Brief overview
- Description: Respiratory distress or shortness of breath; occurs acutely or chronically; sometimes at rest, sometimes only with exertion; accompanying symptoms such as cough, palpitations, chest pain, or dizziness possible.
- Causes: respiratory problems, including foreign bodies or asthma; cardiovascular problems, including pulmonary hypertension or myocardial infarction; fractures, trauma to the chest; neurological problems or psychological causes
- Diagnosis: listening to lungs and heart by stethoscope; blood test, pulmonary function test; pulmonary endoscopy; imaging procedures: X-ray, computed tomography or magnetic resonance imaging.
- When to see a doctor? As a rule, always in case of dyspnea; shortness of breath with chest pain, blue lips, choking or even respiratory arrest are emergencies. Immediately call 112 and possibly give first aid.
- Treatment: Depending on the cause, such as antibiotics for bacterial infections, cortisone and expectorants for pseudocroup, cortisone and bronchodilators for asthma and COPD, and surgery and others for certain causes.
- Prevention: among other things, giving up smoking prevents chronic dyspnea; no specific prevention against acute causes
What is dyspnea?
However, the faster the patient breathes, the shallower the breaths become – shortness of breath occurs. Suffocation and fear of death are then often added to the problem, exacerbating it.
Forms: How does dyspnea manifest itself?
For physicians, dyspnea can be characterized more precisely based on various criteria, such as the duration or the situations in which it mainly occurs. Some examples:
Depending on the duration of the shortness of breath, a distinction is made between acute and chronic dyspnea. Acute dyspnea is caused, for example, by an asthma attack, a pulmonary embolism, a heart attack, or a panic attack. Chronic dyspnea is observed, for example, in heart failure, COPD or pulmonary fibrosis.
If shortness of breath already occurs at rest, this is called resting dyspnea. If someone only loses their breath during physical exertion, this is known as exertional dyspnea.
If the shortness of breath is mainly noticeable when lying flat, but improves when sitting or standing, it is orthopnea. In some sufferers, it is even more difficult: The shortness of breath torments them especially when they lie on their left side and less when they lie on their right side. This is then called trepopnea.
The counterpart of orthopnea is platypnea, which is characterized by shortness of breath that occurs primarily when the patient is in an upright position (standing or sitting).
Sometimes the form of dyspnea already gives the physician clues to the underlying cause. Trepopnea, for example, is typical of various cardiac diseases.
What can be done about it?
When dyspnea occurs, the best thing to do is to see a doctor immediately. In the short term, the following tips can sometimes help against shortness of breath:
- In case of acute shortness of breath, the affected person sits down with an upright upper body and supports the arms (slightly bent) on the thighs. In this posture (“coachman’s seat” called), certain muscles support the inhalation and exhalation mechanically.
- For those affected, it is advisable to remain as calm as possible or to calm down again. Particularly in the case of psychologically induced dyspnea, this often helps breathing to return to normal.
- Cool, fresh air also has a beneficial effect. Not least because cold air contains more oxygen. This often alleviates dyspnea.
- It is advisable for asthmatics to always have their asthma spray to hand.
- Patients who have had chronic lung disease for a long time often have oxygen cylinders at home. It’s best to discuss the dose of oxygen with your doctor.
Dyspnea: Treatment by the physician
The treatment of dyspnea depends on the cause. Accordingly, it varies. Some examples:
People with asthma are usually given anti-inflammatory glucocorticoids (“cortisone”) and/or beta-sympathomimetics (dilate the bronchi) for inhalation.
In the event of a pulmonary embolism, the first thing people often receive is a sedative and oxygen. If necessary, the physicians stabilize the circulation. The trigger of the embolism – the blood clot in the pulmonary vessel – is dissolved with medication. It may also have to be removed in an operation.
If anemia due to iron deficiency is responsible for the dyspnea, the patient is given an iron supplement. In severe cases, blood (red blood cells) is administered as a transfusion.
If a cancerous tumor in the chest area is the reason for the shortness of breath, the therapy depends on the stage of the disease. If possible, the tumor is surgically removed. Chemotherapy and/or radiation therapy may also be appropriate.
Causes
Many different causes of dyspnea are possible. Some of them are directly related to the upper or lower respiratory tract (e.g. inhaled foreign body, pseudocroup, asthma, COPD, pulmonary embolism). In addition, various heart conditions and other diseases are also associated with shortness of breath. Here is an overview of the main causes of dyspnea:
Causes in the respiratory tract
Foreign bodies or vomit: If a foreign body is “swallowed” and enters the trachea or bronchi, this results in acute respiratory distress or even suffocation. The same happens, for example, if vomit enters the airways.
Angioedema (Quincke’s edema): A sudden swelling of the skin and/or mucous membrane. In the area of the mouth and throat, such swelling triggers shortness of breath or even choking. Angioedema may be allergic, but is sometimes triggered by various diseases and medications.
Pseudocroup: Also known as croup syndrome, this respiratory infection is usually caused by viruses (such as cold, flu or measles viruses). It involves swelling of the mucous membrane in the upper respiratory tract and at the laryngeal outlet. Whistling breathing noises and a barking cough are the consequences. In severe cases, respiratory distress may also occur.
Diphtheria (“true croup”): This bacterial respiratory infection also causes the mucous membrane of the upper respiratory tract to swell. If the disease spreads to the larynx, the result is a barking cough, hoarseness and, in the worst case, life-threatening dyspnea. Thanks to vaccination, however, diphtheria is now rare in Germany.
Paralysis of the vocal cords: Bilateral vocal cord paralysis is another possible cause of dyspnea. It occurs, for example, due to nerve injury resulting from surgery in the throat area or nerve damage in the course of various diseases.
Vocal frenulum spasm (glottis spasm): In this case, the laryngeal muscles suddenly cramp, narrowing the glottis and causing shortness of breath. If the glottis is completely closed by the spasm, there is an acute danger to life. Occurs mainly in children. It is triggered by irritants in the air we breathe (such as certain essential oils).
Bronchial asthma: This chronic respiratory disease is very often the reason for attacks of breathlessness. During an asthma attack, the airways in the lungs temporarily narrow – either triggered by allergens such as pollen (allergic asthma) or, for example, by physical exertion, stress or cold (non-allergic asthma).
Chronic obstructive pulmonary disease (COPD): COPD is also a widespread chronic respiratory disease associated with a narrowing of the airways of the lungs. However, this narrowing is permanent, unlike asthma. The main cause of COPD is smoking.
Pneumonia: In many cases, it brings dyspnea in addition to symptoms such as fever and fatigue. Pneumonia is often the result of a respiratory tract infection and usually heals without major complications. However, pneumonia can be dangerous for children and the elderly.
Covid-19: Many Covid sufferers complain of breathing difficulties even after mild courses of the disease. Doctors suspect pathological changes in the blood vessels in the lungs and tiny clots that impede gas exchange as the cause. In severe cases, massive tissue damage and remodeling of the fine blood vessels in the lungs are observed. Long- or post-covid can also be accompanied by dyspnea.
Atelectasis: Atelectasis is the term used by physicians to describe a collapsed (“collapsed”) section of the lung. Depending on the extent, dyspnea may be more or less severe. Atelectasis may be congenital or result from a disease (such as pneumothorax, tumor) or an intruded foreign body.
Pulmonary fibrosis: Pulmonary fibrosis is when the connective tissue in the lungs increases pathologically and then hardens and scars. This progressive process increasingly impairs gas exchange in the lungs. This causes shortness of breath, initially only during physical exertion, later also at rest. Possible triggers include inhalation of pollutants, chronic infections, radiation to the lungs, and certain medications.
Pleural effusion: The pleura (pleura) is a two-bladed skin in the chest. The inner sheet (pleura) covers the lungs, and the outer sheet (pleura) lines the chest. The narrow gap between them (pleural space) is filled with some fluid. If this amount of fluid increases due to illness (for example, in the case of moist pleurisy), it is called pleural effusion. Depending on its extent, it triggers shortness of breath, a feeling of tightness in the chest and respiratory pain in the chest.
Pneumo-thorax: In pneumo-thorax, air has entered the gap-shaped space between the lung and pleura (pleural space). The resulting symptoms depend on the cause and extent of this air infiltration. For example, there is dyspnea, irritable coughing, stabbing and respiratory pain in the chest, and blue discoloration of the skin and mucous membranes (cyanosis).
Pulmonary hypertension: In pulmonary hypertension, the blood pressure in the lungs is permanently elevated. Depending on the severity, this triggers symptoms such as shortness of breath, rapid fatigue, fainting or water retention in the legs. Pulmonary hypertension is a disease in its own right or may be the result of another disease (such as COPD, pulmonary fibrosis, HIV, schistosomiasis, liver disease, and others).
“Water in the lungs” (pulmonary edema): This refers to an accumulation of fluid in the lungs. It is caused, for example, by heart disease, toxins (such as smoke), infections, inhalation of fluid (such as water), or certain medications. Typical symptoms of pulmonary edema include dyspnea, cough, and frothy sputum.
Tumors: When benign or malignant tissue growths narrow or block the airways, dyspnea also presents. This happens, for example, with lung cancer. Scar tissue after surgical removal of a tumor may also narrow the airways, obstructing airflow.
Causes in the heart
Various heart conditions may also be responsible for dyspnea. These include, for example: Heart failure, heart valve disease, heart attack, or inflammation of the heart muscle.
Heart valve defects may also cause shortness of breath. If, for example, the mitral valve – the heart valve between the left atrium and the left ventricle – is leaking (mitral valve insufficiency) or narrowed (mitral valve stenosis), those affected suffer from shortness of breath and coughing, among other symptoms.
Sudden severe dyspnea, a feeling of anxiety or tightness in the chest, as well as anxiety or even fear of death are typical symptoms of a heart attack. Nausea and vomiting also occur, especially in women.
If shortness of breath on exertion, weakness and increasing fatigue occur in conjunction with flu-like symptoms (cold, cough, fever, headache and aching limbs), the reason may be inflammation of the heart muscle (myocarditis).
Other causes of dyspnea
There are other possible causes of dyspnea. Some examples:
- Anemia: Deficiency of the red blood pigment hemoglobin, which is necessary for transporting oxygen in red blood cells. Therefore, anemia possibly triggers shortness of breath, palpitations, ringing in the ears, dizziness, and headaches, among other symptoms. Possible triggers of anemia include deficiency of iron or vitamin B12.
- Injury to the chest (chest trauma): Shortness of breath also occurs, for example, when the ribs are bruised or broken.
- Scoliosis: In scoliosis, the spine is permanently curved sideways. In severe cases where the curvature is severe, this impairs lung function, resulting in dyspnea.
- Sarcoidosis: This inflammatory disease is associated with the formation of nodular tissue changes. These potentially form anywhere in the body. Very often, the lungs are affected. This can be recognized, among other things, by a dry cough and exertion-dependent dyspnea.
- Neuromuscular diseases: Some neuromuscular diseases also sometimes cause dyspnea when the respiratory muscles are affected. Examples include polio (poliomyelitis), ALS, and myasthenia gravis.
- Hyperventilation: the term refers to unusually deep and/or rapid breathing associated with a feeling of shortness of breath. In addition to certain diseases, the cause is often great stress and excitement. Women are affected more often than men.
- Depression and anxiety disorders: In both cases, sufferers sometimes have a phasic feeling of not being able to breathe.
Psychologically induced breathlessness (in depression, stress-related hyperventilation, anxiety disorders and others) is also called psychogenic dyspnea.
When to see a doctor?
Whether gradual or sudden – it is always advisable for people with dyspnea to see a doctor. Even if no other symptoms appear at first, serious illnesses may be the reason for the shortness of breath.
If additional symptoms such as chest pain or blue lips and pale skin appear, it is best to call an emergency physician immediately! Because these may be signs of a life-threatening cause such as heart attack or pulmonary embolism.
What does the doctor do?
First, the doctor will ask specific questions about the medical history (anamnesis), for example:
- When and where did the shortness of breath occur?
- Does the dyspnea occur at rest or only during physical activity?
- Is the shortness of breath dependent on certain body positions or times of day?
- Has the dyspnea gotten worse recently?
- How often does the dyspnea occur?
- Are there any other symptoms besides shortness of breath?
- Do you have any known underlying conditions (allergies, heart failure, sarcoidosis, or others)?
The anamnesis interview is followed by various examinations. They help to determine the cause and extent of the dyspnea. These examinations include:
- Listening to the lungs and heart: The doctor listens to the chest with a stethoscope to detect suspicious breathing sounds, for example. He also usually listens to the heart.
- Blood gas values: Among other things, the doctor uses pulse oximetry to determine how saturated the blood is with oxygen.
- Pulmonary function test: With the help of a lung function test (such as spirometry), the physician can assess the functional state of the lungs and airways more precisely. This is a very good way of assessing the extent of COPD or asthma, for example.
- Lung endoscopy: By means of lung endoscopy (bronchoscopy), the pharynx, larynx and upper bronchi can be viewed in more detail.
- Imaging procedures: They may also provide important information. For example, X-rays, computed tomography and magnetic resonance imaging can detect lung inflammation, pulmonary embolism and tumors in the chest cavity. Ultrasound and nuclear medicine examinations may also be used.
The severity of dyspnea can be assessed using the Borg scale: This is done either by the physician (based on the patient’s description) or by the patient himself using a questionnaire. The Borg scale ranges from 0 (no dyspnea at all) to 10 (maximum dyspnea).
Prevention
Many acute causes, on the other hand, cannot be specifically prevented.
Frequently asked questions about dyspnea
What is dyspnea?
When a person has difficulty getting enough air, it is called dyspnea. This is the medical term for shortness of breath or shortness of breath. The causes are, for example, heart and lung diseases, lack of oxygen, poisoning by escaping gas or by other toxic substances. Depending on its severity, dyspnea may be mild, severe or persistent.
What are the symptoms of dyspnea?
Difficulty breathing, shortness of breath and the feeling of not getting enough air are the typical signs of dyspnea. Other symptoms include chest pain, dizziness, sweating and anxiety. In severe dyspnea, there may be a bluish discoloration of the lips, face or extremities due to lack of oxygen.
What are the causes of dyspnea?
Cardiovascular disease, lung disease and anemia are common causes of dyspnea. Even slight exertion leads to shortness of breath, and sometimes this occurs even during physical rest. Other triggers are poisoning, oxygen deficiency or obesity, psychological stress situations or anxiety and panic states. The causes should always be clarified by a doctor.
Is dyspnea dangerous?
What can I do if I have dyspnea?
In the case of pronounced dyspnea, sit upright, support yourself with your arms at your sides and try to find as calm and steady a breathing rhythm as possible. Avoid stress and physical exertion. If shortness of breath does not subside or worsens, seek medical help immediately. In the long term, weight loss, breathing exercises and regular light physical exercise often help.
What are the different types of dyspnea?
There is a distinction between acute and chronic dyspnea. Acute dyspnea occurs suddenly and requires immediate medical attention. Chronic dyspnea persists over a longer period of time and is often associated with long-term conditions such as asthma or COPD. Other types include orthopnea (while lying down), paroxysmal nocturnal dyspnea (while sleeping), and exercise-induced dyspnea (during physical exertion).
How should you sleep if you have dyspnea?
For dyspnea, it is best to sleep with the upper body elevated. This is particularly relieving in many forms of heart failure that are associated with water retention (edema) in the legs. Avoid alcohol and heavy meals before going to bed, as these can increase shortness of breath.
Which doctor is responsible for dyspnea?
