chronic breathing problems for asthmatic

[kitten722]

My son is 15 and has suffered with asthma since age 5. He has asthmatic bronchitis and allergies. He's been on prednisone for attacks since age 5. He takes allergy shots. He blows 124% on PFTs when he is well, lower when he is sick but still 100+. Dr. said his lung capacity is approx. 120+ percent of normal. This last episode, Dr. found reduced but good lung function as measured by PFT, no sinus infection and says he is moving air. My son has chronic cough which accompanies his asthma episodes and he is severely short of breath. The shortness of breath is consistent with each episode and keeps him out of school. Prednisone is the only thing that really helps in addition to his meds. Sometimes nebulizing doesn't help. Dr. is baffled and says that prednisone not really helping but I know it reduces and eventually stops the cough and the excess mucus production. He coughs up little balls of mucus when he is in episode. What could be causing severe shortness of breath and hard to breathe that Dr. may not have checked in ordinary tests. Dr. Has done blood work & checked for inflammation and the IGE level which was 249. Dr. said not high enough to be concerned.Dr. cannot find anything. Please help. He can hardly walk through house without severe shortness of breath. Please help me.

[David Tinkelman, M.D.]

Several possibilities come to mind.  The first is that your son has severe, labile asthma.  That is, that the degree of obstruction to airflow in his airways (bronchial tubes) varies widely and quickly,  so that the pulmonary function tests (PFT’s), performed when he is asymptomatic or relatively so, do not reflect the severity of his bronchial constriction at the times when is experiencing “severe shortness of breath.  You and your son’s doctor differ in you assessments of the benefits of prednisone (“Dr. is baffled and says that prednisone not really helping”) and yet you have observed that it, “it reduces and eventually stops the cough and the excess mucus production”.  The truth may lie somewhere in between , in that his asthma may be somewhat steroid non-responsive.  You make no mention of inhaled steroids (I”CS) and it would be useful to know what his response to the regular use of ICS has been.

The second possibility is, while your son may well have episodes of “asthmatic bronchitis” and multiple allergies, that he either does not have asthma or that he has asthma in conjunction with another respiratory disease and that the two combined are responsible for his marked respiratory impairment.  This circumstance could account for his less than optimum relief with therapy for asthma.  There are a number of other respiratory diseases that can simulate or mimic asthma, or compound it, two examples of which would be Cystic Fibrosis and a condition called Vocal Cord Dysfunction.  And there are others, including spasm of the vocal cords (laryngospasm), heart disease (“cardiac asthma”) and a condition called Bronchomalacia (characterized by floppy, collapsing airways).  With Bronchomalacia, however, it would be unusual to observe “normal” PFT’s at anytime.

Your description that he “can hardly walk through house without severe shortness of breath”, is inconsistent with his doctor’s observation that “he is moving air” and his “normal” PFT’s assuming that he experiences severe shortness of breath, at times in close proximity to the doctor’s exam and the PFT’s.  In this regard it would be helpful to know what are your son’s peak flow measurements, when he is severely short of breath, and if there is a component of difficulty breathing in as well as the expected (with asthma) difficulty breathing out and to know if his doctor’s PFT’s included measurements of inspiratory air flow rates.

My message is that there are a number of unusual features of your son’s asthma that warrant further investigation by an expert in the diagnosis and treatment of asthma, not only to assess the severity of your son’s asthma and determine what might constitute optimum therapy but to also to determine if there is any other respiratory disease that co-exists with the asthma.

Such evaluations are performed at a number of institutions, including the Mayo Clinic in Rochester, MN, John’s Hopkins Medical Center in Baltimore, the Cleveland Clinic, the University of Pittsburgh (PA.) Medical Center (Dr. Sally Wenzel) and National Jewish Health (formerly National Jewish Medical and Research Center) in Denver Colorado.  Note:  I am a member of the medical staff at NJ Health.

I also recommend that you share the above information with your son’s doctor, for his/her advice.

Good  luck

[ill13632]

you could try to get a second opinion and a chest xray.  does your son have sleep apnea?
you have to be careful with prednisone because of liver damage and high blood sugar
my FEV 1 is only 70% and I don't know how to increase it.  is there a way?