A Struggle for Breath
Cars whizzed by as the 51-year-old man made his way along the grass-lined highway just outside of Peekskill, N.Y., riding his industrial-sized tractor-mower. The early summer sun beat down relentlessly, causing beads of sweat to trickle into his eyes. The air was thick with the scent and fragments of freshly cut grass that clung to his clothes and skin. Suddenly, he was struck by a wave of panic; he found himself gasping for air. His chest felt constricted, as if there was no space for a new breath because the old air was stubbornly lodged inside.
In a moment of desperation, he tightened the muscles in his stomach and chest, attempting to push out the stale air. It felt like trying to blow through a narrow, crimped straw, and any added pressure only made his situation worse. He had a history of allergies and severe asthma, worrying that something in the grass he had just mowed was exacerbating his condition. He fought to breathe slowly and worked to calm his racing heart. “Something bad happened,” he told his wife when he finally reached her on the phone. She could sense the underlying fear in his voice. “Did you use your inhaler?” she asked, her tone steady and soothing. In the grip of panic, he hadn’t thought to use it. Now, he did, but it offered little relief, and he struggled to navigate the mower back to the storage facility.
Once home, he immediately called his pulmonologist. The following day, the doctor assessed him in her office. It was likely just his asthma acting up, she concluded, prescribing a five-day course of prednisone along with an antibiotic. When that didn’t alleviate his symptoms, he was given another round of medication. Frustrated and still struggling to breathe, the man decided to seek answers beyond his usual allergies and asthma; this was a different kind of problem.
Seeking Answers
He made an appointment with his primary-care physician. While he still felt short of breath, his oxygen levels registered as normal during the examination. There was no wheezing to indicate an asthma attack, leaving the question: was it his heart? At his age, the risk for heart disease naturally increases. He also considered the possibility of esophageal spasms, which can create a sensation of chest tightness that mimics a heart attack. However, an endoscopy to check for spasms returned normal results, ruling out reflux as a cause.
His new cardiologist conducted a series of tests: an EKG, an echocardiogram, and a stress test. All results came back normal. When the cardiologist called to discuss the findings, he asked if the patient had ever consulted an ear, nose, and throat (E.N.T.) specialist. By mid-December, the man finally secured an appointment with an E.N.T. in Poughkeepsie. After listening to his story, the doctor requested he exhale forcefully. The air whistled out, a disconcerting sound that prompted the E.N.T. to recommend a closer examination of his airway.
The patient agreed, and the doctor inserted a slender tube into his throat, monitoring the images as the scope advanced. Without revealing a definitive diagnosis, the E.N.T. suggested he consult a surgeon who specialized in tracheal disorders. This led him to Lenox Hill Hospital in New York City in mid-February to meet with Dr. Matthew Inra, a thoracic surgeon renowned for treating lung and trachea diseases.
Dr. Inra explained that the E.N.T.’s examination was focused on detecting any masses in the trachea, possibly cancer, that could be obstructing his airways and causing the sensation of constricted breathing. While the E.N.T. could see as far as the vocal cords, the surgeon suspected there might be an obstruction deeper in the trachea. He asked the patient to take deep breaths in and out forcefully. The inhalation was normal, but the exhalation produced a sustained musical tone — akin to a whistle. The trachea, a rigid structure supported by C-shaped cartilage rings, typically allows air to flow smoothly and quietly. However, a fixed obstruction would disrupt this airflow, causing noticeable noise during exhalation. In this case, the sound only emerged during exhalation, hinting at an intermittent obstruction. Dr. Inra suspected the man might be suffering from tracheobronchomalacia, a condition characterized by weakness in the tracheal cartilage that could lead to movement or even collapse during heavy breathing.
