Asthma / sudden choking sensation - speculation?

In My Humble Opinion
1

My daughter, Moon Unit, has asthma and has most of her life (she’s 17). Mild, was on an inhaled steroid for maintenance for several years, had not had a flareup for years, and stopped using even the maintenance steroid about 6 months ago.

Long story short, while away for 3 weeks she started having a flareup, and the inhaled steroids and a burst of oral barely knocked it back. She was managing but not feeling fantastic. It may have been triggered by a respiratory infection, and/or aggravated by something environmental in the old dorm she was staying in - hard to tell.

Then on the trip home, she coughed, then had a sudden I CAN’T BREATHE sensation. Scared the crap out of her (and me too), though by the time I skidded to a stop on the shoulder she was moving air again if not well. An inhaler (then a hastily dug out and set up nebulizer) had her feeling better and by the time we got to the nearest ER several hours later (OK, it was 15 minutes) she was back to normal.

Doc listened to her, and said her lungs sounded good (which surprised me given how much she’d been coughing and for how long; even if the nebulizer worked great wouldn’t there still be some residual crackling or something?). We came out of this with a longer course of steroids pending a local doctor visit once we got home.

My first thought with such a sudden throat-tightening would be anaphylaxis but she hadn’t had any different food nor been exposed to anything unusual.

My next thought was that her throat was irritated from 3 weeks of coughing and just basically said “I. Have. Had. Enough!” and spazzed out. Any merit to that theory?

My additional theory is that the “can’t breathe” caused understandable panic, and THAT caused additional breathing issues just in and of itself - so we spent a fair bit of time on the drive talking about that, and how a true physical event causes panic which worsens the physical event, which worsens the panic…

She’s had a few coughing fits since then and when I’m around I talk to her and remind her to breathe slowly. This seems to help - whether the coughing would escalate or not, I don’t know, since I just don’t know what really happened the other day.

Thoughts on where to go from here? I don’t know if the pediatrician will look as hard at this as I might wish, if I don’t push on it. It’s possible it’s an asthma mimic such as GERD or sinusitis though she doesn’t have other signs of those.

2

It does sound anaphylactic. I wonder if there was something airborne that triggered it? Does she see a pulmonologist?

3

I’m diagnosinglaryngospasm. Was it relatively easy to exhale and extremely difficult to inhale with distinctive stridor sounds? Then I can practically guarantee it.

4

That sounds pretty spot-on - thank you!!

Anaphylaxis didn’t make sense to me. I mean, I know it can come on very fast, but she hadn’t been exposed to anything just then, and a delayed reaction would, I thought, have not come on that quickly. Nor would it have resolved that fast - within a minute or two she was talking, if a bit hoarsely.

If laryngospasm could be triggered by coughing (“coincident with a cold or flu”) then this especially makes sense, as she did cough once just before she started choking. No stridor that I heard, but we were in a noisy car and she definitely had trouble inhaling.

5

Suddenly feeling like you can’t breathe although air is moving can be a symptom of a pulmonary embolism, where one or more bloodclots block the bloodflow to your lungs. It’s a leading cause of sudden death, but few people recognize the symptoms. The ER can rule it out with a simple blood test.

6

Though it’s probably not related to her current issue, it would be surprising if she doesn’t have GERD too. 3/4ths of asthmatics do, though no one seems to really know why.

7

I lean toward GERD, also, but sometimes food allergy/anaphylaxis hits out of the blue: cross-contamination with a known allergen, food with a high load of mold, cross-reactivity of a food with an allergy like ragweed.

8

:eek:

Actually this is basically what happened to a relative - he was young (40 or so) but had been in ill health for years, and one morning he basically “woke up dead” (gasping, unable to breathe). He was gone before the EMTs got there. They didn’t do an autopsy but that fit the symptoms.

Moon Unit, on the other hand, was fine after a minute or so. She’s just finished her course of steroids, and is still coughing a bit, with the occasional cough that makes her need to stop and breathe slowly.

We’ve been to the doctor, who concurred that laryngospasm sounded likely, and wanted us to start her on Zantac (instead of a proton pump inhibitor) as the first thing; if that didn’t help, either move on to a PPI or to a nasal steroid.

The Zantac didn’t help, so she started a nasal steroid a few days later. Still not back 100%, so I’ll probably suggest we add a PPI to the mix when we go back for a followup in a couple weeks.

GERD is indeed a very real possibility - my husband and I both have it. In fact I posted a thread here a year or so asking about “silent reflux”.