Breathing Difficulties: Causes and Solutions for Nasal Issues

Hello doctor, I have been experiencing shortness of breath for the past two years?

Hello Doctor, I have visited two major hospitals without any results, and the doctors were quite impatient and had a poor attitude.
Later, I went to an ENT clinic where a doctor finally examined me.
I would like to summarize the key points for your assessment and to see what the situation might be:
1.
During middle school, a classmate kicked a water-filled plastic bottle in the classroom, which hit my left nasal bridge.
Now, at 38 years old, a check-up on September 1, 2023, revealed a deviated septum on the right side and enlarged nasal mucosa on both sides.
2.
Breathing difficulties: Over the past two years, I have gained weight from 75 kg to 95 kg, and I have started experiencing shortness of breath.
There is always one side of my nose blocked, making it hard to breathe, and the air I breathe feels less fresh and comfortable than before.
Occasionally, I feel like air is not reaching my lungs, and during severe episodes, I experience dizziness.
3.
A CT scan of my lungs showed a 0.8 cm ground-glass opacity.
4.
I have high intraocular pressure and was diagnosed with diabetes two years ago.
I would like to know if obesity could lead to enlarged nasal mucosa and breathing difficulties.
Due to a chronic condition in my legs, I cannot exercise or stand for long periods, and combined with mental health issues, I have been sedentary at home for two years without exercising or working.
Since gaining weight over the past two years, I have started experiencing breathing difficulties, and the lung scan showed a 0.8 cm ground-glass opacity.
The clinic doctor mentioned a deviated septum, enlarged nasal mucosa, and sleep apnea.
However, I do not experience breathing difficulties only during sleep; I have trouble breathing even when lying down, and sometimes I can only feel comfortable sleeping on my side.
The breathing difficulties have been occurring daily for the past two years, with only variations in severity.
Could you please advise whether I should consider surgery to correct the deviated septum or the enlarged nasal mucosa, or should I focus on weight loss first, which may improve my condition? Could the ground-glass opacity in my lungs contribute to my breathing difficulties? I originally purchased a nasal spray (Wenwei) that provides some relief, but my doctor advised against using it due to my high intraocular pressure.
Do you have any recommendations for alternative nasal sprays?
What other suggestions do you have regarding lifestyle, nasal sprays, follow-up care, and monitoring? Additionally, if I experience severe breathing difficulties or feel that air is not reaching my lungs, what immediate self-care measures can I take to alleviate the discomfort? I apologize for the lengthy message, and thank you, Doctor.

Axiang, 30~39 year old female. Ask Date: 2023/09/02

Dr. Zheng Jueyi reply Otolaryngology

Hello, a deviated septum or hypertrophy of the nasal turbinates generally affects nasal congestion but does not typically cause respiratory distress.
If there is severe respiratory distress, it is recommended to promptly seek evaluation from a pulmonologist and a cardiologist to assess pulmonary and cardiac function.
Additionally, weight loss may need to be considered to reduce the burden on the heart and lungs.
Regarding nasal congestion, it is advisable to consult an otolaryngologist for evaluation and to explore the use of other medications or different types of nasal sprays for management.

Reply Date: 2023/09/02

More Info

Breathing difficulties can be a complex issue, often stemming from multiple factors, especially when combined with a history of nasal trauma, obesity, and other health conditions. Based on your detailed description, it seems that several interconnected issues may be contributing to your breathing difficulties.
1. Nasal Anatomy and Trauma: The history of trauma to your nose from the water bottle incident may have led to structural changes, such as a deviated septum and enlarged nasal mucosa. These conditions can obstruct airflow, leading to chronic nasal congestion and difficulty breathing. The recent findings of a deviated septum and nasal mucosal hypertrophy suggest that surgical intervention, such as septoplasty or turbinate reduction, could potentially improve your breathing by restoring normal airflow through your nasal passages.

2. Obesity and Breathing: Your significant weight gain from 75 kg to 95 kg can also play a crucial role in your breathing difficulties. Obesity is associated with increased fat deposition around the neck and chest, which can lead to obstructive sleep apnea (OSA) and other respiratory issues. Excess weight can contribute to inflammation and swelling of the nasal passages, exacerbating your symptoms. Weight loss may improve your overall respiratory function and reduce the severity of nasal congestion.

3. Lung Health: The presence of ground-glass opacities (0.8 cm) in your lung scans could indicate underlying lung issues, such as inflammation or early signs of interstitial lung disease. While these findings can contribute to breathing difficulties, they are not the sole cause. It is essential to follow up with a pulmonologist to monitor these findings and assess lung function through pulmonary function tests.

4. Allergies and Nasal Congestion: Chronic nasal congestion can be exacerbated by allergies, which may lead to inflammation of the nasal mucosa. If you have not already, consider seeing an allergist for testing and management options, including antihistamines or nasal corticosteroids that may be safer for your eye pressure condition.

5. Management and Treatment Options:
- Surgical Options: If your symptoms persist despite conservative management, surgical options like septoplasty or turbinate reduction may be warranted. These procedures can help alleviate nasal obstruction and improve airflow.

- Weight Management: Engaging in a weight loss program, even with limited mobility, can significantly improve your breathing. Consider working with a healthcare provider or nutritionist to develop a safe and effective plan.

- Nasal Sprays: Since you have high eye pressure, it's crucial to avoid nasal sprays that may exacerbate this condition. Discuss alternative nasal sprays with your doctor that are safe for your situation, such as saline sprays or other non-steroidal options.

- Self-Care Techniques: When experiencing acute breathing difficulties, try to remain calm and focus on slow, deep breathing. Sitting upright can help facilitate better airflow. If you have a history of asthma or reactive airway disease, having a rescue inhaler on hand may be beneficial.

6. Follow-Up Care: Regular follow-ups with your ENT specialist, pulmonologist, and primary care physician are essential to monitor your condition and adjust treatment as necessary. Keeping a symptom diary can help identify triggers and patterns in your breathing difficulties.

In summary, your breathing difficulties are likely multifactorial, involving anatomical, physiological, and lifestyle factors. A comprehensive approach that includes potential surgical intervention, weight management, and careful monitoring of your lung health will be crucial in addressing your symptoms. Always consult with your healthcare providers before making any changes to your treatment plan.

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