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Dyspnoea – Shortness of Breath: Causes, Symptoms & Treatment

Dyspnoea refers to the subjective sensation of breathlessness or difficulty breathing. It can occur acutely or chronically and is a common symptom of many medical conditions.

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Things worth knowing about "Dyspnoea"

Dyspnoea refers to the subjective sensation of breathlessness or difficulty breathing. It can occur acutely or chronically and is a common symptom of many medical conditions.

What is Dyspnoea?

Dyspnoea (from Greek: dys = difficult, pnoe = breath) is the subjective sensation of breathlessness, shortness of breath, or laboured breathing. Patients often describe it as not being able to get enough air, or as an uncomfortable effort to breathe. Dyspnoea is not a disease in itself but a symptom that may indicate a wide range of underlying medical conditions.

Causes

Dyspnoea can be triggered by disorders of various organ systems. The most common causes are grouped as follows:

Pulmonary Causes (Lungs)

Asthma: Episodes of breathlessness caused by airway narrowing
Chronic Obstructive Pulmonary Disease (COPD): Progressive limitation of airflow
Pulmonary Embolism: Blockage of a pulmonary artery by a blood clot
Pneumonia: Inflammatory changes in lung tissue
Pneumothorax: Air entering the pleural space causing lung collapse

Cardiac Causes (Heart)

Heart Failure: Reduced pumping capacity of the heart leads to fluid accumulation in the lungs
Myocardial Infarction (Heart Attack): Acute disruption of blood supply to the heart
Cardiac Arrhythmias: Irregular heartbeat impairing oxygen delivery

Other Causes

Anaemia: Reduced oxygen-carrying capacity of the blood
Obesity and overweight
Anxiety disorders and panic attacks
Poisoning or metabolic imbalances

Symptoms and Associated Findings

While dyspnoea itself is a symptom, it may be accompanied by other signs that point to the underlying cause:

Tightness or pressure in the chest
Coughing or wheezing (stridor)
Bluish discolouration of the lips or fingernails (cyanosis)
Rapid heart rate (tachycardia)
Dizziness or altered consciousness
Leg swelling in cases of heart failure

Classification

The severity of dyspnoea is commonly assessed using the NYHA Classification (New York Heart Association), especially in cardiac conditions:

NYHA Class I: No symptoms during ordinary physical activity
NYHA Class II: Slight limitation during more strenuous activity
NYHA Class III: Marked limitation even during mild activity
NYHA Class IV: Breathlessness at rest

A distinction is also made between acute dyspnoea (sudden onset) and chronic dyspnoea (persisting over weeks or months).

Diagnosis

A variety of diagnostic tools are used to identify the cause of dyspnoea:

Medical history and physical examination: Assessment of onset, duration, triggers, and associated symptoms
Spirometry (lung function test): Measurement of breathing capacity and airflow
Blood gas analysis: Measurement of oxygen and carbon dioxide levels in the blood
Chest X-ray: Assessment of the heart and lungs
ECG (Electrocardiogram): Evaluation of cardiac function
Echocardiography: Ultrasound examination of the heart
Blood tests: e.g. D-dimers for suspected pulmonary embolism, full blood count for anaemia

Treatment

Treatment of dyspnoea is always directed at the underlying cause:

Bronchodilators and corticosteroids for asthma or COPD
Diuretics for heart failure to reduce fluid buildup
Anticoagulants for pulmonary embolism
Antibiotics for pneumonia
Oxygen therapy when blood oxygen levels are significantly reduced
Breathing exercises and pulmonary rehabilitation for chronic conditions

In cases of acute, severe breathlessness, immediate medical attention is required. In an emergency, call 911 (US) or your local emergency number.

When to See a Doctor?

Dyspnoea should always be evaluated by a physician, especially if it occurs suddenly, is present at rest, is accompanied by chest pain or loss of consciousness, or is progressively worsening. Acute dyspnoea is a medical emergency.

References

World Health Organization (WHO): Chronic respiratory diseases. Available at: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Loscalzo, J. et al.: Harrison's Principles of Internal Medicine, 21st Edition. McGraw-Hill Education, 2022.
Parshall, M. B. et al.: An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. American Journal of Respiratory and Critical Care Medicine, 2012; 185(4): 435-452.

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