I have severe asthma, but my lungs have never hurt. If other inflammatory process in the body I have heard of has pain associated with it. So, why does the inflammation associated with asthma not cause pain?
I’m not an anatomist, but I would guess it’s because bronchioles don’t have nerves. Personally, I find that my severe attacks involve “pain”, though not in the “I stubbed my toe” sense.
Lung tissue tends to lack the type of receptors that signal pain. They tend to be programmed to signal irritation instead, and this triggers coughing.
If the inflammation gets so bad that it involves the pleura (lung lining), then visceral pain receptors can send pain signals, but most inflammation doesn’t have to involve the pleura.
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Other inflammatory responses aren’t associated with pain, as anyone who has has an allergic reaction can tell you. The face can blow up like a balloon, but no pain.
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Asthma isn’t an inflammatory response as such. Normal inflammation results from the blood vessels becoming leaky and fluid moving into the tissues. That results in swelling that can be, but often isn’t, painful. Asthma is mostly caused by a contraction of muscle tissue around the airways, making them shrink. No swelling, no pain.
What Qad said (as usual he’s spot on)
Asthma is most definitely an inflammatory disease. The reason the “contraction of muscle tissue around the airways” occurs is because of inflammation in the area.
Remember, as well, that glucocorticoids (the gold standard treatment for inflammation) are the mainstay of asthma therapy.
In any case, here is a 2010 review summarizing the (recent) thinking of asthma as an inflammatory disease (with the first author probably among the top couple of asthma researchers in the world)
Is there a difference in the OP’s mind between pain and aching? My chest aches when I’m exposed to high concentrations of my triggers (primarily pollen and humidity) and I’d say that it hurts some to breath. Not to mention if you google “Asthma chest pain” you’ll find lots of people who claim that it causes pain.
Preach it, Brother! Asthma is a disease of inflammation, first and foremost.
Just to pile on…asthma is generally thought of as having three components (each of which contribute to narrowed airways): Inflammation, bronchospasm, and increased mucus production.
As far as asthma hurting, I guess it doesn’t hurt directly, but I’ve seen plenty of asthmatics with chest discomfort/pain.
mmm
No chest pains but the induced coughing results in intense pain in my kidney area and the backs of my thighs and calves. Followed by extreme headaches.
You (the OP) do not have serious asthma if you have not experienced pain. As someone who spent weeks as a child unable to sleep lying down because of the coughing, I can assure you that there is plenty of pain involved.
Also… most inflammatory processes in the body have pain and inflammation resulting from some common cause. The pain isn’t resulting from the inflammation. For example, if you burn yourself or sprain an ankle, the burn or sprain results in both pain and inflammation. You would have pain even if your body somehow lacked an inflammation response.
Most asthmatic chest pain comes from strain in the intercostal muscles and cartilage between the ribs and sternum, from the repeated coughing that goes on with asthmatics. This is pretty straightforward musculo-skeletal type pain, and can be quite severe.
The pleura, or lung lining, can also become irritated from all the coughing, and rubbing up against either the chest wall, or against the irritated, inflamed tissue of the lung itself. This too can be severe, and this is more of a visceral pain, which can be harder to treat. This pain tends to be more poorly localized than the musculo-skeletal pain noted above, and may occur in the gut, chest, back, or even down in the groin or up into the shoulders, arms, and neck. Jaw pain is also possible. This can often get mistaken for cardiac pain.
The mechanisms of pain are myriad, and this space is too small to dissect them out here, but suffice it to say that pain can often result from inflammation, and inflammation can even result from pain, but this is less frequent.
And in the health-care delivery system I work for (circa 23,000 patients), I am the resident expert on asthma. And pain. Which just shows that I have to wear too many f**king hats.
I don’t know about most, myself. I get a agonizing burning in my chest, along with the frightening tightness. Most asmatics I know don’t cough - they wheeze. I can be pretty active, but I have to thottle back my physical adventurousness to make sure I don’t tip over into the red zone and trigger an attack.
Granted, I know you’re a doctor and all. I’m just curious because this is completely at odds with my experience.
Let me modify my answer. Most musculo-skeletal asthmatic chest pain comes via that type of mechanism (though wheezing can also cause this to and extent, too).
Your pain sounds pleuritic/visceral in nature, as I described in that same post. It’s pretty damn common among asthmatics also.
Again, pain is complex, and dividing asthmatic pains into these two categories only, is a gross oversimplification.
Of course. I was just curious because I’d never encountered that aprticular phenom you described. Well, not from asthma. shudders in memory of that one night with the horrifically bad cough
Is it possible to have moderate to severe asthma and not know it? I got a talking to from my doc to use my Symbicort inhaler every day, even when I didn’t have any symptoms. I still have a hard time convincing myself that I have asthma, because it only tends to show up when I’ve got a cold, and I think of it as being just symptoms of the cold.
Say, Doc, can’t that cause head pain?
Asthma is generally classified as mild intermittent (episodes of shortness of breath less than twice a week), mild persistant (episodes greater than twice a week but not daily), moderate persistant (episodes daily) and severe persistant (continuous symptoms).
Anyone who has mild persistant or more severe asthma ought to be on daily maintenance medications, of which Symbicort is a common one.
That’s because asthma is truly a disease of inflammation, and symptoms more than once a week mean inflammation is lurking in the background, ready to trigger the next attack. Maintenance meds reduce this inflammation.
Now, one principle of asthma treatment is to cut back on medications after an appropriate interval. It is certainly reasonable to inquire about reducing or eliminating medications after the asthma episodes decrease significantly in frequency.
Only when I wear the “Tim the Enchanter” hat that one of my staff gave me.
Thank you good doctors for answering my question! If I can ask another asthma related one:
I, like many asthmatics, take a LABA, with the “BA” standing, of course, for beta agonist. Now then, I have a mild tremour in my hands, which my GP suggested I take a beta blocker for if I wanted to, but which I declined because I was aware that beta blockers are contraindicated for asthmatics. (My GP on the other hand, may his soul rest in peace, wasn’t a stickler for some of these contraindications and saw the issue as largely theoretical.)
So here we go: the tremour, which can be treated by a beta blocker suggests that my body has too much “beta” (whatever that is) and thus needs to be cut down. My lungs, on the other hand, suggest that my body isn’t making enough “beta” (whatever that is) and so needs stimulation (if I understand what an agonist is doing). So what gives? How can I have too much of something (causing the tremour) and not enough of the same something (causing the brochospasms).
Bonus points if you can somehow work in hypertension and ocular eye pressure (which I know both also respond to beta blockers, but mercifully, have no direct relevance to me)!
PS to dracoi, my respirologist begs to differ! 
D18, try looking at it this way:
Your bronchioles are irritated and inflamed enough that they need a lot of beta stimulation to relax their smooth muscles and open up wider. So much is needed, that it causes a bit more stimulation for the nerves than they want. The nerves, after all, are doing just fine and not having to cope with local inflammation.
Meanwhile I do give some of my asthmatics beta-blockers; I use the cardioselective ones like metoprolol, with good results. They lower blood pressure and may help reduce tremor without having much significant effects on most asthmatics’ lungs. So your doctor’s suggestion for a beta blocker isn’t necessarily misguided. Just avoid the non-cardioselective ones.
Unfortunately the noncardioselective ones tend to be better at reducing tremor (and migraines) than the cardioselective ones.