Very Stubborn Case

[Hikari32872]

I am 21 years old and I’ve been having a hard time breathing for the last 4 months. At first, I thought it was just my asthma and my doctor agreed, so he put me on Advair and Singulair for maintenance and Medrol to help bring the inflammation under control. Two weeks later, I still wasn’t better, so he raised the dosage on the Advair and put me on Prednisone for 15 days and ordered some tests (Chest X-Ray, bloodwork, spirometry, and an echocardiogram). The only abnormal thing that came up was an elevated IgE count, so I was referred to an allergist about 3 weeks after the second doctor’s appointment. He didn’t know what the problem was either and said it might be an infection, so I was put on antibiotics and the Advair was raised again so that it’s now 500/50. He kept me on Singulair and also put me on Allegra in case I had a hidden allergy. Well, those things didn’t work, so about a month and a half ago, I was referred to a pulmonologist. He told me that based on my normal test results, that it was probably just my asthma and to come back in 6 months while keeping everything else the same. So 4 months after the initial symptoms appeared, I’m still not any better and I’m wondering if it is just my history of asthma like he says. I still have a very hard time with daily activities and get short of breath very easily whether I’m just sitting or am active and my chest is almost always tight. I also began getting strange chest pains recently that result in a sharp, tearing sensation just left of the center. They come and go, usually only lasting about 10 minutes at a time. Before it goes, it feels like a pop occurred in the lung and then the pain is gone. I’m at a loss for what to do. Do you think it is still just asthma? Should I keep pursuing this? Any help you can offer me is greatly appreciated. Thanks.

[National Jewish Health]

What you describe, the fairly sudden progression of heretofore controllable asthma to very difficult to control asthma is unusual but not unheard of.  In most instances, the cause can be found, but not always.  But, you are right to ask if this is truly what has happened.  The elevated IgE may provide a clue.  High levels are associated with a condition, seen mostly in people with asthma, called allergic bronchopulmonary mycosis (ABPM), an allergic reaction to one of a number of fungi.

Beyond that condition, there are other lung diseases, usually with abnormal chest x-ray findings, that could be the cause of your symptoms, superimposed on the asthma.  These could include recurrent pulmonary emboli, commonly called clots to the lungs, hypersensitivity pneumonitis (HP), endobronchial sarcoidosis, which is in the airways, and diseases of the blood vessels of the lungs, some with pulmonary hypertension.

Bottom line – this may not be just asthma and your doctors might want to consider additional testing, including blood tests, complete pulmonary function tests (PFTs), CT scanning of your lungs and maybe even bronchoscopy.  If they don't, you should seek yet another opinion from a pulmonary specialist at a lung center such as the National Jewish Medical and Research Center or the Johns Hopkins Medical Center or the Mayo Clinic.  If that is not feasible, you might want to get another pulmonologist’s opinion at the nearest medical school clinic.

[WCraig]

It could be a heart condition.  In that case, you don't want to undertake any exercise without medical advice!

[WCraig]

Oops!  Scratch that last comment!  I didn't notice that you mentioned the chest pains.  Be careful!  Could somebody please delete my posts?

[WCraig]

Don't give up.  It can take years to find a doctor who will even listen.  Exercise and allergy shots help tons.  I have this condition.  Makes you want to hit somebody, doesn't it?