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Forum Name: Miscellaneous Chest Diseases

Question: Why did my CXR show hyperinflation of my lungs?


 HyperinflatedDude - Sat Dec 05, 2009 8:28 am

(28 y/o male) I recently saw my primary care MD regarding "waking up at night gasping for air." This has gone one for many years, and I have never been seen for it previously. I wake up when trying to go to initially fall sleep gasping for air about 1 - 15 times before I actually fall asleep. This comes and goes. One week I'm fine, the next I have the gasping for a few nights in a row. I figured I could get an OSA work-up done. My doctor ordered CXR, overnight pulse ox, (and maybe a sleep study too). The CXR was 2 weeks ago, my doctor's nurse called me the next day and said the CXR showed "hyperinflation" in my lungs. The office scheduled me in 3 months with a Pulmonologist (I guess for PFT's etc...). I have the overnight pulse ox (at home) scheduled next week. Not sure if they actually ordered a sleep study.

I sometimes feel like I have difficulty swallowing. I MAY have some minor chest tightness or may just be over-aware of my respiratory system in light of all this. I do not have SOB at rest or with activity. I swim, bike, run, and am very active. I smoked on and off for about 11 years but quit 7-11 months ago completely. I was sick with a ST/cough/malaise/etc "probably a cold" the ARNP said, for about 2 weeks right before the CXR was taken. I'm wanting to know #1) Why are my lungs "hyperinflated" on the CXR??? 2) What's up with the gasping??? and 3) Am I on the right track to getting to the bottom of this??? I'm worried I have early COPD. Could my recent flu/coughing spell have caused the hyperinflation? Could I have mild asthma and not know it? I can recall having an IS done when I had a cold 2 years ago, and was wheezing and felt like my throat was nearly closed up, I remember the doctor said my IS was "slightly below normal" for me. They did a CXR at that time, but I never heard anything about it. Should I get those records for my Pulmonoligist to compare at my appointment. I want to be thorough about this and get to the bottom of everything so I can continue an active healthy lifestyle. The only other information I can think of that might be relevant is that when I had a Hep B vaccine a few years ago I may have had an undiagnosed GBS type reaction. The day after vaccination I had left arm tingling and weakness and noticed my limbs fell asleep VERY easily. I DO have anxiety history which is largely controlled in the absence of binge drinking and exhaustion. I remember feeling like it was hard to breath when all this GBS type stuff was going on, but everything kind of went away after a couple or few weeks. Lastly, Since I was a kid I can remember getting sudden weakness in my hand for example, like when grasping a pencil then it would go away after a minute or so. SInce January I have that weakness everyday, which seems to come and go through the day- mostly in the morning. It's hard to squeeze my fists (like when you're laughing so hard you get weak). So I guess I was wondering could the possible GBS could have anything to do with my CXR/gasping like s/t something with my diaphragm. And I was also concerned the hand weakness since January might be early MS, could this have anything to do with my respiratory situation? This is everything I can think of, please let me know if I can provide more information or f/u. Thanks!!!!!!!!!!! -Steve-
 John Kenyon, CNA - Tue Dec 29, 2009 1:10 am

User avatar Hi there -- First, let's establish a couple understandings: first, hyperinflation of the lungs may or may not mean something -- anything or nothing. It usually is seen with certain chronic pulmonary problems, but you do not sound, based on your exercise tolerance, as though you have any of these. Second, you have pretty well identified yourself as an anxious person. There is nothing innately wrong with that, except that it makes life less pleasant and it also often prejudices medical people, so it really needs to be dealt with, separately, for both those reasons.

Now then: given you tolerate exercise really well, that you suffer from anxiety issues largely played out via somatic awareness (what your body is doing or what it may be doing -- see? already anxiety begins to cloud the issue), the hyperinflation may well be due to chronic sighing and hyperventilation, both of which are part of a faulty breathing habit associated with -- you guessed it -- anxiety. This does not mean you can not have something else going on, only that it's less than likely. It certainly doesn't mean you shouldn't have any real physical issues ruled out first, but if this is accomplished you will then have to work hard on managing the anxiety -- and likely will have to in any case.

Further: those nocturnal episodes of waking up gasping are quite common in the anxious person, either because of nocturnal panic attacks (a very real and well- recognized phenomenon) and/or sleep paralysis, an equally common but not-as-well understood phenomenon, quite benign but extremely disturbing to the sufferer, although over time most people tend to adapt to it til it doesn't "work" anymore and goes away. This, however, can take years, so again, real pulmonary problems, unlikely as they are, should be ruled out, not only for your physical well being but for your reassurance and peace of mind.

As for the GBS question, you could possibly have had a very, very mild episode, but of course it was too long ago and too short-lived to have any bearning on anything going on now, and again, being an axious person (who knows just enough medical stuff to get himself into trouble), you may well have been anticipating such a thing, so felt what otherwise might have passed unnoticed, normal physiologic sensations of the moment. At any rate, GBS does not lie dormant for years. It's an acute illness and slowly gets better. It won't show up suddenly months or years later. So you can turn that one loose.

Again, you could very well have some (minor) pulmonary problem such as asthma, but again your ability to tolerat exercise makes this very unlikely. Still the PFT and nocturnal O2 sat tests should be done. The latter is fairly unreliable, but would of course expose anything grossly wrong, like possible sleep apnea. And again, I'm betting heavily against that. I strongly suspect nocturnal panic attacks and/or sleep paralysis.

If all physical causes for your concerns are cleanly eliminated you'll need to look at something like cognitive behavioral therapy (CBT) to help you with your anxiety issues -- and CBT can be very effective in most cases. It is a self-limited form of interactive therapy, not "talk" therapy, but rather a type of behavior modification that helps to patient learn to recognize the triggers, onset and mechanism of anxiety so as to dismantle the problem from the inside out. For this reason it doesn't take nearly as long as insight psychoanalysis. It even involves some literal homework which can be really eye-opening. Let's hope this is where this all leads, as it's a lot simpler than having some exotic lung disorder.

Hope this is all helpful. Good luck to you and please follow up with us here as needed.

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