Breathing difficulty may involve:A.D.A.M.

Considerations

No standard definition exists for difficulty breathing. Some people may feel breathless with only mild exercise (for example, climbing stairs), even though they do not have a medical condition. Others may have advanced lung disease but never feel short of breath.

Wheezing is one form of breathing difficulty in which you make a high-pitched sound when you breathe out.

Common Causes

Shortness of breath has many different causes.

For example, heart disease can cause breathlessness if your heart is unable to pump enough blood to supply oxygen to your body. If your brain, muscles, or other body organs do not get enough oxygen, a sense of breathlessness may occur.

Breathing difficulty may also be due to problems with the lungs, heart, airways, or other health problems.

Problems with the lungs:

• Asthma
• Blood clot in the arteries of the lungs (pulmonary embolism)
• Bronchiolitis
• Pneumonia
• Pulmonary hypertension
• Other lung diseases
• Chronic obstructive pulmonary disease (COPD), such as chronic bronchitis or emphysema

Problems with the airways leading to the lungs:

• Blockage of the air passages in your nose, mouth, or throat
• Choking on something stuck in the airways
• Croup
• Epiglottitis

Problems with the heart:

• Heart attack or angina
• Heart defects from birth (congenital heart disease)
• Heart failure
• Heart rhythm disturbances (arrhythmias)

Other:

• Allergies (such as to mold, dander, or pollen)
• Climbing to high altitudes where there is less oxygen in the air
• Compression of the chest wall
• Dust in the environment
• Emotional distress, such as anxiety
• Hiatal hernia
• Obesity
• Panic attacks

Home Care

Sometimes, a small amount of breathing difficulty may be normal and is not cause for concern. A very stuffy nose is one example. Strenuous exercise, especially when you do not exercise often, is another example.

If breathing difficulty is new or is getting worse, it may be due to a serious problem. Though many causes are not dangerous and are easily treated, call your health care provider for any breathing difficulty.

If you are being treated for a long-term problem with your lungs or heart, follow your health care provider's directions to help with that problem.

Call your health care provider if

Go to the emergency room or call the local emergency number (such as 911) if:

• Breathing difficulty comes on suddenly or seriously interferes with your breathing
• Someone completely stops breathing

See your health care provider if breathing difficulty starts suddenly or is severe, or if any of the following occur with breathing difficulties:

• Chest discomfort, pain, or pressure
• Fever
• Shortness of breath after only slight activity or while at rest
• Shortness of breath that wakes you up at night or requires you to sleep propped up to breathe
• Tightness in the throat or a barking, croupy cough
• You have breathed in or choked on an object (foreign object aspiration or ingestion)
• Wheezing

What to expect at your health care provider's office

The doctor or nurse will examine you and ask questions about your medical history and symptoms:

• Do you make grunting or wheezing sounds while breathing?
• Do you have to work hard to breathe?
• How long have you had breathing difficulty?
• Did it slowly progress over weeks to months?
• Did it begin recently?
• Did it begin suddenly?
• Is there a sequence of separate episodes? How long does each last, and does each episode have a similar pattern?
• Has the breathing difficulty gotten worse recently?
• Does breathing difficulty cause you to wake up at night (paroxysmal nocturnal dyspnea)?
• Does the amount of breathing difficulty change over time?
• Does breathing difficulty occur while you are at rest?
• How long does each episode last?
• Is it worse when you lie flat (orthopnea)?
• Is it worse when you change body position?
• Did it develop within 4 to 6 hours after exposure to something that you are or may be allergic to (antigen)?
• Is it worse after exercise?
• Does shortness of breath occur only when you are wheezing?
• Is your breathing pattern irregular?
• Do you draw back the chest muscles with breathing (intercostal retractions)?
• What other symptoms do you have?

Tests that may be done include:

• Blood oxygen saturation (pulse oximetry)
• Blood tests (may include arterial blood gases)
• Chest x-ray
• CT scan of the chest
• ECG
• Echocardiogram
• Exercise testing
• Pulmonary function tests

If the breathing difficulty is severe, you may need to go to a hospital. You may receive many different medicines to treat the cause of breathing difficulty.

If your blood oxygen level is very low, you may need oxygen. High doses of supplemental oxygen may be hazardous for some patients, however. Oxygen is not always needed for shortness of breath.

References

1. Schwartzstein RM, Adams L. Dyspnea. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 28.

Review Date: 5/25/2011.

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.