Shortness of Breath
What is shortness of breath?
Shortness of breath is a common symptom of allergy, infection, inflammation, injury, or certain metabolic conditions. The medical term for shortness of breath is dyspnea. Shortness of breath results when a signal from the brain causes the lungs to increase breathing frequency. Shortness of breath may come on suddenly, within seconds; or, it may occur over days, weeks or months. Severe shortness of breath can be frightening. You may feel like you're being suffocated, with a tight chest and a feeling of ‘air hunger’—that you can't take in the air that you need.
You may experience shortness of breath because of conditions affecting the lungs, the entire pulmonary system, or in association with more generalized conditions, such as obesity or low blood pressure (hypotension).
Sometimes shortness of breath has common, relatively non-serious causes, such as following a bout of intense exercise. Shortness of breath in pregnancy is also a common and usually harmless condition, which occurs most often in early and late pregnancy due to hormones and other factors related to the growing baby. Other times, being short of breath indicates a severe condition requiring medical attention.
Inflammation of the lungs and bronchial tubes are common causes of shortness of breath, as is injury to the respiratory tract caused by smoking or other toxins. Shortness of breath may occur with injury to the lungs, such as a collapsed lung (pneumothorax).
Allergic asthma reactions lead to shortness of breath, which can be severe and even life-threatening. Most, if not all lung diseases involve shortness of breath and, in rare cases, shortness of breath may present as a symptom of serious infections of the lungs or bronchial tubes. Shortness of breath can also be an indication of lung cancer, especially if accompanied by hemoptysis (coughing up blood).
Numerous heart conditions that lead to low oxygen levels in the blood (hypoxia) also result in shortness of breath. Depending on the cause, you may experience shortness of breath only while lying down or when either lying down or sitting up. Congestive cardiac failure may be accompanied by shortness of breath in addition to other symptoms, including pink, frothy mucus, rapid breathing (tachypnea), wheezing, and rapid heartbeat.
Seek immediate medical care (call 911) if you have shortness of breath accompanied by any life-threatening symptoms, including bluish coloration of lips; fingernails or skin; confusion or loss of consciousness for even a brief moment; high fever (higher than 101 degrees Fahrenheit); sudden swelling of the face, tongue or lips; chest pain or pressure; or rapid heart rate (tachycardia).
If your shortness of breath persists, worsens, or causes you concern, seek prompt medical care.
What other symptoms might occur with shortness of breath?
Shortness of breath may accompany other symptoms, which can vary depending on the underlying disease, disorder or condition. Symptoms known to commonly affect the respiratory system may also involve other body systems.
Respiratory symptoms that may occur along with shortness of breath
Shortness of breath may accompany other symptoms affecting the respiratory system including:
- Cough that gets more severe over time
- Coughing up blood (hemoptysis)
- Coughing up clear, yellow, light brown, or green mucus
- Stuffy nose or nasal congestion
- Wheezing (whistling sound made with breathing)
Cardiovascular symptoms that may occur along with shortness of breath
Shortness of breath may accompany symptoms related to the cardiovascular system including:
- Bluish coloration of the lips, fingernails or skin (cyanosis)
- Chest pain or pressure
- Irregular heart beat (arrhythmia)
- Rapid heart rate (tachycardia)
Serious symptoms that might indicate a life-threatening condition
In some cases, shortness of breath may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:
- Bluish coloration of the lips, fingernails or skin
- Chest pain or pressure
- Confusion or loss of consciousness for even a brief moment
- Heart palpitations
- High fever (higher than 101°F)
- Rapid heart rate (tachycardia)
- Sudden swelling of the face, lips or tongue
What causes shortness of breath?
Common causes of shortness of breath include asthma, allergic reactions, COPD (chronic obstructive pulmonary disease), infections (such as viral or bacterial pneumonia), and obesity. Cardiovascular conditions, such as an abnormal rhythm (arrhythmia), heart attack and heart failure, can cause shortness of breath, but usually along with other symptoms.
Categories of shortness of breath causes include respiratory, cardiovascular, life-threatening, acute, chronic, and other, with some overlap between them.
Respiratory causes of shortness of breath
Shortness of breath may be caused by respiratory conditions including:
- Airway obstruction
- Asthma and allergies
- Bronchiolitis (inflammation of the small airways known as bronchioles) or bronchitis
- Bronchiectasis (dilation of the airways)
- Empyema (accumulation of pus around the lungs)
- Hemothorax (blood in the lung)
- High altitude
- Infection such as COVID-19
- Inhalation injury
- Lung cancer
- Pneumothorax (collapsed lung)
- Pulmonary edema
- Pulmonary embolism (blockage of a pulmonary artery due to a blood clot)
- Pulmonary fibrosis (interstitial lung disease)
- Tuberculosis (serious infection affecting the lungs and other organs)
Cardiovascular causes of shortness of breath
Shortness of breath can also be caused by cardiovascular disorders including:
- Arrhythmia (irregular heart beat)
- Cardiogenic shock (shock caused by heart damage and ineffective heart function)
- Cardiomyopathy (weakened or abnormal heart muscle and function)
- Cardiovascular disease (due to atherosclerosis, or hardening of the arteries, or other causes)
- Congenital heart defects
- Congestive heart failure (deterioration of the heart’s ability to pump blood)
- Heart attack
Other causes of shortness of breath
Shortness of breath can also have other causes including:
- Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)
- Fluid overload
- Kidney or liver failure
- Pregnancy (more likely in the first and third trimesters)
- Sepsis (life-threatening bacterial blood infection)
Causes of sudden (acute) shortness of breath
When you feel short of breath over hours to days, some common causes include:
- Airway obstruction
- Asthma (bronchospasm)
- Carbon monoxide poisoning
- Low blood pressure
Causes of chronic shortness of breath
When shortness of breath occurs over days to weeks and lasts longer than 4 to 8 weeks, some common causes include:
- Cardiovascular conditions such as heart failure
- Poor fitness level (“out of shape”)
- Pulmonary fibrosis
- Pulmonary hypertension
- Lung cancer
Serious or life-threatening causes of shortness of breath
Some causes of shortness of breath are life threatening and should be immediately evaluated in an emergency setting. These include:
- Cardiogenic shock
- Diabetic ketoacidosis
- Pulmonary embolism
When should you see a doctor for shortness of breath?
You should always see a doctor for shortness of breath, unless it’s a minor, one-time event or tied to intense exercise and goes away when you are at rest.
Shortness of breath with any of these symptoms might be signs of a life-threatening condition. Seek immediate care, including calling 911 if necessary, if you have:
- Bluish coloring in your lips, fingernails or skin
- Loss of consciousness, even if it's very brief
- Rapid heart rate
- Severe shortness of breath that comes on suddenly and makes it difficult to function
- Sudden swelling of your face, lips or tongue
See a doctor promptly
Some worrisome symptoms that you should bring to your doctor's attention include:
- Trouble breathing when lying flat
- Waking up in the night with shortness of breath
- Experiencing shortness of breath with daily activities
- Having shortness of breath along with swelling in your feet or ankles
- Feeling short of breath or wheezing along with a high fever, chills and cough
- Breathlessness that doesn't go away after resting for 30 minutes
Your primary care physician can address your shortness of breath concerns, but also may refer you to a specialist. Doctors who specialize in lung conditions are pulmonologists. If your shortness of breath is related to heart problems, you may need to see a cardiologist.
Whichever health professional you choose, it's important not to deny or downplay symptoms, especially regarding something as potentially serious as shortness of breath. Your doctor can answer your questions and provide treatment to help relieve your symptoms.
How do doctors diagnose the cause of shortness of breath?
Diagnosing the cause of shortness of breath brings you a step closer to relief, as treatment depends on the underlying problem. Your doctor will listen to the sound of your lungs and heart with a stethoscope, check your oxygen levels, then perform a more comprehensive physical exam.
Your doctor will take a detailed medical history and ask you questions to learn more about your symptoms, such as how long you’ve been experiencing breathing difficulties and if it comes and goes or is constant.
Questions for diagnosing the cause of shortness of breath
In order to diagnose your condition, your healthcare provider will ask you a series of questions related to your shortness of breath including:
- What does it feel like when you breathe?
- How long have you felt shortness of breath?
- Do you have any other symptoms?
- What medications are you taking?
- Do any particular activities cause you to feel short of breath?
- How much exercise can you do before you become short of breath?
- Does your shortness of breath prevent you from performing your normal activities?
- Are you experiencing any other symptoms, such as chest pain or nausea?
Tests and procedures
In-office tests and other procedures to evaluate your lungs and heart and diagnose the underlying cause include:
- Blood tests to look for markers of inflammation or disease
- Breathing and pulmonary function tests, such as spirometry to measure your lung function
- Chest X-ray and other imaging tests, such as MRI (magnetic resonance imaging) or CT (computed tomography)
- Echocardiogram (ultrasound of your heart) to evaluate heart structure and function
- Stress test to evaluate heart function during exercise
It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.
How is shortness of breath treated?
Treating the underlying cause of shortness of breath can usually improve your symptoms. In most cases, the cause is short-lived, not serious, and there is an effective treatment strategy. Examples include respiratory infections and allergies.
Depending on the cause and severity of dyspnea, medical interventions may include:
- Breathing exercises
- Breathing treatments with a nebulizer
- Bronchodilators, including asthma and COPD inhalers
- Heart medicine
- Pulmonary rehabilitation with a respiratory therapist
- Supplemental oxygen
- Surgery and minimally invasive procedures
Shortness of breath treatment at home
To ease your shortness of breath or keep it from getting worse, there are several self-care steps including:
- Address any other medical problems you have that may be contributing to your shortness of breath.
- Increase the amount of cool air around you, such as using a fan or cool mist humidifier or by sitting near an open window (if the outside air is cool).
- If you are at elevations above 5,000 feet, use caution or avoid exerting yourself.
- Keep any supplemental oxygen you may use well-stocked and in working order.
- Lose weight if you are overweight. Ask your doctor for guidance on safe methods of weight loss.
- Stop smoking and avoid tobacco (such as secondhand exposure).
- Stay away from other environmental irritants, like allergens that affect your breathing.
Alternative treatments for breathlessness, such as yoga, mindfulness and acupuncture, are not significantly better than control treatments, according to a review of dyspnea management by the American Thoracic Society. However, alternative treatments may be helpful for specific underlying causes of shortness of breath or in combination with medication, oxygen and other treatments.
What are the potential complications of shortness of breath?
It is vital to seek prompt treatment if you experience shortness of breath as it can be a sign of a serious disease and, left untreated, may put you at risk of serious complications and even permanent damage.
Once your doctor has diagnosed the underlying cause, you should make every effort to follow the recommended treatment plan precisely in order to minimize risk of potential complications including:
- Brain damage from lack of oxygen
- Heart failure
- Progression of symptoms
- Spread of cancer
- Spread of infection