed azmacort. This seemed to help with my exercise for awhile, too. Then, I had an episode and they changed it to advair. When it wasn’t helping much with the exercise, they switched to singulair. This seemed to help some, but I was having some other problems so they sent me to an allergist. The allergist found I wasn’t allergic to *anything*. He ordered a pulmonary function test, but he really didn’t think I had asthma. He also told me to go off all medications prior to the PFT and methocoline challenge. So, that is kind of the background.

My results are as follows:

FEFmax: 9.65 which is 144% of the predicted
MVV: 175 which is 149% of the predicted
My lung volume was similarly high… all the numbers were well over 100%

Diffusion:
DSb(adj) 23.77 which was 74% of what was predicted
Dco(adj) 27.82 which was 86% of what was predicted
VA(sb) 5.22 which was 79% of what was predicted
D/VA(adj) 5.33 which was 88% of what was predicted

My O2 when I was in was 92% and went as high as 95% while I was there, but it has been as high as 99%

The doctor looked at it and said normal. However, when I exercise, I become dizzy, breathe hard, but feel short of O2. I have never had a problem of wheezing… in fact, generally when my O2 is low, I can’t really tell except for feeling tired and ‘fuzzy’.

Some doctors say ‘you obviously have asthma’ others say ‘you obviously don’t have asthma’. I’m very confused and am starting to get really worried about this. I can’t exercise without literally going to my knees and feeling horrible.

Why would my lung capacity be so good if I don’t do aerobic exercise regularly? Could it be to compensate for lower diffusion values? I’m probably going to try and get sent for a second opinion, but none of the doctors seem to think there is much of a problem.

Any help, thoughts, ideas would be really appreciated as I’m having trouble finding much information. Sorry this was so long.

[charleyhorse]

This is a bit of mystery - must be very frustrating. I would go for that second opinion. Obviously something is causing your symptoms. There are several 'asthma mimics' that can cause symptoms very similar to asthma. I know there are a few heart problems that can be tricky to diagnose, and vocal cord dysfunction can cause some pretty strange symptoms if its exercise induced. Did they do an excercise test? I would think with your symptoms that might be a worthwhile thing to do. You have a right to a proper diagnosis here - don't take shoulder shrugging for an answer. Good luck.
Barb

[wrin]

This doesn't sound like an obstructive problem to me at all, in the least.

If I were forced to offer a suggestion as to what this SEEMS TO ME like it could be, I would suggest possibly interstitial fibrosis, if only because fibrosis tends to pooch diffusion while stretching airways and increasing airflow way beyond predicted, but makes it harder to take a deep breath and is helped marginally sometimes by oral corticosteroids.

Keep in mind that I have not done any kind of assessment on you and have done no testing and am just another idiot at the other end of a computer screen offering an opinion.

What I *do* think is that I agree with you -- this sounds hella-weird in a big way, and I'd be very very curious, personally, to see what a chest x-ray would look like.

[cb50]

You may want to ask for a stress test as it sounds vaguely as if it could be your heart, and a stress test would show if this is the case. Because you get dizzy makes me wonder if the blood flow is compromised somewhat. As the above posting said, there are many heart problems that can cause symptoms when exercising, and could be something as simple as a valve not opening and closing correctly. When I was first diagnosed with asthma, a thallium stress test was one of the tests my doctor ordered just to rule that out. And while you're on the treadmill, they can see immediately what is going on...if anything.

Do you get these symptoms any other time, or only when your heart rate is up?

[DawnV]

No, I haven't had a exercise or stress test. That was one of the things we want them to look at. I have had a lung x-ray, and it looks clear (that was for something else). Several years ago I had a ct scan of my lungs, too… again, for something else, and they seemed clear.

Every once in awhile I find myself catching my breath even without exercise; however, the most obvious problems occur when I do any kind of aerobic exercise. When I get sick, my lungs get ‘tight’ and my O2 goes down into the 80s. Even then, though, I can’t tell there is much going on, and after they nebulize me, I can’t tell a huge difference. I don’t wheeze, but have been told in those instances, it sounds like asthma in my lungs. And, my O2 does go up with asthma treatment. I generally just feel a little tired or very tired when that happens.

I had a heart murmur as a baby, but that has since gone away. Nurses have noted that I skip beats from time to time when they are taking my pulse. I haven’t had an ekg since I was 14, though.

Thanks for the suggestions; when I go into the doctor on the 4th, we’ll insist on a second opinion. I let you all know what happens.