Feel like I'm going to die

[arit]

*Posting this for a friend as he doesn't have a credit card* -> 27 Years old. Diagnosed with asthma at 21. Only time I had chest tightness before this was two years before after there was a fire where I lived and had exposure.  I had coughing for a week or so after and it went away. Taking advair 500/50 and it controls symptoms 95% of the time. Had a Xray done every year, one catscan, PFT's pretty consistent for the last 5 years. Would you recommend a hospital in NYC to get a full workup ? Or just national jewish - it would be hard to travel for me so looking at other options. I am worried that my lungs will get progressively worse, will die very young, and this is not really asthma but airway hypersensitivity or something from the fire/smoke inhalation? Can you please tell me how to proceed.

[David Tinkelman, M.D.]

If I understand your message correctly, you have had asthma (at least diagnosed as such) for 6 years and, during this period have had a normal CT Scan (by my calculation, this would have been two or more years after the smoke exposure), normal chest X-rays and PFT’s consistent with the diagnosis of asthma and showing no loss of lung function over a five year period.  That is to say that your current lung problem is just asthma and not some other, smoke induced, lung disease.  You mentioned your concern about hypersensivity lung disease (hypersensitivity pneumonitis or HP).  That’s highly unlikely, without evidence of progression, after many years.  

Were you to have experienced permanent lung damage, even with insidious progression, it should be evident by the above testing, by this time.  However, the smoke exposure might well have contributed to the clinical expression and continued symptoms (if not medicated) of your asthma.  That is asthma, nonetheless, not another disease secondary to smoke-induced lung damage.  Y

It is well for you and your doctors to keep in mind that not all that wheezes is asthma.  Although very unlikely in your case, other diseases that can mimic asthma should be kept in mind.

The odds are highly in your favor that, even if there were underlying inflammation of your lungs caused by a disease other than asthma, its not having progressed over many years, it is not a problem and is not going to worsening of your lung condition, resulting in death when you are “very young”.  

Were there any signs or symptoms to suggest disease other than asthma, I would strongly suggest that you come to National Jewish.  Otherwise, you and your doctors would do well to monitor your lung condition and lung function, in the absence of new symptoms or signs, with annual PFT’s and biennial (every two years) chest X-rays.  If your present doctor is not a lung specialist, I would suggest you seek consultation with a pulmonary specialist recommended by him/her, or at one of the following institutions.

If you currently need the reassurance that comes with expert opinion, I suggest you consider seeking evaluation at the New York Presbyterian Hospital, National Jewish Health in Denver, the Cleveland Clinic in Cleveland Ohio, or the Mayo Clinic in Rochester, Minnesota.

Good luck

[arit]

FVC - 86%, FEV1 99%, FEF25-75% 130%, PEF 100%, FIVC 82%, TLC 81%, VC 86%, IC 80%, ERV 94%, FRCN2 73%, RV 60%, DLCO 118%, DL Adj 118%, VA 80%, DLCO/VA 138%