Friday, June 15, 2007

Shortness of breath

Submission from outside reader:

Hi I have been looking at this blog for since 2005 on a weekly basis and wonder if you take questions from patients. Your site is informative it is a pity you are not getting the hits.

I am a 38yo M and I have a chronic symptoms now for many years with NO DIAGNOSIS despite pressing for one.

I have a hacking cough with some sputum in the morning, I also have nearly constant SOB with an inability to get a deep breath. A feeling of stiffness in my lungs. I feel constantly like my breathing is not good. This has been with me since 2003. Excercise tolerance is ok i.e. I could run a mile in 10min but I struggle to breathe throughout.

Pleurisy type pain on and off weekly, specifically located in same location at upper left back. Lower rib pain on left.

Asthma as a child, allergic rhinitis as a teenager and young adult, smoked in college (10 a day) and socially (30 at weekend) till I was 33. On and off asthma meds since 1994. Tried Singulair, Symbicort, Spiriva etc. Tried also extensive courses of Zoton, Nasocort etc.

Have been evaluated many times over the years by 3 pulmos spent '000$ and the best they can give me as a diagnosis is " a chronic inflammation similar to chronic bronchitis with little or no asthma but we are reluctant to give it a title "

Here is the dilemma, all tests normal my FEV1 is 4.45…101%, FVC 5.8…104%, FEV/FVC 76. DLCO Normal. FEF25-75 83% Lung Vols Normal

Here is the question:

Why do I have symptoms if all tests are normal. What do you guys think.. have you seen this before, normal tests but chronic symptoms with dyspnea.

Chest xray x 4 Normal
2 x HRCT (1 year between) Normal, Body Ples Normal. Methacholine Normal
ECG Stress Test Normal
Echo Cardio Normal
Bloods Normal, 2 x HRCT (1 year between) Normal, Body Ples Normal. Methacoline Normal

MRI ordered by Rheumo .. Normal

Not in my brain either!! I have loads of other stuff to worry about like kids, my stressful job as a broker, mortgages etc

4 comments - CLICK HERE to read & add your own!:

Jennings said...

The normal PFT's, methacholine challenge and HRCT, make lung disease unlikely as the cause. The negative stress test and echo also make cardiac etiology less likely. This leaves a muscle disease as a possibility. This can be diagnosed by checking maximum inspiratory pressures (done during the PFT test), but if your disease is subtle, this may not pick that up. An EMG would be the next test that I would order, followed by proximal muscle biopsy if the EMG is abnormal.
Pulmonary hypertension is another possibility, but when you say the echocardiogram is normal, I assume they specifically looked at the PA pressure?
Also what is your weight and height and has there been any weight gain over the period in which you have been short of breath?

Ann said...

Thank you very much for sharing your thoughts. It is always great pleasure to read your posts.

Anonymous said...

I have these same symptoms, undiagnosed. Am wondering why Jennings asked about the weight gain?

Janine said...

Hi, I am having the same problem.
It has been going on for at least 10 years with gradual worsening. I have been diagnosed with COPD, but some of the SOB is different. I think it is related to Pulmonary Hypertenson, but since the echo and stress are normal, I am treated as if I am crazy. I get so short of breath sometimes just from walking that I feel as if I will pass out. As soon as I rest I am okay. Any suggestions or thought would be greatly appreciated. I will ask my doctor about the muscle angle. Thanks, Janine