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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes shortness of breath?

Answered by
Dr.
Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14568 Questions

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Posted on Thu, 27 Nov 2014 in Lung and Chest disorders
Question: Over 14 Years , I have taken 6 Pulmonary Function tests. The First Test taken in late 2000, the last July of 2014 .
The first had the following results, FVC 110% of Predicted, FEV1 103% of predicted, Ratio Fev1/FVC 77%, FEV 25-75 85% Dlco 87 TLC 110, DLCO/VA 61%
Most Current one FVC 114, FEV1 103, /ratio 72%, FEV25 75 69%m DLCO 81 TLC 102, DLOC/VA 83
The four tests in between have varied little from the range of these two that I have listed. The only one that has bounces is FEV25/75, it has dropped to 49% and back up. The pulmonologist has concluded, a mild Ventilatory defect with small air trappings. Over this entire time it has been considered "a Very mild obstruction". The pulmonologist has recently reported it as Asthmatic Bronchitis, but I have no cough or mucus.

Until 2008, I have been physically active in that I ride 25 miles a day on the bike, 3 days a week. In 2008 I became a grandpa and have exercised less and less. I am not sure how much of this I can attribute to my problem but I am sure that lack of exercise has some part of my problem.
I need an answer to the question, If all of the pft's stay at similar percentage of predicted levels, should I see any physical changes that were not visible before? I have talked to Pulmonologist, Pulmonologist nurse and a certified Respiratory therapist who all say pretty much the same. That there should not be any changes since the Tests are the same. I forgot to mention, I can blow full meter on athma tester.
I do have high anxiety and constant gad Panic, Could this issue cause such a tighness around the upper chest with inspiration that inhaling must take place in lower area where it should and then cause stomach to press on lungs. When I took my first PFT, the Pulmonary DR included in her diagnosis that i had high anxiety and that was most of my breathing issue at the time. 6 months ago, I was on the treadmill and while walking, I answered a phone call. The combination of talking and walking made me Short of Breath. It has happened a couple other times and is frightening when it seems to be different than usual getting winded.
The big question in this text is to understand if Panic and High anxiety can tighten up chest to keep from taking a good breath in. I also notice a burning in my throat similar to that you get when running except it is noticeable all day long. When I go to sleep it dissappears. I think that is overbreathing.

I really have not seen much change over the years except for becoming short of breath (SOB) when talking or answering the phone. I also can become S.O.B. when walking and talking or just trying to talk when physically active.
I have had a series of heart tests over the past few years and they all are fine so that is excluded. Reflux is there but controlled with meds.
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
your diagnosis is unlikely

Detailed Answer:
Hi,

thanks for your question on HCM and for the detailed history.

In our standard textbooks of pulmonology, there is no term written like ASTHMATIC BRONCHITIS. So I am not in favour of your diagnosis.

FEV 25-75 is a marker of small airways. And again it is not a standard marker for small airway disease. It depends hugely on effort. And with the age FEV25-75 decreases. So no need to worry for low FEV 25-75.

Anxiety can definitely cause tightness in chest and if it is associated with panic disorder chances of shortness of breath and chest tightness are high. And inspiration takes in whole lung, not only lower part of lung. So upper chest tightness can be seen in anxiety and panic disorder.

Reflux disease too have effect on chest symptoms. So your throat burning may be due to reflux only.
So in my opinion anxiety, panic disorder and reflux cause symptoms in your case. No need to worry about asthmatic bronchitis at present. Control anxiety, panic disorder and reflux disease for better control of your chest symptoms.

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. Shanthi.E
doctor
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Follow up: Dr. Kaushal Bhavsar 2 days later
So, if I understand you clearly, the term Asthmatic Bronchitis is not an actual diagnosis. If that is so. what might the pulmononologist meant by that term when they put it on my PFT?

Would it be safe to say that 6 PFT's over a time span of 14 years with little variation might mean that physical lung changes for the worse may be mostly those that come about by age. That is a comment I heard from a respiratory therapist who looked at the comparison chart of all 6 tests.

For you knowing that I have high anxiety and panic attacks, you have an opinion that would tend to answer that to be my issue to breathing issues. That I can live with, if I can get the anxiety to come down.

I live with a memory that terrorizes me, 2 years ago, I watched my 91 year old mother die from COPD. She battled it for 9 years and at the end it wasn't so much what I saw but what she told me as each day got closer to her end.

I am an ex smoker, I quit 15 years ago. I quit because I had my first panic attack. A panic attack that made me believe that I was having a heart attack. That then led to hyperventilation. There it led me to believe that I couldn't breath and I went and had a PFT. That is when the pulmonologist said I had anxiety issues and when I relaxed it went away.

Ok I am now back to panic because I run in to shortness of breath when doing physical things. I wonder if all that I saw is not happening to me. I had a Dr look at the PFT charts and could only conclude that I have a physical issue with asthma and a mind issue with anxiety and Panic.

The following is a summary of each test. From the years 2001-2010 I lived symptom free, I exercised and seemed to keep my stress in line with activities and exercise. In 2010 I started the year with a divorce, ended the year starting a relationship with someone who eventually put me in high stress. I also acquired a new job that put pressure on me like I have never had before. This all while dealing with my mother.

Below is the summary of the PFTS and the years taken. Note that they all seem to be in the same percentage range. (I do understand, that the percentages do not match the actual numbers because the percentages are the figures expected for my age. But I will say that the FVC and Fev1 of my first and last test are numerically close even those the current percent is greater.)

Year     FVC     FEV1     FEV1/FVC     FEF2575     DLCO
2001     110      103      77     85      67
2001     108      97      74     69      64
2002     89      85      78     72      87
2013     101      86      68     49       70
2014     92      84      73     59      81
2014     114      103      72     69      81

I am not a Pulmonologist, but as I read these, I reflect that I should feel pretty much the same today as I did 5, 10, or 14 years ago.

If so, anxiety has clamped down hard on my chest making breathing uncomfortable.


I wish to ask you an odd question. I find it stress relieving to sit in a hot tub and relax. The hot tub is sanitized with Bromine not chlorine. How bad are the fumes from Bromine for an Asthmatic.

doctor
Answered by Dr. Kaushal Bhavsar 4 hours later
Brief Answer:
Better to consult Psychiatrist.

Detailed Answer:
Hello dear, Thanks for your query on HCM.
I don't think you are having any structural lung disease like asthma or COPD, Since your lung functions are maintained throughout the years. If you have asthma or COPD lung functions must be deteriorated over years. No need to worry for FEF25-75.
So I again emphasize on anxiety and panic attacks as cause for your breathing issues.
You yourself told that I am having hyperventilation at the time of panic attacks.
And you went through emotional period when your mother died and relationship issues happening simultaneously, this will also affect stress and anxiety and panic attacks.
So i advice you to consult psychiatrist and start treatment for anxiety and panic attacks. Counselling sessions to identify your stressors in life and to find solution for it - is an useful option. You may need some medicines too, to alleviate anxiety and panic attacks.

Hope I have solved your queries. If you are not having further queries please close the conversation and rate the answer. Wishing you good health. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 19 hours later
Thanks for your follow up advice. FYI, I am seeing a therapist and he has me on low dose lexapro daily, and low dose xanax when it gets a bit too much. I will focus on undoing what I have done to myself over the past few years with allowing anxiety to compound itself to the point of causing the problems that need help to go away. Your explaining the PFT info has helped immensely and I will use it to assist in making my anxiety go down.

I better take it easy in getting myself in the exercise routine once again, and find those stressors that aggravate my daily life and rid them one at a time. I have lived always on the go, go , go. Now I must learn a new way to enjoy life and breath freely again.

One final question that I am not sure if you have the answer but tell me if the following is an accurate statement. I heard that it takes longer for Anxiety to leave the body than what it took to let it in? is that a true statement? If so I have to ignore all the continual symptoms and be patient for it to go away and continue relaxation techniques until it does.
doctor
Answered by Dr. Kaushal Bhavsar 3 hours later
Brief Answer:
you can definitely get over it whenever you want.

Detailed Answer:
Hello dear, thanks for your query.
Your statement is not always right. It may be right for some person.
But if you start identifying your stressors and work positively towards it than it will not take longer time to improve.
So forget about past, your disease is in your mind and your mind is controlled by you only. So you can definitely get over this whenever you want. So think positive and live your life to the fullest.
Hope I have solved your query. If you are not having further queries than please stop the conversation and rate the answer. Wishing you good, stress free life. Thanks.
Above answer was peer-reviewed by : Dr. Raju A.T
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