Shortness of breath or dyspnea is an unpleasant and especially anxious feeling of insufficient breathing. In that case one also speaks of ‘shortness of breath’. The main causes of shortness of breath are respiratory and lung diseases, heart problems, diseases of the larynx or vocal cords and other causes such as poor physical condition and/or obesity. A large number of possible causes of shortness of breath. The list of causes is not exhaustive. Persistent complaints of shortness of breath are a reason to visit the doctor. When shortness of breath and fatigue occur together, it is certainly recommended to visit the doctor as soon as possible. This may, for example, indicate problems with the heart.

• Shortness of breath on exertion or rest

• What is shortness of breath?
• During exertion or rest

• Symptoms
• Forms of shortness of breath
• Specific groups

• Pregnancy
• The elderly and people with serious health problems
• Babies

• Causes of shortness of breath
• Causes of shortness of breath at a glance

• Poor physical condition
• Exercise-induced asthma
• Heart failure
• Collapsed lung
• Pleural effusion
• Pulmonary fibrosis
• COPD
• Extrinsic allergic alveolitis
• Overweight
• Leukemia
• Lung cancer
• Pneumonia
• Bronchiectasis
• Pulmonary hypertension
• Anemia
• Side effect of some medications
• Sarcoidosis
• Throat cancer
• Hyperventilation and stress
• Legionnaires’ disease
• Heart attack
• Cardiac arrhythmia
• Bronchitis
• Low blood pressure and high blood pressure
• Vitamin B12 deficiency
• Overactive thyroid gland
• Tuberculosis (TB)
• Coronavirus

• Call a doctor

• Make an appointment with your GP
• Alarm symptoms

• Examination and diagnosis
• Therapy

• Medication
• Diet and exercise
• Extra oxygen
• Pulmonary rehabilitation
• Cardiac rehabilitation
• Lifestyle adjustments

• Naturopathy and aromatherapy
• Complications
• Prevention and avoidance

• Quit smoking
• Air pollution
• Healthy weight

• Prognosis

 Shortness of breath / Source: Wavebreakmedia/Shutterstock.com

Shortness of breath on exertion or rest

What is shortness of breath?

Shortness of breath is also called dyspnea , which literally means ‘difficult breathing’. This causes an unpleasant and especially anxious feeling that breathing is inadequate; Dyspnea is a conscious experience of a disturbance in breathing. Shortness of breath may indicate a possible heart or lung problem or other problem.

During exertion or rest

A distinction is often made between dyspnea during exertion or at rest. With shortness of breath on exertion, you suddenly feel out of breath after a bike ride or climbing stairs. With shortness of breath at rest, you already feel short of breath while you are doing nothing, so not after exertion.

Symptoms

Additional symptoms of shortness of breath include:

• respiratory distress
• air hunger

Tightness in the chest / Source: InesBazdar/Shutterstock.com

• shortness of breath
• smothered or suffocated feeling due to difficulty breathing
• difficult breathing
• tight feeling in the chest
• rapid, shallow breathing
• palpitations
• wheezing
• cough

 

Forms of shortness of breath

Shortness of breath can occur gradually or suddenly, which is called acute dyspnea . The complaints may last a short time or be present continuously. This distinction can help identify the precise cause of shortness of breath. An average adult takes 12 to 15 breaths per minute at rest. When short of breath, a person breathes faster.The acute form is characterized by the sudden onset (or within a few hours) of the complaints. With slowly increasing or chronic shortness of breath, the symptoms of shortness of breath develop over a longer period of time and your body can become used to this, so immediate treatment is not necessary. It is important to distinguish between these two forms of shortness of breath, because acute shortness of breath is more threatening than slowly increasing shortness of breath.Shortness of breath during pregnancy / Source: Zerocool, Pixabay

Specific groups

Shortness of breath can affect specific groups of people in different ways:

Pregnancy

Mild symptoms of shortness of breath are common during pregnancy. This is because pregnancy changes a woman’s breathing capacity. Breathing capacity increases during pregnancy, but there is also a reduction in lung volume of up to 20 percent at the end of an expiration or exhalation. The number of breaths a pregnant woman takes per minute, or breathing rate, usually does not change during pregnancy.

The elderly and people with serious health problems

Shortness of breath can occur when people are in the advanced stages of serious (chronic) diseases. For example, in the palliative phase, 45 to 56% of patients with cancer experience complaints of shortness of breath; for lung cancer this is approximately 70% and people with severe COPD experience more frequent and severe shortness of breath and fatigue.

Babies

Upper respiratory tract diseases causing acute shortness of breath are a relatively common emergency in infants. It is one of the most common causes of shortness of breath in infants. Croup, inhalation of a foreign body and inflammation of the epiglottis (epiglottitis) are all common causes of shortness of breath in babies.Imaging examination of the lungs / Source: Minerva Studio/Shutterstock.com

Causes of shortness of breath

There is no clear link between shortness of breath, blood oxygen levels or performance. Everyone experiences this differently and what is experienced as serious for one person may not be so for another. The patient is as dyspnoeic as he says he is. The same applies to pain complaints. The extent to which dyspnea is experienced does not depend on the severity of the underlying cause.The main causes of shortness of breath are:

• respiratory and lung diseases;
• heart problems;
• diseases of the larynx or vocal cords; and
• other causes such as poor physical condition and/or obesity.

 

Causes of shortness of breath at a glance

Possible causes of shortness of breath—in no particular order—include:

Poor physical condition

Poor fitness can lead to shortness of breath upon exertion. Movement is an elixir of life. It has a positive effect on the body. The heart works more efficiently, as do the muscles. After a short period of regular, moderate-intensity exercise, the risk of a heart attack drops by about 25 percent. The more often this type of training is repeated, the faster the muscles get their energy from the fat deposits. Blood pressure drops, bones become more stable and firmer and the risk of diabetes and cancer decreases. You will also no longer feel short of breath as quickly when you exert yourself. Exercise trains the muscles and you also get stronger lungs. The blood supply to the brain is also stimulated and the beneficial messenger substances can provide a reward there. This spreads to the entire organism and gets you going. All these effects have been known for years. However, they will usually only occur if you exercise regularly.

Exercise-induced asthma

You may become short of breath due to exertion, for example when exercising or when sprinting to the bus. Exercise-induced asthma mainly occurs when you move too quickly. With exercise-induced asthma, it is therefore important to start an activity slowly, so that the lungs can get used to the transition from rest to exercise. Stress and intense emotions can also worsen the complaints, especially in the case of exercise-induced asthma. The temperature and humidity of the air can also have an influence on exercise-induced asthma. Cold and moist air are often annoying for people with exercise-induced asthma.Shortness of breath is one of the symptoms of heart failure / Source: Wou, Wikimedia Commons (Public domain)

Heart failure

Heart failure leads to a gradual onset of shortness of breath. One of the causes of heart failure is a leaky heart valve. As a result of a leaking heart valve, blood flows backwards and the heart has to exert more force to pump the same amount of blood. This leads to complaints such as fatigue and shortness of breath during exertion. The patient is aware of the strong beating of the heart.

Collapsed lung

Pneumothorax or collapsed lung is the presence of air between the membranes of the lung and chest wall. Part or all of the lung has collapsed, causing pain or tightness in the chest, shortness of breath and shortness of breath.

Pleural effusion

There is too much fluid between the membranes that surround the lungs. The accumulated fluid compresses the lung below, gradually causing shortness of breath.

Pulmonary fibrosis

Pulmonary fibrosis is progressive thickening and inflammation of the walls of the alveoli, leading to shortness of breath, persistent, dry cough and joint pain.

COPD

COPD stands for ‘chronic obstructive pulmonary disease’, which was previously called chronic bronchitis and emphysema. In chronic obstructive pulmonary disease, airways and lungs are gradually damaged, causing increasing shortness of breath. This condition is mainly caused by long-term exposure of the lungs to harmful substances such as tobacco smoke.

Extrinsic allergic alveolitis

This is an allergic reaction to inhaled dust or chemicals, usually developing symptoms within four to eight hours of initial exposure. These symptoms include fever and chills, coughing and wheezing and tightness in the chest and possibly shortness of breath.Overweight / Source: Kurhan/Shutterstock.com

Overweight

Because excess weight causes a build-up of fat under the diaphragm and chest wall, breathing is hindered, causing shortness of breath. Shortness of breath can occur after exertion, such as after walking or cycling, but one can also become short of breath during daily activities such as dressing or climbing stairs.

Leukemia

Leukemia is the collective name for various types of bone marrow cancer. Many symptoms can occur with leukemia, including fatigue, pale skin and shortness of breath on exertion due to anemia.Lung cancer / Source: Muratart/Shutterstock.com

Lung cancer

Lung cancer is a collective name for a number of malignant tumors that originate in the lungs. Shortness of breath is one of the symptoms of lung cancer.

Pneumonia

Pneumonia is an inflammation of the alveoli, which is often caused by an infection. The culprit is often bacteria. One of the characteristics of pneumonia is shortness of breath, rapid shallow breathing, while at rest.

Bronchiectasis

This indicates chronic, abnormal dilation of the wall of the airways, the bronchi. A common cause is a recurring bacterial respiratory infection in patients with cystic fibrosis. Recurrent infections in COPD can also lead to bronchiectasis.

Pulmonary hypertension

This condition causes abnormally high pressure in the blood vessels to the lungs. All kinds of heart and lung diseases can cause this. Symptoms include shortness of breath that worsens with exertion and fatigue.Fatigue due to anemia / Source: Istock.com/dolgachov

Anemia

Anemia is a medical condition in which there are too few red blood cells in the blood and/or the red blood cells do not function properly. With more serious anemia, the following symptoms may occur: fatigue, feeling of weakness, pale skin, shortness of breath during mild exertion or sometimes even at rest, palpitations, ringing in the ears, dizziness, light-headedness, headache and cold hands and feet.

Side effect of some medications

Some medications can cause shortness of breath as a side effect.

Sarcoidosis

Sarcoidosis is a condition in which inflammation occurs in different parts of the body. It is also called Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, after its discoverers. Sarcoidosis in the larynx consists of shortness of breath, swallowing disorders and coughing. Sarcoidosis in the lungs can also cause complaints such as shortness of breath or dry cough.Alcohol consumption is a risk factor for throat cancer / Source: Marian Weyo/Shutterstock.com

Throat cancer

Throat cancer (larynx cancer or head and neck cancer) involves a malignant tumor in or near the larynx. Throat cancer causes chronic cough and a lot of mucus in the throat in its later stages. With a large tumor, one may also experience shortness of breath and swallowing problems.

Hyperventilation and stress

Shortness of breath can also be caused by hyperventilation, which is often the result of anxiety or stress, causing you to breathe quickly or sigh deeply. Anxiety, hyperventilation and panic attacks increase the risk of dyspnea.

Legionnaires’ disease

Legionella Pneumophila is a bacterium that can cause Legionnaires’ disease, which causes pneumonia or a milder form of infection – legionella flu. You can become infected by inhaling contaminated water mist from a contaminated water source.Cause of a heart attack / Source: Alila Medical Media/Shutterstock.com

Heart attack

Shortness of breath is a major symptom of a heart attack. Other symptoms include:

• pressure, tightness, pain, or a pinching or painful sensation in the chest or arms that may spread to your neck, jaw, or back
• nausea, indigestion, heartburn or abdominal pain
• cold sweat
• fatigue
• sudden dizziness

 

Cardiac arrhythmia

A cardiac arrhythmia is a recurring disturbance of the heart rhythm, in which the heart beats too fast, too slow or too irregularly. One of the symptoms that may occur is shortness of breath.

Bronchitis

Bronchitis is an acute inflammation of the bronchi and can cause shortness of breath, among other things. The symptoms of acute bronchitis and chronic bronchitis may include:

• cough
• production of mucus (sputum), which may be clear, white, yellowish gray or green in color – in rare cases it may be streaked with blood
• fatigue
• shortness of breath
• mild fever and chills
• chestpain

If you have acute bronchitis, you may have cold symptoms, such as a mild headache or body ache. Although these symptoms usually improve after about a week, you may experience a nagging cough that lasts for several weeks. Chronic bronchitis is characterized by a productive cough lasting at least three months, with recurrent attacks occurring for at least two consecutive years. If you have chronic bronchitis, you likely have periods when your cough or other symptoms worsen.

Low blood pressure and high blood pressure

Both low blood pressure and high blood pressure can lead to shortness of breath.Shortness of breath due to vitamin B12 deficiency / Source: Istock.com/NatchaS

Vitamin B12 deficiency

Shortness of breath can be caused by a vitamin B12 deficiency. The body is able to store large reserves of vitamin B12. That is why a deficiency arises gradually. It can cause a range of complaints, including shortness of breath.The list of symptoms of vitamin B12 deficiency is long because it affects all bodily functions. The first signs can occur separately or in combination with other complaints:

• fatigue
• mood swings
• concentration problems
• sleep problems
• physical and mental exhaustion

Because the symptoms are quite diffuse and can also indicate completely different diseases, the diagnosis of vitamin B12 deficiency is not always obvious. That is why it is often only discovered after years. Moreover, the first symptoms of a deficiency often only occur after the body has not been sufficiently supplied with the nutrient for a number of years. If vitamin B12 intake decreases, the body uses the B12 stores in the liver and muscles. However, when the last reserves of the body’s cells are used up, the first symptoms appear.Thyroid ultrasound / Source: Dreams Come True/Shutterstock.com

Overactive thyroid gland

An overactive thyroid gland (Hyperthyroidism) can cause a range of complaints, including shortness of breath.When the thyroid gland produces too many hormones, there is an overproduction, which is known as hyperthyroidism. The symptoms are varied due to the many roles of the thyroid hormones. Symptoms can creep in slowly or come on very abruptly. These include:

• weight loss despite unchanged or even increased appetite
• hair loss
• sweat more
• heat intolerance
• warm, moist skin
• diarrhea
• menstrual disorders

Thyroid hormones have a stimulating effect on the cardiovascular system, which is manifested, among other things, in an increased heart rate. The influence of hyperthyroidism on the central nervous system is manifested in increased nervousness, restlessness, tremors, sleep disorders and mood swings.The symptoms listed may vary in severity. Furthermore, hyperthyroidism does not necessarily have to be accompanied by all the symptoms mentioned.

Tuberculosis (TB)

Tuberculosis (TB) is a bacterial infectious disease that can cause shortness of breath, among other things. Other complaints include persistent cough (sometimes with blood), fever, chest pain, sweating during sleep (night sweats), fatigue, reduced appetite and weight loss.

Coronavirus

People infected with the new coronavirus COVID-19 develop lung complaints and shortness of breath.

Call a doctor

Make an appointment with your GP

If you experience shortness of breath at rest or during any form of exertion, it is wise to consult your doctor. Even if shortness of breath worsens or occurs in combination with one or more of the following symptoms, it is advisable to see a doctor:

• Wheezing (stridor);
• swollen ankles or feet;
• Not being able to lie flat;

Fainting / Source: Andrey_Popov/Shutterstock.com

• Signs of an infection, such as fever, chills or coughing.

 

Alarm symptoms

In case of shortness of breath in combination with the following symptoms, it is wise to seek emergency help immediately and not to let the person in question drive a car themselves because there is a risk of unconsciousness:

• Dizziness;
• Pass out;
• Shortness of breath that starts suddenly or is severe;
• Nausea or vomiting;
• Chestpain.

 Consultation with the doctor / Source: Syda Productions/Shutterstock.com

Examination and diagnosis

Typically, a doctor can diagnose shortness of breath based on a complete physical examination, along with a full description of your symptoms and experiences. The doctor will also take your medical history into account. the doctor will ask how and when your attacks of shortness of breath started, how long they last, how often they occur and how severe they are.If necessary, the doctor will order imaging tests in the form of chest x-rays and CT scans to make a more specific diagnosis and evaluate the health of the heart, lungs and related systems. An electrocardiogram (ECG) can help show signs of a heart attack or other electrical problem in the heart. Spirometric examination can be done to measure airflow and lung capacity. This can help determine the type and extent of breathing problems. Additional tests may be done regarding the oxygen level in the blood and the blood’s ability to carry oxygen.

Therapy

Treatment of shortness of breath focuses primarily on its underlying cause.Medication for shortness of breath / Source: Stevepb, Pixabay

Medication

The doctor may prescribe medication to remove excess mucus from the airways and improve breathing. The doctor prescribes corticosteroids or bronchodilator drugs to open the airways so that breathing improves. Asthma normally responds well to medication. Antibiotics may be useful for a bacterial infection, such as bacterial pneumonia. The doctor may also prescribe opiates, anti-inflammatory drugs, and anti-anxiety medications if necessary.

Diet and exercise

If being overweight or obese and poor fitness is the cause of the shortness of breath you experience, it is important to make lifestyle changes under the guidance of a dietitian, such as diet changes and more exercise. If you have a medical condition that limits your movement, discuss with your GP what a suitable exercise program is for you. Physiotherapy may offer a solution.

Extra oxygen

COPD and other lung problems require the care of a pulmonologist, a doctor who specializes in the health of your lungs and respiratory system. You may need extra oxygen. There are different oxygen systems for the home with different properties. In addition, there are all kinds of mobile systems on the market. What all types have in common is that the oxygen enters your nose through a tube, where it mixes with the air you breathe. Extra oxygen can greatly improve the quality of your life. You can do this yourself to promote therapy:

• Do not smoke.
• Exercise enough.
• Follow your doctor’s instructions carefully.

 

Pulmonary rehabilitation

Pulmonary rehabilitation can also be useful. This is a program with breathing exercises, where good improvements in symptoms can be achieved. The program focuses on:

• More knowledge about your disease.
• Obtaining better fitness, for example by cycling, walking and strength training.
• Learning to deal with your lung disease and your limitations within your family, work or in your free time.
• Properly distributing energy throughout the day.

 

Cardiac rehabilitation

Shortness of breath is one of the symptoms of heart failure. Cardiac rehabilitation can help you recover and improve your complaints. The program consists of physical training for patients admitted for heart problems.Exercise is good for blood circulation, breathing, muscles, joints and bones / Source: Goodluz/Shutterstock.com

Lifestyle adjustments

Making lifestyle changes is important to reduce the severity of symptoms, such as:

• Lose weight if necessary;
• Quit smoking;
• Avoiding exposure to pollutants and smoky environments;
• Move more.

 

Naturopathy and aromatherapy

Various medicinal plants and medicinal herbs can be useful for complaints of shortness of breath. In addition to the decoctions and teas, this also includes inhalations and baths. The following medicinal plants and herbs are particularly suitable for breathing difficulties:

• borage oil

1887 image of real sage / Source: Walther Otto Müller, Wikimedia Commons (Public domain)

• verbena
• eucalyptus
• honey
• horseradish
• sage
• black cumin oil
• thyme
• hawthorn

If there is extra mucus, you can also resort to:

• alant
• coltsfoot
• plantain

 

Complications

Shortness of breath may be associated with hypoxia (a condition in which tissues in the body as a whole or in a particular part of the body are not supplied with sufficient oxygen) or hypoxemia (which is a low level of oxygen in the blood). This can lead to a decreased level of consciousness and other serious symptoms. If dyspnea is severe and persists for some time, there is a risk of temporary or permanent cognitive impairment. Shortness of breath can also be a sign of the onset or worsening of other medical problems.Quit smoking / Source: Serhiy Kobyakov/Shutterstock.com

Prevention and avoidance

Quit smoking

Preventing shortness of breath means avoiding or controlling its many possible causes. The most obvious risk factor for shortness of breath is smoking. If you smoke, ask your doctor for help in quitting smoking. In 2023, there are many effective products and therapies available that can help you quit. It’s never too late. Your heart and lung health improves within hours of stubbing out your last cigarette.

Air pollution

Air pollution and exposure to chemicals can also lead to respiratory problems. So if you work in an environment with poor air quality, consider using a mask and make sure your workplace is well ventilated. If you live right next to a highway, consider moving.Aim for a healthy weight / Source: Istock.com/VladimirFLoyd

Healthy weight

Maintaining a healthy weight can help you prevent a number of health problems. If you need help losing weight, consult a nutritionist or dietitian.

Prognosis

The outlook for people with shortness of breath depends on the cause. If the underlying condition can be successfully treated and improved, such as pneumonia or non-severe asthma, breathing problems can be eliminated or greatly reduced. However, if shortness of breath is due to serious or chronic diseases that worsen over time, such as chronic heart failure, severe asthma or COPD, the improvement may be limited but sometimes enough to provide some relief.

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