Expert: Marc Rubin, RPh Asthma Educator - 8/10/2009

Question
QUESTION: Hi i am 30 years old and an ex smoker. Smoked for 11-12 years approx 4-6 cigarettes a day. I was diagnosed with mild asthma when i was 12 years old. I only ever use my rescue inhaler if i have a cold or flu which makes my asthma flare up.
I also suffer from allergies and was told i have rhinitis.

Recently i have noticed whenever i have cold like symptoms or the flu i get an itchy sensation in my upper back near the right lung. I cannot scratch it as it is inside my body and i am sure it is in my right lung. In fact i think i have had this sensation before when my asthma was alot more severe when i was younger. IT starts as soon as i have a sneezing/coughing fit.
I have searched the net and discovered a lot of people with asthma and allergies describe a similiar sensation. What causes this? I fear it maybe serious lung disease as i am an ex smoker. I have spoken to my own GP who has listened to my lungs on several occassions and says that my chest sounds clear. I have no other symptoms such as cough etc.the only symtoms i have are allergy symtoms: runny nose, sneezing, itchy throat and ears.
Thanks



ANSWER: Hi S,

First, I'd like to congratulate you for becoming an ex-smoker! This is a difficult challenge to win, and the benefits will continue for years to come.

I'm not sure precisely what is going on, but I believe it is an airway constriction in one of the smaller airways. The sensation you have may be compared to the tickle at the back of your throat with a post-nasal drip, or mild unproductive cough.

While most asthma patients have airway disease of the larger bronchi, some patients also have the affliction of the smaller, distant airways. With the airways inflamed, and the increased amount of mucous in a very small space, their may not be enough air movement for the sound to be detected. Remember, although I'm specialized in asthma, I'm not a physician, and therefore I cannot make a diagnosis. But, I do believe it would be in your best interest to see an allergist or pulmonologist to have their specialized skills applied to listening when this is occurring, and, if you have not already done so, have a pulmonary test called spirometry done on you. You just breath into a tube hooked up to a computer to measure your lung function.

Even though you have quit smoking, it would be important to determine if it left any residual damage to your lungs. After the age of 25 (when our lungs reach maximum size), all people gradually loose breathing capacity, where by the age or 55, you typically have lost ~ 20%, nothing noticeable in a normal life. Although tobacco smoking may increase the rate of loss, from the day you had your last puff, the further rate of decline will then mirror that of a non-smoker. You don't regain the damaged tissue from smoking, you just slow down the decrease to that of a normal person. This should be monitored though, both from an ex-smoker as well as asthma patient perspective. If it is found that the smoking has affected your lungs, COPD guidelines call for yearly spirometry tests (insurance will cover). If smoking has not affected the predicted level of lung function, then asthma guidelines call for repeating spirometry every other year. By doing this you are taking positive action to keep yourself in the best condition.

Regarding your allergic rhinitis, the physician should prescribe a nasal steroid for you. It would dramatically improve your symptoms, and reduce your asthma symptoms as well. Should the doctor go ahead and prescribe it, read the instructions thoroughly, and be sure to spray either towards the back wall of the nose, or outward towards the nasal flare. You do not spray the mist straight up the nasal sinus (unless you want to risk nose bleeds or a sinus fungal infection).

I hope this addresses your concerns.

Sincerely,

Marc



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

QUESTION: Thank you for the reply. I have had a spirometry test done just recently and the doc was happy with the results. Funny thing is when i have the itchy sensation my GP has listenend to my chest and said it was clear! The itchy sensation is a lot like the itchiness i get in my throat and ears due to allergies. Is it possible that whatever is making my throat and ears itch is doing the same inside my lungs?
The thing i find weird is that i recall this sensation from when i was 14 years old! The itchy sensation tends to only happen when i have cold like symptoms and it is bought on by sneezing/coughing only.
Does it sound like a symptom of lung disease?

Thanks

Answer
Hi S,

It may be. Allergens (pollen, mold, etc.)cause the release of many chemicals from the cells that line your lungs, nose, ears, skin, etc. Histamine is the one that causes, among other things, the itching. Taking a 24 hour antihistamine may help. Another product, Intal (Cromolyn Sodium) may also be tried, but it is a pain to deal with. It is an inhaler that needs to be used 3-4 times a day for the best result, and takes a few days of continuous use to see improvement. If you miss a day, you are starting over from scratch ( no pun intended :))

I'm happy to hear that your spirometry came out well, but remember that this is something to repeat yearly. Also, don't forget to get your annual flu shot, and check to make sure that you are up to date on your pneumonia vaccine.

Regarding lung disease, asthma is a lung disease, and even when symptom-free, never goes away. This is why it is important to do your regular screenings and preventative measures to keep you in the best of health, and, should changes occur, you are able to intervene early to keep you with the best quality of life.

Best wishes, and get back to me if anything else should arise.

Sincerely,

Marc