Why you shouldn’t ignore shortness of breath

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young woman breathing  
Do you ever find yourself getting winded from walking up two flights of steps? Or, do you ever find yourself gasping for air while walking down the block, or worse, just trying to walk across the room?
 
Don’t ignore shortness of breath – it’s your body trying to tell you something isn’t right.
 
Shortness of breath can be caused by many things, ranging from common and benign such as deconditioning (in other words, being out of shape) to life-threatening. 
 
Shortness of breath can be due to difficulties in:
  • getting air into the throat or lungs
  • getting air out of the lungs or throat
  • transferring oxygen from the lungs into the bloodstream
  • pumping oxygenated blood through the body
  • acid/base balance, sometimes related to medications, kidney dysfunction, severe infection, or other metabolic problems
  • anxiety
Why is shortness of breath dangerous?
 
Shortness of breath can be a symptom of multiple potentially life-threatening conditions, including pneumonia, heart attack, pulmonary embolism (blood clot in the lungs), sepsis (severe reaction to infection), pneumothorax (collapsed lung), and others.
 
It can also provoke anxiety, which can worsen some causes of shortness of breath.
 
Many conditions can cause breathing difficulties, including:
  • Lung diseases such as asthma, emphysema or pneumonia
  • Problems with your trachea or bronchi (parts of your airway system)
  • Heart disease, which can make it hard for you to pump enough blood to supply oxygen to your body
  • Conditions that cause damage or weakness to the nerves or muscles that control breathing  
How can it be treated? 
 
Treatment of shortness of breath depends entirely on the cause. For example, if you have pneumonia, antibiotics are the treatment.
 
If you have chronic obstructive pulmonary disease (COPD)/emphysema and asthma, inhaled medications that open constricted airways can help. 
 
If you’re suffering heart failure, diuresis that will cause you to urinate off excess fluid is often the treatment. 
 
If you’re having a heart attack, getting blood flowing to the heart muscle again as soon as possible is critical. 
 
If you’re having problems with vocal cords interfering with breathing, sometimes speech therapy or surgery can be necessary. Airway collapse or airway blockages can sometimes be treated with stents or surgeries. 
 
If you’re having nerve or muscle issues that cause weakness of the breathing muscles, sometimes a breathing support machine (CPAP or BiPAP or even a ventilator) can be necessary.
 
If oxygen levels are low enough, giving oxygen can help. If levels are normal, though, giving oxygen can actually cause harm. Several small research studies have found that sometimes using a fan can help a person to feel less short of breath. 
 
For patients who are near the end of life, small doses of opioid medications can help relax the blood vessels in the lungs and can ease the brain’s sensation of shortness of breath.
 
When should you seek medical help? 
 
If your shortness of breath is worsening, and especially if it’s keeping you from doing things you used to be able to do, see your doctor. Here are some signs of shortness of breath that you shouldn’t ignore: 
 
  • Chest pain or pressure, especially during or immediately after exertion
  • High fever, chills, and cough
  • Coughing up significant amounts of blood (more than a tablespoon or two in a day, and especially increasing amounts)
  • Lips or fingertips turning blue
  • Wheezing – abnormal whistling type sound when you breathe in or out
  • Stridor – a high pitched noise that occurs with breathing
  • Worsening of pre-existing shortness of breath after using your inhalers
  • Breathlessness that does not go away after 30 minutes of rest
  • Feeling lightheaded, like you might lose consciousness
  • Swelling in your feet and ankles (new or significantly worsening)
  • Trouble breathing when you lie flat (worsening)
 All of these can be signs of severe problems that could be life-threatening.
 
If your shortness of breath is with any of the do-not-ignore signs above, call your doctor immediately or seek emergency care. However, those with swelling or shortness of breath when lying flat without any other danger symptoms may not need emergency care.
 
What are the risk factors?
 
In developed nations, cigarette smoking is the biggest risk factor for developing emphysema and COPD. 
 
Asthma is often, but not always, associated with allergies. Heart disease and heart failure are associated with obesity, poor diet, cigarette smoking, lack of exercise, diabetes, hypertension, family history and high cholesterol levels. 
 
Pneumonia can happen to anyone, but especially the very young and very old, and those with compromised immune systems.
 
Pneumothorax (collapsed lung) typically happens after chest trauma, but it can also happen spontaneously in people whose lungs have abnormal areas already, such as emphysema or cystic lung diseases.
 
Pulmonary embolism (blood clot in the lungs) is often associated with immobility (long car or plane rides, or prolonged hospital stays), or sometimes leg trauma. It’s also more common in conditions that cause blood to clot more easily, such as cancer, and in some hereditary clotting disorders.
 
What is pulmonary rehabilitation?
 
Pulmonary rehabilitation is a multifaceted program designed to help patients with any lung disease improve and maintain mobility and endurance, improve their nutrition, quit smoking if applicable, and cope with their lung disease. 
 
It’s often recommended to start at three days a week for 12 weeks, and is followed by a maintenance program, but the frequency and duration can be adjusted to meet the patient’s needs. Pulmonary rehab can make a tremendous difference in patients’ lives.
 

Lauren Goodman specializes in pulmonary, critical care and palliative medicine at Ohio State's Wexner Medical Center. 

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