July 23, 2018
Senior man with chest pain

Don't Blow Off Shortness of Breath

by Stephanie Watson

Feeling breathless after a passionate kiss or during the heady rush of a roller-coaster ride can be thrilling. But when you regularly struggle to catch your breath after climbing a few stairs, or your chest tightens with each inhalation, breathlessness becomes a frightening experience.

Shortness of breath—also called dyspnea—goes beyond feeling a little winded after you’ve exerted yourself. Unlike the temporary breathlessness you may feel after engaging in strenuous exercise or traveling to a high altitude, unexplained dyspnea is a symptom that’s usually caused by an acute or chronic medical condition.

People who have dyspnea describe the symptom in different ways, depending on its cause. Sensations may include shallow breathing, chest constriction or tightness, a hunger for more air, a feeling of suffocation, an inability to take a deep breath, heavy breathing, rapid breathing, and an increased effort to breathe.

Acute dyspnea develops quickly within minutes or hours (such as during a heart attack) or over a few days (such as with a respiratory infection) and often requires immediate medical treatment. Chronic dyspnea lasts for four weeks or longer and could signal the presence of a long-term condition such as lung disease. Some people mistakenly chalk it up to a symptom of aging. So, if you or someone you know has been experiencing lingering shortness of breath for a month or more or has experienced recurrent episodes of breathlessness, read on to learn what may be behind the discomfort and what can be done about it.

Causes of acute shortness of breath

Acute shortness of breath comes on quickly, and it can occur along with other symptoms like chest pain or coughing. Possible causes include:

  • A heart attack
  • A severe allergic reaction (anaphylaxis)
  • A respiratory tract infection
  • An asthma attack
  • A blood clot in the lung (pulmonary embolism)
  • A collapsed lung (pneumothorax)
  • Anxiety or a panic attack

If your shortness of breath is accompanied by chest pain or pressure, call 911 immediately.

Common causes of chronic breathlessness

Most often, chronic or recurrent shortness of breath signals a problem with your lungs or heart. Many cases of breathlessness are treatable once the cause of your symptom is diagnosed. You may need to see a pulmonologist, who treats lung and respiratory disorders, or a cardiologist, who treats heart conditions. Treatment depends on the cause, your age, symptom severity, and any coexisting medical conditions. The most common chronic conditions that cause dyspnea include the following.

Chronic obstructive pulmonary disease (COPD) is a lung disorder that involves inflammation and damage to the airways and lung tissue, causing limited airflow. Both forms of COPD—emphysema and chronic bronchitis—often occur together, mostly affecting current and former heavy smokers.

Associated symptoms: Bronchitis typically causes a chronic cough that produces phlegm, whereas a cough caused by emphysema is dry. COPD may also produce wheezing, chest tightness, frequent respiratory infections, and fatigue.

Heart failure occurs when damage to the heart muscle prevents it from pumping enough blood to meet the body’s needs, resulting in shortness of breath, fluid retention, and fatigue.

Associated symptoms: People with heart failure have difficulty breathing, especially while lying flat on their back. They may also wake up at night gasping for air. Fluid retention can cause swelling of the feet, ankles, legs, and sometimes the abdomen. Severe shortness of breath, accompanied by wheezing, coughing, and pink, blood-tinged phlegm, is a sign of pulmonary edema (a buildup of fluid in the lungs). This condition requires immediate medical attention, especially if accompanied by a rapid or irregular heartbeat, chest pain, or fainting—symptoms that could signal a heart attack.

Interstitial lung disease refers to a large group of chronic disorders in which lung tissue is damaged, the walls of the lungs’ air sacs become inflamed, and scarring (fibrosis) begins in the interstitium—tissues within the lungs that provide support to the air sacs. The scarring makes it harder to get enough oxygen into the lungs. Causes range from connective tissue diseases, such as rheumatoid arthritis and lupus, to drugs used for chemotherapy or heart disease, to environmental exposure to toxic materials like asbestos.

Associated symptoms: Other symptoms depend on the underlying cause and can include a persistent dry cough, fatigue, loss of appetite, and weight loss.

Asthma, often thought of as a children’s disease, also strikes older adults. Asthma inflames and narrows the airways, making it difficult to move air in and especially out of the lungs. Triggers like pollen, pet dander, mold, and exercise often set off asthma attacks.

Associated symptoms: Other symptoms may include wheezing, coughing, and chest tightness.

Physical deconditioning—or being out of shape—can cause shortness of breath in people when they try to exercise. Deconditioning is a weakening of the heart and other muscles and decreased heart and blood vessel function as a result of prolonged inactivity. Deconditioning is most common in sedentary older adults.

Associated symptoms: For some unfit people, normal activity such as climbing stairs can cause shortness of breath. Deconditioning can also lead to fatigue.

Obesity can prevent the chest from fully expanding while breathing. Excessive weight around the lungs and in the abdomen that presses against the chest increases the amount of effort needed to breathe, leading to a condition known as obesity hypoventilation syndrome, which in turn can lead to heart failure.

Associated symptoms: People with obesity hypoventilation syndrome often have sleep apnea—also a cause of shortness of breath—and fatigue in addition to dyspnea.

Anemia occurs when the body doesn’t have enough red blood cells to carry an adequate amount of oxygen to tissues and organs to meet the body’s demands.

Associated symptoms: Physical activity brings on shortness of breath; other symptoms may include fatigue, weakness, dizziness or light-headedness, pale skin, and rapid heart rate, especially during exercise.

Other causes of dyspnea include high blood pressure in the lungs’ arteries (pulmonary hypertension), fluid in the chest cavity (pleural effusion), and lung cancer.

When to call 911

Call for emergency medical help if:

  • Your shortness of breath is accompanied by chest pain or pressure, you’re struggling to catch your breath, or you also have symptoms like confusion, night sweats, heart palpitations, or nausea—you might be having a heart attack
  • You are having difficulty breathing and have a fever, a cough, and chest discomfort—you could have a serious infection such as pneumonia
  • Breathlessness comes on suddenly
  • You become breathless while at rest
  • Shortness of breath gets worse with exercise
  • Breathlessness lasts longer than 30 minutes

Always treat sudden and severe difficulty breathing as an emergency. Chronic symptoms like wheezing, coughing, and fatigue warrant an appointment with your doctor. Even if you don’t have other symptoms, you should never ignore prolonged shortness of breath.

This article first appeared in the July 2018 issue of UC Berkeley Health After 50.

7 Tips to Help You Breathe More Easily

The American Thoracic Society suggests taking these steps to help you control breathlessness once your doctor has diagnosed the underlying cause.