Ask the Doctor: I have difficulty in breathing

I am a 30-year-old mother of one. From childhood, I have had some respiratory complications. Whenever I am in enclosed spaces I literary run short of breath. Dust, strong perfumes or cigarette smoke cause me to have difficulty in breathing. A week or so ago, I hugged a workmate with a strong cologne and I felt like I was going to collapse. I avoid lifts and other enclosed spaces. I don’t think I have asthma and it doesn’t run in our immediate family. I do not have problems during cold weather and I don’t catch a cold easily. I would like to know how I can have less of these cases and also ask if I might have a developing lung infection. Diane Uwamahoro, Kicukiro Dear Uwamahoro, It is not clear whether you have a problem of breathlessness when walking or in the night during sleep or that if it occurs due to a blocked nose. Your symptoms seem to be due to allergy. Allergy can be caused by anything under the sun including the sun itself. Most common allergy producing substances are dust of any kind including house dust, smoke and fumes, pollens and spores of plants, chemicals and proteins present in food items. In bronchial asthma, there is closure of the airways due to allergy, which causes difficulty in expiration. Due to local inflammation, secretions are formed which are not removed easily. This sequence of events leads to wheezing, difficulty in breathing and there may be associated cough. This can be detected and diagnosed clinically. Other manifestations of allergy are where one gets a frequent cold, a running nose and the nose getting blocked due to secretions. All these problems may or may not be associated with skin rashes. Asthma and allergic cold are inherited in 99% cases. Nobody in the immediate blood relatives may be having this problem. But the problem may have been present in someone existing maybe two or three generations ago. Since genes are passed from one generation to another, one may have asthma, without the parents having it. The confirmed diagnosis of allergic conditions is done by a simple blood test which shall reveal a high eosinophil (cell component of white blood corpuscles which is increased in allergy) count. The substances producing allergy can also be detected by allergy tests. Here, subcutaneous injections of the potential allergy producing substances are given. The response is seen after 24-72 hours, where precipitation of symptoms or a big wheal indicates a positive reaction. These tests are done only when one is comfortable, hence no problem in the past 48 hours or so. Otherwise there is a risk of a severe allergic reaction. But in most of the cases, substances causing allergy are self evident. A person knows from experience that this substance makes them sick and they should avoid them. Like in your case, you have identified that you felt sick due to the strong smell of the cologne your friend used. Avoid exposure to dust, fumes, smoke and strong perfumes. For once you can get yourself examined clinically to confirm that you have bronchial asthma. Carrying an inhaler containing bronchodilator (substance reversing the narrowing of airways like salbutamol) will be useful to you. The moment you feel breathless, taking two puffs will cause improvement. Breathing exercises like yoga, if done regularly, are also very beneficial for breathing trouble. Dr. Rachna Pande is a specialist in Internal Medicine at Ruhengeri Hospital