Regarding Two Asthma Symptoms

[LowMac]

My question is regarding two asthma symptoms I experience and whether or not these are common with typical asthma conditions.

Before I list these, I want to mention that I do not have a heart condition and in-fact I was tested for BNP levels at my request twice, over a year period. My first BNP was at "4" and the one a year later, at "16", both of which are far below the level that indicates heart failure (100> would indicate mile heart failure). I also do not have fluid retention in my lungs nor do I experience any edema, anywhere in my body. Also no heart enlargement shown on a chest xray.

Symptom #1: Mild cracking sounds on both the inhale and exhale -- but mostly at night in bed.

Symptom #2: An immediate feeling of less breathing ease, when lying on my back (supine).

Can typical asthma cause these two symptoms?

Also: I'm age-48 and non-smoker all my life and I'm overweight a bit, especially my mid-section.

[LowMac]

Dr. Tinkelman,

After getting your response and adding my response of thanks to it, I did one more online search about crackles when breathing (I tried a different set of search words and finally found sources addressing this). I hope you do not think I'm posting these quotes from other Dr.s, to contrast your response because I feel your answer has very good common sense and medical expertise in it. I again thank you for it.

I will say that it gets a bit frustrating when researching symptoms, even making sure that it is information by qualified MDs or med sources, that contradictory info is found. I have found this true of so many health conditions, that it's just simply amazing.

These are quotes from doctors answering questions for patients experiencing crackling sounds with breathing or who wrote medical papers on the subject.

"If you have asthma, then you can have copious secretions brought about by alveolar and small airway edema. If the asthma is uncontrolled, then you have these persistent crackling sounds."

Link: http://www.askdoctorforfree.com/lung-noises---crackling-sounds-while-laying-down-9071 (Dr Paul S, MD)

"Early inspiratory crackles are often associated with asthma while late inspiratory crackles are usually associated with interstitial lung disease and early congestive heart failure."

Link: http://journals.lww.com/em-news/Fulltext/2001/08000/Not_All_That_Wheezes_is_Asthma.21.aspx (Not All That Wheezes is Asthma -- By: Tinker, E. Charles MD)

"Another explanation for crackles is that air bubbles through secreations or incompletely closed airways during expiration.
                - ARDS
                - asthma
                - bronchiectasis
                - chronic bronchitis
                - consolidation
                - early CHF
                - interstitial lung disease
                - pulmonary edema"

Link: micunursing.com/breath.htm (Pulmonary Concepts In Critical Care Breath Sounds)

"The cause of the crackles can be partly identified by when it is heard during inspiration. Some of the causes include :

Asthma – bubbling sound with wheeze"

Link: http://www.healthhype.com/abnormal-breathing-sounds-types-and-causes.html (Abnormal Breathing Sounds – Types and Causes -- By: Dr. Chris)

Thanks for allowing me to add this information.

[LowMac]

Thank you Dr. Tinkelman,

Yes, the crackling coming from upper airway does make sense. I also have GERD -- many years of it and I feel it may be contributing to the crackling sounds. When I do some throat-clearing, I can feel small amounts of plegm come up and the crackling will disappear for a while afterward. It certainly does seem at times to be coming from my lungs.

In regard to my diaphragm muscles, I suspect overall body-weakness as a possible contributor to my increased breathing difficulty when lying supine (I have believed since 2003 that I have Chronic Fatigue Syndrome). I'm six-foot and about 235lb, so not terribly overweight but I definitely carry a spare tire around the middle.

I also have peripheral neuropathy secondary to vitamin deficiencies and autoimmune hypothyroidism that are treated now but the PN has continued. I'm trying not to let my thinking go toward believing that I'm losing breathing ability over time because I can walk fine, just with pain and intermittent weakness and I feel surely that my PN would have to become much more severe before any danger of true breathing loss. It's my understanding that breathing difficulty with PN is rare and I'm not a diabetic.

As he saying goes, I'll just have to play it by ear.

Thank you for your response -- I really appreciate it.

[David Tinkelman, M.D.]

It is highly unlikely that these cracking sounds originate in your lungs.  A more likely possibility is that these sounds originate in your upper airways, including mouth, nose, throat, larynx or wind-pipe.  “Cracking sounds” of any type are not characteristic of asthma.

Shortness of breath when you assume the supine position is also not characteristic of asthma.  Given that you have mid-section obesity, your shortness of breath when supine is likely secondary to an upward shift of abdominal contents and abdominal fat, where it can push against the diaphragm.

Good luck