Expert: Marc Rubin, RPh Asthma Educator - 2/25/2008

Question
Hello,

Let me start off by saying that I know upfront that you can't diagnose me online, but I was wondering if you could advise me on the strange symptoms I'm having and maybe point me in the right direction...

For the past 2 years I have been having some odd breathing problems.  I've had a chronic night-time and morning cough for more months than I can even remember.  Sometimes I wake up in the middle of the night unable to catch my breath from coughing.  I often gag and even throw up from the fits.  When I was pregnant with my baby (who's 5 months old now), things really got intense.  The farther along I got, the worse my breathing was.  After I delivered her, I did improve, but now my lungs feel tight.  I feel like I can't expand my lungs to full capacity.  I often breath faster trying to get that feeling of a full breath (if that makes sense).  Since Winter is in full swing here in New York, I've suddenly got a new symptom.  As soon as I go outside the cold air triggers coughing.  I will just cough and cough until I get warm again.  It's EXHAUSTING!  I have been to my doctor many times.  He has suggested that it might be asthma, but nothing to date has been done about it.  I'm not sure how to push the issue.  And based on his non-chalent attitude about it, I feel like maybe what I feel is all in my head or normal somehow.  Do my symptoms suggest asthma to you?  What steps should I take with my doctor to get evalutated and treated?  This is really scaring me...

Thanks!

-Tanya

Answer
First, you are presenting with in-your-face signs of probable asthma. It is apparent that your physician is not at all aware of a proper workup: e.g.: NIH Expert Guidelines #3 (http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm)that just came out late last year, but also not aware of EP#1 or #2 either. It is not your responsibility to inform him.

I would immediately locate a local allergist or pulmonologist for a proper evaluation. If you are in a locale that doesn't have many specialists, call your local hospital for guidance. Many times, the best resource is asking a nurse in the intensive care unit, or on a general medicine floor to see who they would recommend. Keep in mind, the lay public may like their doctor for their bedside manner, but that does not always relate to their level of expertise. The nurses see this every day.

I would then ask the specialist who they would recommend as a good general practitioner, who is up to date on current practices. You've given your physician more than enough opportunity to educate himself, and has shown no interest. This has put you at risk and your child at risk while you were pregnant, and it is unacceptable.

Do not wait any longer. As soon as you can, address this situation, and work until it is resolved. Please get back to me as to how this is resolved, and I'll give you guidance on how to take full control.

Good Luck!