Does Your Asthma Feel Like Something Is Stuck In Your Throat?

What is asthma?

Have you experienced shortness of breath, tightness in the chest, coughing or wheezing? These are common symptoms of asthma, a condition in which one has difficulty breathing, particularly during expiration. It is a common chronic obstructive lung disease in which the bronchi and smaller bronchioles are hypersensitive to allergens.1 This triggers chronic inflammation with excess production of mucus and smooth muscle spasms, which narrows the airways leading to difficulty breathing.1 Common triggers include cold air, dust, pollen, pollution, air particles, smoke and sometimes exercise or stress.1 Respiratory infections or a family history of asthma can also increase the risk of developing asthma. It affects one in every 12 adults and one in every 11 children, influencing people of all ages, with symptoms often emerging during childhood.2

During an asthma attack, one may find it more difficult to expire than inspire. When we expire, lung and airway volume decreases, narrowing the airway slightly. During an asthma attack, smooth muscle contraction and an inflamed airway further narrow the airways, increasing resistance. This increases the duration for expiration, and breathing becomes more difficult. Asthma patients often find they struggle to inspire, but this is because the time available for inspiration has reduced. During an asthma attack, inspiration does not cause a problem since the bronchi widen due to the expansion of the lungs.3

Resistance is a measure of the ‘difficulty’ of flow. It results from friction between gas particles and from friction between the gas and tube wall. It is affected by the dimensions of the airway. During an asthma episode, narrowing of the airways, along with increased mucus production, increases resistance and decreases airflow through them.1 This is why you may find it hard to breathe during an asthma attack.3

Common symptoms of asthma 

The severity of asthma symptoms can vary from one individual to the next. In most cases, symptoms occur intermittently and can be controlled. Symptoms often get worse in response to a particular allergen or trigger, particularly early in the morning and late at night. Consult your GP at the earliest to ensure symptoms are managed correctly.

The most common signs of asthma include:

  • Wheezing (high-pitched wheezing sound when from your airways when breathing out)
  • Feeling of breathlessness, shortness of breath and persistent coughing (often gets worse during exercise)
  • Tightness in the chest
  • Feeling fatigued

Asthma symptoms often get significantly worse during an asthma attack. Symptoms include:

  • Inhaler fails to provide instant relief
  • Wheezing, coughing and chest tightness are severe and constant
  • Rapid breathing and heart rate
  • breathlessness
  • Numbness in the lips or fingers
  • Feeling dizzy, drowsy or exhausted

Call 999 and seek medical help immediately during a severe asthma attack.4 

Is the feeling of something stuck in your throat a symptom of asthma?

Asthma is a chronic inflammatory disorder of the airways associated with airway hyperresponsiveness leading to recurrent episodes of wheezing, chest tightness, breathlessness, coughing and difficulty breathing.1 

These episodes are associated with airways obstruction within the lungs. Inflammation or mucus collection in the airway tract reduces breathing rate and gives the feeling of something stuck in your throat. The mucociliary system consists of mucus-secreting goblet cells and hair-like projecting ciliated cells. 

These cells produce a continual overturning layer of mucus, providing a protective covering to our airway epithelium cells and preventing foreign particles from entering into our lungs.3 Under normal circumstances, the mucus protects the epithelium lining of the airway by entrapping various bacteria, viruses, and foreign particles and clearing them out. However, during clinical conditions, like asthma mucus shifts from a protective role to one that generates a respiratory disease by increased production of mucus referred to as hypersecretion, which may cause difficulty breathing or infection. 

This is observed pathologically by mucus metaplasia (increase in intracellular goblet cell number caused by differentiation of proximal airway epithelium leading to an increased rate of mucus production) or mucus in the airway lumen.4 Excessive luminal mucus may become impacted, progressing to airway closure.3 Mucus plugging of airways is fatal, comprising of plasma proteins, cells, DNA, and proteoglycans, with mucins forming the major gel component.3 Significantly increased amounts of mucus are found throughout the airways of chronic asthma patients with fatal asthma. 

This is linked to an elevated presence of mucus markers in the sputum. Increased luminal mucus is associated with sputum production, reflecting an increased airway secretion, specifically during or following an asthma attack. Airway obstruction is a consequence of reduced mucociliary clearance, epithelial shedding and damage, goblet cell hyperplasia and mucus plugging. This causes ventilation/perfusion mismatch.3 The uneven mucus obstruction diverts ventilation from one alveolar region to others leading to an imbalanced gas exchange and difficulty breathing.3

What is gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux disease (GERD) is a common condition where acid repeatedly leaks up into the oesophagus from the stomach. This acid reflux occurs as a result of weakening or relaxation of the lower oesophageal sphincter. It is a severe, long-lasting condition which can irritate the oesophageal lining and lead to complications over time if not treated correctly. GERD often presents with symptoms of heartburn and regurgitation.

Connection between asthma and GERD

GERD and asthma are often encountered together, owing to complex interactions GERD may worsen asthma symptoms, or asthma may trigger severe GERD symptoms. Studies have found that the prevalence of GERD symptoms is often greater in asthma patients than in the general population.6 There are several mechanisms by which Gastroesophageal Reflux Disease and asthma can interact. 

GERD can instigate asthma either directly, by affecting the airways with an aspiration-induced response or indirectly, through neurogenically induced inflammation. The oesophagus and lungs share a common embryonic origin giving rise to complex interactions. Reflux of gastroduodenal contents could also induce bronchoconstriction (via vagus-mediated reflex) by neural bronchial reactivity or directly through microaspiration.6

Asthma can lead to a predisposition to GERD by increased intrathoracic pressure, vagus nerve dysfunction, altered diaphragmatic crural function and decreased lower oesophageal sphincter pressure. Asthma patients commonly suffer from lung hyperinflation.6 Lung hyperinflation and increased work of breathing may lead to pressure gradient changes between the stomach and oesophagus which can develop herniation of the lower oesophageal sphincter into the chest, impairing the barrier to reflux.6 This causes potentially continued reflux due to decreased lower oesophageal sphincter pressure.6 

Who can have GERD-related asthma?

Gastroesophageal Reflux Disease is a clinical condition which often occurs together with asthma. Studies suggest that common GERD symptoms (heartburn, regurgitation) are often experienced by nearly 80% of diagnosed asthma patients6. Anyone can develop GERD-related asthma symptoms either periodically or chronically.7 

Other reasons for the sensation of something stuck in the throat

  • Dysphagia from food obstruction: food or foreign object stuck in the oesophagus which can cause contact irritation, erosion or inflammation damaging the oesophageal lining over time.8
  • Globus: is a sensation which can make you feel like you have a lump in your throat and is usually caused by tension of muscle or an irritation in the throat.9

Diagnosis 

Respiratory disorders can affect lung volumes, airflow, or both. Spirometry and the use of spirograms and volume flow loops is a common method to diagnose these disorders. 

Many important aspects of lung function can be determined by measuring airflow and the corresponding changes in volume. This is called spirometry, and it is the most common pulmonary function test that is routinely performed. Spirometry uses a device called the spirometer to record changes in lung volume directly. The resulting graph of lung volume with respect to time is referred to as a spirogram. In these recordings, inspiration produces an upward wave deflection, whereas expiration produces a downward deflection.3

In order to calculate a rate, we need both the volume and time taken to transfer that volume. For spirometry, the standard time is one second after expiration from the maximal expiration. This volume is the forced expiratory volume in one second (FEV1). FVC is the maximum volume of air that a person can forcibly expire after a maximal inspiration. It is important to compare the patients FEV1 with their FVC.3 This produces a ratio FEV1/FVC. Knowing the ratio allows one to know the fraction of FVC that was able to be expired in a second.3 Lower ratio indicated that the airways are more likely to be obstructed. A healthy person will have a ratio of 0.8 (80%) or more.3 This value is often used to help determine whether a patient suffers from obstructive or restrictive lung disease.3 

A low FEV1/FVC ratio (below 70%) may indicate that an individual has a slower rate of expiration.3 This may be due to increased resistance in the airways as a result of obstructive lung disease. 

Treatment 

· Exogenous inhalants such as irritants, pollutants, or certain allergens should be identified and avoided as much as possible.

· Bronchodilators dilate the bronchus, thereby reducing mucus secretion. Asthma inhaler relaxes the smooth muscle, increasing the airway radius, thereby allowing more airflow and mucus clearance.

· Anti-inflammatory steroid drugs reduce inflammation. (Eg. Glucocorticosteroids)

· Mucolytic drugs (Eg. N-acetylcysteine, nacystelyn) target mucus and reduce thickening.

· Use a humidifier, this will loosen the mucus, relieve wheezing and improve breathing and airflow.

· Gargle with salt water to ease throat pain and clear mucus. Sterile nasal saline spray may help thin the mucus and reduce secretion from the nose. The saline present helps to remove any pollen, dust, debris, pollen or other allergen, along with loosening thick mucus. Hot drinks can help to break and thin out mucus providing temporary relief.1

When to consult a doctor

When you experience symptoms such as fever, persistent cough, chest pain, shortness of breath, change in mucus colour, wheezing and chest pain for more than 10 days, it is important to consult a doctor to get the best treatment suitable for you.10 

Summary

Mucus airway secretion is an essential homeostatic mechanism which protects the respiratory tract and lungs. Mucus has to have accurate and proportionate components, viscosity and elasticity for optimum cilia interaction enabling effective mucociliary clearance. During an asthma attack, protective function of airway mucus secretion is lost and instead goblet cell hyperplasia, and mucus hypersecretion occurs, which leads to accumulation and obstruction in the small airways. This could be dangerous and therefore great care should be taken to manage your symptoms.

References

  1. NHS - Asthma. Available here: https://www.nhs.uk/conditions/asthma/
  2. British Lung Foundation - Asthma statistics. Available here: https://statistics.blf.org.uk/asthma 
  3. Human Physiology 5th Edition Gillian Pocock, David A. Richards, Christopher D
  4. NHS inform - Asthma. Available here: https://www.nhsinform.scot/illnesses-and-conditions/lungs-and-airways/asthma#symptoms-of-asthma
  5. NHS inform - Gastrointestinal Reflux Disease. Available here: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord
  6. Insight into the Relationship Between Gastroesophageal Reflux DIsease and Asthma. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395714/
  7. Asthma and Allergy Foundation of America - Asthma and Gastroesophageal Reflux Disease. Available here: https://asthmaandallergies.org/asthma-allergies/asthma-and-gastroesophageal-reflux-disease/ 
  8. NHS - Dysphagia. Available here: https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
  9. NHS inform - Feeling of something stuck in your throat (Globus). Available here: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/feeling-of-something-in-your-throat-globus 
  10. Everyday Health - What is mucus? Available here: https://www.everydayhealth.com/mucus/
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hannah Khairaz

BSc Biomedical Sciences Student, University College London

Hannah Khairaz is passionate about health, research, medical writing and educating the public about current advancements in medicine.

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