Breathing issues

[rmking74]

I am a 35 yo male, in excellent shape with healthy eating habits.  I'm a regular runner (10-20 miles per week as time permits) but over the past 1.5 years have experienced extreme difficulties breathing after 10-15 minutes of moderate running.  I also routinely experience shortness of breath and tightness of chest during other normal activities and at bedtime - strong pressure that sometimes feels like bloat but for which I can get no relief (burping doesn't seem to help).  I also regularly experience nasal congestion.  I had a complete work-up by a gastroenterologist 2 years ago including upper endoscopy and stomach empyting study with nothing abnormal found other than some acid reflux which I treat with protonix.  I recently visited an allergist who detected no allergies other than dust mites.  I had a breathing test which indicated normal lung function (I did have asthma as a child).  The allergist did prescribe a rescue-inhaler to use before exercising but as of yet, I've seen no real difference while running.  She also tested for gluten intolerance (celiac) but my blood tests were negative.  My last physical (within past 9 months) indicated good health.

I did have a physical with a previous doctor about 3 years (the first in many years) in which a baseline chest x-ray was ordered.  A granduloma was detected and confirmed with a CT scan of my chest.  I also learned that my aunt on my father's side was diagnosed with sarcoidosis during her 30s (she is now in her 60's).  Other family members on my father's side also have auto-immune diseases (rheumatoid arthritis)

I'm curious to know if my symptons and family history indicate possible sarcoidosis and what my next steps should be.  The breathing issues are begnning to impede on my ability to run, get a good night's sleep, etc.

[National Jewish Health]

It is understandable that diseases of the lungs would be the first consideration, as the cause of shortness of breath in a seemingly healthy 35 year old man, the most common of these being asthma or, more specifically, Exercise Induced Asthma (EIA), and that may prove to be the case.  “Normal pulmonary function tests” do not rule out this diagnosis.  Pulmonary function testing, immediately upon the onset of shortness, following exercise would be much more informative in this regard.  One quick caveat.  There is a condition called vocal cord dysfunction (VCD), that results of inappropriate closure of the vocal cords, primarily during inspiration (as opposed obstruction of air flow during exhalation, typical of asthma), a condition that can closely mimic asthma.

But, with a negative or normal exercise test, it would still be unwise to assume that the problem resides within the lung’s airways or within the sponge-like substance of the lung, where gas exchange (oxygen & carbon dioxide) occurs.  What you describe could be the result of heart disease, progressive weakness of one or more of the respiratory muscles (including the diaphragm), blood clots to the lung, with or without pulmonary hypertension or primary pulmonary hypertension.

You should request evaluation of your shortness of breath by a lung specialist to first be screened for, the most common cause, exercise induced asthma.  This would require complete pulmonary function tests (PFT’s) at rest and with exercise..  If asthma is not the cause, the next step would be a chest X-ray and even if interpreted as negative/normal probably a high resolution CT scan of the lungs to rule out interstitial lung diseases and other diseases, including Sarcoid, a disease that, as can autoimmune lung disease, occur with increased frequency in a given family.  Rarely, sarcoid can primarily involve the bronchial tubes, rather than the remainder of the lung and adjacent lymph nodes.  At some point, it might be appropriate to also evaluate diaphragmatic muscle function (both strength and endurance..

If it appears that the problem is not what we call intrinsic lung disease (disease that arises, primarily, within the lungs) the next step would be to rule-out blood clots to the lungs and if that evaluation is negative, to then evaluate your heart, as heart disease can develop in otherwise healthy young adults in at least six categories:  1) as a late manifestation of congenital heart disease, 2) as disease of the coronary arteries (CAD), 3) as disease of the heart muscle (cardiomyopathy), 4) as disease of one or more of the heart valves (as seen with rheumatic heart disease, 5)  as the result of high blood pressure, either in the general (systemic) circulation or elevated pressure in the pulmonary arteries and, 6) as the result of abnormal heart rhythms.

Heart evaluation, following examination by a cardiologist, would initially include a chest X-ray, an EKG, an exercise study and an echocardiogram.

All of the preceding assumes a physical or physiologic cause of your shortness of breath but it should be remembered that emotional causes, such as acute and chronic anxiety can cause the symptoms you’ve experienced and feel every bit as real as those caused by physical disease.

Good luck