Learn About Shortness of Breath
Breathlessness, or shortness of breath, describes discomfort or difficulty with breathing. The medical term for shortness of breath is dyspnea.
- Shortness of breath is a common symptom that may be related to serious diseases or may be a result of being out of shape.
- Medical evaluation should assess if shortness of breath is treatable with lifestyle changes such as quitting smoking or losing weight.
- Asthma, COPD, heart disease (heart attacks, heart failure) anemia, and blood clots in the lungs (pulmonary embolism) are some examples of serious conditions associated with shortness of breath.
What Is Shortness of Breath?
Shortness of breath is the uncomfortable sensation of not getting enough air to breathe. This may occur when walking, climbing up stairs, running or even when sitting still. It can come on suddenly or slowly over weeks to months.
People describe the feeling they get when breathless in different ways. They may use the words “short of breath,” “tightness in my chest,” or “cannot get enough air.” Breathlessness can be uncomfortable and sometimes scary, but being breathless does not damage your lungs. It can, however, be a sign of another medical condition.
How Serious Is Shortness of Breath?
In a healthy person, very strenuous exercise, extreme temperatures, bad air quality, obesity and high altitude can all cause shortness of breath. But in non-extreme situations, shortness of breath may be a sign of a medical problem.
If you have unexplained shortness of breath, especially if it comes on suddenly and is severe, see a medical professional as soon as possible. If chest pain or pressure, fainting or nausea accompanies shortness of breath, it may be a sign of a more serious medical condition.
Shortness of Breath Symptoms You Shouldn’t Ignore
Some people with respiratory problems can feel breathless just by doing normal activities like getting out of a chair or walking to another room. See your medical professional if your shortness of breath is accompanied by:
- Swelling in your feet and ankles
- Trouble breathing when you lie flat
- High fever, chills, and cough
- Lips or fingertips turning blue
- Wheezing – abnormal whistling type sound when you breath in or out
- Stridor – a high pitched noise that occurs with breathing
- Worsening of pre-existing shortness of breath after using your inhalers
- Breathlessness that does not go away after 30 minutes of rest
What Causes Shortness of Breath?
Most causes of shortness of breath are due to heart and lung conditions. Your heart and lungs are involved in transporting oxygen to your body and removing carbon dioxide, and problems with either of these processes affect your breathing.
Breathing is regulated by the brain and a complex interaction between various chemicals in the blood and in the air that we breathe. Oxygen levels, carbon dioxide levels, and the amount of hemoglobin in blood play a role. If blood carbon dioxide levels rise, the brain tells the body to increase the breathing rate, which can result in deeper or faster breaths. This may lead to a sensation of difficulty breathing. Likewise, too much acid in the blood from an infection, lactic acid build-up or other causes can lead to an increase in the breathing rate and the sensation of shortness of breath.
Causes of acute shortness of breath can include:
- Flare in COPD
- Allergic reaction (such as bee stings)
- Carbon monoxide poisoning
- Heart attack
- Low blood pressure
- Anemia (low red blood cell count)
- Upper airway obstruction (blockage in your throat)
- Heart failure
- Enlarged heart
- Abnormal heart beats
- Foreign object inhaled into the lungs
- Guillain-Barré Syndrome
- Myasthenia gravis
- Pulmonary embolism (blood clot in the lungs)
In the case of chronic shortness of breath, the condition is most often due to:
- COPD (chronic obstructive pulmonary disease)
- Abnormal heart function
- Other lung disease
What are Risk Factors?
Having prior lung diseases, muscle weakness, low hemoglobin, being out of shape from lack of exercise or illness, severe obesity, and continued exposure to asthma triggers are some examples. Smoking is a major risk factor as it causes diseases that result in shortness of breath.
When to See Your Doctor
You should visit your doctor if you experience any shortness of breath that is not expected from an activity and the current state of your fitness or health. Breathing difficulty that comes on suddenly, is persistent or interferes with your daily activities should be evaluated by a medical professional. Shortness of breath that does not decrease with treatment or that is accompanied by other symptoms like chest pain needs urgent evaluation possibly in an emergency room type setting.
Diagnosing and Treating Shortness of Breath
Shortness of breath needs prompt diagnosis and management of the cause and symptoms. A medical history as well as examination can often give a good explanation but sometimes special tests are required.
What to Expect
Your doctor or other healthcare provider will ask you a series of questions such as the nature of the shortness of breath, when it gets worse and when it gets better and if you are having any additional symptoms like chest pain, dizziness, cough, or sputum (mucus or phlegm). They will listen to your heart and lungs with a stethoscope, and may order additional tests, which could include chest scan, pulmonary function, blood tests, or an echocardiogram.
How Shortness of Breath Is Diagnosed
Information about the symptoms reported by the patient or other observers is usually sufficient to diagnose shortness of breath. An examination and further tests as noted above may be required. Some patients may need more complex testing including high resolution CT scans or cardiopulmonary exercise testing.
How Shortness of Breath Is Treated
The treatment depends on the cause and the duration of symptoms. For example, once it is clear if the problem is from the lungs or the airways, specific treatment like bronchodilators to relax the airways, may be prescribed. If the problem is due to anemia, a patient may need iron supplements. Avoiding asthma triggers, stopping smoking, using oxygen or enrolling in a pulmonary rehabilitation program will also be recommended in certain situations. Most patients will respond to simple interventions once the diagnosis is clear.
Living with Shortness of Breath
Shortness of breath can usually be controlled by medication, breathing techniques, exercise and supplemental oxygen. Other things you can do to prevent and control shortness of breath include:
- Pace yourself.
- Try not to hold your breath.
- Use pursed lips breathing technique.
- Sit in front of a fan so it is blowing on your face.
- Ask your doctor if pulmonary rehab is right for you.
- Lose weight if you are overweight.
- Avoid exertions at elevations above 5000 feet unless trained and adapted.
- Avoid triggers that worsen asthma.
- Avoid exposure to pollutants in the air both indoors and out.
- Stop smoking. The benefits of quitting include decreasing your risk for lung disease and heart disease even if you have been smoking a long time.
- Get a general health checkup, since shortness of breath is often a symptom of a more serious problem.
- Speak up to your healthcare provider about concerns and worries about your shortness of breath.
- Continue medications on the schedule that has been recommended to you.
- Follow a disease management action plan developed with your healthcare provider.
- If you rely on supplemental oxygen be sure your supply is adequate and the equipment works properly.
Questions to Ask your Healthcare Provider about Breathlessness
- Am I breathless because of my age?
- What if I stop smoking?
- How can I reduce indoor pollutants for grandkids and myself?
- How can I exercise if I use oxygen?
- Why do I get more short of breath when it is cold outside?
- How can my asthma be controlled?
- Do I have a lung cause of shortness of breath or is there any other cause?
- Set up a meeting with your doctor to go over the management of shortness of breath and if you will qualify for specific treatment like pulmonary rehabilitation
Alan Roth, RRT, FCCP
Sai Praveen Haranath, MBBS, MPH, FCCP
Date Last Reviewed