Respiratory Therapist/COPD

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Question
Recently, my brother was diagnosed with COPD. He went to the doctor because he was having difficulty sleeping due to coughing fits. However, when he mows the lawn or goes to work (he is a mechanic) he does not have any coughing fits or shortness of breath. The doctor also ruled out emphysema and lung cancer. The doctor gave him a rescue inhaler and Spiriva but the Spiriva does not appear to be working. I do have some college degree pre-medical background but I'm not sure what else could be the problem. I thought maybe it could be orthopnea but when he tries to sleep sitting up, he still wakes up at night coughing and shortness of breath. Any suggestions and what could possibly be going on would be greatly appreciated!

Answer
To me, it sounds like classic paroxysmal nocturnal dyspnea (PND), which refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening. Though simple orthopnea may be relieved by sitting upright at the side of the bed with legs dangling, in those with PND, coughing and wheezing often persist in this position.


PND is caused in part by the depression of the respiratory center during sleep, which may reduce arterial oxygen tension, particularly in patients with interstitial lung disease and reduced pulmonary compliance. Additionally, in patients with congestive heart failure the pulmonary circulation may already be overloaded because the failing left ventricle is suddenly unable to match the output of a more normally functioning right ventricle, which in turn can cause pulmonary congestion. It is also important to note that left-sided heart failure can lead to right-sided heart failure. Pulmonary congestion decreases when the patient assumes a more erect position, and this is accompanied by an improvement in symptoms.


Treatment for paroxysmal nocturnal dyspnea depends on the underlying cause. Options often include oxygen, diuretics, heart medications, antihypertensives, and bronchodilators to reverse wheezing. While I cannot say this IS the issue he is having, I can say I am confident that it SOUNDS like what you are describing. I hope this helps!

Best of health to you!

Larry W, RRT

Respiratory Therapist

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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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