Should I 'demand' a CT scan?

[txpacotaco66]

I have asthma.  I also have chest pain, which a heart workup 6 years ago showed was not due to heart disease.  My asthma doc diagnosed it as unexplained chest pain.  Last year, after a lot of home remodeling projects, my asthma suddenly became about 100% worse than it had ever been before, and I spent months with daily, intense symptoms.  Last spring my asthma doc gave me a one week burst of prednisone, and that helped.  

My symptoms have escalated over the past 6 months.  Chest pain is more or less constant, and it's spread out - my ribs now seem involved and it often feels as though there is something under my left breast causing pain.  Sometimes there's also a burning sensation in my entire left lobe that I can feel from my breast bone down to the bottom of my rib cage and back around and up to my left shoulder blade.  I also have days when asthma symptoms are uncontrollable, even with use of a nebulizer.  I've seen my regular doc 3 times about this (as well as a recurring bladder infection) since October and have had 2, 10-day courses of Cipro and 1, 10-day course of something else that was for the bladder only, but nothing has improved the chest pain/asthma symptoms.  Neither doc has ordered so much as an xray, and I've become concerned that somebody needs to take a look 'under the hood' to figure out what's going on.  

Final concern is that I caught a cold the first of November and have had a loose, highly productive, though not at all painful, cough ever since.  Phlegm is yellowish-brown (I'm a smoker), sometimes rust-flecked, and at times a bit pink.  Weird thing is, I actually feel pretty good other than the symptoms mentioned here (and being easily winded from the asthma).

I know this is last-minute, but I'm seeing my asthma doc again tomorrow afternoon, and wonder if you think it would be appropriate for me to ask him for a CT scan?  To be honest, I'm a bit worried about cancer, which runs in my family.  

Thanks for your advice...

[National Jewish Health]

It is highly likely that your asthma worsened in response to the debris (insulation, plaster and wood dust, dust, decaying insects, possibly lead-based paint) that released into your environment during the remodeling.  Some of that may still be in your environment in the air, drapes and carpets and the heating-cooling ducts.  You may need to consult with an industrial hygienist to assess your home.

It is possible that those exposures led, not only to asthma worsening, but possibly also to an allergic pneumonitis, such as hypersensitivity pneumonitis.  But, at the same time, it is highly unlikely that your chest pain is on the basis of lung disease.

You will need a chest x-ray to assess your lungs and the chest pain.  The pain you describe is not typical of the pain of heart disease but your heart should be re-checked.  Your pain could be on a muscular/chest wall basis, including the ribs, cartilage, ligaments and chest muscles.  Another possibility would be that the pain is neurogenic; on the basis of compressed, stretched or inflamed nerves the most likely sites for this being where the nerves emerge from the bony spine, in your back, or in a bundle of nerves called the brachial plexus.  Lung specialists and heart specialists may, sometimes, not consider these possibilities.  Pain similar to yours can also originate, on a similar basis, at the apex of one’s lung.  A CT scan would be in order to look for any abnormalities that might suggest one of the preceding.

You may also want to consider consultation with a doctor at the nearest university hospital pain clinic as they are more attuned to looking for less frequent causes of such pain.

Good luck.

[txpacotaco66]

Hi again, and sorry it's taken me so long to reply back.  Poor thing, you sound so frightened, and who could blame you?  You get a cold, and next thing you know somebody tells you there's something wrong with your lungs, AND you're headed off for tests on your heart.  

I think everybody with asthma would probably describe their symptoms in slightly different ways.  You asked if I've ever had trouble getting enough air even without wheezing or coughing, and the answer is yes.  In fact, I saw my asthma doc for a checkup once back before things got worse last year, and felt great - no wheezing, no coughing - but my lung function tests came back far below normal.  The doc had me use an inhaler and a nebulizer while I was still in his office, then tested me again - and my lung function tests came back normal (in other words, I had responded well to the asthma meds).

You also asked if it makes sense that you would sometimes feel as though mucous was covering your airways, and the answer is yes!  The thing about asthma is that it causes inflamation in your airways, and the inflamation causes your airways to produce mucous.  The body's natural reaction is to cough to clear your airways.

I hope your tests come back negative (i.e., that you don't have problems with your heart).  I think it's normal to feel anxiety about the medical issues you're working through right now.  Take it easy on yourself, and I hope you feel better soon.

[heartfluttersflyawayplz]

so glad you got a answer and things are looking up for you .i know with my asthma i feel the same not sure i really have it but drs say i do when i do the breathing test, says my small airwys are not where they should be which i not understand that

can i ask you . with your asthma do you have times where you just dont have enought air, even without the whezing or cough? ive been worried about it thinking maybe its my heart not asthma.

i feel now and than that musc is covering my windpipe if that makes any sence.

i also have xhest pains its a dull ack and has lasted for 2 days but had another ekg done today and dr said was fine, going next week for the stress/nuclear test to make sure just anxiety/asthma/ i also have a sinus infection with mine

[txpacotaco66]

I saw my asthma doctor this week, and feel very reassured.  He believes my chest pain is consistent with costochondritis, which makes sense to me since I've had mild arthritis since I was a kid.  My asthma has not changed since I was last checked in May - lung flow and volume are essentially unchanged.

Per my doc, he thinks the biggest problem I've got right now is likely mucus plugs in the small airways in my lungs, which he suspects are coming from a chronic sinus infection.  He put me on another prednisone burst, and ordered a chest and sinus xray.  If the xray is positive for a sinus infection, he'll have me take an antibiotic and we'll work together to clear it up.  I may also need to see someone about my deviated septum, which might be contributing to the problem.  If my chest xray is abnormal we'll also talk about that, but he isn't expecting it to be.  If both xrays are normal, we'll get a CT scan done to rule out anything else.  Per my doc, my asthma meds had always returned my lung function to pretty much normal levels.  He expects that those levels will return when we get the mucus problem resolved.

Final note:  I had mentioned that I had seen my regular doc 3 times since October, and that he'd had me on two courses of Cipro (which he told me would resolve any sinus or lung infection).  Problem is, according to my asthma doc, he didn't prescribe a version of Cipro that would have any impact on lung or sinus infections.  Wish I'd known that months ago!

Thanks for the replies - doubly reassuring to see that your response is inline with my personal asthma doctor's response (he's a good guy).  

[heartfluttersflyawayplz]

thank you for support words, am trying to adjust to having something new,  plz let me know how your appt goes

[txpacotaco66]

Hey, thanks for replying back, and I'm so sorry to hear about your troubles.  I've had asthma since I was a child, but it didn't trouble me until I was an adult, and even then only if I had bronchitis.  In fact, a severe case of bronchitis about 6 years ago was when I first began taking med's for it regularly.  I currently use Symbicort (2 puffs twice daily) and Ventolin - a rescue inhaler - 2 puffs twice daily plus more if needed.  I don't know if either raise my heart rate but if they do, it isn't anything I've felt myself.  However, my doctor also prescribed Xopenex, a type of medication used with a nebulizer, for use twice daily, and I can't take it because it causes severe anxiety and the shakes for me, and does make my heart feel like it's going to pound right out of my chest.

Give you asmanex a chance to work, and don't be afraid to ask your doctor about using something else if you are still experiencing asthma symptoms.  I've had the  type of treadmill test you're talking about and, although coughing wasn't an issue for me at the time, my results came back inconclusive because, if I remember correctly, I had so much air trapped in my chest from my asthma that it clouded the images they were taking.

I know asthma can cause chest pain as well - in fact, that's probably what's causing me - so I do hope you'll speak to your doctor again (or even see a specialist if you need to), and that you feel better soon.  

Take care and reply back if you need some support.

[heartfluttersflyawayplz]

hey sorry your having these problems , i think you should ask for test and e-rays , i know it would make me feel better , i never had asthmas and this year got a cold and they say it turned into asthma, so been on a rescue inhaler and they want me to take asmanex at night have you ever had that , the meds scare me as i have a fast heart rate and skiped beats. do they have you on stronge meds for your  asthma .  i ask about  having a ct scan my ins would not pay they told me it was 7000 so i didnt have it , am to have a echo/thaum test where  you run on treadmill than they take pictures of heart with the dye, but with this asthmas i cant do because you cant cough or test no good. so i have chest pains to and worry its my heart but cant do test right now,  i wish i could help you out but am glad your goig to see asthma dr tomorrow plz let us know how you are and i hope smeone can come on here and help you . but yes i say ask for test. scan what ever will make you feel better .

[txpacotaco66]

Sorry to go on and on (and on...!) here, but a couple of things I couldn't fit in:

1)  I'm 42 and have smoked since I was 10.  Seriously doubt I'll ever be able to quit.
2)  I also have severe GERD, for which my asthma doc has be take Protonix twice a day (seems very well controlled, so long as I don't miss a dose).

Thanks again.