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Patient Instructions

Breathing difficulty involves a sensation of difficult or uncomfortable breathing or a feeling of not getting enough air.

See also: Difficulty breathing - first aid

No standard definition exists for difficulty breathing. Some people may feel breathless with only mild exercise (for example, climbing stairs), even though they do not have a specific disorder. Others may have advanced lung disease but never feel short of breath.

Wheezing is one form of breathing difficulty.

See also:

• Apnea
• Lung diseases
• Rapid breathing

Shortness of breath has many different causes.

• A blockage of the air passages in your nose, mouth, or throat may lead to difficulty breathing.
• Heart disease can cause breathlessness if your heart is unable to pump enough blood to supply oxygen to your body. If your brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur.
• Sometimes emotional distress, such as anxiety, can lead to difficulty breathing.

The following problems may cause breathing difficulty:

Problems with the lungs

• Pneumonia (severe)
• Bronchiolitis
• Chronic obstructive pulmonary disease (COPD), asthma, and other chronic lung problems
• Blood clot in the arteries of the lungs (pulmonary embolism)
• Pulmonary hypertension

Problems with the airways leading to the lungs

• Choking on something stuck in the airways
• Croup
• Epiglottitis

Problems with the heart

• Heart attack or angina
• Heart failure
• Heart rhythm disturbances (arrhythmias)
• Children born with heart defects (congenital heart disease)

Other problems

• Rapid ascent to high altitudes, where there is less oxygen in the air
• A large amount of dust in the environment
• Allergies (such as to mold, dander, or pollen)
• Lack of exercise
• Obesity
• Compression of the chest wall
• Panic attacks
• Hiatial hernia

In some circumstances, a small degree of breathing difficulty may be normal. Severe nasal congestion is one example. Strenuous exercise, especially when you do not exercise regularly, is another example.

If difficulty breathing is new or is getting worse, this may indicate a serious problem. Though many causes are harmless and easily corrected, any breathing difficulty requires that you contact your health care provider.

If your doctor has been treating you for a long-term problem with your lungs or heart, follow your health care provider's directions to help with that problem. (See: asthma, COPD, heart failure)

Go to the emergency room or call the local emergency number (such as 911) if:

• Breathing difficulty comes on suddenly or seriously interferes with your breathing
• Someone completely stops breathing

See your health care provider if breathing difficulty starts suddenly or is severe, or if any of the following occur with breathing difficulties:

• Chest discomfort, pain, or pressure
• Shortness of breath after only slight exertion or while at rest
• Shortness of breath that wakes you up at night or requires you to sleep propped up to aid breathing
• Wheezing
• Having inhaled or choked on an object (foreign object aspiration or ingestion)
• Tightness in the throat or a barking, croupy cough
• Development of a fever or significant cough

Your health care provider will take a detailed medical history and perform a physical examination.

You may be asked the following medical history questions:

• Do you notice shortness of breath?
• Do you make grunting sounds while breathing?
• Do you have to work hard to breathe?
• How long have you had breathing difficulty?
• Did it slowly progress over weeks to months?
• Did it begin recently?
• Did it begin suddenly?
• Did it come on slowly (gradual onset)?
• Is there a sequence of separate occurrences (episodes)? How long does each last, and does each episode have a similar pattern?
• Has the breathing difficulty worsened recently?
• Does breathing difficulty cause you to wake up at night (paroxysmal nocturnal dyspnea)?
• Does the amount of breathing difficulty change (variable over hours)?
• Does breathing difficulty occur at rest?
• How long does each episode last?
• Is it worse when you lie flat (orthopnea)?
• Is it worse when you change body position?
• Did it develop within 4 to 6 hours after exposure to something that you are or may be allergic to (antigen)?
• Is it worse after exercise?
• Does shortness of breath occur only when you are wheezing?
• Is your breathing pattern irregular?
• Do you draw back the chest muscles with breathing (intercostal retractions)?
• What other symptoms do you have?

The physical examination will include a thorough check of your lungs, heart, and upper airway passages.

Tests that may be performed include the following:

• Blood tests (may include arterial blood gases)
• Measurement of blood oxygen saturation (pulse oximetry)
• ECG
• X-ray of the chest
• Pulmonary function tests
• Exercise testing
• CT scan of the chest
• Echocardiogram

In severe cases of difficulty breathing, hospitalization may be required. Many different medications aimed at treating the cause of breathing difficulty may be used.

If your blood oxygen level is very low, you may need to receive oxygen. High doses of supplemental oxygen may be hazardous for some patients, however. Oxygen is not necessary in all cases of shortness of breath.

Shortness of breath; Breathlessness; Difficulty breathing; Dyspnea

Braithwaite S, Perina D. Dyspnea. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier;2006:chap 18.

Kraft M. Approach to the patient with respiratory diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 83.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.