Tight Chest struggling!

Hi

Can anyone please help me with this? I would be really grateful for any help or advice. I am on the highest dose of steroid inhaler. I have been taking this for a couple of years now and been relatively ok! For the past 2 weeks I have been struggling to breath and have a very tight chest. Initially I thought this was due to hormones as a week before my period I tend to become tight chested and breathless and once it starts I usually feel ok. However it is lasting longer than usual. I have been to see my GP who wants me to check my peak flow for the next 2 weeks. I have noticed that there is no change in my peak flow result and it is remaining the same before and after taking the inhaler. Which would surely indicate that the inhaler isn’t helping. She also thinks that I could be suffering from anxiety which could be triggering the asthma. This is possible I guess because obviously it’s a worry when we can’t breath! Can anyone shed any light on this? Thank you

[EmmaF91 Community Ambassador]

Hi

One of the easiest ways to tell if it’s asthma or anxiety.... does PF/symptoms change with your reliever/blue inhaler? (Can’t tell if you were talking pre/post maintenance or reliever 😅). If the blue has an affect then is very very unlikely to be anxiety driven tightness.

Anxiety can trigger off asthma, but if you don’t feel anymore anxious to usual prior to the tightness then again it’s less likely to cause problems. I have very specific ‘exam stress’ as a trigger which I can always feel, but general anxiety/stress doesn’t affect me.

It could be that you’re having issues with the change of weather, plus hormones, plus oncoming cold, plus stress etc (trigger Jenga) and you need something to calm it down. It could also be that you need a different preventer if yours has ‘stopped’ working if a time, or that you need an add on medication

Hope that helps.

[Lysistrata Administrator Community Ambassador]

Hi, sorry to hear you're struggling at the moment! When you say there's no difference in your peak flow before and after taking your inhaler, do you mean taking the preventer inhaler or your reliever? Which preventer is it?

I wouldn't expect much immediate change in peak flow from the preventer, and if it's not working so well then it might not do much even after a couple of weeks. Is your reliever inhaler helping with symptoms? Sometimes preventers do stop helping or you need something more on top.

Have you noticed anything else triggering the symptoms eg does it seem to be related to the folder weather or something at home/work?

[Hidden in reply to Lysistrata]

Hi Lysistrata thank you for your reply. I mean no change after the preventor inhaler although the reliever isn’t doing much either. I can’t say I have noticed much of a change in previous years with the weather either.

[ChrissieMons]

It depends if you really do have some underlying anxiety about something other than the asthma. Only you can decide this! Give it a bit longer and if nothing improves and you suspect your GP is not getting a handle on it, insist on seeing a consultant. If there is no infection and no tension, you have to find out what is making you feel unwell.

[hilary39]

My peak flow almost never changes, even during terrible attacks, and I learned it's because severe asthma can manifest more in the small airways for some people than in their large airways (peak flow and FEV1 in spirometry measure the big airways only).

[Hidden in reply to hilary39]

Thank you for your reply. That’s really interesting.

[-Butterfly- in reply to hilary39]

This is interesting, shame some in the medical profession get so hung up on peak flow 😩

[hilary39 in reply to -Butterfly-]

It’s so true. There is a pulmonologist in the states, Sally Wenzel, who argues severe asthma should have a different name altogether since it is actually a different phenotype than mild and moderate asthma.

I also don’t wheeze much and I have discovered I can be in a really bad attack but get dismissed by some nurses because my peak flow is normal-ish and I’m not wheezing.

I think a lot of doctors and nurses have a limited understanding of asthma and how to treat it. There are 300 million people with asthma and probably about as many manifestations of the disease!

[-Butterfly- in reply to hilary39]

I rarely wheeze too! And my best pf is well above average. And sats tend to be pretty good.

Yes you're right, it cant be the same for every single person.

[WindsweptRissa in reply to hilary39]

I Apologise for going off track on the original post, but that’s interesting. I have some obstruction in my small airways which shows up on spirometry, although my peak flow and volume is better than expected for my age etc and in July a CT scan showed some mild mucus plugging at the bottom of my lungs which was said to be consistently with small airways disease. I find that my peak flow is not really a good indicator of how I’m feeling. I have in the past been so short of breath that I struggled with the lightest of household tasks but my peak flow was barely affected and officially in the green zone but other times my peak flow has dipped quite a bit and although I am having trouble I’ve been worse with less of a dip. I don’t have severe attacks just periods with a gradual worsening of symptoms usually because of an infection. I haven’t been diagnosed with severe asthma, but I’m on medication that according to some definitions would put me in the severe category and still occasionally need a short course of steroid tablets. Also although I used to wheeze really loudly when I was younger I hardly ever get an audible wheeze now, even when I had a time that I could barely speak or eat. When I was younger my asthma was more typical, sudden tight chest, wheezing and coughing which was fixed fairly easily with ventolin but now I decline so gradually I don’t even notice until I’m at a point I can’t ignore it anymore (my husband spots it first). I guess I find my asthma confusing and wish some doctors didn’t rely on peak flow/wheeze quite so much.

[Fedupwithasthma in reply to WindsweptRissa]

This is so interesting. I wonder if I’m the same. I’ve been having so much trouble (been really ill this week tbh). But my PF is always good. Had to go to out of hours yesterday after vomiting all day and eventually got antibiotics after three visits to doc and nurse previous two weeks where I told them how bad I felt! But oh no, PF is fine and they can only hear a ‘bit of a wheeze’. Well they obviously missed an infection? Can they hear that kind small airway issue through a stethoscope?

[WindsweptRissa in reply to Fedupwithasthma]

I don’t think its something they can pick up with a stethoscope. I only had the sprirometry and then CT scan because I’ve had a pretty much daily productive cough for 6-7 years and then last year I was getting a bacterial chest infection roughly every 6-8 weeks. They thought I might have bronchiectasis but the mucus plugging wasn’t enough to diagnose me with that. But I was prescribed carbocysteine and a spiriva respimat inhaler to take on top of my usual medication. Now as soon as I start coughing up green gunk I take a sample to the doctor and they send it off for testing and in the meantime get me started on antibiotics based on what I’ve had before.

[Fedupwithasthma in reply to WindsweptRissa]

Interesting, thanks. I’ve been referred so hopefully get more proper tests done. I’ve had a cough for a year and four chest infections this year. Just been given Spiriva too.

Good luck with it all!

[Barbs80]

Hi I am with you on the chest tightness, no wheezing and peak flow only slightly lower. Doctors told me it was my anxiety and stress in work. I have also found that my resting heart is a lot higher than normal. I have been taking my salbutamol to help with chest tightness and trying to relax more.

[WindsweptRissa]

Firstly you won’t get a change in peak flow after taking your preventer as the preventer builds up over time, hence when trying a new inhaler it is necessary to try it for several weeks to see if it is having any affect. There are several reasons for an increase in problems, including having had a cold or an infection (if you cough up sputum you should get it checked for a bacterial infection), something new in your environment or a seasonal thing (e.g. drier air in the house due to central heating). But it could also be time for a different inhaler. There are quite a few different types and you might need to change to something new, maybe even a combination inhaler. Plotting your peak flow over time will show the doctor how your asthma changes and how much variation there is. Although as has been said below peak flow isn’t everything and you should also take note of your symptoms.