Shortness of breath, also known as breathlessness or dyspnoea, is the uncomfortable feeling of not getting enough air or needing extra effort to breathe. Some patients may describe it as air hunger, chest tightness, heavy breathing, or a feeling of suffocation.
Shortness of breath is not a disease by itself, but a symptom that may be related to different underlying conditions. It can be caused by lung problems, heart conditions, anaemia, obesity, anxiety, airway obstruction, infection or other medical issues.
Acute shortness of breath may occur suddenly and can be associated with asthma attacks, pneumonia, pneumothorax, pulmonary embolism, heart attack, heart failure, upper airway obstruction or carbon monoxide poisoning. Chronic shortness of breath lasting for weeks may be related to asthma, chronic obstructive pulmonary disease, interstitial lung disease, obesity, heart dysfunction or breathing pattern disorders.
Patients with chest tightness, breathlessness or persistent breathing discomfort may consult a respiratory specialist, chest physician or family medicine doctor. If symptoms are sudden, severe or associated with warning signs, urgent medical attention is needed.
Patients with shortness of breath may feel that they cannot breathe deeply, cannot get enough air, or need to breathe harder than usual. Some may experience wheezing, rapid breathing, increased heart rate, chest tightness or difficulty lying flat.
Other associated symptoms may include cough, fever, chills, chest pain, fatigue, bluish lips or fingers, swelling of the feet or ankles, nasal flaring, or visible pulling-in of the chest wall during breathing.
Warning signs include sudden severe breathlessness, worsening breathing difficulty, shortness of breath that limits daily activities, chest pain, fainting, nausea, high fever with chills and cough, difficulty breathing when lying flat, or swelling of the legs and ankles. These symptoms may suggest a more serious condition such as heart disease, lung infection, pulmonary embolism or heart failure.
Diagnosis begins with a detailed review of symptoms, medical history and physical examination. The doctor may ask when the breathlessness started, whether it is sudden or long-lasting, whether it occurs during activity or at rest, and whether it is associated with chest pain, cough, fever, wheezing, swelling or fainting.
The doctor may also ask about smoking history, lung disease, heart disease, anaemia, obesity, anxiety symptoms, medication use and possible exposure to pollutants or carbon monoxide.
During the examination, the doctor may check the breathing rate, oxygen level, heart rate, blood pressure, chest movement and listen to the lungs and heart. Depending on the suspected cause, further tests may be arranged, such as blood tests, chest X-ray, electrocardiogram, lung function test, CT scan, echocardiogram or other investigations.
Treatment depends on the underlying cause of shortness of breath. If it is caused by asthma, chronic obstructive pulmonary disease or bronchospasm, inhaled medications may be used to open the airways. If infection such as pneumonia is suspected, treatment may include appropriate medication and supportive care. If the cause is related to heart disease, anaemia, pulmonary embolism or other serious conditions, targeted medical treatment is required.
Lifestyle adjustments may help some patients reduce symptoms or prevent flare-ups. These include avoiding smoking and second-hand smoke, reducing exposure to air pollution or asthma triggers, maintaining a healthy weight, pacing activities, avoiding breath-holding, and following the treatment plan given by healthcare professionals.
Breathing techniques such as pursed-lip breathing may help some patients manage breathlessness. Pulmonary rehabilitation may also be recommended for suitable patients with chronic lung disease.
Patients should seek medical attention promptly if shortness of breath is worsening, persistent, sudden in onset, or associated with chest pain, fainting, confusion, bluish lips, high fever, leg swelling or difficulty breathing while lying flat.
