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What causes chest distress, shortness of breath and cough?

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Posted on Thu, 21 May 2015
Question: Dear Dr. XXXXXXX

My symptoms are : chest distress, shortness of breath (dyspnea), a little bit of coughing (around 2 times per day), no sputum, no fever. These symptoms are lasted for around 2 weeks.

Then, I took a chest X-ray (the report is attached). My GP doctor told me that I am suffering from bronchitis.

I would like to learn more about the meaning (clinical significance) of "streaky opacities scattered in both lungs" which was observed on my chest X-ray. Is it a serious medical problem ?

In addition, I am an ex-smoker (smoking history of around 20 years) and I have quitted smoking for around 2 months.

If you need me to provide further information, please advise. Many thanks for your opinion !



doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
Better to get done PFT first.

Detailed Answer:
Thanks for your question on HCM.
I can understand your situation and problem.
Bronchitis is inflammation of airways.
It is common in smokers. Cigarette smoke causes persistent inflammation and irritation in the airways.
So gradually airways start modification and cause permanent changes in their structure.
These changes can be visible on chest x ray as streaky opacity scattered in both lung fields.
In many cases, X ray can be normal.
So no need to worry much for your x ray report.
Bronchitis due to smoking is functional lung disease and hamper functional capacity of lungs.
This is the reason for breathlessness (dyspneoa) in your case.
So better to get done PFT (Pulmonary Function Test).
This is must for the diagnosis of bronchitis.
It will also tell you about severity of the disease and treatment of bronchitis is based on severity only.
So get done PFT first.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (48 minutes later)
Dear Dr. XXXXXXX Bhavsar,

Thank you very much for your helpful opinion. Definitely, I will take a PFT soon :-)

I would like to provide additional information about my symptoms for your further reference :

no hemoptysis, my appetite is normal, no weight loss within recent 2 months, but abnormal sounds were heard by my doctor when she used the stethoscope to do the examination for me. Also, my coughing is non-productive (no phlegm or sputum).

Actually, I am worrying about the worst condition, lung cancer (I am an ex-smoker…..). When I searched from the Internet, it is noted that the key symptom of bronchitis is “frequent coughing with phlegm / sputum production”. However, my coughing is so infrequent (just around 1~2 times per day), also, my coughing is “dry” without phlegm / sputum.

Instead, my key symptoms are chest discomfort / distress and breathlessness
(dyspneoa). According to my chest X-ray findings and clinical symptoms, will the chance of considering lung cancer be low ? (it seems that lung cancer should be considered if a nodular shadow or mass is seen on the chest X-ray (?)).

Again, I sincerely thank you so much for your professional opinion. I appreciate for your kindness and patience.

Yours sincerely,

XXXX
doctor
Answered by Dr. Kaushal Bhavsar (3 hours later)
Brief Answer:
Lung cancer is less likely in your case.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
But lung cancer is less likely in your case because
1. You are not having hemoptysis or weight loss or fever
2. Your chest x ray is not showing any mass lesion or nodule.
And not all patients with bronchitis develop cough with expectoration.
Some can have breathlessness with dry cough as prominent symptom.
Please let me know
1. How many cigarettes you smoke per day?
2. You feel breathing difficulty on exertion or on rest?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (7 hours later)
Dear Dr. XXXXXXX Bhavsar,

Thank you for your explanation and helpful information. Appreciated.

1. I smoked at least one pack (20 cigarettes) per day, sometimes I smoked
around 30 cigarettes per day. However, I have quitted smoking for 2 months.

2. I feel breathing difficulty on both exertion or on rest.

When I am on rest, the feeling of chest discomfort / chest distress is more
prominent. I am feeling that I always need to take deep breathing.

When I climb stairs, the feeling of breathing difficulty is more prominent. I need
to breathe faster and faster after climbing stairs.


Many thanks. I am looking forward to hear from you soon.


Yours sincerely,

XXXX
doctor
Answered by Dr. Kaushal Bhavsar (16 minutes later)
Brief Answer:
Possibility of COPD is more in your case.

Detailed Answer:
Thanks for your follow up question on HCM.
You were heavy smoker.
So possibility of COPD (chronic obstructive Pulmonary disease) is more in your case.
It is functional disease of airways due to cigarette smoking.
It is having two sub types
1. Emphysema
2. Chronic bronchitis.
You are mostly having emphysema variant because your prominent symptom is breathlessness.
While chronic bronchitis is having prominent symptom of cough with expectoration.
Please let me know
1. Do you hear whisteling sound from chest during breathlessness?
2. Do you have gastric reflux disease?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (10 hours later)
Dear Dr. XXXXXXX Bhavsar,

Thank you for your reply with helpful information.

1. I don’t hear whisteling sound from chest during breathlessness.

2. Yes, I have gastric reflux disease (GERD) and chronic gastritis.

In addition, the chest X-ray which I took is in a posteroanterior (PA) view. Do you think that I need to take an additional chest X-ray film in a lateral view ?


Thank you for your comment. I am looking forward to hear from you soon.

Yours sincerely,

XXXX
doctor
Answered by Dr. Kaushal Bhavsar (4 hours later)
Brief Answer:
Possibility of emphysema is more in your case.

Detailed Answer:
Thanks for your follow up question on HCM.
Chest x ray is taken in PA view in most of the cases. And it is the most informative view.
Lateral view is needed in special conditions like mediastinal pathology, mass like lesion on PA view, pleural effusion etc.
So in your case, no need for Lateral chest x ray.
Better to get done HRCT thorax as it will tell you types of emphysema.
GERD (gastroesophageal reflux disease) is common association with emphysema and smoking is common risk factor for both of them.
You need to control GERD for better relief in emphysema symptoms.
Stress is independent risk factor for GERD.
So please let me know
1. Are you having stressful life?
2. Are you smoking due to stress?
3. Have you undergone HRCT thorax?
4. Are you taking any treatment for GERD?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14852 Questions

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What causes chest distress, shortness of breath and cough?

Brief Answer: Better to get done PFT first. Detailed Answer: Thanks for your question on HCM. I can understand your situation and problem. Bronchitis is inflammation of airways. It is common in smokers. Cigarette smoke causes persistent inflammation and irritation in the airways. So gradually airways start modification and cause permanent changes in their structure. These changes can be visible on chest x ray as streaky opacity scattered in both lung fields. In many cases, X ray can be normal. So no need to worry much for your x ray report. Bronchitis due to smoking is functional lung disease and hamper functional capacity of lungs. This is the reason for breathlessness (dyspneoa) in your case. So better to get done PFT (Pulmonary Function Test). This is must for the diagnosis of bronchitis. It will also tell you about severity of the disease and treatment of bronchitis is based on severity only. So get done PFT first. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.