Dyspnea (Shortness of Breath): Causes, Triggers, and Relief Strategies | Max Hospital

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Dyspnea (Shortness of Breath): Causes, Triggers, and Relief Strategies

By Dr. Sharad Joshi in Pulmonology

May 21 , 2024 | 11 min read


Breathing, the fundamental act that sustains life, is a process so intrinsic to our existence that its significance often goes unnoticed, until it becomes compromised. Dyspnea, or shortness of breath, serves as a stark reminder of the vital role that breathing plays in our lives. In this article, we explore the intricacies of dyspnea, covering its diverse manifestations, causes, triggers, and strategies for relief. Let’s begin by starting the disorder. 

What is Dyspnea (Shortness of Breath)?

Dyspnea, commonly referred to as shortness of breath, is a subjective sensation of breathing discomfort or difficulty. Characterized by a feeling of breathlessness, air hunger, or the perception of insufficient airflow, dyspnea can result from a wide range of underlying conditions affecting the respiratory or cardiovascular systems, Anemia (low hemoglobin) as well as factors such as physical exertion, anxiety, deconditioning (low stamina) or environmental influences. Therefore, proper evaluation by a healthcare professional is crucial to determine the cause and appropriate management of dyspnea. 

What are Acute and Chronic Dyspnea?

Acute dyspnea

Acute dyspnea refers to a sudden or rapid onset of shortness of breath that typically requires immediate medical attention. It often arises suddenly and can be severe, causing significant distress and discomfort. Acute dyspnea may be triggered by various factors such as asthma attacks, pulmonary embolism, heart failure exacerbations, or severe allergic reactions, Pneumonia, rupture of lung, Pleural effusion.

Chronic dyspnea

Chronic dyspnea, on the other hand, refers to persistent or long-lasting shortness of breath that occurs over time. It may develop gradually and persist for weeks, months, or even years. Chronic dyspnea is often associated with underlying chronic conditions such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, heart failure, or obesity hypoventilation syndrome. 

Unlike acute dyspnea, which requires immediate medical attention, chronic dyspnea may be managed through ongoing medical treatment, lifestyle modifications, and pulmonary rehabilitation.

What are Paroxysmal Nocturnal Dyspnea and Sighing Dyspnea?

Paroxysmal nocturnal dyspnea (PND) and sighing dyspnea are two distinct forms of dyspnea with different characteristics:

Paroxysmal nocturnal dyspnea (PND)

PND refers to sudden, severe episodes of shortness of breath that awaken individuals from sleep, usually occurring during the night or early morning hours. It is often associated with heart failure or other cardiovascular conditions, such as ischemic heart disease or left ventricular dysfunction. Individuals experiencing PND may also report symptoms such as coughing, wheezing, chest pain, or anxiety during these episodes. The condition occurs due to fluid accumulation in the lungs (pulmonary edema) while lying down, which redistributes upon standing, causing relief of symptoms. 

Sighing dyspnea

Sighing dyspnea refers to frequent, exaggerated sighing or deep breaths, interspersed with normal breath often occurring involuntarily or as a conscious effort to relieve a sensation of breathlessness. It may occur in individuals with anxiety disorders, hyperventilation syndrome, or other psychological or emotional conditions or neurological conditions. It may be accompanied by symptoms such as dizziness, lightheadedness, chest tightness, or tingling sensations in the extremities. Individuals experiencing sighing dyspnea may feel as though they cannot take a satisfying breath, leading to persistent feelings of breathlessness or air hunger. 

Both paroxysmal nocturnal dyspnea and sighing dyspnea are concerning clinical manifestations that warrant medical evaluation to determine the underlying cause and appropriate management strategies.

Variety of Presentation

Presentation can vary depending on the underlying cause and the severity of the condition. Common signs include:

  • Breathlessness: A subjective sensation of difficulty or discomfort in breathing, feeling as though you cannot get enough air.
  • Increased respiratory rate: Rapid or shallow breathing, where you may notice an increase in the number of breaths per minute.
  • Increased heart rate: In response to increased respiratory effort, your heart rate may also elevate.
  • Chest tightness: A feeling of pressure or tightness in the chest, which may accompany breathlessness.
  • Oxygen Level: If any one feels breathless, then monitor SpO2 i.e oxygen level using pulse oximeter at home (a handy instrument). 
  • Wheezing: A high-pitched whistling sound heard when breathing, often associated with narrowing or obstruction of the airways, as seen in conditions like asthma or COPD.
  • Coughing: Some individuals may experience coughing, especially if dyspnea is caused by respiratory conditions such as asthma, pneumonia, or bronchitis.
  • Difficulty speaking: In severe cases of dyspnea, individuals may find it challenging to speak in full sentences due to breathlessness.
  • Use of accessory muscles: In an effort to increase airflow, individuals may visibly use accessory muscles in the neck or chest to aid breathing.
  • Nasal flaring: Flaring of the nostrils during breathing, which can indicate increased respiratory effort.
  • Cyanosis: In severe cases of dyspnea, where oxygen levels in the blood are significantly reduced, the skin, lips, or nail beds may appear bluish or cyanotic.

If you experience sudden or severe shortness of breath, especially if accompanied by chest pain, fainting, confusion, or other concerning symptoms, seek proper evaluation by a healthcare professional to determine the underlying cause and initiate appropriate treatment.

What Causes Shortness of Breath (Dyspnea)?

Dyspnea can be caused by various factors, including:

  • Respiratory conditions: Respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary embolism, interstitial lung disease, or bronchitis can lead to shortness of breath, pleural effusion and pulmonary hypertension, lung cancer.
  • Heart conditions: Heart-related issues such as heart failure, coronary artery disease, myocardial infarction (heart attack), arrhythmias, or pericarditis can cause dyspnea by impairing the heart's ability to pump blood effectively or causing fluid buildup in the lungs. Various Valve disorders also cause Dyspnea. 
  • Anemia: Anemia, characterized by a low red blood cell count or decreased hemoglobin levels, can lead to reduced oxygen-carrying capacity in the blood, resulting in dyspnea and fatigue.
  • Obesity: Excess weight can put pressure on the chest wall and lungs, making it more difficult to breathe, especially during physical activity.
  • Anxiety or panic disorders: Psychological factors such as anxiety, panic disorders, or hyperventilation syndrome can lead to dyspnea due to rapid or shallow breathing patterns.
  • Rheumatological disorder: In ankylosing spondylitis, rheumatoid arthritis, sclerosis and many other disorders can affect lungs leading to dyspnea. 
  • Breathing and lungs: may be affected in any unrelated disease in advance stage like, Advanced kidney disease, liver disease, neurological disease, muscular diseases or abdominal diseases.
  • Environmental factors: Environmental factors such as high altitude, pollution, allergens, or exposure to irritants can trigger dyspnea in susceptible individuals.
  • Physical exertion: Strenuous physical activity or exercise can cause shortness of breath as the body requires more oxygen to meet increased metabolic demands.
  • Neuromuscular disorders: Conditions affecting the nerves, muscles, or chest wall, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, or myasthenia gravis, can impair respiratory muscle function and lead to dyspnea.
  • Medications: Certain medications, such as beta-blockers, ACE inhibitors, or opioids, can have respiratory side effects and contribute to dyspnea in some individuals.
  • Other factors: Other factors such as smoking, exposure to secondhand smoke, or underlying metabolic conditions like diabetes can also influence respiratory function and contribute to dyspnea.

How is Shortness of Breath (Dyspnea) Treated?

Treatment for shortness of breath (dyspnea) depends on the underlying cause and severity of the condition. Here are common treatment approaches:

  • Management of underlying condition: The treatment of dyspnea includes identifying and addressing any underlying medical condition contributing to the condition. 
  • Oxygen therapy: Supplemental oxygen therapy may be prescribed for individuals with severe dyspnea or low blood oxygen levels. Oxygen can help improve oxygenation of tissues and relieve breathlessness, especially during exertion or at rest.
  • Use of CPAP, BiPAP, AVAPS devices: in cases of pulmonary edema, Heart failure, Sleep Apnea and Respiratory failure/ Distress can be of great help. 
  • Bronchodilators: In conditions such as asthma or COPD, bronchodilators (inhaled medications) are used to relax the muscles surrounding the airways, allowing for easier breathing and relief of dyspnea.
  • Corticosteroids: Inflammatory conditions affecting the airways of lungs may be treated with corticosteroids to reduce inflammation and improve breathing.
  • Diuretics: Diuretic medications are commonly used to reduce fluid buildup in the body, particularly in individuals with heart failure or pulmonary edema, to alleviate dyspnea.
  • Lifestyle modifications: Lifestyle changes such as smoking cessation, weight loss, regular exercise, and dietary modifications may be recommended to improve overall respiratory health and reduce dyspnea, particularly in individuals with obesity or respiratory conditions.
  • Medication: Several Autobiotics, painkillers (NSAIDS), anti-cancer drugs and other medications can damage lungs or airways and can lead to dyspnoea. Therefore expert opinion is must.
  • Pulmonary rehabilitation: Pulmonary rehabilitation programs offer structured exercise training, education, and support for individuals with chronic respiratory conditions to improve lung function, physical fitness, and quality of life.
  • Relaxation techniques: Stress and anxiety can exacerbate dyspnea. Relaxation techniques such as deep breathing exercises, mindfulness, or meditation may help reduce anxiety and improve breath control.
  • Positional changes: Adjusting body position, such as sitting upright or using pillows to elevate the head during sleep, can help ease breathing and alleviate dyspnea, particularly in individuals with conditions like heart failure or sleep apnea.
  • Surgical interventions: In some cases, surgical procedures may be necessary to address underlying anatomical issues contributing to dyspnea, such as lung resection for cancer, or interventions to repair heart defects.

Can Dyspnea be Cured?

Whether dyspnea can be "cured" depends on the underlying cause. In some cases, addressing the underlying condition or trigger may alleviate or significantly improve dyspnea. However, in some cases, dyspnea may be a chronic or persistent symptom that requires ongoing management rather than a cure.

Is Dyspnea Life-Threatening?

Whether dyspnea is life-threatening depends on the underlying cause and the severity of the condition. In some cases, dyspnea may be a symptom of a serious or potentially life-threatening medical emergency, such as:

  • Acute respiratory failure: Severe dyspnea accompanied by other symptoms such as cyanosis (bluish discoloration of the skin), confusion, or decreased level of consciousness may indicate acute respiratory failure, which requires immediate medical attention.
  • Myocardial infarction (heart attack): Dyspnea, especially when accompanied by chest pain, nausea, sweating, or arm pain, may be a sign of a heart attack, a life-threatening condition that requires prompt medical treatment.
  • Pulmonary embolism: Sudden onset of dyspnea, chest pain, coughing up blood, or rapid heart rate may indicate a pulmonary embolism, a blockage in the pulmonary arteries, which can be life-threatening if not treated promptly.
  • Severe asthma attack: Severe dyspnea, wheezing, chest tightness, or inability to speak in full sentences during an asthma exacerbation may indicate a severe asthma attack, which can be life-threatening if not managed promptly with appropriate medications.
  • Cardiogenic shock: Dyspnea, hypotension (low blood pressure), weak pulse, and altered mental status may indicate cardiogenic shock, a life-threatening condition characterized by inadequate blood flow to the body's organs due to heart failure.

While dyspnea itself may not always be life-threatening, it can be a warning sign of underlying medical conditions that require urgent medical attention. It is, therefore, essential to seek prompt medical evaluation if you experience sudden or severe dyspnea, especially if accompanied by other concerning symptoms.

How to Prevent Dyspnea?

Preventing dyspnea involves adopting lifestyle habits and practices that support respiratory health and minimize the risk of breathing difficulties. Here are some strategies to help prevent dyspnea:

  • Avoid smoking and secondhand smoke: Smoking damages the lungs and airways, increasing the risk of respiratory conditions such as asthma, COPD, and lung cancer. Avoid smoking, and limit exposure to secondhand smoke to protect your respiratory health.
  • Avoid environmental pollutants: Minimize exposure to air pollutants such as vehicle exhaust, industrial emissions, and indoor pollutants to protect respiratory health.
  • Maintain a healthy weight: Obesity can contribute to respiratory problems by putting pressure on the chest and lungs, making it harder to breathe. Maintain a healthy weight through a balanced diet and regular exercise to reduce the risk of obesity-related breathing difficulties.
  • Stay active: Regular physical activity strengthens the respiratory muscles, improves lung function, and enhances overall fitness. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week, as recommended by health guidelines.
  • Practice good posture: Maintain good posture to optimize lung capacity and airflow. Sit and stand up straight to allow for proper expansion of the chest and lungs.
  • Manage allergies and environmental triggers: Allergens such as pollen, dust mites, mold, and pet dander can trigger respiratory symptoms and dyspnea in susceptible individuals. Take steps to reduce exposure to allergens by using air purifiers, keeping indoor spaces clean, and avoiding outdoor activities during high pollen seasons.
  • Use dust-proof bedding: Encase mattresses, pillows, and bedding in allergen-proof covers to prevent exposure to dust mites and other allergens while sleeping.
  • Practice good respiratory hygiene: Cover your mouth and nose with a tissue or your elbow when coughing or sneezing to prevent the spread of respiratory infections.
  • Stay hydrated: Drink plenty of water to maintain proper hydration and thin respiratory secretions, making it easier to breathe.
  • Manage stress: Stress and anxiety can exacerbate dyspnea by increasing respiratory rate and muscle tension. Practice stress-reduction techniques such as deep breathing exercises, meditation, yoga, or progressive muscle relaxation to promote relaxation and reduce stress-related breathing difficulties.
  • Follow treatment plans: If you have underlying respiratory conditions such as asthma or COPD, adhere to prescribed treatment plans, including medications, inhalers, and other therapies, to manage symptoms effectively and prevent exacerbations.

Wrap up

Encountering persistent or recurring dyspnea despite proactive efforts warrants seeking specialized medical guidance to address any underlying issues effectively. At Max Hospitals, our team of experienced specialists is committed to delivering tailored care to suit your unique requirements. Through comprehensive evaluations, cutting-edge diagnostic methods, and personalized treatment strategies, we prioritize your respiratory health and overall well-being. Your path toward optimal respiratory health begins with a consultation at Max Hospitals.

Do not ignore Respiratory symptoms; it may be a warning sign of life-threatening conditions.