Dyspnea (Shortness of Breath)

What Is Dyspnea (Shortness of Breath)?

Dyspnea, commonly described as shortness of breath or “air hunger,” is a subjective symptom, meaning it is based on how breathing feels rather than a single measurable test. You may feel short of breath even when oxygen levels are normal. Dyspnea can range from mild discomfort during activity to a severe sensation of not getting enough air. According to the journal Respiratory Medicine, approximately 10% of the U.S. population (Opens in a new window) is affected by dyspnea.

Dyspnea may be acute or chronic. Acute dyspnea develops suddenly over minutes to days and may signal a medical emergency. Chronic dyspnea lasts weeks or longer and is often linked to underlying heart or lung disease. In all cases, the goal of care is to identify the cause and relieve symptoms so breathing feels comfortable again.

Sudden dyspnea or a rapid feeling of intense air hunger may indicate a medical emergency. Call 911 if you experience severe or rapidly worsening symptoms. Prolonged dyspnea can lead to confusion, weakness, and an increased risk of falls.

Causes

Dyspnea may indicate that something is not working right. It may be caused by a tumor blocking an airway or replacing part of your lung, fluid in or around the lungs (edema, pleural effusion), blocked blood flow in the major blood vessels to the heart (superior vena cava syndrome), blood clots in your lungs (pulmonary emboli), pneumonia or another respiratory infection, anemia (low red blood cell count), or hyperventilation due to anxiety, or obesity. It is also common during pregnancy. 

There are many possible other causes for dyspnea, including:

• Chest injuries/trauma/lung collapse
• Chronic lung diseases
• Emotional distress, anxiety
• Extreme weather conditions (such as cold)
• Heart disease, coronary disease, and other heart conditions such as valvular disease
• Heart failure (both with and without a normal pump function)
• High altitude exposure
• Obstruction of the air passages of the nose, mouth, throat from allergies, congestion, foreign objects, etc.
• Obesity
• Pulmonary hypertension
• Severe bronchospasm or asthma
• Strenuous exercise (especially when you don't exercise regularly)

Signs & Symptoms

Symptoms of dyspnea can include the following:

• Difficult or labored breathing
• Feeling of suffocation or smothering
• Inability to get enough air
• Exercise intolerance
• Tightness or pains in the chest

You should consider calling your doctor any time you are concerned about your breathing. Call your doctor if you are experiencing persistent shortness of breath in the following circumstances:

• If you experience shortness of breath from slight exertion or when you're resting
• If you experience shortness of breath when you are sleeping
• If you have new swelling in your feet or ankles
• If your shortness of breath gets worse when you exercise
• If your shortness of breath includes chest pain and a dry cough
• If your shortness of breath is accompanied by wheezing
• If your shortness of breath is accompanied by a high fever, chills and cough

Do not drive yourself to the hospital if you experience chest pain and shortness of breath. Call 911.

Diagnosis

A complete medical and exposure history is essential for diagnosis. Your doctor will conduct a complete physical exam and ask you questions about your lifestyle, including your family history, your job, your habits, your hobbies, your current medications and your symptoms. When dyspnea is suspected, your doctor may have you do a number of tests.

Breathing and Exercise Tests

Pulmonary function tests: Pulmonary function tests provide a more in-depth measure how well you are breathing, as they combine spirometry with measurements of lung volumes and ability of the lung to transfer inhaled gases from the air into the bloodstream. The results of pulmonary function testing can help your doctor determine the cause of your dyspnea. 

Exercise Testing: An exercise test requires a patient to exercise on a treadmill or bicycle, sometimes with EKG and blood pressure monitoring. Measurements are taken to determine the response of the heart and lungs to physical activity.

Imaging Tests

Chest X-rays: A chest X-ray is a picture of the inside of the chest, used to evaluate the lungs, heart, and other structures of the chest.

CT scan of the chest: A CT or CAT scan is a shortened name for computerized tomography. During a CT scan of the chest, detailed pictures are taken of cross sections or slices of the thoracic structures in your body. Thoracic structures include your lungs, heart and the bones around these areas. Sometimes intravenous contrast is administered to better see the blood vessels in the lung.

Echocardiography: An ultrasound of your heart can be done to determine heart and valvular function, along with other problems affecting your heart.

Coronary evaluation: This can often be done with exercise stress testing, nuclear stress testing, or cardiac CT angiography. This allows your clinicians to check the blood supply to your heart.

Lab Tests

Blood tests: Blood tests can help determine if you have a condition, such as heart disease, blood clots, or metabolic issues that may be causing your dyspnea.

Diagnostic Procedures

Electrocardiogram: An electrocardiogram (EKG or ECG) is a non-invasive test that reads electrical signals from your heart as it contracts and relaxes. By monitoring your heart’s rhythm, doctors are able to look for signs of abnormalities or damage, which could be producing dyspnea. 

Right Heart Catheterization: This allows your clinical team to measure pressures and pump function inside of your heart and is a low risk minimally invasive procedure that can provide a wealth of information in cases of dyspnea that are difficult to sort out. It is commonly done when shortness of breath may be stemming from a heart issue.

Dyspnea Scale

Your doctor may ask you to rate your breathlessness on a scale similar to the one below.

1. No dyspnea except with strenuous exercise
2. Dyspnea when walking up an incline or hurrying on a flat surface
3. Walks slower than most on a level surface, or stops after 15 minutes of walking
4. Stops after a few minutes of walking on the level
5. Dyspnea with minimal activity such as getting dressed, cant' leave the house

Sometimes dyspnea is difficult to diagnose. If your condition is complicated, you may need to see specialists who focus on the heart and lungs. Your doctor should design a treatment plan for your specific needs.

Treatment

Treatment of dyspnea often focuses on the underlying cause of your shortness of breath. Your breathing can be affected by a number of physical or psychological issues. If you feel consistently short of breath, or if you have a severe episode, it’s important to seek medical attention.

Medications

Your doctor may prescribe medications to ease the work of breathing, open airways, and remove fluid buildup in your lungs. Inhaled drugs called bronchodilators can lead to your airways being more relaxed and can help with dyspnea or conditions such as COPD or asthma, which may be the root cause.

Additionally, medications to relieve pain or anxiety may help with breathlessness, if your dyspnea is the result of a psychological condition. In some cases, your doctor may recommend using supplemental oxygen to improve your ability to breathe.

Lifestyle Management

In many cases your dyspnea can be managed, improved, or cured by adopting different lifestyle habits.

Habits to Adopt

• Open a window to increase air circulation and cool your room.
• Place a small fan nearby to increase air circulation and create a breeze blowing across (not directly at) your face.
• Practice pursed-lip breathing to improve ventilation, release trapped air and promote relaxation.
• Try relaxation therapy, massage, or guided meditation to slow your pace of breathing.
• Exercising regularly may reduce these symptoms.

Habits to Avoid

• Alcohol and caffeine.
• Smoking and spending time in smoke-filled rooms.
• Respiratory irritants, such as pollen and other allergens.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with dyspnea have access to clinical trials and should speak with their physician to determine what trials might work best for them.

See a Specialist

It’s important to be evaluated by a pulmonologist who specializes in dyspnea if you or a loved one:

• Is experiencing shortness of breath
• Would like strategies to help improve your shortness of breath

At National Jewish Health in Denver, Colorado, we treat thousands of patients a year with breathing issues like dyspnea. Learn more about our Respiratory Program, or use the button below to make an appointment.