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

Introduction

Overview of asthma and common symptoms

A lot of people all over the world have asthma. Some people have allergy-induced asthma, nocturnal asthma (asthma that worsens at night), exercise-induced asthma, and some have cough-variant asthma, which is the type of asthma where cough is the main symptom. There are other types of asthma caused by the work environment, where workers are exposed to some allergens, and there is also asthma due to the place where you live, called urban asthma.¹

However, regardless of the type of asthma you have, the symptoms are usually the same. The most common symptoms of asthma are dyspnoea (shortness of breath), chest tightness or pain, wheezing (where the sound of breathing usually resembles a whistle), and coughing. Factors that can trigger asthma include allergens, cold air and strong odours.¹

What is asthma?

Asthma is a chronic disease where the airways are inflamed, causing multiple symptoms like shortness of breath, chest pain, and cough. In asthma, the airways are hyperresponsive to the triggers mentioned earlier, causing obstruction. However, this obstruction of the airways is reversible and it is not always obstructed in asthmatic patients.¹

Understanding the throat sensation in asthma

What is the globus sensation?

The word “globus” means a feeling of a lump or obstruction in the throat. It is not painful, and it does not interfere with swallowing food. Those with a globus sensation can easily swallow food with no pain. Patients usually describe a globus sensation as if a pill is stuck in their throat; they have the feeling of fullness or maybe a tickle in the throat, and unfortunately, it is a persistent feeling. This feeling may be physiological due to stress, anxiety, or depression, or may be due to inflammation in the larynx or muscle tension in the upper sphincter in the oesophagus.²

Multiple studies have shown that there is no evidence that the globus or sensation of a lump in the throat is caused by any anatomical structure or an actual object obstructing the throat. Other studies showed that if someone did frequent swallowing, this would cause entrapment of air, leading to a feeling of something stuck in the throat.²

One of the things that could cause this feeling to exist is an increased pressure on the upper sphincter of the oesophagus (like a gate at the upper part of the oesophagus), but on the other hand, there was no evidence to prove that gastroesophageal reflux causes globus.²

Studies showed that after undergoing endoscopy, a gastric inlet patch was found at the upper esophageal sphincter in patients. This patch consists of ectopic gastric mucosa and has been linked to globus sensation.² 

How can asthma cause throat discomfort?

Asthmatic patients, especially those who have cough variant asthma, often have the urge to clear their throat and sometimes have a tickling sensation, and its scientific name is laryngeal paresthesia. This makes them have an urge to cough.³ 

Both asthma and coughing cause laryngeal paraesthesia that may lead to laryngeal motor dysfunction (also known as vocal cord dysfunction). It can also cause globus sensation and dyspnoea.³ 

Increased mucus production contributes to the feeling of blockage.

25% of adults with asthma experience mucus hypersecretion. This increases coughing to expel this mucus, which often gives the sensation of blockage in the throat.³

Is there a link between asthma and gastroesophageal reflux disease (GERD)?

GERD as a common asthma trigger

There is a strong connection between asthma and GERD, where there is a 30-65% risk of an asthmatic patient having GERD.⁴

Other studies showed that common symptoms of GERD, like heartburn and regurgitation are experienced by 80% of asthmatic patients. A study conducted on 100,000 patients showed that patients with GERD were 1.15 times more liable to getting asthma than other patients who did not have GERD.⁴

How can acid reflux exacerbate asthma and create throat irritation?

Acid reflux in GERD can worsen the symptoms of asthma and cause throat irritation and a globus sensation. It worsens these symptoms either directly through the effect of acid on the throat and aspiration-induced response (inhalation of stomach contents into the airways) or indirectly through inflammation that is induced by the nervous system.

Since the oesophagus and the lungs have the same origin when they were developed through the embryonic stage, GERD sensation can cause bronchoconstriction (narrowing of the airways due to muscle tightening) and difficulty breathing by stimulating the vagus nerve through the vagus-mediated reflex.⁴

Moreover, oesophageal exposure to acids can cause an increase in the resistance of the airways, thus difficulty in breathing.⁴

We can suspect that this is GERD-induced asthma if symptoms of asthma become worse after eating large meals, sleeping in the supine position, or if there was poor control despite taking medications.⁴

Symptoms overlap

How can GERD symptoms mimic or worsen asthma symptoms, especially throat tightness or discomfort?

As we know in GERD, the acid in the stomach refluxes into the oesophagus; this reflux of acid induces a cough, and in asthmatic patients, the cough frequency and strength increase.⁵

It was found that the mechanism involved in inducing a cough during GERD was a mechanism that links the oesophagus, trachea, and bronchioles. Further studies proved that non-asthmatic patients who had GERD were more sensitive to cough triggers due to GERD.⁵

This leads us to the conclusion that GERD symptoms sometimes mimic asthma symptoms leading to throat irritation and the globus. Also, in case asthma is present, it makes it even worse.

Vocal cord dysfunction (VCD) vs asthma

What is VCD?

VCD is a condition that is intermittent where the vocal cords constrict usually during inhalation, which causes shortness of breath. Some scientists called it paradoxical because the vocal cords act completely opposite to what they are supposed to do normally; some otolaryngologists call it paradoxical vocal fold motion disorder.⁶

The problem with vocal cord dysfunction is that it is usually misdiagnosed as asthma until the medications and therapies for asthma don't work.⁶

A study including 95 patients who had intractable asthma a type of asthma in which the only effective drug is corticosteroid); 10% of these patients only had VCD and no asthma, and 30% of them had both.⁶

VCD and throat tightness

VCD symptoms include wheezing, globus sensation, chest pain, and throat tightness or irritation. These symptoms were either triggered by inhaled irritants or exercise, and there was no improvement by treating them with inhaled medicines.⁶

How does VCD cause the sensation of something stuck in the throat or difficulty breathing, especially during asthma-like episodes?

Vocal cord dysfunction mimics the symptoms of asthma, especially exercise-induced asthma. Symptoms include shortness of breath, air hunger, and chest tightness in addition to globus sensation, choking sensation, loss of voice, or change of voice.⁷

Episodes of VCD are intermittent and can last for a short time or a long time. These episodes are triggered by irritants, coughing, respiratory infection, exercise, acid reflux, odours, talking, and laughing.⁷

Managing throat symptoms in asthma

Asthma treatment strategies to reduce throat discomfort

Inhalers, bronchodilators, and other medications

Asthma can now be treated by several drugs, including:⁸ 

• Antihistamines
• Corticosteroids 
• Mucolytics 
• Beta-agonists

Sometimes it can be treated by one drug, or a combination of two or more drugs.

The new antihistamine drugs produce perfect clinical results without developing drug tolerance. The new anticholinergic drugs can also treat asthma without producing mucus plugs. Inhaled beta-agonists are the drug of choice when it comes to fast control of bronchoconstriction.⁸

Techniques to clear mucus

Mucolytic agents are very effective; they can be applied either topically or inhaled through steam or taken orally or inhaled.⁸

Addressing GERD and acid reflux

Lifestyle changes and medications that reduce reflux

Lifestyle changes and habits are considered a non-pharmacological treatment, and it can immensely improve GERD symptoms. This includes dietary adjustments, weight management, and sleep position modifications.⁹

On the other hand, the most potent medication for GERD are proton pump inhibitors (PPIs) because they prevent acid production from the stomach, helping with acid reflux and decreasing the irritation of the oesophagus.⁹

Speech therapy for VCD

Vocal exercises to relieve throat tightness and improve breathing control

The most effective treatment is speech therapy, where the patient is treated through several trainings, like respiratory retraining which is called the quick release technique to help the patient bring the vocal cords back to a normal position after being constricted.¹⁰

Summary

Asthma is a chronic condition characterised by inflammation of the airways. There is a clear correlation between GERD and asthma since acid reflux worsens respiratory symptoms by stimulating the vagus nerve and causing direct irritation. Globus sensation, which is a persistent feeling of a lump in the throat, can be associated with asthma, GERD, and vocal cord dysfunction. You can manage the condition by using techniques like proton pump inhibitors, mucolytics, bronchodilators, inhalers, and making some lifestyle changes. In order to enhance breathing control, speech therapy is crucial for VCD.