Silent Chest question

[tryingtonurse]

Hi all, could somebody, anybody please tell me what are the treatment options for 'silent chest'

[Homely2 Administrator]

They used this phrase, the last couple of times I have gone to a and e. They never explained it to me, I initially thought it just meant that I did not wheeze, now I realise it means they cannot hear anything at all in my chest. To me a heavy asthma attack means that my chest totally shuts down.

On my yearly asthma review, the asthma nurse went on about my asthma attacks being life threatening, which I thought was obvious. So I do not think it is a good phrase.

In my case, in practice, it just means that I get priority treatment, a consultant turns up and I get promoted to a bed directly opposite the doctors station they then just nebulise and pred me very heavily. They are just very keen to get the airways open ASAP.

Luckily I respond to this treatment, so have not had to explore the next rungs of treatment.

[Troilus]

Hi there. My understanding is that there is not enough movement in the chest to produce wheezing. In other words, the air that is in there can’t get out and so very little air can get in. This is also causes oxygen levels in the blood to drop.

I was given 2 nebulisers at home, oxygen on the way to hospital, followed by another 2 nebulisers. Sent home with a course of prednisone.

( The X-ray showed hyper inflated lungs, whi means that there is air trapped in the lungs, which pushes the diaphragm down.)

When I got home I call a call to go back to A&E for another ecg, which was still dodgy. I was kept in for heart scan and angiogram. All was fine. I was told that the attack had put an immense strain on the heart. Discharged with referral for pulmonary function tests.

After that initial “experience” I had the pulmonary function tests about 2 weeks later and attended the chest clinic at the hospital every 6 weeks while they optimised my meds. The appointments became every 3 months until covid. I now have a treatment plan that works for me so I now have yearly appointments with the consultant.

My current meds are Fostair 200/6. Fostair 100/6 ( to take when my peak flows start to slide) Spivira Respimat (taken at night) Montelukast and of course the blue inhaler.

All I have to do is take my meds and keep a check on my peak flow (daily)

Hope you find this helpful. I suppose as with all asthma types it is just about getting and keeping control.

[Lysistrata Administrator Community Ambassador]

As others have said, 'silent chest' tends to be something that happens in a severe asthma attack, when the airways are very closed up and not much air at all is moving, so there isn't much to hear.

So in that case it would be hospital treatment - often Ventolin and Atrovent nebulisers, usually steroids (either injected or taken by mouth), perhaps other treatments like magnesium sulphate through a drip or more, depending on what they think is appropriate and what might work. As it's usually a severe attack it would - or should! - be treated quickly and quite intensely.

Sometimes doctors and others use 'silent chest' just to mean there's no wheeze. That's confusing and not very helpful of them, but if that's the case it would just be treated exactly the same as asthma with a wheeze. Asthma with a wheeze isn't worse or different from asthma with no wheeze, and it doesn't need special treatment (except as above, if there is no wheeze because your airways are really closed up, then that tends to need more treatment and a hospital admission).

[Troilus]

Found this

bnf.nice.org.uk/treatment-s...

Might be of interest.

[Cloudancer]

I have difficult to control asthma and during an episode have a "silent chest" -I only start to wheeze when my airways open back up.It can be an issue when junior doctors listen and say "there's no wheeze"!Luckily the respiratory team knows me well.

But I do wish that more health professionals were aware not all asthmatics wheeze during an attack.As a Doctor once said to his team on a ward round "beware the silent chest".

Wishing you well