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Respiratory Disorders (Expert Forum)
'Forgetting' to Breath?
Answered by
This forum is for questions and support regarding lung and respiratory issues such as: Allergies, Asthma, Bronchitis, Colds - Flu, Chronic Cough, COPD, Cystic Fibrosis, Emphysema, Fibrosis, Lung Abscess, Nasal Polyps, Pleurisy, Pneumonia, Sarcoidosis, Sinusitis, Tuberculosis.
'Forgetting' to Breath?
by Cyranae, Nov 21, 2004 12:00AM
I'm a 43 y.o. 'intermitent' smoker who has had some breathing problems in the past (e.g. EIA, when I used to run track; allergies manifested through coughing in the summer/spring months, etc.) None of this has been debilitating at all and in fact have only just this year started taking something for it (Singulair, 1x/day). However, during the past year I have been having a different problem which is difficult to describe. I did read a previous post that describes the prob. to a "t." If I may quote: "I have a "heaviness" in my breathing. As I reach the end of an exhale, it is though my lungs wish to keep moving in that direction--as opposed to reversing the process and inhaling." I have been to the emergency room 3x for the past 4 months with this feeling. I had a normal PFT, normal chest x-rays, and 100% pulseox reading. I have no cough and rarely have shortness of breath. It's almost as if (as one doctor put it) my lungs/chest "forget" to breath. I am not ready to attribute these episodes to panic (I have experienced panic attacks in the past), as it doesn't 'feel' like a panic attack, and the problem also surfaces after I have taken an ativan (I'm very sensitive to the ativan and it only takes .25 mg to get my attacks under control.) I'm not even convinced it's a lung problem...could it be muscle-centric instead? I hope you can give me some advice; my internist is a great guy, but I think he is beginning to think this is 'all in my head' and I'm truly not convinced of this (yet!) This is severely curtailing my lifestyle and any advice you can give is welcome.
Doctor's Answer
by National Jewish, Nov 24, 2004 12:00AM
, Nov 24, 2004 12:00AM
Since your PFTs, chest x-ray, and oximetry are all normal this is not a lung problem. What you have described strongly suggests a panic disorder.
My advice would be to take the Ativan® (lorazepam) on a regular basis, for a while, to see if this will bring a halt to your problem.
Another possibility is vocal cord dysfunction (VCD). This is a condition that can mimic asthma. However, VCD is not helped by asthma medicines. While inhaling the vocal cords should open to let air into the lungs. With VCD the vocal cords close together during inhalation. This makes it difficult for air to get into the lungs. A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, reflux, cigarette smoke, singing, emotional upset, postnasal drip and exercise. Sometimes the trigger is not known. These attacks are also often seen with panic attacks. Testing needs to be done while you are having symptoms. Breathing tests may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while you are inhaling. A laryngoscopy is a procedure done by a specialized doctor using a small camera at the end of a flexible tube to see how your vocal cords open and close. VCD is treated by a speech therapist that will instruct you in open throat breathing techniques. Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD. Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information. It is important for you to be evaluated by a doctor to determine the diagnosis and appropriate treatment.
My advice would be to take the Ativan® (lorazepam) on a regular basis, for a while, to see if this will bring a halt to your problem.
Another possibility is vocal cord dysfunction (VCD). This is a condition that can mimic asthma. However, VCD is not helped by asthma medicines. While inhaling the vocal cords should open to let air into the lungs. With VCD the vocal cords close together during inhalation. This makes it difficult for air to get into the lungs. A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, reflux, cigarette smoke, singing, emotional upset, postnasal drip and exercise. Sometimes the trigger is not known. These attacks are also often seen with panic attacks. Testing needs to be done while you are having symptoms. Breathing tests may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while you are inhaling. A laryngoscopy is a procedure done by a specialized doctor using a small camera at the end of a flexible tube to see how your vocal cords open and close. VCD is treated by a speech therapist that will instruct you in open throat breathing techniques. Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD. Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information. It is important for you to be evaluated by a doctor to determine the diagnosis and appropriate treatment.
