Alternative names   

Breathlessness; Dyspnea

Definition   

Breathing difficulties involve a sensation of difficult or uncomfortable breathing or a feeling of not getting enough air.

Considerations   

No standard definition exists for difficulty breathing. For some individuals, a sense of breathlessness may occur with only mild exercise (for example, climbing stairs) without an indication of the presence of a specific disorder. Others may have advanced lung disease and difficulty exchanging air but may never feel a sensation of shortness of breath.

In some circumstances, a small degree of breathing difficulty may be normal. Severe nasal congestion is one example. Strenuous exercise, especially when a person does not exercise regularly, is another. In many situations, however, difficulty breathing represents the presence of significant disease and should be evaluated by a health care provider immediately.

Wheezing is one form of breathing difficulty. See also rapid breathing, apnea, and other lung diseases.

Common Causes   

Shortness of breath has many different causes. Obstruction of the air passages of the nose, mouth, or throat may lead to difficulty breathing. Heart disease can cause breathlessness if the heart is unable to pump enough blood to supply oxygen to the body. If the brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur. Sometimes emotional distress, such as anxiety, can lead to difficulty breathing. Specific causes include the following:

• Congestive heart failure (CHF)
• Coronary artery disease
• Asthma
• Emphysema
• Heart attack (myocardial infarction)
• Allergies (such as to mold, dander, or pollen)
• Heart arrhythmias
• Deconditioning (lack of exercise)
• Obesity
• Panic attacks/hyperventilation syndrome

Home Care   

Breathing difficulty, whether sudden or long term, should always be taken seriously. Though many causes are harmless and are easily corrected, any difficulty breathing requires a thorough medical evaluation.

Follow prescribed therapy to treat the underlying cause.

Contact your GP if you are concerned or if you have the above symptoms

Call 111 if:  

Or go to the emergency room or call the local emergency number (such as 111) if difficulty breathing comes on suddenly or seriously interferes with breathing, or if someone completely stops breathing.

Call your provider if any of the following accompany breathing difficulties:

• Chest discomfort
• Shortness of breath after only slight exertion or while at rest
• Shortness of breath that wakes you up at night or requires you to sleep propped up to aid breathing
• Wheezing (may be an indication of asthma or early emphysema)
• Having inhaled or choked on an object (foreign object aspiration or ingestion)
• Tightness in the throat or a barking, croupy cough
• Development of a fever or a significant cough

What to expect with your doctor:

Your health care provider will take a detailed medical history and perform a physical examination.

Medical history questions documenting breathing difficulty may include the following:

• Do you notice shortness of breath?
• Do you make grunting sounds while breathing?
• Do you seem to be having to work hard to breathe?
• How long has the difficulty been present?
• Did it slowly progress over weeks to months?
• Did it begin recently?
• Did it begin suddenly?
• Did it come on slowly (gradual onset)?
• Is there a sequence of separate occurrences (episodes)? How long does each last, and does each episode have a similar pattern?
• Has the breathing difficulty worsened recently?
• Does breathing difficulty cause you to awaken at night (paroxysmal nocturnal dyspnea)?
• Does the amount of breathing difficulty change (variable over hours)?
• Does breathing difficulty occur at rest?
• How long does each episode last?
• Is it worse when lying flat (orthopnea)?
• Is it worse with a change in body position?
• Did it develop within 4 to 6 hours after exposure to something that you are or may be allergic to (antigen)?
• Is it worse after exercise?
• Does shortness of breath occur only when wheezing?
• Is the breathing pattern irregular?
• Do you draw back the chest muscles with breathing (intercostal retractions)?
• What other symptoms are also present?

The physical examination will include a thorough examination of the lungs, heart, and upper airway passages.

Diagnostic tests that may be performed include the following:

• Blood tests including arterial blood gases
• Measurement of blood oxygen saturation (pulse oximetry)
• ECG
• X-ray of the chest
• Pulmonary function tests
• Exercise testing
• CT scan of the chest
• Echocardiogram

In severe cases of difficulty breathing, hospitalization may be required. Many different medications, aimed at treating the cause of breathing difficulty, may be used in treatment.

In situations where the blood oxygen level is significantly low, supplemental oxygen is helpful. High doses of supplemental oxygen may be hazardous for some patients, however, and is not necessary in all cases of shortness of breath.

Update Date: 8/7/2006

Updated by: David A. Kaufman, M.D., Assistant Professor, Division of Pulmonary, Critical Care & Sleep Medicine, Mount Sinai School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.