Most of us, if not, all of us have experienced shortness of breath in our lifetime. Shortness of breath, while running, climbing, performing the strenuous physical exercise, is a normal physiological process. We are more concerned about the pathological causes of shortness of breath, which occurs in the absence of physical activities and in rest. Shortness of breath is also known as dyspnea in medical terms which is an unpleasant subjective awareness of the sensation of breathing. Shortness of breath may have resulted from psychological, social and environmental factors as well. It may or may not be associated with decrease oxygen level in the blood or rapid respiratory rate.
Causes of Shortness of Breath
Most of the causes of shortness of breath are associated with the pathology of heart and lungs. Other non-cardiopulmonary causes of shortness of breath like anemia, metabolic acidosis, obesity, and hyperventilation are also common.
Some of the common causes of the shortness of breath are described as below:
1. Chronic Obstructive Pulmonary Disease (COPD) :
It is defined as the presence of obstruction of the airways, which does not change over several months but is not fully reversible. It includes chronic bronchitis and emphysema. The main feature of COPD is a cough and sputum production. The patients have a smoking history for a long period of time.
2. Bronchial asthma:
Bronchial asthma is functionally characterized by the airflow obstruction which is variable over a short period of time and reversible with treatment. In bronchial asthma, chronic airway inflammation and increase airway hyper-responsiveness are present. The main feature of bronchial asthma is respiratory distress. It has seasonal variation and a history of Allergen.
Pneumonia is defined as an acute respiratory illness associated with recently developed radiologist pulmonary shadowing which may be segmental, lobar or multilobar. It presents with fever, shortness of breath, cough, sputum production, etc. These are caused by organisms such as Streptococcus pneumonia, Mycoplasma pneumonia, Haemophilus influenza, etc.
4.Myocardial infarction or Heart attack:
It occurs when the blood flow to a part of the heart is compromised, which also means the oxygen demand of the myocardial muscle is more than the oxygen supplied to it. In addition to shortness of breath, it presents with symptoms such as central chest pain radiating to jaw, throat or left arm, sweating, anxiety, or fear of impending death etc.
Blockage of the pulmonary artery by emboli (dislodged clot mostly from lower limbs) is called pulmonary embolism. It presents with chest pain, shortness of breath, coughing up of blood, swelling of the legs etc. It is a medical emergency.
It is a clinical condition characterized by the decrease in the hemoglobin concentration of blood below the lower level of the normal range. Hemoglobin carries oxygen to the tissue and supplies it to the tissues. Since hemoglobin levels are low in anemia, oxygen supply to tissues are compromised. They present with shortness of breath on physical activity. It is because the blood cannot meet the increased demand of the tissue.
Metabolic acidosis is a clinical condition caused by the accumulation of excessive amounts of acid in the blood. It may be due to overproduction of acid by the body or due to decreased renal excretion of the acid. When acid accumulates in the blood it results in shortness of breath and people start panting. Metabolic acidosis is caused due to diabetic ketoacidosis, chronic kidney failure, infections etc.
More or less shortness of breath needs an immediate visit to the hospital and should be diagnosed and treated promptly. The dangerous symptoms are:
a.Shortness of breath or dyspnea at rest.
b.Associated with a chest pain, discomfort, a feeling of the heart beating fast (palpitation).
c. Associated with a decreased level of consciousness, confusional state etc.
d. Night sweats and weight loss.
Other causes of shortness of breath are acute pulmonary edema, Pneumothorax, acute respiratory distress syndrome, laryngeal edema, hyperventilation, chronic congestive cardiac failure, Pleural effusions, interstitial lung disease such as sarcoidosis, fibrosing alveolitis, pneumoconiosis, lymphatic carcinomatosis, bronchial carcinoma etc.
The diagnosis shortness of breath starts with the symptoms of the person, past medical history, family history, and then the physical examination and appropriate laboratory investigations.
Since how long you are suffering from shortness of breath?
Whether shortness of breath started slowly or suddenly?
Do you feel the shortness of breath while doing exercise and even when you rest? Whether the shortness of breath is triggered by cold, inhalation of pollen grains?
What are the exacerbating and relieving factors?
Whether you smoke tobacco or not?
Does he have any history of lung or cardiac disease?
Does anyone in the family have a history of cardiovascular and pulmonary disease?
Physical examination includes inspection, palpation, and auscultation of the chest. After taking a history from the patient and performing physical examination the doctor will ask for lab and radiographic evaluation.
- Pulse oximetry: pulse oximeter is kept on the finger of the patient( most thumbs) to measure the oxygen level in the blood and it should be above 90%.
- Chest x-ray: to support the diagnosis chest x-ray is important for further investigation. A pulmonary disease like pneumonia, tuberculosis can be diagnosed from a chest x-ray.
- Electrocardiogram (ECG): It is a very useful investigation to determine the cardiac diseases such as myocardial infarction, pulmonary embolism etc.
- Pulmonary function test: it is mostly done when chest x-ray does not diagnose lung disease, but the physical examination shows lung disease. It helps to measure the severity of the pulmonary lesions. It also distinguishes COPD from bronchial asthma.
- Cardiac enzymes: Cardiac enzymes such as troponin and creatine phosphokinase when raised are diagnostic of myocardial infarction.
- D- dimmer: It is a test to diagnose the pulmonary embolism. Another investigation includes the deeper study of a lower leg, CT scan of the chest etc.
- Blood investigation to see the hemoglobin level, electrolyte imbalance, white blood cell count.
- Arterial blood gas analysis: Blood is taken from a radial artery of the femoral artery and is reported to have seen acidosis or alkalosis.
Treatment of shortness of breath
Treatment of the shortness of breath depends upon the severity and its cause.
- A patient with a low oxygen saturation level on the pulse oximetry is supplemented with oxygen using oxygen mask or nasal prongs. Mechanical ventilation may be needed in patients with gasping respiration, altered level of consciousness and are in a confusional state.
- In patients with chronic obstructive pulmonary disease and bronchial asthma are provided oxygen therapy. Bed rest in propping up position, nebulization with Salbutamol, ipratropium, adrenaline, injection of diuretics such as Frusemide helps in reducing the shortness of breath.
- Patient with pulmonary embolism should receive anticoagulants like heparin, warfarin, etc., which dissolves the blood clot quickly. Anemia may be treated with iron tablets, blood transfusion, supplementation of folic acids, depending upon the severity.
- Patients with a myocardial infarction should receive antiplatelet drugs. Aspirin 300 mg, clopidogrel 300 mg which reduces the blockage of coronary arteries. They should also receive lipid-lowering agents like atorvastatin.Pneumonia is caused by the bacterial infections and should be treated with antibiotics.
If pleural effusion is present it should be drained. Chest pain can be managed by giving opioid analgesics like morphine in myocardial infarction or pulmonary embolism.
Prevention of dyspnea/ shortness of breath
- Avoid smoking: Smoking is related to many pulmonary and cardiac causes of shortness of breath such as COPD. Myocardial infarction, cessation of smoking helps to avoid these pathologies reducing the incidence of shortness of breath.
- Avoid allergens: People who have allergic histories should be conscious about the allergens like pollen grains, dust, smoke to reduce the frequency of shortness of breath.
- Obesity: Obesity is the widely prevalent cause of shortness of breath. Decreasing weight by 5 % to 10% of total body weight by diet control and exercise reduces the frequency of breathiness.
- Breathing exercises reduces the incidence of shortness of breath while climbing running etc