[38F] With chronic severe shortness of breath and nasal congestion

Patient Description

A 38-year-old female has been experiencing severe shortness of breath for about a year, which worsens when lying down at night. Despite propping her head up on pillows, there is no relief. She reports spitting up thick, sticky mucus that is sometimes dark brown and yellowish. Despite being treated with four different antibiotics, the mucus has not resolved. The patient also experiences congestion in both nostrils, which started four months ago and persists despite regular use of nasal spray. Additionally, she reports severe lower back pain and significant weight gain. Her legs ache constantly, although there is no swelling or recent injuries. She has a family history of heart conditions and renal failure. The patient has a known allergy to dust mites and cats and recently started a job in a dusty environment, which may be exacerbating her symptoms. She is currently only taking Tylenol at night to aid sleep due to breathing difficulties. No other medications or supplements are reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing:

  1. Chronic Obstructive Pulmonary Disease (COPD) or Asthma Exacerbation: Given your history of asthma and the persistent shortness of breath, especially when lying down, it's possible that your asthma is not well-controlled or that you might be experiencing a chronic obstructive pulmonary condition. The thick, sticky mucus and nasal congestion could also be related to this.

  2. Chronic Sinusitis or Allergic Rhinitis: The persistent nasal congestion and mucus production, despite antibiotic treatment, suggest that you might be dealing with chronic sinusitis or allergic rhinitis. Your known allergies to dust mites and cats could be contributing to this, especially with your new job in a dusty environment.

  3. Heart-Related Issues: Given your family history of heart disease and recent significant weight gain, it's important to consider potential heart-related issues, such as heart failure, which can cause shortness of breath, especially when lying down.

  4. Obstructive Sleep Apnea: This condition can cause severe shortness of breath at night and is often associated with weight gain. It might be worth discussing with your healthcare provider.

Typical treatments or testing for these conditions might include pulmonary function tests, allergy testing, imaging studies like a chest X-ray or CT scan, and possibly a sleep study to evaluate for sleep apnea.

What you can do

Shortness of Breath and Asthma:

  • It's crucial to see a healthcare provider to reassess your asthma management plan. You may need adjustments to your inhaler regimen or additional medications.
  • Consider using a humidifier in your bedroom to help with mucus production and breathing at night.
  • Keep a journal of your symptoms using MDandMe to track any patterns or triggers and share this information with your healthcare provider.

Nasal Congestion and Mucus:

  • Try using a saline nasal spray or rinse to help clear your nasal passages.
  • Consider allergy-proofing your home and work environment as much as possible, such as using air purifiers and dust mite covers.
  • Discuss with your healthcare provider the possibility of allergy testing or seeing an allergist for further evaluation.

Weight Gain and Heart Health:

  • Schedule an appointment with your healthcare provider to discuss your weight gain and potential heart-related concerns.
  • Focus on a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.
  • Engage in regular physical activity, as tolerated, to help manage your weight and improve cardiovascular health.

What you should look out for

Given the severity of your symptoms, it's important to seek medical care promptly. Be vigilant for the following signs that may require more urgent attention:

  • Worsening shortness of breath or difficulty breathing
  • Chest pain or pressure
  • Swelling in your legs or feet
  • Sudden weight gain or loss
  • Persistent or worsening cough

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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People Also Ask


What could be causing my shortness of breath, especially at night?

Shortness of breath at night can be caused by conditions such as asthma, COPD, heart-related issues like heart failure, or obstructive sleep apnea. It's important to consult with a healthcare provider for a proper diagnosis.


Why am I experiencing persistent nasal congestion and mucus despite using nasal sprays?

Persistent nasal congestion and mucus could be due to chronic sinusitis or allergic rhinitis, especially if you have allergies to dust mites and are in a dusty environment. Consider seeing an allergist for further evaluation.


Could my weight gain and family history of heart conditions be related to my symptoms?

Yes, weight gain and a family history of heart conditions could be related to your symptoms. Heart-related issues can cause shortness of breath and other symptoms. It's important to discuss these concerns with your healthcare provider.


What are some potential treatments for my severe lower back pain and leg aches?

For severe lower back pain and leg aches, treatments may include physical therapy, pain management strategies, and lifestyle modifications. It's important to consult with a healthcare provider to determine the best approach for your specific situation.


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