What is shortness of breath and how does it happen?
Breathing is regulated by the respiratory center, which responds to oxygen and carbon dioxide levels, lung stretch, and signals from muscles. Shortness of breath occurs when the need to breathe exceeds the ability of the lungs, heart, or blood to deliver oxygen. Doctors distinguish between acute shortness of breath, which develops over minutes and hours, and chronic shortness of breath, which increases over weeks and months. The type also matters: with bronchial diseases, it is difficult for a person to exhale; with heart diseases, shortness of breath increases when lying down. The degree of shortness of breath is assessed by how much load a person endures.
- Acute - develops suddenly, requires urgent help
- Chronic - increases gradually
- Expiratory - difficulty exhaling, as in asthma and COPD
- Inspiratory - difficulty breathing, as if the larynx or trachea is narrowed
- Orthopnea - shortness of breath while lying down, relief while sitting
- Nocturnal attacks of suffocation
Possible reasons
The causes of shortness of breath are conventionally divided into pulmonary, cardiac and other. Among the pulmonary diseases are bronchial asthma, COPD, pneumonia, pleurisy, interstitial lung diseases, pulmonary embolism. Cardiac causes include heart failure, coronary artery disease, arrhythmias, and valve defects. Others include anemia, obesity, thyroid disease, kidney failure, and pregnancy. Anxiety and panic attacks cause a feeling of incomplete inspiration, but this diagnosis is made only after heart and lung diseases have been excluded.
- Bronchial asthma and COPD
- Pneumonia, pleurisy, pneumothorax
- Pulmonary embolism
- Heart failure and coronary heart disease
- Heart rhythm disturbances
- Anemia and thyroid disease
- Obesity and detraining
- Anxiety disorder, panic attacks
Associated symptoms
Associated symptoms help distinguish one cause from another. Wheezing and coughing are common in asthma and COPD. Swelling of the legs, weight gain over several days, and the need to sleep on a high pillow indicate heart failure. Shortness of breath along with pressing pain behind the sternum during exercise may be a manifestation of angina pectoris. Fever and cough with sputum accompany pneumonia. Paleness, weakness and palpitations occur with anemia. Tingling fingers and dizziness due to stress are typical of hyperventilation.
- Wheezing, cough
- Swelling of the legs, rapid weight gain
- Pain or pressure behind the sternum with exertion
- Temperature, sputum
- Paleness, brittle nails, hair loss
- Heart palpitations and interruptions
- Numb fingers, feeling of anxiety
What examinations are needed
If shortness of breath gradually increases, you can undergo a scheduled examination. The doctor measures blood oxygen saturation with a pulse oximeter, listens to the lungs and heart, and assesses edema. The basic set includes an ECG, chest x-ray, spirometry and a complete blood count to rule out anemia. Natriuretic peptide testing helps to suspect or exclude heart failure, and echocardiography shows the function of the heart muscle and valves. According to indications, CT scan of the chest, analysis of thyroid hormones, stress tests and daily ECG monitoring are prescribed.
- Pulse oximetry
- ECG
- Chest X-ray
- Spirometry with bronchodilation test
- Complete blood count, ferritin, TSH
- NT-proBNP
- Echocardiography
- CT scan of the chest - according to indications
What to do and how to treat it
In case of sudden shortness of breath, especially with chest pain, cyanosis or confusion, you need to call an ambulance at 103, sit down, unfasten tight clothing and do not be alone. Chronic shortness of breath is treated depending on the cause: for asthma and COPD, inhaled bronchodilators are prescribed, for heart failure - complex therapy, for anemia - iron replacement after determining the cause of the deficiency. The doctor selects the treatment. Quitting smoking, losing weight and regular, feasible physical activity are of great importance.
- Call 103 for sudden or severe shortness of breath
- Treatment of lung or heart disease as prescribed by a doctor
- Quitting smoking
- Weight loss for obesity
- Pulmonary and cardiac rehabilitation
- Regular walking at a manageable pace
- Vaccination against influenza and pneumococcus for chronic diseases