Throat Constriction and Exercise-Induced Asthma

[mdrfromga]

I'm a 30 year old swimmer and have suffered from asthma since I was 9.  Over the past few months, I have experienced a chronic wheezing when exhaling; I'm symptom free when inhaling.  When I'm not exercising, this wheezing is barely noticable.  

However, when I start my laps, the wheezing worsens.  I'm not able to move air sufficiently, become exhausted, and have to stop (rather than drown). : )

The use of a rescue inhaler before, during, and after exercise is completely ineffective.  

If I were to put my finger on it (literally,) I would say that my throat is tight just below my adam's apple to just above the center of my collar bone and extending a few inches around my throat in both directions.  

Thoughts?  Thanks in advance.

[National Jewish]

It is possible for asthma to change over time.  You may simply need an adjustment in your asthma treatment to control this change in your asthma.  With asthma there is both swelling and tightness in the airways of the lungs.  A rescue inhaler helps with the tightness, but doesn’t do anything for the swelling.  For some people exercise is the only thing that triggers their asthma.  In these situations using a rescue inhaler as needed is often enough.  However for some people this is not enough.  Some people need to regularly use a long-acting inhaled bronchodilator along with an inhaled steroid.

Your throat tightness does raise one other possibility.  That is vocal cord dysfunction (VCD).  This condition can mimic asthma.  However, it is not helped by asthma medicines.  One thing that doesn’t quite fit with your symptoms is that typically the wheezing is heard on inhalation.  While inhaling the vocal cords should open to let air into the lungs.  With VCD the vocal cords close together during inhalation.  This makes it difficult for air to get into the lungs.  A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, cigarette smoke, singing, emotional upset, post-nasal drip and exercise.  Sometimes the trigger is not known.  Testing needs to be done while you are having symptoms.  Breathing tests may be normal, but the “breathing in” or inspiratory part, also called a flow volume loop will show little airflow while you are inhaling.  A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how your vocal cords open and close.  VCD is treated by a speech therapist that will instruct you in open throat breathing techniques.  Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD.  Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information.  It is important for you to be evaluated by a doctor to determine the diagnosis and appropriate treatment.

[nurse12hr]

When did you last see your pulmonologist?  I would suggest you start there.  A rescue inhaler alone may not be the best option for treatment.  There are plenty of new therapies available.  Offhand, I would say you need to be on at the very least, an inhaled steroid for a while to see if that helps.
So, off to the doc for some PFT's! (pulmonary function tests) and get some professional advice!

[Concerned lady]

I agree with Christie's advice to see a Pulmonologist (lung specialist doc).

I also recommend seeing an ENT (Ear, nose & throat specialist doc), to find out what's going on in your throat area.

There may be one or more causes for your symp[toms, and, people can have more than one thing going on at the same time. This is why it's good to see at least one specialist doctor.

I hope you get correctly diagnosed and treated soon. You can also speak with a LUNG LINE nurse at Nat'l Jewish, by calling the LUNG LINE, at 1-800-222-LUNG(5864), to get good advice on what to do now. Maybe you could be seen at Nat'l Jewish Medical & Research Center (a GREAT respiratory medical center), in Denver, CO. Or, the LUNG LINE nurses may know of a doc in your area, who studied at Nat'l Jewish, and who may be able to diagnose you.

My husband and I found Nat'l Jewish to be very nice, kind, and knowledgable. They diagnosed us each with VCD/Vocal Cord Dysfunction years ago. With their doctors', nurses', and speech pathologists' good help, plus our working on getting rid of all our underlying causes, we were able to control the VCD, and stop having attacks.

Until you get correctly diagnosed and treated, you may want to hold off on doing strenuous exercise. Later on, after being diagnosed and treated, exercise hopefully will not be a problem.

Sincerely, concerned lady
<a href=http://cantbreathesuspectvcd.com>http://cantbreathesuspectvcd.com<a/a>

[gfdykstra]

A related discussion, vocal chord restriction was started.