Question:I have been experiencing shortness of breath for the past three months. It comes on about 10 to 15 minutes after any exertion. I am a 51 year old man, never-smoked, and am not overweight. I have asthma but the shortness of breath doesn't appear to be asthma-related. I take one puff of Advair twice each day. If I use my alburterol inhaler before activity, I still get shortness of breath. I have had a stress test, VQ test, echocardiogram, CT scan, PFTs -- all of which are normal except for the PFTs readings which are consistent with someone who has asthma. None of these tests explain the shortness of breath. My doctor now thinks it might be reflux, but I don't have any other symptoms of reflux -- no heartburn, cough, bitter taste, etc. that would normally be associated with reflux. Is it possible to just have shortness of breath caused by reflux?
Dr. Hibberd's Answer:
You are relatively young and deserve further aggressive investigation. Do not accept any further delays or guesswork. Yes, it is possible to have reflux (of acid) with wheezing and cough as the only recognized symptoms in some people, especially young children. Reflux control is very important for patients who have co-existing respiratory complaints.
There is excellent treatment for asthma combined with reflux, but the catch here is to be alert to its possibility. Without details of your investigation so far, it is hard to be more specific. Persistence of symptoms, especially shortness of breath, should always generate further investigation.
At this point you need to avoid guessing. It may be advisable to seek alternate consultation given that your present consultants do not seem to have progressed with any reasonable treatment plan for you, neither do they appear to have adequately explained the cause of your shortness of breath. Request a referral from your doctor to seek alternate consultation.
Reflux will usually be managed by weight control, PPI suppression therapy (i.e. Nexium, Prilosec, Protonix etc). and motility agents, such as Reglan and Zelnorm.
Any asthma symptoms that are unaccounted for, or that do not respond to therapy, should force additional evaluation. In addition, your consultants may need to search for other lung diseases and conditions that may mimic asthma.
Remember that good lung function requires a healthy heart, clear airways with healthy lung tissue, and excellent blood circulation to the tissues of both the heart and your lungs. Any disorder of these systems may cause shortness of breath.
Serious conditions such as pulmonary embolism may be missed if the symptoms are not sudden and dramatic, or if initial testing misled your consultants.
Usually a careful history and clinical examination is far more productive than random testing, especially for shortness of breath complaints. So, a negative heart and lung function evaluation in the presence of shortness of breath does require further aggressive evaluation and additional treatment. It sounds like time for a complete re-evaluation without delay.
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