Struggling to Breathe: A 36-Year-Old's Journey Through Multiple Specialists

Q: Struggling to Breathe: A 36-Year-Old's Journey Through Multiple Specialists

Helpless person： First, I would like to confirm if you have quit smoking. <br>If not, it will be difficult to help you! Your condition still resembles allergic rhinitis, which can be triggered by exposure to air conditioning, consuming cold foods or foods with cooling properties

Shortness of breath?

I am 36 years old and used to smoke about one and a half packs a day.
In May of this year, I suddenly felt very short of breath, with a heavy and painful sensation in my chest.
I sought medical attention and felt much better after receiving an injection, but the symptoms returned within a few days and have persisted until now.
I continue to experience chest tightness and pain, and my nose frequently becomes suddenly congested (which feels different from typical cold-related nasal congestion).
I often feel like my throat is blocked by phlegm, making it difficult to breathe.
Whenever I sit in a chair, especially if my body is bent or slouched, I experience severe nasal congestion and difficulty breathing, which only improves when I sit up straight or stand.
At night, I often wake up because I feel unable to breathe, and the nasal congestion becomes severe again, requiring me to sit up to feel better, but lying down triggers the symptoms again.
During this time, I consulted a pulmonologist and underwent pulmonary function tests and chest X-rays, both of which showed no issues.
I then saw a cardiologist and had an electrocardiogram, echocardiogram, and exercise stress test, all of which also returned normal results.
I subsequently visited an otolaryngologist, who diagnosed me with mild nasal allergies and prescribed a nasal spray.
However, when I returned for a follow-up and mentioned that the nasal congestion problem was unresolved, the doctor suggested it might be a psychological issue.
I then consulted a gastroenterologist, who performed an endoscopy and found no signs of gastroesophageal reflux disease.
Now, I am unsure which specialist to see next or which doctor to consult.
I hope the physician can provide me with some advice.

Wu zhu de ren, 30~39 year old female. Ask Date: 2009/08/12

Dr. Yang Wenda reply Pulmonology

Helpless person: First, I would like to confirm if you have quit smoking.
If not, it will be difficult to help you! Your condition still resembles allergic rhinitis, which can be triggered by exposure to air conditioning, consuming cold foods or foods with cooling properties (such as bitter melon, cucumbers, Chinese cabbage, bamboo shoots, radishes, pears, watermelon, starfruit, tomatoes, kiwi, bananas, pineapple, herbal tea, mung beans, etc.), leading to nasal mucosa swelling and nasal congestion.
The nasal spray prescribed by your doctor should be used twice in each nostril every morning and evening, and with consistency over 3-6 months, you should see improvement.
If the nasal congestion symptoms are too severe, you may also consider taking oral antihistamines, but be aware that they may cause drowsiness, making it unsafe to operate heavy machinery or drive (taking them before bedtime should not affect your daytime activities).
Wishing you well!

Reply Date: 2009/08/12

More Info

It sounds like you are experiencing a complex and frustrating set of symptoms that have led you on a journey through multiple medical specialists without a clear diagnosis or treatment plan. Your symptoms, including difficulty breathing, chest tightness, nasal congestion, and a sensation of throat obstruction, can be distressing and impact your quality of life significantly. Given your history of smoking and the various tests you've undergone, it's essential to approach this situation systematically.

Firstly, it's important to recognize that respiratory symptoms can arise from a variety of causes, including but not limited to pulmonary issues, cardiac conditions, allergies, and even gastrointestinal problems. Since you've already seen specialists in pulmonology, cardiology, ENT (ear, nose, and throat), and gastroenterology without definitive answers, it may be time to consider a more integrative approach.

1. Revisit Pulmonology: Although your lung function tests and chest X-rays were normal, it might be worth revisiting a pulmonologist, especially one who specializes in complex respiratory issues. Conditions like asthma, chronic obstructive pulmonary disease (COPD), or even interstitial lung disease can sometimes present with normal initial tests. A thorough evaluation, including a methacholine challenge test for asthma or a high-resolution CT scan of the chest, might provide more insights.

2. Consider Allergies and Sinus Issues: Since you mentioned nasal congestion and that an ENT specialist noted some allergies, it may be beneficial to see an allergist. They can perform specific tests to identify allergens that might be contributing to your symptoms. Additionally, chronic sinusitis or nasal polyps can cause persistent nasal obstruction and may require more than just a nasal spray for treatment.

3. Psychological Factors: Your symptoms have been suggested to have a psychological component. While it is essential to rule out physical causes, anxiety and stress can manifest as physical symptoms, including difficulty breathing and chest pain. Consulting a mental health professional, such as a psychologist or psychiatrist, could help address any underlying anxiety or panic disorders that may be exacerbating your physical symptoms.

4. Gastroesophageal Reflux Disease (GERD): Even though your gastroenterologist ruled out GERD, it might be worth discussing the possibility of silent reflux (laryngopharyngeal reflux), which can cause throat discomfort and breathing issues without typical heartburn symptoms. A trial of dietary modifications and proton pump inhibitors could be beneficial.

5. Holistic Approach: Sometimes, a multidisciplinary approach can yield better results. Consider seeking a comprehensive care clinic where specialists from different fields collaborate to address complex cases. This can provide a more holistic view of your health and ensure that all potential contributing factors are considered.

6. Lifestyle Modifications: Given your history of smoking, it is crucial to address this aspect of your health. Smoking cessation can significantly improve respiratory symptoms and overall health. Engaging in regular physical activity, practicing relaxation techniques, and maintaining a healthy diet can also support your recovery.

7. Follow-Up: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

In summary, navigating complex health issues can be challenging, but persistence is key. By revisiting specialists, considering psychological factors, and adopting a holistic approach, you may find the answers and relief you seek. Don't hesitate to advocate for yourself and seek out the care that feels right for you.

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