What Causes Dyspnea?

Dyspnea – the medical term for shortness of breath – can be either acute, occurring suddenly, or chronic, persisting over a long period of time. It is an extremely common symptom, occurring in 1 out of every 4 people who visit their doctor’s office. Despite its commonality, the quality of dyspnea seems to vary from person to person with no single definition embodying all its characteristics.

Common Causes of Dyspnea

Causes of dyspnea involve interaction between several different systems in your body, including the respiratory and cardiovascular systems. The following table lists some of the more common causes of dyspnea by organ system:

System Acute Chronic
Cardiovascular

Pulmonary edema

Heart attack

Cardiac tamponade

Heart failure

Angina

Pericarditis

Respiratory

Acute exacerbation of COPD and other obstructive lung diseases

Pulmonary embolism

Pneumothorax

Pneumonia

ARDS

COPD

Asthma

Interstitial lung disease

Pulmonary hypertension

Lung cancer

Pleural effusions

Sleep apnea

Gastrointestinal/Hepatic Acute liver failure

Ascites

Pleural effusions

Hepatopulmonary syndrome

Renal (Kidneys) Acute renal failure

Pleural effusions

Pericardial effusions

Hematological (Blood) Hemorrhage Anemia
Neuromuscular

Lesions to high cervical spine

Trauma to phrenic nerve

Central sleep apnea

Myasthenia gravis

Deconditioning

Myopathies

Amyotrophic lateral sclerosis (Lou Gehrig’s disease)

Possible Accompanying Signs and Symptoms

There is an exhaustive list of signs and symptoms that may accompany dyspnea. For the purpose of this article, only the most common are listed below:

  • Cough
  • Fever
  • Pleurisy
  • Wheezing
  • Chest pain
  • Pedal edema (swelling of feet and lower legs)
  • Jaundice (yellowing of the skin)
  • Ascites (swelling of abdomen)
  • Decrease in urine output & puffy eyes
  • Use of accessory muscles to breathe
  • Clubbing (rounding of the nailbeds) and cyanosis (bluish tint to nailbeds, lips, skin) both due to chronic oxygen deprivation

Diagnosis

dyspnea, short of breath, shortness of breathThe most common initial diagnostic test for assessing dyspnea is a chest X-ray. Although this test primarily targets the lungs, it also helps doctors evaluate the cardiovascular system, chest wall, pleura (membrane lining the lungs), mediastinum (membranous partition between the lungs) and upper abdomen.

Other tests that may be ordered to help evaluate the underlying cause of dyspnea include:

  • Cat scan (CT scan) of the chest
  • Magnetic resonance imaging (MRI)
  • Pulmonary function tests
  • Echocardiogram
  • Stress test
  • Polysomnography (sleep study)
  • Arterial blood gas (ABG) study
  • Complete blood count (CBC)

Treatment

There are two important aspects to the management of dyspnea: treatment of the underlying disorder and relief of symptoms. Management of the underlying disorder depends upon what the underlying disorder is. Management of symptoms is outlined below.

Management of symptoms

First and foremost, symptomatic relief of dyspnea involves making sure the patient is breathing well enough to support their oxygen needs. If not, then oxygen therapy should be initiated. If the patient is unable to sufficiently breathe on their own, then either non-invasive positive pressure ventilation (NIPPV) or intubation (tube inserted down the throat) and artificial ventilation will be necessary.

Additional measures that may be used in the symptomatic relief of dyspnea include:

  • Bronchodilators – to relax and widen constricted air passages
  • Inhaled corticosteroids – to reduce swelling and inflammation of the air passages
  • Mucolytics – help clear mucus from the air passages to keep them free of obstruction
  • Phosphodiesterase-4 inhibitors – an oral medication used in some cases to relieve inflammation in the air passages
  • Pulmonary rehabilitation – plays an important role in relieving symptoms and increasing the ability to withstand exercise
  • Pursed-lip breathing – and other breathing exercises help control shortness of breath
  • Weight loss – if dyspnea is related to obesity
  • Smoking cessation – for those in which a smoking-related disease is the underlying cause of their dyspnea
  • Surgical techniques – such as lung volume reduction surgery (LVRS); may be an option for a select group of patients who don’t respond to standard treatment measures

If you think you have dyspnea and have not yet been to the doctor, make an appointment as soon as possible. In some cases, dyspnea can be an important warning sign that something serious is going on.  

Source:

[1] Cleveland Clinic. Dyspnea. Published July, 2015.

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