Expert: Marc Rubin, RPh Asthma Educator - 3/14/2008

Question
QUESTION: I have asthma which is triggered by both exercise and allergies.  Last November, I had an anaphylactic episode in response to penicillin, which was prescribed for another illness.  I felt my throat closing and called my doctor's office immediately.  (I had anaphylaxis as a child from a reaction to Sulfa as well.)  My doctor told me to stop taking the penicillin and prescribed another medication, but did not see me.  My reaction did not go as far as shock, but I did have disorientation and vision comprehension issues, and was severe enough that the next day I woke up with laryngitis and terrible bronchitis.  The laryngitis lasted about ten days, the bronchitis six weeks.  I did not see a doctor, since I had no symptoms indicating a bacterial infection.  However, one of my lungs still feels odd.  Sometimes when I breathe very deeply and fill my lungs, one side feels like the tissue is stretching or pulling to fill.  I notice it primarily when I wake up or have been resting and breathing shallowly.  I can exercise vigorously with no problems and never notice shortness of breath.  What would cause this continuing issue, and should I be seeking medical attention?  Other than the odd feeling in my lung, I feel fine now.  My main concern is that I might be more susceptible to illness.  I'm also wondering why I'm having that sensation in the first place.  It is deeper than my bronchial tubes; does this mean I had pneumonia, or something else?  Lastly, are there exercises I should do to help my lung finish healing?  I walk daily, do Pilates three times a week, and ride horses regularly.  For whatever it's worth, I realize that next time my throat is closing, I need to bypass the doctor's office and head to an ER.  Thanks very much in advance.

ANSWER: Hi,
I'm disappointed in your physicians response to your inital drug reaction. You should have been advised to go to the hospital to be observed. One cannot safely predict how severe the reaction will proceed.

Your lung discomfort also concerns me. The lungs are made up of 5 lobes. There may be an issue with one of the lobes which would explain your continuing difficulty. You really should seek an evaluation by a pulmonologist. The test they would initially do is called spirometry, where you have both your inhalation and exhalation measured by blowing into a sensored tube. If abnormal, the physician would order further testing.

If it is found that you had incurred damage to your lungs, there are programs in pulmonary rehabilitation that you could do to increase your lung function. A threapist would work with you, and give you exercises appropriate to your needs.

I hope this helped you.

If you have any further questions, feel free to contact back.

Good luck!

Marc

---------- FOLLOW-UP ----------

QUESTION: I'm curious what sort of complication from the anaphylaxis would cause the sensation I'm experiencing.  Any ideas?  I've speculated about something similar to scar tissue caused by pneumonia or partial collapse...?

ANSWER: I'll join you in the speculation...partial collapse... but I could not make that assessment professionally, it would be irresponsible. Your path is clear..a complete evaluation by a pulmonologist is definitely in order. Please let me know how that turns out.

Good luck!

Marc

---------- FOLLOW-UP ----------

QUESTION: Hi again Marc,
I went to a GP, and he did an x-ray.  He said he could not see anything nor could he hear any problems in my lungs.  He said the sensation I was experiencing is a "spasm".  I was relieved to hear the x-ray was clear, but I don't believe I'm having spasms.  I have the same sensation EVERY morning when I take my first deep breaths for the day, and it is on just one side, in my back.  Do you think I should seek another opinion, or since all else was clear, is this minor enough it will finish healing on its own?

Answer
I'd go to a specialist and have the spirometry repeated, except this time with a methacholine challenge. This is a drug that is administered that will trigger a bronchospasm in an asthmatic at a lower dose than in a person with normal lungs. The specialist may use another product instead, but the point is to determine if your lungs are "twitchy". If this testing comes out negative, then I'd have the doctor to review other likely issues.

Let me know how this goes.

Marc