Is it asthma or something else?

[Nicolette1987]

I am having a very difficult time finding out if my breathing problems are asthma or something else. I was first diagnosed with asthma when I was around 3 years old and had on and off symptoms my whole life, sometimes disappearing for years. My grandma also had asthma.

Problems came back a few years ago when I was around 22. I get this feeling that I cant breathe all the way in and that I will suffocate. I yawn a lot to try to get air in and feel breathless. Breathing feels like a chore to me when I get symptoms.I also get this cough that starts as a small tickle but turns into this nonstop coughing attack for hours. One time I needed a steroid shot because I couldn't stop coughing for so long. The coughs are dry and I get this feeling that my lungs are itchy if that makes sense.  

I was put on Symbicort and it helped me a lot. I barely had symptoms and rarely used my rescue inhaler. Most of my past doctors said what I have is a mild asthma, but what confuses me is that my spirometry tests come back really good, like I was told I have 'super lungs'. Then why is it so hard for me to breathe? My current pulmonologist is skeptical because of how good my test was and now I am getting confused. He wants me to do the methocholine challenge, which I have scheduled in a few weeks. I did it when I was younger and it was negative however my specialist at the time still said its asthma.

I also have a deviated septum and nasal congestion that gets very bad. I think I get a post nasal drip from the congestion but I am not sure. To add to this, I have problems eating wheat/gluten. I get constipation and bloating and it gets worse when I eat those things. This also started when I was little and the test results for celiac were negative. I am wondering if eating gluten/wheat maybe makes it hard for me to breathe as well.

I've been dealing with this for many years and want to really know what is going on with me. Is it asthma? Is it something else?

[David Tinkelman, M.D.]

Yours is a very common history of asthma that varies in intensity over time through a lifetime, often for reasons that are not immediately obvious.  The great response to Symbicort is very encouraging and the best indicator that you have controllable asthma.  I would interpret your “normal” pulmonary function tests in that same manner.

I can understand why your having “normal predicted” PFT’s, at any given time when the asthma was not overtly active but that normality would not rule out the diagnosis of asthma.  One’s PFT’s can be in the normal range when the airways are still inflamed but not constricting.  Any measurement of pulmonary function, in an attempt to “pin-down” the diagnosis should be performed at a time when you are symptomatic.  The Methacholine challenge is generally quite reliable test, but there are instances, albeit rare, when the test is falsely negative for a person who otherwise undeniably has asthma.

It is wise for your lung specialist to consider other lung diseases, or diseases of the vocal cords, that can mimic asthma but ultimately the ability to effectively control your asthma symptoms with standard asthma drugs will be the most important matter for you and your doctor.

Good luck

[Nicolette1987]

Also to add to my previous comment. I get symptoms from dust, smoke, chemicals, perfumes, cold air, and maybe wheat/gluten. Thats when the coughing or shortness of breath starts. Also after exercising I cant stop coughing. When I was on Symbicort I didn't have any symptoms.