People with shortness of breath feel as though they cannot get enough air or are "out of breath."
Shortness of breath can be due to many different causes. It is normal with strenuous activity. An affected person has the feeling of "air hunger," as though he or she cannot take in enough air. Breathing heavily may or may not make the person feel better.
Healthcare professionals often ask about several things when a person has shortness of breath. These questions may include: when the condition startedwhether it came on suddenly or graduallywhether it occurs at rest or only during activitywhether it is worse when lying down or sitting uphow many pillows the person sleeps withwhether the person has any history of heart or lung diseasewhether the person has any other symptoms, such as fever, cough, swelling in the legs, chest pain, or anxietywhether anyone else in the family has shortness of breathwhether or not the person smokes
Other questions may be asked, based on the answers to these questions and on the physical exam findings.
The many causes of shortness of breath can be divided into categories: exercise or other activity, especially if the person is in poor physical shapelung conditions, such as asthma, pneumonia, chronic bronchitis, lung cancer, pulmonary edema, or emphysemaheart conditions, such as stable angina, a heart attack, congestive heart failure, or chronic mitral regurgitationblood and blood vessel problems, such as anemia or a pulmonary embolusanxiety, such as from a panic disordertoo much acid in the blood, which can occur with diabetes, serious blood infections such as septicemia, salt imbalances or severe dehydrationrapid ascent to high altitudes without allowing the body time to adjust, known as acute mountain sicknesscigarette smokingallergiesairway obstruction, such as in a child who may have choked on an object
Other causes are also possible. In some cases, the cause cannot be found.
Prevention depends on the cause. For example, avoiding strenuous activity can prevent shortness of breath. Regular exercise can get a person in shape so that he or she is less likely to get short of breath with normal activity. Many cases of shortness of breath from asthma, congestive heart failure, and panic disorders can be prevented by taking medications regularly. Many cases cannot be prevented.
In some cases, the cause of shortness of breath is obvious to the healthcare professional from the history and physical exam. Usually, however, more tests are needed based on the suspected condition. Blood tests and chest x-rays are commonly performed.
Other tests may include special X-rays, pulmonary function (breathing) tests, and an electrocardiogram (ECG) which measures the electrical activity in the heart. An ECG can often help diagnose heart conditions that may be causing shortness of breath.
Long-term effects are related to the cause. For example, shortness of breath due to exercise has no long-term effects. Continued exercise is usually encouraged but at a more gradual pace.
Pneumonia treated with antibiotics often goes away and causes no long-term effects. Shortness of breath due to lung cancer may result in death. Heart attacks and congestive heart failure may cause serious disability and limit a person's ability to perform normal activities.
Most causes of shortness of breath are not contagious and pose no risk to others. However, if the cause is an infection like pneumonia, it may be contagious.
Treatment is directed at the cause. For example, asthma is often treated with inhaled bronchodilators such as albuterol (AccuNeb, ProAir HFA, Proventil, Ventolin) or steroids such as fluticasone (i.e. Flovent). Congestive heart failure is treated with several different types of medication to strengthen the heart and reduce fluid overload.
Inhaled bronchodilators are also used for emphysema. Lung or blood infections are usually treated with antibiotics. Lung cancer may require surgery, radiation therapy, or chemotherapy. People with anemia, or low blood counts, may need a blood transfusion.
Every medications has its own set of side effects. Inhaled bronchodilators can cause dizziness, palpitations, or a rapid heart rate. Some of the common side effects of other medications include allergic reactions, stomach upset, and headaches. Surgery can be complicated by bleeding, infection, or reactions to anesthesia. More specific side effects depend on the type of surgery. Blood transfusions carry a risk of allergic reactions and infections.
This depends on the cause of shortness of breath. If the underlying cause goes away, no further treatment may be needed. In these cases, people can return to normal activities as soon as they feel able. Other people, such as those with emphysema, may need treatment for life.
Monitoring also depends on the cause. For example, people with anemia may need blood tests to make sure their blood counts have returned to normal.
Cecil Textbook of Medicine, 1996, Bennett et al.
