Expert: Marc Rubin, RPh Asthma Educator - 7/6/2010

Question
I UNDERSTAND, unquestionably that you can not furnish a diagnosis, and as such I will not take any feedback you are willing to provide as one, nor will I seek to treat myself without first visiting a doctor...

That said, I have a medical question, about an issue I am fairly concerned about, and was hoping to you could give me a sense of what I MIGHT be looking at.  I am uninsured, and reluctat to pay to get diagnosed, as cvoerage will then be harder, I imagine, with a "pre-existing condition"

I am 30, 6'4" 190lbs -- live in NY- maintain moderate activity--somewhat unbalanced diet (meat and dairy heavy).  For the last 4-5 weeks I have frequently been getting shortness of breath, characterized by a a feeling of being unsatisfied, and gasping often...This could mean any number of things I know.  Wondering is it possible that it is emphysema?  late-onset of asthma? something else?  Allergies otherwise?  

Some details:

1) I have been smoking, a pack plus a day, since I was 12 (trying to quit)

2) Symptoms seems  to come on 3-4 time a week -- more, perhaps-- one they start, tend to last hours, exhasserbated, perhaps, by gasping and nervousness -- often after hours of struggling breathing, I have gotten numbness in my limbs and face (oxygen shortage?)

3) heat and humity, as well as smoke and anxiety seem to be the primary triggers.  air conditioning seems decidedly to help.

4) NOTE:  I spent a couple weekends out of the city in upstate NY, still hot and humid, but breathing was virtually unincumbered by comparison (even with some smoking)

5) Breathing through my mouth it is much easier to force a satisfying breath than through my nose,, during episode

AGAIN, I understand the liability associated with giving medical advice.  I WILL NOT take what you offer as diagnosis, but if you could based on my description give me any feedback, any advice, anything that could potentially put my mind at easy, or give me a direction, I would be most appreciate.

Thank you,
David Dillon

Answer
Hi David,

You are astute in assessing probable causes of your present situation. You also realize that to make the correct diagnosis will require lung function testing and evaluation by a physician. Have it done by a pulmonologist for an accurate assessment. From the symptoms you describe, the most likely cause would be COPD (Chronic Obstructive Pulmonary Disease) of an emphysema nature. You did not describe your occupation, which may also be of a contributing nature, in addition to the smoking history.

The likely reason for your improvement upon going upstate is probably due to lower ozone levels up there. With the heat wave hitting the east coast, ozone as well as particulate levels rise, both of which have a significant impact on breathing.

It is great that you are trying to quit smoking. On average it takes 7 attempts to become successful. You need to take certain steps to help reach that goal:
1) Thorough cleaning of your car and home environment to eliminate smoke odor.
2) Toss out the cigarettes
3) Every time you fell like lighting up, if you can, go for a 15 minute walk. It really helps to knock out the craving.
4) REWARD YOURSELF! A pack of cigarettes probably cost ~ $6.00. Each day, put the $6 into a piggy bank (or whatever you want to use that you won't touch). At the end of 30 days, take out $40 and treat yourself to something: dinner/movie/night club, shopping, whatever. After 90 days, take out 3 weeks worth ($120). At the 1 year celebration, go take a vacation with the $2000+ you saved. DO NOT USE IT TO PAY BILLS! Before, you were burning up the cigarettes and money. Now you are enjoying a healthier life! Keep up this savings plan to give yourself an annual vacation.

For help in accomplishing this, check out the NY branch of the American Lung Association:

http://www.lungusa.org/associations/states/new-york/

They may also provide no or low cost lung evaluations.

And to get a better understanding of the benefits of smoking cessation, check out this excellent Medscape article and graph: http://tinyurl.com/COPDandSmoking-Cessation

At the point you succeed in quitting, you change the rate of lung degradation to near that of of a person who has not smoked. You don't regain destroyed tissue, but the airways that were blocked, will, over time, clear out and resume function.

Hopes this helps to guide you.

Sincerely,

Marc