Chest Pain and Cough: Seeking Effective Treatment Options

Q: Chest Pain and Cough: Seeking Effective Treatment Options

Dear K： I apologize for the delayed response due to the holiday. <br>Based on your symptom description, it is likely that you have atypical asthma. <br>However, the treatment approach needs to be adjusted. <br>You can start with inhaled corticosteroids for control, or you may vis

Chest pain/chest tightness/shortness of breath & cough/medication consultation

Hello, Doctor.
Since around the middle of last year, I have been experiencing severe coughing at night/midnight, which I initially thought was due to an unresolved cold (I returned from Europe at the end of March with a cold, and after taking two or three packets of medication, I felt much better).
However, since early December of last year, I have started to experience: central chest pain (a heavy pressure sensation), sharp pain in the upper left and right chest, shortness of breath, and occasional coughing (like a reflexive cough as if someone is pressing on my chest).
I consulted an ENT specialist, who diagnosed me with pharyngitis and prescribed somacapsule, cosopin, dexadrol, thecough, and strocain.
I felt significantly better after the first dose, but subsequent doses had less effect.
I then visited a pulmonology clinic, where the doctor assessed it as mild pleuritis.
Auscultation and blood oxygen levels were normal (99), and a chest X-ray showed no fluid, pneumothorax, or tumor abnormalities.
After taking the first three-day course of medication, there was no significant improvement.
I returned for two follow-up visits, and the doctor still believed it was mild pleuritis.
After changing medications, there was some improvement, but it still felt like scratching an itch through a boot; I couldn't find the root cause to treat it effectively (since it was a private clinic, I don't have a detailed list of medications to share, but there should be B vitamins involved).
Subsequently, I went to a hospital's pulmonology department, where I underwent a chest X-ray, spirometry (comparing inhalation of bronchodilator before and after four times), and blood tests, all of which showed no abnormalities or inflammatory responses.
The doctor believed it was atypical asthma and advised me to use a bronchodilator when feeling uncomfortable and to take more B vitamins.
(My job is purely administrative in an office setting, with no exposure to hazardous waste.) After using the bronchodilator, I felt much better, but since it is an acute medication, I am concerned about developing a tolerance and do not want to rely on it too much.
After stopping for a week, I returned to square one; I easily become short of breath and experience difficulty breathing when walking quickly, with a heavy pressure sensation in my chest and occasional coughing.
(Previously, I exercised five times a week for over an hour each time, running more than 10 kilometers each session.) Additionally, I had an electrocardiogram and echocardiogram, and the cardiologist deemed my heart condition normal, concluding that the chest pain was not related to the heart.
I was prescribed muscle relaxants and painkillers, but after taking two packets, there was no improvement.
A breast ultrasound also showed no abnormalities.
Regarding my gastrointestinal health, I do not have symptoms of gastroesophageal reflux disease, but interestingly, drinking water, eating, and forcing myself to burp can relieve the chest pain.
I sincerely seek your guidance on what direction I can take for further diagnosis or treatment, as I feel I have consulted all the necessary specialists without finding a resolution to the underlying issue.
(As I type this, I have already used the bronchodilator twice, but the discomfort persists.) Thank you very much for your time and response.

K, 30~39 year old female. Ask Date: 2024/02/05

Dr. Huang Yiwen reply Pulmonology

Dear K: I apologize for the delayed response due to the holiday.
Based on your symptom description, it is likely that you have atypical asthma.
However, the treatment approach needs to be adjusted.
You can start with inhaled corticosteroids for control, or you may visit the outpatient clinic for a more detailed examination.
Changhua Hospital is concerned about your well-being.

Reply Date: 2024/02/05

More Info

It sounds like you have been experiencing a complex set of symptoms that have significantly impacted your quality of life. Your history of persistent cough, chest pain, and difficulty breathing, particularly at night, suggests that there may be multiple underlying issues at play. Given the extensive evaluations you've undergone, including visits to various specialists, it’s understandable that you are seeking further guidance on how to manage your symptoms effectively.

Understanding Your Symptoms
1. Coughing and Chest Pain: The combination of a persistent cough and chest pain can be indicative of several conditions, including bronchitis, asthma, or even gastroesophageal reflux disease (GERD). The fact that your symptoms worsen at night and improve with certain actions (like drinking water or eating) suggests that GERD could be a contributing factor. In GERD, stomach acid can irritate the esophagus, leading to a sensation of chest pain and cough.

2. Asthma: Your diagnosis of atypical asthma is also significant. Asthma can present with cough, wheezing, and chest tightness, especially at night. The use of a bronchodilator (like your rescue inhaler) can provide temporary relief, but it’s crucial to manage underlying inflammation with inhaled corticosteroids for long-term control.

3. Musculoskeletal Pain: The chest pain you describe could also be related to musculoskeletal issues, especially if it feels like pressure or tightness. This is often exacerbated by certain movements or positions and can be mistaken for cardiac pain.

Recommendations for Management
1. Follow-Up with a Specialist: Given the complexity of your symptoms, it may be beneficial to revisit a pulmonologist or an allergist who specializes in asthma and respiratory conditions. They can perform further testing, such as a methacholine challenge test or a peak flow measurement, to assess your asthma control and determine if there are any triggers that you may not have identified.

2. Consider GERD Management: Since you noted that drinking water and eating can alleviate your symptoms, it might be worthwhile to explore GERD management strategies. This can include dietary modifications (avoiding spicy, fatty, or acidic foods), lifestyle changes (elevating the head of your bed), and possibly medications like proton pump inhibitors (PPIs) if recommended by your healthcare provider.

3. Inhaled Corticosteroids: If asthma is confirmed, transitioning to a daily inhaled corticosteroid can help reduce inflammation in your airways and decrease the frequency of your symptoms. This is crucial for long-term management and can help reduce reliance on rescue inhalers.

4. Physical Therapy: If musculoskeletal pain is suspected, physical therapy may help address any underlying issues related to posture or muscle tension that could be contributing to your discomfort.

5. Regular Monitoring: Keep a symptom diary to track when your symptoms occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in tailoring a treatment plan that works for you.

6. Stress Management: Since stress can exacerbate both asthma and gastrointestinal symptoms, consider incorporating stress management techniques such as mindfulness, yoga, or breathing exercises into your routine.

Conclusion
Your situation is multifaceted, and while it can be frustrating to navigate through various diagnoses and treatments, continued communication with your healthcare providers is key. Don’t hesitate to advocate for yourself and seek further evaluations if your symptoms persist or worsen. It’s essential to find a comprehensive approach that addresses all aspects of your health to improve your overall well-being. Remember, managing chronic conditions often requires a combination of medical treatment, lifestyle adjustments, and ongoing support from healthcare professionals.

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