Pulmonary Bullae

[PinkPaisleyStrat]

I've been having shortness of breath at rest for over a year now.  It is every day and causes me to yawn and sigh all the time.  I can still exercise, so the SOB isn't exercise.  I smoked a pack a day for 30 years and quit over 3.5 years ago.  The SOB problem started after I had a bad reaction to a flu shot in October 2012, which immediately made my thoat feel tight, and I was dizzy, anxious, cold.  It brought on a bad case of gastritis and GERD, daily tachycardia for several weeks, exhaustion, and dizziness.  Allergy test for eggs was negative and there were no preservatives in the single dose flu shot I received, but I still had a reaction.  I took Prilosec for 2 weeks for the stomach problems.  It was a few days after I stopped when this breathing problem started.  I tried Prilosec again, but it didn't stop.  All these tests were normal - laryngoscopy, chest x-ray, abdominal ultrasound, PFTs, EKG and echo.  Barium swallow showed a small amount of acid reflux. Treadmill stress test showed inappropriate sinus tachycardia.  My heart rate raises too fast, maxes too high, and takes too long to come back down.  I tried a beta blocker for 2 weeks, but it exhausted me and didn't help SOB.  Atrovent didn't work.  I've been on an inhaled steroid for 2 weeks, and  I feel a little clearer, but I still feel the need to take a deep breath.  It is not anxiety.  If that were the case, it would be relieved by anti anxiety meds or when drinking alcohol.  Alcohol seems to make it worse.  I had a chest CT scan done last week and the impressions was: "Subcentimeter bullae at the right lung apex which could represent early emphysema.  Otherwise clear lungs."  Everything else on scan was normal, but the bullae have me nervous.  It didn't say how many there were.  Could this be causing the breathing problem?  Is this really emphysema even with normal PFTs?  Can you have normal PFTs and still have shortness of breath at rest?  

[PinkPaisleyStrat]

Thanks for the reply. VCD is suspected. I recently started taking Zantac since my original post and it stops the feeling of suffocation. Also reduces the yawning, but it hasn't completely stopped. Still it's the only medication that's made a difference. I've also elevated the head of my bed and plan on trying a course of nexium. I suspect that my GERD is causing this, but I can't be sure. I also get extremely out of breath when I talk a lot, which makes me focus on vocal cords again. The reason I'm not sold on this diagnosis is that everything I've read on VCD seems to suggest it happens in attacks and then goes away until another attack. My problem seems to be more constant. I saw a GI but he wasn't aware of these disorders. This problem is really affecting the quality of my life. I don't agree it's anxiety at all. It starts as soon as I wake up when I'm not anxious and still half asleep. I've heard this from many doctors but if I listened to them I would be only be doped up on anxiety meds with the same problem unsolved. I've tried that route and it's not the answer. Anxiety meds do not make it better. At this point I wish the doctors would trust my judgment and help me search for the problem. The symptoms seems to be located in my throat, and the urge to yawn is located at the bottom and top of my esophagus suggesting GERD. Acid problems run in my family.  My father died of esophageal cancer caused my untreated GERD, smoking, and drinking.  I'm trying to find an ENT who specializes in VCD. The shortness of breath while talking has grown worse, yet I can still walk a couple miles no problem so it is not my lungs. There are also neurological disorders of the vocal cords, abductor dysphonia causes sob while talking.

[David Tinkelman, M.D.]

You have provided a nicely detailed description of your problem.  And the good news is that all the tests you have had that comprise a comprehensive evaluation are normal/negative.  The sub-center bullae are of no consequence and , while bullae are seen with COPD/emphysema, the normal PFT’s rule out the diagnosis of emphysema.

Yawning and “the need to take a deep breath are characteristic of anxiety with panic disorder and this may well be your problem.  t in shortness of breath and you may want to discuss this with the cardiologist, along with the question of whether you could have a cardiomyopathy with a normal size heart..

I note that you had a normal laryngoscopy but there is a condition called Vocal Cord Dysfunction that might not be evident on a random laryngoscopy.

My final thought is that your shortness of breath could be on the basis of recurrent pulmonary emboli (clots to the lung)  with or without pulmonary hypertension.  

Despite your disclaimer, I suspect that you probably have no serious disease of your heart or lungs and that anxiety is playing a significant role in your illness.

Good luck