### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have always had asthma that gets worse usually twice a year when grass seeds. This year is has been a lot worse, my doctor did a breathing test and it showed I am getting enough air in but not fully exhaling. I did have improvement after inhaler was used. The recommended dulera twice a day- this caused throat swelling so I can not use it plus it really didn t give me much relief. Lately I have had severe chest tightness and pain in the right rib and shoulder. They put me on Adderall and Progesterone about a year ago could this be causing heart issues. I have been on Synthroid probable 6 years now. What is really concerning me is I take my inhaler before I run, I can walk at a fast pace with no issues but when I begin to run I get extreme pain in the middle of my chest and right shoulder. The pain goes away when I begin to walk again. Could this be heart related?

### output:

Hello dear, thanks for your question on Chat Doctor. In my opinion your central chest pain is more suggestive of HERD (gastroesophageal reflux disease). But better to rule out cardiac cause first. So get done ECG. If ECG is normal then HERD is more likely. You are also having worsening asthma. This also favors HERD more. Because uncontrolled HERD can lead to worsening of asthma. So better control of HERD is needed to achieve good control in asthma. Try to follow these lifestyle modifications for better symptomatic relief in HERD. 1. Avoid hot and spicy food. 2. Avoid stress and tension. 3. Avoid large meals, instead take frequent small meals. 4. Start Proton pump inhibitors. 5. Keep 2 - 3 pillows under head in bed to prevent reflux. 6. Go for walk after meals. Don't worry, you will be alright.