Overview

    Breathing difficulty is a broad term that is used to describe discomfort when breathing, and the feeling that you cannot draw a breath. This can develop gradually, or your breathing may suddenly become more laboured. In either case, medical attention should be sought quickly.

    Breathing difficulty can be caused by a number of different conditions, or it can develop as a result of stress and anxiety.

    You may also refer to breathing difficulty as being short of breath, having breathing problems, or dyspnea.

    What Are the Causes of Breathing Difficulty?

    According to the experts at the Mayo Clinic, lung and heart conditions are the top two reasons for breathing difficulty (Mayo Clinic, 2010).

    Lung Conditions

    There are a number of lung conditions that can cause breathing difficulty. All of these require immediate medical attention, some more immediate than others:

    • Asthma is an inflammation and narrowing of the airways that can cause shortness of breath, wheezing, chest tightness, and coughing.
    • Pneumonia is lung inflammation that is caused by infection. Symptoms may include shortness of breath, cough, chest pain, chills, sweating, fever, muscle pain, and exhaustion. This condition, in some cases, can be life threatening.
    • COPD (chronic obstructive pulmonary disease) is the term used for a group of diseases that cause difficulty exhaling and other symptoms, such as wheezing, a constant cough, and chest tightness. Emphysema, often caused by years of smoking, is in this category of diseases.
    • Pulmonary embolism is a blockage in one or more of the arteries leading to the lungs. This is often caused by a blood clot from elsewhere, often a leg, which has travelled up to the lung arteries. This condition can be life threatening and requires immediate medical attention. Other symptoms include swelling of the leg, chest pain, cough, wheezing, profuse sweating, abnormal heart rate, dizziness, and/or a bluish tint to the skin.
    • Pulmonary hypertension is high blood pressure that affects the lung and heart arteries. This condition is often caused by the narrowing or hardening of the lung arteries. Symptoms of this condition are very similar to those of a pulmonary embolism. Immediate medical attention is needed.
    • Croup is a respiratory condition caused by an acute viral infection and is known for its distinctively loud, “barking” cough. Make an appointment with your doctor if you or your child has croup. Children under 5 are more susceptible to more serious complications with this condition (Mayo Clinic, 2010).
    • Epiglottitis is a swelling of the epiglottis (the tissue that covers the windpipe) due to infection. This is a life-threatening disease that requires immediate medical attention. Other symptoms include fever, sore throat, mouth drooling, blue skin, difficulty breathing and swallowing, strange breathing sounds, chills, and hoarseness. There are vaccinations to prevent this condition.
    • Hiatal hernia is the protrusion of the stomach through the diaphragm into the chest. Individuals with this condition may also experience chest pain, difficulty swallowing, and heartburn. Small hiatal hernias can often be treated with medications and lifestyle changes; larger hernias or smaller ones that do not respond to treatment may require surgery.

    Heart Conditions

    You may notice yourself getting out of breath more often if you suffer from a heart condition. This is due to the heart struggling to pump oxygen-rich blood out to the body. Possible conditions that can cause this problem include:

    • coronary artery disease (CAD): a disease that causes narrowing and hardening of the arteries connected to the heart. Symptoms also include chest pain (angina) or heart attack.
    • congenital heart disease: problems with the structure or functioning of the heart that were present at birth
    • arrhythmias: disorders of heart rhythm or heart rate, which can cause an irregular heartbeat or a heart that beats too fast or too slow
    • heart attack
    • heart failure

    Environmental and Lifestyle Factors

    Environmental and lifestyle factors are another common cause of breathing difficulty. Examples include:

    • extreme stress and anxiety
    • exposure to allergens such as dust or pollen
    • panic attacks
    • high altitudes where there is less oxygen
    • obesity

    When Is Emergency Care Needed for Breathing Difficulty?

    Contact an emergency doctor if breathing difficulty comes on suddenly. Seek immediate medical attention for anyone whose breathing appears to have slowed considerably or to have stopped. After you have called 911, perform emergency CPR if you are trained to do so.

    The following symptoms, along with breathing difficulty, can indicate a serious problem. These problems may indicate an angina attack, a lack of oxygen, or a heart attack. Symptoms to be aware of include:

    • fever
    • pain or pressure on the chest
    • wheezing
    • tightness in the throat
    • a barking cough
    • shortness of breath that requires you to sit up constantly
    • shortness of breath that wakes you up during the night

    How Is Breathing Difficulty Diagnosed and Treated?

    The treatment for breathing difficulty depends on the condition causing it. Your doctor will first want to discuss your medical history and symptoms, so he or she can determine the cause of your breathing difficulty or the tests needed to determine the cause.

    Allergies

    If your doctor suspects allergies to be the cause of your breathing difficulty, he or she may have you take allergy tests. These may include skin or blood tests.

    There are a number of allergy skin tests. One common test (skin prick test) involves injecting a tiny amount of potential allergy triggers (food and environmental) into your skin to see if there is a reaction. This may also be done with patches that are placed onto your skin for 48 hours. A skin reaction usually indicates an allergy to that particular substance. Sometimes a potential allergen is injected into the skin of your arm to test whether there is a reaction.

    Blood tests may be performed to determine allergies. One common test is the allergen-specific immunoglobulin E (IgE) test. This blood test can determine whether IgE antibodies are present in the body. These antibodies are produced by the immune system when the body perceives a threat—in this case, an allergen. Different IgE antibodies are produced in response to different allergens, so this testing can help your doctor to determine the specific allergy that is causing your symptoms.

    Your doctor may prescribe antihistamines or allergy shots to prevent shortness of breath triggered by an environmental cause, such as an allergy.

    Other Environmental and Lifestyle Triggers

    Breathing problems triggered by high altitude will usually not occur again at lower altitudes. You may be advised to restrict activities that take you to higher altitudes, such as climbing.

    Breathing difficulties triggered by panic attacks, stress, or anxiety will usually result in a referral to a therapist. A therapist can help you work through the issues and prevent reoccurrence of symptoms.

    Medical Care

    If your doctor suspects your breathing difficulty to be linked to a medical condition, he or she will likely conduct some tests. These tests could include:

    • blood oxygen test: For this test, a clip is placed on the finger. This clip will measure the level of oxygen in the blood to ensure that the heart and lungs are oxygenating blood correctly.
    • X-ray of the chest: A painless image of the chest can show if pain and breathlessness is being caused by broken bones or by inflamed muscles.
    • computed tomography (CT scan): A computer image of the chest can show masses, calcifications, and bone trauma.
    • electrocardiogram (ECG): This test involves the placement of sticky pads (electrodes) on the chest, which are connected to a monitor that records the heart’s electrical activity.
    • echocardiogram: This ultrasound test produces a 2D or 3D model of the heart to check for abnormalities.
    • exercise tolerance (stress test): This test involves exercising, often on a treadmill, while connected to monitors that record heart and lung function.

    Severe breathing difficulty is usually treated in the hospital. Oxygen treatments may be given to raise your blood oxygen level. Sometimes, medications or an inhaler may also be provided.

    Weight may appear to be the cause or a contributing factor to your breathing problems. In this case, your doctor may suggest a referral to a dietitian and possibly a weight-loss program.

    What Is the Outcome if Breathing Difficulty Is Left Untreated?

    Never ignore the symptom of feeling short of breath, especially if it occurs suddenly. Any unusual breathing difficulty should be checked out by a doctor immediately to ensure that it is not the sign of a serious medical condition.

    Left untreated, your breathing could worsen, and the condition could prove fatal.

    Do not hesitate to call 911 if you are struggling to breathe, especially if it has come on suddenly and/or is accompanied by other symptoms such as chest tightness, headache, wheezing, numbness, or fever.

    Can Difficulty Breathing Be Prevented?

    There are a number of ways you can prevent having difficulty breathing.

    • Avoid smoking.
    • Monitor your weight to prevent weight gain.
    • Take any medications your doctor has prescribed to help with your breathing.
    • Exercise regularly to strengthen the lungs. Avoid over-exerting yourself, which can make breathing difficulty worse. Make sure that you discuss any new exercise regimen with your doctor, especially if you have a heart or lung condition.