Shortness of breath is a common symptom, prompting people to make a visit to their doctor. This symptom may come on rapidly or come on so slowly that it's not recognized at first.
If you are experiencing shortness of breath, that does not mean you should necessarily be worried about lung cancer. There are many causes of shortness of breath. Yet, since "less common" causes of shortness of breath are often overlooked, it is important to make an appointment with your doctor to determine the cause.
What Is Shortness of Breath?We don’t have a clear definition of shortness of breath, but most people describe this symptom as a subjective sensation of difficulty with breathing. You may have a feeling of being unable to get enough air in or that it takes more effort to breathe than usual. Some people also describe a sensation of chest tightness. Shortness of breath can come on acutely in a matter of minutes or hours; or chronically over days, weeks, months or even years.
Some Possible Causes of Shortness of BreathIn 85% of people, conditions related to the heart and lungs are responsible for shortness of breath. Though most of us think of our lungs first if we feel short of breath, heart conditions need to be carefully considered. In fact, a study that looked at people who had shortness of breath as their only symptom of heart disease had a greater chance of dying than those who had typical chest pain.
Some of the more common causes include:
- Heart attacks
- Pulmonary embolism, a blood clot that breaks off from another blood clot (deep vein thrombosis) in the legs or pelvis and travels to the lungs
- Infections such as bronchitis and pneumonia
- Congestive heart failure
- Pneumothorax, a collapse of a lung
Other common causes include:
Less common causes of shortness of breath may include:
- Benign and malignant tumors, including lung cancer
- Anxiety and panic attacks
- Objects inhaled accidentally into the lungs
- Heart valve problems
- Acid reflux
- Allergic reactions (anaphylaxis)
- Neurological diseases such as multiple sclerosis
- Other lung diseases such as sarcoidosis and bronchiectasis
- Lack of regular exercise
When to See Your DoctorIt’s important to make an appointment to see your doctor if you develop shortness of breath, even if you think there is a clear reason to explain your symptoms. Contact your doctor or call 911 immediately if you have chest pain, feel lightheaded or if your symptoms worsen rapidly.
Questions Your Doctor May AskWhen you visit your doctor, she will take a careful history and do a physical exam. Some of the questions she may ask include:
- When did you first experience shortness of breath and how did it first begin?
- Do your symptoms occur at rest or only with activity? If you only feel short of breath with activity, which activities seem to cause your symptoms?
- Do you feel more winded when you are sitting up or lying down?
- Do you have any other symptoms, such as chest pain, a cough, wheezing, fever, leg pain, unexplained weight loss or fatigue?
- Do you have a personal of family history of any heart or lung problems?
- Have you ever smoked? If so, for how long?
- Have you traveled recently by car or by plane?
Evaluation of Shortness of BreathThe tests your doctor will recommend will depend on your particular symptoms and physical findings, but may commonly include:
- Pulse oximetry, a test performed by putting a clamp on your finger or earlobe to estimate the amount of oxygen in your blood
- An Electrocardiogram (EKG) to look for signs of a heart attack or irregular heart rhythms
- A chest X-ray to look for infections or growths in your lungs
- Blood work to look for anemia and other causes
- Pulmonary function tests to look for asthma or emphysema and other lung conditions
Other tests may include:
- A CT scan of your chest
- A stress test
- An echocardiogram. This is an ultrasound of your heart to look for problems with your heart valves, how strong your heart is and if you have any damaged areas in your heart
TreatmentThe treatment of your shortness of breath will depend on the causes.
Abidov, M. et al. Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing. The New England Journal of Medicine. 2005. 353:1889-1898.
National Institute of Health. Medline Plus. Breathing Difficulty. Updated 05/05/11. http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm
Nishino, T. Dyspnoea: underlying mechanisms and treatment. British Journal of Anaesthesia. 2011. 106(4):463-74.
Paulman, P., Paulman, A., and J. Harrison (Eds). (2006). Taylor’s 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter (2nd ed). Philadelphia: Lippincott Williams & Wilkins.