Social Security uses the results from your lung function test taken after you take your rescue inhaler

When you have a lung disease like COPD or asthma, Social Security wants to know how your lungs perform under the conditions you actually live with—which means after you've used your rescue medication. The medical term for this is post-bronchodilator spirometry. The "post" means after; the bronchodilator is the rescue inhaler that opens your airways.

Social Security's medical consultants review both sets of numbers from your spirometry test—the pre-bronchodilator results (before the inhaler) and the post-bronchodilator results (after the inhaler)—but they focus on the post-bronchodilator numbers when they decide whether your lung function is severe enough to meet their standards. This matters because it shows what your actual breathing capacity is when you're using the treatment you depend on.

Your doctor's office performs both tests during a single visit. You blow into a spirometer, the machine measures how much air your lungs hold and how fast you can push it out, then you use your rescue inhaler and wait 15 minutes, then you blow into the spirometer again. Social Security receives both results on your medical records.

Key Takeaways

  • Social Security focuses on post-bronchodilator spirometry results—the lung function numbers recorded after you use your rescue inhaler.
  • Your doctor performs both pre- and post-bronchodilator tests in one visit, but Social Security weighs the post-bronchodilator numbers more heavily in their decision.
  • The post-bronchodilator test shows your actual breathing capacity under real-world conditions, which is what Social Security uses to compare against their severity standards.
  • If your post-bronchodilator results do not meet Social Security's thresholds, having a large improvement from pre to post may still support your case by showing your lungs are responsive to treatment.

Why Social Security looks at results after medication, not before

Social Security's reasoning is straightforward: they want to know whether you can work, and you would be taking your medication while you work. Testing you only before your rescue inhaler would show your worst-case breathing, not your actual day-to-day capacity. The post-bronchodilator test reflects the real world—the one where you're using the treatment your doctor prescribed.

This approach also helps Social Security distinguish between two different situations. Some people have airways that are blocked temporarily (like in asthma) and improve significantly after medication. Other people have permanent airway damage (like in COPD) and improve only slightly or not at all. Both sets of results matter, but the post-bronchodilator number is what Social Security compares to their published thresholds for severe lung disease.

What the numbers mean and how Social Security uses them

Spirometry measures two main things: FEV1 (how much air you can force out in one second) and FVC (your total lung capacity). Social Security has specific cutoff numbers for FEV1, and they use the post-bronchodilator FEV1 to make the comparison. If your post-bronchodilator FEV1 falls below their threshold for your age and height, your lung function alone may be severe enough to meet their standard.

Social Security publishes these thresholds in a document called the Listing of Impairments, under the respiratory system section. The exact number depends on your age, sex, and height—there is no single number that applies to everyone. Your doctor's office should have access to these thresholds, and you can also find them on Social Security's website.

If your post-bronchodilator FEV1 does not quite reach Social Security's threshold, the difference between your pre- and post-bronchodilator numbers can still matter. A large improvement shows that your lungs respond to medication, which might support other parts of your case—for example, that you need frequent breaks to use your inhaler, or that you have side effects from the medication that limit your work capacity.

How to make sure your spirometry test is done correctly

Not all spirometry tests are performed the same way, and Social Security's medical consultants know this. They look for certain details in your test results to make sure the test was reliable. The test should be performed by a trained technician, usually at a hospital pulmonary function lab or a pulmonologist's office, not at a routine doctor's visit.

Before your test, tell the technician if you have taken any inhalers or other respiratory medications that morning. Some medications can affect the results, and the technician may ask you to wait or may note the timing on your report. Bring a list of all your medications and any inhalers you use, including rescue inhalers and maintenance inhalers.

After the test, ask for a copy of the full report—not just the summary. The full report shows your actual numbers, the predicted normal values for someone your age and size, and the percentage of predicted (what you achieved compared to normal). Social Security's medical consultants review all of this detail.

What happens if your post-bronchodilator results are borderline

If your post-bronchodilator FEV1 is close to but not quite at Social Security's threshold, you are not automatically denied. Social Security can still find you meet their standard if other test results or medical evidence shows severe impairment. For example, if your oxygen level drops significantly during a walk test, or if you have frequent hospitalizations, or if your doctor documents that you cannot tolerate the medications needed to improve your lung function, these can support your case even if spirometry alone does not meet the threshold.

This is why it matters to have a complete medical record. Social Security's medical consultants review spirometry, but they also review your medical history, your doctor's notes about your symptoms and limitations, any imaging (like chest X-rays or CT scans), and records of hospitalizations or emergency room visits. The post-bronchodilator spirometry is one piece of the picture.

The difference between meeting the listing and winning on other grounds

Social Security has two main paths to approval for people with lung disease. The first is meeting their published threshold for FEV1 (using the post-bronchodilator number). The second is showing that even if you do not quite meet that threshold, your combination of symptoms, test results, and medical history is severe enough that you cannot work.

The second path is called meeting the listing by equivalence or winning on residual functional capacity grounds. It requires more medical evidence and more detailed documentation, but it is possible. This is where details like how often you need to use your rescue inhaler, whether you have oxygen therapy at home, and whether your doctor has restricted your activities all become important.

Frequently Asked Questions

What if I did not use my rescue inhaler before my spirometry test?

Tell your doctor or the testing facility right away. The test results may not be valid for Social Security's purposes because they need the post-bronchodilator numbers. You may need to schedule another test. If your medical records show you did not use the inhaler beforehand, Social Security's medical consultants will note this and may request that your doctor order a new test.

Can I use my maintenance inhaler before the test?

Ask your doctor or the technician before your test. Some maintenance medications can affect spirometry results, and the technician may ask you to wait a certain number of hours before testing. The important thing is that the test report clearly documents what medications you took and when, so Social Security knows what the numbers mean.

Does a big improvement from pre to post mean I do not have a severe lung disease?

Not necessarily. A large improvement can mean your airways are very responsive to medication, which is actually common in asthma. Social Security still looks at the post-bronchodilator number and compares it to their threshold. If that number is still below the threshold, you may still meet their standard. The improvement itself can also support your case by showing you need frequent medication use.

What if my spirometry results are normal but I still cannot breathe?

Spirometry measures only one type of lung function. Some people have normal spirometry but other problems—like oxygen not transferring well into the blood, or exercise-induced breathing problems that do not show up in a resting test. Ask your doctor about additional tests like a diffusion capacity test or a six-minute walk test. These results also go into Social Security's review.

How recent do my spirometry results need to be?

Social Security generally wants spirometry from within the past year or so, though this can vary depending on your condition and how stable it is. If your most recent test is older than a year, ask your doctor whether a new test would be helpful for your case. Bring any recent test results you have when you submit your medical records.