ZocdocAnswersI've been suffering dabilitating shortness of breath and intense pain in my bronchial tube that gets worse while I'm sleeping or lying down. What could be wrong with me?

Question

I've been suffering dabilitating shortness of breath and intense pain in my bronchial tube that gets worse while I'm sleeping or lying down. What could be wrong with me?

For 6 weeks, I've been suffering dabilitating shortness of breath and intense pain in my bronchial tube that gets worse while I'm sleeping or lying down. I don't have a cough; my temperature is consistently 97 degrees. Pressure often radiates out of my chest/bronchial area and climbs up my neck, causing sinus tension. I was hospitalized ro 3 days where I received intense asthma treatment round the clock. This pushed the symptoms back somewhat, but didn't cure them. Tests I've had include: x-ray, CT scan, pulmonary function test, ekg, echocardiagram, blood tests. All tests are normal, showing no abnormality. My oxygenation is normal. What could be wrong with me? I know I've been exposed to toxic mold in the recent past, but the doctors don't think this is a problem as they say I would have other symptoms if I had an infection.

Answer

I am sorry to hear about your symptoms, and it sounds like they are severely impacting your life. It is not possible to make an accurate diagnosis without completing a thorough medical history and physical exam as well as reviewing your medical tests in person. I recommend you schedule an appointment with both a pulmonologist and a cardiologist at an academic medical center, which is usually affiliated with a medical school. Positional shortness of breath is often caused by fluid, or edema, that builds up in your lungs. This frequently occurs in patients with congestive heart failure. Although your EKG and echocardiogram are reportedly normal, it is important for a cardiologist to examine you and review these in person. Positional shortness of breath can also be caused by blood flow preferentially moving into less healthy parts of your lungs. A review of your chest CT by a pulmonologist would be useful. If your shortness of breath is worse with activity, a stress test along with a measurement of your maximal oxygen consumption may be useful to determine precisely how limited you are. In some cases, patients need to undergo cardiopulmonary exercise testing to evaluate both the heart and lungs at the same time. Again, I strongly encourage you to raise these possibilities with both a cardiologist and a pulmonologist.

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