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Chest pain, short of breath with no help from ALBUTEROL.

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Three weeks ago I started having this pain in the right side of my chest right below the clavicle along with trouble breathing. My doctor sent me to the emergency facility to get checked out in case it was a heart issue. I had an EKG (clear), and an x-ray. The x-ray showed peribroncial cuffing or mild reactive airway (not sure if these are the same things, but I have heard both terms from the doctor since). I had a breathing treatment and was sent home with Albuterol. I went to follow up with my doctor and he thought it could be allergies since I was having sinus issues as well. He prescribed a Z-Pak and a nasal spray and directed me to take a cheap OTC allergy medicine. My sinuses cleared up right away, but the chest pain and breathing problems remained. A few days ago my breathing became worse and I found myself getting winded with slight exertion. I went to see the doctor today and got an earlier appointment with a different doctor. She had me walk around with an oxygen saturation monitor. I walked very slowly up and down three hallways and my oxygen went down to 94 and my heart rate spiked to 125. She gave me another EKG and another breathing treatment. Then she gave me a prescription for a steroid pack and ordered a CAT scan. I am home now and still very short of breath and the Albuterol and the breathing treatment did little to help this time. What could this possibly be?

Category: Pulmonologist

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Category: Allergy and Immunologist
 32 Doctors Online


Thank you for your query at

May I also know your, smoking and occupational history and treatment history. Other than sinus problems and bronchitis, do you have any other significant medical problem? Did it have any radiation to neck, and did you notice any alleviating factors? Can you also describe the pain? Have you taken any hormonal treatment?

I gather that you did not benefit from albuterol.
The likely cause of pain I gather should me muscular in origin. X ray was normal. EKG also normal. You do mentioned that saturation fell to 94% however can I know the base line?

Other than musculo-skeletal pain, the only possible cause would be a pulmonary embolism that produces desat, chest pain and increased heart rate.
I too suggest a CT scan of chest to rule out any minute causes of chest pain and breathlessness.
Kindly reply so that we may help you better.
Rega RDS,
Dr. Jacob George P

Patient replied :

I was exposed to a great deal of second hand smoke as a child and as such I was in and out of the hospital and doctor's office often. I was diagnosed with chronic bronchitis as a child and was given a nebulizer for the home as well as albuterol. I started smoking at age 11 and then at age 15 I started smoking kreteks (clove cigarettes) and other strong cigarettes. I quit smoking five years old patientago. The pain does have a slight radiation to neck at times and can not be alleviated. I have even tried Advil. The pain dull and seems to be worse when I am having trouble breathing. It comes and goes. No hormonal treatment. I also have endometriosis and aednomiosis. Albuterol does help. But I started having shortness of breath with activity, which was a new development. X ray was not normal. It showed peribronchial cuffing. Oxygen saturation baseline 98.
I also noticed last night that my heart rate goes from 70s sitting to over 100 upon standing.


There is a possibility of pulmonary embolism from the description you give. However I still feel its vague, and cannot be that. I feel it is mostly musculo skeletal in origin. As for breathlessness, it should be the same asthmatic attack. Albuterol can cause muscle spasm and cramps. Anyway I suggest a CT to rule out pulmonary embolism. (Your x rays are suggestive of chronic bronchitis only and does not account for your symptoms)
Please feel free to discuss further,

Dr. Jacob George P

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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