Tight chest - breath shortness

[ClareS]

Hi there - please help, dont know what to do now.

I have had very bad respiratory discomfort for seven months now - tight chest, SOB, I actually feel diasbled as my life has become so restricted. I am  29 (female, non smoker, normal weight, physically fit) and have already had to pass up two jobs because of this.

Have been diagnosed mildly/moderately asthmatic by a chest specialist but he says my asthma is under control; (85% what it should be) and that there is no reason why i should feel tight chested all the time. I have been on steroids for 4 months but dont feel better and I am going to see him next month and he may be giving me a bronchoscopy.

Other tests
Chest x-ray - normal but hyper inflated lungs
Blood pressure - normal (slightly low)
Oxygen (when had endoscopy) 100%
Heart beat - 60-80 bpm
IgE - normal
Blood count, glucose etc - normal
Peak flow - 400-450
Endoscopy - normal apart frpm some candida in oeasphagus (from inhalers?)
H-Pylori - Positive - have been treated over a month ago.

My GP on the other hand is convinced that asthma is not the main problem and says that it must be muscle tension around the lungs but will not prescribe me tranquilisers to help me get on with my life; she says that I (or anyone else) would be addicted in two weeks and they cause more problems than they solve

My questions:

can you think of any other tests that i could have done?
Should i accept the diagnosis of muscle tension?
What wouldf a bronscopy show? Is this a dangerous procedure
What is your opinion on tranquilisers?

[National Jewish]

Typically the symptoms of asthma would go away after 4 months of steroids.  Since you don’t feel better further testing is needed to identify if you have asthma or if some other problem is causing your symptoms.

To know for sure if your chest tightness and shortness of breath are due to asthma you will need to have testing done.  Generally testing 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, an inhaled bronchodilator.  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.

There is a complex asthma test that is the gold standard for diagnosing asthma.  This is called a methacholine challenge.  You will blow into a spirometer before and after each increasing dose of an inhaled medicine.  This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine.

If this testing shows that you do not have asthma a bronchoscopy may be considered.  This is a procedure where a tube called a bronchoscope is passed through your nose into your windpipe to look into your lungs.  A bronchoscopy is a safe procedure that is done on an outpatient basis.  With the bronchoscope tiny pieces of lung tissue can be taken for further testing.  This is called lung biopsy.

Vocal cord dysfunction (VCD) is a condition that can mimic asthma.  However, VCD is not helped by asthma medicines.  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, reflux, cigarette smoke, singing, emotional upset, postnasal drip and exercise.  Sometimes the trigger is not known.  These attacks are also often seen with panic attacks.  Testing needs to be done while you are having symptoms.  Spirometry testing may be normal, but the “breathing in” or inspiratory part, also called an inspiratory 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 thoroughly examined and tested so that your problem is found and you are started on helpful treatment.

[Stella4]

Clares... I am not a med. professional but a fellow sufferer.  I am having similar symptoms as you, & similar frustrations.  My methocoline challenge came back as "mildly" asthmatic, not enough to treat with meds though.  I'm not entirely certain of the path that my respitory specialist is going down, he is attacking the SOB from the "acid reflux" angle, saying that the airway is constricted due to reflux.  Not sure about that since the lack of air is very distinctly coming from the chest & not the throat.

I know that my SOB improves, chest tightness goes away if I exercise very regularly (4 - 5 times/week), and/or if I am exposed to cold, fresh air.  Go figure, doesn't sound like asthma!  

My resp. dr. did make mention but for whatever reason did not pursue -- hyperventilation syndrome.  I am going to check into this again when I go back to my GP.  You may want to read this article, from what I can tell it fits my symptoms pretty closely, it may fit yours as well:  http://www.remcomp.fr/asmanet/edit9702.html.  If it is as easy to treat as teaching proper breathing techniques it would be worth it!  Good luck...

[dorpheus1]

I received the small poxs shot and develop costochondritis. Can costochondritis aggravate sleep apena by making it more difficult to breathe.