HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Chest Tightness And Shortness Of Breath While Having Bronchial Asthma

Posted on Thu, 7 Jan 2016

Question: Hello Doctor,

I am 31 yr old, was diagnosed with bronchial asthma 15 years back. I would like to present my history for a better understanding.
1 - 5 yrs : I was on salbutamol inhaler on SOS and deriphyllin. ( when symptomatic - medicine duration approx. 15 days )
6 - 10 yrs : foracort 1MDI twice daily + montelukast LC + salbutamol inhaler on SOS. ( when symptomatic - medicine duration approx. 30 days, off LC after 7 days ) .
10 to 14 yrs : same as 6 to 10 yrs + inhaled corticosteroids increased in 13th and 14th yr - foracort 400 - 2MDI twice daily.
15th year ( last 02 months ): symbicort 160/4.5 - 2MDI twice daily + montelukast + Salbutamol inhaler on SOS.
Last 15 days : Spiriva 18 mcg added.

- Chest X-rays were always clear.
- URTI very rare (once a year from past 05 yrs)
- Negligible phlegm in chest - since begining.
- wheeze : very rare (negligible)
- chest tightness : always
- shortness of breath : always
- Physical exercise : at least 20mins daily, no exercise in last month ( no exercise induced )
- work : Stressful, place : petrochemical industrial area.

I am worried that my health is gradually worsening, medicines increased drastically, psychologically affected, breathing has become conscious - I still catch for breath, chest tightness, shortness of breath such that I have Ventolin while writing this.

I have consulted many pulmonologists. With my little knowledge that I have gained over years, I feel it's more than asthma, COPD or towards emphysema probably.

Request for your guidance in proper diagnosis and medication.

Thank you.

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
COPD

Detailed Answer:
Hello

Thanks for the query and the detailed history. However in order to help you I need a few more details

1. What is your weight and height ?
2. Is it possible to attach the x ray so that I can have a look at it
3. Do you smoke ? ( many of my patients who are asthmatic smoke)
4. Do you have recurrent chest infections or sinusitis as well?
5. Do you exercise?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Thank you Doctor.
1. 75kg/176cm
2. I am not able to attach the x-ray, will try attaching all latest records incl. x-ray.
3. I dont smoke.
4. Very rare chest infections ( once a year - mild ), sinusitis - 2 times a year - very mild, clears quickly with steam inhalation.
I am not sure if my continuous moderate to severe wrist and ankle joints pain since 06 months is related to my medication.
5. I exercise regularly ( walk / jog on treadmill for 3 to 5 kms : 4 times a week, i have not exercised from past 01 month as i am afraid that my condition might worsen. Never observed exercise induced asthma
)

Answered by Dr. Rakesh Madhyastha (20 hours later)

Brief Answer:
Need not be progression of asthma

Detailed Answer:
Hello

Thanks for getting back with the details. From the history you have given it looks like you have good effort tolerance. You are able to jog 5 km and that's excellent for an asthamatic.
It could be that there is an allergen which is triggering your attack. Please find out what the allergen is, one has to look carefully. It could be a new curtain, pet, un-vaccumed carpets. Some individuals get an attack of asthma from eating a particular group of food. Furthermore Symbicort twice a day is still a very minimal dose and one should not worry about it.

Nonetheless if you are still worried then I recommend getting a pulmonary function test to rule out restrictive airway disease like fibrosis of lung.

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Rakesh Madhyastha (3 days later)

Thank you Dr. XXXXXXX
I am attaching a picture of my x-ray if you may find something.
My daily PEFR on a cipla breathometer is consistent is consistent ( 556 to 580 l/min ) (ht-175cm, wt-74kg)
My PFT was normal 02 months back.
I am still feeling the same doctor.
I am desperately looking for help Doctoras its very difficult to go through episodes of shortness of breath.

Thanks & Regards,

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
COPD changes

Detailed Answer:
Hello , Welcome back to HCM.

Thanks for getting back with the x ray. Your x-ray is essentially normal however I see chronic obstructive pulmonary disease ( often seen in asthma) changes like slightly increased intercostal space and straightening of the ribs. However this is nothing to worry about .

Tips to keep exacerbations under check

1. Be on long acting drugs like SALMETEROL
2. Find out what triggers your asthma by keeping a close observation of the environmental factor
3. Keep your weight under check
4. Exercise regularly
5. Last resort would be to start a low dose oral steroid

I hope I was of help, if you have any further queries please get back to me

regards

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee