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Respiratory Therapist/shortness of breath for 6 months now

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QUESTION: Hello, I am currently seeing a pulmonologist but I would like to ask a few questions.
I am a 30 year old female, started experiencing difficulty taking a deep breath occasionally throughout the day starting in February.  It continued to progress to the point where it was constant- it felt like my lungs weren't expanding. Pft's at my GP showed lung age of 84 on one of my worst days.  Have been on advair, spiriva; currently taking advair, albuterol every 6 hours as needed, and singulair.  No medications have made a remarkable increase in how good I feel.  
So:
Arterial blood gas test normal (slightly elevated carbon dioxide)
Blood allergy tests all negative
CT scan no signs of emphysema but rads show hyperinflated lungs, flat diaphragm, heart positioned more central.
No reaction to methycholine challenge
Blood work negative for indications of inflammatory diseases, autoimmune diseases, not a carrier of the antrypsin (?) gene.

He thought asthma, but I hadn't had the methycholine test yet.  Found out 2 days ago that yup no reaction so dr will discuss things with you at follow up in 2-3 weeks.

So what gives? There are days where I can barely do laundry.  I work in the animal healthcare field and it is a struggle everyday, all day to do my job.  I am a non-smoker, but my entire family smokes and majority of friends; my mom has smoked since she was a teenager and smoked while pregnant with me. I have my medical marijuana license for IVDD and smoke about 2 grams per week.  I am incredibly frustrated and would greatly appreciate some insight.
Thank you!

ANSWER: Hi Juliann,

Thank you so much for entrusting me with your very complicated, interesting situation. Not even sure where to start here...OK, here we go...with everything you have given me (thank you for the details, it really helps) thus far, my first inclination was pointing to something along the likes of Alpha-1 Antrypsin (genetic form of Emphysema), but that was already ruled out via labs tests. Generally speaking, you are too young to have COPD, but the inhaler medications you are prescribed are generally meds prescribed for the treatment of COPD (chronic obstructive pulmonary disease), especially the Spiriva. At the same time, your elevated CO2 and hyperinflated lungs/flat diaphragm are totally indicative of COPD as COPD'ers tend to have hyperinflated lungs that don't allow CO2 to be fully exhaled, causing COPD'ers to have CO2 retention. But at your young age, being just an occasional pot smoker (pot has less carcinogens than tobacco/nicotene), being a NON-smoker and even accounting for the massive amounts of second-hand smoke, the odds are slim that this is an issue at age 30. These inhaler meds are also occasionally prescribed for asthmatics, but if all of your PFT tests suggest your lung scores didn't improve with these meds, odds are Asthma is not a culprit because it is a REVERSIBLE airway disease that would have responded at least somewhat positively to the breathing meds.

In summary, this is truly a mysterious case study I would read about in a medical journal. All signs and symptoms point to COPD, but your lifestyle and age don't really match up with COPD. Just a wild card here, I can't help but wonder if your Intervertebral Disc Disease is playing a hidden role in some way, like if a buldge is somehow pressing on a nerve in or around your diaphragm that is imparing your ability to take full breaths, which could cause hyperinflation and CO2 retention. Just a wild-eyed guess, but maybe worth asking your pulmonologist about.

Sorry I can't offer any more definitive thoughts than your Pulm doc, but I do sincerely thank you the challenge of trying to solve this mystery.  Feel free to hit me back if you find out more or have your follow-up.

Get well soon,

Larry W, RRT

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for getting back to me Larry!
I will ask my pulmonologist about my disc disease- had not even thought of that but it makes sense.

I forgot to mention that I do have an occasional dry cough but am constantly clearing my throat. I can feel stuff in my throat sometimes but can never get any to come up.  I also commonly have to take the "tripod" stance to breathe and the skin around my neck/collarbone sucks in quite a bit.  Not sure if that additional information helps at all.  I think you hit the nail on the head when you said this is a mystery case, just wish my pulmonologist would admit it and look outside the box more :(

Thank you again for taking the time to answer my questions

Answer
You are certainly welcome, I love using my background to potentially help others free of cost. BTW, the dry cough with nothing coming up is also very COPDish, because the cilia "hairs" in our trachea that help sweep mucus up and out get essentially burnt out with smoke coming and going, which gives the throat a constantly dry, tickling feeling that never seems quite resolved. If you were a heavy smoker, this would all make so much more sense! lol.

The tripod position is very common in patients with heart problems, most notably CHF (congestive heart failure). Has your heart been fully considered as a cause? I know the previous chest xray showed the heart to be in a normal place, but I won't be surprised if your doc recommends a quick ultrasound or echocardiogram of your heart to see how effectively it is functioning. Heart ailments often contribute to shortness of breath. Just a thought.  

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Larry W. Wical, BA-RRT

Expertise

I CAN answer: ALL questions and queries related to the following topics... - Oxygen - Asthma - COPD - Bronchitis - Emphysema - Pneumonia (Viral/Bacterial) - Tuberculosis (TB) - SARS - Influenza (Flu) - Vaccines - Pulmonary Embolism - Pleural Effusion - Atelectasis - Inhalation injuries (burns, chemicals, etc.) - PFTs - Cardiovascular health - Sleep Apnea - BiPap/CPAP - Ventilators (Respirators) - Aspiration injuries - Thoracic injuries - Lung contusions - Tracheal injuries - Artificial Tracheostomy - Secretions - Prolotherapy/Regenerative Injection Therapy (RIT): A patient's experience/perspective - General health and fitness - Prolotherapy (from a patient's perspective) I CANNOT answer: Questions that vary too far from my primary scope of pulmonary and cardiovascular care and fitness. I promise to be open and honest about my knowledge of submitted topics, and will always openly provide my personal as well as professional feedback as it relates.

Experience

Registered Respiratory Therapist (RRT, RCP) since 2005. I have worked primarily in the acute care, critical care, burn care and home care settings.

Organizations
NBRC - National Board of Respiratory Care AARC - American Association of Respiratory Care

Publications
-All About Kids Magazine -The Clermont Sun -Cincy Sports & Fitness Magazine -Many online Fitness and Health blogs and "webazines"

Education/Credentials
- B.A. in Communication (1997) - A.A.S. in Respiratory Science (2005) - RRT license (state of OH, KY and IN) - Basic Life Saving (BLS) - Advanced Cardiovascular Life Support (ACLS) - Advanced Burn Life Support (ABLS)

Awards and Honors
N/A

Past/Present Clients
Currently work in the city's largest academic/research hospital.

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