Breathing difficulty

[kharee]

My father has developed shortness of breath. He has had all the tests from stress tests to blood work and all came back great. His doctor suggested more exercise which he has done - walking and rowing - but still shortness of breath, mostly when he bends over. He gets "heaviness" in his chest also. He has had a hyoital hernia for 30 years that contributes problems of its own but surgury is not an option. He has occasional panic attacks at night that are very disorienting, accompanied by shortness of breath. He also uses an inhaler twice a day for mild asthma and 1/2 a zanex daily. My mother has just finished radiation, following chemo for breast cancer and I know he has been very stressed. He doctor says he can't find anything wrong, that he's just getting older (he's only 77!) and may have to adjust to this as a way of life. I live at an elevation of 3000 feet and when he comes to visit - which is very rare now - he says he can't breath very well. Any ideas?

[National Jewish]

There are so many reasons for shortness of breath.  You have mentioned several.  Altitude may cause shortness of breath, but this happens more when people with emphysema or chronic obstructive pulmonary disease (COPD).  Shortness of breath can be a symptom of asthma.  If this is the case, then the inhaler should help.

A hiatal hernia can crowd the chest area giving the lungs less room to work.  In addition to shortness of breath, this could also cause the ‘heaviness’ that your father feels in his chest.  Often this is worse when bending over.

Shortness of breath can certainly happen with panic attacks and cause the panic attack to worsen.  The stress that your father has been under could be adding to this situation.  The Xanax® (alprazolam) that he is taking can help.  Another option is for your father to work with a therapist to learn relaxation techniques.  Then your father could gain control over these panic attacks and be able to break the cycle of panic and shortness of breath.

Pulmonary rehabilitation is a program to bring back your quality of life through aerobic exercise done on a regular basis.  The walking and rowing that your father is doing are excellent.  When done routinely, this conditions the entire body so that the muscles are working as efficiently as possible.  This allows the breathing muscles to use the least amount of energy to move air in and out of the lungs.  Over time this helps to lessen shortness of breath.  Some programs will also include education about your lung condition and nutrition.  Please read our Pulmonary Rehabilitation MedFact at http://www.nationaljewish.org/medfacts/pulmonary.html for more information.  Share this information with your doctor to see if this would be helpful and where in your area there are programs.

Shortness of breath is NOT a normal process of aging!  To know for sure if this is due to a lung problem your father may need to have further testing done.  Generally testing for a breathing problem starts with a simple breathing test called spirometry.  This test provides detailed information about how your lungs are working.  If your father’s symptoms are due to a lung problem, this testing should identify the cause.  A pulmonologist would be the type of specialist to identify a lung problem and the best treatment.

Another possible cause of shortness of breath is a heart problem.  A cardiologist would be the type of specialist to identify a heart problem and the best treatment.

[starion]

You didn't mention him having BREATHING TESTS, called spirometry or pulmonary function tests.  This would be very important to figure out how his asthma and/or other lung condition(s) are doing.  Generally, if a patient needs to take albuterol more than twice a WEEK, it is good to talk to the doctor and see whether his asthma treatment plan should be adjusted.  There are longer-acting medications which are similar to albuterol but have fewer side effects and last for 12 hours, such as Serevent and Foradil as well as a low to moderate dose of inhaled steroid to help control inflamation (inflammation) of his airways that might be useful to consider for his asthma.  Best of luck!
Starion