Shortness of breath: what causes it and what it may mean

Shortness of breath is a feeling of not getting enough air, in which the rate, rhythm, and depth of breathing change. It can be a harmless companion to exertion, or it can be a sign of a serious disease. Below — what causes shortness of breath, what the numbers mean, and when you must not delay.

What shortness of breath (dyspnea) is

Dyspnea is an adaptive function of the body: the rate, rhythm, and depth of breathing change, often with a feeling of not getting enough air. It is convenient to picture the respiratory system as a pipeline with a pump: air travels through the pipes, and the heart pumps blood carrying oxygen. If the pipe narrows or the pump weakens, a feeling of not getting enough air appears.

Physiological shortness of breath occurs with increased physical exertion, while pathological shortness of breath occurs with disease-related damage to body systems. The criterion for pathology: shortness of breath appears in normal situations, with ordinary exertion, when it was not there before, for example when walking quickly on a flat surface.

By respiratory rate, two types are distinguished. Tachypnea — rapid shallow breathing above 20 per minute: anemia, fever, blood diseases; in hysteria the rate reaches 60–80 per minute. Bradypnea — 12 or fewer per minute: damage to the brain and its membranes, severe and prolonged hypoxia, acidosis, for example in diabetic coma.

What causes shortness of breath: main causes

Common causes: bronchial asthma, chest infection, excess weight, smoking, panic attack. A blocked nose or intense exertion also make breathing difficult, but are not a disease.

Serious causes: chronic obstructive pulmonary disease, scarring of the lungs (idiopathic pulmonary fibrosis), heart failure, lung cancer. A feeling of not getting enough air is also caused by heart disease, problems with the trachea and bronchi, allergies, anxiety and panic attacks, poisoning with toxic and narcotic gases and refrigerants, and dysfunction of the nervous system with severe agitation, rage, hysteria, or fright. Cerebral shortness of breath occurs with irritation of the respiratory center — tumors, hemorrhages.

The nature of the shortness of breath suggests where to look. Inspiratory shortness of breath, with difficulty inhaling, is typical of heart disease: first with exertion, then at rest, especially in a horizontal position, because of which the person is forced to sit (orthopnea); sudden nighttime attacks are a manifestation of cardiac asthma. Expiratory shortness of breath, with difficulty exhaling, occurs when the lumen of the small bronchi and bronchioles narrows in asthma or when the lung tissue loses elasticity in emphysema.

Difficulty breathing: what symptoms accompany shortness of breath

Shortness of breath rarely comes alone, and accompanying signs help to understand how serious the situation is:

• a feeling of tightness or heaviness in the chest;
• pain radiating to the arms, back, neck, and jaw;
• very pale, blue, or gray lips and skin — on dark skin this is more noticeable on the palms;
• cough for three weeks or longer, blood in the sputum;
• swelling of the ankles, palpitations, pain or swelling of one leg, nausea.

When shortness of breath requires an urgent visit to a doctor

A routine visit is needed if shortness of breath worsens with usual activities or in a lying position, if swelling of the ankles has been added to it, if a cough does not go away for three weeks or longer. The doctor assesses breathing and the history of complaints, and if necessary prescribes examinations: arterial blood gas analysis, spirometry, lung function tests, bronchoscopy, sputum culture. The choice of treatment depends on the cause, so self-diagnosis does not work.

Shortness of breath by itself is not a reason to call an ambulance; 103 or 112 — if a person is gasping, choking, or cannot say a word, if there is tightness or heaviness in the chest, pain radiates to the arms, back, neck, and jaw, the lips or skin have become very pale, blue, or gray, or sudden confusion has appeared. In a child — if they make grunting sounds, pull the abdomen in under the ribs, turn blue, are suddenly agitated, or go limp and do not respond.

This material is for reference: it names possible causes and guidelines, but does not replace consultation with a doctor, who sees the person, not a list of symptoms.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer