My highest FEV1 in 25 years.

6 weeks ago I completed my annual SARP research visit. To my surprise (and everyone elses), during the spirometery tests I blew a post bronchodilator FEV1 of 49% or 1.3 liters! That’s nearly a 30% increase from 12 months ago. My FEV1 has only reached the high 40’s twice now in 25 years.

More impressive and even more reassuring, is the fact that my airways opened up significantly after inhaling 6 puffs of Albuterol. Using the accepted pulmonary function criteria applied in most asthma research studies, a minimum of 12% increase in FEV1 is required to demonstrate airway reversibility, mine was 20%! In simple terms, my airways were responsive to short acting beta 2 agonist medications ( ie Albuterol), meaning that my severe airway obstruction is at least partially reversible. This is a very important finding, because reversibility is what distinguishes asthma from other obstructive lung diseases, such as COPD and Emphysema, which are not reversible.

There are probably several factors in play here responsible for this improvement, including a recent steroid taper and hospitalization. I always seem to do better in the weeks following the recovery from an exacerbation. But if I was a betting man, Id say that the recent surgeries to dilate my upper airway may have something to do with it as well. Back in January of 2019, just a couple weeks before discovering I had glottic stenosis, my baseline FEV1 ( day to day FEV1) was only running about 0.75 liters or 31% of normal. And though I didn’t have any pulmonary function tests done after the first 3 dilation surgeries, I did notice a huge improvement in my peak flow measurements after the 4th one. They actually went from 260 to 350! My Otolaryngologist is not quite as convinced, as the stenosis in my upper airway is a completely separate condition from my underlying asthma and if anything, would put a limit on my expiratory flow rates. Essentially, the smaller the aperture or opening, the harder it is for air to pass through it. He does agree however, that the dilation of my glottis makes it easier to breath when Im not flaring.

Ah, but it’s a bit too soon to claim a total victory here. The welcome spike in airway responsiveness was very short lived (lasting less than an hour),but seeing a significant improvement in my pre-bronchodilator numbers as well (from 28-40%), for whatever reason, gives me some much needed encouragement. It’s a little difficult to see the numbers from the image in this post, but even as recent as 3 years ago my baseline FEV1 was hovering the 20’s.

Of course a baseline FEV1 of 40% is still pretty low, but Ill take it. At the very least, that bump in FEV1 will afford me a little more wiggle room when my asthma gets really bad. Ill be interesting to see how my numbers trend going forward, and if they’ll correlate with changes in my upper airway stenosis and/or patency. I obviously still have ridiculously severe asthma, but I feel a huge sense of relief, that at least for now, I dont have to worry about living with a tracheostomy on top of everything else.