Lung problems and peak flow

[Rocksteadyeddie]

I have been suffering with a lung issue for the last 6 weeks or so. The initial diagnosis was bronchitis as apparently I had a chest infection. The infection appears to have been knocked on the head by a couple of courses of antibiotics, but the symptoms remain. I have sporadic coughing fits. On an average day perhaps 4-6, and then 2-4 during the night. They are severe enough to make me totally lose my breath (feels like what I imagine drowning feels like), my eyes to water, and occasionally to vomit. I also have a sore chest although I have had broken ribs in the last period so put it down to this. I believe the chest problems pre-dates the broken ribs.

I recently had a chest X-ray and am awaiting the results. In the meantime the Dr has prescribed me a peak flow meter. I have been blowing 460-480 against an average for my age and height of 650. I am also very fit, and had been racing my bike at a high level prior to this illness. - does fitness affect peak flow as I would imagine I would be above average ordinarily? I am permanently shattered (although not having slept through the night for 6 weeks isn't helping) and despite not riding my bike (normally I'd burn 8-10,000 calories a week) am losing weight. I have lost about 3lbs in the last 3 weeks - could be muscle wastage? I also get breathless walking upstairs.

Anyone got any thoughts on the peak flow numbers - particularly with respect to underlying fitness, and any wider thoughts on my condition? If I'm gonna die I need to make sure I give away all my decent stuff to people I like!

[motco]

I am not a doc but weight loss must be taken seriously. Be a bit more insistent with the GP?

[maffski]

motco said:

I am not a doc but weight loss must be taken seriously. Be a bit more insistent with the GP?

I'd go with this. I had similar breathing problems - except I wasn't any better than average fitness to start with. Turned out to be heart failure (it causes fluid retention which causes fluid in the lungs). Are there any signs of swelling around your feet or ankles? I've just been for a follow up x-ray this week and the bloke said it should take a max of 4 days for your GP to get the image - so if it's been that long it might be worth phoning them and just confirming they've received it.

Loosing weight may just be that you were so physically active and haven't been using the muscle?

[brianthemagical]

What's you diet like. As I'm sure you know, 10,000kcal is a lot of food. I assume you've cut back but do you know by how much? 1lb a week isn't much.

[Rocksteadyeddie]

brianthemagical said:

What's you diet like. As I'm sure you know, 10,000kcal is a lot of food. I assume you've cut back but do you know by how much? 1lb a week isn't much.

I haven't really cut back at all although with it being warmer I guess we all eat fewer calories anyway. Hence the question really. I would expect to be gaining weight, certainly not losing it.

[aw51 121565]

Are you having reflux of stomach contents at night? You'll know if you are, sooner or later...

I am on this journey at the moment, it came out of the blue almost 2 years ago and is very debilitating! My peak flow in the good old days was around 650l/min daily average, now it's a bit over 800l/min average with now-decreasing doses of Seretide BD - I can sort this problem out by losing several stone but due to personal circumstances (my wife has a long term illness and is in hospital though her discharge is being planned) it's not going to happen imminently...

I'm on 40mg Omeprazole BD and 300mg Ranatidine Nocte each day, which coupled with me sleeping at an angle on pillows (head and thorax elevated) is working with the s I eat and drink every night (comfort zone stuff ) to mostly knock the head on the nightly reflux problem.

Having said this, I am doing "sleepovers" more or less every second night with my wife in hospital, sleeping in a zed-bed with no alcohol or crisps but taking the Ranatidine while sleeping on a level zed-bed (head and thorax not propped up on pillows) with no reflux ...

Not that I'd recommend the latter if reflux is a problem!

[HughS47]

Reflux can cause cough at night but there are another couple of things you need to be clearer with - have you ever been a smoker or have you seen any blood in your sputum. If so, get back to your GP sharpish and let him/her know.

PEF is to see if you demonstrate diurnal variation - reversible airway disease (asthma). The process of taking deep breaths also works as a mild form of physio post infection to open up your lung bases.

There are a lot of questions that could be asked of your symptoms - weight loss, breathlessness etc are both concerning, especially when twinned with a cough. If your CXR is clear then that is a start - I don't want to scare you but I'd consider asking your GP to take another look at you.

You haven't said how old you are?

Have you ever worked with asbestos? Alternatively, do you keep racing pigeons or have pet birds in the house? EAA/emphysema would be differentials but it is too early to start down that route. Has your GP done a full blood count/film?

[Rocksteadyeddie]

aw51 121565 said:

Are you having reflux of stomach contents at night? You'll know if you are, sooner or later...

No. No problems like this. Yours sound terrible. I wish you a continued recovery.

[Rocksteadyeddie]

HughS47 said:

Reflux can cause cough at night but there are another couple of things you need to be clearer with - have you ever been a smoker or have you seen any blood in your sputum. If so, get back to your GP sharpish and let him/her know.

No, neither. Aside from the very occasional cigarette but not for many years.

HughS47 said:

There are a lot of questions that could be asked of your symptoms - weight loss, breathlessness etc are both concerning, especially when twinned with a cough. If your CXR is clear then that is a start - I don't want to scare you but I'd consider asking your GP to take another look at you.

Chest X-ray is back early this week. If we have no answer I will push him further. An MRI has been suggested. As a layman this seems a sensible next step. Thoughts?

HughS47 said:

You haven't said how old you are?

39

HughS47 said:

Have you ever worked with asbestos? Alternatively, do you keep racing pigeons or have pet birds in the house? EAA/emphysema would be differentials but it is too early to start down that route. Has your GP done a full blood count/film?

No. I have had a boring office job all my life. I commuted daily to London by motorbike or cycle though (pollution). I have been helping my friend do a bathroom renovation recently so have probably breathed more dust than I ought to have done. I had a full blood test in hospital about 5 weeks ago after I crashed my bike. Would this ordinarily have picked up abnormalities?

Thanks very much for your help.

[Slink]

Rocksteadyeddie said:

I commuted daily to London by motorbike or cycle though

umm, i would start by trying to drive in, in a car with the air resurculation on with the windows up and air con on, as there is quite a lot of pollution in london, and that can cause 'lung' problems, or other problems.

after being near to the country for most of my life, when going into london the air does feel thicker if you know what i mean.

why do you think people in china wear those face masks all the time now, its to stop some of the pollution getting to their lungs.

[K77 CTR]

This could just be a viral illness, often takes about 6 weeks to resolve. Wonder if you'd benefit from an inhaler if reduced peak flow and tight chested.

[Cheib]

OP....get yourself referred pronto. Has he tested your Blood Oxygen Level as well as peak flow?

I had Pneumonia two years ago....I was off work for six weeks. Still felt absolutely knackered afterwards and was doing half days at best. Went to the GP after a couple of weeks...he listened to my chest etc and said I was fine and would recover slowly. I carried on for another month and got fed up and asked to be referred to a specialist. I am lucky that I could afford to pay for it.

I went to see the specialist, he did the peak flow tests and Blood/Oxygen and listened to my chest etc He said he could hear crackling on my lungs despite the idiot GP not being able to hear anything....also my Blood/Oxygen level was low at 93...it should be over 95 and ideally 98 or so.....my peak flow was down around 400 or so and diagnosed something called bronchiolitis which required treatment over a few months with a steroid (Prednisolene). Once I had eventually come off the steroids (peak flow now close to 600) I felt much better but I could still hear a wheezing on my breath especially at night and still didn't feel 100%....all the tests were okay at this stage but I got another chest infection and at that point asthma was diagnosed so I am now on Seretide which works fine.

The standard GP response seems to be "you'll eventually get better" meanwhile you don't and you waste weeks or months. Even when I was seeing a reassuringly expensive consultant it took a good while to get things sorted and the asthma wasn't initially diagnosed even by the specialist.

Good Luck!

[HughS47]

Cheib said:

and diagnosed something called bronchiolitis

Bronchiolitis is a disease limited to the under 2yrs - are you sure this was what he diagnosed you with? Could it have been something sounding very similar like bronchiectasis?

K77 CTR said:

This could just be a viral illness, often takes about 6 weeks to resolve. Wonder if you'd benefit from an inhaler if reduced peak flow and tight chested.

As he said - common things are common. Regarding MRI - I don't think that would be indicated just yet, but I'm not a chest specialist. Wait for the CXR result - if normal, discuss the ongoing symptoms with your GP regarding a step-wise plan of further investigations. Hope your symptoms improve!

[Cheib]

HughS47 said:

Cheib said:

and diagnosed something called bronchiolitis

Bronchiolitis is a disease limited to the under 2yrs - are you sure this was what he diagnosed you with? Could it have been something sounding very similar like bronchiectasis?

Absolutely 100% sure. I've read that on the web too but clearly it's wrong or I am a medical freak. He certainly never mentioned that it was rare that I had it as an adult.

The guy I saw is this bloke http://www.thelondonclinic.co.uk/consultants/dr-no...

I am actually seeing him for a check up today so I can ask him if you'd like.......

[Cheib]

HughS47 said:

Cheib said:

and diagnosed something called bronchiolitis

Bronchiolitis is a disease limited to the under 2yrs - are you sure this was what he diagnosed you with? Could it have been something sounding very similar like bronchiectasis?

Asked the specialist....he confirmed I did have Bronchiolitis and that it does occur in adults.

I suppose what that show's as far as the OP is concerned the value of seeing a specialist if he can get access to one.

Edited by Cheib on Tuesday 16th July 16:47

Edited by Cheib on Tuesday 16th July 16:48

[HughS47]

Cheib said:

Asked the specialist....he confirmed I did have Bronchiolitis and that it does occur in adults.

I suppose what that show's as far as the OP is concerned the value of seeing a specialist if he can get access to one.

I stand corrected - I now have the topic I was looking for to discuss at the next Grand Round! Of interest - http://www.uptodate.com/contents/bronchiolitis-in-...

NB - OP - this is a total side track and in no way related to your original question!

Edited by HughS47 on Wednesday 17th July 03:12

[Cheib]

HughS47 said:

Cheib said:

Asked the specialist....he confirmed I did have Bronchiolitis and that it does occur in adults.

I suppose what that show's as far as the OP is concerned the value of seeing a specialist if he can get access to one.

I stand corrected - I now have the topic I was looking for to discuss at the next Grand Round! Of interest - http://www.uptodate.com/contents/bronchiolitis-in-...

NB - OP - this is a total side track and in no way related to your original question!

Edited by HughS47 on Wednesday 17th July 03:12

Well I am pleased it's been of interest/use to you!

Shows the need for the OP to see a specialist though is a medical professional like yourself (at least I assume you are?!?) didn't know about it.

[HughS47]

Cheib said:

Shows the need for the OP to see a specialist though is a medical professional like yourself (at least I assume you are?!?) didn't know about it.

Quite right - I work in Paediatrics - hence my confusion at the diagnosis being given to anyone other than the under-2s. Maybe I should take this as a sign and re-train as a GP...