What Is Dyspnea?

Man getting an oxygen mask
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In This Article

Dyspnea is shortness of breath that is often described as a feeling of being "hungry for air." Anyone can become dyspneic with strenuous exercise, and it can also occur as a result of medical problems like lung or heart disease, obesity, or anxiety.

Dyspnea is uncomfortable and it can even be painful. If you experience recurrent, sudden, or severe shortness of breath, you should see a doctor. You may need urgent medical intervention, and long-term management will depend on the cause of your dyspnea. 

Dyspnea Symptoms

Dyspnea can be chronic, gradually worsening and possibly interfering with your physical activity. It can also be acute, occurring suddenly and causing you to feel frightened or overwhelmed. Cases of each can range in severity.

Common symptoms of dyspnea include breathing that is:

  • Short
  • Rapid
  • Shallow
  • Effortful, labored
  • Slow
  • Painful or uncomfortable

You may also experience severe symptoms such as:

  • Chest pressure, tightness, or heaviness
  • A feeling of suffocation
  • An inability to breathe altogether

Sudden or extreme dyspnea is dangerous and requires emergency medical attention.

There are times when you may notice that someone else is experiencing dyspnea. Someone who is short of breath may appear to be choking or may have very loud breath sounds.

Be sure to call for urgent medical help if you witness any of the following:

  • Clearly audible, loud, labored breathing
  • An anxious, distressed facial expression
  • Flaring nostrils
  • Protrusion of the abdomen and/or chest
  • Gasping
  • Cyanosis (pale or blue face, mouth, lips, or extremities)

Keep in mind that a person who is short of breath might not be aware of the situation or might not be able to ask for help.

Complications

The effects of dyspnea-associated oxygen deprivation can cause confusion or loss of consciousness.

Prolonged oxygen deprivation can also lead to consequences such as hypoxia (low oxygen in the body's tissues) and hypoxemia (low blood oxygen). Serious issues, including brain damage and kidney failure, can occur due to low oxygen.

Types and Causes

Exercise is the most common and harmless cause of dyspnea in a healthy person. When you exercise, your body needs more oxygen. This makes you breathe faster, especially if the activity is more intense than you are used to. This type of dyspnea is nothing to worry about and should improve after a few minutes of rest.

But dyspnea can also occur due to medical problems, including certain diseases and conditions.

Acute Dyspnea

Some illnesses cause sudden episodes of dyspnea with completely normal breathing between episodes.

You can develop intermittent or acute dyspnea due to:

Chronic Dyspnea

Chronic dyspnea generally progresses over time. As it worsens, you might feel short of breath with moderate activities like climbing stairs.

The most common causes of chronic dyspnea include:

You are likely to have chronic dyspnea with lung or heart disease because these conditions interfere with your body's oxygen supply. Obesity and systemic illnesses increase your body's oxygen demands, which can also make you feel short of breath.

Chronic dyspnea can also flare up with exposure to cigarette smoke and environmental fumes. And you can also experience fluctuations in your chronic dyspnea due to problems like a respiratory infection.

Dyspnea can be related to your body position, and some people with heart disease only experience it when bending over because this position changes the airflow dynamics in the body.

Sometimes chronic illnesses only cause dyspnea at night when your muscles are more related and you may have less respiratory effort. This is described as nocturnal dyspnea.

Risk Factors

Some people are at high risk of dyspnea. Young babies, elderly adults, and anyone who has a major health problem is susceptible to shortness of breath, even from a mild respiratory infection.

Pregnant women may experience dyspnea with mild exertion or even at rest. Increased oxygen demands, physical pressure on the lungs as a result of the growing uterus, and hormonal influences contribute to dyspnea during pregnancy.

Diagnosis

Dyspnea is diagnosed with an evaluation of your breathing pattern. The immediate effects—such as low oxygen levels—are assessed with diagnostic tests. Your medical team will also evaluate you to identify the cause of your dyspnea, but that part of your diagnosis may come after your immediate situation is stabilized.

Urgent Assessment

When you are short of breath, your doctor may begin your medical evaluation with a physical examination, especially if you are not able to answer questions to provide a medical history.

Your breathing rate, heart rate, and the intensity of your pulse will be checked. Your doctor will look to see if you are gasping for air or using accessory muscles to breathe.

Your oxygen level will be measured with pulse oximetry or arterial blood gas. If there is any concern that you could be having a heart attack or have unstable heart disease, you may need an electrocardiogram (EKG). You may also need an urgent chest X-ray if there is a concern about pneumonia or another lung disease.

Medical History

Once you are stable, your medical team will ask questions such as whether you experience dyspnea during activity or at rest, and whether it comes on suddenly or slowly. Your doctor will want to know if you had any specific exposures before you developed dyspnea, such as to pollen or food that you might be sensitive to.

Certain risk factors, such as a history of smoking, can help your doctor rule out some conditions and give more consideration to others.

The severity of your dyspnea can also be graded on the Medical Research Council (MRC) scale, which is based on your description of symptoms. Your MRC dyspnea grade can be used to assess the severity of your condition, as well as the impact of your treatment.

MRC Scale
Grade Degree of Breathlessness
1 Breathlessness only occurs with exercise
2 Short of breath when hurrying on level ground or walking up a slight hill
3 Walk slower on level ground than most people of the same age; stop after walking one mile or 15 minutes
4 Stop for breath after walking a few minutes or 100 yards on level ground
5 Too breathless to leave the house; breathless from the activity of dressing and undressing

Your MRC grade can be used as part of your BODE index score, which calculates the risk of death based on body mass index (BMI), obstruction (calculated using FEV1 value after using a bronchodilator), MRC dyspnea scale, and exercise ability (six-minute walking distance).

Diagnostic Tests

Further diagnostic testing may be needed to assess your lung health and to identify medical illnesses that cause dyspnea.

Tests that you might have include:

  • Blood tests: Can help diagnose infections and inflammatory disease
  • Chest imaging: Chest computerized tomography (CT) and magnetic resonance imaging (MRI) can often identify lung disease
  • Spirometry: Can assess how much air you can breathe
  • Pulmonary function testing: Can evaluate your breathing capabilities in more detail than spirometry by measuring how much air you can breathe in and out, and how quickly
  • Echocardiography: May be ordered if your EKG suggests that you have heart disease
  • Exercise treadmill testing: Evaluates your breathing and heart function when you have increased oxygen demands

Treatment

Urgently, interventions to help you breathe and maintain proper oxygen levels may be necessary. After that, treating the underlying cause of your dyspnea becomes paramount.

Medication

The proper drug treatment, if any, for your dyspnea depends on the cause in your case.

If an asthma attack or COPD exacerbation is making it difficult to breathe, for example, medications such as short-acting bronchodilators and steroids can help alleviate shortness of breath by, respectfully, opening the airways and reducing inflammation.

Your doctor will treat your infection with antibiotics if you develop dyspnea due to a condition like bacterial pneumonia. Dyspnea due to heart failure may be treated with diuretics, which are medications that help the body eliminate excess fluid.

Surgical Procedures and Interventions

Dyspnea caused by structural problems such as chest trauma or pneumothorax may require surgery or other interventional procedures. For example, a chest tube may be placed to relieve pressure due to pneumothorax or a pulmonary effusion.

More extensive surgery may be required to remove blood due to severe chest trauma or to remove a tumor in the lung.

A condition like a pulmonary embolus can require intravenous (IV) medical treatment with blood thinners as well as a procedure, such as interventional treatment with thrombolytics, which are powerful medications used to directly break up the blood clot.

You may also need respiratory support as you are recovering from dyspnea of any cause.

Oxygen and Respiratory Assistance

In some cases, oxygen supplementation can be helpful while you are recovering. And in a severe situation when you are not able to adequately breathe on your own, mechanically assisted breathing may be necessary with non-invasive pressure ventilation or intubation.

Prevention

If you have chronic dyspnea due to a condition such as heart failure, lung disease, or obesity, then the strategy for preventing yourself from developing dyspnea (or making your dyspnea worse) is centered on disease management, typically with prescription medication.

In other cases, avoiding triggers may also be essential. For example, if you already know that you have asthma or allergies, or you experience panic attacks, taking daily medication to manage your condition and making an effort to avoid triggers whenever possible will help prevent episodes of dyspnea.

As such, a combination of prevention strategies may be necessary.

Lifestyle Management

When obesity is contributing to your dyspnea, weight loss can make a big difference in helping you breathe easier. Exercise can increase your muscle strength and prevent a decline of heart and lung conditions so that you will be less prone to dyspnea and less dependent on medications.

Whenever possible, avoid inhaling pollutants by wearing an appropriate mask if you work with environmental chemicals.

And if you smoke, quit. The habit can cause COPD and heart disease, and smoking can trigger asthma attacks and COPD exacerbations.

If you become short of breath when active, building up physical endurance with consistent training will help you exercise with more intensity before you become dyspneic.

Regulating Anxiety

If an anxiety disorder or panic attacks are causing you to experience dyspnea, cognitive behavioral therapy and/or medication can help prevent your episodes.

You might not realize that stress about your dyspnea can make it worse. Disease-specific fears about exercise, shortness of breath, social exclusion, or a decline in your condition can interfere with rehabilitation and physical therapy, resulting in the progression of the disease. And these fears can amplify your shortness of breath, making an acute episode more severe.

If anxiety is playing a role in your dyspnea, discuss your feelings with your medical team. A combination of medication, counseling, and behavioral management can help reduce the impact of anxiety on your dyspnea.

A Word From Verywell

If you notice severe and sudden shortness of breath, you should get emergency medical attention. Dyspnea can be treated, and you will also need a long-term plan for prevention if you have a condition that predisposes you to this issue.

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Article Sources
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Additional Reading
  • Donald A. Mahler; Denis E. O'Donnell (20 January 2014). Dyspnea: Mechanisms, Measurement, and Management, Third Edition. CRC Press. 
  • Wills CP, Young M, White DW (February 2010). "Pitfalls in the evaluation of shortness of breath". Emerg. Med. Clin. North Am.