More Short of Breath But Stable PFTs
More Short of Breath Over The Past Year, But Breathing Tests Are Unchanged
Dear Dr. Mahler:
I recently saw my doctor because my breathing has been slowly getting worse. This is quite noticeable when I play golf 3 to 4 times a week. I ride in a cart and always try to get as close as possible to the tee and to my ball. My golf partners laugh about this. I also find that walking up stairs and up an incline on the golf course makes me feel short of breath.
At my recent appointment, my doctor told me that my PFTs are the same as a year ago and that my COPD is stable. He asked me about my activities since March when coronavirus caused “stay at home” orders. I told him that my husband and I have been quite inactive, and shared with him that I have gained 6 pounds since March.
My COPD medications are Stiolto in the morning and Ventolin as needed, but I rarely use this inhaler. I haven’t had a COPD flare-up for at least two years. Do you have any thoughts on why I am more short of breath?
Sincerely,
Diane from Longmeadow, MA
Dear Diane,
Your problem of feeling more shortness of breath with stable breathing tests is a common situation in my practice. Many of my patients assume that their COPD has progressed as the reason for their increase in breathing difficulty. In fact, there is a general relief when I provide reassurance that their lung function is the same as the previous test 6 to 12 months ago.
There are several possibilities to consider why a person experiences more shortness of breath while their COPD is stable. First, it is important to make sure that the person’s oxygen level is adequate at rest and with activities. An oxygen saturation of 90% or higher is generally considered adequate.
Comorbidities (other medical conditions) are common in those with COPD, such as anemia, anxiety, depression, heart disease, and another lung condition. In addition, deconditioning due to reduced physical activities and weight gain are also quite common causes for shortness of breath.
In my practice, I typically suggest a complete blood test to check for anemia, and a chest xray as a simple screening test to check for heart size and and a lung abnormality. I also ask whether the individual feels anxious and/or depressed.
Diane – based on the information that you provided, it is likely that deconditioning and weight gain are likely explanations for your feeling “more short of breath.” Deconditioning is a low level of fitness due to reduced physical activity. It is commonly called being “out of shape.” With deconditioning, the heart and lungs must work harder to deliver oxygen to all parts of the body. This means that even at rest your heart beats faster and you must breathe more. The demands are even greater with physical activities when muscles demand more oxygen. To take in more oxygen, breathing becomes deeper and more frequently and leads to the typical experience of “I feel out of breath.”
With weight gain, excess fat tissues is added to the chest and abdomen. As a result, a person takes shallow breaths and must breathe faster to compensate for the low volume of air with each breath. These alterations increase the work of breathing and lead to breathing difficulty – a common complaint with weight gain.
What should you do?
You might consider starting an exercise program and losing the 6 pounds that you gained. You may wish to ask your doctor about a referral to the local pulmonary rehabilitation program. Participation provides supervised exercise training and educational discussions about COPD. Even 5% to 10% weight loss can improve lung function and reduce shortness of breath.
Man participating in pulmonary rehabilitation program
Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.
Sincerely,
Donald A. Mahler, M.D.