Good sats - so why so breathless?

[Timberman]

THAT is indeed the question. Why, with my peripheral O2 levels at 94/5 %even 96% am I still fighting to breath?

It goes like this. I wake short of breath. I rise and take my Oximeter (I have several; they all show the same) . My level is, say 92%. I do controlled breathing using a computer monitor and it rise to 94. I am still breathless. I need the loo so I get up and go. On my return the oximeter shows 82% - no surprise - all that muscle action!

Now be aware that I am on continuous oxygen by canular at 2.5 litres per minute.

I go back into controlled breathing, concentrate on nasal intake and the O2 sat rises to 92-3%. My breathing remains tight and difficult. I resort to the bluey. Little effect. I sit quietly for 10-15 minutes and everything returns to0normal. Hooray.

Until I decide to get dressed and we are off again. After 30 laborious minutes I am clad for the day. But still breathless, still on O2 of course and so await my sats to return top the mid 90s.

Now look - I know all about the lungs. How my little alveolis are so distorted they fail to pass O2 into the blood (even when I am stuffed with it canular inflation!). My blood capillaries are so damaged they do not pass blood well enough. And the bronchiectasis means I have stumpy little cilia (if any) to shift the naturally generated mucus up and out of the bronchi.

Which is why I am now on the nebuliser three times a day. Five minutes of 5mcg salbutamol. No diiscernible difference (and yes, I know I should not use the little bluey but what do you do in a hurry?).

Now a clue - I also have arrythmia and mild congestive heart disease (meaning oedema and continues furosemide). But I see no oedema in my limbs so it is not fluid.

CT and X-rays have shown nothing. Indeed, on some scales I am in decent nick for an 80s year old.

SO DOES ANYONE HAVE ANY IDEA WHY I MIGHT STILL BE SO BREATHLESS?

For info - I am 80, recovered from leukemia 20 years ago by allogenic bone marrow transplant, two bouts of HVGD pneumonia and diagnosed with emphysema and bronchiectasis by lung biopsy 2006, diagnosed with arrythmia 20016, mild congestive heart failure 2018.

[knitter]

a question I have asked many times …..I have been sat in an ambulance struggling to breathe ‘ sats are fine ‘ I was told but it’s like trying to breathe through a straw ….and that horrid stridor noise .

Alternatively I have been given a nebuliser through a high oxygen stream and my 02 levels set off alarm as they fall so low .

Someone mentioned the Bohr Effect to me once ….the balance between carbon dioxide and oxygen .

Just wondering if as well as the Ventolin are you using a preventer .

I don’t do well with a combined reliever preventer , so mine are separate …I have to get the balance right between the two .

Aluk has a helpline open during the working week for UK residents .

Best wishes .

[JigsawAddict in reply to knitter]

My partner has COPD and has similar. His oxygen levels will be about 94/95 and he's very breathless. He says that can happen when he's starting with a chest infection.

[garshe in reply to JigsawAddict]

Oxygen levels with COPD should be 88/91 above can cause problems xSheila

[caryhug in reply to garshe]

Sorry?? Can you explain that comment please?

[garshe in reply to caryhug]

I was hospitalised as too much oxygen . I was 96,97 thought it was marvellous almost killed me . Taken off oxygen immediately..I was told too much oxygen dangerous for COPD. My Sats are 88/92 now xx Sheila

[caryhug in reply to garshe]

Oh I see. I am not on oxygen.

[Timberman in reply to caryhug]

Our lungs have to get rid of CO2 but the damage in severe COPD is such that this can be difficult. As a result having a lot of oxygen (O2) in the alveoli can interfere with CO2 expulsion. If the CO2 builds up too high it blocks the airways to O2 and this can be a serious risk.

It is why we mostly carry a cared telling paramedic in ambulances not to give us too much O2 (they often go to level 5 or 6) as this could be dangerous.

But the good news is that not everyone is what they call a retainer. This can be discovered during a gases survey by a COPD nurse. I am one so have to be careful. You might not be (and probably not at risk yet anyway) .

Talk to your clinician.

[Timberman in reply to knitter]

I am aware of the CO2 problem although it isn 't about balance. The CO2 in the air we breath is almost negligible and must be so (its why such a tiny increase in climate change is so terrifying!). But when we use O2 we make a small amount of CO2 which most people easily vent through the alveoli. But with COPD this ability can be damaged (as in my case) and CO2 'retentrioin' is a problem. It can be overcome by breathing techniques. Ventolin is a reliver, not a preventer. I am on salbutamol (same thing) by nebuliser but this does not include any oxygen (indeed ever so far as I am aware). I have Trimbow which includes a preventer (which is mostly steroidal).

For info:

The Bohr effect describes red blood cells' ability to adapt to changes in the biochemical environment, maximizing hemoglobin-oxygen binding capacity in the lungs while simultaneously optimizing oxygen delivery to tissues with the greatest demand.

(Note - CO2 inhibits this capacity)

[Ern007]

I have found the same, Breathless and sats between 92 and 94/95. I have COPD, Angina and AF - Lots can cause that,

I went to me GP and she diagnosed dyspnea in other words breathlessness. I am in late 70s -

if this is new or unknown to your GP, would be best to be seen. Specifically for your breathing..

[Timberman in reply to Ern007]

Oh they know all about it. And have no clue like the cardiac specialist, the respiratory specialists.... they know WHAT it is but no one seems to know WHY it happens or what might be done to avoid it. Except do nothing. Then it doesn't happen....

[garshe]

Oxygen level with COPD should be 88/91 . Higher can cause problems. Oxygen is not to help with breathing but to protect other organs xx.Sheila

[Timberman in reply to garshe]

88-92 acceptable for COPD etc. But the O2 is to ensure your overall O2 levels are high enough to avoid peripheral organ damage. If your periopheral O2 falls and persists below about 75 it would indicate a losS of O2 in the areas of the brain, lower limbs and possibly even kidneys and liver. The brain would be first to provide symptomatic evidence - head pain, flashing lights, wooziness, fainting. Very serious requiring immediate action .

Now to higher than 92% - no problem in fact for the majority of people but a small number (like me) are what are called 'retainers' - this means we have a tendency to retain CO2 (carbon dioxide, which is the result of use of O2). Normally this leaves the blood througn the alveoli in a similar way but the opposite direction to the O2. CO2 retained in the alveoli reduce the sp[ace available for O" and thus can lead to partial as[phyiation. There are techniques for clearing CO2 and keeping the addditional O" at our below 2.5 lpm helps.

Finally the percentage is a bit arbitrary as a highly fit and trained opera singer or coral diver will be able to hold higher O2 level then the average person. But this will not be 110% as the percentage is effectively what the blood is able to retain the point of measurement: the finger or ear lobe. This is why the excruciating need to take arterial blood arises!

[PaulineHM]

Hi Timberman,

Sorry that you are still struggling with your breath. Sadly the mistake often made is that there is definite link between oxygen sats and levels of breathlessness.

Respiratory physiology is definitely a very specialised subject.

Can you discuss with your GP or Resp Team or Asthma +Lung UK helpline.

Go well,

Pauline

[Timberman in reply to PaulineHM]

Oh I agree that but you see our body responds to signals and these are generated by what you could call the body management unit (like a car EMU). Fit normal people carry about 20-30% more O2 than they needs on a standard activity basis. We do not.

Now if we need extra oxygen to meet exercise demand, two things will happen - oxygen supply to non-vital areas will be reduced while it is increased to vital organs. Thus our peripheral sats fall since the BMU rates out limbs less vital than heart, lungs, kidney, lever etc. But to help compensate the BMU sends out a call to breath faster.

And that is where our problem starts. Now if that signal could be overridden then we could take personal control (as we have to laboriously do anyway!) and enter our controlled breathing regime, delivering, with the extra O2 arriving by capillary remember, better O2 absorption in the blood vessels inside the lungs. And we use medical aids in the form of salbutamol/steroids etc.

But nobody listens...

[PaulineHM in reply to Timberman]

There are so many variables though - and varying from person to person.

Take care.

[Hidden]

it has occurred to me that the breathlessness may be due to developments with your heart. Congestive heart failure can cause it. My sats are always 96/98 but I am always breathless. I get bounced backwards between cardiac and respiratory teams as many heart/lung patients can be - both blaming the other- but in this case with me it is definitely my heart condition causing the breathlessness as on my last ct scan my lungs had actually improved a little.

[Timberman in reply to Hidden]

Sounds exactly like me!

[O2Trees in reply to Hidden]

Good to hear your lungs have shown some improvement LP.

[Hidden in reply to O2Trees]

Thankyou.

[garibaldon]

any movement of the body needs extra O2 to drive the effort. Our lungs are damaged and cannot feed the demand for O2 fast enough to cope with the exertion. This is why a higher Sat reading is normal in a sedentary state. It when we try to exceed our damaged lung capability we find this out .

[O2Trees in reply to garibaldon]

Actually I don't think it's quite true that every movement requires extra O2, garibaldon. I use ambulatory O2 for walking and other aerobic exercise.

But for anaerobic exercise such as lifting weights I don't need it at all. In fact my O2 can sometimes go up from normal baseline when doing weights (without using the supplementary oxygen).

[garibaldon in reply to O2Trees]

ok, O2, I respect your reply. Just that my consultant gave me the reason for the very question posed by the author when I asked him . Perhaps wight lifting needs less O2 than walking…I have no idea.. thanks for your response anyhow and I wish you well.

[O2Trees in reply to garibaldon]

Hi again. I see Timberman has put up something about anaerobic exercise. Here's another similar piece about the difference between anaerobic v aerobic on the net. There is lots more you can look up.

"What is anaerobic vs aerobic?

Aerobic exercise involves continuous movement fueled by oxygen from the air you breathe. Anaerobic exercise involves short bursts of high-intensity movement fueled by energy stored in your muscles."

[Timberman in reply to garibaldon]

I think we need to take care when interpreting anaerobic -

Anaerobic exercise involves short, fast, high-intensity exercises that don't make your body use oxygen like it does for cardio (or aerobic) activities. Instead, anaerobic activities break down glucose that's already in your muscles for a form of energy.20 Jul 2023

Anaerobic Exercise: What Are the Health Benefits? - WebMD

WebMD

webmd.com › ... › Reference

I strongly suggest that it will use loads of O2 IF you do not have spare glucose running in your system.

[O2Trees in reply to Timberman]

This has been interesting for me - anaerobic exercise is said to break down or use glucose in your muscles, so good for diabetes (also read this). I do accept that for some people who desaturate more readily, are further down the line with copd, lifting weights without using supplementary O2 won't be ok for everyone with copd. Im just aware of my own experience and I was responding to garibaldon's statement that "any movement of the body requires extra O2 to drive the effort". But we are all different and I wanted to stress that there's a difference between aerobic/anaerobic exercise and it's need for extra O2. But your last statement makes perfect sense.