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    What causes asthma and chest tightness after quitting smoking?

Posted on Wed, 25 May 2016 in General Health
Question: So asthma it is. I now treat it but need to find out triggers. For now, I am assuming stress and anxiety are the main ones. Getting it as an adult is rare but does happen. I wonder if it began before or after I quit smoking. If I have mild and my chest gets tight and bothers me. I wonder what someone with severe feels like. Oh my.

I tried to give you my rating but hcm has a lock on how many stars you can give someone

Answered by Dr. Alexander H. Sheppe 1 hour later
Brief Answer:
Private Consultation

Detailed Answer:
No worries about the rating, I don't care about the stars! Just care about being helpful.

I think it is important to reiterate that I believe the main problem here is anxiety and panic, not asthma. Asthma attacks are specific events that involve wheezing and require bronchodilator treatment to resolve. Anxiety and panic can mimic asthma attacks, but do NOT resolve with bronchodilator treatment and obviously have very different causes. I think we have a lot of evidence that your biggest problems are related to anxiety and panic. Asthma, a very mild variant in your case, may be playing a role, but the shortness of breath you are having with panic attacks will often not be resolved with bronchodilators, and will require other cognitive techniques to improve over time. So while these latest PFTs are helpful, don't fall into the trap of believing brochodilators will solve all your problems -- treating the anxiety and panic is in my opinion even MORE important.

What has your doctor suggested as treatment for your asthma? An albuterol inhaler as needed, I presume?

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Alexander H. Sheppe 28 minutes later
Believe it or not, I have had both long acting and emergency albuterol inhalers for 15 years, In that whole time, I have never used enough to finish one up.

I also forwarded a copy of my pft to DR Bhavsar Pulmonologist. His reading is close to yours he said no copd/no asthma, but small airway obstruction, and that can be affected quite a bit by stress and anxiety. I was already aware that airways are constricted by stress for someone with asthma so I may have a varient. Before either of you responded telling me your readings of the PFT, I chose to work dilligently on stress removal and reduction then see where it takes me.

I have had nothing given recently regarding asthma treatment, last I had was 3 years ago when I had a pft in april 2013 and they finally entered ASTHMA on report. Want to drop a note to DR today for his recommendations but as you said, it is mild so I would not care to be dependent on them but adjust lifestyle to help
Answered by Dr. Alexander H. Sheppe 15 hours later
Brief Answer:
Private Followup

Detailed Answer:
It's good that you're not overusing inhalers. I see this a lot in people with panic disorder, because they want to use anything that will help to relieve that horrifying SOB sensation, but it can actually make things worse in the long run.

I took a look at Dr. Bhavsar's answer and I am in agreement with it. He's actually saying that you have neither asthma nor COPD, but rather mild small airway obstruction. You can see that even calling this very, very mild asthma may have been an overstatement on my part.

For mild asthma, the treatment is rarely anything more than using an inhaler as needed. So I suspect there will be no change in your medical approach to this situation.

But, my area of expertise is stress and anxiety management, so I'll stick to that. It seems you have been doing well recently with stress reduction and cognitive restructuring techniques. It can be good to take a step back and assess how things are going. What is your impression of things so far? Do you feel the same, better, or worse than when we started? Is there anything I could be doing differently to help you more?

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Sonia Raina
Follow up: Dr. Alexander H. Sheppe 9 hours later
How am I doing now?, hmm. Well I am much more informed and more confused. The 7 PFTs are in the normal range and all Drs say the same thing, your fine.

I have GAD and detest what it does to my thought process. My mind tries to make me believe things that it wants me to believe.

I acknowledge too many stressful situations and the need to unwind

I lost a few chapters in the handbook on growing old so I missed the part on aging and respiration

So I had an appointment with pulm in late January or early February, was told I was fine, no lung damage and that I would live to be really old. Had a pft and once again I was told the same thing and had a paper to show it. Both times I felt much better but within days started to question it because of my physical symptoms

if and I say if I have very mild asthma I should not have much in symptoms normally. Reading up about asthma I see that stress and anxiety play havoc with asthma. Now let's turn this around. If I do not have asthma and my PFTs are normal. What causes my actual breathing in to be less than it should and when I exercise or carry things or even lose breath as I speak. I understand you when you say that the body takes in only the amount of air it needs but when simple movements trigger breathing issues and that they are very limited what is the cause.

If having so much built up stress and anxiety inside is the cause what is exactly going on so that I can reduce it. What reaction fron the anxiety is causing the physical restriction of taking a breath that is being called for. Is the stress actually tightening up the airways or is my old age come but the PFTs don't show that. The actual numbers not percentage are the same as those when I was 40 except fev25/75 Bhavsar said stress can influence that. What do you think he means. That it can swell up the airways keeping it from moving in and out

I hope you do not have to untangle this and can give a good reason.
Answered by Dr. Alexander H. Sheppe 14 hours later
Brief Answer:
Private followup

Detailed Answer:
I think this is one of the key things we need to unpack:

"If I do not have asthma and my PFTs are normal. What causes my actual breathing in to be less than it should and when I exercise or carry things or even lose breath as I speak. I understand you when you say that the body takes in only the amount of air it needs but when simple movements trigger breathing issues and that they are very limited what is the cause...Is the stress actually tightening up the airways or is my old age come but the PFTs don't show that."

It is a persistent concern you have that something is physically wrong with your lungs that are preventing you from breathing adequately.

The PFTs, which are the gold standard test of lung function, do not show anything functionally wrong with your breathing. There is a mild improvement in a couple measures with bronchodilator therapy -- but this measure is not classically associated with asthma, which is why Dr. Bhavsar says this is likely not asthma. Even if it is asthma, it is a very mild variant and can be adequately managed with as-needed albuterol inhalers. In your many PFTs done, there is no evidence of COPD at all.

When you have a panic attack, you feel like you cannot breathe in enough air. This is a FEELING rather than a physical FACT, which I think is important for you to remind yourself of. We have no evidence at all on PFTs that your lung function is compromised. You're getting all the air you need. But you FEEL like you are not getting enough. This is due to complex chemical reactions in the brain involving neurotransmitters in the amygdala that we do not fully understand, but it does NOT mean that your anxiety is causing your airways to constrict or swell in a dangerous way. You FEEL that, but it is not true. Your mind is playing a trick on you. It takes cognitive therapy and medication like Zoloft to reverse this trick.


Dr. Sheppe
Above answer was peer-reviewed by : Dr. Sonia Raina
Follow up: Dr. Alexander H. Sheppe 13 hours later
The next few paragraphs are the recent thread from Bhavsar. There is no ganging up here but i will say the two of you win in regards to stress relaxation therapy. I will do my best to make time to find a new way for relaxation. I really miss my therapy with music practicing. In SD, I had a room devoted to music. It had a full stereo system that could compete with a power driven Bass Amp. It had several bass guitars and a powerful amp. I once explained to my mother that to truly understand the bass line in a song, you had to turn it up to hear the notes, the subleties, the intonations. When you played along side it, you had to have power to feel and be felt . this room provided it. and It had a bed so you could take a nap when worn out. Ha . Here i have nothing and I have to be at a low volume when the kids are visiting.

I have cut and pasted the key parts out of the current two threads you and I have and added parts from Bhavsar to a document form. When I get the Local pulm dr report, i will add it to it. Then I will print it and keep it with me for support thinking positive thinking and out cognitive therapy.

In your opinion would it be beneficial or not beneficial to think back to each occurance to my issues that caused a recalling memory and see if it can be matched up to an high or continuing stressful event or events. would this help to realize that there was a factor to the event and not just degenerative lung disease. after all, it has been 15 years and 7 pfts with basically the same results.

Oh to veer away from the subject, I want to get my hands on the new bass in SD and get it down here to play. I may have to make a new trip back very soon to get it and when I do I will take a bunch of stuff alown. but the veering was to say I want to try my new bass out ssooooo badly I want to get the old sound room set up and let loose ohhhh what fun that would be. the only thing that would be different is I find that I cant enjoy the one beer I would have because one of my meds doesnot like beer and gives me a hell of a headache. So its coffee, a stimulant

Bhavsar recommended yoga bear and i agree but i need practice in that field. but I could use a weekly session with a massage therapist. and after I could let my 8 year old grand daughter walk up and down my back oh that would feel sooo good. hahaha i must drain my hot tub, clean the filter. sanitize the lid, clean and refill and put to use.

Stress is proven risk factor for small airway disease.
stress operates by altering the magnitude of the airway inflammatory response that irritants, allergens, and infections bring about in persons. Stress on its own is NOT capable of modifying immune functions in a way that leads to small airway symptoms. Rather, stress is viewed as a process that accentuates the airway inflammatory response to environmental triggers and, in doing so, increases the frequency, duration, and severity of patients' symptoms.

I think there is vicious cycle running in your mind which is not letting you forget these things.
Your uncontrolled stress and anxiety are causing inflammatory changes in airways.
This reflects in PFT as small airway obstruction.
You are better when your stress levels are low. You yourself admitted this.
Please let me know
1. When did you consult psychiatrist? (recent one)
2. When you are asymptomatic, do you have any sort of stress and anxiety?

We all doctors are trying to convince you that you are not suffering from major organic disease. So you will not die soon.
Your all symptoms are associated with stress and anxiety.
So don't think negatively.
For your deep breathing issue and trapped air issue, in my opinion, you should start Yoga and meditation.
These will also help in reducing stress and anxiety.
Please let me know, have you tried Yoga and meditation?

Yes, yoga is a bit difficult in initial phase but once you used to it, it will be easy.
Meditation is excellent for mind peace.
Don't worry, you will be alright. Forget everything, focus on peace only.

Answered by Dr. Alexander H. Sheppe 2 hours later
Brief Answer:
Private Followup

Detailed Answer:
I think you have a clear path to stress reduction in your music. It's unfortunate your practice room (which sounds frankly amazing, especially the bed for naps) is all the way back home. But you'll get back to that eventually. For now, doing jam sessions with buddies and playing whatever you can in your current home clearly helps you relax. I think when you are beginning to panic or feel anxious, playing music should be your immediate go-to activity. There are other things of course -- taking a shower, lighting candles -- but music really occupies your mind and can help redirect that panic short-circuit.

Yoga and meditation are also great ways to relax. Guided meditations are available on YouTube, for example. Doesn't take a lot of skill -- just load up a video and follow the instructions. Many people find these very helpful.

Your idea about having a document with several doctors' statements on it with you to look at in times of anxiety is a fantastic idea. I wish I had thought of it myself. This is perfect as a way to promote healthy, rational thinking when your mind is stuck in the anxiety circuit. You're clearly developing a lot of insight and coming up with your own techniques to combat anxiety. I'm proud of you.

I don't think dwelling on past panic events at this point is hugely necessary. I think we can analyze them together as the are happening or have recently happened. I think that would be more useful than going back over them in detail, as this might worsen anxiety. It's not a terrible idea, and I'd certainly be willing to go over them with you to try to figure out specific triggers, but I think it might be more useful to go over them as they happen in the future.

Looks like this thread is finished. Rate and close and we'll continue on your other thread or a new one.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Alexander H. Sheppe 2 days later
I just sent you the full PFT. I will comment on a new thread.
Answered by Dr. Alexander H. Sheppe 35 minutes later
Brief Answer:
Private Followup

Detailed Answer:
I took a look at the full PFT report. A chest X-ray was also included. It's interesting that the PFT report is interpreted as normal lung volumes and no airway obstruction, but the lungs are mildly hyperinflated. Mild hyperinflation can be a normal physiologic variant, not necessarily abnormal or related to asthma (as your doctor wrote). So overall, this to me is just one more normal report that should be reassuring to you regarding the physical health of your lungs.

I look forward to talking to you in the next thread about your interpretation of these results. Rate and close this thread and we'll keep going!

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Dr. Alexander H. Sheppe


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