I have chest tightness with shortness of breath and throat irritation. What is the problem?

Question

Hello doctor,

I am suffering from chest tightness, which at times turns into pain. I feel like I am breathing into a tight chest with constricted chest wall muscles along with shortness of breath and throat tightness. The doctor said I have mild asthma, and nothing he is giving me is working (Albuterol, Dulera, Oral Prednisone). I even tried GERD therapy to see if it would help, and it did not. I am suffering a lot. Please help. I have been tested for coronavirus three times, and it came back negative. My chest x-ray and echocardiogram have been normal as well.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Since when have you been suffering from chest tightness? Is it aggravating at night or early morning?

Possible causes are like

1. Episodic asthma, in which you may feel repeated episodes of chest tightness and breathing difficulty.

2. GERD (gastroesophageal reflux disease), in which the lower esophageal sphincter leads to acid reflux, which may enter into the larynx and cause an asthmatic episode.

3. Diffuse esophageal spasm: This is an esophageal motility disorder that leads to painful spasms of esophageal musculature. On barium swallow it appears as a string of beads.

4. Panic attacks lead to chest wall muscle tightness regarding this attack.

5. Postnasal discharge.

6. Neuromuscular disorders, etc.

Until an examination is done, it is difficult to say what it is. So please get it done: spirometry, 24-hour pH monitoring, esophageal manometry (which may be useful), serum IgE levels, barium swallow chest x-ray, and absolute eosinophil count. Avoid spicy food at night, and elevate the head end of the bed. In case of allergic asthma, using tablets of Montelukast and Levocetirizine once a day (night) may be useful.

Use tablet Deriphylline (Etofylline + Theophylline) twice a day for five days. Avoid allergens that trigger the episode. allergens like household dust, molds, mites, and pollen. If there is no improvement, please consult with your physician or pulmonologist; he will examine and treat you accordingly.

I hope this addresses your concern.

Please provide comments and let me know if you have any more questions.

I would be pleased to assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

24-hour pH monitoring is nothing but esophageal pH monitoring through a sensor inserted through the nose. Yes, you may need to stay for one day at the hospital.

NM disorders like muscular dystrophy, myasthenia gravis, Lambert Eaton syndrome, and Charcot Marie disease, etc. In this disorder respiratory muscle dysfunction lead to breathing difficulty. To diagnose the disorder I need proper history and examination. Investigations like muscle biopsy, serum CPK levels, nerve stimulation test, etc.