Can Respiratory Reflux Cause Shortness of Breath?

At present, I am practicing virtual medicine, 30-minute consultations; and in order to save time taking a detailed history; in advance, I have each consultee submit an intake form focused on Respiratory Reflux symptoms. You may be surprised that roughly 50% complain of Shortness of Breath (SOB). So on Zoom, I always probe …

“I’m going to describe three different symptoms that people call shortness of breath. The first is shortness of breath with exertion, like after running up stairs huffing and puffing. Second, you might have trouble getting air in and/or out of your lungs, sometimes with wheezing. And finally, perhaps you have some discomfort taking a full deep breath in. Now, I’d like to know which of those you experience, or maybe your SOB is something else?”

And for those who also indicate that they have “asthma,” I ask, “When you have an asthma attack, do you have more difficulty getting the air IN or OUT?”  Hard Rule: Out is asthma, In is reflux.

With SOB from respiratory reflux, the pattern is usually Silent Nocturnal Respiratory Reflux. However, if you have that, it is likely that you and your doctor may not recognize that respiratory reflux as the underlying cause of your problems.

Inability or Discomfort Taking a Full Deep Breath IN

This symptom appears to be strictly associated with respiratory reflux; and, it is by far the most common reflux-related SOB symptom of my patients. And although this symptom is caused by respiratory reflux, the mechanism is unknown. … I believe that it is vagally-mediated. 

Say reader, can you easily take a full deep breath IN … all the way? If not, you probably have respiratory reflux.

People with this type of SOB have normal breathing otherwise, as well as normal chest x-rays and pulmonary function tests. Nevertheless, with any type of SOB, if you haven’t had one, I suggest that you ask your doctor to get a chest x-ray.

The proof is in the pudding. Inability/discomfort to take a full breath IN is exclusively due to respiratory reflux … the proof? This symptom vanishes on effective antireflux treatment, usually within a few weeks. 

SOB On Exertion

SOB on exertion is the second most common type of SOB associated with respiratory reflux. The lungs may be normal … but respiratory reflux can have a much greater negative impact if there is any prior or ongoing lung damage or disease. In other words, smoking, exposure to airborne toxins, or any disorder or disease that has compromised lung function can amplify SOB on exertion. 

Case Illustration: A patient with progressive, oxygen-dependent COPD with SOB at rest came to see me for evaluation. And yes, his respiratory reflux was very bad. Subsequently, with on-going and tight antireflux treatment, his COPD not only stabilized, but improved. Click here for more details about this case. 

On chest x-ray or lung CT-scan, some people with respiratory reflux-caused SOB may show some lung changes, typically “a ground-glass appearance” around the bronchi. Mainstream medicine thinks that this is the first stage of “idiopathic” pulmonary fibrosis, but I disagree. This radiographic pattern is consistent with long-standing micro-aspiration of reflux. Fix the reflux and these people do fine; there is no progression of lung disease. In addition, reflux-cause SOB on exertion may be one of the fastest symptoms to resolve with treatment, within weeks

Note: Seen in athletes, who otherwise do not appear to have respiratory reflux, there is one variation of exercise-induced SOB. For people exercising for a period of greater than an hour, the SOB can begin soon after starting exercise and disappear after about a half-hour. This temporary SOB is most commonly experienced by long-distance runners. Meanwhile, exercise-induced reflux generally depends upon the type of exercise … check those posts to see if your exercise program is making your reflux worse.  

Case Illustration: A world-class marathoner presented complaining of SOB for the first half-hour of running. He did not have other symptoms of respiratory reflux. I made four recommendations: (1) Do not eat within 3 hours of a marathon; (2) Take 20 mg of famotidine first thing in the morning and another 20 mg before the start of the race if it is in the late-morning or afternoon; (3) Take a tablespoon of Gaviscon Advance Aniseed 15 minutes before the start of the race; and (4) Chew gum or suck on hard candy while running. He did it and his SOB ceased.

SOB From Airway Obstruction

Difficulty getting air in, during inhalation, is usually related to airway obstruction at the level of the vocal cords. I have posted on Laryngospasm, which is what happens when acid triggers the vocal cords to clamp shut (presumably to prevent aspiration). Laryngospasm “attacks” last seconds to minutes; but if it lasts longer, then there’s another common diagnosis, Paradoxical Vocal Cord Movement … it is like laryngospasm, but the SOB is not as severe … but it can last days, weeks, or even longer. 

With PVCM, the vocal cords partially close during inspiration, and that’s wrong. Normally, the vocal cords open as you inhale, and close slightly as you exhale. Because it’s backwards, that’s why it is called “paradoxical.” Most cases of PVCM are caused by reflux, but there are other causes. 

Other causes of airway obstruction: Indeed, there are serious anatomic causes of airway obstruction such as laryngeal scarring, subglottic stenosis, or tumors, but these are uncommon. In addition, these type of blockages are usually slowly progressive; that is, breathing gets harder over time as the laryngeal opening shrinks. Finally, there are non-laryngeal causes of progressive airway obstruction such as thyroid or lung cancer.

Summary

There are three common patterns of SOB caused by respiratory reflux: (1) Inability to take a deep breath in; (2) SOB on exertion; and (3) Difficulty getting enough are in.

Pearl of the Week

Lemon is the most acidic thing in nature (pH 2.7); however, the yellow outer rind of the lemon, the zest, tastes almost as good lemon juice. Zest can be used on fish, salad, etc. Good News: Lemon Zest is pH 6.3, and that’s great for refluxers. Personally, I use a Microplane for zesting. May all your lemons be white!

If you would like to schedule a virtual consultation with me, Book Online. For more information about diagnosis and treatment of respiratory reflux, see my two companion books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. For coughing, and for cough, The Chronic Cough Enigma.