SHORTNESS OF BREATH - Full extract (no story)

Shortness of breath is probably the most distressing of all symptoms. It is felt when the effort required for breathing is out of proportion to the physical work being done at the time. Some people have to work really hard to breathe, even to the point of becoming quite exhausted.

It can be caused by a whole range of conditions, heart failure, pneumonia, lung clots, asthma and stress to name a few. There are also all grades of breathlessness, from mild symptoms on heavy exertion such as running, to very severe symptoms at rest. To work out why the breathlessness is occurring, a careful history and examination are essential.

It is important to establish whether the shortness of breath is longstanding or acute. People with chronic lung problems like emphysema tend to develop shortness of breath over many years. In contrast, conditions such as asthma and heart failure usually cause more sudden or acute symptoms. An inhaled foreign body may cause very sudden breathing difficulties by blocking the upper airway.

The severity of the breathlessness is also important. Shortness of breath at rest is always a worrying symptom. Other factors like whether there has been a cough or a fever need to be considered, as well general health, occupation and whether the person smokes.

On examination, the person may be obviously distressed and working really hard to breathe. There may be the obvious, barrel-shaped chest that is seen in some people with chronic lung conditions. The person's lips may have a bluish colour. This is called cyanosis and it indicates that not enough oxygen is being exchanged in the lungs. Listening with the stethoscope may reveal wheezing or signs of congestion. There are numerous other signs we look for in anyone who complains of shortness of breath, but sometimes the physical examination may reveal no abnormalities at all.

A number of investigations may be arranged to help sort out the cause of the breathlessness. This might include a chest X-ray, cardiograph and basic blood tests. Sometimes referral to a respiratory physician for special breathing tests is required. If someone suddenly becomes very short of breath, it may be necessary to go straight to casualty, by ambulance if necessary...even before the cause is known.

Aside from the more common lung and heart problems, there can also be more general causes of shortness of breath. Sometimes anaemia can be responsible, especially in older people with a degree of heart failure. Being very overweight can also cause breathlessness, particularly with exertion.

At times, shortness of breath turns out to be due to psychological causes such as stress and anxiety symptoms. The person may complain of difficulty getting enough air into the lungs, and the need to take frequent deep breaths. This may be associated with a tight feeling in the throat. Shortness of breath can only be attributed to stress after a thorough assessment and investigations have ruled out other causes.

The treatment of shortness of breath depends on the underlying cause. These days the cause can usually be quickly and accurately diagnosed. If the shortness of breath should persist or recur check with your doctor again, in case further investigation and treatment is required.

Health tip:
* Sudden severe shortness of breath is a medical emergency. It always requires immediate medical assessment.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001