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Suggest treatment for recurrent respiratory problems

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Posted on Mon, 11 May 2015
Question: I've been experiencing respiratory problems for the past several months. I would get periods mainly at night where I would struggle to breathe and it felt like my chest was tight / it was taking longer than usual for my lungs to fill. When I went to my GP she listened to my lungs and got me to inhale once or twice and diagnosed it as a psychological problem, but it's been getting worse recently. For the past two days my throat has felt sore and I didn't think anything of it until I took pictures of the back of my throat (http://s22.postimg.org/gx9ru2rxd/0000_223417.jpg) and the underside of my tongue (http://s1.postimg.org/aumh6k45b/underside_of_tongue.jpg), which both look inflamed. What is happening to me?
doctor
Answered by Dr. Sandip Kabra (19 minutes later)
Brief Answer:
Could be upper respiratory infection or early asthma.

Detailed Answer:
Hi,

Welcome to health care magic, I have seen the uploaded images.

It could be upper respiratory infection or early asthma.

Majority of cases throat pain are due to viral infection(EB virus,adenovirus) but in some cases it might be related to bacterial infection (streptococcal pharyngitis).

We differentiate the cause through routine blood counts with throat examination, pharyngoscopy to rule out non infective causes.You should also go for pulmonary function tests if you are having breathing difficulty since several months.If there is anything found positive on pulmonary function tests (PFT) then you need thoroughly respiratory examination by pulmonologist.

Otherwise, it is advisable to see the doctor,Preferably ENT specialist for complete medical history including history of sensitivity to antibiotics and thoroughly clinical examination.

You might require antibiotics (levofloxacin or ofloxacin from quinolones group) or azithromycin (macrolides group) to prevent super infection if cause is viral with analgesics, antiinflammatories,antihistamine and mast cell stabilizer combination (montelukast with levocetrizine) and steam inhalation 2 to 3 times a day.

Hope this information will be helpful and if you have any doubt then feel free to ask me.

Thanks and Regards,

Dr.Sandipkabra
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Sandip Kabra (20 minutes later)
Thank you for your answer, I appreciate the detail you've included and I hope my GP will do the tests you've suggested. One thing I've been worried about is that these problems started after I smoked what I thought to be heroin but wasn't, and instead made it difficult for me to breathe normally. Because my oxygen saturation levels were fine at the hospital they said it was just a panic attack. Is it possible these issues I've been having are a complication from taking whatever the drug/chemical was?
doctor
Answered by Dr. Sandip Kabra (2 hours later)
Brief Answer:
Yes,it could be due to exposure to smoke.

Detailed Answer:
Hi XXXXXXX

Thanks for the follow-up query,

As I said earlier,your breathing difficulty could also be related to early asthma.As asthma is itself a allergic disease due to smoke or cold or dust or pollens or grass etc.

The tracheobronchial tree becomes hyper responsiveness to this stimuli causing difficulty in breathing for a while and in some cases gets subsided by itself or after the discontinuation of the triggering factor,here smoking in your case.

To diagnose or rule out this condition, you will need complete history and thoroughly respiratory system examination by pulmonologist (not by GP) followed by chest X-ray,pulmonary function tests etc.

The best way to cure allergy is complete avoidance of allergen or triggering factor,here smoking in your case.

Treatment is mainly symptommatic which includes inhalational steroids, beta receptor agonists, anticholinergics as a MDI or rotahaler.

You consult pulmonologist for further advice.

Thanks and Regards,

Dr.sandipkabra
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sandip Kabra (4 hours later)
Thank you for all of your help so far. I went to see a doctor this morning and after looking at the images and my throat he came to the conclusion that it was acid reflux. Does this seem like an appropriate diagnosis? I told him again about the breathing problems I've been having and how they are worse at night but when he checked my lungs they sounded clear so he said asthma and inflammation were not a possibility. I couldn't sleep all night and I didn't have the energy to argue about it. I think I might have to go privately to get a complete diagnosis, the NHS is extremely reactive.
doctor
Answered by Dr. Sandip Kabra (48 minutes later)
Brief Answer:
Could be possible that your throat inflammation is because of acid reflux.

Detailed Answer:
Hi,

Thanks for the follow-up query,

It could be possible that your throat inflammation is because of acid reflux from the stomach but the question is whether you are having any symptom of reflux esophagitis like lower chest pain or upper abdominal pain or nausea or hiccups etc.

Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm, mostly these episodes comes in the night time.

The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning.

I am not saying that you had a asthma but as per your history and symptoms of breathing difficulty specially during night, it must be ruled out.

Therefore,you must go for spirometry (pulmonary function tests) to measure peak expiratory flow rate and which will help to make a clear diagnosis along with your symptomatology.

Here, clear sounds on auscultation do not rule out the possibility of early asthma when there are symptoms of breathing difficulty with chest tightness since several months.

So,it would be advisable that you consult pulmonologist for your respiratory system thoroughly examination with PFT interpretation.

Hope i have explained it in a much simple way to understand.Feel free to ask any doubt.

Thanks and Regards,

Dr.sandipkabra
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Sandip Kabra (14 hours later)
I don't think I have reflux esophagitis as I have no pain in my upper stomach and very rarely would bring up any liquid from the stomach. I only started to feel pain in the throat two days ago, which makes me wonder whether it's more likely an allergic reaction...would reflux esophagitis typically take longer to create that amount of swelling? I am extremely scared in case it was an allergic reaction and that I could suffocate from whatever this is in the not too distant future. Is that irrational? In the meantime I will push for the doctor to take the respiratory problems seriously and rule out the more frightening possibilities. Thank you again for your help.
doctor
Answered by Dr. Sandip Kabra (6 hours later)
Brief Answer:
Better to consult pulmonologist rather than GP.

Detailed Answer:
Hi,
Thanks for the follow-up.

As per our discussion, you need to rule out asthma by spirometry testing (pulmonary function test).

The other possibility could be your repeated throat infection which might also cause breathing difficulty when triggered by some allergic substance.Now, this throat infection might be due to viral infection or some times bacterial (streptococcal pharyngitis) or allergic or due to reflux of acid(does not seem to be in your case).

So,it must be ruled out with routine blood counts,throat examination with pharyngoscopy, chest X-ray and spirometry testing.

It would be better you consult pulmonologist which could diagnose it correctly.

All these possiblites we have already discussed earlier, so better you do not consult GP rather you see specialist.

Thanks and Regards,
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Dr. Sandip Kabra

General & Family Physician

Practicing since :2009

Answered : 3078 Questions

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Suggest treatment for recurrent respiratory problems

Brief Answer: Could be upper respiratory infection or early asthma. Detailed Answer: Hi, Welcome to health care magic, I have seen the uploaded images. It could be upper respiratory infection or early asthma. Majority of cases throat pain are due to viral infection(EB virus,adenovirus) but in some cases it might be related to bacterial infection (streptococcal pharyngitis). We differentiate the cause through routine blood counts with throat examination, pharyngoscopy to rule out non infective causes.You should also go for pulmonary function tests if you are having breathing difficulty since several months.If there is anything found positive on pulmonary function tests (PFT) then you need thoroughly respiratory examination by pulmonologist. Otherwise, it is advisable to see the doctor,Preferably ENT specialist for complete medical history including history of sensitivity to antibiotics and thoroughly clinical examination. You might require antibiotics (levofloxacin or ofloxacin from quinolones group) or azithromycin (macrolides group) to prevent super infection if cause is viral with analgesics, antiinflammatories,antihistamine and mast cell stabilizer combination (montelukast with levocetrizine) and steam inhalation 2 to 3 times a day. Hope this information will be helpful and if you have any doubt then feel free to ask me. Thanks and Regards, Dr.Sandipkabra