Concerned about Tight Chest: Testing for asthma

Posted by emtaylor @emtaylor, Mar 29 11:39pm

Hi, I have good health profile, normal test results, no improvement on PPIs. I've had laryngoscopy, endoscopy, chest x-ray, pulmonary function test, many blood tests, etc., and I'm on allergy meds. Thanks for any insight you might have - it's driving me a little nuts, although I'm aware that overall I feel very healthy.

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Update: budesonide helped a ton, and I’ve been diagnosed with cough variant asthma. Going to stay on it for 3 months and then see how I do with a lower dose.

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Profile picture for Lisa Lucier, Moderator @lisalucier

Hi, @emtaylor - it sounds as though you've been through quite a bit of testing with the laryngoscopy, endoscopy, chest X-ray, pulmonary function test, many blood tests, plus taking allergy meds and a budesonide inhaler. I also have asthma. My symptoms were mostly coughing and chest tightening, which I later recognized with a physician's help as inaudible wheezing.

I took a lot of the same tests you mentioned, including spirometry, chest X-ray and body plethysmography (also called lung or pulmonary plethysmography). I also did a test for reflux medication, to see if that might affect my symptoms, which it didn't. Sounds like you did something similar. My allergist also trialed me on a maintenance inhaler plus a rescue inhaler. Since that worked effectively, I was determined to have asthma.

I'm glad to hear you've had major improvement of your chest tightness. That is a big relief, literally and figuratively.

You mentioned your pulmonologist said that based on symptoms and the testing she had seen, you have asthma or reactive airway disease. Will you share more about which symptoms and results from your testing most made her feel you had one of these two diseases?

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Hi Lisa, my symptoms returned even with the inhaler, so she put me on a higher dose, and then it actually made my symptoms worse (or it was a coincidence - who knows?) But that got me very concerned that something else was going on. (I have health anxiety, so this is what happens.) I went back and she showed me the results of my PFT and why the numbers supported the asthma diagnosis and NOT anything else (COPD, pulmonary fibrosis, etc.). I'm going to do a methacholine challenge on Monday, and that might definitively confirm the diagnosis, or it might not, which would just mean that I have "cough variant" asthma or something. She told me that reactive airway disease is usually more of a short-term reaction to something specific. I don't get notifications about these posts, so I'm just seeing this now.

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I also have chest and back tightness. I’ve been diagnosed with asthma/copd. I can go for days with no symptoms. And suddenly have the tightness, low oxygen and weak. Also can’t do most inhalers because I lose my voice. I’ll try your suggestions. Thanks

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Profile picture for ebiedean @ebiedean

I also have chest and back tightness. I’ve been diagnosed with asthma/copd. I can go for days with no symptoms. And suddenly have the tightness, low oxygen and weak. Also can’t do most inhalers because I lose my voice. I’ll try your suggestions. Thanks

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Try to figure out what triggers your attacks- pollution, fragrance in cream, shampoo, scented candles, new furniture, etc. is it allergic or chemical triggers? Once you figure it out you can eliminate it.

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Profile picture for emtaylor @emtaylor

Hi Lisa, my symptoms returned even with the inhaler, so she put me on a higher dose, and then it actually made my symptoms worse (or it was a coincidence - who knows?) But that got me very concerned that something else was going on. (I have health anxiety, so this is what happens.) I went back and she showed me the results of my PFT and why the numbers supported the asthma diagnosis and NOT anything else (COPD, pulmonary fibrosis, etc.). I'm going to do a methacholine challenge on Monday, and that might definitively confirm the diagnosis, or it might not, which would just mean that I have "cough variant" asthma or something. She told me that reactive airway disease is usually more of a short-term reaction to something specific. I don't get notifications about these posts, so I'm just seeing this now.

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Hi, @emtaylor - thinking of you and wondering how you are doing. I seem to recall, if I'm remembering correctly, that the methacholine challenge is where they kind of "yell" at you like an athletic coach to breathe harder, etc. How did it go?

@rebeccabloch - did your doctor say why you react to the propellant in nebulizers or inhalers?

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Hi Lisa, I'm doing well - thanks! I started the Breo inhaler about a month ago and my asthma symptoms are pretty much gone, so I think it really was the inhaler (Symbicort) that was the problem in terms of treatment. The methacholine results were very borderline. I am now trying to figure out what is causing my postnasal drip - it's either LPR (silent reflux) or allergies - been driving me crazy since November and seems to be what caused the chest tightness to flare up.

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@lisalucier He didn't have any ideas. Just based on my history and documented reactions. I can't stress how important it is to clearly document reactions and symptom changes. I know it can be hard to do but even a best guess after the fact is better than nothing.

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Has anyone talked to their doctor about Doxycycline as an add-on medication for asthma? I had a 6 week flare up that finally resolved after a seven day course of Doxycycline. I’ve read some studies about the anti-inflammatory properties of this antibiotic and potential uses for chronic asthma.

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