Asymmetrical Information

Why don't you see a pulmonologist? I had a similar problem, and the pulmonologist told me it was a low-grade bronchial infection that kept returning.

Since I don't smoke my lungs were strong enough to compensate but I had to take antibiotics to kill the infection off completely.

Don't know if that's the same issue as you're describing, but it could be...

Mine is not a medical sugggestion, but rather a technique suggestion. Rather than expanding your chest to fill your lungs, you might try expanding your abdomen, utilizing your diaphram to pull air into your lungs from the bottom.

Dear Jane,

Of course, I second Dave's idea that you should see a pulmonologist. There's too many conditions causing "tightness of the chest" for me to suggest otherwise.

However, that said, it might give you more insight into symptoms like yours to consider that in general the lungs are not a homogenous mass of tissue in which each part is equally easy to ventilate and also equally easy to perfuse with blood. Doctors generally separate the lung into "West zones," after Professor John West currently at UCSD. These zones exist because the hydrostatic pressure of blood in the lungs increases from the top (apex) of the lung to the bottom (base).

Zone 1, the zone above the heart, has the lowest hydrostatic pressure, and is thus easiest to ventilate. Zone 3, the zone below the heart, has the highest hydrostatic pressure, and is thus hardest to ventilate. Imagine a bunch of rubber balloons under a deep pool of liquid, and how much harder it would be to move air in and out of the balloons under the liquid as opposed to balloons not under a pool of liquid.

Add to that the fact that the balloons when empty tend to be harder to fill than when they are partially full. You can see this for yourself by blowing up a real rubber balloon; it's harder to get it started than to pump more air into it when it's already somewhat full. So, if the pool of liquid manages to crush the little balloons (say, during expiration, when the balloons don't have that much air in them to start with), then it's harder to fill up the little balloons again on the next breath. It may require a supranormal effort, such as that provided by a weird yawn-like thing, to get air into the balloons again.

Add in a little diffuse inflammation, just enough to tip the already difficult-to-ventilate-but-not-noticeably-so zone 3 balloons into a noticeably-difficult-to-ventilate state, and I think you can see how symptoms like yours might be related to asthma.

The solution? Again, see your pulmonologist. In general, it sounds like someone with symptoms like yours (I am NOT writing about you specifically) might benefit from more aggressive anti-inflammatory therapy, i.e. steroids, cromylin, monteleukast, etc.

I hope this was helpful.

I do see a pulmonologist; my asthma is in the mild range. It's possible that the stress of moving to England, or lingering symptoms of the flu I had a couple of weeks ago, or the fact that I forgot to take my singulair two days in a row, is causing the tightness, but it's not enough to send me rushing to the doctor. (It will be, if it doesn't go away in a couple more days). I was just curious as to the physical explanation of the tightness, not the genesis, which I know all too well . . .

That was a very interesting explanation. Thanks.

Don't discount the London air. I had a major attack, after 10 years of relapse, while visiting London for the first time. Fortunately for me, Ventolin (albuterol) was then available in the UK, before it had been approved in the US. The UK has a disproportionate level of asthma and other respiratory problems, and seems to approve drugs for them quicker than here.

Last summer I was experiencing the same symptoms, and on the third day heard the news of elevated surface ozone. I started watching the daily ozone levels and noticed a correlation between high levels and that vague tight-chestedness you describe.

But DO see your doctor. And you DO monitor your peak-flow readings, I hope.

There's a mechanical manouver that may help: Fill your lungs as much as possible and then blow out through lips that are so tightly pursed as to cause a buzz -- like playing the trumpet or like making a very loud "Bronx cheer". Then do it again, harder.

The tightness is actually the lungs being unable to expell all the air out.

Also, remember that volume available for air to fill goes as the cube of the effective diameter. So a swelling reducing effective diameter to, say 95% of normal, reduces available volume to ~86% of normal.

Similar reasoning applies to diameter of bronchia and flow rates through them for a given pressure differential. Upshot is that a small change in diameter requires significantly more muscle power to suck air through them at the same flow rate.

That's not medical per se. It's just simple math.

Definitely see a pulmonologist.

Jane,

if you would post a picture of yourself, nude from the waist up, I'm pretty sure I could diagnose the problem from that alone. I might be able to diagnose the problem from a picture of you in lingerie or a bikini, too, but nude would be best.

Well, my dear so-called "qualified pulmonologist," I think we have YOUR problem identified, but fortuitously, there is an easy cure. It simply requires a section of 1/4" rope, a hammer, and a quantity of ice cubes.

1. Tie the rope into a slip-knot lasso.

2. Crush the ice into marble-sized pieces with the hammer. You are done with the hammer; set it aside.

3. Remove pants (in your case, this step may be superfluous). Loop the lasso around your genitalia, cinch it to the point of just snug.

4. Restore pants, keeping the other end of the lasso accessible as you do so. Fill pants with ice. Continuously replenish ice as necessary.

5. If symptoms persist unabated after several minutes, pull sharply on the rope.

This treatment has rarely been known to fail. Once all symptoms have subsided, you can finish off the evening with a glass of burgundy and a book of ettiquette. Good luck!

So I'm guessing a quick flight to London for an in-person exam is out of the question, eh?

Madam:

The splendid Mayo Clinic web site has an extensive review of your condition that may be of interest:

www.mayoclinic.com/invoke.cfm?id=DS00021

Meanwhile, tea has naturally occurring theophylline compounds that ease breathing. And since you're in Blighty...

As a related asides.

I recall reading that England has the highest incidence of allergies in Europe, France the lowest. Not coincidently England has the greatest use of carpet, France the lowest.

If you even recall who I am from my limited posts to the comments in your blog you have probably concluded that I'm a lunatic not worth listening to. I'll plow ahead anyway.

My wife is a clinical pharmacist who works for GlaxoSmithKline. I had a bunch of information in this paragraph designed to lend credibility to her qualifications but she, upon reading it and rightly I think, asked me to remove it as she is not interested in being fired. Sorry. These comments are definitely off label.

I have spent hours listening to her talk about how her drugs work and arguing with her about the evils and wonders of big Pharma.

If I recall correctly you are using Singulair. This is probably a major contributor to the chest tightness that you are experiencing. The drug is not controlling your asthma.

I no longer recall the specifics but I do know that my wife was appalled by the way Singulair was marketed by Merck and the frequency with which it was prescribed in the face of clear data that showed that it only works for a small percentage of the people who have asthma. Yeah -- I just said that it doesn't work for most asthmatics and that there is study data to prove it.

Advair is a combination of the drugs Serevent and Flovent, one or both of which are steroids. (Can't remember which any more) Properly dosed this drug will very likely control the problem that you are having.

It is very simple -- if you are having chest tightness your asthma is not controlled. The drugs you are taking are not doing what they are purported to do.

My suggestion is to find a physician who understands the difference between Singulair and Advair and have them change your prescription. You should have no problem finding one in London as GSK is headquartered there.

If you find that this works you can buy me a beer.

Good Luck.

I had asthma as a child, but outgrew it as I outgrew my allergies. To the best of my recollection asthma is the inflamation of the bronchial tubes. Most of the time its related to an allergic reaction. There is also exercise induced asthma, ditto the above but substitute physical exertion for the allergic reaction. If it's not severe enough to seek out an MD's opinion you can treat it yourself with an OTC puffer or ephedrine(or another bronchidilator). Two problems with ephedrine, it's a pill, so it takes a while to work, and it's not really legal anymore because of all the meth cooks.

I recently faked an asthma attack in order to get out of a very tedious, uncomfortable situation. Sort of the asthmatic Sleepless in Seattle. You never know when a virtually symptomless condition can come in handy.

In my case it actually is a steel band around my chest, but that's just part of, well, a ... lifestyle that I've been getting into lately.

Dear Jane,

While I won't comment on the specifics of your situation, I've had asthma all my life and have a bit of experience.

I heartily recommend Advair, as a previous poster did. The combination of an inhaled steroid and a long-acting bronchodialator do wonders. I've been taking it for years, and it is truly amazing.

- Scott

I'm one of the lucky ones who's responsive to Singulair -- I just forgot to take my pills for a couple of days. Readers will be happy (I hope) to know that taking my pill as usual last night has eliminated the symptoms.

In order to be healthier in general, I strongly recommend both probiotics and fish oil (Omega 3 esssential fatty acids). The probiotics are especially useful if you've had antibiotics frequently, or even occasionally (and who hasn't?).

Here's an article on probiotics that lists some easy yogurt drinks for you to pick up in the U.K.:

http://thescotsman.scotsman.com/s2.cfm?id=329742005

There are indications that probiotics can prevent (at least in some cases) asthma and allergies. The right ones also boost your immune system and help in a variety of other ways. You might want to start slow, as there can be uncomfortable gastrointestinal side effects at first, but these are temporary and overall you'll be much healthier if you're careful to pick a good brand. Yakult, Actimal and Tesco Probiotics are all good choices.

As for fish oil, again it's important to pick a good brand. A recent study indicated that fish oil supplements are on average safer than eating fatty fish, because the supplements are more carefully screened to avoid heavy metal contaminants, etc. My favorite brand is Pro-EFA by Nordic Naturals, because they've worked hard to take out the taste that can lead to "fishy burps". I put it in my son's 7up and he doesn't know (I have to leave it in the can, since the oil is visible in liquid). Believe me, there aren't many fish oils that you could put into a drink with very little taste!

Omega 3 is an anti-inflammatory. Double-blind medical research results on whether it helps asthma are mixed, with some showing a positive effect and some not being significant, but there's no real debate in the medical community on safety. Omega 3's may also be able to help with allergies, arthritis, attention deficit disorder, depression, schizophrenia and bipolar disorder, and it's pretty well accepted that they reduce the risk of heart attack or stroke. They're needed to make the brain work well. And, EFAs may make your hair shinier and your skin less dry. After all, we give cats fish so that they'll have nice shiny coats. They may help with weight loss (one of the latest areas being looked at), are good for the eyes and may reduce the risk of cancer.

Summary - there's evidence, not yet conclusive in many cases, that essential fatty acids, particularly Omega 3, may help in an amazing range of problems, and it's generally accepted that Omega 3 supplementation is safe. The benefits of Omega 3 are part of the reason that sick people used to be pressed to take cod liver oil.

Sorry for the long post, but if you do the research, it just makes sense to try these two things as part of a healthy diet, especially for someone with asthma.

The "steel band around your chest" is residual congestion in the lower areas of your lungs. It may be an effect of food allergies, or seasonal pollens, aggravated by the presence of a low-grade bronchial infection.

A temporary remedy is to create mild back pressure when you exhale. Purse your lips or blow into a cloth pressed lightly against your hand as you exhale. Subsequent breathing may get easier for a while.

A combination of Ventolin, Advair, and an antihistamine (Allegra) may be most effective for long term. A course of antibiotics may be a good idea as well.

I had "steel band around chest" as long as I remember myself. Now it is gone.

The reason for it seems to be psychosomatic reaction to deep anxiety.
The cure was practise of pranayama and yoga in general.

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