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  • Q&A with Australian Health Practitioners

    What might cause tightness of chest for no reason followed by an asthma attack?

    Suffers with asthma as child. on Seretide twice a day now as adult. But now as adult being in hopital twice within 6mth time frame with accute asthma attacks. All dr says it's anxiety panic attacks. But she says her chest is always tight feels like someone is sitting on it. Feels very frustrated nobody can give us answers
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    Dr Richard Beatty

    GP (General Practitioner)

    Brisbane GP With Special interest in Complex Medical, Men's health, antenatal, paediatrics. Skin Cancer Clinic Designated Aviation Medical Examiner Specific interests in Vasectomy, Dermatology & … View Profile

    There is some specific issues that need to be considered with this case. Firstly, It's always important to double-check the diagnosis of difficult to control asthma because other conditions can do similar things. This is especially important when a doctor is suggesting there may be panic attack because this implies that a wheeze was not heard on examining the chest with a stethoscope. Therefore, the doctor will need to look at her complete history to get a feel for how certain the diagnosis is; there are specific tests that can be done in a respiratory clinic (and a referral sounds like it might be worthwhile anyway because of 2 admissions in 6 months). Sometimes, the breathing test (reversing with the blue inhaler) isn't accurate enough and measuring exhaled nitric oxide in a specialist clinic, or measuring airway response to a medication may be needed.

    Other conditions can make asthma more difficult to control, especially well known are not taking preventer medication regularly, sinus problems (including hayfever or rhinitis), depression & anxiety. Also, occupation, smoking, obesity & gastric reflux can make it worse. Vocal chord dysfunction can cause similar symptoms and is difficult / rarely diagnosed but does need to be at least considered when there isnt' actual wheezing although the childhood history of asthma does make this unlikely I think especially if she was under the age of 8 when the asthma starts.

    Hyperventilation may be causing or contributing to your daughter's symptoms and diaphragm breathing exercises can help a lot (we all benefit from those anyway). When breathing in using the diaphragm, the tummy will go “out” whereas the tummy goes “in” when breathing using the chest wall (try breathing in using your chest wall and this will cause anxiety).

    So, in summary, check the preventers are being used daily, check out breathing exercises, make sure any sinus or acid reflux symptoms are being treated, work on a healthy lifestyle (weight loss if needed, general exercise) and consider a respiratory clinic referral. Good luck!

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