Tight Chest That Is Ruining My Life. Any help?

[Stashle]

Hi All,

Thanks for any help or reassurance in advance.

Me:

33-Year-Old Male. Ex smoker (as of 4 weeks ago - light smoker over the years, probably 4-pack years max). Well-controlled asthma for about 15 years (Beclametasone ICS, never needed rescue inhaler when not smoking).

My recent story:

i) 3 months ago I had a minor exacerbation (tight chest - no mucus, no cough, no wheeze) after a heavy night smoking (duhh, I know).

ii) Went to the doctor, he prescribed Symbicort (160/4.5). Went off all other asthma drugs, just 2 puffs of Symbicort/day. Recovered in around two weeks.

iii) A few weeks later after some beers I thought my lungs felt so good that it was time for a few cigarettes

iv) Woke up with a super tight chest again (no mucus, no cough, no wheeze).

v) Upped my Symbicort dose to 4 puffs a day.

vi) Slow improvement over 2 or 3 weeks before smack bang at square one of this current situation.

vii) Back to doctors to be prescribed stronger Symbicort (320/9 - two puffs a day) and Montelukast.

viii) Since then, there has been zero improvement and zero change.

ix) Another doctor appt on Friday to advise I'm not improving.

Other stuff that may be clues to what's going on:

- I feel fine in the evenings at home and when sleeping. I wake up in the morning feeling almost normal. In the office feel OK until around 1-2pm when the tightness comes on

- Only Asthma trigger I've ever known is smoking. Had cats forever with no issues, no hayfever, no other allergies, lived in cities with terrible air etc...

- No allergies, no wheezing, no mucus, no coughing.

- Ventolin is having a negligible effect right now.

- Fit and healthy generally, plenty of sports and cycling etc.

- Peak flow is always good. Blood oxygen always good.

- I'm currently not in the UK but have access to a respiratory specialist department within 24 hours and a great team of docs.

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So err, yeah... That's my story. Anybody ever experienced anything similar? Anyone got any advice what might be the issue or what might help recovery?

I'm so anxious right now that I desperately need to know this tight chest will not be with me forever.

[madonbrew]

Hi,

I have no great advice at all, but just wanted to say hope your appointment is helpful on Friday!

It’s good you have a respiratory team. They would hopefully offer you some help and advice.

[Stashle in reply to madonbrew]

Hey, thank you so much for taking the time to respond.

Yeah, I hope we can start fixing this soon. I'll report back to the thread if anything changes.

[Sausagesog]

I find taking antihistamines help. I seem to be getting more allergy symptoms as I get older. I’m 44. Tight chest, no energy and sometimes headache. The antihistamines usually help.

[Stashle in reply to Sausagesog]

Thank you so much for the suggestion!

I've tried antihistamines and they don't seem to have any effect. I have no known allergies so I'm thinking it might be an infection or I've just inflamed my lungs with smoking and they're currently hypersensitive.

[Alliblob]

Hi, completely with you on this. Do you suffer from Anxiety? I ask as I was diagnosed with it a year ago now and I believe it is linked with asthma. My anxiety causes me chest pain and exacerbates my asthma leaving with a dull ache across my chest, your symptoms sound like what I am currently dealing with (off work at min as struggling). I sleep well, my peak flow is ok, I also walk a lot but I still have tight chest and struggle with breathing. I would see your GP, I do hope you feel better soon.

[Stashle in reply to Alliblob]

Sorry to hear that you're having such a hard time. I'm also taking time away from the office now and then right now. Fortunately my boss is very understanding and I'm OK working from home.

I don't have anxiety as a disorder, I'm fairly sure. But when my chest gets tight I have all the symptoms you'd associate with it. As soon as my chest loosens up I feel totally normal.

[Poobah]

It's interesting that it appears to be linked to your smoking but only time you struggle is at lunchtime. You say you have no known allergies, apart from the reaction to smoking, but have you changed your breakfast or lunchtime diet, including drinks, in anyway? The reaction maybe to breakfast rather than lunch.

I'm wondering if you have developed an intolerance or sensitivity or are eating something new or in greater quantities than usual.

[Stashle in reply to Poobah]

Hey Poobah!

I think the smoking triggered this exacerbation (or whatever it is). But I haven't smoked for 4 weeks now so there aren't any known triggers.

I take my Symbicort approximately at 8am when I still feel OK after sleeping. By the time I finish work I feel tight again. I get home and take my Symbicort's second puff at around 7pm, then I'm OK until morning.

My environment, diet, lifestyle, worklife, etc. have all been steady for a long time. I rarely eat the same thing every morning/lunch either.

Perhaps it is something to do with GERD? Maybe I'll try some Lansoprazole for a few days and see if that has any effect.

[Poobah in reply to Stashle]

Just thinking about your reply. When I have a flare up I find that even though I increase my morning & evening inhaler dose, I do get SOB about 4pm. It could be that you need a reliever (Ventolin) during the day to keep you going.

I was on Symbicort but I didn't respond well to it. The consultant increased the dose up to the maximum and expected me to use it as a reliever if I got SOB during the day. My asthma just gradually got worse. It just wasn't for me. Now I'm on Fostair I do feel better. My asthma nurse explained that I needed an inhaler with finer particles. I'm on a much lower dose than when I was on Symbicort but still get that late afternoon SOB some days.

Have a chat with your doctor and see if you can take a reliever during the day to help you.

All the best.

[Stashle in reply to Poobah]

When I first got on Symbicort it worked really well. Everything just got out of control when I decided to smoke again. But of course that was 4 weeks ago.

I do feel that my issue is in my small airways though and I have read literature that says that fine particle inhalers tend to get a better response with this type of breathing issue. I'll certainly bring it up with my doc.

[hilary39]

Often our asthma worsens underlyingly and while we have no real everyday symptoms something like smoking or exposure to an allergen can reveal that our asthma has been worsening over time.

If you're not already on an asthma action plan, see if you can get on one at your next appt. That way you can step up / step down additional medicine to see if it helps. You may need to be on a daily controller inhaler for the time being til things improve, for example. Your GP should be able to give you some good guidance on that.

Here's a sample template: asthma.org.uk/b42999dc/glob...

[Stashle in reply to hilary39]

Hi Hilary!

Thanks so much for taking the time to help.

I'm already on combined LABA and ICS and Montelukast. The fact that I'm still struggling is what is worrying me!

I also have an asthma plan with my respiratory doctor and I have an appointment with her tomorrow.

[hilary39 in reply to Stashle]

Oh good, I hope the appt goes well and is helpful!

[Jollygood]

Hi

I was just wondering how you are doing & if the appointment was any help?

[Stashle in reply to Jollygood]

Hi Jollygood! That's cool of you to check in :).

After the appointment we decided to move me off from Symbicort and onto Advair/Seretide (actually my suggestion). The difference has been amazing. After only a week my chest feels great. After so long feeling terrible I'm trying not to get too excited about this being a permanent fix, but right now I'm feeling much better.

I assume the issue is that my asthma triggers right down in my small airways. Symbicort's large particle size (dry powder inhaler) means that it can't get deep down into my small airways, but with Advair as a metered dose inhaler can.

[Jollygood]

Interesting about the advair. I don't always do great on fostair so I shall make a note of that. Glad you are feeling better, it's nice to hear some positive news at this slightly depressing time 😁😀.

[Stashle in reply to Jollygood]

If you're on the powdered inhalers and your main symptom is a tight chest then I would certainly recommend giving an aerosolised one a go. I absolutely noticed a difference.