Breathlessness cannot be interpreted objectively, unlike oxygen saturation or lung volumes. It occurs in perfectly healthy people but it can be caused by an advanced disease. This review is about the mechanism of breathlessness, its causes, and management methods.
What is Breathlessness
You may have encountered the term breathlessness as “shortness of breath”, “difficult breathing”, or dyspnea. It is how it sounds—an occurrence when the patient feels trouble with having enough air. When trying to describe the sensation, people can mention air hunger, chest tightness, the feeling of being suffocated, and the increased effort required to breathe.
Dyspnea is subjective and can be only assessed from the patient’s interpretation. Unlike oxygen blood saturation or lung volumes, there is no specific medical equipment to evaluate breathlessness.
Normal breathlessness
People can experience breath shortness under perfectly normal conditions. For example, if the person has outperformed physically, they can be out of breath for a while. Another example of when feeling breathless can be normal is when the person is much higher above sea level than they are used to, in the thinner air.
Abnormal breathlessness
Breathlessness is considered abnormal when it is connected with a health issue and does not pass after the person has some rest and access to fresh air, rich in oxygen. Its intensity ranges from mild to severe.
Biological mechanisms
Abnormal breathlessness does not just naturally occurs in the body after physical exertion. It involves a complex set of interactions that include psychological, emotional, and physical factors that are complemented or altered by the fears, expectations, and experiences of an individual.
As a result, the sensation that patients identify as breathlessness consists of:
- The work of the respiratory center in the brain. It is responsible for how the need for air is perceived which affects the work of our respiratory system. Then it receives feedback from chemo and mechanoreceptors about the physical aspects of breathing that involve our respiratory system. The apparent mismatch is perceived by the patient as a hunger for air.
- The cortical system adds to the experience all the thoughts, fears, beliefs, memories of previous experiences, and perceived self-efficacy.
- The limbic system fuels the sensation with emotions and anxieties.
Causes of Breathlessness
Dyspnea can be short-term or long-term (chronic, persistent). Therefore, the type of breathlessness the patient would feel depends respectively on the condition that caused it, which may be acute or chronic.
Chronic conditions
A chronic illness is a sickness that develops over time or a human health condition that is persistent or has other long-lasting impacts. Chronic dyspnea is often related to respiratory and cardiovascular issues.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic inflammatory process in the respiratory system. The term covers emphysema and chronic bronchitis. Breathlessness develops in 95% of COPD cases.
Asthma
Inflammation and mucus in the lining of the airways create asthma. It complicates breathing and, as a result, physical activity becomes harder or even impossible to perform. Although asthma is a chronic condition, it has an acute phase called an asthma attack. During asthma attacks, coughing, shortness of breath, chest tightness, and/or wheezing intensify.
Heart disease
All of the organs and tissues in the body are supplied with oxygen thanks to the heart that pumps blood. If it does not operate efficiently due to the illness, the deficit of oxygen will be reflected in dyspnea. Breathlessness is reported in 88% of cases of cardiac failure.
Acute conditions
Acute conditions develop swiftly and suddenly. They manifest with intense symptoms that require immediate addressing or become life-threatening. Acute conditions may be a consequence of a chronic condition; a chronic disease may cause an acute seizure, or an acute illness can become chronic.
Pneumonia
Pneumonia is an inflammatory infectious disease of the alveoli—small air sacks located in the lungs. It can affect one lung or both. An alveolus becomes filled with fluid or pus. It obstructs gaseous interchange in the lungs causing difficulty breathing, cough, fever, etc.
Panic attack
A panic attack is an abrupt episode of extreme dread that results in significant bodily symptoms even when there is no immediate risk or obvious reason for them. Panic attacks can manifest differently in people, but chest or throat tightness and shortness of breath are common symptoms.
COVID-19 or other similar infections
When the patient contracts an infection that develops rapidly in their body and affects the respiratory system, dyspnea is a sign that shows often. Viral infections, such as COVID-19, usually manifest faster than bacterial ones but they can leave lasting consequences, breath shortness among them.
Lifestyle Factors
Breathlessness causes include the consequences of an unhealthy lifestyle. Surely, the patient cannot prevent inheriting a heart condition or having a panic attack, but certain unhealthy habits and the lack of beneficial activities can contribute to shortness of breath.
Smoking
The specialists in pulmonary health agree that if you are smoking, your lungs are chronically inflamed. By the way, it does not matter what you like to smoke: vape, tobacco, or marijuana. Smoking is also a primary risk factor for such conditions as asthma and COPD.
Lack of physical activity
Not having enough exercise makes you less fit, your muscles are not as strong, and your lungs are not used to an increased need for air. Therefore, when such a need arises, your body is not ready for it. Moreover, sedentarism is associated with many conditions that, in turn, cause breathlessness. Cardiovascular issues can be an example of that.
Obesity
Excessive weight increases the physical strain that you put on your heart to pump blood, to your respiratory system (a bigger body needs more oxygen), and your organism in general. Obesity also contributes to the development of illnesses that cause dyspnea and, yes, we can point at cardiac failure again.
Non-medical Ways to Manage Breathlessness
In this section, we are talking about how to manage breathlessness without pharmacological support. Most of the methods we describe here do not even require financial expenses—only the patient’s willingness and discipline.
Pursed-lip breathing
Breathing through pursed lips gives you better control over your breathing and helps to shift the focus if you are having an anxiety attack.
Diaphragmatic breathing
In order to breathe diaphragmatically, one must inhale deeply into the stomach. This makes the diaphragm stronger and improves the effectiveness of the lungs. It could also encourage a state of serenity or relaxation. For obvious reasons, it is also called belly or abdominal breathing.
Quitting smoking
Smoking is a primary cause of breath shortness. If you have trouble quitting by yourself, try self-help courses and handbooks; you can also opt for counseling.
Regular exercise
Safe and carefully designed physical activity makes you stronger, improves your immune system to prevent infections, enhances your cardiac health, and supports your mental well-being.
Portable oxygen devices
You may obtain supplemental oxygen with the help of lightweight, compact, and silent devices known as portable oxygen concentrators, or POCs. There are models more suitable for use at home and those that allow you to be more mobile.
POCs draw air in through a filter and compress it. Thus, you get more oxygen from one inhale than you would from breathing normally.
Inspiratory muscle trainers
IMT provides you with resistance exercises to make your inspiratory muscles stronger. The resistance, created by trainers, helps muscles adapt to difficulties that cause breathlessness.
Medical Management of Breathlessness
Medication for breathlessness depends on what caused the symptom in the first place. For example, treatment for breathlessness in heart failure will include diuretics (medicine that eliminates excessive fluids from the body), beta-blockers that steady your heart rhythm and manage its need for oxygen, and angiotensin-converting enzyme inhibitors that help control blood pressure.
Bronchodilators for lung conditions
Bronchodilator inhalers are the first treatment line in COPD breathlessness management. They are also very helpful for those who have asthma for relieving asthma attacks. Although they belong to the over-the-counter medication for breathlessness, we recommend you consult your healthcare provider before trying them.
Antianxiety medicines
In patients, whose dyspnea is induced by panic attacks and anxiety, focusing on mental health is a primary task. While therapy and finding your ideal method to calm down during a panic attack are very helpful, a medication-supported approach can allow you to feel relief much faster.
Surgical options
Surgical intervention always comes with careful risk-benefit ratio evaluation. It is mostly used for addressing chronic conditions but can be necessary in some cases of acute issues. For example, when it is necessary to drain lung fluids in a person with severe pneumonia.
Summary
Every patient who experiences understands dyspnea, gives the word “breathless” individual meaning. The causes and severity of the condition vary as well. Managing breathlessness can include medical and non-medical options and lifestyle improvements.
FAQ
How can breathlessness be managed?
The treatment for breathlessness largely depends on what caused it. Targeting the source of the problem is always more efficient than addressing the symptoms alone.
How can I improve my shortness of breath naturally?
Yes, by ditching bad habits, exercising, and breathing training.
What is the most common cause of shortness of breath?
Cardiovascular issues, respiratory conditions, and panic attacks.
Why am I short of breath but my oxygen saturation is good?
Breathlessness does not always correspond with the physical possibilities of your body.