21M – Post-viral chest tightness/SOB, pulmonologist says intermittent asthma with hyperinflation but spirometry and IgE normal. Looking for interpretation.
21M – Post-viral chest tightness/SOB, pulmonologist says intermittent asthma with hyperinflation, but spirometry and IgE normal. Looking for expert opinions.
Age: 21
Sex: Male
Height/Weight: 165 cm / 57 kg
Non-smoker, no vaping, physically active, regular gym-goer before illness.
Past history:
- No childhood asthma
- No prior inhaler use
- No known allergies
- No eczema
- No exercise intolerance before this illness
- Previous viral URTIs in last 1 year resolved normally without chest symptoms
- Known Gilbert syndrome
Timeline:
About 2.5 weeks ago I developed:
- sore throat
- fever
- runny nose
- mild cough
I took paracetamol + cetirizine. Fever/cough mostly improved within about a week.
Around day 8–10:
- chest tightness/heaviness started
- intermittent mild shortness of breath
- mucus sensation in throat/nose
- minimal cough
- occasional chest irritation/pain
No severe wheezing. No oxygen saturation documented low.
Important:
I previously had viral infections multiple times over the past year but NEVER had chest tightness/SOB before this episode.
Pulmonologist assessment:
- “Intermittent asthma”
- “Significant hyperinflation”
- Tonsillitis
- Said lungs are hyperinflated/enlarged but lung function is normal
Treatment prescribed:
- Montair-LC
- Acebrophylline SR
- Foracort 200 Synchrobreathe inhaler PRN
- Betadine gargles
Response:
- Nebulization with Duolin + Budecort gave some relief
- Inhaler gives inconsistent relief
- Sometimes SOB resolves on its own
- Symptoms fluctuate
Current symptoms:
- intermittent chest tightness/heaviness
- occasional mild SOB
- occasional chest pain/irritation
- minimal/no cough
- some mucus in throat/nose
- no major fever now
Investigations:
CBC:
- WBC normal
- Platelets normal
Dengue/Hepatitis/HIV:
- Negative
LFT:
- transient bilirubin elevation consistent with Gilbert syndrome flare during illness
- SGOT/SGPT normal
IgE:
- 9.6 IU/mL (normal)
Chest X-ray:
Formal radiology report:
- “No significant abnormality detected”
- lungs clear
- CP angles clear
- heart size normal
However pulmonologist visually interpreted hyperinflation.
Spirometry/PFT:
- FEV1 ~125–126% predicted
- FVC ~114–119%
- FEV1/FVC ~91–95% (83.3% predicted for my age)
- overall interpretation: “Normal spirometry”
- no significant bronchodilator response
Questions:
Does this sound more like post-viral reactive airway hyperresponsiveness vs established intermittent asthma?
Can transient hyperinflation occur post-viral with normal spirometry?
How significant is “hyperinflation” if formal X-ray report is normal?
Can mild intermittent asthma exist with:
- normal spirometry
- normal IgE
- no childhood history
- no previous exercise limitation?
How long can post-viral airway hyperreactivity last after URTI?
Is repeat spirometry during symptoms useful?
Would appreciate pulmonology opinions. Thanks.