As a part of a recent set of tests to determine whether I have Mast Cell Activation Syndrome (more on that later), I learned that I have asthma. We’ve known that this was likely for a while, because I every time I get an upper respiratory infection, it tries to take residence in my chest. Inhaled and oral steroids are usually needed in order to coax out the infection. Albuterol is usually necessary to be able to cough and breath in the meantime (sort of important).
My allergist is a conservative type, and wanted confirmation that asthma is the problem, and not my immune system. Therefore, he ordered a methacholine challenge (a diagnostic test used to look for asthma in patients with asthma symptoms that present with apparent normal pulmonary function). To be honest, asthma was not really near the top of my list of diagnoses to get sorted out, but I agreed. What’s one more medical procedure, right?
So on Monday, my husband took me to the hospital for the procedure. During the main event, a tech used a nebulized medication called methacholine to try and induce an asthma attack (spoiler alert: it worked). The tech used a booth like the one below where I sat inside and breathed any medication that she handed me through a nebulizer while she monitored my vitals and ability to breath into a spirometer.
Before the actual test could begin, a pulmonary function test was completed using the spirometer to establish a baseline. This was apparently necessary even though I brought one with me that was completed at the Dr’s office (I wasn’t at all annoyed). On both pulmonary function tests I showed normal numbers, good even.
The first nebulized solution I was given was saline. Each time I was given the nebulizer I was asked to inhale slowly 5 times. The tech would then wait 30 seconds to allow the medication (or saline) to enter my system. Then the tech would give me nose plugs to wear and I would be asked to breath into the spirometer as quickly and as hard as I could 3 times. The saline test also produced normal numbers. It is considered another baseline measure.
There were 5 doses of methacholine, which each increased in potency. If at any time during the test a patient’s numbers drop below 20% of baseline, the procedure is stopped and albuterol is provided via the nebulizer in order to reverse the effects of the methacholine. The test is then considered positive for asthma.
My first round of the methacholine went easily. I chatted with the teach (who was super nice) about my career and her son with special needs in between breaths into the spirometer.
The second and third methacholine treatments were also received relatively uneventfully, although I became noticeably flushed, which the tech said is a normal reaction to the medication.
After recieving the fourth methacholine treatment I began to feel lightheaded (more than usual). My numbers were still decent, however.
Almost immediately after the fifth treatment was administered I felt my airway tighten up. My attempts to breath into the spirometer were more like glorified coughing. The tech recorded my attempts and then immediately provided about ten minutes of nebulized albuterol. She also began monitoring my oxygen levels to make sure the attack was successfully reversed. After my O2 went up, I was asked to breath into the spirometer for one last set of measures. I was able to demonstrate that the attack was reversed, so I was released (Hooray for no complications!).
The whole process took about 1.5 hours. The official results aren’t back yet, but the 5th methacholine treatment put my numbers significantly below 20% of my original functioning, which the tech explained means that I have asthma.
Apparently, I am not the only EDSer to struggle with this problem. A 2007 study completed by Morgan, Pearson, Davies, Gooi, & Bird in the Annals of Rheumatic Disease found that people with EDS or Joint Hypermobility Syndrome (a similar condition) tend to have an increased lung volume (hence my good baseline numbers) with an increased prevalence of asthma and airway collapse.
Source: Morgan, A. W., Pearson, S. B., Davies, S., Gooi, H. C., & Bird, H. A. (2007). Asthma and airways collapse in two heritable disorders of connective tissue.Annals of the Rheumatic Diseases, 66(10), 1369–1373. http://doi.org/10.1136/ard.2006.062224
Disclaimer: I am not a doctor. I am simply describing my experience. If you have any concerns about your health, or do not understand a procedure that you are going to have, please consult with your physician.