asthma symtoms or something else??

[sb786]

i am 30 yrs old female and a recent ex smoker. i used to smoke approx 6-7 cigarretes a day for 11-12 yrs. i am now 5 weeks pregnant. i was diagnosed with asthma when i was 11 years old and used to suffer from bad asthma episodes. for the past 10 yrs i have been off all asthma meds and have been almost symtom free. the only time i need to use my rescue inhaler is when i have a cold or flu. recently i was told i have inflammed sinuses and was given a nasal spray which has helped a little.
for the past week i have been having a tightness in my chest i went to my doc straight away and he listened to my chest and said it was just my asthma. he refused to give me any antibiotics or medication. when i use my inhaler my asthma subsides but the tightness comes back after an hour or 2. my question is, is it possible for asthma to come back suddenly like this? is chest tightness a symtom of asthma? i don't really have a cough or wheezing but get a pain in my throat on and off and sometimes slight ear ache. when i do cough i get white mucus in my mouth which has a very very unpleasant taste infact i have been getting this unpleasant tast in my mouth sinse i was told my sinuses were inflammed. i am concerned that my gp is not taking me seriuosly and it maybe something serious as i am a recent ex smoker. please advise i am going out of my mind. thank you.

[National Jewish Health]

You raise several important issues.  Your long history of exposure to cigarette smoke, and its inflammatory effect on your bronchial tubes (airways)  could be a contributing factor to the worsening of asthma, for quite some time (months to years) after complete smoking cessation.  You have made a wise decision to quit smoking and I urge you to stick with it.

Asthma is a chronic disease and its severity typically fluctuates significantly over long periods of time.  Thus, the symptoms can recur spontaneously, after years or even decades of quiescence, often without identification of any external precipitating factor.  And, yes, the “tightness of the chest”  that you are experiencing, is in all likelihood and indicator of active asthma.  But, do not let that discourage you, for asthma is a very treatable disease and current therapy is very effective.

In your situation, there are several factors that may be contributing to your current asthma worsening.  Sinus inflammation, be it secondary to infection or allergy can be a major cause of asthma worsening, if left untreated or treated sub-optimally.   Nasal sprays can be most effective when allergy is the cause, especially when combined with daily nasal saline irrigations.  If your sinusitis is secondary to bacterial infection, you may need an antibiotic.  If that is decided-upon, you and your doctor should be certain that the antibiotic chosen is one that has been proven to be safe for both mother and fetus, over many years of experience.  For example, Penicillins are safe.  Cephalosporin drugs may not be safe (see below) and Tetracyclines & Aminoglycosides  are definitely unsafe (see below).

In contrast all currently used asthma medications are considered to be safe.

It has been repeatedly shown that, of all pregnant women with a history of asthma,  in approximately 1/3 the asthma improves; in 1/3 there is no change and, in 1/3 the asthma worsens.  That suggests that you might be in the last group.  The national evidence-based recommendations are that asthma control should be a top priority for all pregnant women,  for the benefit of both mother and child.  You should ask your doctor why he/she chose not to treat your asthma.  Both asthma and sinusitis should be treated vigorously.  If your doctor is unwilling or unable to do that, you should request consultation with an asthma specialist and/or an obstetrician who specializes in high-risk pregnancies.

You can have it both ways.  That is you can have optimum therapy for your asthma and sinuses and, at the same time, not endanger your baby.

Good luck,

Antibiotics and Anti-Infective Agents

Because pregnant patients are particularly susceptible to vaginal yeast infections, antibiotics should be used only when clearly indicated. Therapy with antifungal agents may be necessary during or after the course of therapy.

Penicillins

Penicillin, ampicillin, and amoxicillin (Amoxil) are safe in pregnancy. Amoxicillin/clavulanate should be avoided in women at risk for preterm delivery.

Cephalosporins

In a study of 5,000 Michigan Medicaid recipients, there was a suggestion of possible teratogenicity (25 percent increased birth defects) with cefaclor, cephalexin, and cephradine, but not other cephalosporins. However, another study of 308 women exposed in the first trimester showed no increase in malformations.[The consensus is that these drugs are safe.]

Tetracyclines

Tetracyclines readily cross the placenta and are firmly bound by chelation to calcium in developing bone and tooth structures. This produces brown discoloration of the deciduous teeth, hypoplasia of the enamel, and inhibition of bone growth. The staining of the teeth takes place in the second or third trimesters of pregnancy, whereas bone incorporation can occur earlier. Depression of skeletal growth was particularly common among premature infants treated with tetracycline. First-trimester exposure to doxycycline is not known to carry any risk. First-trimester exposure to tetracyclines has not been found to have any teratogenic risk in 341 women in the Collaborative Perinatal Project or in 174 women in another study. Overall, alternate antibiotics are currently recommended during pregnancy.

Aminoglycosides

Streptomycin and kanamycin have been associated with congenital deafness in the offspring of mothers who took these drugs during pregnancy. Ototoxicity was reported with doses as low as 1 g of streptomycin twice a week for 8 weeks during the first trimester.  Of 391 mothers who had received 50 mg/kg of kanamycin for prolonged periods during pregnancy, nine children (2.3 percent) were found to have hearing loss.

[Macroz]

The coughing up of the white mucous with an unpleasant taste seems a lot like reflux to me.  The chest tightness could be a reaction to reflux acid also.  I was similarly diagnosed with asthma like that and it turned out to be caused by reflux - no other reflux symptoms but cough, white mucous and asthma type symptoms!