Shortness of Breath in COPD

Shortness of breath is the hallmark of COPD

A man takes a lung function test.
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Shortness of breath, which is also described as dyspnea, is the hallmark effect of chronic obstructive pulmonary disease (COPD). In mild or early-stage COPD, dyspnea is worse with physical exertion. As the disease progresses, you might feel short of breath even when you are at rest.

You can have other causes of dyspnea—even if you have COPD—so you may need some diagnostic pulmonary tests to assess the severity of your lung disease and to identify other conditions (like heart disease).

If you struggle to breathe due to your COPD, you will need to take medication, and you may need to use oxygen supplementation or mechanical respiratory assistance too.

Symptoms

When you have COPD, shortness of breath can make you feel like you are hungry for air. You may also feel like you or struggling to breathe, and this often leads to anxiety or even a sense of panic.

The most common symptoms of shortness of breath in COPD include:

  • Rapid, shallow breaths
  • Working hard to breathe
  • Loud breathing, often with wheezing sounds
  • Problems when eating

Not everyone experiences shortness of breath in COPD the same way. It can manifest with a variety of symptoms.

Late-stage COPD can cause more pronounced shortness of breath, with symptoms that affect your whole body.

With advanced COPD, your shortness of breath can cause:

  • Gasping for air
  • Struggling to breathe
  • Movements of your whole chest, abdominal and/or neck muscles when you breathe
  • Expansion of your nostrils when you breathe
  • Grimacing or anxiety associated with breathing
  • Slow breathing
  • Discomfort when breathing

Be sure to discuss symptoms of advanced COPD-associated shortness of breath with your doctor.

These symptoms can be indicators that your COPD is advancing or that you are developing a respiratory infection, like pneumonia or bronchitis. Even an infection like a stomach virus can wear you down and exacerbate your shortness of breath when you have COPD.

Severe Symptoms

In some instances, shortness of breath in COPD is a sign of a major medical issue, such as respiratory failure or heart failure.

Symptoms of a COPD-associated respiratory or cardiac emergency include:

  • Cyanosis (bluish or pale color of your lips, fingers, hands, or toes)
  • Chest pain or tightness
  • Inability to breathe

Be sure to get prompt medical attention if you experience any of the signs of a respiratory or cardiac emergency.

Causes

You are more likely to experience COPD-associated shortness of breath when you are experiencing a COPD exacerbation. These episodes can be triggered by an illness or an infection.

Exercise and physical exertion (climbing stairs for example) can cause shortness of breath in COPD too. This is often described as exercise intolerance. Cold weather can also make you feel short of breath when you have COPD.

Many people who have COPD also develop heart disease—either as a result of COPD or due to another cause. Heart failure compounds the dyspnea of COPD.

As the COPD progresses, your resting shortness of breath can worsen.

How Shortness of Breath Develops in COPD

The shortness of breath that occurs as a result of COPD is related to the condition's effects on the lungs. COPD-associated lung damage occurs due to chronic inflammatory damage—which is usually caused by smoking, toxic chemical inhalation, or chronic respiratory infections. Recurrent inflammation damages the lungs, resulting in the production of thick mucus and scar tissue.

When the lungs are damaged in COPD, air does not pass through as efficiently as it should, and it takes more effort to achieve each breath. You may also feel that you aren't getting enough air, even as you work hard to breathe. This is because the body's oxygen absorption that happens in the alveoli (air sacs) becomes partially occluded (blocked) in COPD.

Diagnosis

There are several ways of diagnosing shortness of breath in COPD. Your own subjective feeling is vitally important. If you feel short of breath or if you are anxious about your ability to breath, then you will need treatment.

However, sometimes people do not notice a decline in symptoms with chronic disease. So your breathing should be objectively assessed periodically when you have COPD.

Physical Examination

Your doctor will examine your breathing with a physical examination. When you are short of breath, you may use more muscles to breathe than you normally would. If you involuntarily (not on purpose) use your neck and abdominal muscles to help you breathe, your doctor can observe this pattern—which is a sign of respiratory distress (breathing problems)

If you are short of breath, your respiratory rate may be faster or slower than average. The average respiratory rate for adults is between 12 to 18 breaths per minute. Your medical team will also keep track of whether your breaths are occurring at regular intervals or whether they are erratic. Irregular breathing is a sign of respiratory distress.

Diagnostic Pulmonary Tests

Your medical team may use some tests to evaluate how effectively you are breathing. These tests may need to be repeated to monitor your treatment and you may also need them repeated if you experience more severe or distressing dyspnea.

  • Pulse oximeter: This is a non-invasive test that measures your oxygen saturation (O2 sat.), which is the percent of hemoglobin in your red blood cells that is saturated (filled) with oxygen. It is a reflection of how well your body is absorbing oxygen.
  • Arterial blood gas: This is a blood test that measures oxygen saturation and pressure, as well as your carbon dioxide and bicarbonate levels in your arterial blood. It is not a standard test, so you would only have your arterial blood gas checked if your medical team is concerned about respiratory distress.
  • Spirometry: This is a non-invasive test that requires you to breathe into a small handheld device. The device measures how much air you can breathe in and out.
  • Lung diffusion test: This is a noninvasive test that requires you to breathe in and out into a mouthpiece. The air you breathe out is collected to measure carbon dioxide. This result is used to assess the health of the alveoli in your lungs.
  • Imaging tests: Your lung structure can be seen with a chest x-ray or computerized tomography (CT) scan. These tests can also identify problems like pneumonia, which can trigger a COPD exacerbation.

    Heart Tests

    Shortness of breath with COPD can be associated with heart problems. You may need tests that can detect heart problems.

    • Electrocardiogram (EKG): This is a non-invasive electrical test in which small metal plates are placed on the skin of the chest. These metal plates (often called leads) detect the heartbeat and produce a drawing of your heartbeat that can identify some types of heart disease, such as arrhythmias (irregular rhythm).
    • Echocardiogram (echo): An echo is a non-invasive ultrasound that visualizes your heart motion on a screen. This test can identify heart valve problems, heart failure, and structural heart issues that can cause shortness of breath.

    Treatment


    Strategies for managing shortness of breath in COPD include medication, pulmonary rehabilitation, oxygen, and, in some instances, surgery. You may need a combination of these approaches.

    Medication

    When you have COPD-associated dyspnea due to a short term illness or infection, medications such as prescription steroids or inhalers can help improve your ability to breathe.

    Steroids can reduce inflammation, particularly if you are having a COPD exacerbation. Inhalers work by widening your bronchi (breathing tubes) to allow more air to pass when you breathe.

    Your doctor may also prescribe an antibiotic if you have a bacterial infection.

    Pulmonary Rehabilitation

    There are several things that you may be instructed to do as part of a pulmonary rehabilitation program.

    Incentive spirometry is a type of breathing exercise that you can do at home. You can use a spirometer to breathe in and out, with progressively improving targets set by your doctor or therapist. This type of exercise can strengthen your muscles and improve your control over your breathing.

    Physical exercises can be beneficial in COPD. You should consider starting an exercise regimen under the supervision of a physical therapist who is experienced in working with COPD. Physical activity can improve your exercise tolerance.

    Oxygen and Respiratory Support

    Supplemental oxygen cannot correct dyspnea, but it can help improve your oxygen level. You may need oxygen supply through a nasal cannula (a small tube placed in your nostrils), with a face mask, or through a tube that would be surgically placed with a tracheostomy procedure.

    Surgery

    Sometimes, COPD can cause severe lung damage that may require surgery. Hyperinflation, a complication of COPD, may improve with lung surgery that involves removal of the damaged regions of the lung.

    A Word From Verywell

    Shortness of breath is a struggle when you have COPD. It is important that you do not ignore dyspnea—it can be a sign of a COPD exacerbation or worsening COPD. Be sure to talk to your doctor about your shortness of breath.

    If your dyspnea worsens with COPD, you will need short term or long term strategies to help you breath more comfortably.

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