Breathing Difficulty

[motox320]

25yr male. Never had a breathing issue until last year. Did smoke, but quit. Breathing issue came on fast. Just a feeling of not being able to breathe right, not getting enough air, hard to expand chest, pain in between breaths, feels like I am kinda holding my breathe (the feeling I have) no hypervenolation, average breaths per minute about 12-16. Can still run a mile. I do suffer from gerd, have a small hitial hernia. Have had all heart realted tests, EKG's, blood test for heart, 24 hour heart monioting, all came back good. Had chest x-ray clean, chest CT clean, chest CT w dye clean, doctor has never heard weezing in lungs, same as pulmonogist. Had pul function test: (pre ref%) FVC 103 FEV1 100 FEF25-75 90 PEF 120 FIVC 97 MVV 99. Volumes (pre ref%) VC 103 TLC 104 RV 111 FRC PL 97. All apparently gd. Diffusion was messed up, pulmologist said maybe mouthpeice leak or something??? they were (pre-ref%) DLCO 249 DLCo/VA 253 Kroghs 205. anyways, should I worry about something like pulmonary fibrosis? or am I ok, because of the tests I have had? If not that, what other things could I look into? Or could chest pressure from gerd, just make breathing feel difficult? I do have a small hitial hernia. I can hold my breathe for 2min. pulse oxogen always 99-100%. I do sneeze a couple times per day. I have had this breathing issue for 1 year, has not got worse or better. It is pretty much constant all day long, sometimes I get a couple days of relief, cant find triggers. Could it just be chest pressure from gerd related problems? or any idea? because of my test I have had done, can I stop worrying about fibrosis, or something like that? thanks for your time, if you need any other info, I will reply back

[motox320]

I forgot to say: the Pulmonary function test was done with and with-out broncodilators. The only differnce it made was:

FIF50% L/sec  (pre) 7.34    Post 9.24  (post change)  26%
PIF L/sec         (pre) 8.35   Post 9.91  (post change)   19%
FEF/FIF50        (pre) .78     Post .62    (post change) - 21%

everything else on the Spirometry was w-i (2%) pre- to post broncondialtors.

Never had asthma as a child. No immediatly family has asthma
Cousin on mothers side has asthma until age 12-15, then grew out of it

They have given me ashma inhalers to try, noticed no difference

did smoke for 3 years, quit about the time problems began.

Thankyou again, just trying to give all information possible.

Was thinking about asking for a Methadone Challege, but the doctors dont think I need it I guess.

[motox320]

I would also, like to mention that i dont have a regular cough. I do cough, but its only to clear my throat, because I hack allot of mucus up most likey due to gerd issues. I recently put my bed at a tilt. I have never been woken up in the middle of the night, coughing or chocking. Maybe once or twice, I have had a dry cough in the back of my throat. When, I do, I have a coughing attack for about 2 mins, somtimes gets to my gag refux, and I feel like I am going to throw up. but this has only happed like 2 times over the last 6 months,  I think its just reflux, giving me a cough spasm.

-Even during the winter when I had sore throat - winter cold cough, the doctor has not heard weezing in my lungs.

-No light headness

-Have not smoke for a year

-Was a college runner, out of shape now but still can run a mile

-When breathing issue occurs, I do not hypervenolate, it do not gasp for air.

- Can still lift heavy weights, work out while this is occuring, its just uncomfortable....

-not overweight 6'0" 200lbs

-no family history of lung problems until after age 70, most were lung cancer due do years of smoking

-issue, is just a bad feeling of not being able to breathe, sometimes a buring feeling

-started 1 year ago, came on in one day

-can feel the pressure tightness type of feeling in between breaths.

-cant get any answers

Thank you very much for your time and input, I appreciate it

[National Jewish Health]

You need not worry that you might have pulmonary fibrosis.   Your measured pulmonary function is normal and, combined with the normal CT scans, effectively rules out that diagnosis or, for that matter rules out any intrinsic disease of your lungs.  That statement assumes that the CT scans were technically satisfactory and that your doctors, on the basis of the scans were also able to rule out pulmonary emboli (clots to the lungs) and pulmonary hypertension.  You might want to ask about this.  Another condition not ruled out by the normal spirometry is Vocal Cord Dysfunction (VCD).

Your cardiac testing rules out some, but not all, heart disease.  For example, it would not detect disease of the heart muscle (cardiomyopathy), cardiac valvular disease, or a condition called constrictive pericarditis.  An Echocardiogram could provide that information.

Yes, your symptoms of “pain in between breaths” could be on the basis of esophageal spasm, secondary to GERD but not the feeling of not getting enough air.

Finally, there is the possibility that your symptoms are not on the basis of physical abnormalities of the heart, lung or GI disease.  That is on the basis of chronic anxiety, possibly with what is called panic disorder.   A common response is for a person to quickly reject this possibility.  While it is an emotional disorder, the symptoms can be every bit as real as those that occur with physical abnormalities, and I would urge you to keep an open mind about this disorder.

Thank you for the additional information.  I agree that the pulmonary function tests do not suggest the diagnosis of asthma.  Based on your statement that you “can still run a  mile”, I assume that you can run the mile, without respiratory distress of any type; either the combination of symptoms you describe below in the sentence that begins “Just a feeling …..” or any other respiratory distress, such as chest tightness and wheezing.  While some individuals, with asthma, experience respiratory distress only with exertion, your description suggests that you experience these symptoms at rest.  And, if this were asthma, while at rest, it should have been evident on pulmonary function testing, with a clinically significant bronchodilator effect.  Bottom line is that your symptoms are not consistent with the diagnosis of asthma.

I am uncertain about the role of GERD, in all this.  Seems to be little doubt that you have GERD, a condition that can be associated with heartburn, can be silent, or can be a combination of the two.  When silent, you would not likely associate GERD with your respiratory symptoms.  With aspiration, into your windpipe, you could have acute bronchospasm (with or without wheezing) or vocal cord spasm with inappropriate closure of the cords, in response to the aspiration of gastric (stomach) contents resultant from the GERD.  It could be informative to test this premise, by arranging for direct examination of your larynx and cords by an experienced examiner, with the use of a fiberoptic laryngoscope.  Another approach, the one you mistakenly  referred to as “methadone challenge”,  would be a methacholine challenge that would answer the question of a relationship between your symptoms and vocal cord function and provide further evidence to rule out the diagnosis of asthma, should there be any lingering suspicion of that diagnosis.  

Your doctors might want to consider additional pulmonary function testing to assess the respiratory musculature,  These would include inspiratory and expiratory pressures and an MMV (maximum voluntary ventilation) test.

I would reaffirm my initial conclusions and recommendations, below, including the suggestion that your symptoms do not have a physical basis, and suggest that you seek answers to the questions posed.  Basically, the diagnoses to be ruled out would include intrinsic disease of the lungs, disease of the respiratory muscles (that includes impairment of the mechanical, or “bellows” function of the lungs and chest wall , disease of the pulmonary blood vessels including pulmonary vasculitis and clots to the lungs and, finally, occult cardiac disease.

Good luck