Ok, I understand that CF is an obstructive disease that is not fully reversible and asthma is generally a fully reversible disease. Ok, so here are my questions. My children also have asthma so when they do pfts they usually do pre and post bronchodilator. Do cf clinics do pre and post bronchodilator on ALL cf patients, or only those with an asthmatic component? My other, bigger question is on my non-cf child who has asthma. He's been diagnosed with asthma based on the basis that he has symptoms (wheezing/coughing/ and/or shortness of breath) with illness and exercise and he has an "obstructive flow loop" on pfts. He also has never had a "normal" pft even on advair 250 and even after a week of oral steroids in addition to the advair (highest FEV1 was just at 80% but small airways are usually in the 60% even when the FEV1 is 80%). The other thing is his PFTs have NEVER improved after albuterol and his peak flows only improve marginally (20 pts max even when wheezing. His normal is 425). They said that doesn't indicate that he doesn't have asthma, it just means his problem is inflammation, not bronchoconstriction. Does this sound right to you? He had a negative sweat test but has never had a genetic test for cf. I guess I'm just confused because I thought you had to have reversibility with a bronchdilator to qualify for an asthma diagnosis?? Any thoughts welcome. Thanks!
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Luke or anyone with RT experience or thorough knowledge of PFTs
- Thread starter anonymous
- Start date
this is a difficult case to diagnose without all of the data. The problem with making any diagnosis is that you have to fit pieces of a puzzle together and I do not have all of the pieces.
You have done your homework, good job! It seems as though your doctors are on the right track but have told you conflicting information. You are correct; you can not make a true asthma diagnosis without the presence of reversible airway disease. The FEV1 and FEF25-75 values you stated may be absolutely normal; the abnormal part is the Flow Volume Loop. I would have to see the FVL to see the obstruction; yes it can be obstructed in different ways.
Let’s assume it is an obstructive lung defect. There are 5 disease that cause this:
1. Cystic Fibrosis, ruled out via sweat test, probably needs genetic testing
2. Asthma- does not show reversing component, can not preclude asthma, but further testing is needed
3. Bronchiectasis- nope to young
4. Emphysema- nope to young, there is a rare genetic disorder, but still too young
5. Bronchitis-this one fits a little better, is not reversible, caused by inflammation, sounds right
Maybe a combination of Bronchitis and hyperactive airway disease. Has your child ever been tested for allergies?
As for the CF question, I have seen it either way, pre/post or not we normally do not reverse but it never hurts to check.
Hope this help...I was assuming your child was pediatric age
luke
You have done your homework, good job! It seems as though your doctors are on the right track but have told you conflicting information. You are correct; you can not make a true asthma diagnosis without the presence of reversible airway disease. The FEV1 and FEF25-75 values you stated may be absolutely normal; the abnormal part is the Flow Volume Loop. I would have to see the FVL to see the obstruction; yes it can be obstructed in different ways.
Let’s assume it is an obstructive lung defect. There are 5 disease that cause this:
1. Cystic Fibrosis, ruled out via sweat test, probably needs genetic testing
2. Asthma- does not show reversing component, can not preclude asthma, but further testing is needed
3. Bronchiectasis- nope to young
4. Emphysema- nope to young, there is a rare genetic disorder, but still too young
5. Bronchitis-this one fits a little better, is not reversible, caused by inflammation, sounds right
Maybe a combination of Bronchitis and hyperactive airway disease. Has your child ever been tested for allergies?
As for the CF question, I have seen it either way, pre/post or not we normally do not reverse but it never hurts to check.
Hope this help...I was assuming your child was pediatric age
luke
Thanks, Luke. My ds is almost 15, and according to his drs, almost fully grown. Not sure how they know that though. Anyway, both the pulmo and the RT at the clinic said that his flow loop is obstructive. He does go to the same clinic as his sister and brother. It's a satellite clinic of Riley's children's hospital. The drs are part of an accredited cf clinic but the satellite clinic sees kids with all types of pulmonary conditions. He did have allergy testing last year but tested negative which surprised me since everyone else - me, dh, sister & brother all have allergies and asthma. Can you have bronchitis for a long period of time (as in months to a year?) The pulmo did say that if one of his numbers were just a little different it would be indicative of a totally different disease. I guess I just need to pin him down better and ask him to show me the numbers. He likes to make the children feel more grown up so reviewed his pfts with ds but did not show them to me - just told me what they meant. I think I will ask for a copy next time and a genetic test just for my piece of mind.
Thanks again!
Dawn
Thanks again!
Dawn
chronic bronchitis can last a while, it probably should have decreased somewhat with the steroids though? Not an eazy case. Sorry I can't help you more. I would encourage you to see a pediatric pulmonologist if you haven't already. I do wonder what his FVC is, do you know it? Does he have curvature of the spine? I just wonder if it is a restrictive diease with a secondary obstructive component, they should have caught that though?
luke
luke
Thanks, Luke. He is a pediatric pulmo but he & I have not hit it off very well. This is the group that told us that we should "just" have youngest ds's sinuses surgically cleaned every year to manage his sinus problems (he was 5 at the time, 1 year post op from his first surgery. Thanks to his allergist and ENT we have made it another year and a half and may make it another year <img src="i/expressions/face-icon-small-smile.gif" border="0"> ) Anyway, oldest ds does not have curvature of the spine but he does have a "sunken" chest (can't remember the name). The allergist and pulmo both said he had some mild restrictive "issues" related to that but that it was nothing to worry about. I didn't see his FVC but was told it was not normal. According to the pulmo, the only number that is ever "normal" or close to normal is FEV1. He goes back in April and I will definitely ask the RT for a copy of the pfts this time. As far as the steroids, to be honest, I'm not sure if they help. He had been on advair for a few months and had just finished his first 5 day burst of prednisone when they did the first set of pfts. Those pfts were a little better than any of the others. His last ones were the worst so they put him on another 7 days of prednisone but didn't retest him when he finished. This all started in August.
Thanks for your input, I really appreciate it.
Dawn
Thanks for your input, I really appreciate it.
Dawn