attack came without warning

[suustsu]

Hello, I am a newcomer.  My 16 year old daughter was diagnosed with Asthma last year.  She rarely used the inhaler being that she was doing very well.  She was able to dance, exercise, etc.  She started telling me that she felt like if she was swallowing her tongue and would get a choking sensation.  I thought this was common b/c it happens to my husband as well.  Her allergies flared up pretty bad and was taking medication.  Last week, she woke up in the middle of the night gasping for air.  I took her to the doctor.  She said her lungs were really thick.  She gave her Auberterol in a breathing treatment. and she Rxd. Prednisone, Augmentin, Singular, Zyrtec Z and a Ht.Qual or something like that.  She told me she would work on a machine for the house.  her symptoms worsened.  Her episodes came two to three times per night.  I was able to obtain a machine and medicine by other means.  I put her on the machine and treatments and was doing this two to three times at night.  When in school, I would give her one in the morning, pick her up at lunch time for another and then when she got home and another before to bed.  Nonetheless, we still woke up in the middle of the night.  I took her to dr. again and she increased the steroids six day treatmen plus advair.  Referred her to ENT and allergist.  I have not given her any treatment b/c I found that if I can get her to calm her breathing during an attack, she can begin breathing on her own.  She had an attack while at the drs.  Could this be VCD or severe asthma?

[National Jewish]

It is possible to have vocal cord dysfunction (VCD) with or without asthma.  It will take testing to answer your question and to determine your daughter’s problem.  If she has both, it is important that she learn to tell whether it is the VCD or the asthma causing the attack.  Only then will she be able to use the treatment that will help stop the attack.

With asthma the basic problem is chronic inflammation along with tightness of the airways of the lungs.  This inflammation increases the sensitivity of the airways to a variety of things that make asthma worse.  These asthma triggers vary from person to person.

Generally testing for asthma starts with a simple breathing test called spirometry.  This test provides detailed information about how your daughter’s lungs are working.  It will show if there is obstruction in her airways.  To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol that she is using.  This measures how much the bronchodilator helps her lungs by reversing the problem.  When there is a 20% increase the test is positive for asthma.

Generally asthma needs to be treated on a regular basis to keep the inflammation under control.  Albuterol works on the tightness, but does nothing for the inflammation.  Your daughter may need an inhaled anti-inflammatory medicine, like the Flovent® (fluticasone) that is contained in the Advair™ Diskus® (fluticasone/salmeterol).  This will decrease the inflammation so she may not wake up in the middle of the night gasping for air.

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.

Testing for VCD needs to be done while you are having symptoms.  Spirometry may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while your daughter inhales.  A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how her vocal cords open and close.

VCD is treated by a speech therapist that will instruct your daughter in open throat breathing techniques.  You may be doing something similar when you get your daughter to calm her breathing during an attack.  Counseling can help her 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 your daughter to be evaluated by a doctor to determine her problem.  Only then can she be treated appropriately, since asthma medicines do not help VCD and the open throat breathing technique does not help asthma.

[Ellis7]

She might benefit from a diagnosis from a major university hospital pulmonary dept. See this link for another possibility:
http://www.aaaai.org/aadmc/currentliterature/selectedarticles/1999archive/panicdisordersandasthma.html
Panic disorders and asthma    Excerpts:
"Panic disorders (PD), an extreme form of anxiety reaction, were reviewed recently by Carr of the University of Medicine and Dentistry in Newark, NJ. PD are characterized by episodes of sudden onset of fear, an intense urge to escape the immediate environment and at least 4 of a group of symptoms including dyspnea, chest discomfort, choking or smothering sensations, trembling, nausea, tachycardia, numbness and/or paresthesias. Infrequent panic attacks are fairly common; frequent recurrent episodes are estimated to occur in about 2% of the population in the USA............................
Many of the symptoms of PD can be seen in acute asthma flares making distinction between the 2 disorders difficult at times. The presence of wheezing, mucus congestion and cough are most helpful in distinguishing asthma from PD...............
Editor's Comments
This review addresses situations seen fairly frequently by those treating a lot of asthmatics: 1) individuals diagnosed as have acute asthma unresponsive to therapy which turn out to have PD instead; 2) distinguishing the cause of acute dyspnea and distress in asthmatics who also have PD. I have found that the absence of coughing and a normal peak expiratory flow rate during an acute episode is a fairly reliable guide that these patients are having a PD episode rather than an asthma flare."

[Concerned lady]

You can telephone the LUNG LINE and speak with a Lung Line nurse about your daughter's breathing problems. Ask about VCD (Vocal Cord Dysfunction), and ask about asthma.

Also, ask about possible gastric reflux, which is a common cause or "aggravator" of both VCD & asthma.

You can call the LUNG LINE, at 1-800-222-LUNG(5864).

Concerned lady
http://cantbreathesuspectvcd.com

[AndyRRT]

This is most likely Asthma. Not VCD. She needs to be recommended to a pulmonologist in your area. Pulmonary function testing will be more diagnistic.

My recommendation would be to continue her albuterol as indicated. Dont be afraid to gove multiple treatments in a row if she gets bad. Albuterol is a relatively benign medication. The most common side effect is a racy heart. Thats okay in kids, they can tolerate elevated heart rates. You need to flood her lungs with the bronchodialtor to stimulate her beta receptors.

A another suggestion would be to see an allergist. she needs to identify what her triggers are and AVOID them. Rugs, dust, bed mites can all contribute to her nightly exacerbations. Try changing her bedding more frequesntly. Wash them in bleach solution (will kill mites). Getting rid of any rugs in her bed room and adding an air purifier helps as well...

Goodluck!

-Andy, RRT, CPFT