Shortness of Breath (Dyspnea)

Shortness of breath has many causes affecting either the breathing passages and lungs or the heart or blood vessels. An average 150-pound (70 kilogram) adult will breathe at an average rate of 14 breaths per minute at rest. Excessively rapid breathing is referred to as hyperventilation. Shortness of breath is also referred to as dyspnea.

Doctors will further classify dyspnea as either occurring at rest or being associated with activity, exertion, or exercise. They will also want to know if the dyspnea occurs gradually or all of a sudden. Each of these symptoms help to detect the precise cause of the shortness of breath.

Causes of shortness of breath include asthmabronchitispneumoniapneumothoraxanemialung cancerinhalation injury, pulmonary embolismanxietyCOPD, high altitude with lower oxygen levels, congestive heart failurearrhythmiaallergic reactionanaphylaxis, subglottic stenosis, interstitial lung diseaseobesitytuberculosis, epiglottitis, emphysemapulmonary fibrosis, pulmonary artery hypertensionpleurisycrouppolymyositisGuillain-Barré syndromesarcoidosis, rib fracture, carbon monoxide poisoning, obesity, and aerobic exercise.

Shortness of breath can be associated with symptoms of chest painpain with inspiration (pleurisy), anxiousness, fatigue, dizzinessfaintingcoughwheezingbloody sputumneck pain, and chest injury.

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Most cases of shortness of breath are due to heart or lung conditions. Your heart and lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing.

Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including:

  • Asthma (bronchospasm)
  • Carbon monoxide poisoning
  • Cardiac tamponade (excess fluid around the heart)
  • Heart attack
  • Heart failure
  • Low blood pressure (hypotension)
  • Pneumonia (and other pulmonary infections)
  • Pneumothorax (collapsed lung)
  • Pulmonary embolism (blood clot in an artery in the lung)
  • Sudden blood loss
  • Upper airway obstruction (blockage in the breathing passage)

In the case of shortness of breath that has lasted for weeks or longer (called chronic), the condition is most often due to:

  • Asthma
  • COPD (chronic obstructive pulmonary disease)
  • Deconditioning
  • Heart dysfunction
  • Interstitial lung disease
  • Obesity

A number of other health conditions also can make it hard to get enough air. These include:

Lung problems

  • Croup (especially in young children)
  • Lung cancer
  • Pleurisy (inflammation of the membrane surrounding the lungs)
  • Pulmonary edema (excess fluid in the lungs)
  • Pulmonary fibrosis (scarred and damaged lungs)
  • Pulmonary hypertension (high blood pressure within the lungs' blood vessels)
  • Sarcoidosis (collections of inflammatory cells in the body)
  • Tuberculosis

Heart problems

  • Cardiomyopathy (problem with the heart muscle)
  • Heart arrhythmias (heart rhythm problems)
  • Heart failure
  • Pericarditis (inflammation of the tissue around the heart)

Other problems

  • Anemia
  • Broken ribs
  • Choking: First aid
  • Epiglottitis (swelling of the "lid" of your windpipe)
  • Foreign object inhaled: First aid
  • Generalized anxiety disorder
  • Guillain-Barre syndrome
  • Myasthenia gravis (condition causing muscle weakness)

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.

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

Your doctor will examine you and listen carefully to your lungs. You might have a lung function test, called spirometry, to measure how much air you can blow in and out of your lungs and how fast you do it. This can help diagnose asthma and COPD.

Other tests you might have include:

  • Pulse oximetry -- a device is clipped to your finger or ear lobe, and a light on it measures how much oxygen is in your blood.
  • Blood tests, including a complete blood count (CBC) to see if you have anemia (when your body doesn't make enough red blood cells) or an infection and other tests to check for a blood clot or fluid in your lungs.
  • Chest X-ray or a computerized tomography (CT) scan to see if you have pneumonia or a blood clot in your lung. A CT scan puts several X-rays taken from different angles together to make a more complete picture.
  • Electrocardiogram (ECG) to measure the electrical signals from your heart to see if you're having a heart attack and find out how fast your heat is beating and if it has a healthy rhythm.

Treatment will depend on the cause of the problem.

A person who is short of breath due to overexertion will probably get their breath back once they stop and relax.

In more severe cases, supplemental oxygen will be needed. Those with asthma or COPD may have an inhaled rescue bronchodilator to use when necessary.

For those with chronic conditions, such as COPD, a health care provider will work with the individual to help them breathe more easily.

This will involve developing a treatment plan that helps to prevent acute episodes and slow down progression of the overall disease.

If dyspnea is linked to asthma, it typically responds well to medications such as bronchodilators and steroids.

When it is due to an infection such as bacterial pneumonia, antibiotics can bring relief.

Other medications, such as opiates, non-steroidal anti-inflammatory drugs (NSAIDs), and anti-anxiety drugs, can also be effective.

Breathing troubles stemming from COPD can improve with special breathing techniques, such as pursed-lip breathing and breathing muscle strengthening exercises.

People can learn how to do these on pulmonary rehabilitation programs.

The Dyspnea Lab, a research center specializing in shortness of breath, report that people find these programs helpful, even if the root causes of the problem remains.

If tests indicate low levels of oxygen in the blood, supplemental oxygen may be supplied. However, not everyone with shortness of breath will have low blood oxygen levels.

According to the Dyspnea Lab, many people with dyspnea find that a gentle stream of cool air around the head and face helps improve their symptoms.

Individuals with dyspnea can take measures to improve their overall health and give themselves more breathing room.

These include:

  • quitting smoking
  • avoiding second-hand smoke where possible
  • avoiding other environmental triggers such as chemical fumes and wood smoke
  • losing weight, as this can reduce stress on the heart and lungs and make it easier to exercise, both of which can strengthen the cardiovascular and respiratory systems
  • take time adjusting to higher altitudes, ease into activities gradually, and reduce exercise levels at altitudes above 5,000 feet

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