Orthopnea is the medical term used when referring to the occurrence of dyspnea (shortness of breath) when you are lying flat. This symptom is often a sign of heart failure. However, orthopnea can also be due to other health conditions. Dyspnea (shortness of breath) is not the same with orthopnea. People who have dyspnea have shortness of breath regardless of the type of activity they are doing and what position they are in. People who experience orthopnea must be evaluated by a doctor.
Causes of Orthopnea
Orthopnea is due to an increase in the pressure of blood vessels in the lungs. When people lie down, blood flows from the legs back to the heart and lungs. Healthy individuals do not have any problems when it comes to the redistribution of blood. However, those who have heart problems, such as heart failure and other types of heart disease may have problems pumping extra blood out of the heart, leading to an increased pressure in the capillaries and veins inside the lungs. When this happens, fluid may leak out into the lungs, making it difficult to breathe.
In some cases, people experience orthopnea when they have a pulmonary disease, particularly when their lungs produce excessive amounts of mucus. Breathing becomes harder because it is more difficult for their lungs to clear mucus when they lie down.
The following underlying causes of orthopnea are considered serious:
1. Congestive Heart Failure
Also commonly called as heart failure, this condition develops when the heart is unable to properly perform its function to keep up with the body's needs. Its most common symptoms are fatigue and shortness of breath. Although it can be managed by taking medications, surgery, and other types of procedures, the condition is serious with an accompanying risk of death within 5-10 years. Congestive heart failure is usually the end-stage result of heart problems like heart rhythm abnormalities and coronary artery disease.
Pulmonary congestion and pulmonary edema may also occur in people with congestive heart failure and cause shortness of breath. Some may even develop other symptoms, such as wheezing or coughing when lying down.
Asthma is a type of chronic lung disease that causes difficulty breathing along with other symptoms such as coughing, wheezing, chest tightness, and shortness of breath. The symptoms of asthma are primarily caused by the tightening of the airway muscles and constriction, including irritation, soreness, swelling, and inflammation of the airways in the lungs.
Orthopnea is also seen in females who have asthma and who are 60 years old and above. Shortness of breath in people with asthma also tend to get worse when they lie down, particularly at night.
3. Chronic Obstructive Pulmonary Disease (COPD)
COPD is an umbrella term used when describing chronic lung diseases that limit lung airflow. These lung diseases include chronic bronchitis and emphysema. COPD can cause coughing, wheezing, shortness of breath, and chest tightness. Orthopnea caused by COPD usually immediately starts after lying down unlike in heart failure.
When COPD is left undiagnosed and untreated, it can lead to worsening respiratory infections and heart problems, which may progressively lead to death.
4. Gastroesophageal Reflux Disease (GERD)
Another serious cause of orthopnea is gastroesophageal reflux disease (GERD). In this condition, stomach acid flows back up to the tube that connects the mouth and stomach, causing symptoms of discomfort.
Shortness of breath that occurs with GERD happens because the stomach acid that flows back up into the esophagus can also enter the lungs and cause swelling of the airways. It usually happens during sleep and can lead to aspiration pneumonia or asthma reactions.
A variety of changes occur in the normal physiology of respiration due to obesity. These changes include a decreased lung volume, an increase in the depth of ventilation and an increased effort needed to create a normal rate of ventilation. When an obese person lies flat, he or she tends to experience shortness of breath.
Other life-threatening conditions that can cause orthopnea include:
- Pulmonary Embolism - In this condition, the artery in the lungs gets suddenly blocked. The affected lung may get permanently damaged due to an inadequate amount of oxygen to the organs or low levels of oxygen in the blood.
- Restrictive Cardiomyopathy - The function of the heart muscles tends to change because the heart squeezes poorly or fills poorly. Both problems may be present together in some instances.
- Carcinoid Syndrome - This advanced condition is often seen in people with tumors. It can cause breathing difficulties along with other symptoms, such as rapid heartbeat, skin flushing, and diarrhea. It also represents a group of symptoms associated with carcinoid tumors.
- Eisenmenger Syndrome - This is a complication that arises when there is a defect in the heart. It occurs when there is an increased blood flow pressure in the lungs.
Once your healthcare provider diagnoses the main cause of orthopnea, you may be treated using medications, devices, or surgery.
The following are some medications that can help relieve orthopnea in people with heart failure:
- Diuretics: Diuretics are medications that can help prevent fluid buildup in the body. An example of a diuretic is furosemide (Lasix), which can help remove excess fluid in the lungs.
- Angiotensin-converting enzyme (ACE) inhibitors: These medications are usually recommended for those who have left-sided heart failure. These drugs improve the flow of blood and prevent the heart from working harder. Examples of ACE inhibitors include captopril (Capoten), lisinopril (Zestril), and enalapril (Vasotec).
- Beta blockers: These drugs are also prescribed for people who have heart failure. Other types of medications may also be prescribed by your healthcare provider depending on the severity of your heart failure.
For people who have chronic obstructive pulmonary disease (COPD), treatment usually involves taking medications that help relax the airways and reduce lung inflammation. These medications include:
- Bronchodilators - Tiotropium (Spiriva), albuterol (ProAir HFA, Ventolin HFA), salmeterol (Serevent), and ipratropium (Atrovent).
- Inhaled Steroid Medications - Fluticasone (Flovent HFA, Flonase) and budesonide (Pulmicort Flexhaler, Uceris).
- Combination Medications - These drugs are a combination of inhaled steroids and bronchodilators. Examples are salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort).
- Supplemental Oxygen - This might also be given to help you breathe while sleeping.
The outlook may depend on the type of condition that's causing the orthopnea, the severity of the condition, and how the condition is treated. Taking medications and other types of treatments are usually effective when it comes to relieving such symptom and other conditions that cause it, such as COPD and heart failure.