A look on the inside

At a recent appointment I learned that my lungs were unusually small for an adult. I wasn’t particularly surprised since I was born premature, however, I was surprised that this information had not come up yet in any of my previous follow up appointments. It made me wonder how long the docs have been sitting on this information. I will say that, it didn’t seem to be a deciding factor on anything, expect it was noticed during a bronchoscope evaluation for Bronchial Thermoplastic (BT). I had the bronchoscopy in December 2014, however, I just learned of my small lung factor a few weeks ago. It is my understanding that during the BT evaluation, they take a look at the branches and overall lung size. In my circumstance it was noted that my overall lung size is smaller and the bronchoscope was not able to go as far as they would have thought it would. The jury is still out if BT would actually help me, for now it is an idea that is on the back burner. The discussion started when a fellow was instructed to do further research ion my itty bitty lungs, I had a fancy MRI that looks at the mechanism of respiration with a hyper polarized gas. The fellow was instructed to look for any correlation between the smaller lungs and mechanisms of respiration. I promise to report back on any theories that they come up with.

It made me think of a presentation by Dr. Mark Fitzgerald who addresses some of the ideas about lung function, being determined in utero. Researchers are now discovering that patients in their mid years with reduced lung function, may well reflect lung growth that they started out with in utero. Essentially their lungs do not develop as much as others in their mid years. Lung growth is said to be effected by premature birth and, or, a history of childhood respiratory illness, can affect lung growth. This statement really resonated with me, I certainly was a child that had a host of childhood respiratory illnesses, plus being a preemie. I have also had a long athletic career and managed to been asymptomatic for decades. I could not quite wrap my brain around the idea of how I could function so well for so long, with itty bitty lungs. Dr. Fitzgerald has an analogy, that it is like having 6 cylinders but that you can function quite well on just 4. Lung function does not necessarily determine everything. The positive effects of exercise on lung function, are just one of the factors that can contribute to this.

Many doctors attest that some of their asthmatic patients tend to minimize the risk of their symptoms, or not perceive their symptoms as   risk. It is generally thought that because they have adapted so well to coping with asthma symptoms, or being tolerant of them. Patients do not perceive them as concerning. This makes doctors nervous as patients who are exacerbating, do not always seek out treatment when they should. I feel like this is a double edge sword, as an asthmatic, I don’t want to be limited by my asthma. However, I need to keep an eye on symptoms and trends of declining asthma control. What are your thoughts on your asthma control? Are you a poor perceiver?

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