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Q. I am not able to breathe properly after getting up in the morning. Is it due to asthma?

Answered by
Dr. Muhammad Zubayer Alam
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Feb 19, 2021

Hi doctor,

My breathing issues came back before ten days. I was fine for a month. I had normal PFT, chest CTA and EKG. All the vitals were normal. I do not have any other health issues. I can run for seven kilometers. Doing exercise helped me a lot and my breathing got improved. I started exercising more and eating healthy foods. I can breathe perfectly at night with nice deep breaths. It was fine throughout the day. After getting up, I have difficulty to breathe for ten days. Currently, I am using Albuterol, Fluticasone, and Singulair. I am functioning much better than the last time. I have difficulty in breathing at the starting of the day. Sometimes, I have a small wheeze. I feel it as a tough situation. Do you understand the cause? I consulted a primary care physician and he told that it seems to be mild asthma. Is there any serious disease that mimics the above condition?

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Hi,

Welcome to icliniq.com.

I understand your concern. According to the statement, you are suffering from exertional dyspnea. As you have occasional wheeze along with negative results for respiratory tests, so it can be asthma. In this condition, investigations can be negative. You need to undergo a reversibility test in which two FEV1 (forced expiratory volume in 1 second) are measured before and after administration of bronchodilators or steroids in patients with bronchial asthma. Some environmental factors outside the home, occupational history, and some irritants or allergens can aggravate your asthma status. But during the night, you may be free from these factors. For this reason, your asthma can be stable. You need to undergo an echocardiogram to exclude any cardiac causes.

Thank you doctor,

Can it be a serious lung disease? It lasted for eleven days last time and after that, I was normal. I was able to exercise normally. I am 38 years old without any health issues. My vital signs seem to be normal. BNP was good. Prednisone did not help me for the first time. I have a history of heartburn and it is not now. CTA and PFT are normal. I have breathing issues on the top of the day.

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Hi,

Welcome back to icliniq.com.

You can have mild asthma due to occupational exposure, environmental, or any other type of allergen exposure. You can feel better at home and sometimes exertional dyspnea occurs in the daytime. All the investigations are normal. As you have exertional dyspnea, you need to undergo a routine echocardiogram test. All your reports suggest that you are a healthy person. As you have a history of mild breathing problems, especially after exercise, wheezing with a history of taking bronchodilators, corticosteroids, and Montelukast, so you can have asthma or any type of allergy. Some triggering factors can aggravate your asthmatic status or allergies. Kindly avoid it.

Thank you doctor,

I do not have any history of breathing problems and I feel better after doing exercise. I do not have a history of asthma or any breathing issues other than one episode that lasted for 11 days. My inhaled medications did not help me. My BNP was 20. I am a teacher and I did not have any exposure to new allergens. I live in my house for many years. I did some woodwork, sanding, and cutting woods two days back before having my breathing issues. But I am not exposed to it for 12 days. Could a day of exposure to sawdust cause breathing issues for ten days? I seem to have some improvement after ten days.

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Hi,

Welcome back to icliniq.com.

Cutting woods and smoothing the surface of woods with sandpaper is known as sanding. As you had exposure to dust of woods, it acted as allergens or irritants causing allergy or pre-asthmatic attack. It is the possible reason for your suffering at that particular time. You have an allergy to a specific type of dust or wood or all types of wood.

According to your spirometry report provided here, (attachment removed to protect patient identity) your FEV1 (forced expiratory volume 1) and FVC (forced vital capacity) remain above 80% and FEV1/FVC (tiffeneau-Pinelli index) remains below 70%. Having FEV1 and FVC above 80% is considered normal. But having a ratio below 70% indicates obstructive types of lung disease such as asthma, COPD, bronchitis, and bronchiectasis.

According to your spirometry report, you can have some pre-asthmatic status indicating obstructive lung disease as FEV1 and FVC remain above 80% but FEV1/FVC ratio remains below 70%. Dust of woods has triggered your pre-asthmatic status or allergy and your doctor has prescribed medications for it. Prevent yourself from having exposure to dust woods.

Thank you doctor,

I do not have any exposure to wood dust for 13 days. I have tried using many different asthma medications. But nothing helps me. Still, I have breathing issues. Can I have ILD?

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Hi,

Welcome back to icliniq.com.

ILD (interstitial lung disease) is a restrictive pattern of lung disease. In these cases, FVC remains less than 80% and FEV1/FVC ratio remains above or equal to 85% in spirometry. But your FVC and FEV1 remains above 80% and your FEV1/FVC ratio is below 70%. So it indicates obstructive types of lung diseases like asthma, COPD (chronic obstructive pulmonary disease), bronchitis, and bronchiectasis. Your spirometry results indicate that you do not have ILD. You seem to have a pre-asthmatic status or allergies. You can undergo MRI (magnetic resonance imaging) or CT (computed tomography) chest to rule out ILD. You seem to have anxiety and stress. It aggravates your pre-asthmatic status or asthmatic status. You seem to have minor respiratory problems.

Thank you doctor,

I am unable to have deep breathing. Is this normal? I have trouble in reaching top of my breath. I yawn a lot as I feel hard to reach top of my breath. I feel hard to breath in and I feel easier to breathe out. My asthmatic medications did not work for 12 days. I have tried using Prednisolone, Fluticasone, Albuterol and Singulair. But nothing helps me. Does asthma make breathing harder?

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Hi,

Welcome back to icliniq.com.

You have difficulty in breathing because surrounding muscles around your airways squeeze timely with swelling inside. Your airways make more mucus inside it and so it makes breathing harder. These type of changes in airways causes coughing, wheezing and prevents you from having deep breathing. This is known as an asthma attack or episode. Taking some medications and avoiding asthma triggers helps to reduce swelling and relax tight muscles present in the airways. Many conditions can cause these symptoms. They are more likely to be asthma if it occurs often and keeps coming back. It becomes worse in the morning or night. It seems to happen in response to triggers like exercise, allergy to pollen, animal fur, wood dust. You can add Doxophylline and antihistamines like Fexofenadine, and Cetirizine along with your current medications.

Thank you doctor,

My breathing remains more restricted than obstructed. I cannot take a deep breath. Is this normal while having obstructive diseases? I do not have any response to medications. Can I have ILD? I did a chest CTA and it was good. Does early fibrosis show on CTA? I want to rule out ILD completely.

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Hi,

Welcome back to icliniq.com.

CTA or CTPA (computed tomography angiogram or pulmonary angiogram) is used to determine small, medium, or large blood clots in lung blood vessels. It also determines the degree of potential compromise in the pulmonary system. In other words, it is used to detect pulmonary embolism formed due to blood clots. It is not used to detect ILD. CT (computed tomography) scan or MRI (magnetic resonance imaging) of the chest is the gold standard test used to detect ILD. The primary signs and symptoms of ILD are shortness of breath at rest and dry cough. Patients having a history of long-term exposure to occupational and environmental factors like silica, asbestos, aged persons, patients with a history of autoimmune conditions like RA (rheumatoid arthritis), mixed connective tissue disease, medications, and chemotherapy are more prone to develop ILD. Your spirometry results suggest that you have some minor respiratory issues of obstructive type. As you had wheezing and inability to take deep breathing, it occurs commonly in obstructive type lung diseases like asthma and COPD. You can do HRCT (high resolution computed tomography) of the chest to exclude ILD.


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