Asthma, or not?

Hi.  I have been having trouble breathing for about 5 months now.  I had a bad bout of bronchitis in December 2001.  I had a pulmonary function test done in Feb, came back as dx of asthma.  My problem seems to be expanding my lungs.  It also aches underneath my right and left rib cage.  I went to dr. today, was told my lungs are clear.  I am 25f.  I am afraid that this is neuromuscular in nature, or worse.  I also have GERD.  A pulmonoligist read the pft, which was done only without a bronchial dilator.

[National Jewish]

It is not uncommon to have asthma symptoms following a "bad bout of bronchitis". These symptoms are not necessarily constant and can lead to days where lung function is abnormal and other days when the tests are normal.  In addition, gastroesophageal reflux disease (GERD) is a fairly common aggravating factor for people with asthma. I would follow up with the pulmonologist to have lung function tests before and after a bronchodilator and rule in or out asthma as the cause of your symptoms.

[starion]

I am puzzled as to how your PFT could come back with a diagnosis of asthma without your having used a bronchodilator.  One of the ways asthma is diagnosed is comparing your lung measurements before & after using the bronchodilator.  What steps have been advised and/or taken to help you with your breathing?  Has there been any improvement and/or worsening of your symptoms?  Do you have a peak flow meter?  (Many doctors will give you a free one from a drug company if you ask, otherwise you can get one with or w/o a prescription for about $20 or less, at the drug store or via internet.)
There's lots of good info about asthma at www.NationalJewish.org (particularly their MedFacts, LungFacts, and asthma education, as well as Understanding booklets), but your doctor should be able to help you reduce your symptoms and suggest why you might be having pain and how to minimize it.  If your current doctor isn't able to give you the answers you need & deserve, you may have to consider getting a second opinion from a doctor who can answer your questions.
Best of luck!
Aloha,
Starion

[Concerned lady]

GERD can cause lung damage, if the irritating stomach liquid (or the fumes evaporating off the "reflux material") is "aspirated" (breathed in).

This type of GERD is called LPR/Laryngeal-Pharyngeal Reflux, where laryngeal refers to the larynx (voice box), containing the vocal cords, and pharyngeal refers to the throat.

LPR can also cause VCD/Vocal Cord Dysfunction, which can "mimic" asthma, but isn't asthma: The vocal cords close up (also called a "laryngo-spasm"), with VCD. A good Pulmonologist (lung doc) &/or ENT (Ear, Nose & Throat doc) can help you figure out if you might have VCD. National Jewish Hospital knows the most about VCD, and is most expert at treating VCD.

I agree with Starion--get another opinion from better docs, and read National Jewish Hosptital's excellent website.

You can also see neuromuscular experts, to "rule out" the possibility of neuromuscular problems.

You can email me, if you'd like some Gastric Reflux "tips" that don't include acid blockers. You can check these tips with your docs to be sure they are OK for your specific health situation.

My husband and I were greatly helped by National Jewish Hospital (NJH), with our VCD, so if you can be seen there, in Denver, Colorado, that would be good. NJH is expert, at treating all kinds of respiratory problems, etc., and they recognize the connection between GERD and lung problems, &/or vocal cord problems!

I wish you the best.

Sincerely, Concerned lady
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[sunnygal]

I had a NCV and EMG done on my right arm and related paraspinals that came back normal.  All my blood work is normal, ANA, CK, CBC, Arthritis panels, Lupus panel, etc.  I guess they think all that's left is asthma?

[spicer]

Hi Sunnygal - Did your doctor give you inhalers to use?  If so, do they seem to help?  I have the same problem as you, can't seem to expand my lungs or take a deep breath at times, they diagnosed asthma but sometimes the inhlaers work and sometimes they don't.......

[spicer]

wanted to say too, that I passed the breathing test, it only showed a 15% restriction on inhaling.  Doctor still thought it was asthma.  What I find strange is that I bought a peak flow meter and it says the same thing no matter how I'm feeling, and I know I'm using it correctly.  My 'personal best' is about 390.  I use it 3 times a day and it doesn't matter if I'm having chest tightness or feeling great, it says the same thing - 410 or 420.  My husband says maybe it's because I have a problem on INhaling, not EXhaling.  But if you have asthma, isn't this meter suppose to help you or at the very least, show you a noticeable difference in your numbers?

[Concerned lady]

Dear Spicer,

Have you telephoned the LUNG LINE nurses, yet? They can possibly help you. It's a free call: 1-800-222-LUNG(5864), available between 8am & 4:30pm, Rocky Mountain daylight savings time (Colorado).

I suggest you either go to National Jewish Hospital (NJH) (where the LUNG LINE is located), in Denver, CO, or, find out from the LUNG LINE nurse which docs are in your area, who were trained at NJH. NJH are the best experts at respiratory (& other) problems! :-)

To answer your question on another "thread" here, yes, these comments ARE "for real".

When you get a chance, read my website about VCD/Vocal Cord Dysfunction, because VCD (an asthma "mimic", which can exist without asthma, or along with asthma) usually affects INhaling. My husband & I had VCD, and were greatly helped by NJH. I didn't forget about the ailment, just because I got better. I made a website about it. Here's a link: http://cantbreathesuspectvcd.com

Sincerely, Concerned lady
***@****

[spicer]

I tried to call but couldn't get through so I emailed them instead and asked some questions.  I'm still trying to find someone to answer my questions about the peak flow meter before I go back to my doctor next week.  It seems to be somewhat useless to me as it never changes no matter how I feel.  I don't really see what good it does.  Isn't it suppose to change?  I had a couple bad days this week and it said exactly the same thing it did on my good days.  Very confusing.  
I have already read your website and the other one, some parts of a typical VCD profile don't fit me.  In fact most don't except for the fact that asthma doesn't seem to fit me in certain areas either.  I could answer a questionaire for both and probably fit in about 50% for both.  This is very frustrating for me, to say the least.  I'm 49 yrs. old and petite, only weigh 105 (as opposed to many VCD patients who are obese, according to what I've read).  I have no psychological problems, I'm about as normal and balanced as they come.  I hardly ever get sick, am very healthy and active, and have no reflux or anything of that nature.  This just came right out of left field, was on the treadmill one day and felt like I couldn't swallow so immediately got off.....and it was just downhill from there.  Next day noticed the heaviness in my chest and had trouble breathing.  Day after that was still bad so went to the doctor and felt like I was going to suffocate on the way there, awful feeling.  No wheezing, no coughing, none of the 'usual' asthma symptoms, but that's what everyone seems to think it is.  Sometimes the inhalers help, sometimes they don't.  Right now I feel like too many doctor's have their fingers in the pot, and each one wants to be 'the one' to correctly diagnose me.  I go next week for allergy testing to find out what's triggering 'my asthma'.  I'll be curious to see if it shows anything at all............
I don't usually do these forums like this but sometimes people want to talk to other people with the same symptoms and see what they've found out, kind of like a support group.  Just helps to make one feel better.

[Concerned lady]

Dear Spicer,

Not being a doctor, these are just several ideas, as food for thought:

Having symptoms during the treadmill workout, makes me think of several things, in addition to asthma &/or VCD.

Have you had your heart checked?

Have you had your blood vessels checked for for aneurisms &/or ?

Might you have had a GERD/Gastro-esophageal reflux disease "episode" (very common among athletes & people who exercise), possibly brought on by the treadmill work? A GERD episode can "trigger" an asthma attack, &/or a VCD attack, &/or maybe some esophageal spasms, &/or ???

What was the air quality like, where you were on the treadmill? Might there have been any "irritants" &/or toxic chemicals outgassing in your area? (like from a NEW CARPET, NEW BUILDING MATERIALS, MOLD, extra high levels of carbon dioxide & fumes, where WINDOWS DON'T OPEN, etc.)

Are you possibly taking any meds that have adverse/bad side effects that could be causing (&/or contributing to) your symptoms?

I think that if you could go to Nat'l Jewish Hospital, that they could help you figure out what is going on with you, and what the causes are. Then, you would have treatment options. They work as a team, with many specialists in various fields! And, they are kind, nice, & knowledgable!

I wish you the best. Hang in there!

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com

[spicer]

You are so helpful, I really appreciate your taking time out of your day to try and help me.
The treadmill I was on was my own, it's in one of our bedrooms and I've been using it for years without a problem.
I've had my heart checked by EKG (normal) and echocardiogram (not back yet).  
No medication, no fumes anywhere, no known medical problem that would be contributing to this.  No reflux whatsoever, never have (wouldn't I know?).
Wanted to ask though....what is esophageal spasm and what does it do?  I've never heard of it.
Thanks so much.........

[Concerned lady]

Dear Spicer,

A good GI doc (Gastro-intestinal doc) should be able to examine you, and do tests, to find out if esophageal spasms &/or GERD/Gastro-esophageal reflux disease, are parts of your problem with the treadmill. Esophageal spasms can be related to GERD (gastric reflux).

On Monday, you could telephone the LUNG LINE, at Nat'l Jewish Hospital, and speak to one of the LUNG LINE nurses, who might recognize your symptoms. The LUNG LINE nurse could also tell you which Nat'l Jewish Hospital-trained docs are in YOUR area. Call 1-800-222-LUNG(5864), between 8am & 4:30pm, Colorado time.

If you could be seen at National Jewish Hospital, that would be the best. If not, get doctors' names from them, who they recommend, for additional opinions.

Gastric reflux episodes can sometimes happen without obvious symptoms. I'll post some Gastric Reflux tips below, that you can show to your doc, before trying them, if you are interested, to be sure that they are OK in your particular situation.

I hope you get this figured out soon! By the way, one reason that some VCD patients are overweight, is that the steroids they were on, due to having asthma (or being thought to have asthma)--those steroids caused the weight gain (edema, etc.).
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Some GASTRIC REFLUX TIPS (without acid blockers):

GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)

LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords. Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)

Reflux=acidic or alkaline stomach material that backs up into the esophagus (food tube), causing any of these problems: VCD/Vocal Cord Dysfunction/Laryngospasm attacks, cough, voice problems, asthma, globus (feeling of lump in throat), constant need to clear throat, worsening of sinus condition, sore throat, pre-cancerous conditions of throat &/or esophagus, etc.

SOME GER/LPR CONTROL THINGS WE DO, that we learned from the excellent book: STOMACH AILMENTS AND DIGESTIVE DISTURBANCES, by Michael T. Murray, N.D. See page 9, References, in my website: http://cantbreathesuspectvcd.com   and, also see GER/LPR info on page 5, and on LINKS page.

PLEASE READ THIS GREAT BOOK. It may possibly be bought on-line, from Michael T. Murray

[sunnygal]

Thanks for the input.  My ENT dr. is ordering another (2nd) Pulmonary Function Test which includes the Metaclopromide (sp?) challenge.  He says this will tell us if the problem is indeed asthma.  It took me 2 months to get it through the dr's heads that the singulair wasn't doing any good, and the albuterol is giving me major palps without much positive effect.

[RTFLY]

Hi Spicer...I hope you have had some more help in figuring out your dilema. As for the Peak Flow Meter numbers, they may improve, they may not. Generally, PEF measurements improve with bronchdilator therapy if status asthmaticus or severe bronchospasm is the underlying problem. I agree with Starion in saying that I find it hard to understand how a diagnosis of asthma is ascertained on pulmonary function studies without the aid of pre and post bronchdilator therapy testing. A 15-20% increase in FVC and FEV1 lung volumes confirms positive response to bronchdilator therapy in reactive airway disease patients. Asthma is actually an OBSTRUCTIVE disease but can have some restrictive symptoms. It feels like people can't catch their breath or get air into their lungs. So the problem with asthma, like other obstructive diseases is that you can't get air out. Bronchodilators act on the smooth muscle that surrounds your airways and helps them to relax, in turn making airflow more laminar (smooth) and less turbulent. This hopefully makes it easier for you to breathe. As for cardiac function, your EKG will show what the heart is doing at the time the EKG is taken. I'm glad that was normal and hope your ECHO was normal as well. If albuterol (Ventolin) gives you undesirable side effects, maybe check out a drug called levalbuterol(Xopenex). It is basically Ventolin with a slight change in the drug make-up and seems to have less of the "bad" side effects that Ventolin has. I hope all works out for you and would be interested in knowing what your outcome was. Feel free to e-mail me at "***@****" Good luck...
                                       J.C.I., RCP RRT