Asthma or something else?

[Iza]

I had cough, chest pain in the area of chest bone, back pain and congested throat. I went to the doctor, who prescribed me zithromax, which did not help much. Another doctor for the same complains sent me to have a chest and spinal radiography. The results: slight hyperinflation of lungs and scoliosis of spinal column. The rest, bronchs and lungs described as normal. On the base of just those results the doctor diagnosed me with asthma and prescribed "singulair" - medicine for asthma.
I feel much better now than on the day of the x-ray. I still have kind of ticklish cough, for example when I take air or bend my head back it itches in my throat and I cough. I also have sometimes a slight pain in the middle of the chest around the chest bone and stomach pain between the ribs, especially when I press on it, it is kind of sensitive (from the cough?). I don't have breathing problems which I had when I was sick.
I will appreciate very much your comments and please explain me what other causes can have hyperinflation? Could it be the virus that I had that time or something else? I must add that I never had lung problems before.

[National Jewish]

Hyperinflation of the lungs means air is trapped in the small airways so the lungs appear larger than usual on the chest x-ray.  This simply means that you were breathing hard when the chest x-ray was taken.  In the short term, it really does not mean anything serious.  This is a very common finding when asthma is poorly controlled, like during an asthma attack.  This same finding is seen in the lungs of chronic smokers.  It can be due to a virus.  However an antibiotic like Zithromax® (azithromycin) would not have helped because antibiotics help infections that are caused by bacteria not viruses.  When it happens in only one lung, blockage of the bronchus to that lung is usually the problem.

It is not clear from the information that you provided if your congested throat is coming from mucus above or below your throat.  If the mucus is coming from above your throat it could be postnasal drip.  This is drainage from the nose and sinuses dripping down the back of the throat.  If the mucus is coming from your chest it could be due to asthma.  In some people with asthma, the mucus glands in the airways make a lot of thick mucus that causes chest congestion.  With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs.  A fast-acting inhaled bronchodilator medicine, like albuterol, reverses the bronchospasm quickly by relaxing the smooth muscles, but does not do anything for the inflammation and may not work on the mucus.  Inhaled steroids and leukotriene modifiers, like Singulair® (montelukast sodium), decrease inflammation and mucus.  When used routinely inhaled steroids have the added benefit of preventing inflammation.  If this inflammation is not controlled, it increases the sensitivity of the airways to a variety of things that make asthma worse.  These asthma triggers vary from person to person.  For some people infections cause more asthma symptoms, but for other people infections do not cause asthma symptoms at all.  Postnasal drip is a common trigger.  Wheezing is the most common symptom.  However some people only cough.

Asthma symptoms can develop at any point in time even in someone who has never had lung problems before.  For some people, the first time they develop asthma is after an infection of their lungs.  This can happen at any age, but is more common in adults.  To know for sure if your symptoms are due to asthma you will need to have further testing done.  Generally testing for asthma starts with a simple breathing test called spirometry.  This test provides detailed information about how your lungs are working.  It will show if there is obstruction in your airways.  To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol.  This measures how much the bronchodilator helps your lungs by reversing the problem.  When there is a 20% increase the test is positive for asthma.  However it is possible for this test to be normal when a person with asthma is not having breathing difficulty.  A chest x-ray is done to be sure that there isn’t any other problem that would need to be treated differently.  A pulmonologist would be the type of specialist to arrange for this testing and to help you get the best treatment.  Please read the information on the National Jewish Medical and Research Center’s website at http://asthma.nationaljewish.org/ for more information about asthma.