Breathlessness

Naturally, one of my most common patient concerns is shortness of breath.

There is, however, one unique situation that is surprisingly common. In fact, I will often see several new patients every week that I have come to conclude that they share this common diagnosis.

These individuals often experience similar sensations of “not being able to take in a full, satisfying deep breath”, “feeling like they are not getting enough oxygen”, “not being able to fully expand their lungs”, “yawning or sighing more”, or other complaints.

I will often hear that someone close to the patient may comment that they are aware their friend or spouse is appearing to struggle to breathe. Usually this is intermittent, most often at rest, and is without other pulmonary complaints such as wheezing, coughing or mucous production. There may be chest discomfort present under the sternum or along the ribs laterally. It may be described as a soreness, a pressure, an ache or other descriptive phrases.

Usually there is nothing that can be pointed to that makes it worse, such as exercise, sleep or different body positions. While nothing may be defined as making it worse, when asked what makes it better, medications such as inhalers are often met with an uncertain benefit or none at all.

Many new patients have been given the diagnosis on “asthma”. Many may even have been evaluated in the emergency room for severe episodes. This may have resulted in medications such as steroids or inhalers or some other combination being prescribed.

This form of shortness of breath may be episodic, repetitive, cyclical or without patter. Often it is habitual or chronic. Yet, for others, it may be their first time experiencing such discomfort that is clearly of great concern.

When other diseases can be excluded, this issue can often be ascribed to “air hunger” which is a variant of hyperventilation syndrome. When over-breathing or being overly concerned about one’s breath occurs, this can lead to repeatedly attempting to take yet another breath in order to be “satisfied” with the quality and quantity of the breath being taken in.  This pattern can become habitual and very disconcerting for an individual or their family.

The cause of this is unknown. Maybe it is due to a reseting of the respiratory center in the brainstem. Maybe it relates to the stretching mechanism of one’s chest wall mechanics. But the result may be the increase of lactic acid, lowering of the blood’s carbon dioxide level, a shift of one’s acid base balance and then the ramifications of changes in electrolyte balance in the blood with some complicated issues involving serum calcium, for one. This results in a tingling sensation of the finger tips or around the lips, for examples. One can feel weak in the knees or nearly faint feeling. Overall, a sense of panic or anxiety may ensue. Thus, this is where a trip to the emergency room often is the end result of more severe spells.

Blood flow the the brain may occur during an episode. This can result in impaired brain function, decreasing ability to focus or maintain one’s attention, or to be able to deal with calculations or thought processes. Dizziness, lightheadedness, confusion and other perceived feelings can develop.  The tingling can lead to numbness. Overwhelming fatigue or generalized weakness is often associated with these episodes or following an episode.

Patients may already have issues with anxiety, depression, stress in their lives, nervousness, being overwhelmed with personal issues they are dealing with, anger management issues or other psychologic stresses.  It is no wonder that when a person is having palpitations, being short of breath, exhausted, having chest pains, tingling, and feeling lightheaded, for examples, leads to further anxiety, worries and fears.

This situation can affect not only the lungs, the heart, the mind, the limbs, but also the stomach with nausea, bowel issues, or an aggravation of underlying colon problems, such as irritable bowel syndrome or colitis, for examples.

However, all of this must be dealt with by first seeing your doctor. Describing what you are experiencing and then to run some basic tests to be assured that, in fact, there is no significant disease mimicking these complaints.