Expert: Marc Rubin, RPh Asthma Educator - 6/16/2009

Question
QUESTION: Hi, i am 30 yrs old female recent ex smoker. smoked approx 6 a day for 12 years. i was diagnosed with asthma as a child but for the past 10 years or so i have not needed to use my inhalers. Recently i was diagnosed with haveig inflammed sinuses and since then  i have found i need to use my rescue inhaler a lot more. My symptoms at the moment are dry, itchy throat and itchy ears and chest tightness which subsides when i use my inhalers. as i haven't really had any asthma problems for so long i am not sure if the chest tightness (and sometimes slight wheezing) is an asthma symtom. i have been to see my gp and all she gave me was a nasal spray and said my chest did not sound too bad!!! it has been a week now and i still get these symptoms. in your experience does it sound like asthma? i also have an awful bad taste in my mouth when i cough up clear mucus. i am really scared as i am 5 weeks pregnant and as i am arecent ex smoker i am scared it is something more serious. thank you very much.

ANSWER: Hi S,

The surface tissue of the nasal passages contains the same reactive "mast" cells which are in the airways and lungs. IF the nasal passages become inflamed, they can trigger the rest of the airway system into increased response. This is very common in asthma. With your history, your physician should restart you on controller medications. Also, you should have a lung function test done, called spirometry. You cannot "hear" the degree of impairment, you must properly test to evaluate it. In the new asthma guidelines, we have two main targets, 1) decreasing the risk of an attack, and 2) reducing lung impairment, or reduced lung function.

I have a feeling that the nose spray you received is the antihistamine
"azelastine HCl", known in the US as Astelin. It has the terrible taste you speak of. Preferentially, you should be put on a nasal steroid. Better results for your sinuses and lungs. Technique is very important. Do NOT spray UP, but, while looking down at the counter, hold the unit perpendicular to the surface and spray to the back wall of the nose. This decreases side effects like nose bleeds and fungal infections.
Should you gp not want to test and properly evaluate you, get yourself to a specialist who will properly investigate why you've developed this change. This is quite possible related to the pregnancy since the changing hormone levels have variable effects. Some women have improved asthma during pregnancy, others have it worsen. It is controllable.

The inhalation steroids, when chosen and used properly (I'd suggest budesonide), will not have an effect on your baby. If your lung function goes down, your oxygen levels go down, as well as that of your developing baby. We want you to have the best function you can have.

Please, after your child is born, stay away from smoking. Second hand smoke can result in your child developing asthma.

Best wishes for you and your family!

Sincerely,

Marc

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

QUESTION: Thank you Marc. I spoke to my gp on the phone and he is convinced that its all due to the inflammed sinusitis and a possible head cold as my ears, head and throat are hurting a little today too.. He would not even give me an appointment to see him! he told me to just use the salbutamol inhaler. My question is is it possible for asthma to suddenly return like this after very little symtoms for 10 years? also is it common for the inhaler to give me immediate relief but then for the chest tightness to return after a couple of hours? once again thank you for your help i really appreciate it?

Answer
Hi S,

Something weird happened, I answered this question right after I got it, and somehow it never transmitted...never happened before)

Your GP is ignoring your medical history, and only looking at the sinus infection w/o looking at the whole patient. The albuterol will not reduce lung inflammation, and your sinus infection is triggering the problem. A short course of oral steroids would bring your lungs back under control while the sinus infection gets resolved. I'd find another doctor who listens. If you can, speak with an allergist about locating a doctor who they feel has a good grasp of current thought in treating asthma patients.

Asthma is a medical condition that does not go away. It can hibernate at very low, unnoticeable levels of inflammation for a long time, until something triggers it to flare up again. Typically this would be a virus, but there are a few bacterial infections which can bring it out. In addition, there are cells that line the sinuses that also line the lungs (and exist on the skin, which is why a lot of asthma patients also have psoriasis or eczema), which, when they get inflamed (the sinuses), trigger the same cells down the airways into the lungs. THis is what is most likely taking place with you.

I'd try to get yourself into an allergist for a review to see if something else is going on.

Let me know how this turns out.

Again, sorry for the system glitch. I'm just glad I double checked the account.

Sincerely,

Marc