Asthma or something else?

[Jolius]

Hello all, I already asked this question but since I didnt find any solution I will try again.

Symptoms:

So for aprox. 2y now I started to have breathing problems (chest tightness, feeling that I cant breath out air from my lungs nor breath enough air in, ; after this symptoms start I ussualy start to panic if I am around the people my arms start to sweat and I am feeling that I am going to pass out, but when I am at home I can calm myself down.)

This ussualy start when I am around cigarette smoke, strong perfumes/smell or anything that doesnt feel like "clean" air.

My "attacks" ussualy start all of a sudden even if I just smell something strong for couple of seconds (ex. my colleague at work is smoking vape but not in the same room where I am but when I am going to bathroom I can feel the smell of it for couple of second which is enough to trigger me??)

History of illness:

As a child I was diagnosed with asthma and bronchitis which retreated at puberty. I have very big allergy on pollen and grass. In 2020 I had two nose surgerys and was diagnosed with cronic alergic rinithis.

Doctors I visited:

Cardiologist- everything fine

Otolaryngologist-Alergic rinithis whic is treated at first with antibiotics and currently I am using Flixonase. At the last examination doctor said that my nose shouldnt make me that much of a problem now since the septum is fixed and inflammation is treated. She also noticed that I am at some kind of stress (I dont know how but....)

Thyroid hormones- everything fine

Psychiatrist- told me that I have anxiety problems (since I have some family issues) but that I dont need any medication for it

Pulmonologist- Says that it is Asthma and she give me Fostair 2x twice a day+1puff if needed and Spiriva respitam 2x once a day. My lung functions and x-ray was good and every examination my tests are fine even when I am feeling like I described which is strange (my PF doesnt drop)

My question is how it is possible that I have this symptoms everyday even while I am taking my therapy as prediscribed? What else could be a problem? Is it possible that all of this is just in my head?

Any advice is helpfull!!!

[twinkly29]

Anxiety is the most likely cause given what the various doctors have said and your symptoms. You will still get the symptoms despite taking your asthma medications and any others because those drugs only work for other conditions, not for anxiety. So when the tightness (and other chest symptoms) are caused by anxiety, the inhalers etc will not be helping. The symptoms can feel the same as asthma but they are not caused by inflammation or narrowed airways.

Anxiety isn't only helped by medication - however plenty of medications can help it. Do you have a GP or general primary care doctor? (Not sure if you're in the UK, I can't remember!) Ask them about anxiety medication, most people with anxiety are managed by a GP not a specialist psychiatry doctor - the one you saw doesn't sound very helpful if they're dismissing your problems after diagnosing them but maybe they're used to much more complex psychiatric disorders. I don't mean to minimise anxiety because it can have a big impact (and is doing for you) - it's very common to have such anxiety and can be easily managed by medication a GP can give you.

Medication isn't the only solution though. Other therapies including breathing exercises, relaxation, CBT (cognitive behavioural therapy) work well but you also need this teaching to you I think so those qualified in the techniques work with you to apply it to you and your symptoms and needs. Again the GP can sort all this out.

Unfortunately I don't think the symptoms will improve or go away until this is all happening for you - anxiety needs its own treatments, no asthma treatments will work for anxiety. I know the psychiatrist said you don't need medication but maybe they are wrong - se medications are brilliant for anxiety. But even if you don't need medication then you need support in another way. Contact your GP and ask them, tell them that if anxiety is causing these symptoms you need help with it because it's having a big impact on your life.

[ChrissieMons]

Twinkly is absolutely right in that anxiety resists most medications. It would be so nice if a simple pill could take our worries away! I think your best bet is some kind of talking therapy if you are prepared to be really honest about your situation. Therapists don’t judge, they listen carefully and help.

[Jolius]

Thanks twinkly29 ChrissieMons ... The only thing that I find unusual is that in the moment when "attack" is happening 1 extra puff of fostair does help me immediately? Not sure is this because of other side effects of asthma inhaler or?

I will try to call my family doctor and see what can I do about the therapy for anxiety. I dont think that antidepressants is the way to go since I am scared of it and have 2 close cases where people my age killed themselves. Also my situation in family is still not good so I would not have proper support from them.

[twinkly29 in reply to Jolius]

Asthma relief takes time to kick in, only 15/20 minutes usually, but it doesn't work the instant it's taken because the drug needs to get to work.

Not all anxiety medication involves antidepressants, there will be other options, but antidepressants are usually very safe. It is a case of finding the right one for you - I tried one and it made me quite sick so I tried another (both antidepressants but good ones for anxiety) and, after the few weeks of it kicking it, it was brilliant. I took it for a few years at various doses but haven't needed it for several years now so it's not something you'd necessarily be stuck on (but any changes should be done in conjunction with a doctor). But your doctor may be able to suggest something to help that is a different kind of drug, if you both want to give medication a go. Some people prefer medication because it's doing a definitive thing - other therapies can be brilliant too but they require persistence and need to be kept up.

Finding the right drug, if meds are chosen, can be life changing - hanging on to something that's not actually helping (especially long term even if you feel it helps instantly when symptoms occur) is never going to help unfortunately.

Make sure you tell the doctor you haven't got family support as that's important - it might make them notice that you do need their (the doctor's) support!

[Jolius in reply to twinkly29]

Damn I just cant see the way out if it... I am not depressed or smth but not sure how will this all work out. Thanks for your time!!

[twinkly29 in reply to Jolius]

Anxiety and depression can be linked but very often it's one or the other - the medications are just similar.

There will be a way out of it but it's the anxiety that needs dealing with or it won't improve. But the first step is to talk to your family doctor and see what they suggest for anxiety - they might suggest something that is ideal for you, and it might not be medication.

A really simple thing to use when you suddenly get the tightness or other breathing symptoms, instead of using your inhaler, is to look at anything that is a rectangle (eg a TV screen or picture frame). Trace the edge of it with your eyes and as you go along the short sides, you breathe in (normally). As you go along the longer sides, breathe out (again normally). Go round the rectangle 3 times doing this, breathing in on the short sides and out on the long sides. By the time you've done it 3 times, the symptoms should be much less. It helps to regulate and relax the breathing and chest muscles so relieves the symptoms. If you do it each time you get symptoms, gradually you'll get the symptoms less often anyway as things are generally more relaxed inside.

[runcyclexcski]

Must be quite frustrating. Did they do spirometry before and after a metacholine challenge, or spirometry before and after a beta-agonist (albuterol)? The latter was a test that nailed my asthma diagnosis. My parameters went from 100% predicted before albuterol ("normal" for most patients) to 125% predicted after albuterol (my own "normal"/baseline). They need to show variability/hyper reactivity from your own baseline which they do not know until they show dynamics (unless you are doing worse than the "average" patient at the time of the test). I also observed that every time I travelled to a desert or to the mountains (I lived in CA, USA back then) my symptoms resolved in a week, and returned immediately after coming back. Unfortunately, not easy to get to a desert from the UK, even for a weekend, even w/o a pandemic. So I created a "desert" in my bedroom instead (dry clean air).

Before the key test, I've spent 2 years running between doctors, including those you've mentioned -- cardiologists, gastro, vocal cords, lung cancer tests, COPD tests, psychiatrists eyeroll) -- etc. Another parameter in my spirometry most doctors ignored were the FEV50% and FEV75% being <50% of predicted (i.e much worse than most patients). Most doctors just go with PF and FEV1, b.c. it's easy for them, a box can be ticked off, it works for most people, and doctors have only 15 min to diagnose what could be bothering you for years. No reason to spend 2 hrs on 1 atypical (atopic) patient if they can treat 8 in the same time period with standard methods.

Medicine-wise, in my case only Xolair and oral steroids helped. I think I responded poorly to inhaled steroids because of the severity of the allergies and the allergen ubiquity (sounds similar to what say "I have very big allergy on pollen and grass.")

[Jolius in reply to runcyclexcski]

Hey runcyclexcski , I never did this test nor did my pulmonologist offered to do it... I will definitely ask for it on next meeting... My spirometry was always good and I had bad allergies all my life but never had this much of a problem... thanks for comment I will try to speak with my pulmonilogist soon

[runcyclexcski in reply to Jolius]

I've had allergies all of my life, and "grew" out of asthma (at least for a while), just like you.

[Gareth57]

Is it possible that subconsciously you associate the smells as asthma triggers which results in what you think is an asthma attack but which is really a panic/anxiety attack. I had a similar experience and weirdly once the doctor explained this they stopped!Good luck I hope you get it sorted out. 🤞

[Jolius in reply to Gareth57]

Hey Gareth57 , it could be that.... when I smell smth strong like that vapour from my colleague I get instant attack where I feel like my chest are to tired to breath in or out , my hearth start to pump like crazy and I get very hard dizzynes where I feel like I will pass out any second if I dont take my inhaler... It is driving me crazy....

[Gareth57 in reply to Jolius]

That does sound like the symptoms I was getting, speak to your doctor about it, there will be something they can do to calm anxiety