Breathlessness: Causes, Symptoms, and Treatment
An unpleasant sensation of rapid breathing or difficulty breathing is known as breathlessness. People sometimes complain of feeling winded, puffed, or out of breath. Medically, it is called as dyspnea. Breathing may hurt and the person may feel tightness in the chest. It is normal to experience breathlessness, especially when exerting to a great extent such as running to catch a bus. However, sometimes, breathlessness may also indicate a serious health problem.
Breathlessness or difficulty breathing may be suddenly or gradually experienced over a period of time. In breathlessness, the oxygen requirement increases, so the body also tries to get more oxygen. The flow of oxygen-rich air increases into the lungs when you breathe faster. The oxygen from the lungs gets into the bloodstream and is carried around the body.
Causes of Breathlessness
- Asthma - Colds or allergies may trigger this condition. An individual may feel breathless and may produce a wheezing sound while breathing.
- Chronic Obstructive Pulmonary Disease (COPD) - This long-term condition causes breathlessness and cough due to inflammation and narrowing of the airways. The condition also becomes worse in the presence of a chest infection.
- Pneumonia - Breathlessness is caused due to a chest infection. The person may feel unwell with a cough along with a high body temperature.
- Heart Disease - The pumped blood is inefficient like in the case of heart failure. The increased pressure in the blood vessels may cause the fluid to build up in the tissues. The ankles swell due to gravity and extra fluid buildup.
- Anxiety - It can make people suffer from panic attacks, rapid heartbeat, and may cause breathlessness along with sweating.
- Pulmonary Embolism - A painful and swollen calf due to a blood clot in the leg. If an individual is immobile for a long time, then a clot may develop, breaks off, and may reach the lungs through the bloodstream.
- Medications - Breathlessness may also be caused by some medications such as aspirin. Beta blockers may cause breathlessness if the person has asthma.
Breathlessness may also be caused by other conditions such as pain, anemia, panic attack, hyperventilation, and coronary artery thrombosis.
- Neoplasia or Cancer - Lung cancer may cause breathlessness in the later stages of the disease. Cancer obstructs or invades the airways and produces malignant pleural effusion. Lung cancer may cause hemoptysis, lymphangitis, and chest pain. All these symptoms are frequently associated with smoking. Shortness of breath may also be caused by lung metastasis or cachexia.
- Anemia - A reduced amount of red blood cells (RBCs) in the bloodstream is associated with anemia. The primary cells bind to hemoglobin and transport oxygen to the body from the lungs. Adequate oxygen cannot be received if there are not enough blood cells. Thus, the heart tries to compensate and pump more blood, which can worsen congestive heart failure and angina. It may cause permanent cardiac damage leading to further breathlessness.
Sometimes, breathlessness may be caused by emotional distress or anxiety. When you experience breathlessness, you may feel anxious, which makes it more difficult to breathe. Other metabolic problems that can cause breathlessness are obesity and hyperthyroidism. Another possible cause is fatigue. Many cases of breathlessness do not arise from the lungs. Thus, the following conditions must be ruled out first in case of frequent breathlessness:
- Acute pulmonary edema
- Pulmonary embolism
- Acute asthma
Signs and Symptoms
Coughing is the most common and frequent presentation of breathlessness. Other signs and symptoms include:
- Cyanosis (blue discoloration of the fingers, toes, or mouth due to the amount of deoxygenated hemoglobin)
- Chest pain
- Altered breathing pattern
- Abnormal sputum
- Lung infection when there is fever along with breathlessness
Some causes of breathlessness are harmless but some may need proper medical evaluation.
The causes of chronic breathlessness may include:
- Uncontrolled asthma
- Lack of exercise
- Heart rhythm problems
- COPD due to smoking
If breathlessness is sudden and severe, it is considered as a medical emergency. In such cases, call for immediate medical help or rush into the nearest emergency room.
All people are affected by breathlessness during exercise. If a person is not fit or is overweight, then that person may be affected more easily. However, there could be some serious underlying medical problems if breathlessness comes all of a sudden.
Young children and the elderly may experience breathlessness due to pneumonia. There is an increased chance of lung and heart disease in smokers. Heart failure is also more common among the elderly. However, any age group may be affected by these conditions.
There are different methods to measure breathlessness. The modified Medical Research Council (mMRC) scale is used by many doctors. The scale is often used because of its simplicity and usability. The scale basically shows how breathlessness interferes with your daily activities.
In the mMRC scale, a scale of 0-4 is used to determine the disability caused by breathlessness. Each grade describes a person's breathlessness:
- 0 - Breathlessness caused by vigorous exertion or strenuous exercise
- 1 - Breathlessness caused by walking up slopes
- 2 - You tend to walk slower than other people of your age due to breathlessness. You need to stop walking on level ground to catch your breath.
- 3 - You need to stop and take a breath after a few minutes of walking (100 yards or 91 m).
- 4 - You feel breathless when dressing or too breathless to leave the house.
The doctor will conduct a physical examination and take your medical history. You may be asked for specific tests to check your heart and lungs. The doctor may also ask the following questions:
- How long have you been feeling breathless?
- Are you experiencing a sudden or gradual breathlessness?
- Have you observed any pattern of breathlessness?
- Do you experience breathlessness all the time or does it come and go?
- Describe your occupation or job.
- Do you experience breathlessness when lying flat? Does it go away or does it get worse?
- Do you experience breathlessness on a specific time of the day or does it become worse at a specific time?
- Did anything around you cause you to feel breathless?
- Do you have a history of thyroid disease, heart disease, lung disease, or anemia?
- Are you anxious, depressed, hopeless, or frightened?
- Have you made any changes in your life because of breathlessness?
The doctor will also check the following:
- Blood pressure
- Heart rate or rhythm
- Body temperature
- Number of breaths taken per minute
- Oxygen level in the blood
- Color of your nails
- Signs and symptoms of anxiety or depression
A blowing test is done to see if you have inhaled polluted air or smoke. The doctor will conduct a test called microspirometry, which is a carbon monoxide test. You will be told to blow hard for a few seconds into a machine. As you breathe the doctor will see the movement of your chest, feel the movements, and listen to the sound coming from your chest.
To check if the lymph glands are swollen, the doctor will examine your head, armpits, and neck. Your weight, waist, height, and body mass index (BMI) will also be measured.
Seeing a Doctor
You may not be in the state of breathlessness when you see a doctor. You may have walked a short distance or may have sat down for a long time before your checkup. Thus, it is important to have someone accompany you, who can describe breathlessness for you.
It is important to get a proper diagnosis for long-term breathlessness. It may take some time to get an accurate diagnosis since all possible causes will be taken into consideration. Repeated tests may be necessary to make sure of the actual cause. To get things under control, various conditions and factors need to be considered, so it is important to discuss goals and setting priorities with your doctor.
- Complete Blood Count (CBC) - This is done to exclude anemia and to monitor the severity of the disease. To find out the type of respiratory failure, an arterial blood gas test is useful.
- Pulse Oximetry - A pulse oximeter is a device placed on the toe or finger to measure the oxygen saturation of the blood.
- CT Scan or MRI - These imaging scans may be needed to determine serious lung problems such as lung cancer.
- Lung or Pleural Biopsy - A sample tissue from the lungs is viewed under the microscope for further examination.
At a local testing center, the following tests may be suggested:
- Spirometry test or blowing test to determine lung function
- Chest X-ray
- Blood tests to detect anemia, liver disease, kidney problems, heart disease, and certain allergies
- Electrocardiogram (ECG) to record the heart's electrical activity
Treatment of Breathlessness
Treatment usually depends on the cause of breathlessness. If you are a smoker, you will be strongly recommended to give up smoking. If you are overweight, it is better to lose weight. The doctor may refer you to a lung or heart specialist depending on the underlying cause of breathlessness.
- Medications - Breathing can be slowed down by opioid medications. Benzodiazepines can help reduce anxiety and help people to calm down. Bronchodilators such as inhaled steroids and Ventolin are beneficial for some people.
- Oxygen Therapy - It is given to restore the level of oxygen in the body. However, in chronic breathlessness, high levels of oxygen can be harmful.
Management of Chronic Breathlessness
To help reduce breathlessness, the following breathing techniques can be used:
- Slow Deep Breathing - Relax and try to breathe slowly and deeply. Inhale gently through your nose and exhale through your nose and mouth.
- Paced Breathing - Use your diaphragm to expand your lungs. Try to control your breathing at a comfortable speed.
When you feel breathless, use the different comfortable seating and standing positions:
- While Standing Up - Lean from the hips while resting your forearms on some support, which is placed at a comfortable height. For instance, a kitchen work surface or a chair.
- When Sitting - Lean forward. On your knees, rest your forearms on an armchair or table.
- While Standing or Walking - Place your hand in your pocket or on your hips to get support.
Try to rest whenever you experience breathlessness. When doing physical activities, take a break whenever needed before starting again. Organize everyday items in such a way that they are within your reach.
How to Avoid Breathlessness
If possible, try to identify and address what causes your breathlessness. If you are a smoker, it is necessary to stop smoking. Most smokers are usually affected by breathlessness. Perform daily regular exercises to remain fit.
Generally, the outlook is good, but the prognosis depends on the underlying cause of breathlessness. People tend to become increasingly breathless due to the side effects of smoking. In some cases, oxygen needs to be given for people who frequently experience breathlessness.