I have frequent whistling (wheezing) when I lie down - sometimes even sitting - or standing. I take Propulsid four times a day but it does not seem to be helping. On three occasions i have gotten very tight in the chest with difficulty in deep breathing with a lot of wheezing. My allergist tell me it is not asthma - but my esophagus. My primary care doctor is treating me with the Propulsid. I am concerned. Is there more I should be doing? Should I contact a Gastroenterologist?
Thank You
REPLY:----------
Reflux of stomach acid and digesting food up into the esophagus and down into the lungs through the trachea can worsen existing asthma and chronic lung disease. Some patients respond to head-of-bed elevation, acid reducing drugs, weightloss, and medications such as Propulsid which hasten the emptying of the stomach contents and may increase the strength of a weak lower esophageal sphincter (valve). Some patients even require surgery to repair a hiatus hernia to prevent reflux from causing worsening lung function or recurring lung infections.
It is not clear to me that your breathing problems are actually related to reflux. There are a number of tests which can be done to see if you have an abnormal amount of reflux from the stomach, if you have a weak sphincter at the bottom of the esophagus, or if you have a hiatal hernia. A referral to a gastroenterologist seems like a very good idea at this point to clarify exactly what is going on.
Probably the most common reason for worsening of breathing with lying down in bed is some degree of heart failure where fluid accumulates in the lungs and interferes with oxygen getting into the bloodstream; this has nothing to do with the esophagus or with reflux.
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Bruce Sckolnick, M.D.
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