No he's not had a methacholine challenge test with the spirometry - he blew into the spirometry equipment and was told the recorded result. He's been given Bricanyl turbohaler, Pulmicort turbohaler and Symbicort turbohaler.
Hi. I'm very confused over this question of whether or not he has asthma. He never responded to inhalers throughout his childhood, also he never made any wheezing noises (my Dad had asthma and he made very distinctive wheezing noises) - the only noises he's ever made are whistling noises on exhalation and some bubbling noises. Also, he never "gasped" for breath but would only be unable to complete a full breath in when ill which is what he's experiencing now. Our GP told us that the turbohalers he's been prescribed since this illness started are the strongest ones that are available and yet they've not helped him one bit. He's been no worse since he stopped using the inhalers than he was when he was using them at the beginning of this illness. Whether or not he's had the challenge spirometry test, wouldn't the strongest inhalers be effective IF he does have asthma?? - so they should have helped his breathing by now? Doesn't the fact that the inhalers haven't improved his symptoms prove that he can't have asthma? Since these inhalers aren't effective then I am EXTREMELY concerned if he could actually have asthma as he's now had these symptoms for 9 weeks and the last couple of days has been coughing up more sputum. We've taken him to 2 GP's 4 times and A&E once prior to seeing the respiratory consultant and everyone has given us a different opinion on whether or not he has asthma. IF he has asthma and these inhalers haven't been effective, then my understanding from his GP is that there aren't any stronger inhalers available so I don't understand what treatment he can have to help his breathing?? Do you think steroids would help?
Are you saying that there is nothing on the CT scan which would account for him having these breathing problems, coughing up sputum and the discomfort and soreness in his chest? Would the mild emphysematous changes account for these symptoms? Can you please answer this particular question.
I note what you say about testing for the antitrypsin deficiency and this is something I'll ask his consultant about. Would you say that it's unusual to find these changes in a 17 year old?
Hi. Thanks for your comment on the CT scan not accounting for his current symptoms - this is something which I was wondering about. I appreciate what you're saying that he's not been fully evaluated for asthma and I agree with you. I just wish someone had done the challenge spirometry somewhere along the line.
With regards ***** ***** he did have an allergy blood test just over a year ago as his lips kept swelling up randomly (not associated with eating). He tested positive for allergy to house dust mites and his IgE was very high. He started taking cetirizine tablets and his lips have never swollen up since then and co-incidentally he's only had one chest infection since taking the cetirizine - until he became ill 9 weeks ago. So I've wondered whether his chest problems are allergy related and yet he doesn't respond to inhalers. Also, he's always found it difficult to breathe through his nose - could this have any bearing on his symptoms?
Other than checking for antitrypsin deficiency and possibly a challenge spirometry do you think it would be worthwhile for the consultant to carry out any other investigations? We need to know what is making our son have these symptoms which are showing no signs of going and are making his life very difficult. If the CT scan does not hold the answer to what is causing the symptoms and IF he doesn't have asthma - then what else could be causing them?
The scan results said: "Minimal scarring and atelectatic changes with mild traction bronchiectasis is noted in the right middle lobe. The rest of the lungs appear unremarkable with no significant bronchiectasis. Mild emphysematous changes noted, consistent with small airway disease. No other significant findings are seen"
Could you please give me your interpretation of the results of the CT scan?
So - the only questionable part of the scan (as far as you can say without actually seeing it) is the mild emphysematous changes. Even this, if it indicates that he may develop emphysema in the future, is only mild at this stage so you don't think it could account for his current symptoms. So, the scan doesn't appear to answer why he has his current symptoms. The consultant was very confident that he doesn't have asthma. So, as far as I can see, there must be another cause for his symptoms which hasn't showed up on the scan or on the spirometry test. Is there a possibility he could have cystic fibrosis? I believe this is diagnosed with a sweat or blood test? He has also had a normal chest x-ray a few weeks into this illness. Do you think cystic fibrosis should be considered?