Martin E. Liebling, M.D., FACP
Although shortness of breath is a natural response to situations such as exercise or emotional stress, it may also be a symptom of a more serious underlying condition. Also known as dyspnea, shortness of breath is one of the most common symptoms experienced by individuals with progressive illnesses, such as cancer, emphysema and heart disease.
For people experiencing breathing problems, shortness of breath can be physically and emotionally frightening. Individuals may experience feelings of tightness in the chest, inability to get enough air and suffocation. This, in turn, can cause feelings of panic, which in turn often leads to a greater sense of breathlessness.
Dyspnea typically occurs in individuals with lung cancer but it may also develop when cancer in other areas has spread (metastasized) to the lung tissue. It also can occur in cancer patients who show no evidence of cancer in their lungs. Dyspnea can also be a side effect of cancer treatments, such as chemotherapy or radiation therapy.
A person whose heart or lungs are weak may become short of breath because these organs cannot work to meet the oxygen needs of the rest of the body. Therefore, anyone who regularly experiences shortness of breath for no apparent reason, or shortness of breath with less strenuous activity, is encouraged to see a physician to determine the cause. Shortness of breath and accompanying symptoms can be most effectively treated after the underlying cause has been determined. Management of dyspnea may include medications for the underlying condition or simply activities and lifestyle changes that can reduce the symptoms. Some individuals also use various complementary and alternative therapies to help reduce breathing problems. Patient should also check with their physicians before beginning any treatments of dyspnea.
About breathing problems
The medical term for shortness of breath is dyspnea. Shortness of breath is a feeling of not being able to get enough air. Individuals who experience dyspnea often report tightness in the chest or a feeling of suffocation. It can be very distressing, causing both physical and emotional responses.
The normal rate of breathing is 16 to 20 times a minute. A person who is experiencing shortness of breath will breathe at a much higher rate. This can result in rapid heart rate, anxiety and panic.
Shortness of breath is common after periods of heavy exertion, such as exercise. Exercise increases the amount of carbon dioxide (a waste product) in the blood, causing the heart and breathing rate to increase. The lungs exchange carbon dioxide from the blood (which is exhaled from the body) with fresh oxygen. Once the blood is oxygen-rich, it leaves the lungs to nourish the body. If the heart and breathing rate cannot exchange enough carbon dioxide for oxygen, then the person may feel short of breath.
Shortness of breath is also common during or immediately after periods of emotional stress, anxiety or fear. This is due to stress hormones (e.g., adrenaline), which can increase heart rate and breathing rate as with exercise. When people regularly feel short of breath for no apparent reason, then a potentially serious underlying disorder may be the cause.
In some cases, dyspnea may leave people gasping. Affected individuals may want or need to breathe in more rapidly (tachypnea), or inhale and exhale more deeply. They may also feel the need to stop moving or sit down to catch their breath. Shortness of breath is sometimes described by patients as “hunger for air” or “chest tightness.”
Dyspnea, or breathing difficulties, is a result of the heart and lungs not being able to get oxygen to the rest of the body. The anxiety that breathlessness can cause often makes the situation even worse, sometimes causing panic in the individual.
There are many possible causes of breathing problems. Many of the conditions that lead to a shortness of breath are mild and are often treatable. In some cases, breathing problems can be a symptom of a more serious disease, including cancer. Although in some cases it may present as an early symptom of cancer, having difficulty breathing is more common among people who have advanced stages of cancer.
Other symptoms related to breathing problems
The underlying condition is the most likely cause of additional symptoms related to breathing problems. In the case of milder conditions, such as an allergy, the shortness of breath can be due to nasal congestion, which may be accompanied by a sore throat or cough. For patients who experience dyspnea from heart problems, such as cardiomyopathy (enlarged heart), they experience irregular heartbeat and fatigue.
Though many of the additional symptoms can be related to mild conditions, it is important to seek the advice of a physician to determine the underlying cause of the breathing problems. If cancer is causing the breathing difficulties, then it may result in chest pain as it spreads, such as with lung cancer. For more serious conditions, breathing problems may be accompanied by hoarseness or coughing, including coughing up blood.
Potential causes of breathing problems
There are many common causes for shortness of breath. If the nose, mouth or throat becomes blocked in any way, a person may experience difficulty breathing. This can be caused by anything from exercise to a stuffy nose (nasal congestion) or from heart disease to advanced stages of cancer.
With advanced lung cancer, it is possible for the cancer to spread to one of the large tubes (trachea or bronchi) through which air passes as it enters the lung. This can be common for advanced stages of lung cancer or cancers that started in other areas of the body and metastasized to the lungs. The cancer can block the flow of air either by growing inside the trachea or bronchus or by compressing it from the outside.
Dyspnea and related symptoms also may occur when a patient develops fluid in the lungs (pleural effusion) or around the heart (pericardial effusion). It is relatively uncommon for cancer to spread to the sac surrounding the heart, but this metastasis can also cause shortness of breath.
Shortness of breath that is not related to exercise, stress or a heart condition may be the result of any of the following:
- Primary cancers, especially in late stages. In addition to lung cancer, these include:
- Cancers of the pharynx and larynx
- Thyroid cancer
- Esophageal cancer
- Non-Hodgkin’s lymphoma
- Hodgkin’s lymphoma
- Multiple myeloma
- Secondary cancers. The lungs are a common metastatic location for several types of cancer, including breast cancer and bone cancer.
- Certain cancer treatments, including radiation therapy to the throat or chest area, as well as certain chemotherapy drugs.
- Pulmonary embolism (a blood clot lodged in a blood vessel of the lung, blocking blood flow to the lung and causing shortness of breath).
- Emphysema and chronic bronchitis.
- Anemia (low red blood cell count) from any cause.
- Asthma (may be accompanied with moderate to severe wheezing).
- Some medications (e.g., aspirin and other nonsteroidal anti-inflammatory drugs [NSAIDs], and beta blockers, particularly in persons with asthma).
- Lung disease, including pneumonia.
- Renal insufficiency.
- Allergies, or an allergic reaction.
- Sleep apnea.
- Heart disease or heart attack.
- Exposure dust, second-hand smoke or polluted air.
- New arrival at high altitudes.
- Stress or anxiety.
Treatment options for breathing problems
The treatment for breathing problems depends on the cause of the condition. Individuals may receive different treatments from their physicians depending on their diagnosis.
For mild cases of breathing problems, there are some simple steps that may help decrease the symptoms. Initially, the patient should become as relaxed and calm as possible. Family members and caregivers can help patients control their breathing and reduce their symptoms.
Some health experts recommend the pursed-lips technique to help control breathing. The simple steps are as follows:
- Purse the lips (pucker up).
- Count the seconds it takes to breathe in a normal breath.
- Exhale (keeping the lips pursed) for two times the number of seconds it took to inhale (e.g., if it took five seconds to inhale, exhale slowly for 10 seconds).
- It is best to try to create a whistling sound while you exhale.
- Avoid forcing the air out. Instead breathe in a normal but controlled manner (lips still pursed).
Another approach is the abdominal breathing technique, which may help facilitate more controlled breathing:
- Lie down face-up on a bed or on the floor.
- Bend the knees or place a pillow underneath the knees for support.
- Place one hand on the upper part of the chest.
- The other hand should be put on the center of the abdomen, near the bottom of the breastbone.
- Through pursed lips, inhale deeply and feel the abdomen expand outward.
- Slowly exhale in a controlled manner, squeezing the abdominal muscles inward and upward.
It can also help to use pillows to elevate the head and upper body at a 45-degree angle. If these techniques do not help, some individuals may want to discuss the possibility of receiving supplemental oxygen or medications. Only a physician can determine whether or not a patient needs oxygen or medications, such as opioids or sedatives, that help reduce pain or lower anxiety levels.
If the shortness of breath is due to fluid that has built up around the lungs because of an advanced stage of cancer, then the fluid may need to be removed. Once the fluid is removed, the individual should be able to breathe more easily.
Before treatment can be prescribed, the physician will need to determine what is causing the shortness of breath. Because people describe shortness of breath in a variety of ways, physicians have developed detailed questionnaires to help narrow the diagnosis.
In addition, physicians may run tests that include a chest x-ray (which produces a picture of the general size, shape, and structure of the heart and lungs) and/or an electrocardiogram (EKG, which painlessly measures the electrical activity of the heart). Depending on the results of these tests, other tests that may be run include the following:
- Echocardiogram. A test that uses sound waves to visualize the structures and functions of the heart.
- Pulmonary function test. A painless test for determining how well the lungs are functioning. It measures how much air the lungs can hold and how fast air can be moved in and out of the lungs.
- Arterial blood gases. An analysis of the oxygen and carbon dioxide from a blood sample.
- Computed axial tomography (CAT) scan or magnetic resonance imaging. These imaging tests may be ordered to help detect the presence or spread of certain cancers.
Once the cause of the shortness of breath has been determined, then appropriate treatment can begin. Medications may be prescribed to control symptoms. Also, lifestyle changes (e.g., less strenuous physical activity or weight loss) may help relieve the symptoms of the underlying disorder. The type of treatment will always depend on the cause of the shortness of breath (e.g., cancer, heart disease, etc.) and additional factors.
Prevention methods for breathing problems
The best way to prevent shortness of breath is to prevent or treat the underlying conditions that cause it. Although people may have no control over developing certain conditions such as asthma, there are some strategies that may be used to avoid flare-ups or a worsening of the condition.
Strategies for maintaining a healthy heart, as well as controlling sleep apnea and obesity, include the following:
- Eating a diet that is low in saturated fats and cholesterol.
- Weight reduction.
- A routine regimen of moderate to vigorous exercise, depending on an individual’s overall health, is invaluable in maintaining general well-being.
- Quitting smoking is critical for all smokers. Tobacco use is the leading cause of preventable death in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC).
- Controlling diabetes.
- Controlling high blood pressure.
- Getting regular physical examinations, particularly if a person is in a high-risk category for cancer, heart disease or diabetes.
- Protecting oneself from irritants in the air, including exhaust fumes, coal dust, air pollution, chimney smoke, secondhand tobacco smoke, hair spray and even heavy perfumes.
- Washing hands frequently to prevent the exposure to germs that cause illnesses,
- Keeping the home well-ventilated and free of mold.
- Getting an annual flu shot and regular pneumonia vaccines.
- Avoiding exposure to hazardous substances, such as asbestos or other chemical ot physical agents that can cause damage to the lungs.
Questions for your doctor about breathing
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about breathing problems:
- What medical conditions do you suspect as a cause of my breathing problems?
- What tests can help diagnose my condition?
- Can lifestyle changes help lessen my breathing difficulties?
- Will medications help my condition?
- Can you recommend exercises or techniques that can help my breathing?
- Do I need to see a specialist for my condition?
- If I have cancer, do breathing problems mean my disease has progressed?
- Could the breathing problems be related to my cancer treatments?
- Will oxygen help my shortness of breath?
- Are there any complementary or alternative therapies that could help me?
- Is there a way to prevent further breathing problems?
- At what point are my breathing problems considered critical?
- Will I experience increasing restrictions of activity?