Definition
Dyspnea is generally any form of difficulty in breathing that is associated with shortness of breath. It does not necessarily have to be accompanied by pain, but merely describes the condition in which a patient has a subjective feeling of breathlessness due to a variety of possible causes.
Causes
The causes of shortness of breath (dyspnoea) with accompanying shortness of breath are very diverse. Since it is a matter of respiratory problems, the lungs with their surrounding structures may be primarily affected. For example, lung cancer in its final stage leads to shortness of breath.
More information on the topic: How do you diagnose lung cancer? However, it is also possible that the cause of the shortness of breath is in the heart or due to psychological stress. In order to provide as broad an overview as possible of the causes of shortness of breath, this article will first look at the upper airways, i.e. everything from the mouth to the larynx, then at the lower airways, including the lungs.
Other causes of shortness of breath, such as heart problems or inflammation, will also be dealt with separately. Breathlessness can also be caused by a bruised rib. In this case, the affected person tries to breathe as shallowly as possible to prevent great pain.
The upper airways include the mouth (oris), throat (pharynx) and larynx. The causes of respiratory distress rarely lie in the mouth. However, in the case of an epileptic seizure, for example, the patient may lose control of the muscles of the tongue and the tongue may fall back and close the throat so that the patient can no longer breathe.
Particularly in first aid, it is therefore important to ensure that patients who are not conscious but are still breathing are placed in a stable lateral position in order to prevent the tongue from falling back and thus a cause of shortness of breath with the accompanying shortness of breath. In addition to the tongue, there are other structures in the mouth that may be a cause of shortness of breath. On the one hand, breathing difficulties can be caused by incorrect food intake, whereby lumps of food enter the windpipe.
Children are particularly at risk, so small children should not play with swallowable objects without supervision. In the area of the upper respiratory tract there are also various lymphatic tissues, which are summarised as the Waldeyer pharyngeal ring. These include, for example, the tonsils (Tonsilla pharyngea), which can be easily recognized in pairs at the transition between mouth and throat.
These tonsils can be the cause of breathing difficulties, especially in children. On the one hand it can lead to “simple” tonsillitis. In most cases the so-called A-streptococci (Streptococcus pyogenes) are the pathogens causing tonsillitis.
On the one hand, the bacteria cause a whitish pus coating on the tonsils, on the other hand there is a strong swelling of the tonsils. Particularly in children, but also in adults, untreated tonsillitis can therefore quickly become a cause of respiratory distress. Especially at night, patients complain of shortness of breath because the slightly receding tongue puts additional strain on them and makes it difficult for them to breathe.
Pseudocroup (subglottic laryngitis, laryngospasm) is also caused by infectious pathogens. This is an inflammation of the larynx caused by a virus. Mainly parainfluenza viruses, but also influenza viruses are to blame for the pseudocroup and the accompanying shortness of breath.
Pseudocroup mainly affects small children, more rarely adolescents. The symptoms typically start late in the evening or in the middle of the night. There is a strong barking cough and the children complain of severe shortness of breath because the mucous membrane swells so much due to the inflammation that the airways become very narrow.
This is to be taken seriously in any case, because in particularly bad cases there is a danger of suffocation. The real croup (diphtheria) is to be distinguished from the pseudo croup. This is almost extinct in Germany because of the vaccination, but there are always new cases.
Diphtheria has similar symptoms to normal tonsillitis, except that the coatings on the tonsils appear rather continuous and white-yellowish in a diptheria infection. If one tries to remove them, there is additional bleeding. Due to the swollen tonsils, an infection with diptheria can also lead to shortness of breath.
Another infection that mainly affects small children is epiglottitis. This is an inflammation of the epiglottis caused by bacteria. The causing bacteria are usually Haemophilus capsule type B.
As the symptoms appear suddenly and quickly become worse and worse, it is important to see a doctor quickly, otherwise the airways may be blocked, which is then the cause of respiratory distress and can quickly lead to death if left untreated. However, before respiratory distress occurs, it is important to pay attention to symptoms such as a sudden rise in fever, hoarseness and difficulty swallowing. In addition to the bacterial and viral causes of shortness of breath, swelling of the mucous membrane in the area of the larynx can also lead to acute shortness of breath.
This is known as angioedema (quinckeedema). This is usually caused by drug intolerance, but can also be triggered by a tumour or by a deposit of immune complexes. Since an acute, painless swelling occurs quite quickly, especially in the case of allergic reactions, but does not go away on its own, an emergency doctor must be called in any case, otherwise there may be increased shortness of breath or even respiratory arrest.
Breathlessness can also occur within the lower airways. These include the windpipe (trachea) and all the branched bronchial branches, which branch out like the roots of a tree and continue to branch out all the way to the round alveoli where the gas exchange takes place. The cause of the breathlessness can be on the one hand in the trachea.
This lies in close proximity to the oesophagus. If there is an enlargement in the area of the esophagus, for example because it is difficult for food to pass from the esophagus to the stomach, the trachea can be constricted by the enlargement of the esophagus. However, there is also the so-called tracheal stenosis, which causes a narrowing in the area of the windpipe.
This tracheal stenosis can either be congenital or result from long-term intubation. A very large goiter, i.e. an enlargement of the thyroid gland, can also cause the windpipe to become constricted and the patient suffers from shortness of breath. In the area of the bronchi, the cause of shortness of breath can also be a lung carcinoma, i.e. cancer.
This is usually located in the area of the first major branch of the windpipe and therefore causes shortness of breath in an advanced stage. More common in the bronchial region, however, is the classic asthma disease, which can be accompanied by severe shortness of breath. Most often an asthma attack is caused by an allergen (for example pollen in spring), but it is also possible that the asthma attack occurs without external influence due to frequent pneumonia.
Asthma is one of the most common causes of breathlessness with an ever increasing tendency. Patients can also suffer from severe shortness of breath if gas transport across the membrane of the alveoli is disturbed. The alveoli must be imagined as an exchange station.
Here, the fresh oxygen-laden air is exchanged for the carbon dioxide particles in the blood and the CO2 is breathed out. This exchange takes place through the membrane of the alveoli. If, for example, increased fibre formation in pulmonary emphysema or pulmonary fibrosis results in a reduced oxygen exchange, the patient subjectively has the feeling that not enough oxygen reaches him.
This can lead to increased breathing and the subjective feeling of breathlessness. Acute pneumonia is also associated with shortness of breath. Pneumonia is widespread and causes serious problems, especially in hospitals.
Often bacteria, or more precisely pneumococci, are to blame for the pneumonia and the associated shortness of breath. Pulmonary embolism is a particularly serious cause of shortness of breath. Here, a small thrombus is transported by the bloodstream to the lungs, where it clogs a vessel.
This can go so far that the affected areas of the lung collapse, which is then subjectively experienced by the patient as severe shortness of breath. Cystic fibrosis can be another cause of respiratory distress. In this hereditary disease, an increased excretion of chloride ions occurs due to a channel defect.
This results in a viscous mixture of mucus in the bronchial tubes, which the patient can only cough up with difficulty. This leads to severe shortness of breath and severe coughing attacks. Bronchiolitis also leads to shortness of breath and an increased cough with mucusy sputum.
Bronchiolitis, however, is an acute inflammation of the alveoli, usually caused by parainfluenza viruses. A final important cause in the lower respiratory tract that can lead to shortness of breath is chronic obstructive pulmonary disease (COPD). As the name suggests, it is a chronic inflammation of the lungs, which leads to frequent mucusy coughing and severe shortness of breath.
Acute pneumonia (pneumonia) is also associated with shortness of breath. Pneumonia is widespread and causes serious problems, especially in hospitals. Bacteria, or more precisely pneumococci, are often to blame for the pneumonia and the associated shortness of breath.
Pulmonary embolism is a particularly serious cause of shortness of breath. Here, a small thrombus is transported by the bloodstream to the lungs, where it clogs a vessel. This can go so far that the affected areas of the lung collapse, which is then subjectively experienced by the patient as severe shortness of breath.
Cystic fibrosis can be another cause of respiratory distress. In this hereditary disease, an increased excretion of chloride ions occurs due to a channel defect. This results in a viscous mixture of mucus in the bronchial tubes, which the patient can only cough up with difficulty.
This leads to severe shortness of breath and severe coughing attacks. Bronchiolitis also leads to shortness of breath and an increased cough with mucusy sputum. Bronchiolitis, however, is an acute inflammation of the alveoli, usually caused by parainfluenza viruses.
A final important cause in the lower respiratory tract that can lead to shortness of breath is chronic obstructive pulmonary disease (COPD). As the name suggests, it is a chronic inflammation of the lungs, which leads to frequent mucusy coughing and severe shortness of breath. When experiencing shortness of breath or shortness of breath, many patients initially think of the lungs themselves as the cause, but the heart plays almost as important a role as the lungs.
On the one hand, left heart failure can lead to increased pressure in the pulmonary circulation. This pressure “squeezes” fluid from the small blood vessels. This results in pulmonary oedema.
This pulmonary edema is accompanied by severe shortness of breath and requires urgent treatment. However, it is also possible that the shortness of breath is in fact exclusively due to a functional disorder of the heart. Many patients with angina pectoris complain of increased shortness of breath.
In addition to pain in the area of the left chest, a heart attack also manifests itself with shortness of breath, which can even become so bad that the patient is afraid of suffocating. In general, there are many causes for shortness of breath and the list is by no means exhaustive. Many allergies, psychological factors or even muscular or neural causes can lead to shortness of breath.
The body can react to stressful situations with shortness of breath or a feeling of breathlessness. In such situations, the part of our autonomic nervous system that is mainly active and which increases the willingness to act when under actual or perceived stress – the sympathetic nervous system – is predominantly active. Through an increased heart rate, reduced intestinal activity, increased sweat production and a prepared lung, the body is thus made more willing to perform under stress or danger, which in extreme cases can result in shortness of breath.
Breathlessness or shortness of breath can also be caused by allergies. Even slight physical exertion can lead to shortness of breath in the presence of an allergy. However, these breathing problems are often accompanied by other symptoms such as a runny nose, sore throat, watery eyes, sneezing or coughing, severe itching or redness of the eyes.
In connection with breathing difficulties, an allergy is often only thought of when these are so pronounced and are reminiscent of allergic asthma. Typical is a season-dependent occurrence of the symptoms, the occurrence in certain rooms or situations. If respiratory problems are already present in connection with an allergy, this already indicates involvement of the lungs and can be a harbinger of allergic bronchial asthma.
In these cases, it is essential to consult a doctor to have the symptoms investigated. There is then the possibility of carrying out an allergy test. If an allergy is present, the factors or situations causing respiratory distress should be avoided and an emergency spray should be prescribed and always carried with you.
For some allergies, hyposensitisation can also be carried out, by which the allergy can be contained and future attacks of shortness of breath can be avoided. In extreme cases, an enlarged thyroid gland can also lead to symptoms such as breathing difficulties. In addition to possible cosmetic problems, there may be a choking or general tightness in the throat, which becomes worse when lying on your back.
Swallowing difficulties, hoarseness or a coughing irritation are also possible. An enlarged thyroid gland is also known as goiter or goiter and the most common cause of an enlarged thyroid gland is iodine deficiency. It is important in this context that it is not only a matter of breathing difficulties caused by an enlargement of the thyroid gland, which is in itself very unpleasant, but that it is absolutely necessary to clarify why such an enlargement of the thyroid gland has occurred in the first place.
In addition to the iodine deficiency just mentioned, the formation of cysts, autoimmune diseases, enzyme defects or benign and malignant tumours can also lead to the formation of goiter. Since therapy must be initiated according to the disease causing it, it is important to consult a doctor if symptoms occur, such as shortness of breath with an enlarged thyroid gland. Iron deficiency is the most common human disease worldwide, although the cause of the deficiency condition can vary greatly.
Iron deficiency can lead to dry nails and hair changes, cracks in the corners of the mouth and also to anaemia. Typical symptoms of anaemia due to iron deficiency are shortness of breath on exertion (exercise dyspnoea), rapid heart rate (tachycardia), paleness of skin and mucous membranes and rapid fatigue or diminished performance. Therapeutically, iron preparations should be taken and, if possible, the cause of the iron deficiency should be eliminated.
Acute shortness of breath can occur for various psychological reasons. For example, in the course of an anxiety or panic attack, the anxiety leads to faster breathing (hyperventilation) and even to feelings of suffocation and fear of death, accompanied by accompanying vegetative reactions such as increased sweating, palpitations, trembling, hot flushes, cold showers and dry mouth. Panic attacks, which can be the expression of a panic disorder, can occur repeatedly, in attacks and in unspecific situations.
Anxiety disorder or hyperventilation syndrome can also cause breathing difficulties. Great excitement, anxiety or stress can also trigger a so-called psychogenic dyspnoea. In this case affected persons start to hyperventilate.
Hyperventilation is an unphysiologically accelerated breathing, which causes the gas exchange in the lungs to be disturbed. Changes in the depth and frequency of breathing can lead to muscle cramps, dizziness, sensation of discomfort in the extremities and feelings of anxiety as a result of hyperventilation. If hyperventilation is psychologically induced, the sedation or, if necessary, sedation of the affected person in combination with controlled rebreathing usually leads to an improvement of the symptoms.
Symptoms of lung cancer often only appear in advanced tumour stages. Typically, this is when respiratory distress, haemoptysis, chronic coughing or recurrent colds, increased night sweats, possibly fever and weight loss occur. If any of these symptoms occur, a doctor should be consulted as soon as possible to clarify the symptoms.
Problems with breathing up to shortness of breath can be caused by tension. Contrary to the widespread idea that the lungs fill and empty themselves more or less by themselves with oxygen and that the surrounding structures move along with it, it is so that we expand the chest with the help of muscles, thereby creating a negative pressure and the lungs follow this passively and thus inflate and fill with oxygen. This means that the lung is pulled apart and compressed again by external muscles. Depending on how much oxygen we “need” and the condition of the lungs, different numbers of muscle groups are used – there are also postures that make breathing easier. This also explains that tension in the respiratory muscles (in a sense, these are abdominal and chest muscles) can lead to significantly poorer breathing.
