Definition
Breathlessness is the subjective feeling of a person not being able to get enough air. This can be caused by difficult or insufficient breathing. Indications for this are usually an increased breathing rate.
In addition, affected persons often use their respiratory assistance muscles. This can be seen, for example, by resting the hands on the thighs. A further objective finding is the so-called cyanosis, which becomes noticeable by blue lips and mucous membranes.
What are the causes of shortness of breath?
Cardiac causes (originating from the heart) Heart failure (cardiac insufficiency) Cardiac arrhythmia Heart attack Coronary heart disease Pulmonary causes (originating from the lungs) Pulmonary embolism (blood clot in the lungs) Asthma Pneumonia Water in the lungs Inhalation of a foreign body COPD (chronic obstructive pulmonary disease) Bronchitis (inflammation of the airways) Other causes Stress/Psychic poisoning
- Cardiac causes (originating from the heart) Heart failure (cardiac insufficiency) Cardiac arrhythmia Heart attack Coronary heart disease
- Heart failure (cardiac insufficiency)
- Cardiac arrhythmias
- Heart attack
- Coronary heart disease
- Pulmonary causes (originating in the lungs) Pulmonary embolism (blood clot in the lungs) Asthma Pneumonia Water in the lungs Inhalation of a foreign body COPD (chronic obstructive pulmonary disease) Bronchitis (inflammation of the airways)
- Pulmonary embolism (blood clot in the lung)
- Asthma
- Pneumonia
- Water in the lungs
- Inhalation of a foreign body
- COPD (chronic obstructive pulmonary disease)
- Bronchitis (inflammation of the airways)
- Other causes Stress/Psychic poisoning
- Stress/Psychic
- Poisoning
- Heart failure (cardiac insufficiency)
- Cardiac arrhythmias
- Heart attack
- Coronary heart disease
- Pulmonary embolism (blood clot in the lung)
- Asthma
- Pneumonia
- Water in the lungs
- Inhalation of a foreign body
- COPD (chronic obstructive pulmonary disease)
- Bronchitis (inflammation of the airways)
- Stress/Psychic
- Poisoning
The feeling of shortness of breath can be caused by stress. In stressful situations the body activates the so-called sympathetic system. This is a part of our nervous system that is responsible for the “fight and flight reaction”.
In stressful situations, our body prepares itself to become active. Along with this, the body also expects an increased oxygen demand, which is why the breathing rate is increased. This reaction dates back to the beginning of human development, but is still noticeable today.
Because although escape on a stressful workday is not a solution, the body prepares itself exactly for it. For this reason many people know the feeling of shortness of breath when they are stressed. If this shortness of breath occurs more frequently, it can even lead to anxiety.
In the worst case, these express themselves in panic attacks and hyperventilation. The heart is the motor of our circulation, which is why it also plays an important role in connection with oxygen intake and breathing. In the lungs, the blood is enriched with oxygen.
It then reaches the left half of the heart, from where it is pumped throughout the body. There it is intended to supply the individual tissues with oxygen and other nutrients. This system causes problems if the heart no longer pumps sufficiently.
This is the case, for example, with heart failure (cardiac insufficiency), but it can also occur after a heart attack or as a result of coronary heart disease (calcification of the coronary arteries). Often with these problems, the shortness of breath does not occur at rest, but is most noticeable during exercise. In these cases the heart is not able to adequately compensate for the increased oxygen demand during physical exertion.
Another reason for shortness of breath can be heart defects in which the oxygen-rich blood from the left half of the heart mixes with the oxygen-poor blood from the right half. In most cases, such heart defects have a hole in the cardiac septum which separates the two halves of the heart.In these clinical pictures, “mixed saturated blood” (mixture of oxygen-poor and oxygen-rich blood) is pumped from the heart into the circulation, so that all tissues and organs are supplied with less oxygen-rich blood. An important and often unrecognized symptom of high blood pressure can be shortness of breath.
Even at low levels of stress, the body is no longer able to transport enough oxygen; one gasps for air. The problem lies in the heart or in the blood vessels. Because of the high blood pressure, the oxygen often cannot be transported fast enough into the tissues (especially muscles), which leads to a feeling of shortness of breath.
An extremely rare type of high blood pressure is the so-called “pulmonary hypertension” (high blood pressure in the lungs). In this clinical picture, too, shortness of breath occurs due to high blood pressure, which is not elevated in the entire body but only in the lungs. You can read about how dangerous this pulmonary hypertension can be in our article: Pulmonary hypertension – How dangerous it isChildren are particularly susceptible to shortness of breath because they often choke on small things.
Especially popular are all kinds of small toys (Lego brick, marble, etc.) but children also choke on food (nuts, insufficiently chewed chunks of food, etc.). Instead of going down the oesophagus, the object ends up in the windpipe and thus blocks the airway.
This is usually manifested in children by sudden shortness of breath or a conspicuous cough. In this case it can help to lay the child over the lap so that the head is a little lower than the stomach. By tapping on the back (the strength should be adapted to the child’s age) the object in the windpipe can possibly be loosened.
Children are also very susceptible to colds or other infections. This can cause the nose to become blocked, which can make it difficult to breathe. If the infection worsens and becomes bronchitis (inflammation of the small branched airways) or pneumonia, the children sometimes cannot get enough oxygen into the blood.
This also causes breathing difficulties. Children with pneumonia should be treated as inpatients in hospital. Many children also suffer from (mostly allergic) asthma.
The resulting narrowing of the airways can also cause shortness of breath. Just as with children, respiratory distress in infants is often caused by swallowing small parts. Within the first year of life, infants explore their environment.
Many objects are put in the mouth and thus examined more closely by the child. The object can accidentally enter the windpipe and block it. In this case, the infant will try to get the object out of the windpipe again by coughing suddenly.
If this does not succeed, the infant can be placed on the lap, as with larger children, so that its head lies slightly below the rest of the body. Careful tapping on the back may loosen the object. It is also popular for infants to stick objects up their nose, which also hinders breathing.
The object may need to be removed by an ENT (ear, nose and throat) doctor. Infants are also susceptible to infections such as colds, and in worse cases bronchitis or pneumonia. These illnesses can manifest themselves as shortness of breath and may have to be treated in hospital.
Bronchitis is an inflammation of the bronchial tubes. The bronchi are the small airways that branch out in the lungs. A distinction is made between acute bronchitis, which is a newly developed inflammation, and chronic bronchitis, which is characterized by a long-lasting process.
Symptoms of acute bronchitis are production of mucus, cough and fever. Mucus production and coughing are also typical signs of chronic bronchitis. The mucus blocks the airways and causes the symptom of shortness of breath.
Asthma is a disease of the airways characterized by hyperreactivity (overreaction). The overreaction causes a sudden obstruction (narrowing) of the airways. The allergic asthma is particularly well known.
Here the body reacts sensitively to allergenic substances such as pollen, house dust, mites or animal hair. In an acute emergency, an asthma spray usually helps. This contains substances that dilate the airways again and thus make breathing easier.In severe cases, the emergency physician may also administer systemically (in the whole body) acting drugs.
Pneumonia (also called pneumonia) is the inflammation of the lung tissue caused by viruses, bacteria, fungi or parasites. A possible cause is also an inflammation as a reaction of the body to accidentally inhaled gastric juice or toxins. The pneumonia manifests itself by coughing and fever, in addition the breathing frequency increases, because otherwise the body has difficulties to take up enough oxygen.
Depending on the cause of the pneumonia, it can be treated with antibiotics (in case of a bacterial infection) or antivirals (viral). Furthermore, bed rest, possibly antipyretic agents, oxygen administration when needed and expectorants are recommended. An overfunction of the thyroid gland (also called hyperthyroidism), leads to an increased metabolism.
This hyperthyroidism can be accompanied by palpitations, high blood pressure, outbreaks of sweating, sleep disturbances and some other symptoms that express a kind of “inner restlessness”. Due to the increased metabolism, the body has an increased oxygen demand, which can be expressed by an increased breathing rate and/or the feeling of shortness of breath. Enlargement of the thyroid gland (both benign and malignant) can also cause breathing difficulties if the thyroid gland tissue is enlarged to such an extent that it constricts the windpipe.
Shortness of breath after eating can have various causes. First, it is possible to choke on chunks of food. Instead of entering the oesophagus, these chunks of food enter the windpipe and can clog it.
Children are particularly susceptible to this. The shortness of breath after eating can also be caused by an overproduction of gastric acid. One calls the then occurring complaints heartburn.
They can occur as a slight burning sensation in the area of the chest, but also as such severe chest pain that breathing difficulties occur. In heartburn, the very corrosive acid passes from the stomach into the esophagus, where it attacks the mucous membrane. Breathlessness, which is caused by problems in the windpipe, initially indicates a blockage of the air tube.
This can be caused by all kinds of accidentally inhaled small parts (food, in children’s case toys). Depending on the size of the swallowed object, individual branches of the branched respiratory system or, in severe cases, even (almost) the entire windpipe may be blocked. Tumors located inside the trachea can also block it.
Presumably, such a tumor is not noticeable at first, but only when it has grown large enough to cause breathing difficulties will it be possible to search for it specifically. But it is not only tumors located directly in the trachea that can cause breathing difficulties. It is also possible that a tumor in an adjacent structure (lymph nodes or thyroid gland, for example) becomes so large that it presses on the trachea, thereby narrowing it.
Another thing that can be noticed in infants in the first hours of life is that the trachea is not properly formed. Since the oesophagus and trachea run directly side by side, such a malformation can create a connection between the trachea and oesophagus, which can also cause breathing difficulties. COPD is an abbreviation for Chronic Obstructive Pulmonary Disease.
It is therefore a disease of the lungs in which the airways are narrowed. This initially causes few problems during inhalation, but the exhalation phase is more problematic. The narrowing means that not all the air in the lungs can be breathed out.
As a result, a lot of air remains in the lungs, which contain only a little oxygen, and accordingly, only a little oxygen-rich air will fit into the lungs again the next time you breathe in. This results in a lack of oxygen in the air we breathe, which leads to shortness of breath. A pulmonary embolism is a condition of the lung in which blood clots block one or more pulmonary vessels.
The lung serves to absorb oxygen. For this purpose, the blood is transported to many very small and branched vessels. These are located close to the surface of the lung and can therefore absorb oxygen from the air we breathe through the tissue.
In a pulmonary embolism, large vessels may already be blocked, which means that the small vessels behind them are not supplied with blood. All these vessels are no longer able to absorb oxygen, which can lead to shortness of breath.Depending on the size of the clot and the extent of the obstruction, pulmonary embolism can be harmless or acutely life-threatening. In pulmonary fibrosis, tissue changes occur in the lungs.
On the one hand, this leads to a reduction in the volume in the lungs. As a result, it is no longer possible to breathe in as much air, which means that the body can absorb less oxygen. In addition, the body has to transport the oxygen from the air it breathes through the lung tissue into the blood vessels.
Lung fibrosis makes the tissue thicker and more impermeable to oxygen, which is why much less oxygen can be absorbed from the air we breathe. Water in the lungs is in most cases the result of heart failure (cardiac insufficiency). In affected persons, the heart is unable to pump the necessary amount of blood into the circulation.
For this reason, the blood accumulates back into the pulmonary vessels, among other things. Little by little, the water from the blood vessels passes into the lung tissue. This condition is also called pulmonary edema.
Other causes can also be gas poisoning, a viral infection or inhalation of water. Areas of the lung that are filled with water can no longer be supplied with air. This means that the blood in these areas can no longer be enriched with oxygen.
This leads to respiratory distress. In emphysema, more air remains in the lungs due to the destruction of parts of the lung. This is often caused by obstructions (blockages) in the airways.
Reasons for this can be infections or bronchitis. However, COPD can also lead to emphysema in the long term. Because of the obstruction, inhaled air cannot be exhaled from the lungs.
However, in the next breath additional air is added. This causes the alveoli (alveoli where oxygen enters the bloodstream) to burst and be destroyed. For this reason, symptoms such as shortness of breath occur.
An inflated chest is also a sign of emphysema. The term atelectasis refers to a lack of ventilation in the lungs. In addition to congenital causes, this can also be caused by external influences.
For example, pressure on the chest leads to atelectasis. Similarly, a blockage of the airways can lead to insufficient ventilation. In people suffering from atelectasis, the oxygen-depleted blood cannot be enriched with oxygen in all places.
Therefore, it flows out of the lungs as blood still low in oxygen and combines with the oxygen-rich blood. If the proportion of blood that is not enriched is large enough, there is a lack of oxygen throughout the body, which leads to respiratory distress. Myocarditis (inflammation of the heart muscle) in our latitudes is usually caused by a viral infection.
Other triggers are toxins or autoimmune processes, in which the body starts a defensive reaction against itself. The symptoms of a heart muscle inflammation can initially look like a normal flu: Fever, cough, tiredness, possibly even diarrhea. In addition, heart-specific complaints such as chest pain and cardiac arrhythmia are also evident.
If the heart is so badly affected that it can no longer pump properly, water retention in the legs and lungs can also occur. The water in the lungs can cause a feeling of breathlessness. The pleura consists of two pleural leaves that can be moved against each other, which lie on the outside of the lung and almost completely surround it.
One leaf lies directly inside the thorax, the other sits on the lung. Between the pleural leaves is the so-called pleural gap, which contains a small amount of fluid. If the thorax expands during inhalation, the lung is also pulled apart by the pleura.
It enlarges and air can flow into the lungs. A pleural effusion can consist of various fluids: Depending on its origin, it can be blood, pus, lymphatic fluid or individual blood components. This accumulation of fluid hinders the breathing mechanism and thus leads to shortness of breath.
