What is Dyspnea?
Dyspnea, also known as shortness of breath, is an uncomfortable feeling when you’re struggling to breathe. This feeling can be different for each individual and can be very intense for some. It’s a common issue that affects millions of people and can be a leading symptom of respiratory, heart diseases, nerve or muscle problems, psychological issues, general body disorders, or a mixture of these. Dyspnea can be short-term, happening over a few hours or days, or long-term, lasting for more than 4 to 8 weeks.
What Causes Dyspnea?
Dyspnea, or difficulty breathing, is a symptom rather than a disease on its own. It can be caused by a variety of factors that can be grouped into four main categories: respiratory, heart-related, neuromuscular, psychological, other systemic illnesses, or a combination of these.
Respiratory causes of dyspnea can include asthma, severe flare-ups of chronic obstructive pulmonary disorder (COPD), pneumonia, blood clots in the lungs, lung cancer, punctured lungs, or choking.
Heart-related causes can include congestive heart failure, fluid buildup in the lungs, acute coronary syndrome, the heart being unable to pump properly due to the fluid around it, heart valve defects, high blood pressure in the lungs, heart rhythm disorders, or internal heart blood leaks.
Neuromuscular causes can be due to injuries like chest fractures, extreme obesity, abnormal curvature of the spine, nervous system or spinal cord problems, paralysis of the phrenic nerve, muscle diseases, or nerve diseases.
Psychological causes can be due to hyperventilation syndrome, psychogenic breathlessness, abnormal functioning of the vocal cords, and choking on foreign objects.
Other systemic illnesses that can cause dyspnea include anemia, acute kidney failure, metabolic acidosis, thyroid disorder, liver cirrhosis, severe allergic reactions, blood infection, swelling beneath the skin, and inflammation of the epiglottis.
Risk Factors and Frequency for Dyspnea
The number of people suffering from dyspnea, or shortness of breath, can greatly vary based on what’s causing the condition.
Signs and Symptoms of Dyspnea
When looking at an individual’s medical history and conducting a physical exam, it is critical to check if there is any ongoing heart, lung, bone and joint, or mental health issues. It is essential to know when the symptoms started, how long they have been going on, and whether they occur at rest or during physical activity. A cough could suggest conditions like asthma, COPD (a long-term lung disease that makes breathing difficult), or pneumonia (which is an infection of the lungs).
Serious throat pain could indicate an inflamed epiglottis (a flap at the base of the tongue that keeps food from going into the windpipe). Chest pain that gets worse when you take a deep breath or cough could suggest various conditions such as inflammation of the heart lining, lung blood clot, collapsed lung, or pneumonia. Night-time shortness of breath, swollen feet or ankles, and waking up gasping for air are signs that may point towards congestive heart failure (a chronic condition in which the heart doesn’t pump blood as well as it should). Smoking increases the risk of developing certain diseases like COPD, congestive heart failure, and lung blood clots.
Discomfort or difficulty in swallowing could suggest disorders related to stomach acid reflux (where the stomach acid frequently flows back into the tube connecting your mouth and stomach) or aspirating stomach secretions into the lungs. A harsh, barking cough in children might be a sign of croup, a common respiratory problem in younger children that causes a barking cough and hoarseness, and fever usually hints at an infection.
- Onset, duration, and triggers of symptoms
- Cough
- Serious throat pain
- Chest pain on deep breathing or coughing
- Shortness of breath at night
- Swollen feet or ankles
- Smoking history
- Discomfort or difficulty in swallowing
- Harsh, barking cough in children
- Fever
In the physical examination, it’s important to quickly check the airway, breathing, and blood flow (known as the ABCs). After confirming the patient’s stability, a more thorough examination can be conducted. This entails observing the patient’s respiratory effort, usage of additional muscles to breathe, mental state, and ability to speak. Swollen neck veins could indicate a strain on the right side of your heart due to conditions such as severe COPD, congestive heart failure, or fluid buildup in the space around your heart. Enlarged thyroid may suggest overactive or underactive thyroid. A shift in the location of the windpipe could suggest anatomical abnormalities or a collapsed lung.
Listening for a high-pitched sound made during breathing (stridor), unique sounds made while tapping on the chest (percussing), and the presence of air or fluid under the skin can all help to diagnose different conditions. Abnormal sounds heard during a lung examination, variances in heart rhythms, abnormal heart sounds, and signs of heart failure or bloating in the abdomen could all be suggestive of different health conditions. Swelling in the legs could indicate heart failure or deep vein thrombosis (a blood clot in a deep vein, usually in the leg), which could potentially lead to lung blood clot. Clubbing of fingers or toes, where they become wide and thick, and bluish color change in extremities from lack of oxygen, are also examined.
- Observing airway, breathing, and circulation (ABCs)
- Checking for respiratory distress
- Looking for swollen neck veins
- Examining the thyroid and tracheal positioning
- Listening for high-pitched sound made during breathing (stridor)
- Examining chest by tapping (percussing) and palpation for presence of air or fluid under the skin
- Listening for abnormal lung and heart sounds
- Symptoms and signs of heart failure
- Examining for abdominal bloating, legs swelling, clubbing of fingers or toes, and bluish color change in extremities due to oxygen deficiency
Testing for Dyspnea
When a patient gets examined, the first step is to assess the person’s ABC status, which stands for Airway, Breathing, and Circulation. If these are stable and there’s no immediate danger, the doctor can proceed with a detailed history and physical exam. They’ll also check vital signs such as heart rate, breathing rate, body temperature, body mass index, and oxygen levels. A fever could indicate that the patient has an infection.
If the patient has difficulty breathing, a chest x-ray is the first test doctors typically resort to. If the x-ray shows something unusual, it’s usually due to a heart problem or lung disease. An echocardiogram and an electrocardiogram will be required to check the heart’s functioning. If there’s a high level of a heart hormone called pro-BNP, it may indicate heart failure. If the X-ray is normal, lung function gets tested via a technique called spirometry.
This test can help determine whether the patient has an obstructive disease (like asthma or COPD), restrictive disease (like fibrosis), or muscle weakness because of muscular or neurological issues. If the spirometry is normal, doctors will need to look for other causes of low oxygen levels or hypoxia. They may perform arterial blood gas testing for this.
If the oxygen level is less than 70 mm Hg, a V/Q scan may be performed. This test can help identify a pulmonary embolism, a blocked blood vessel in the lungs. CT scans of the chest can also help here. If no issues are found, doctors might look for high blood pressure in the lungs or heart issues using a procedure called cardiac catheterization.
If oxygen levels are okay but the oxygen saturation is abnormal, it might hint towards carbon monoxide poisoning or an unusual hemoglobin molecule. Also, if there are no issues with oxygen saturation, a complete blood count test would be done to measure the amount of hemoglobin and the percentage of red blood cells, among other things. A lower than 35% hematocrit value is considered as anemia.
If the cause of the breathing problem is still unclear, doctors might do exercise pulmonary function tests. If these tests are okay, the reason for the patient’s symptoms could be physical deconditioning, psychogenic dyspnea (breathing difficulty due to anxiety or panic), or a hypermetabolic state (increased metabolism).
If an infection is suspected, a sample of the germ causing the illness may be grown in the lab for further examination. Depending on where the infection is, this sample might be collected from a person’s sputum (mucus that’s coughed up), blood, or lung washings.
Diagnostic tests should be selected carefully based on the patient’s history and symptoms in order to avoid unnecessary procedures and costs.
Treatment Options for Dyspnea
Acute dyspnea, or sudden breathing difficulty, often signals a serious health concern that needs immediate treatment. It’s essential to provide these patients with additional oxygen, measure their heart rate with a pulse oximeter, and monitor their heart’s functioning. Treatment should commence based on the suspected or confirmed cause of this breathing difficulty. If their breathing is dangerously failing, doctors should not hesitate to insert a breathing tube into the patient’s windpipe. Tests to understand the exact problem should be conducted once the patient is stable.
What else can Dyspnea be?
When you suddenly find it hard to breathe (this is called acute dyspnea), it could be due to a variety of health issues. These could range from heart-related problems like acute heart muscle damage or heart failure, to lung issues like bronchospasms (tightening of the muscles that line the airways), lung blood clot, a collapsed lung, or a lung infection from bronchitis or pneumonia. Acute dyspnea could also result from a blocked airway due to choking on something or a severe allergic reaction.
On the other hand, if you’ve been finding it hard to breathe for a long time (chronic dyspnea), it could be due to conditions such as asthma, chronic obstructive pulmonary disease (a type of lung disease), interstitial lung disease (a group of disorders that cause scarring of your lungs), heart muscle dysfunction, being overweight, or being out of shape.
What to expect with Dyspnea
Dyspnea, or shortness of breath, isn’t harmful on its own. It’s important to remember though, it’s a symptom rather than a disease itself. That said, how it impacts an individual really depends on the root cause of the dyspnea and the specific characteristics of the patient, like age or overall health.
