Shortness of Breath

Shortness of breath, or dyspnea, is a common symptom in which the person feels breathless or have difficulty in breathing. It is one of the most common causes of hospital or emergency room visit.

The experience of breathlessness may vary with the individual and the underlying condition that causes dyspnea. Exercise and high altitudes increase the breathing rate under normal conditions.

The increase in breath rate increases the discomfort in a person. The rate may also increase in several disorders. Increased breathing rate is often accompanied by a sensation of lack of air for breathing.

It makes the person feel unable to breathe fast or deep enough to supply oxygen. They often need to apply more effort to expand the chest to inhale and exhale. Before the exhalation of air, they may feel an urgent need to inhale.

Many describe tightness of chest as another symptom associated with shortness of breath. Other symptoms like a cough and chest pain may depend on the underlying conditions.

Most cases of dyspnea are caused by issues of heart and lungs. Both these organs are involved in the transport of oxygen to different parts of the body, and problems with these may affect breathing rate and depth.

Shortness of breath may have a sudden onset or be chronic, causing long-term difficulty in breathing. Sudden onset of shortness of breath requires medical attention as it may be associated with problems in airways or heart.

Acute shortness of breath has a sudden onset and is caused by conditions like: 

• Respiratory tract infections – infections like pneumonia cause sudden difficulty in breathing and is often associated with other symptoms like fever and cough.
• Anaphylaxis – anaphylaxis is a very severe allergic reaction and is characterized by itching, swelling, rashes and other symptoms.
• Asthma – asthma is one of the common causes of acute shortness of breath, and has to wheeze as one of the symptoms.
• Blockage in respiratory tract – inhaling a foreign object may block the respiratory tract, leading to shortness of breath.
• Blood clot – blockages in an artery of lungs like a clot leads to insufficient supply of air, leading to breathlessness.
• Collapsed lung – this condition is characterized by filling of air in the space outside the lungs, affecting the expansion of organ during breathing.
• Interrupted blood flow to heart – it often happens during a heart attack and is associated with other symptoms like pain and pressure in the chest.
• Heart failure – inability of the heart to pump blood to different parts of the body leads to breathlessness.
• Pregnancy – shortness of breath is a normal change associated with pregnancy.

Chronic shortness of breath is caused by:

• Asthma
• Chronic obstructive pulmonary disease
• Interstitial lung disease
• Cardiomyopathy
• Deconditioning
• Obesity
• Pulmonary hypertension

The underlying condition of shortness of breath is diagnosed based on medical history, physical examination, and other symptoms.

Some of the tests that help in the identification of cause include:

• Blood tests like hematocrit
• Chest x-ray
• EKG
• Spirometry
• Oximetry

Treatment of shortness of breath depends on the underlying cause of the condition. Supplemental oxygen helps people who have low blood oxygen level. Mechanical ventilation is suggested for people who cannot breathe deeply or rapidly enough to supply oxygen to different parts.

Shortness of breath may be acute or chronic. Acute shortness of breath develops suddenly within minutes or hours, while chronic shortness of breath develops gradually over weeks or months. Causes of the two types of the condition may vary.

Acute shortness of breath is caused by: 

• Respiratory tract infections – infections like pneumonia is one of the most common causes of acute shortness of breath. It is usually associated with other symptoms like high fever and cough. Pneumonia may be caused by bacteria or viruses.
• Anaphylaxis – anaphylaxis refers to a severe allergic reaction characterized by itching, skin rashes, and difficulty in breathing.
• Asthma – shortness of breath could be a symptom of an asthma attack. The airways become narrow and the production of mucus or phlegm increases. Wheezing and coughing are other symptoms of this condition.
• Blockage in respiratory tract – inhaling a foreign object large enough to block the airways may lead to difficulty in breathing.
• Blood clot – blockage of a blood vessel in the lungs, also called pulmonary embolism, caused by a clot or any other reason may affect the flow of blood. This indirectly affects the rate and depth of breathing.
• Collapsed lung – also known as pneumothorax, this condition occurs when air leaks from the lungs to the space between chest and lungs. A small tear in the surface of lungs may result in the collapse of lungs.
• Interruptions in blood flow to heart – this usually happens during a heart attack. It is usually associated with other symptoms like pain in the chest.
• Heart failure – in this condition, the heart finds it difficult to pump blood to all parts of the body. This usually results from weakening or stiffening of heart muscles.
• Atrial fibrillation – changes in heart rate and rhythm may also lead to shortness of breath.
• Panic attack or anxiety – panic attack leads to rapid breathing which in turn results in shortness of breath.

Diabetic ketoacidosis and pleural effusion are two other probable causes of shortness of breath.

Chronic breathlessness is caused by:

• Asthma – this is the most common cause of chronic shortness of breath.
• Chronic obstructive pulmonary disease (COPD) – this is lung condition that affects smokers and is characterized by emphysema and chronic bronchitis.
• Interstitial lung disease – interstitial lung disease refers to a group of conditions that involve scarring of tissue in the lungs.
• Cardiomyopathy – changes in the size of the heart that affect the functioning of the organ is referred to as cardiomyopathy. It affects the ability to pump blood to different parts of the body.
• Deconditioning – not enough physical activities decondition the body to extra activities. Thus a person not used to regular exercise or activities may have shortness of breath while climbing stairs.
• Obesity – extra mass on the chest and abdomen increases the effort on breathing muscles, leading to breathlessness.
• Pulmonary hypertension – increased pressure in the blood vessels of lungs is referred to as pulmonary hypertension. Shortness of breath is a symptom so this condition.
• Bronchiectasis – this is a condition characterized by unusual widening of airways. It may cause a persistent cough and shortness of breath.

Evaluation of symptoms and medical history are the first steps in the diagnosis of the cause of shortness of breath. Information on the onset of breathlessness, duration of dyspnea, and other medical conditions help to evaluate the possible causes of the symptom.

During the physical examination, the doctor may look for congestion, wheezing, and any other abnormal heart sounds. Swelling in both the legs may indicate heart failure, while swelling in one of the legs may suggest blood clot.

Pulmonary function testing (PFT) helps to evaluate the functioning of lungs. PFT and measurement of the functioning of lungs before and after methacholine are used to diagnose asthma.

Chest x-ray and bronchoscopy are the suggested tests to check for foreign objects in airways. Heart attack and heart failure are diagnosed using echocardiography and chest x-ray.

Blood tests that measure cardiac markers also may be suggested for the confirmation of these heart issues. Imaging studies like chest x-ray is useful in the diagnosis of pneumothorax.

Ventilation-perfusion scanning and CT angiography are used to check for pulmonary embolism. A chest x-ray is used in the diagnosis of other conditions like pneumonia, interstitial lung disease, COPD, and restrictive lung disease.

Sometimes cardiac catheterization may be suggested for diagnosing coronary artery disease. A complete blood test may reveal anemia.

Treatment of shortness of breath depends on the underlying cause. The first step of any treatment is to provide adequate oxygen to the body. Supplemental oxygen may be recommended if the patient is very short of breath.

Some medications that are commonly used to treat shortness of breath include:

• Bronchodilators – this drug helps to open up the airways and is usually used in the treatment of asthma and COPD.
• Corticosteroids – corticosteroids are useful in controlling inflammation of airways and lungs. Patients with asthma and COPD use corticosteroids through an inhaler.
• Antibiotics – these are useful for controlling bacterial infection that leads to conditions like pneumonia and acute bronchitis, both of which are underlying causes of shortness of breath.

Certain breathing techniques like pursed-lip breathing and diaphragmatic breathing help to relieve the symptom. Changing the position also helps to relieve shortness of breath.

Sitting up and leaning forward help to increase the space within the rib cage, allowing lungs to expand more. Planning rest periods after a period of activity helps to avoid shortness of breath.

Identifying and avoiding factors and activities that trigger asthma also help to avoid shortness of breath. Pulmonary and cardiac rehabilitation help some patients to relieve shortness of breath. Special exercise regimen to strengthen arms and legs allow people to engage in physical activities even with medical problems.

Steam inhalation is a good home remedy, especially if the respiratory issue is the cause of breathlessness. It helps to decongest the nasal passages. It will also help in breaking and dissolving mucus in the airways so that it is easy to remove it from the system.