asthma???

[Roxy16224]

Hello Doctor,
      My name is Roxanne and I am 21 years old.  I have had allergy problems for as long as I can remember but have only had breathing issues for the past 8 years.  I am seeing an allergist and am allergic to trees, weeds, grass, dogs, cats and cockroaches.  I have seen 4 doctors about this breathing and coughing issue but all of them have said that I do NOT have asthma but I am still convinced that I do.  I have bad anxiety so I know that sometimes my breathing issues are anxiety attacks, but other times I will be happy and laughing alot and all of the sudden my chest will become tight and will not relax for an hour or so.  I cough all the time and my friends are continuously telling me that I need to go to the doctor.  I'm on over the counter allergy medicine and have tried many prescriptions that do not help very much including allegra and singular. I take mucinex almost every day which helps alot with my mucous which is sometimes clear and sometimes shades of yellow.  I have sinus headaches all the time but have learned to live with them.  Do you have any idea what this could be?  Does it sound like asthma to you?  Please help I'm so tired of suffering...

[National Jewish Health]

There is a correlation between asthma and allergy, especially when the allergic state is as severe as yours would appear to be.  It is possible, but unlikely, that four doctors, acting independently, would be mistaken in concluding that you do not have asthma, but the validity of that conclusion would depend, of course, on the comprehensiveness of their evaluations.  Evaluations that should include a methacholine challenge and pulmonary function tests before and after the administration of a bronchodilator.

A condition that can mimic asthma is Vocal Cord Dysfunction (VCD, a functional disorder of the vocal cords, that even experienced lung doctors can confuse with asthma.  That diagnosis can be confirmed by direct examination of the cords, using a fiberoptic laryngoscope, especially if done at a time when you are experiencing symptoms of breath or other respiratory symptoms.  It can also be strongly suggested by abnormality of what is called an inspiratory flow volume loop, when pulmonary function tests are performed.  

And, yes, anxiety can be associated with chest tightness but anxiety alone is not associated with the production of mucous.  That should prompt a search for other diseases of the lungs, for even with a normal chest X-ray,   diagnoses for example bronchiectasis and cystic fibrosis) and recurrent aspiration secondary to gastroesophageal reflux, can occur.  Such diseases may be obvious on a CT scan of the lungs, when the chest X-ray truly is normal and, unless a diagnosis is established with certainty by other methods, your evaluation should include a CT Scan..

If you have not consulted with a lung specialist (pulmonologist), you should; if you have, but only with one pulmonologist, you should get a second opinion.  Your symptoms should be taken most seriously and attempts to establish a diagnosis should not cease, at a minimum, until the above considerations are all addressed.

Good luck