An Approach to Chronic Dyspnea

A discussion of the etiologies and work-up of chronic dyspnea.

[@Cork_UO]

I suffered from chronic Dyspnea for almost 6 years with no help from any doctor. It ended up being my blood pressure medication that was causing it. I went to numerous doctors and all they did was put me on asthma medication. It did nothing for me and their answer was to increase my dosage which again did nothing. Then I had doctors tell me I was overweight and that was the cause of it. So I lost 80 lbs and still had chronic Dyspnea. I gave up going to the doctors and resigned myself to living with this the rest of my life. Then one day I ran out of my blood pressure medication and didn't fill it for a week. In that time my Dyspnea magically disappeared. I refilled my medication and the day after I started taking it the Dyspnea came back. I ended up diagnosing myself that it was my blood pressure medication all along. And not a single cardiologist, primary care, pulmonologist, or any other doctor I saw thought to check my medication as a cause. It's been a year since I changed my blood pressure medication and I no longer have Dyspnea.

[@vl2663]

What did your dyspnea feel like if I may ask?

[@Cork_UO]

@@vl2663 It felt like I couldn't take a deep breath and get enough air. My oxygen saturation was normal though.

[@barbarafallin2038]

What type of blood pressure meds were you on

[@Cork_UO]

@@barbarafallin2038 Amlodipine

[@eosesiom]

So happy for u bro,im having chronic dispnea too for almost 2 years,that shit changed my life in a way u cant think,is every fucking day, I can't even speak properly,idk,i kinda lost hope of find some health,my mom is paying for myself to make exams etc trying too find a cause for this,the medical system in Brazil is really fucked up dude, recently i discovered i have asthma on a exam of 2 years ago that other stupid doctor has see it and say that don't mean asthma on the exam, so i passed in a pneumologist and he said that have,buy idk if thats he only caua of my dyspnea because its soo strong and everyday, I don't even have one day good without this,and in treating my asthma and dont solve it Idk Maybe there people in this video for the same porpoise of i, trying to see if have some hope Goddman...i just want a normal life

[@endlesssurge6920]

How graceful .I have always found your lectures amazingly informative and simple. Your approach is incredible.

[@Oath555]

I'm so glad to find your channel. (gratefully cry lol) Thanks so much! From a resident internist. :)

[@RayBecker]

Doctor, this video is very helpful. I suffer from chronic Dyspnea as a result of two collapsed lungs while Serving in the US Navy. First Spontaneous Pneumothorax was right lung 5/1983. Second was left lung 4/1984. The Doctors could not provide a reason. I suspect that fire training and gas attack simulator with real CS gas may have been the cause. I have located other Veterans who have the same experience. Today, I do receive some VA Disability. Currently, I am Appealing. It seems as though the VA Medical system and/or it's outside contractors cannot or will not help me to attach today's Dyspnea to the collapsed lungs. I also tested positive for Asthma upon leaving the Service at Bethesda; they had given me a Methacholine Challenge (not certain on the spelling). We're trying to get the VA to Service Connect the collapsed lungs and the associated chronic pain and breathing problems. Note, on both procedures I had to be awake and had to roll around on the gurney to assist the Doc in placing the chest tubes. This was the worst pain I'd ever felt. The 2nd tube was SO painful. I don't know why but I could not sit up for almost a week and they had me on hard core pain meds. The feeling of not being able to take a deep breath is scary. Nobody or nothing, except for my breathing can beat me. People would ask if I were tired if I yawned through the day; relief for me is a nice deep yawn. When I can get a deep breath it's like such a relief. If I smell anything like diesel or paint or smoke, chest tightens up and I'm basically screwed. My treatment is Albuterol and my family Doc just put me on Advair. If you have any input, I would greatly appreciate it. Thanks Doc and Great Job!

[@omarmaamouri]

Thank you very much Doctor. Go on 🙏🏻🙏🏻🙏🏻👏👏👏

[@crit-ic]

As always, another great video!

[@sna2520]

Great video series. Very helpful in clinical setting. Would you please consider making a video on Low Back Pain? Thank you

[@samratspeaks]

Hi Dr, I hope to see more of these videos. Hope you are still making them :)

[@alirezateymuri7576]

Thank you doctor

[@RasishSubedi]

an approach to fever.. next please :D

[@HafizahHoshni]

Awesomely informative and perfectly explained! Thank you so much! 😊😊 15/9/2019

[@triciajoy2]

Hello Dr, I have a request, if you have the time could you cover Hypo/Hyperkalemic Periodic Paralysis? I know you already covered regular hypo/hyperkalemia, but was hoping for something more in depth about the Periodic Paralysis. Thank you!

[@adilsheikh4956]

Thanks lots Dr Strong .....

[@littlemiss.s7298]

What is the possible cause of chronic dyspnea at rest without any other associated symptoms in a pt who is hypertensive (well controlled) and all his cardiac a pulmonary and blood tests are normal . And he is not stressed out

[@mathiasamare7319]

Very Educational!! Thank You Doctor. Please Keep On posting these type of videos on topics like epigastric pain, edema.......

[@StrongMed]

You are in luck! Abdominal pain and edema are 2 of the next topics in this series I'll be covering. Hopefully in May (or maybe June).

[@mathiasamare7319]

Again, Thank You sir!! Keep on doing ur great work!

[@mayankaswani5760]

When are ur other symptom videos gonna come up?

[@eniotanaka2229]

You are the saviour from my medical ignorance

[@ishanmewara44]

my gratitude 😊

[@soul177]

Phenomenal!

[@mayankaswani5760]

When are you up to put other symptoms

[@sunving]

thanks Dr Strong

[@hockeydude471]

Hello Dr.Strong, I'm not sure if I'm allowed to ask you random questions but I thought I'd try. I was in class the other day and we were talking about the effect of alcohol on drug metabolism. The case question detailed someone on anti epileptic medication that after alcohol would have seizures. This might be stupid, but my thinking was the reason for this is because the alcohol induces CYP450 thus increasing metabolism of the drug to sub therapeutic levels and that's why. But the teacher said something else to the effect that alcohol directly causes the seizures in these patients. I didn't understand how or why and when I asked the clarification didnt help. Is CYP450 induction not the main mechanism behind this? If not, why not? Sorry if the answers obvious I just didn't get it.

[@crit-ic]

Hi Ahmed, I have a short introductory playlist on pharmacokinetics that you might like! To answer your question specifically, I'd need to know which drug they were talking about. Alcohol metabolism is about 90% through alcohol dehydrogenase (ADH) and about 10% CYP2E1. Hope this helps! Check out my playlist here: kzbin.info/www/bejne/Z37RqnWIg82oqq8

[@hh-zq9io]

Million thx...can u do a video about ( approach to dysphagia),,,thx

[@shif442]

wern't new videos expected in june?

[@jahinulanam7761]

Very helpful video sir 😍

[@salmaesmail861]

Very informative Many thanks

[@khadijahsaleem6775]

Awesome 👌👏

[@MonaSax-ir6cw]

Is it medically safe for people with asthma to scuba dive or would cause problems?

[@StrongMed]

The degree of risk of scuba diving with asthma is dependent on individual factors like the severity of asthma symptoms / how well it's controlled, the severity of airflow limitations, the presence of concurrent medical problems, etc... This is a question best reserved for a conversation between the person who has asthma and the physician who helps them manage their asthma.

[@franciscovillena5940]

how do you feel about preparing a lesson on HFpEF?

[@StrongMed]

I'd love to, but unfortunately no time at the moment. Too many other forthcoming projects/topics, and life stuff. Here's a sneak peak at an ongoing project that has been syphoning off some of my free time lately: kzbin.info/www/bejne/oKatnISpqamlZ6s

[@rashadovchuyev2199]

perfect

[@kurikong2379]

Where do we include tuberculosis?

[@StrongMed]

Tuberculosis is caused by a bacteria in the genus mycobacterium. When it causes chronic dyspnea, it does so most commonly my causing chronic pneumonia (under "alveoli"), but can also do so by causing a pleural effusion.

[@flick-bgmigamer9309]

I'm facing this problem from last 4 days....on the 3rd day it was very critical as I had cold also.... I'm facing AND every night....I don't wanna die like that.... Please help me suggest me something....😭😭😭😭

[@StrongMed]

I'm sorry, but I can't give specific, personalized medical advice here. If you've been experiencing new onset shortness of breath, I strongly suggest you speak with a healthcare professional in person.

[@paolatorres474]

Hello, I have two years with that problem. Did you find out something about this terrible situation?

[@amiramohamedhamed5292]

Why aren’t there new videos ?

[@StrongMed]

The lack of new videos will be addressed soon...

[@amiramohamedhamed5292]

Strong Medicine Waiting 👍

[@davidsoto4394]

If you did not already, please do a few videos about diagnosing and treating cancer.

[@Noah-ec8pw]

Can pneumonia be the cause of chronic dyspnea?

[@StrongMed]

Yes. Some microbes classically cause chronic pneumonia, such as mycobateria (e.g. tuberculosis, MAC) and fungi (e.g. histoplasmosis, coccidioidomycosis). It would be unusual for typical bacterial pathogens to cause chronic dyspnea in the absence of the development of a lung abscess, or recurrent bouts of "acute" pneumonia due to obstruction of a bronchus (as in from a tumor). Also, not all conditions that are labelled "pneumonia" are even caused by infections - for example chronic eosinopilic pneumonia can present with chronic dyspnea, and although the mechanism behind the disease is not well understood, it is not felt to be due to an active, ongoing infection.

[@Noah-ec8pw]

Strong Medicine my question is - chronic dyspnea occurs as difficulty breathing develops over a period of weeks or months.which of the following is the example of chronic dyspnea 1. Pneumonia 2. Pain 3. Obesity 4. Panic attack. Could you please explain it thanks 😊

[@drhans5302]

It was mentioned in the acute dyspnoea video that obesity hypoventilation doesn’t tend to cause dyspnoeic symptoms? Is the chronic dyspnoea in obesity mediated by a mechanism other than hypoventilation?

[@StrongMed]

There are a lot of overlapping pathophysiologies that occur in obese patients that contribute to chronic dyspnea: extrathoracic restriction (i.e. requires greater amount of work to expand the chest cavity with excessive overlying adipose tissue), deconditioning, and OHS-related pulmonary hypertension.

[@drhans5302]

Strong Medicine thank you sir 🙂

[@fonyuydonald6152]

I wish he was teaching rather than reading from a script

[@StrongMed]

Thanks for your comment. I agree! Unfortunately, true teaching requires your audience to be live so that interaction and engagement are possible. I make these videos partially so students and other learners can learn independently, if they are not enrolled in a school or program that covers the material. But I also make them so that my students can watch them at home, which then frees up more in-class time for myself and other teachers to facilitate discussion and practice (rather than lecture). And I do use a script for this style video because if I accidentally leave something out and don't realize it until I'm editting, it is an enormous pain to fix it (my video setup time is 1.5 hrs). Unfortunately, KZbin disabled annotations a while back, which could previously be used as a quick fix. If the style of video that you prefer is a person on camera who physically writes on a whiteboard while talking (i.e. speaking from an outline rather than a script), that's totally fine. Najeeb and Online MedEd are the best that I know of who use that particular style.

[@PrashanthPandian30]

Strong Medicine sir I don’t think you need to respond pragmatically for criticisms like this.. you are doing an amazing job 🙌 keep doing it...