Breathing Difficulties

[dw1979]

I am a 24 year old female. I have mixed connective tissue disease and have been having difficulties breathing for the past 10 years. When I was younger my Dr always said it was heartburn. For a few days, usually every month, I have difficulty breathing, especially at night. I can not lay down because I feel so out of breath and it is very uncomfortable. I usually have to sit up in bed half the night until I finally fall asleep. During the day it is only bothersome if I engage in any activity such as walking a far distance or climbing stairs. I see a pulmonologist a few times a year and he can't seen to find anything much wrong. I've done pft's for the past few years and everything is steady there. Also with this problem it makes my neck and shoulders hurt. A couple months ago I saw a GI dr and have been put on aciphex, before I was taking prilosec. I don't think these medications are helping because I still have the same problems. I really don't want to live the rest of my life with this problem. Do you have any suggestions on what this might be or what is causing it?

[National Jewish]

Your description of difficulties breathing in a young woman "for a few days, usually every month", suggest that there might be a relationship with your menstrual cycle.  This may be seen with peri-menstrual asthma.  Another consideration would be lymphangiomyomatosis, but that is rare.

My advice is that you be carefully evaluated by your pulmonologist at the time of the month when you are most symptomatic.  This would include an exam, pulmonary function testing, a chest x-ray, and perhaps even a CT scan of your chest.

Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube.  This is most commonly called acid reflux or heartburn.  This reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  This could explain your difficulty breathing, especially at night.

GERD can cause the following symptoms:
· Heartburn or a sour taste in the mouth;
· Pain occurring in the middle of the chest;
· Coughing and/or choking while lying down; and
· Increased trouble breathing while asleep.

You will need to check with your doctor to know for sure what is causing your symptoms.  Testing for heartburn may include a pH probe that measures the acid in your esophagus to see if digestive juices are coming up from your stomach.  Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information about things to do to lessen heartburn.  Since you still have the same problem with the Aciphex® (rabeprazole) it is important that you let your gastroenterologist know.  Until your heartburn is controlled you will continue to have this difficulty breathing.

Sometimes people use their neck and shoulder muscles during times when breathing is difficult.  It takes a lot of energy to move a small amount of air with these muscles.  Also they will tire easily because these muscles are generally not used for this amount of work.  This could be why your neck and shoulders hurt.  Diaphragmatic breathing is a technique that may help you move more air in and out of your lungs using less energy.  Here are the instructions:
· Breathe in slowly and deeply through your nose.
· While you breathe in, count 1, 2 and push your stomach out.
· Place your hand on your stomach so you can feel your stomach going out.  This promotes the use of your diaphragm and your lower respiratory muscles.
· Breathe out slowly and deeply through your mouth.
· While you slowly breathe out all the way, count 1, 2, 3, 4 and let your stomach relax.  You can feel your stomach going in with your hand.

[dw1979]

I have recently noticed that the pains usually comes right before my period. I see my pulmonologist next week and will mention what has been said. Has anyone else experience this kind of behavior?