Shortness of breath is a subjective feeling of not getting enough air: as if the breath has become short, as if the chest is gripped by a hoop. It occurs with lung diseases, with heart diseases, and against a background of anxiety, which is why a conversation with a doctor begins with a description — when exactly and for how long the air is insufficient.
What shortness of breath is and how it is described
Medicine calls this dyspnea — "disordered breathing": lack of air, difficulty, rapid breathing, or disturbance of the rhythm and depth of breathing. It is one of the most common symptoms in pathologies of the respiratory and cardiovascular systems, as well as in metabolic and psychogenic disorders.
People describe it in everyday terms: as if after climbing stairs you can't catch your breath, as if there is a wheezing in the chest like a kettle before boiling. The doctor clarifies which phase of breathing is difficult: inspiratory — difficult inhalation — occurs with narrowing of the upper airways, foreign bodies of the larynx, tracheal stenosis, heart failure; expiratory — difficult exhalation — with bronchial obstruction and spasm of the small bronchi, in particular in asthma and COPD; mixed — with massive pleurisy or extensive pneumonia.
Sudden and gradual: minutes versus months
Acute shortness of breath develops suddenly, from several minutes to several hours: pulmonary embolism, pneumothorax, acute pulmonary edema, an attack of bronchial asthma, aspiration of a foreign body. Chronic shortness of breath forms gradually — over weeks, months, or years — it is typical of COPD, chronic heart failure, pneumosclerosis, interstitial lung diseases. Limitation of activity due to shortness of breath is assessed by the doctor using the mMRC scale.
When the cause is in the lungs and when in the heart
On the part of the lungs, shortness of breath is caused by asthma, COPD, pneumonia, pleurisy, pneumothorax, emphysema, bronchiectatic disease, tumors. On the part of the heart — heart failure, myocardial infarction, valvular defects, cardiomyopathies, pericarditis. There are also other mechanisms: severe anemia, metabolic shifts, dysfunction of the respiratory center in stroke or trauma.
Hyperventilation syndrome, anxiety disorder, and panic attack also cause a feeling of insufficient air. The doctor considers the psychogenic mechanism alongside pulmonary and cardiac ones, and among common causes also names respiratory tract infection, excess weight, and smoking. Sometimes something more serious lies behind shortness of breath — COPD, lung scarring, heart failure, lung cancer — which is why self-diagnosis does not work.
How it is examined: saturation, spirometry, X-ray
A comprehensive initial examination includes:
- pulse oximetry — determination of SpO2 saturation and detection of hypoxemia;
- plain chest X-ray or CT of the lungs;
- spirometry with a bronchodilator test — assessment of external respiratory function and reversibility of obstruction;
- ECG and echocardiography — left ventricular ejection fraction, pulmonary artery pressure;
- laboratory tests: blood test (hemoglobin), D-dimer to rule out thromboembolism, natriuretic peptides (BNP / NT-proBNP) to differentiate cardiogenic shortness of breath.
When to see a doctor routinely and when immediately
You make an appointment with your family doctor if shortness of breath worsens during usual activities or when you lie down, if it comes together with swollen ankles, if a cough lasts three weeks or longer — then it is time to figure out whether it is still a cold. Seeking help does not mean wasting the doctor's time.
Call 103 or 112 immediately if: breathing is so difficult that the person is gasping, choking, or cannot say a word; the chest is tight or heavy; pain radiates to the arms, back, neck, or jaw; the lips or skin become pale, blue, or gray (on dark skin this is easier to see on the palms); the person is suddenly disoriented. Do not drive yourself — ask someone to take you or call an ambulance.
Shortness of breath that is stronger than usual, nausea or vomiting, coughing up blood, pain or swelling in one leg, a feeling as if the heart is racing against itself — these are reasons to seek medical help urgently.
This text is a reference conversation about breathing, and it does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer