Dr. Michael BauerDear Dr. Bauer,

I am wondering why my physician has not prescribed oxygen when I have such a hard time breathing!

Sincerely, Sharon O’Brien of Colorado

Many of my patients with lung disease ask “How can I be so short of breath, when my oxygen levels are still OK?”

For those with emphysema or COPD, the normal elastic tissues in the bronchial passages and lung are reduced dramatically. Cigarette smoke alters the enzyme levels in the lung and results in lung destruction. Since the bronchial passages are so “floppy and loose,” they collapse very easily while exhaling. This premature collapse of the lung passages can result in shortness of breath even if oxygen levels are not very low. Pursed lip breathing works so well for patients with lung disease because it tends to keep the airways open longer while exhaling.

Those with lung disease due to fibrosis or interstitial disease have thick- ened, stiff bronchial and lung tissue. This is almost the opposite of emphy- sema, yet shortness of breath is a common denominator. Since the lungs are so stiff with fibrosis, the muscles of breathing need to go into overdrive to get air in and out. This results in sensations of shortness of breath.

I hope these explanations are helpful for you.