Breathlessness

Overview

Breathlessness, or dyspnea, refers to an uncomfortable awareness of breathing or a sensation of not getting enough air. It is a symptom rather than a disease and can range from mild shortness of breath during exertion to severe difficulty breathing even at rest. Breathlessness can be acute (sudden onset) or chronic (persistent over time) and often signals underlying respiratory, cardiac, or systemic conditions that require medical attention. 

Commonly Associated

• Asthma 

• Chronic obstructive pulmonary disease (COPD) 

• Pneumonia 

• Heart failure 

• Pulmonary embolism 

• Anemia 

• Anxiety disorders 

• Obesity and deconditioning 

Causes of Breathlessness 

The causes of breathlessness vary widely and may involve the lungs, heart, blood, or systemic conditions: 

• Respiratory conditions: Asthma, pneumonia, COPD, pulmonary fibrosis, or pleural effusion reduce lung capacity or airflow. 

• Cardiac conditions: Heart failure or arrhythmias impair blood circulation and oxygen delivery. 

• Vascular causes: Pulmonary embolism or pulmonary hypertension block or restrict blood flow to the lungs. 

• Hematologic causes: Severe anemia reduces oxygen-carrying capacity of the blood. 

• Metabolic causes: Acidosis or thyroid disorders can increase breathing rate and demand. 

• Psychological causes: Anxiety and panic attacks can cause rapid breathing (hyperventilation). 

Symptoms of Breathlessness 

Symptoms may vary depending on the underlying cause but commonly include: 

• Feeling of shortness of breath or air hunger 

• Rapid or shallow breathing 

• Tightness or heaviness in the chest 

• Wheezing or noisy breathing 

• Inability to complete sentences without pausing for breath 

• Bluish lips or fingers (cyanosis) in severe cases 

Exams & Tests for Breathlessness 

A thorough evaluation is essential to identify the underlying cause: 

• Physical examination: Observing breathing rate, chest movement, and oxygen saturation. 

• Pulse oximetry and arterial blood gas: Measure oxygen and carbon dioxide levels. 

• Chest X-ray or CT scan: Detect infections, fluid, or structural lung disease. 

• ECG and echocardiography: Assess heart function and rule out cardiac causes. 

• Spirometry: Evaluates lung capacity and airway obstruction. 

• Blood tests: Check for anemia, infection, or metabolic abnormalities. 

Treatment of Breathlessness 

Treatment depends on the cause and severity of symptoms: 

• Asthma/COPD: Inhalers (bronchodilators, corticosteroids) to improve airflow. 

• Heart failure: Diuretics, ACE inhibitors, or beta-blockers to improve cardiac function. 

• Infections: Antibiotics or antivirals to treat pneumonia or respiratory infections. 

• Pulmonary embolism: Anticoagulants to dissolve blood clots. 

• Anemia: Iron supplements, blood transfusion, or treatment of underlying cause. 

• Anxiety-related: Breathing techniques, relaxation therapies, or medication. 

• Oxygen therapy: For severe or chronic breathlessness with low oxygen saturation. 

Source – Breathlessness 

• National Heart, Lung, and Blood Institute (NHLBI) – Breathlessness Overview 

• NHS UK – Breathlessness and shortness of breath