As far as practical things go, it was only when I had the CPET that I realized that one is supposed to take the inhaler puffs 15-30 mins. before exercise (my primary care doc had just said "take before exercise," which I wrongly interpreted to mean take immediately before exercise), so I think that's the main thing to be careful about.
I also ran the coffee hypothesis by the doctor and he found it entirely persuasive. He thinks that it may well be that I can control symptoms just with inhaler and coffee, or even just with caffeine if it's swimming and biking as opposed to running; he suggests beginning to taper the FloVent from 1 puff twice a day to 1 puff once a day, and cut it out altogether if that seems OK.
(I would think it would be something I could use occasionally in very dry cold weather or when recovering from a bronchial ailment rather than relying on all the time - it is a steroid, those things shouldn't be taken lightly!)
He says there is another medication I could try, theophylline, but that there is no reason to go in that direction if the current stuff continues to work. I am optimistic that I won't have further problems - I think that caffeine plus selective pre-exercise albuterol use should be just fine.
We had an interesting conversation about the chart he found particularly striking, the exercise tidal flow volume loop profile. This is the one he was pointing out to the technician during the test, and he says he's been showing it to his students also. Elite endurance athletes (!) show this profile - it's basically a test where you start blowing out hard and the volume conventionally declines with flow along the straight green line in the chart - but athletes can maintain a higher flow even at lower volume (this is the blue line that represents the actual numbers).
He said he didn't know whether it was genetic or a result of training; I said (I always think this!) it must be a result of training, as I have traditionally been so non-athletic, but he pointed out that high-potential athletes are more likely to train and find themselves in the study sample of elite endurance folks, and that it might be that select people who've never taken advantage of their athletic potential would also have this profile. In other words, he is pretty much inclined to attribute it to genetics, and I had to allow as how yes, it is not that I am a super-fast runner, but I am a considerably faster runner than I ever would have expected (or than you would expect me to be if you looked at me!). And it is true that Dr. Dan the running doctor, when I saw him a year and a half ago for that hamstring injury, also seemed very sure that I was a natural athlete from a family of athletes - what a peculiar thought...
All of the numbers are really very good - I think I have counteracted the effects of years of smoking and no exercise - the O2 pulse is 21.1ml/beat, 180% of predicted, and the VO2 in liters/min. is 3.6, 128% of predicted. It is interesting - chemistry has always been one of the sciences I'm particularly attracted to. (This is a good link I found on the relationship between these test numbers and exercise physiology.)
The charts! (There are pages and pages of other charts too, but I will spare you them as I have no idea how to interpret them!)
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